Category: Nursing Home Administrators

Post PHE Modifications and Registration Information for the LTCF COVID-19 Module

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Below is important information regarding Long-term care facilities (LTCF) and reporting COVID-19 data to NHSN once the Public Health Emergency has ended.

Long-term care facilities that are CMS certified will still need to report to the LTCF COVID-19 Module Surveillance Pathways (Resident Impact and Facility Capacity, Staff and Personnel Impact, and Therapeutics) and the COVID-19 Vaccination Module once the Public Health Emergency is declared over on May 11, 2023

In 2020, CMS published an IFC (CMS-5531-IFC) requiring all LTC facilities to report COVID-19 information using the Centers for Disease Control (CDC), National Healthcare Safety Network (NHSN) (42 CFR 483(g)). This requirement was extended through a final rule (CMS-1747-F) and is set to terminate on December 31, 2024. This excludes the requirements at § 483.80(g)(1)(viii), which will continue to support national efforts to control the spread of COVID-19.

Please note, the COVID-19 Module Surveillance Pathways (Resident Impact and Facility Capacity, Staff and Personnel Impact, and Therapeutics) and the COVID-19 Vaccination Module are two separate modules and data will need to be reported to both on a weekly basis. Reporting to only one module does NOT satisfy the CMS reporting requirements.

NHSN provides a pathway to report data but is not a regulatory or enforcement body. Please direct any questions and/or concerns regarding reporting requirements and penalties/fines to CMS for further information.

The COVID-19 Module Surveillance Pathways will undergo updates in response to the end of the Public Health Emergency, including:

  • Reducing vaccination elements to include only up to date status for residents with a positive COVID-19 test
  • Removal of influenza data field
  • Removal of staffing and supply shortages data fields
  • Removal of deaths in the Staff and Personnel Impact Pathway
  • Removal of the therapeutics pathway
  • Addition of a new data field, hospitalizations, in the Resident Impact and Facility Capacity Pathway to assess relevant outcome data on residents with a positive COVID-19 test.

New Updates to the NHSN LTCF COVID-19 Module Surveillance Pathways Webinars

Specific details regarding these changes will be reviewed during upcoming training webinars.

Registration Information for Upcoming Training Webinars

Please register in advance and plan to attend one of the training sessions to learn more about the new updates. Each webinar will cover the same information; therefore, you may only need to attend once.

When: Thursday, June 1, 2023, 02:00 PM Eastern Time (US and Canada)
Topic: New Updates to the NHSN LTCF COVID-19 Module Surveillance Pathways
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_lQ92SJReSe6gu3RlRbiqaA

When: Wednesday, June 7, 2023, 01:00 PM Eastern Time (US and Canada)
Topic: New Updates to the NHSN LTCF COVID-19 Module Surveillance Pathways
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_WO7zz66lSwyFGUfEx2bU7g

When: Thursday, June 8 & Thursday June 13, 2023, 02:00 PM Eastern time (US & Canada)
Topic: New Updates to the NHSN LTCF COVID-19 Module Surveillance Pathways
Register in advance for this webinar: https://cdc.zoomgov.com/j/1605578239?pwd=TWxwb202WW9tSUpoTi9aVWRNZXBUQT09

After registering, you will receive a confirmation email containing information about joining the webinar.

For questions about any of these updates, please send an e-mail to the NHSN Helpdesk at NHSN@cdc.gov with the subject line identifying the topic of the message.

SNF MDS 3.0 RAI v1.18.11 Guidance Training Program

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REGISTRATION OPEN: The SNF MDS 3.0 RAI v1.18.11 Guidance Training Program

The Centers for Medicare & Medicaid Services (CMS is offering a virtual training program that provides instruction on the updated guidance for the Skilled Nursing Facility (SNF) Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) v1.18.11 Manual and Item Set. This training is part of a comprehensive strategy to ensure SNF providers have access to the educational materials necessary to understand and comply with the guidance changes. This guidance will affect reporting requirements associated with the SNF Quality Reporting Program (QRP) that will go into effect on October 1, 2023. A major focus of this training will be on the cross-setting implementation of the standardized patient assessment data elements to ensure more consistent reporting and evaluation across post-acute care settings.

The training program consists of two parts:

Part 1: LEARN Part 1 consists of pre-recorded training webinars that deliver foundational knowledge to assist in learning the new and/or revised items and associated guidance. A supplemental Capstone Case Study is also available to give providers additional practice in coding the new and/or revised items. These videos are intended to be viewed in advance of the Part 2 live event and are available now on CMS YouTube.

Part 2: PRACTICE Part 2 includes the live, virtual workshop sessions that provide practice coding scenarios on select data elements covered in the Part 1 training webinars. These live sessions will take place on June 21 between 12:30 p.m. and 5 p.m. ET. Registration is open and can be completed online through Zoom.

Additional training resources are located within a ZIP file in the Downloads section of the SNF Quality Reporting Program (QRP) Training page. These resources include an acronym list, Action Plan worksheet, Case Study documents, resource guide, and PDF versions of the training webinars.

If you have questions regarding access to the resources or feedback related to the training, please email the PAC Training Mailbox. Content-related questions should be submitted to the SNF QRP Help Desk.

VOYCE’s Upcoming Resident’s First Conference

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June 15, 2023: Residents First Long-Term Care Conference
Location: St. Louis University’s Margaret McCormick Doisy LRC, St. Louis

Join VOYCE in recognizing the St. Louis region on World Elder Abuse Awareness Day for the Residents First Conference! VOYCE is a nonprofit organization that empowers and educates individuals and their families for quality living across the long-term care continuum. This year the focus will be on Residents First by providing attendees with vital information to support and inspire their journey as long-term care professionals.

VOYCE is determined to deliver education, empowerment, and advocacy so families can make informed decisions for long-term care. By working alongside professionals providing services, we can ensure residents are informed of their rights while living safely and with dignity.

Important DHSS Update on PPE and Test Kit Supplies

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Notice for Non-State Agency Healthcare Partners: The DHSS PPE Warehouse will end distribution of PPE items from the state cache on June 30, 2023.

This change comes as the federal public health emergency comes to end today, May 11, the supply chain has stabilized resulting in adequate stock at suppliers, and COVID cases/outbreaks trend downward. The State of Missouri plans to maintain a PPE cache for future public health emergencies and enhance overall healthcare preparedness. Facilities should prepare for June 30th by working with multiple vendors to procure supplies and maintain adequate stock that accounts for potential order or allocation delays. DHSS will continue to ship COVID antigen test kits and COVID/FLU antigen test kits as requested. For questions related to the end of PPE shipping, please reach out to sns@health.mo.gov.

American Rescue Plan Act (ARPA) Funding Opportunity for RCFs and ALFs

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It’s not too late! The Department of Health and Senior Services (DHSS) is still accepting applications for ARPA reimbursement to operators of Residential Care Facilities (RCFs) and Assisted Living Facilities (ALFs) who have not yet applied. Through Missouri’s State Fiscal Recovery Funds, operators may seek reimbursement for expenses incurred between April 1, 2021 and March 31, 2022 that were directly related to preparing, preventing, and responding to the COVID-19 pandemic.

If you operate an RCF or ALF and haven’t already applied for this funding opportunity, please ensure you are registered as a vendor to receive payment from the State of Missouri. Before operators can complete an application for this opportunity, they must register as a vendor with the state’s financial system – SAM II. If the operating entity is already registered as a vendor with the State of Missouri, you do not need to re-register.

The SAM II registration Vendor Input Form can be found at https://oa.mo.gov/sites/default/files/vendor_input_ach_eftd.pdf. The completed Vendor Input Form must be sent directly to the Office of Administration by fax at 573-526-9813 or by mail to Office of Administration/Accounting, PO Box 809, Jefferson City, MO 65102.

Operator Tips in Registering as a Vendor with the State of Missouri:

  • Be sure to register only the legal operating entity and not all individual facilities owned by the same operating entity.
  • Be sure the address used in the State’s financial system is the same address that will be used as the operator’s address on the application and any accounts payable documentation.

Once SAM II registration is submitted, an application for reimbursement must be submitted through the State of Missouri’s American Rescue Plan Act (APRA) Portal located at https://moarpa.mo.gov/. Frequently Asked Questions and an Application Checklist can be found on the “Apply Now” page under the “Operators of Residential Care / Assisted Living Facilities” Grant Program. Requests for additional information about this opportunity should be submitted to LTCARPAReimbursements@health.mo.gov.

Funding for this initiative has been made available through the American Rescue Plan Act (ARPA). Missouri’s ARPA funding opportunities are located here: https://moarpa.mo.gov/available-funding-opportunities/.

2023 SLCR Annual Provider Meetings

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Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation

Advanced registration is not required. There is no cost to attend any of these meetings. Please see the flyer and stay tuned to the listserv for updates including agendas and handouts.

September 6, 2023: Region 7
Location: Crowne Plaza St. Louis Airport, Bridgeton

September 7, 2023: Region 2
Location: Drury Plaza Hotel & Convention Center, Cape Girardeau

September 13, 2023: Region 1
Location: Oasis Hotel & Convention Center, Springfield

September 14, 2023: Region 6
Location: Special Olympics Missouri, Jefferson City

September 27, 2023: Region 5
Location: Moberly Municipal Auditorium, Moberly

October 4, 2023: Region 4
Location: Stoney Creek Hotel, St. Joseph

October 5, 2023: Region 3
Location: Adams Pointe Conference Center, Blue Springs

Updated CMS Memos Related to COVID-19

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CMS released the two memos below this past week. Homes may begin to change their policies and procedures and implement current CDC guidance.

QSO-20-38-NH Testing Expired
QSO-20-39-NH Visitation REVISED

Here is the link to the current CDC guidance for nursing homes: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html#create.

Older Americans Month May 2023

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Each May, the Administration for Community Living leads the celebration of Older Americans Month (OAM). The theme for OAM 2023 is Aging Unbound, which offers opportunities to explore a wide range of aging experiences and to promote the importance of enjoying independence and fulfillment by paving our own paths as we age. This May is the 60th anniversary of OAM and we can participate in Aging Unbound by embracing opportunities to change, exploring the rewards of growing older, staying engaged in our communities, and forming relationships.

This May, the Department of Health and Senior Services (DHSS) invites everyone to explore the benefits of growing older. No matter the age, it is always possible to form new relationships and engage in your local community. To learn more, please visit Health.Mo.Gov/oam.

On Wednesday, May 24, DHSS is hosting a Senior Resource Fair at the Capital Mall in Jefferson City, MO, 12:00-4:00 p.m. to celebrate OAM. Please see flyer. There will be a range of exhibitors offering resources and information to our Mid-Missouri Seniors!

CMS Memo: QSO-23-13-ALL: Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE)

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Memorandum Summary

  • Social Security Act Section 1135 emergency waivers for health care providers will terminate with the end of the COVID-19 Public Health Emergency (PHE) on May 11, 2023.
  • Certain regulations or other policies included in Interim Final Rules with Comments (IFCs) will be modified with the ending the PHE. Certain policies, such as the Acute Hospital at Home initiative and telehealth flexibilities have been extended by Congress through December 31, 2024.
  • Long Term Care and Acute and Continuing Care providers are expected to be in compliance with the requirements according to the timeframes listed below {in the memo}.

Please see the full memo for complete details at https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationgeninfo/policy-and-memos-states/guidance-expiration-covid-19-public-health-emergency-phe.

Payroll-Based Journal (PBJ) Submission Deadline Reminder

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Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 1/1/23 through 3/31/23 is due May 15, 2023.

Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center no later than the Friday before the submission deadline, as the Service Center will be unavailable to assist on the weekend.

More information about PBJ can be found on the following webpages:

CMS PBJ webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ
PBJ Reference Manuals – https://qtso.cms.gov/vendors/payroll-based-journal-pbj-vendors/reference-manuals
PBJ Training – https://qtso.cms.gov/training-materials/payroll-based-journal-pbj

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

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SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. The following data must be submitted no later than 11:59 p.m. on May 15, 2023:

  • MDS data for 10/1/22 through 12/31/22;
  • NHSN data for COVID-19 Vaccination Coverage Among Healthcare Personnel for 10/1/22 through 12/31/22;
  • NHSN data for Influenza Vaccination Coverage Among Healthcare Personnel for 10/1/22 through 3/31/23.

The Minimum Data Set (MDS) 3.0 must be transmitted to the Centers for Medicare & Medicaid Services (CMS) through the Internet Quality Improvement and Evaluation System (iQIES). Data for the National Healthcare Safety Network (NHSN) measures must be submitted to the Centers for Disease Control and Prevention (CDC). No additional data submission is required for the claims-based measures.

As a reminder, it is recommended that providers run applicable MDS reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

CMS SNF QRP Data Submission Deadlines webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Data-Submission-Deadlines
CMS SNF QRP Help webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-QRP-Help
CMS SNF QRP Measures and Technical Information webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Measures-and-Technical-Information
CMS SNF QRP Training Webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Training

iQIES Minimum Data Set (MDS) Submission and Reports is Now Available

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On April 17, 2023, the Centers for Medicare & Medicaid Services (CMS) transitioned to the Internet Quality Improvement and Evaluation System (iQIES) for Minimum Data Set (MDS) record submissions and reports.

All MDS submissions that were performed in the QIES Assessment Submission And Processing (ASAP) system prior to April 13 at 8:00 p.m. ET were processed in that system. As part of the migration, MDS data accepted into the ASAP system prior to the start of the migration were moved into iQIES. All new, modification, or inactivation records must be submitted in iQIES, even if the original record to be corrected was accepted into the QIES ASAP system.

As part of the migration, users are now able to access and run the user-requested reports in iQIES. User’s access to the reports is similar to the access in the Certification and Survey Provider Enhanced Reporting (CASPER) Reporting application, so long as their new HCQIS Access Roles and Profile (HARP) role allows access to generate and view reports. Users are only allowed to run reports for the providers to which they have access.

Register for an iQIES Account

For information and instructions to register for an iQIES account, please visit: https://qtso.cms.gov/news-and-updates/action-required-register-iqies-account.

User Manuals

Video Tutorials

Additionally, the iQIES Team has developed video tutorials to provide an overview of the MDS functionalities in iQIES. The video tutorials can be found on QTSO and are not mandatory: https://qtso.cms.gov/training-materials/iqies-training-videos

  • Upload an Assessment for MDS Users
  • How to Run Reports

iQIES Service Center

  • If you have questions or require assistance, please contact the QIES/iQIES Service Center by phone at (800) 339-9313 or send an email.

Summit for Acute & Post-Acute Care Providers

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June 8, 2023: 2023 Acute & Post-Acute Care Summit
Location: Renaissance St. Louis Airport Hotel, St. Louis

LeadingAge Missouri, MHA, and ACHE are proud to offer the 4th annual Summit for Acute and Post-Acute Care Providers. This gathering of industry professionals is intended to produce solutions across the care continuum for a collaborative healthcare industry. You’ll hear from top experts in the field on topics such as Acute and Post-Acute relationship modeling, Workforce in Healthcare, Payment Reform, incorporating technology into your healthcare landscape, and the future of healthcare from our keynote speaker.

The Summit is a one-day event that brings together acute and post-acute healthcare industry professionals for education and networking, aiming to improve healthcare delivery. It fosters collaboration and is unique in its approach to education and networking.

VOYCE’s Upcoming Education Events

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May 9, 2023: Veteran’s Benefits
Location: St. Louis County Library – Jamestown Bluffs Branch, Florissant

May 23, 2023: Veteran’s Benefits
Location: St. Louis County Library – Prairie Commons Branch, Hazelwood

May 24, 2023: The Bare Necessities – Nursing in Long-Term Care

June 15, 2023: Residents First Long-Term Care Conference
Location: St. Louis University’s Margaret McCormick Doisy LRC, St. Louis

July 11, 2023: Preventing Financial Fraud
Location: St. Louis County Library – Cliff Cave Branch, St. Louis

July 25, 2023: Preventing Financial Fraud
Location: St. Louis County Library – Jamestown Bluffs Branch, Florissant

DHSS Cannabis Prevention and Education Workgroup Survey

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The passage of Amendment 3 in 2022, and legalization of adult cannabis use in Missouri created needs, challenges, and opportunities. The Missouri Department of Health and Senior Services (DHSS) is working to ensure Missourians have access to sufficient evidence-based information to make informed decisions about cannabis consumption and exposure, as well as, be knowledgeable about how it affects safety and the public health of all Missourians. We are asking stakeholder to take the survey linked below by April 28, 2023 to help identify what Missouri partners are doing to address cannabis use/misuse, resources utilized, challenges, needs and opportunities to collaborate.

Thank you for your time, interest and information. We look forward to working with you on strategies to prevent cannabis use and misuse and educate Missourians regarding legal cannabis use.

https://missouriwic.iad1.qualtrics.com/jfe/form/SV_d0eClc80miwNmho

2023 SLCR Annual Provider Meeting Topics

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We are currently in the planning phase to host in-person provider meetings in all regions this year and are considering the best topics to provide the most beneficial information. We would like to hear from you about what LTC related topics and info you believe would be helpful and educational!

Please take a moment to complete a one-question survey by May 10, 2023 at https://www.surveymonkey.com/r/2C82YVN.

New CMS QI Voices Audio Series Offers Nursing Home Leaders the Facts About COVID-19

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Vaccines, Treatments and Promising Practices to Improve Resident Outcomes

CMS QI Voices: Improving COVID-19 Outcomes in Nursing Homes Across America, a new audio series produced by the Centers for Medicare & Medicaid Services (CMS), is available for listening at https://qioprogram.org/cmsqivoices.

This audio series is designed to help busy medical directors, administrators and directors of nursing and education keep residents and staff safe with actionable information to increase COVID-19 vaccination and use of available treatments and improve infection prevention efforts in nursing home and long-term care settings.

In a special series of three 15-minute episodes, CMS Chief Medical Officer Dr. Lee Fleisher leads clinical discussions with experts from the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA) Center for Biologics and Research and the Administration for Strategic Preparedness and Response. These episodes cover:

  • The safety and efficacy of the new bivalent COVID-19 vaccine in long-term care.
  • The benefits, risks and side effects of therapeutics for nursing home residents diagnosed with COVID-19.
  • National programs and partnerships that support nursing homes teams’ efforts to promote COVID-19 infection prevention and vaccination.

In the remaining five-minute episodes, CMS leaders talk with CMS Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) and the nursing homes they serve to discuss:

  • How to increase COVID-19 vaccine confidence in care settings with high resident turnover.
  • How one nursing home is using the power of peer ambassadors to increase vaccine confidence.
  • What nursing home staff need to keep doing to help stop the spread of COVID-19.
  • When, who and how to cohort in your nursing home.
  • How a nursing home serving Native American residents uses a culturally inclusive approach to address health equity and increase vaccine confidence.

The CMS QI Voices: Improving COVID-19 Outcomes in Nursing Homes Across America audio series is available wherever listeners have online access. Nursing home teams may listen at https://qioprogram.org/cmsqivoices or contact LTC@hqi.solutions for more information about the audio series.

MDS Submissions Shut Off in QIES ASAP System in Preparation for April 17 Release

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On April 17, 2023, the Centers for Medicare & Medicaid Services (CMS) will transition to the Internet Quality Improvement and Evaluation System (iQIES) for Minimum Data Set (MDS) record submissions and reports. As part of this transition, the QIES Assessment Submission And Processing (ASAP) system for MDS submissions will be turned off on Thursday, April 13 at 8:00 p.m. ET. Providers should submit completed MDS records prior to 8:00 p.m. ET on April 13 to the QIES ASAP system or wait until 8:00 a.m. ET on Monday, April 17 to submit data in iQIES. Once the transition is complete, all new, modification, or inactivation records must be submitted in iQIES, even if the original record to be corrected was accepted into the QIES ASAP system. Providers are expected to take into account all submission requirements when determining the date that they submit completed MDS records, including but not limited to, submission timeliness, claims processing, and care planning requirements.

MDS submission and records will be available in iQIES beginning Monday, April 17, 2023 at 8:00 a.m. ET. iQIES will be the only system in which MDS data submissions can occur.

What to Expect with the Minimum Data Set (MDS) Transition to iQIES

Please note there are some system-generated reports in the CASPER application that will not be migrated over to the iQIES folders. Users should download and save or print any of these system-generated reports that they wish to retain. For more information on MDS reports, please visit: https://qtso.cms.gov/news-and-updates/what-expect-minimum-data-set-mds-transition-iqies-april-17-2023.

Register for an iQIES Account

Please note that failure to obtain access to iQIES prior to April 17, 2023 will impact your ability to submit MDS records once the migration is complete. For information and instructions to register for an iQIES account, please visit: https://qtso.cms.gov/news-and-updates/action-required-register-iqies-account.

iQIES Service Center

If you have questions or require assistance, please contact the QIES/iQIES Service Center by phone at (800) 339-9313 or send an email. Please note that call volume may be higher than normal during this time.

COMRU Training

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COMRU will be hosting a webinar/Q&A session regarding the online process and the ending of the COVID 19 waiver via WebEx.

April 24, 2023: Join Meeting Here
Time: 10:00 a.m.

Join by meeting number
Meeting number (access code): 2460 830 8201
Meeting password: 67tMfa2hU6R

Tap to join from a mobile device (attendees only)
+1-650-479-3207,,24608308201## Call-in toll number (US/Canada)
+1-312-535-8110,,24608308201## United States Toll (Chicago)

Assessment of COVID-19 Outbreaks in Long-Term Care Facilities

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The Delta variant quickly became the predominant circulating SARS-CoV-2 strain in the USA during summer 2021. Missouri identified a high number of outbreaks in long-term care facilities (LTCFs) across the state with low vaccination rates among LTCF staff members and poor adherence to mitigation measures within local communities. Ten long-term care facilities in Missouri worked with CDC to evaluate case data to assess disease transmission, vaccination status, and outcomes among residents and staff, including onsite visits to facilities with recent COVID-19 outbreaks in communities with substantial transmission to assess mitigation measures. Attached is a copy of the published findings from that study.