COVID-19 TESTING REIMBURSEMENT ENDING JUNE 15, 2022: The last day to submit COVID-19 testing invoices for reimbursement via the DSS invoice portal is June 15, 2022. After June 15, 2022, the portal will be closed and no other testing invoices will be accepted.
Additional Testing Resources: Free Antigen Testing Supplies The Missouri Department of Health and Senior Services (DHSS) continues to have an adequate supply of free ACON Flow Flex rapid antigen tests all Long Term Care Facilities may apply to receive. Full details regarding the product, CLIA requirements, standing physician orders, and the Rapid Antigen Test Kit Application can be found here: https://ltc.health.mo.gov/archives/15339.
Record high number of fatal overdoses recorded, according to most recent data available
With 1,878 deaths, 2020 had the highest number of fatal drug overdoses to date in the state of Missouri – a 19% increase from 2019. 1,375 of these deaths involved opioids. Today, the Missouri Department of Health and Senior Services (DHSS) launched a new,interactive dashboardshowing data regarding both fatal and nonfatal overdoses, where they occurred in the state and the demographic makeup of those who overdosed.
https://health.mo.gov/data/opioids/
Following national trends, drug overdoses have become an epidemic in Missouri over the past decade. Missouri ranked 32nd in the nation for drug overdose death rates in 2020.
Among adults aged 18-44 in Missouri, drug overdose is the leading cause of death, and more than 70% of all drug overdose deaths in the state involve opioids. The opioid class of drugs includes heroin, fentanyl, methadone, morphine, oxycodone and many other prescription and non-prescription pain relievers.
“The opioid crisis is an issue only made worse by the COVID-19 pandemic,” said Paula Nickelson, DHSS Acting Director. “This is a health crisis that knows no bounds–it affects all genders, races and ages in both rural and urban communities. Our efforts at the state level to combat opioid misuse and overdose include monitoring and prevention strategies designed to improve data quality, inform decision making and implement targeted interventions.”
The new dashboard shows a sharp increase in recent years of deaths, from those involving heroin (with no synthetic opioids present) to deaths involving synthetic opioids. Synthetic opioids, including fentanyl and its analogs, were involved in 1,204 drug overdose deaths in 2020 in Missouri. The 2020 figure is nearly seven times higher than the 2015 count of 179 synthetic opioid-involved deaths.
In an effort to alter this trajectory, DHSS has several strategies and activities currently underway or in development. These efforts are supported through theOverdose Data to Action(OD2A) cooperative agreement with the Centers for Disease Control and Prevention (CDC) which began in 2019.
Data Monitoring
Collect and disseminate timely Emergency Department data on all suspected drug, opioid, heroin and stimulant overdoses: Perform monitoring in Missouri’s Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) using case definitions for all drugs, opioids, heroin and stimulant overdoses.
Collect and disseminate descriptions of drug overdose death circumstances using death certificates and medical examiner/coroner data: Collect data from death certificates and medical examiner/coroner reports and enter data into the State Unintentional Drug Overdose Reporting System (SUDORS).
Implement Innovative Surveillance: Link records between two nonfatal data sources, ESSENCE and Patient Abstract System, on various overdose types to evaluate the relationship between overdoses reported with more real time data versus more comprehensive but lagged data.
Prevention Methods
Prescription Monitoring Compliance: Conduct regulatory inspections on high-risk prescribers and outliers; seek regulatory actions and remedies; provide information and education to prescribers about CDC prescribing guidelines.
State/local Integration Efforts: DHSS has established 16 current contracts with select local public health agencies to focus on opioid and illicit drug use prevention and response efforts.
DHSS collaborated with the Missouri Department of Mental Health and provided funding to three local prevention centers to combat opioid misuse and overdose.
The DHSS Office of Minority Health responds to overdoses in the St. Louis area and provides resources to overdose patients regarding treatment services.
DHSS held its inaugural Harm Reduction Conference in June of 2021 and is in the planning stages for the 2022 conference.
DHSS is developing a second Missourivulnerability assessmentfocusing on dual issues of opioid misuse and blood-borne infection.
The DHSS Bureau of HIV, STD and Hepatitis provides Harm Reduction 101 training and technical assistance to local public health agencies and community-based organizations.
Linkages to Care: DHSS has supported contracted HIV Peer Navigators and other designated staff to attend the Missouri Credentialing Board Medication Assisted Recovery training, integrated the HIV Reduction 101 training into the HIV/Hepatitis C training and continues to look for professional certification opportunities to build system staff capacity.
Public Safety Partnerships: The DHSS Bureau of Healthcare Analysis and Data Dissemination has established a linkage of opioid overdose mortality data with offenders released from the Missouri Department of Corrections. DHSS has a linkage with the Midwest High Intensity Drug Trafficking Area to review drug seizure data and compare with opioid overdose mortality data.
Public Awareness: DHSS will launch a new media campaign based on most recent data to raise awareness of opioid misuse and overdose. DHSS has previously implemented three separate campaigns to focus on opioid awareness, harm reduction strategies and CDC Rx Awareness facets. The campaign targeted zip codes with the highest opioid mortality rates; these campaigns have been marketed on radio, billboards, at gas stations, across social media platforms and through other venues and platforms.
The NHSN Vaccination team will host 2 training sessions in preparation for the upcoming NHSN release on May 30th. These sessions were previously scheduled to incorporate the LTC COVID-19 Module Surveillance Pathways, however the training has been scaled down to solely focus on the COVID-19 Vaccination Module.
Please register to attend one or more sessions to learn how reporting forms will change and how to report data accurately. After registering, you will receive a confirmation email containing information about joining the webinar. Please note these training sessions are repeated and you may not find it necessary to register more than once. After each training session, you will be allowed to ask questions as it pertains to the webinar.
Thanks for your participation!
The NHSN LTCF Team
**COVID-19 Vaccination Modules Webinar**
When: Tuesday, May 17, 2022, 1:00 – 2:00 PM Eastern Time (US and Canada) Topic: Updates to the COVID-19 Vaccination Modules for Residents and Healthcare Personnel Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_2vwCHWGkQj63Nvka5h5GUA
When: Thursday, May 19, 2022, 1:00 – 2:00 PM Eastern Time (US and Canada) Topic: Updates to the COVID-19 Vaccination Modules for Residents and Healthcare Personnel Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_dG7knYLOQJu9lwT__8cV2Q
Regulatory Guidance: 19 CSR 30-84.010(9) Training agencies shall be approved for a two- (2-) year period and shall submit a new application for approval thirty (30) calendar days prior to the expiration of approval.
Please check your training applications to ensure they are current for holding the CNA Training Program. Failure to keep your training applications up-to-date may delay the ability to train and/or test CNA’s from your facility. Please see the link below to our website which includes information on training applications:
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!
There will be various revisions to the LTCF COVID-19 Module surveillance pathways and COVID-19 Vaccination Modules for residents and healthcare personnel in the upcoming NHSN May release. CDC will be conducting training webinars next month. Please attend a training session to learn how data entry forms will change and receive instructions for accurate reporting. Below are a few changes you will see starting next month in the COVID-19 Module surveillance pathways.
NHSN COVID-19 Module Surveillance Pathway Forms will be Revised New Changes Coming in May!!
What are the main changes?
Simplifications
REMOVAL of Supplies and PPE Pathway
Users will no longer need to report data to this pathway
The Resident Impact and Facility Capacity Pathway (RIFC) and the Staff and Personnel Impact Pathway will have several data elements removed:
How can I learn more? CDC will be conducting training webinars in May. More information on these webinars will be shared in the coming weeks, so stayed tuned!
If you have questions, please send an e-mail to NHSN@cdc.gov with ‘COVID-19 Surveillance Pathway Forms’ in the subject line. Below are the changes that will also take place in the COVID-19 Vaccination Module starting next month.
NHSN Weekly COVID-19 Vaccination Cumulative Summary Forms will be Revised New Changes Coming in May!!
What are the main changes?
Simplifications
COVID-19 vaccination data will no longer be reported by vaccine manufacturer for questions on primary vaccine series and additional/booster doses.
Questions on vaccine supply will be removed.
Completing monthly reporting plans for COVID-19 vaccination modules in the Long-Term Care Facility Component will no longer be required. Instead, upon saving or uploading data, users will agree to the following:
The data reported are consistent with definitions outlined in NHSN surveillance protocols (including tables of instructions and frequently asked questions).
The data will be sent to the Centers for Medicare and Medicaid Services (CMS) to fulfill CMS quality reporting requirements (when applicable).
Additions
Adding a note at the top of form specifying that data can be submitted by completing the questions on the data collection form or by using the new event-level COVID-19 vaccination forms.
Adding a question for facilities to report the cumulative number of individuals who are up to date with COVID-19 vaccination.
Adding two fields to question #4 to report the cumulative number of individuals who received only one booster dose and two or more booster doses of COVID-19 vaccine (Note: For residents only)
How should I prepare? Facilities should develop or update data tracking mechanisms to collect weekly COVID-19 vaccination data on residents and healthcare personnel for the additional questions.
Tip: Using the new event-level COVID-19 vaccination forms in NHSN’s Long-Term Care Facility Component can simplify the tracking and reporting of data on multiple booster doses and up to date status.
How can I learn more? CDC will be conducting training webinars in May. More information on these webinars will be shared in the coming weeks, so stayed tuned so you can register for the sessions.
If you have questions, please send an e-mail to NHSN@cdc.gov with ‘COVID-19 Vaccination Data Reporting’ in the subject line.
SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS and NHSN data for 10/1/21 through 12/31/21 must be submitted no later than 11:59 p.m. on May 16, 2022.
The Minimum Data Set (MDS) 3.0 must be transmitted to the Centers for Medicare & Medicaid Services (CMS) through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). 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 CASPER 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:
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 1/1/22 through 3/31/22 is due May 15, 2022. 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:
Missouri healthcare providers and public health practitioners: Please contact your Local Public Health Agency or the Missouri Department of Health and Senior Services’ Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7) with questions regarding this Health Advisory.
The NHSN Vaccination Team hosted two office hours webinars for the Event-Level COVID-19 Vaccination Forms on Tuesday, April 12th and Tuesday, April 19th. During these webinars, CDC provided long-term care facilities with an overview of how to use this feature to manage person-level vaccination data directly in the application for the COVID-19 Vaccination Modules and discussed frequently asked questions in detail.
The slides used during the webinars are linked under the “Educational Resources” section of this message, and webinar recordings will be posted on the NHSN website at a later date.
Summary of Key Points:
The Event-Level COVID-19 Vaccination Forms are available in the NHSN application for long-term care facilities (other modules coming soon) to manage person-level vaccination data and simplify summarizing data for weekly COVID-19 Vaccination Modules.
There are three ways to report data: directly into the COVID-19 Vaccination Modules, via .CSV upload, or by selecting the ‘View reporting summary and submit’ button of the Event-Level COVID-19 Vaccination Forms.
SAMS Level 3 access is required to complete reporting using the Event-Level COVID-19 vaccination forms. If your facility does not have a Level 3 user, please contact the SAMS Help Desk between the hours of 8:00 AM and 8:00 PM EST Monday through Friday (excepting U.S. Federal holidays) at the following: Toll Free: 877-681-2901; E-mail: samshelp@cdc.gov. You can also find additional information in the SAMS User FAQs published on the SAMS Homepage at https://sams.cdc.gov.
Data are entered line by line in the optional Event-Level COVID-19 Vaccination Forms, similar to the Excel Data Tracking Worksheet.
You can complete a one-time upload of any current data in the Excel Data Tracking Worksheet to the NHSN Event-Level COVID-19 Vaccination Forms. Once your data are transferred to the NHSN application, do not continue to use/re-upload the Excel Data Tracking Worksheet because the two tools do not function the same way.
There is no need to enter a new line for an individual each week or when their status changes; instead, Event-Level COVID-19 Vaccination Forms capture changes in individuals’ vaccination status over time.
The one exception is for extended leave. If a healthcare worker goes on leave for longer than 2 weeks (14 days) and returns to work after more than 2 weeks, or if a resident is discharged or leaves the facility for any reason for longer than 1 week (7 days) and returns or is re-admitted after more than 1 week:
– You should enter a discharge/end date on the day they were discharged or left.
– When they return or are re-admitted, you should duplicate their row (using the + button next to their row) and enter a new admission date on their new row.
These forms allow users to record religious exemption as a reason for declining COVID-19 vaccination.
2nd booster dose fields will be added to the forms.
Coming Soon – May 2022 Release:
The Event-Level COVID-19 Vaccination Forms will include new columns to record second and third booster doses.
The weekly summary form will include a question on “number of individuals who are up to date on COVID-19 vaccines.” This field will be auto-calculated for those using and submitting data with the Event-Level COVID-19 Vaccination Forms.
The weekly resident summary form will include questions on number of residents who received only one booster dose, and number of residents who received two or more booster doses. These fields will be auto-calculated for those using and submitting data with the Event-Level COVID-19 Vaccination Forms.
Rows will no longer appear green after submission for individuals with a discharge date earlier than 3/28/2022.
Note: NHSN encourages facilities to enter the same IDs for residents and healthcare personnel as those used for reporting the POC Tool and the RIFC Event-Level Form when applicable.
NOTE: The recommended browser for use of MODROP is Google Chrome. Other browsers may cause issues with MODROP.
Facilities will need to register for a MODROP account the first time they use the new portal. MODROP allows reporting of only COVID-19 cases. Reports of other reportable conditions may be faxed to 573-751-6417.
Facilities performing their own COVID-19 testing (antigen testing) must report positive results through one of the following portals:
MODROP
In bulk via HL7 or CSV file using the DHSS- Electronic Lab Reporting process
National Healthcare Safety Network (NHSN) or the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) Platform.
Facilities using an external laboratory (PCR testing) must enter positive case information into MODROP.
We are excited for this change and elimination of duplicate reporting of positive cases! If you have any questions or encounter any issues utilizing MODROP or for questions about HL7 or CSV reporting, please reach out to the EpiTrax Help Desk via e-mail at epitrax@health.mo.gov. The EpiTrax Help Desk e-mail account is monitored from 8AM-5PM CST Monday-Friday.
Please see the FAQ and thank you for your efforts to provide complete and accurate COVID-19 data to public health.
The NHSN Vaccination Team is providing two webinars on Tuesday, April 12thand Tuesday, April 19that 2:00 PM Eastern Time to provide additional training on the Event-Level COVID-19 Vaccination Forms in the COVID-19 Vaccination Modules and to answer frequently asked questions. These worksheets are available in the NHSN application for long-term care facilities (other modules coming soon!) to manage person-level vaccination data and simplify data for weekly COVID-19 Vaccination Modules.
During this session, the team will review key points about the forms and provide answers to frequently asked questions raised during the training webinars held in March 2022. Users attending the training can also ask questions in in the Q&A box.
Registration information for both webinars is listed below. The content for both webinars will be the same, but individuals are welcome to register for and join both for additional reinforcement if they choose.
When: Tuesday, April 12, 2022 at 02:00 PM Eastern Time (US and Canada) Topic: Event-Level COVID-19 Vaccination Forms: Office Hours and FAQs
For specific questions about registration for this webinar, please e-mail NHSN@cdc.gov and place in the subject line: Event-Level COVID-19 Vaccination Form Office Hours.
Beginning April 11, 2022, DHSS will ship PPE, test kits, and other warehoused items on Monday and Thursday each week.
If you have an urgent need outside of these shipment dates, please email Tracy.Niekamp@health.mo.gov after your order has been submitted through the ordering portal.
Note: The requirement to renew the CNA certification every 24 months is not a new regulation; however, the process to renew has been updated and a fee has been added.
**Please see this link for information on how to renew.
When a CNA passes the final examination, the individual’s name is placed on the CNA active registry. For nurse aide certification to remain active, CNAs are required to submit documentation (e.g., pay stubs, W-2, letter from employer, etc.) of their work in nursing or nursing related services for at least one (1) day (e.g. eight (8) hours) within each twenty-four- (24-) consecutive month time-period. Documentation shall be submitted to the department approved third party test administrator and a fee will be assessed for each renewal.
If you are a CNA needing to renew your certification and work in a facility: Log into your profile in TMU and enter your employment under the employment tab, upload your documents for proof of 8 hours of work and then pay the required fee. After the fee is processed, you will show active on the registry.
If you are a CNA needing to renew your certification with out of state employment: Log into your profile and select “out of state employment” and send an email from your employer with name, date of birth, employment dates and hours worked to missouri@hdmaster.com.
If you are CNA working private duty: Log into your profile in TMU and select private duty from a drop down menu. You will need to process the payment then email the proof of work documents to missouri@hdmaster.com. After work is confirmed, your certification will show active on the registry.
If you are a facility wanting to pay for multiple CNA’s renewal: You will need to fill out the form Employer Renewal Payment. If you have additional questions please email them at missouri@hdmaster.com or call at 800-393-8664 and ask for the Missouri team.
The Missouri Department of Health and Senior Services (DHSS) is issuing this Health Update to provide reporting laboratories and healthcare providers information regarding the changes in the reporting requirements for COVID-19 and SARS-CoV-2 test results in Missouri.
During the early stages of the pandemic response there were several changes to the reporting rules that were established through waivers during the State of Emergency issued by Governor Parson. The changes included the requirement that both negative and positive test results for COVID-19 were to be reported to DHSS within twenty-four hours. Additionally, reporters were required to only report directly to DHSS rather than having the option to report to either the Local Public Health Agency (LPHA) or DHSS. After the State of Emergency was lifted by Governor Parson, DHSS filed an emergency amendment to allow these requirements to continue. However, on April 1, 2022, DHSS terminated this emergency amendment and as a result, these requirements no longer exist. Please consider the following guidance regarding the reporting of COVID-19 and laboratory tests results for SARS-CoV-2.
Coronavirus Disease 2019 (COVID-19) remains an immediately reportable condition in Missouri. All positive laboratory results are required to continue to be reported to DHSS or the LPHA in accordance with rules established in 19 CSR 20.20.020. Healthcare providers, laboratories, and other mandated reporters should continue to report all COVID-19 positive test results including results from all Nucleic Acid Amplification Tests such as RT-PCR tests, and all rapid and antigen tests results for SARS-CoV-2. The reporting of positive home use tests is optional. However, DHSS will no longer require, or accept, negative laboratory results for SARS-CoV-2. In addition, DHSS is no longer requesting the routine reporting of positive or negative antibody tests results for SARS-CoV-2.
DHSS greatly appreciates the continued collaboration of our partners in healthcare and clinical laboratories. For questions regarding this Health Update and the reporting of COVID-19 in Missouri, please contact the DHSS Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7), or contact your local public health agency.
Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers
CMS continues to review the need for existing emergency blanket waivers issued in response to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
Over the course of the COVID-19 PHE, skilled nursing facilities/nursing facilities (SNFs/NFs), inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end-stage renal disease (ESRD) facilities have developed policies or other practices that we believe mitigates the need for certain waivers.
Applicable waivers will remain in effect for hospitals and critical access hospitals (CAH).
Join the National Academies of Sciences, Engineering, and Medicine’s Committee on The Quality of Care in Nursing Homes as it discusses the soon to be released report, The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families and Staff.
This new report examines how our nation delivers, finances, regulates, and measures the quality of nursing home care with particular emphasis on challenges that have arisen in light of the COVID-19 pandemic.
A public report release webinar will be held on Wednesday, April 6, 2022 from 10:00 AM to 11:00 AM (Central Time) during which members of the committee will provide an overview of key findings, conclusions, and recommendations, followed by a moderated question and answer period.
Ensuring that potential or new supervisors have the skills to lead is vital to the achievement of your clinical, financial, regulatory, and resident experience goals. Far too often staff are promoted simply because they were exceptional in their current roles. A great nurse, cook, or admission coordinator may not yet be ready to be a great unit manager, food service or marketing director. This webinar series will help your people make that leap – and familiarize you with the strategies you need to help them succeed!
The purpose of the Review Course is to help attendees prepare for the nursing home administrators federal licensure exam. Theoretical, philosophical and practical aspects of long-term care administration are discussed. The instructor will review sample test questions from the study workbook, which is provided free to all attendees. Study tips will be suggested throughout the workshop, therefore, it is recommended that attendees allow sufficient time to study on their own after attending the review course and before sitting for the exam. Review course materials have been revised and updated to reflect the structure of the current examination. This workshop is being offered both in-seat and virtually.
Attached below is important information for the Long-term Care Facility COVID-19 Module regarding modifications for the NHSN release that will occur March 2022. Resources on the NHSN LTCF COVID-19 Module website will be updated, where indicated, with revised forms, instructions, FAQs and CSV templates. Information regarding training opportunities is also available on the NHSN LTCF COVID-19 Module Website.
The Health Quality Innovation Network’s Weekly Dose Office Hours webinar series provides current updates on COVID-19 guidance and vaccine information. As a Medicare Quality Innovation Network – Quality Improvement Organization (QIN-QIO), HQIN is dedicated to helping you increase your vaccination rates.
This forum for vaccine and booster questions features interactive, peer-to-peer collaboration following a brief presentation. Each session includes best practices and innovative idea sharing as well as tips for improving resident and staff safety. Weekly Dose Office Hours are held Wednesdays at 1:00 p.m. CT/2:00 pm. ET. Register for the next Office Hours, as well as upcoming sessions, at this link: https://tinyurl.com/575d66tn.
Ensuring that potential or new supervisors have the skills to lead is vital to the achievement of your clinical, financial, regulatory, and resident experience goals. Far too often staff are promoted simply because they were exceptional in their current roles. A great nurse, cook, or admission coordinator may not yet be ready to be a great unit manager, food service or marketing director. This webinar series will help your people make that leap – and familiarize you with the strategies you need to help them succeed!
If you are like most administrators, your endless daily to-do’s get longer and longer. This course is a new administrator’s one-stop-shop! It is also a great review for an experienced administrator. This course will review operational and administrative topics such as requirements of participation (ROPs), the survey process, CASPER reports (including how to access them), Five-Star Quality Rating System (all three domains!), Care Compare, QAPI and SO MUCH MORE! You will also be guided through all the resources available at your fingertips. Join us for this full day of education that will promote your administrator knowledge to the next level. This workshop is being offered both in-seat and virtually.
