• There are multiple antibody tests for COVID-19 with variable performance.
• At this time, it is not clear which antibody responses are protective or sustained.
• Antibody tests should not be used as the sole test for diagnostic decisions.
• Until more is known about protective immunity, serology results should not be used to make staffing decisions or decisions regarding the need for PPE.

See the attachment or visit this link to read this in full: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/serological-testing-quick-facts-providers.pdf.

Below is a communication to providers around billing for COVID 19 testing. This includes information for billing Medicaid and for testing and treatment of the uninsured.  DHSS is working on guidance to assist homes in determining the best way to obtain facility-wide testing for their communities. Further guidance will be forthcoming.

Provider Communication – Billing for COVID 19 Testing

At this time, DHSS is continuing to follow the guidelines from the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services related to restricting visitors in long term care homes. On 4/27/20, our Department Director, issued an order continuing the current restrictions on visitors in long term care homes. We know that these restrictions are incredibly hard on residents, families and friends- however- we have also seen the devastation that COVID-19 can quickly bring in a long term care home- both in small counties and large cities. https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/economic-reopening.pdf. We are closely monitoring the situation at state and federal levels. We are hopeful families and residents will soon be united face to face. Until then, we encourage you to assist family in communicating with their loved ones virtually, via FaceTime or Skype. Non-essential services, including beauty shop should also be restricted. DHSS has posted guidance for Community Integration for adults 65 and older and other high risk populations. These tools will assist you in helping individuals to reintegrate into the community, once the restrictions have been lifted.

The Department of Health and Senior Services (DHSS) posted to the website on 5/5/2020 a presentation showing the multiple data points to inform Missouri’s COVID-19 response. Included in this data, but not limited to the below, is:

• Hospitalized cases by region
• Hospital and ICU bed availability by region
• Cumulative and daily testing numbers
• Positivity Rates and Positivity Rates by county
• Cases and Cases per 100K by county
• New case growth, including 7-day % case increase
• Modeling of hospitalization rates

Here is the link to this data.
https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/analytics-update.pdf.

Please see the Advisory Message and Fact Sheet from FEMA about PPE packages for nursing homes with details and contact information.

Goes into effect at 12:01 a.m., Monday, May 4, 2020
Statewide Stay-at-Home Order still applies until then.

We have received several questions regarding the impact the Economic Reopening Order has on long-term care communities. The order addresses long-term care communities, specifically in paragraph #3 of the order, which states, “In accordance with the guidelines from the President, the CDC, and the Centers for Medicaid and Medicare Services, people shall not visit nursing homes, long-term care facilities, retirement homes, or assisted living homes unless to provide critical assistance or in end-of-life circumstances. Elderly or otherwise vulnerable populations should take enhanced precautionary measures to mitigate the risks of contracting COVID-19.”

The guidance below issued by the Department on March 13^th and March 17^th continues to be in place.
LTC Memo
LTC Leaving Facility

CMS has created a process to enable states to approve requests for communicative technology that meet CMS parameters. The parameters are detailed in the instructions portion of the application template (below). This template and process will reduce the amount of time for approval of CMP funds for technology that allows residents to engage in virtual social and telehealth visits as restrictions have been placed on visitors to prevent the spread of COVID-19.

The application is for nursing homes certified to participate in Title 18 and Title 19 of the Social Security Act. We encourage companies that operate more than one home to complete one application for all certified homes to the extent possible. This will reduce the number of applications and will help expedite the approval process.

Applications should be submitted to slcr@health.mo.gov. Questions regarding the application process may be sent to this address as well.

Once an application is approved, SLCR will contact each applicant to explain the payment process.

COVID-19 Application Template Final
COVID-19 Application FAQ

SLCR has issued guidance for the implementation of state waivers related to tuberculosis testing for employees and staff. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
Intermediate Care and Skilled Nursing Facilities – Testing for Tuberculosis 4-23-20
TB Testing – 85.042-27- 4-23-20

The Department of Health and Senior Services issued a news release today explaining “Increased testing capacity allows Missouri to expand criteria for patient testing”.

The full press release is available here https://health.mo.gov/news/newsitem/uuid/912934b4-fa13-408b-a9b7-627db5c1c1e1/increased-testing-capacity-allows-missouri-to-expand-criteria-for-patient-testing.

Also, great news, as of yesterday almost 400 providers had signed up for Missouri PPE Marketplace. Remember to access that source through the Department of Economic Development’s website https://ded.mo.gov/.

Thanks so much for everyone who has entered information. This will inform the PPE need across the state as well as help identify new suppliers and manufacturers of PPE. Remember you have to use Edge, Chrome, Firefox, or Opera as your Internet browser. Also, we have heard that emails to complete the registration are going to junk or spam email folders. This is being addressed, but please check those folders if you have started the registration process and have not gotten your email.

**Special Note for Multi-Facility Organizations**
If you are part of a larger organization and would like to submit a request as one corporate entity instead of each facility, please email supplysolution@ded.mo.gov to make a request to register as one corporation. You will be required to put a Missouri facility address in the registration.

SLCR has issued guidance for the implementation of state waivers related to Fire Safety and Emergency Preparedness Standards for Residential Care and Assisted Living Facilities. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
RCF ALF 86.022 Waiver Implementation Guidance 4-23-2020
Residential Care and Assisted Living Facilities 4-23-20

The Department of Health and Senior Services has issued waivers related to physical plant requirements:

• Physical Plant Requirements for all levels of care regarding the two year electrical certification. This waiver allows the required written certification by a qualified electrician to be delayed. Facilities have until two (2) months after the state of emergency has concluded to be current with the required maintenance of electrical systems.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachment below for details.
Physical Plant Requirements for Intermediate Care Skilled Nursing Residential Care and Assisted Living Facilities 4-22-20

On April 21, 2020, CMS issued a COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, which extends the PASRR approval through the end of the emergency declaration.

Effective April 2, 2020 and through the end of the Federal Emergency Declaration, certified Skilled Nursing Facilities and Intermediate Care Facilities will continue to follow the process outlined in the PASRR 1135 Waiver Implementation 4-22-20 for new admissions into Medicaid-certified beds.

Questions regarding this process should be directed to COMRU@health.mo.gov.

In the past few weeks Missouri has seen an increasing spread of COVID-19 from population centers to more rural communities. This is concerning as rural areas tend to have more limited access to health care and populations that are older and have more chronic health conditions. During this time that we all have a role in protecting our communities and limiting the spread of this disease. Whether you have COVID 19, are a caregiver of an individual with COVID 19 , or just going out in public places, there are actions that you should be taking.

See the tip sheet for more information.

The Treasury Department says that the first recipients of stimulus checks have been given to taxpayers that have already filed their 2019 (or 2018) tax returns and have provided direct deposit information to the IRS.

The stimulus money should be treated the same way as the Circuit Breaker Checks/Rent Rebate Checks.  Stimulus money should be used for the resident’s current or foreseeable needs.

In order for the facility to recoup the funds, the facility must have:

• A signed admission agreement stating for residents that owe back Room & Board, the facility may recoup the additional funds; AND
• The resident owes back Room & Board to the facility; AND
• The resident or the resident’s guardian/conservator gives written authorization at the time of the withdrawal.

Please keep in mind:

• Review the Resident’s Trust Fund balance to ensure the resident does not reach the Medicaid Spenddown Limit amount. The amount is currently $4,000 and will increase to $5,000 as of 07/01/20.
• All Resident Funds must be kept separate from the facility’s funds.
• The facility may keep in a petty cash fund up to $50 for each resident for whom the facility is managing funds.

Feel free to contact Lynn Gilmore, SLCR Sr. Auditor, at Lynn.Gilmore@health.mo.gov or 573-508-4150 if you have any questions.

SLCR has issued guidance for the implementation of state waivers related to adult day care programs. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
ADC Waiver Implementation Guidance 4-22-20
Adult Day Care Requirements 4-22-20

The Department of Health and Senior Services has issued waivers related to current exceptions and second business approvals:

• Existing exceptions to state regulations for all levels of care will continue beyond the time specified in the approval notice. Facilities shall have until two (2) months after the state emergency has ended to submit renewal requests to the department.
• Existing second business approvals to continue beyond the time specified in the approval notice. Facilities shall have until two (2) months after the state emergency has ended to submit renewal requests.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
Long Term Care Facilities Exception to Licensure Requirements and Second Business Waiver 4-22-20
Residential Care and Assisted Living Facilities – Second Business Waiver 4-17-20

SLCR has issued guidance for the implementation of state waivers related to assisted living facilities. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
Assisted Living Waiver Implementation Guide
Assisted Living Facilities Requirements 4-14-20
Assisted Living Facilities Requirements 4-17-20

SLCR has issued guidance for the implementation of state waivers related to residential care facilities. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
RCF Waiver Implementation 4-17-20
Residential Care Facilities 4-14-20
Residential Care Facilities 4-16-20