Nursing Home Reimbursement: Beginning to End

The Family Support Division (FSD), Department of Health and Senior Services Central Office Medical Review Unit (DHSS COMRU), and the MO HealthNet Division (MHD) have collaborated to create a new resource for nursing facility providers. We are excited to announce, Nursing Home Reimbursement: Beginning to End.

This resource will walk a provider through the process of nursing home reimbursement from the very beginning of an individual applying for coverage, through the Preadmission Screening and Resident Review (PASRR) process, to billing and receiving payment for services. The resource includes step-by-step instructions for each process, definitions, contact information, and more.

For additional training opportunities, check out the below:

  • MHD offers an interactive webinar for nursing home providers quarterly. This training covers navigating MO HealthNet provider resources, proper billing methods, procedures for claim filing via eMOMED, and more. This training includes an opportunity to ask questions in real-time. Review the MHD Provider Training Calendar here.
  • COMRU PASRR and Level of Care (LOC) Orientation Training, hosted by COMRU, has a monthly orientation training to review the requirements of the PASRR and the Nursing Facility LOC application process.

For additional resources, refer to the Education and Training Resources page and/or sign up for a live webinar by accessing our Provider Training Calendar. For more information, email MHD.Education@dss.mo.gov.

Missouri Master Plan on Aging seeks final input from all Missourians

The Department of Health and Senior Services (DHSS) and Missouri Area Agencies on Aging have published the draft of the Master Plan on Aging: Missourians Aging with Dignity and are seeking comments from the public before the plan is finalized. The comment period is open now through Sept. 15.

A Master Plan on Aging is a cross-sector, state-led strategic resource that can help transform the infrastructure and coordination of services for Missouri’s rapidly aging population. The plan helps build bridges across government agencies, facilitate collaboration with diverse stakeholders, promote equity, raise awareness among policymakers and the public, establish statewide priorities, and incorporate an aging and disability lens across state priorities beyond traditional health care and community.

There are currently more than 1.1 million Missourians over the age of 60. Estimates suggest that older adults will outnumber minors for the first time by 2030 and older adults will greatly outnumber minors by 2060, and the older adult population is also becoming more diverse. These demographic shifts will have a profound impact on the volume and types of services and support that states provide to older adults and people with disabilities, as well as family caregivers. Additionally, approximately 15 percent of the state’s residents have a disability, the most common of which is mobility disabilities. As the population ages, the number of individuals with disabilities is expected to increase.

Aging with Dignity: Missouri’s Master Plan on Aging is a 10-year forward-facing plan that will begin in 2026 and run through 2035. It was established by Governor Parson through executive order in January 2023. The following activities to gain community input have occurred since then:

  • An advisory council convened to guide the process of creating the plan. Seven subcommittees comprised of subject matter experts from diverse communities of practice and constituents met regularly to assess the resources and services currently available in the state, find areas of duplication or gaps in service, and determine possible areas for growth.
  • A series of town hall meetings throughout the state was held to gather feedback from local individuals who know about challenges in their own communities. These results were analyzed and provided to the advisory council, seven subcommittees and local agencies.
  • To gain further insight, the needs assessment was launched in 2024. The effort began with the mailing of over 130,000 postcards to randomly selected residents from all counties of the state. The survey was open to anyone in Missouri who wished to share their needs and wants as the State continued the process of developing the Master Plan on Aging.

“The amount of participation and support we have seen from Missourians across the state over the past two years has been inspiring,” said Mindy Ulstad, who leads the Bureau of Senior Programs within DHSS. “We feel confident that the plan, which is the result of an immense amount of collaboration and active listening, will encompass the needs and wants for all Missourians as we age.”

Community participation has been vital to the process of developing the Master Plan on Aging. Missourians are invited to provide feedback on the draft Master Plan on Aging by submitting comments by emailing MOStatePlanOnAging@health.mo.gov. The draft will be available for public comment until Sept. 15. After public comments, the final plan will be delivered to Governor Kehoe before the end of the calendar year.

The overarching goal of the Master Plan on Aging is that all Missourians, regardless of age or ability, will have access to person-centered programs and services necessary to help them age in their environment of choice in a safe and healthy manner. Learn more about Aging with Dignity.

Temporary Pause of Nursing Home Compare Updates

CMS recently transitioned to a cloud-based Internet Quality Improvement and Evaluation System (iQIES) for nursing home survey and certification data. To ensure accuracy of publicly reported information during this transition, Nursing Home Care Compare updates will be temporarily paused as of July 30, 2025. Updates will resume in October 2025. This temporary pause allows CMS to ensure the accuracy and reliability of publicly reported nursing home quality information. QSSAM-25-03-NH

Skilled Nursing Facility Validation Program

The SNF Validation Program is an audit-based program established to assess the accuracy of Minimum Data Set (MDS)-based quality measures used in the SNF Value Based Purchasing (VBP) and Quality Reporting Programs (QRPs). The SNF validation program audits are scheduled to begin in Fall 2025. SNFs selected for audit will be notified through their Internet Quality Improvement and Evaluation System (iQIES) MDS 3.0 Provider Preview Reports folder. The audit notification will contain instructions for documentation submission, the list of sampled residents for which medical charts are being requested and contact information for the contractor conducting the audit. For the FY2025 performance year/FY2027 program year, noncompliance may result in a 2% reduction of a SNF’s Annual Payment Update for the FY2027 SNF QRP program year.

CMS created a SNF Validation Program website which includes resources that can be found at SNF Validation Program.

CMS Memo Updates

The Focused Infection Control (FIC) survey is retired as of 07-31-2025. Items in the downloads section on the Nursing Home webpage have been updated to align with the revisions to QSO-25-23-ALL.

According to CMS’ website, this also includes QSO 23-10- which contained the requirement for Enhanced Enforcement for Infection Control Deficiencies. EXPIRED: Strengthened Enhanced Enforcement for Infection Control

Additionally, CMS has posted on their website a revision/expiration of QSO-19-07-NH-Enhanced Oversight and Enforcement of Non-Improving Late Adopters/unnecessary psychotropics. EXPIRED: Enhanced Oversight and Enforcement of Non-Improving Late Adopters | CMS

All CMS QSO memos can be found at: Policy & Memos to States and CMS Locations | CMS.

Centers of Excellence for Behavioral Health – Grant Ending Sept 29, 2025

DHSS has received official word from the Centers of Excellence for Behavioral Health that their grant will end on September 29, 2025. COE-BH is currently working on maintaining access to the site, including resources and trainings (without certificates) for 1 year post end of contract, however no consultations with Amber Jennings will be conducted after September 15, 2025. You are welcome to reach out to Amber until 9/15/25 for consultation at amber.jennings@allianthealth.org.

Payroll-Based Journal (PBJ) Submission Deadline Reminder

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 4/1/25 through 6/30/25 is due August 14, 2025. Please submit PBJ data as soon as possible to avoid delays.

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

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 August 18, 2025:

  • MDS data for 1/1/25 through 3/31/25;
  • NHSN data for COVID-19 Vaccination Coverage Among Healthcare Personnel for 1/1/25 through 3/31/25.

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.

Quality Reporting Program: Non-Compliance Letters for FY 2026 APU

CMS is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2024, which will affect their FY 2026 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were placed into facilities’ Non-Compliance Notification folders in the Internet Quality Improvement and Evaluation System (iQIES) for SNFs on July 18, 2025. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 26, 2025.

If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notice of non-compliance and on the SNF Quality Reporting Reconsideration and Exception & Extension webpage.

Health Education Unit News

We are excited to announce that Headmaster D & S has released the NEW option for employers to renew their CNA employee’s certification in TMU.

Just a reminder that it is required that CNAs renew their certification every 24 months to remain active. This new function allows employers to renew through their TMU Employer account, choose their CNA employee, provide the required documentation and pay the renewal fee.

Please see the link below for the “How To” guide: EMPLOYER: How to Renew Employee Certificates.

Don’t have an employer account in TMU???

Fill out the Request to Become Employer application in TMU or contact Headmaster D & S for directions or questions at 888-401-0465.

2025 Senior Day at the Missouri State Fair

Join the Missouri Department of Health and Senior Services (DHSS) and the Missouri Area Agencies on Aging (ma4) on Wednesday, August 13th from 9 am to 2:30 pm, in the Mathewson Building on the Missouri State Fairgrounds. Senior Day festivities include FREE BINGO, line dance lessons, a dance contest and much more! The dance contest, open to those aged 55+, has cash prizes for the top three places in each of the categories of Missouri Waltz, Cha Cha, East Coast Swing, Two-Step, and Line Dancing.

For more information, please visit our website at www.health.mo.gov/seniorday.

E4 Center Updated Toolkit

The E4 Center has just updated our Building and Sustaining Effective Behavioral Health Care for Older Adults: Strategies and Considerations toolkit! The new toolkit reflects developments in Medicare coverage of behavioral health services and with further emphasis on select care considerations – check it out!

Specifically, the toolkit revisions incorporate the following updates on Medicare coverage expansions:

  • Newly recognized workforces
  • Newly covered services
  • Newly covered settings

You can access the full 2025 Updated Building and Sustaining Effective Behavioral Health Care for Older Adults: Strategies and Considerations toolkit here.

Additionally, if you’d like more information on these changes, reviewing the E4 Center’s most recent webinar titled, “The Changing Medicate Landscape: What Behavioral Health Providers Need to Know,” presented by Kate Krajci, LCSW and Bonnie Ewald, MA on July 2nd, 2025 is recommended.

Hopefully this toolkit is a useful reference for you in your efforts to build and sustain effective behavioral health care for older adults! Please reach out to us at E4Center@rush.edu with any questions or comments!

Resource Limit/Spenddown Amount

Effective July 1, 2025, the Resource Limit/Spenddown Amount will increase from $5,909.25 to the new amount of $6,068.80. Facilities are required to notify the resident / financial guardian of the need to spend down when the resident reaches $200 less that amount to ensure Medicaid will not be affected.

For more information, please visit https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf.

Feel free to contact Lynn Gilmore, Lead Auditor, at 573-508-4150 if you have any questions.

CMS Memo: QSO-25-19-ALL: Release of CMS-2567: Statement of Deficiencies and Plan of Correction

Memorandum Summary

  • CMS is committed to the transparency of quality of care findings, so that patients, residents, and their families can make informed health care decisions.
  • The official Form CMS-2567: Statement of Deficiencies and Plan of Correction (CMS-2567) will be publicly releasable within 14 days after receipt by the provider, supplier, or lab. In other words, the CMS-2567 can be immediately released upon receipt by the provider/supplier.
  • This update aligns with the Nursing Home CMS-2567 process, which per regulation, are releasable within 14 days of transmission to the facility (See 42 CFR 488.325).
  • This guidance does not apply to Accrediting Organization (AO) survey findings, except those related to surveys of Hospice and Home Health Agencies.

Please see the full memo for details located at https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos/policy-memos-states-and-cms-locations/release-cms-2567-statement-deficiencies-and-plan-correction.

Changes to the Pre-Admission Screening and Resident Review (PASRR) Level 2 Process

The Department of Health and Senior Services Central Office Medical Review Unit (COMRU) and the Department of Mental Health (DMH) are pleased to announce changes to the processing of Pre-Admission Screening and Resident Review (PASRR) Level 1 applications that indicate a Level 2 evaluation should be completed – those with serious mental illness and/or intellectual disability/developmental disability related diagnoses. The goal of these changes is to streamline the process and to decrease the review time for these applications.

Currently, Level 1 applications that indicate a Level 2 evaluation are first reviewed by COMRU staff to determine whether the applicant meets Nursing Facility Level of Care (LOC) before the application is sent to the DMH for a Level 2 evaluation by DMH’s contractor, Bock Associates. This review process can take several working days to complete, which may delay the transition to a nursing home.

Effective July 1, 2025, Level 1 applications that indicate a Level 2 evaluation, based on the responses on the application, will be sent to DMH for review and determination of whether a Level 2 evaluation is necessary. The LOC determination will be made after DMH makes the determination on the Level 2 evaluation. DHSS expects to complete the LOC within one business day of the DMH determination.

 This change will have no impact to individuals completing applications – there will be no changes to the application or to the submission process.

COMRU does receive several applications that do not indicate a Level 2 evaluation based on the responses on the application, however a review of the application and attachments/supporting documentation shows the application should have indicated a Level 2 evaluation. Often, the individual has already been admitted to a nursing home and payment to the nursing home may be delayed until the Level 2 evaluation is complete. A good refresher on the conditions that indicate a Level 2 evaluation can be found here. Please ensure a thorough review of the application and supporting documentation when making admission decisions. An additional tool that will aid in decision-making is a review of the information in CyberAccess. CyberAccess offers many services to providers, such as where Medicaid clients have been receiving services, billed diagnosis and much more. To register for CyberAccess, please contact 888-581-9797.

A new online application link will be provided on COMRU webpage (https://health.mo.gov/seniors/nursinghomes/pasrr.php) starting July 1, 2025.

2025 SLCR Annual Provider Meetings

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

Registration Now Open!

Please stay tuned to our weekly LTC Information Update email for more details including online registration, agendas, and CEU information.

September 9, 2025: Region 4
Location: Stoney Creek Hotel, St. Joseph

September 10, 2025: Region 3
Location: Adams Pointe Conference Center, Blue Springs

September 16, 2025: Region 5
Location: Moberly Municipal Auditorium, Moberly

September 17, 2025: Region 6
Location: DoubleTree Hotel, Jefferson City

September 23, 2025: Region 2
Location: Drury Plaza Hotel & Convention Center, Cape Girardeau

September 24, 2025: Region 7
Location: Crowne Plaza St. Louis Airport, Bridgeton

October 8, 2025: Region 1
Location: Oasis Hotel & Convention Center, Springfield

 

World Elder Abuse Awareness Day – June 15

Support World Elder Abuse Awareness Day on June 15

World Elder Abuse Awareness Day (WEAAD) is commemorated every June 15th to provide an opportunity for communities to promote a better understanding of abuse and neglect of older adults. WEAAD reminds us that elder abuse has implications for all of us. It is a call to action for individuals, organizations, and communities to learn how to identify, address, and prevent elder abuse so we can all do our part to support everyone as they age.

This year, the theme for WEAAD is Building Strong Support for Elders. Visit the WEAAD webpage for more information and how to get involved.

Transfer or Discharge Notice Expectations

Please see the attached Letter to Administrators and Transfer Discharge Tip Sheet-Certified 4.28.25 from the Long-Term Care Ombudsman’s office to clarify newly issued guidance, provided via CMS QSO-25-14-NH, regarding expectations of permitting residents to return to the Nursing Home, referenced herein as the “facility,” following transfer to an acute care setting. This correspondence clarifies the requirements for when the facility transfers or discharges a resident under any circumstances and documentation required for transfers or discharges, and the email address to where a facility is to send copies of discharge notices to the Long-Term Care Ombudsman Program. To support this information, enclosed are a Question and Answer guide and a document that lists county-specific contact information for the Long-Term Care Ombudsman Program.

Missouri DHSS Issues Emergency Waiver to Assist Missourians Impacted by Severe Weather

The Missouri Department of Health and Senior Services (DHSS) has issued an emergency waiver to assist Missourians in need of critical prescription medications following the devastating tornadoes and severe weather that struck Missouri on May 16.

The action comes after Governor Mike Kehoe issued Executive Order 25-24 authorizing DHSS to temporarily waive or suspend any statutory or administrative rule under its purview to allow medical professionals to better assist those affected by storms

The provisions of § 195.010-195.100 and their attendant regulations and 195.060, RSMo, are partially waived to allow pharmacists to fill controlled substance prescriptions for patients in disaster-impacted areas without the presentation of a written prescription and if the pharmacist determines within his or her professional judgment that an extended supply is needed to avoid interruptions to patient care.

This will ensure that individuals whose prescriptions or prescription records were lost or destroyed, or whose original prescribing physician is unavailable, can continue to receive needed medications even if the pharmacy has not previously dispensed or refilled the prescription.

View the waiver.

SNF QRP CDC Data Submission Deadline Extended

CMS is aware that access to the reporting of the annual National Healthcare Safety Network (NHSN) Influenza Vaccination among Healthcare Personnel data was not available for a short time on May 15th. In response to this circumstance CMS is extending the deadline for reporting this information to the Centers for Disease Control and Prevention NHSN to Friday, May 23, 2025, at 11:59 PM ET.

Note: This extension does NOT apply to Minimum Dat Set (MDS) data.

2025 Older Americans Month

Each May, the Administration for Community Living leads the celebration of Older Americans Month (OAM). The theme for OAM 2025 is Flip the Script on Aging, which focuses on transforming how society perceives, talks about, and approaches aging.

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 honor older adults’ contributions, explore the many opportunities to stay active and engaged as we age, and highlight opportunities for purpose, exploration, and connection that come with aging.

Likewise, DHSS encourages each of you to also take time to celebrate OAM this month. As you make plans to host an event in your local community or become aware of other community events, please share the event information with us so we may add and promote it on our DHSS website, Health.Mo.Gov/oam.

DHSS thanks you for your partnership. Please join us in celebrating OAM as well as recognizing older adults as strong and diverse resources in our local communities!