Regulation Update Notice

House Bill (HB) 1387, known as the “Authorized Electronic Monitoring in Long-Term Care Facilities Act” will become law on August 28, 2020. As a result, the Section for Long-Term Care Regulation has drafted emergency and proposed rules based on that legislation. The emergency and proposed rule sets forth requirements to implement HB 1387 regarding the use of electronic monitoring devices in long-term care facilities. This legislation gives residents of long-term care facilities the right to place electronic monitoring devices in their rooms. Sections 198.610 -198.632, RSMo, outline the parameters of electronic monitoring and requires the department to promulgate rules to implement authorized electronic monitoring and to develop an electronic monitoring device acknowledgment and consent form which must be completed and signed by residents and roommates prior to an electronic monitoring devices being installed and utilized.

The emergency rule was filed on August 20, 2020, with an effective date of September 3, 2020 and expiration of March 1, 2021. A proposed rule covering this same material will also be published in the same issue of the MO Register. The Register publication date is October 1, 2020.

NOTE: The public comment period will be from October 1-31, 2020. The Department will be accepting comments during the comment period by mailing the comments to Craig Schnieders, Interim Director of the Division of Regulation and Licensure, PO Box 570, Jefferson City, MO 65102-0570 or by emailing to Terri.Bass@health.mo.gov.

The proposed rules can be reviewed on our website at: https://health.mo.gov/about/proposedrules/.

Battelle Demobilization

Throughout the COVID-19 response, the Battelle CCDS system has been an important part of lengthening the life of N95 masks, safely. Missouri users will continue to have access to decontamination through Battelle for the foreseeable future, however, some changes are coming for those who use the Battelle CCDS site at the Jefferson City Armory. This site will be demobilized with a projected final closure date of September 12.

Battelle will directly correspond with all users of the CCDS and provide them shipping labels to another Battelle site in a surrounding state. The shipping of masks will be at no cost. Due to increased shipping time, there may be some delays noted – so please plan accordingly.

If your facility is signed up as a Battelle user, you will receive direct correspondence from Battelle in the next 7-10 days. Until told otherwise by Battelle, you may continue to send your masks to the Jefferson City Armory.

2020 Pioneer Network Virtual Gathering – Envisioning the Future

September 1-3, 2020: Envisioning the Future

Join Pioneer Network for three days of networking, education, and discussion with some fun as we Envision the Future of senior living and the world of aging services.

Envisioning the Future: 2020 and Beyond won’t be your typical, sit in front of the computer and watch a screen type of event. Instead, you’ll be part of the action. Each day will start with an opportunity for attendees to gather together to kick off the day. Mid-day, we will again come together for the daily keynote session. In between, there will be concurrent sessions addressing the hottest topics of the day, And at the end of each day, there will be an opportunity to gather around virtual tables with fellow pioneers, sharing information and envisioning the future together.

Action Pact’s Culture Change Now – Conversations with Carmen

August 21, 2020: Meaningfully Engage Individuals – In their Rooms – Especially Those Living with Dementia
Presenters: Carmen Bowman, with Guest Host Megan Hannan

Join us for oodles of ideas to meaningfully engage individuals with their surroundings, especially those living with dementia. Perhaps we are in our biggest challenge ever, to provide meaningful engagement to persons alone in their rooms. What a great opportunity to be creative! Institutionalized, isolated people need the gift of our intentionality to be able to engage naturally with their surroundings, even when there is not a pandemic. We can help to overcome boredom. Get a long list of ideas, contribute to it, and allow it to inform your work into the future.

Leadership and Laughter: The Courage to be Fearless in the Workplace

August 27, 2020: Leadership and Laughter: The Courage to be Fearless in the Workplace
Presenter: Diana Jordan, Professional speaker / author, entrepreneur, CEO, advocate for women’s health and Internationally Certified Laughter Therapist

A dynamic Virtual Presentation delivered with wisdom & a twist of humor!

Purpose:  Learn how courageous leaders can use humor to cope with today’s demands, bolster their effectiveness, build relationships and teamwork. and improve organizational outcomes.

Target audience:  Leaders and aspiring leaders in any health care setting.  If you want to learn how to see the positive in all kinds of changes and use your common sense of humor to deal with challenging situations in the workplace, this webinar is for you!

More Information: https://extension2.missouri.edu/leadership-and-laughter-the-courage-to-be-fearless-in-the-workplace.

Immunization Webinar Series – FREE!

Starting August 20, 2020: Immunization Webinar Series

The purpose of this series of 5 webinars is to update the knowledge base regarding immunization practices and vaccine recommendations based on national guidelines and the latest evidence to guide practice.

Topics:

  • VFC 411 Immunization Scheduling
  • VFC 411 The Basics
  • Influenza Vaccination
  • COVID-19 Vaccine
  • Vaccine Hesitancy

More Information: https://extension2.missouri.edu/immunization-webinar-series-2-fy21.

Electronic COVID-19 Case Reporting – Now Available

The Department of Health and Senior Services (DHSS) is pleased to announce the availability of Electronic COVID-19 Case Reporting. All entities currently required to complete a Communicable Disease Case Report (CD-1) should begin reporting positive COVID-19 cases via the new system*. This system will replace the paper CD-1 process and allow for more timely, appropriate, and accurate data for COVID-19 case reporting.

The new system also fulfills the requirement for residential congregate facilities to report COVID-19 cases under the Congregate Facility Reporting Order. Congregate facilities will no longer need to enter positive case information into the former system, which has been taken down.

The Electronic COVID-19 Case Reporting System can be found on DHSS’ main COVID-19 webpage: www.health.mo.gov/coronavirus. Please do not enter lab result information unless you are a reporting laboratory or you are entering on behalf of the laboratory.

Testing spreadsheets should continue to be provided by facilities to the Division of Regulation and Licensure. Testing spreadsheets can be uploaded at: https://health.mo.gov/safety/longtermcare.php.

*If your organization has already developed an electronic reporting process with DHSS, please continue to follow this process. The Electronic Reporting System is a replacement for those entities currently emailing, faxing or mailing a CD-1 form for COVID-19 case information.

In order to allow for more accurate submission of your data on the Electronic COVID 19 Case Reporting form, please note the following:
      -When you hit the “Submit” button on page 5 of the form make sure you add today’s date.
      -Make sure you choose Resident, Staff, Contracted Staff or “No” on page 2 of the form.

Provider Relief Payment Opportunities – Update

As of July 15th, 192 qualifying Medicaid & CHIP eligible providers in Missouri have applied for the Medicaid & CHIP Provider Relief Fund distribution out of the 5,725 providers identified in the data that your team supplied to CMS. Of these, 93 Medicaid & CHIP providers have been paid from this distribution. To ensure that all qualifying providers are aware of the opportunity, as well as the new application deadline, we are requesting that states reach out to your medical, dental, and long-term services and supports (LTSS) providers to remind them that they can begin the application process here. 

The application deadline has been further extended to offer providers additional opportunity to apply for funding. You must act by Friday, Aug. 28, 2020 at 11:59 p.m. ET to be considered for payment from this distribution. Read more about the extension here.

To support these efforts, included below some resources that the HRSA team has released on the Provider Relief Fund to share:

  • Program Overview:
    The bipartisan Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act provide $175 billion in relief funds to hospitals and other health care providers, including those on the front lines of the coronavirus response. A portion of these funds, under the Medicaid and Children’s Health Insurance Program (CHIP) Provider Distribution, provide help for providers and clinicians who treat our most vulnerable populations, including low-income and minority patients. This is allocated for eligible providers that participate in state Medicaid and CHIP Programs and that did not receive a payment from the Provider Relief Fund General Allocation. The payment to each provider will be approximately 2 percent of reported gross revenue from patient care.
  • Fact Sheet
    The Health Resources & Services Administration (HRSA) released a Fact Sheet for Medicaid and CHIP Providers that is now available on the Provider Relief Fund website.
  • Frequently Asked Questions (FAQs)
    In order to better address your most important concerns, HRSA has updated their FAQs to address common questions, including those submitted during the previous webcasts. The FAQs include expanded information on eligibility, application, payment process, and more.
  • Additional Information
    For additional information, please call the Provider Support Line at (866) 569-3522; for TTY, dial 711. Hours of operation are 7 a.m. to 10 p.m. Central Time, Monday through Friday. Service staff members are available to provide real-time technical assistance, as well as service and payment support.

PEPPERs Available for SNFs

Fourth quarter FY 2019 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) are available for Skilled Nursing Facilities (SNFs). These reports summarize provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities.

For More Information:

NHSN-Missouri Group Request and Data Entry

Many long-term care facilities have begun reporting COVID-19 data into the CDC’s NHSN Long-term Care Component. In an effort to have a more complete representation of COVID-19 data for the State of Missouri, we are asking facilities who are not yet reporting (SNF, ICF, ALF, RCF, ICF/IID) to consider reporting data through the CDC’s NHSN Module and those facilities that are currently reporting to begin sharing their data (conferring rights) with DHSS. In order to share the data you enter into the CDC’s NHSN site, you must join the “Missouri Group” within NHSN and select the option to “Confer Rights”.

Once you have completed the NHSN enrollment process and received your acceptance notification from NHSN, you can login to the NHSN site to:

  1. Access the COVID-19 Module within the Long-Term Care Component
  2. Join the Missouri Group (using the guidance below)
  3. Confer rights to grant the state health department access to your facility’s information.

How do I join the Missouri Group and confer rights to the department?

NHSN website provides instructions – https://www.cdc.gov/nhsn/pdfs/groups-startup/JoinGroup-current.pdf.

The document is titled: NHSN Data Sharing: Joining a Group and Accepting the Confer Rights Template.

Please use the following information to join the Missouri group:
Group ID: 20503
Use password: MHIRS29

DHSS is also encouraging facilities to report each day. This will allow more accurate and timely data that could be used for increased allocation of resources for facilities that start to see increased cases, rather than responding up to a week later when outbreaks are identified.

A Frequently Asked Questions document is now available on the NHSN LTCF COVID-19 Module website. The document was developed to answer the most common questions received from facility and group users participating in the NHSN LTCF COVID-19 Module. The questions are organized by the four COVID-19 Module pathways, as well as enrollment, groups, the CMS rule, and data entry and analysis. Additionally, at the end of the document, there are examples of how to count data for reporting.

State and Community-Based COVID-19 Testing Qualified Vendor List

An updated list of laboratories on state contract has been placed on the DHSS website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/cares-act-funding.php under the Word document titled State and Community-Based COVID-19 Testing Qualified Vendor List.

This Qualified Vendor List has information regarding daily testing capacity, specimen types, billing, turn-around-time, etc., for the laboratories on state contract. The pricing is for work completed at the state/local government’s request, but may be honored for private entities at the lab’s discretion.

This information is being provided to assist with completing testing either for an outbreak situation or for reopening purposes. There are laboratories not listed on the qualified vendor list that conduct testing as well. There is no requirement to utilize a laboratory on this list.

SNF QRP COVID-19 PHE Tip Sheet is Available

The SNF COVID-19 PHE Tip Sheet is now available. This tip sheet is designed to assist Skill Nursing Facility (SNF) providers in understanding the status of the SNF Quality Reporting Program (QRP) during the COVID-19 Public Health Emergency (PHE). Also provided is practical guidance to address SNF quality data submission requirements starting July 1, 2020, now that the temporary SNF QRP exemptions from the COVID-19 PHE have ended. Please navigate to the SNF QRP Training webpage to download this document.

SNF Patient Driven Payment Model (PDPM) Interrupted Stay Billing Issue

A new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a hospital claim). If you billed the interrupted stay correctly, and your claim is rejected, modify your billing so the claim spans past the last day of the interrupted stay:

  • Bill two months at a time, or
  • Bill a month plus the days in the following month that span the interrupted stay plus 1 day

Adjusting the statement covered from and through dates to encompass the entire interrupted stay will allow your claim to process and pay correctly. Medicare Administrative Contractors will finalize any suspended claims that meet the criteria, so you can make corrections and resubmit your claim.

If we rejected an inpatient hospital claim, the hospital should ask the SNF to modify their claim. Until October 5, a SNF cannot submit an adjustment to a paid claim; they must cancel the paid claim and all subsequent claims in the same stay and resubmit them in sequential order.

CMS will correct the system in the future.

MDS Final Item Sets (Version 1.17.2) for October 1, 2020

In response to State Medicaid Agency and stakeholder requests, CMS has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications. These changes will support the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day SNF PPS assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets, which was not possible with item set version 1.17.1. This will allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future payment models.

The changes to the technical data specifications that support these modifications are contained in the Errata v3.00.5 which can be accessed in the file: MDS 3.0 data specs errata (v3.00.5) Final 06-18-2020 in the Downloads section of the MDS 3.0 Technical Information page. Supporting materials including the 1.17.2 Item Change History report and the revised 1.17.2 Item Sets can be accessed in the file: MDS 3.0 Final Item Sets v1.17.2 for October 1 2020 zip, which are also posted in the Downloads section of the MDS 3.0 Technical Information page.

The Department of Social Services (DSS) is required to submit a Medicare Upper Payment Limit (UPL) Demonstration for nursing facilities to CMS at the end of each state fiscal year. Currently, the Missouri nursing facility UPL Demonstration is based on the Medicare Resource Utilization Groups (RUGs) reimbursement system and the associated MDS data. With Medicare’s change in reimbursement to PDPM, CMS has indicated that at some point RUGs calculations will no longer be supported. At that point, or perhaps sooner, the State anticipates transitioning the UPL Demonstration to be based on the PDPM payment methodology that Medicare now uses. DSS will need the additional data items to perform that calculation. This will allow DSS to continue to align the UPL calculation to most closely reflect the Medicare payment methodology. The DSS may also use the additional data for future acuity-based analysis that would require these data elements.

Since Missouri will require the calculation of the PDPM payment codes on the OBRA assessments when not combined with a 5-day SNF PPS assessment, SNFs and NFs in Missouri will need to complete additional items on OBRA assessments when not combined with a 5-day SNF PPS assessment. Additional items include:

  • GG0130 Self-Care items;
  • GG0170 Mobility items;
  • I0020 and I0020B Primary Medical Condition items;
  • J2100 Recent Surgery item. If J2100 is checked yes, J2300-J5000 are to be completed.

Coding instructions for these items on OBRA assessments when not combined with a 5-day SNF PPS assessment will be forthcoming so stay tuned.

HAI-Infection Prevention on the Frontlines: Back to the Basics – in the Midst of a Global Pandemic

July 27 – September 6, 2020: ON DEMAND

Frontline nurses care for patients of all ages, across multiple care settings, with myriad health issues – not just those with infectious disease processes. It is a challenge to stay current with the latest evidence-based knowledge regarding infection prevention and COVID-19 has made this even more demanding. And depending on the practice setting, frontline nurses may have vastly different levels of institutional support and available resources to meet this demand.

The purpose of this conference is to enhance the capacity of frontline nurses to provide exemplary care to individuals with infectious diseases by focusing on the basics – which are applicable to all patients and always changing – and to demonstrate the profound impact an individual caregiver who practices from a proven base of evidence can have on patient outcomes. Linkages to COVID-19 are integrated throughout.

More Information including registration can be found at https://extension2.missouri.edu/hai-infection-prevention-on-the-frontlines-back-to-the-basics-in-the-midst-of-a-global-pandemic.

Summary Strategies to Optimize the Supply of PPE during Shortages

CDC developed a quick reference table summarizes CDC’s strategies to optimize personal protective equipment (PPE) supplies in healthcare settings and provides links to CDC’s full guidance documents on optimizing supplies. These strategies offer a continuum of options using the framework of surge capacity when PPE supplies are stressed, running low, or absent.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/strategies-optimize-ppe-shortages.html

Quality Reporting Program: Non-Compliance Letters for FY2021 APU

CMS is providing notifications to SNFs that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2019, which will affect their FY 2021 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were also placed into facilities’ CASPER folders in QIES on July 13, 2020. Either notification is official notice of non-compliance. 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 18, 2020.

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.

Reminder – Community Testing Opportunities, open to all Missourians

Missouri continues to announce community testing events across the state. Several communities will be conducting COVID-19 testing over the next two weeks. For these testing events, participants will not be required to have a doctor’s authorization and there will be no charge to participants. Anyone who wants to be tested may participate – you will not be required to have a known exposure or be experiencing symptoms. Everyone can register for this event, including those who may be experiencing symptoms and have struggled to be tested. Many of these testing events do not require you to be a resident of the county conducting testing. You must, however, be a resident of Missouri.

Pre-registration for each event is strongly encouraged – https://dcphdo02redcap.azurewebsites.net/redcap/surveys/?s=DEX3J7THHM. Check this site often as new testing locations will be added as they are finalized.

Upcoming Testing Locations:

County

Location

Testing Dates

Jackson

Homefield Sports Facility – Kansas City

July 13-15

St. Francois

Mineral Area Community College – Park Hills

July 14

Cape Girardeau

Arena Park – Cape Girardeau

July 17-18

McDonald

McDonald County HS – Anderson

July 18

Barry

Cassville High School

July 19-20

Jasper

Ozark Christian College – Joplin

July 19-20

Jasper

Carthage Memorial Hall

July 19-20

Macon

Macon County Fairgrounds – Macon

July 20

Newton

Rocketdyne Church of Christ – Neosho

July 21

Johnson

UCM Multi-Purpose Building – Warrensburg

July 21