As of July 1, 2026, all “Change in Condition” (aka Resident Review) applications will follow the same process for submission as a “Change in Status”.

The Department of Mental Health (DMH) will no longer accept “Change in Condition” submissions directly. All requests must be submitted through the DHSS COMRU website (https://health.mo.gov/seniors/nursinghomes/) using the Level I/Level of Care online application. The option for submitting this application will be “Change in Status (MDS) / Change in Condition”. For questions regarding this change or when to submit a “Change in Condition”, please email DMHNotifications@dmh.mo.gov.

We have been notified of a scam email circulating, which is impersonating the Missouri Department of Health and Senior Services. The email claims to provide an important update and includes a link to what it describes as a secure message.

Please be extra cautious and do not click on any links or provide any personal information if you receive an email with a subject line similar to “Your License Suspension from Missouri Board of Nursing Home Administrators” from an unfamiliar sender. The email may appear legitimate, but it is a fraudulent attempt to deceive recipients and potentially gain unauthorized access to sensitive information.

Our cybersecurity team has been notified, and we are taking the necessary steps to address this issue. In the meantime, if you come across such an email, please delete it.

Please see the information below on how the Bureau of Narcotics and Dangerous Drugs address LTCs with Emergency Kits (E-kits).

MO 19 CSR 30-1.052:

(1) Long-term care facilities (LTCFs) and their suppliers shall maintain written records of transfers of controlled substances from the supplier to the LTCF emergency kit.

(2) The records shall include the date of transfer; the name of each controlled substance, the strength, dosage form and quantity; the name, address and controlled substance registration number of the supplier and the name, address and controlled substance registration number of the LTCF.

Note: LTCF cannot use federal DEA forms 222 to document transfer of controlled substance because DEA does not register LTCFs. BNDD transfer form should be used, including for Sched II substances. Transfer forms can be found on the BNDD website, www.health.mo.gov/BNDD, under Applications & Forms.

(3) No physician’s order or prescription shall be used for initial stocking or replacement of controlled substances in the emergency kit. Controlled substances contained in the kit shall be obtained from a pharmacy, hospital or practitioner who holds a controlled substances registration.

(4) The administration and medical staff of the LTCF, in conjunction with the primary supplier, shall designate in written protocols and procedures who may have access to the emergency kit, who may administer controlled substances from the emergency kit and under what circumstances and a list of the controlled substances it intends to maintain in the emergency kit. These protocols and procedures shall be subject to review and approval by the Department of Health. Only those individuals designated in the LTCF’s written policies and procedures shall have access to or administer controlled substances from the emergency kit.

It is the responsibility of the facility to establish proper protocols as to which staff members and under what circumstance they may access controlled substances contained in the E-Kit.

(5) Each administration of controlled substances from the emergency kit shall be based upon a practitioner’s order and shall be recorded in an administration record separate from the patient’s medical record. This administration record shall include: the date, patient’s name, drug name, drug strength, dosage, ordering practitioner’s name and name of the person administering the controlled substance.

Some things to note:

• BNDD will only issue a controlled substance registration to a LTCF that is licensed for skilled nursing. A facility that is assisted living only is not eligible for an Emergency Kit (E-kit) registration.

• Patient private medications (including controlled substance) do not fall under BNDD’s purview. We consider a resident living in an assisted living facility as being at their home. Their medications are considered their personal property. This would be the same as having a visitor come into your home and steal medication from the medicine cabinet. This is a theft that would be reported to the local law enforcement agency.

• The controlled substances in the emergency kit are considered to be LTCF “floor stock” and may be administered only upon the order of a practitioner. A record of transfer, such as an invoice or other record, must be made to document all transfers from the supplier to the LTCF. A prescription cannot be used as the record for initial stocking or replacement.

• Patient personal medications should not be stored with E-kit medications. Doing so impedes the ability to limit which staff can access facility owned controlled substances inside the E-Kit.

Did you know?

Missouri state regulations 19 CSR 30-84.010 for Certified Nurse Aide (CNA) testing require an 80% pass rate for the knowledge test and 100% of the key steps from the skills portion of the test to become certified.

• In the past 12 months, the average pass rate for nurse aides taking the knowledge test (for the first time) has been 63.45%.
  • Students score lower in infection control, personal care and basic nursing skills.
  • The most missed vocabulary words are dizziness, physical needs, and afebrile.
• In the past 12 months, the average pass rate for nurse aides taking the skills test (for the first time) has been 76.3%.
  • Students scored lower in skills for perineal care for a male resident, handwashing, mouth care for a comatose resident, and positioning residents in bed on their side.

Approved instructors and training programs have access to these reports in TMU to utilize in their training programs. If you need assistance to access these reports, please contact Headmaster D&S Diversified Technologies at missouri@hdmaster.com or 888-401-0465.

Looking for resources to further support nurse aide students prepare for the test?

• Missouri’s candidate handbook, mock skills, knowledge and skill test instructions are available on the Headmaster website D&S – Missouri Nurse Aide.
• Also available, a FREE ten-question practice test and “Question of the Day” available on the D&S Headmaster homepage. Although the questions are not taken directly from the exam, they provide helpful insight into the format and expectations for the test.

Federal regulations (F728) require skilled nursing facilities to ensure individuals working in the facility as a nurse aide are competent to provide nursing and nursing related services and to have successfully completed the training and passed the competency evaluation program (are certified as a nurse aide) within 4 months of hire. There are no extensions or waivers permitted beyond this time frame. Practices such as terminating a nurse aide and rehiring them to “restart the clock” are NOT permitted.

A facility must not use any individual working in the facility as a nurse aide who is unable to achieve the certification within the four-month time. Individuals can perform other functions in the facility for which they are trained and competent to perform, however they are not permitted to continue working in the role of a nurse aide until they have successfully completed their certification.

Skilled nursing facilities may not charge nurse aides for the costs associated with nurse aide training and testing, including up to three examination attempts. Skilled nursing facilities may be eligible for reimbursement of these expenses. Additionally, nurse aides who received training outside a nursing facility, but are employed by a SNF within one year, may be reimbursed for costs associated with their certification. A CNA Training Reimbursement webinar was presented by MO HealthNet that explains the process.

If you have questions or need assistance, please contact the Health Education Unit at CNARegistry@health.mo.gov or 573-526-5686.