SLCR has issued guidance for the implementation of state waivers related to skilled and intermediate 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.
SNF-ICF Waiver Implementation 4-17-20
Intermediate Care and Skilled Nursing 4-14-20
Intermediate Care and Skilled Nursing Facilities 4-14-20
Intermediate Care and Skilled Nursing Facilities 4-15-20
Intermediate Care and Skilled Nursing Facilities (2) 4-15-20

This guidance has been updated to include additional information on readmitting residents from a hospital who have a positive COVID-19 diagnosis as well as expended signs and symptoms to include in resident monitoring.

Please see the document below for details.
COVID-19 LTCF Guidance 4.17.20

Please see the health guidance below for healthcare facilities that have employees returning to work after COVID-19 illness.

4-17-20 HG COVID-19 Return to Work

SLCR has issued guidance for the implementation of state waivers related to homes who are licensed as Residential Care Facilities (II) and comply with Administrative, Personnel and Resident Care Requirements under 19CSR30-86.043. Please read through this important guidance.

Questions related to these waivers can be emailed to RegulationUnit@health.mo.gov.

Please see the documents below for details.
RCF II Waiver Implementation Guidance 4-17-20
Residential Care Facility II Requirements 4-14-20
Residential Care Facility II Requirements 4-16-20

SLCR has issued guidance for the implementation of state waivers related to the insulin administration program. Please read through this important guidance. Questions regarding these waivers should be directed to CNARegistry@health.mo.gov.

Please see the documents below for details.
Insulin Administration Program Waiver Implementation 84.040
Insulin Administration Training Program 4-14-20

SLCR has issued guidance for the implementation of state waivers related to the certified medication technician training program. Please read through this important guidance. Questions regarding these waivers should be directed to CNARegistry@health.mo.gov.

Please see the documents below for details.
CMT Waiver Implementation 4-9-20
Certified Medication Technician Training Program 4-9-20

SLCR has issued guidance for the implementation of state waivers related to the Level I Medication Aide training program. Please read through this important guidance. Questions regarding these waivers should be directed to CNARegistry@health.mo.gov.

Please see the documents below for details.
LIMA Waiver Implementation 4-9-20
Level I Medication Aide 4-9-20

SLCR has issued guidance for the implementation of federal and state waivers related to the training and certification of nurse aides. Please read through this important guidance. Questions regarding these waivers and the nurse aide certification process should be directed to CNARegistry@health.mo.gov.

Please see the Nurse Aide Registry Waiver Implementation 4-7-2020 for details.

The Department of Health and Senior Services issued guidance regarding reporting of confirmed and presumptive COVID-19 cases. The guidance can be found at: https://health.mo.gov/emergencies/ert/alertsadvisories/index.php.

Effective immediately, long term care communities must report these cases directly to DHSS utilizing the Disease Case Report (CD-1 Form). The CD-1 form can be accessed at https://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/cdmanual/pdf/CD-1.pdf.

There are two methods of communicating this information: fax or Secure File Transfer Protocol (SFTP). The information reported will be communicated with the Local Public Health Agency (LPHA). Long term care communities may continue to reach out directly to their respective LPHA as well.

Please see the Health Update for details.

Please see the guidance in regards to Waivers for Nursing Home Administrators and Residential Care/Assisted Living Administrators.

As COVID-19 rapidly spreads across the country, more long-term care communities will have residents develop COVID-19. When a resident develops COVID-19 in your facility, there are steps you can implement that may be able to limit the spread.

Please see the guidance for details.

Background:
On March 25, 2020, the Centers for Medicare and Medicaid Services notified MO HealthNet Division of their approval of a Federal Section 1135 Waiver request to suspend pre-admission screening and annual resident review (PASRR) Section 1919(e)(7) of the Act allows Level I and Level II assessments to be waived for 30 days. All new admissions can be treated like exempted hospital discharges. After 30 days, new admissions with mental illness (MI) or intellectual disability (ID) should receive a Resident Review as soon as resources become available.

Effective April 2, 2020 and until April 25, 2020, certified Skilled Nursing Facilities and Intermediate Care Facilities may follow the process outlined below for new admissions into Medicaid-certified beds.

For an applicant that may require a Level II evaluation (have a qualifying mental illness (MI) or intellectual disability (ID) diagnosis):

• The applicant may enter the Skilled Nursing Facility (SNF) prior to completion of a Level II PASRR evaluation or Special Admission Category.
• The Hospital (or other individual completing the paperwork) will send the completed DA 124 C form to the SNF prior to discharge. The SNF should review the client’s information to ensure the Level of Care points (24) would meet prior to admission and ensure they have enough information to determine if they can meet the medical and behavioral needs of the individual.
• The SNF will submit the entire DA 124 application (DA 124 A/B, DA 124 C and any other supporting documentation) with a Special Admission Category form indicating “Waiver due to COVID-19” to COMRU@health.mo.gov. The SNF should indicate if the client plans to reside at the SNF after 30 days.
• DHSS recommends that SNFs submit the complete DA 124 application to COMRU within 14 days of admission to the SNF.
• Once received, COMRU will determine if the applicant meets Level of Care and refer applicants requiring a Level II PASRR screening to DMH.
• After 30 days, new admissions with mental illness (MI) or intellectual disability (ID) will receive a Resident Review as soon as resources become available.

For completed applications already submitted to COMRU for processing:

• The applicant may enter the Skilled Nursing Facility (SNF) prior to completion of a Level II PASRR evaluation or Special Admission Category.
• COMRU will process all pending Level II PASRR applications as Special Admission Category #5 indicating “Waiver due to COVID -19”.
• Upon discharge, the hospital or other submitter will notify COMRU via email of the following information:  the client’s name, DCN or SSN#, and the receiving SNF information (Name, Telephone number and fax number).
• The hospital/submitter will ensure a copy of the DA 124 application (DA 124 A/B form and DA 124 C form) are sent to the accepting SNF prior to discharge.

This information should be added to the DA 124 application in process and sent to DMH. For the DA 124 applications that were already referred for Level II PASRR screening, DHSS will notify DMH and Bock & Associates via email of the individuals change in location.

Questions regarding this process can be directed to COMRU@health.mo.gov. The DA 124 application (DA 124 A/B form, DA 124 C form and Special Admission Category Referral form) can be accessed at https://health.mo.gov/seniors/nursinghomes/pasrr.php.