Please see the following website regarding recommended guidance for extended use and limited reuse of N95 filtering facepiece respirators in healthcare settings from the CDC.
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
The following proposed rulemaking is published in the Missouri Register effective March 30, 2020:
While this particular regulation set has been rescinded under the SLCR rules, facilities still have to comply with following Certificate Of Need regulatory citations regarding the criteria and standards for assessment for the availability of beds:
This rule only outlined the procedures the SLCR was to follow when determining for the Missouri Health Facilities Review Committee whether or not a need existed in a particular locale for additional Medicaid certified beds. Additionally, the Certificate of Need Program (CON) has established its own regulations and procedures for the criteria in determining approval of long-term care beds in varying localities. Furthermore, the SLCR provides information to the CON program upon request.
The personal protective equipment (PPE) burn rate calculator is a spreadsheet-based model that provides information for healthcare facilities to plan and optimize the use of PPE for response to coronavirus disease 2019 (COVID-19).
Please see the following CDC web page for details: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/burn-calculator.html
OCR Issues Guidance to Help Ensure First Responders and Others Receive Protected Health Information about Individuals Exposed to COVID-19
March 24, 2020
The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) issued guidance on how covered entities may disclose protected health information (PHI) about an individual who has been infected with or exposed to COVID-19 to law enforcement, paramedics, other first responders, and public health authorities in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule.
The guidance explains the circumstances under which a covered entity may disclose PHI such as the name or other identifying information about individuals, without their HIPAA authorization, and provides examples including:
This guidance clarifies the regulatory permissions that covered entities may use to disclose PHI to first responders and others so they can take extra precautions or use personal protective equipment. The guidance also includes a reminder that generally, covered entities must make reasonable efforts to limit the PHI used or disclosed to that which is the “minimum necessary” to accomplish the purpose for the disclosure.
“Our nation needs our first responders like never before and we must do all we can to assure their safety while they assure the safety of others,” said Roger Severino, OCR Director. “This guidance helps ensure first responders will have greater access to real time infection information to help keep them and the public safe,” added Severino.
The guidance may be found at: https://www.hhs.gov/sites/default/files/covid-19-hipaa-and-first-responders-508.pdf
For more information on HIPAA and COVID-19, see OCR’s February 2020 Bulletin: https://www.hhs.gov/sites/default/files/february-2020-hipaa-and-novel-coronavirus.pdf
OCR Issues Guidance on Telehealth Remote Communications Following Its Notification of Enforcement Discretion
March 20, 2020
The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) issued guidance on telehealth remote communications following its Notification of Enforcement Discretion during the COVID-19 nationwide public health emergency.
The Notification, issued earlier this week, announced, effective immediately, that OCR is exercising its enforcement discretion to not impose penalties for HIPAA violations against healthcare providers in connection with their good faith provision of telehealth using communication technologies during the COVID-19 nationwide public health emergency.
The new guidance is in the form of frequently asked questions (FAQs) and clarifies how OCR is applying the Notification to support the good faith provision of telehealth. Some of the FAQs include:
“We are empowering medical providers to serve patients wherever they are during this national public health emergency,” said Roger Severino, OCR Director. “We are especially concerned about reaching those most at risk, including older persons and persons with disabilities,” Severino added.
The FAQs on telehealth remote communications may be found at: https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf
The press release on telehealth remote communications may be found at: https://www.hhs.gov/about/news/2020/03/17/ocr-announces-notification-of-enforcement-discretion-for-telehealth-remote-communications-during-the-covid-19.html
The Notification of Enforcement Discretion on telehealth remote communications may be found at: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
For more information on HIPAA and COVID-19, see OCR’s February 2020 Bulletin: https://www.hhs.gov/sites/default/files/february-2020-hipaa-and-novel-coronavirus.pdf
CMS Memo QSO-20-20-ALL: https://www.cms.gov/files/document/qso-20-20-all.pdf
Infection Control Survey Checklist
CMS is prioritizing surveys by authorizing modification of timetables and deadlines for the performance of certain required activities, delaying revisit surveys, and generally exercising enforcement discretion for three weeks. During this three-week timeframe, beginning March 20, 2020, only the following types of surveys will be prioritized and conducted:
CMS is disseminating the Targeted Infection Control Survey checklist developed by CMS and CDC so facilities can educate themselves on the latest practices and expectations. CMS expects facilities to use this new process, in conjunction with the latest guidance from CDC, to perform a voluntary self-assessment of their ability to prevent the transmission of COVID-19. The checklist is attached.
Though the contents of the memo and checklist are provided by CMS, DHSS is adhering to the same requirements for all facilities. All facilities should complete the infection control self-assessment.
A state-wide team is working to develop a list of childcare needs for healthcare and other critical staff across the state to ensure that those individuals are able to work. The intent is to try to see if local school districts are able to provide the care.
The next step is to develop a list of childcare needs from the critical employees. The link below will take people to an online form to fill out if they need childcare in order to be able to work.
https://stateofmissouri.wufoo.com/forms/m1cs1vfl1dde8dt/
Once we have the information gathered, we will create a list of needs by school district to send to each district and see if they are able to help provide care. At this point this is information gathering to see what options might be available.
Please ensure all long term care employees submit this form if they have a need.
Please see the DHSS Guidance to all hospice agencies and all long-term care facilities.
Please see the Morbidity and Mortality Weekly Report from the CDC for more information.
From January 26 through February 16, 2020, a software issue caused Skilled Nursing Facility (SNF) claims to be incorrectly cancelled with a message that there was no three day qualifying hospital stay. This issue is corrected. If your claims were incorrectly cancelled, re-bill them in sequential order to receive payment.
Note:
MLN Matters Bulletin Revised 3-18 -20 Medicare FFS Respnose to COVID-19
March 19, 2020
CMS is delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020, in response to stakeholder concerns. The MDS item sets are used by Nursing Home and Swing Bed providers to collect and submit patient data to CMS. This MDS data informs payment, quality, and the survey process.
In December of 2019, CMS posted a draft of the MDS 3.0 item set v1.18.0 and received feedback from our stakeholders. We would like to thank the stakeholders for sharing their concerns regarding the proposed changes to the MDS 3.0 item sets and more specifically the removal of the Section G items from OBRA assessments.
The MDS changes CMS planned for October 1, 2020 will now be delayed. CMS staff are actively engaged in discussions with various stakeholders, regarding the various changes, the impacts of these changes, as well as, the compressed timeline to educate and train facility staff and update software and IT systems.
Please direct any comments or questions regarding the above information to MDSCodinganswers@cms.hhs.gov mailbox.
Pioneer Network began 23 years ago when a group of committed, innovative and creative disruptors got together and began spreading the word that the world of aging, care and support needs to be focused on people and not the institution. They decided on the name Pioneer Network so all people and organizations of the same like-mind could be involved, disseminate best practices, share information and have a place to go when they needed resources and assistance.
During this challenging time we are facing with COVID-19, we are committed to continuing the work of our founders, being a resource as you navigate this changing world. To that end, we have been gathering resources from our fellow Pioneers on different ways to engage and connect residents and elders with their family, friends and communities. We empathize and want to support all the amazing team members working in care communities right now, so we are sharing everything we have received from our network. We know there is more happening so if you’re doing something you want included or know of other resources, please contact us and we’ll add them to the page.
This is the time for us to come together, as people, as organizations and most of all as a community. Thanks to all of you for the work you’re doing every day, for the care and support you’re providing to residents and elders and for your kindness, compassion and love.
Pioneer Network is proud to be part of a network of caring individuals who are, in the words of one of our founders, Barbara Frank, “sharing shamelessly” as they contribute to Pioneer Network’s latest set of resources, The ABCs of Combating Isolation.
Check out what has been shared so far and check back as we update the resources our partners continue to share with us.
With our conference scheduled for August 9 – 12, five months away, we are hopeful that the current threat related to COVID-19 will have subsided and that it will proceed as planned.
We will continue to monitor the situation especially as the early registration deadline of mid-May approaches and we will provide updates about the conference through email and on our website.
Due to the COVID-19 situation, the Board recognizes the need for Missouri administrators to have flexibility in completing the required continuing education (CE) clock hours for the 2020 license renewal and the memo provides the important updated information.
Please see the documents below for information.
This is guidance from SLCR; it is not a mandate but rather provides facilities with an avenue to protect the health and safety of residents.
It is appropriate for facilities to ask residents not to leave the facility, unless for a necessary medical reason that cannot be addressed in the facility. For those insistent on taking residents out of the facility, SLCR recommends the following:
For residents, primarily in RCFs and ALFs, who leave the facility on a frequent basis, the facility will need to determine at what point those outings pose a risk to the health and safety of the residents in the facility. This includes, but is not limited to, the location the resident is going, whether there are positive COVID-19 cases in the community, whether there is community transmission of the virus, etc. This guidance does not require facilities to issue an emergency discharge notice every time a resident leaves a facility. The resident and their legal guardian, when applicable, should discourage outings, attempt to meet the needs of residents without them leaving the facility, clearly communicate the expectations to residents (including any screening required upon return) and work together should the need arise to give an emergency discharge notice.
The resource requesting process for PPE in our state cache was posted to the DHSS website this at this link:
https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/professionals.php.
All resource requests must go through the respective healthcare coalition (maps and contact information are on the website). The healthcare coalition then submits to the Missouri Department of Health and Senior Services for review, approval and processing. All shipments will occur from Jefferson City and be sent via either Federal Express (FedEx) or United Parcel Service (UPS).
Please see Department of Health and Senior Services guidance regarding visitation restrictions in all long term care facilities including residential care facilities, assisted living facilities, intermediate care facilities, skilled nursing facilities, and intermediate care facilities for persons with intellectual disabilities.
This guidance along with similar guidance from the Centers for Medicare and Medicaid Services should be implemented immediately.
These documents will also be posted to the Department’s COVID-19 website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/ under the Health Care Professionals tab.
All COVID-19 information and resources on the DHSS website for long-term care facilities should be used by all levels of care, including Skilled Nursing, Intermediate Care, Assisted Living, and Residential Care Facilities. Adult Day Care programs will also benefit from reading the information and applying proper infection control practices.
Please see the Health Alert from DHSS for more information.
This video includes information from the Department of Health and Senior Services regarding guidance and education surrounding COVID-19. The focus is on the basics of COVID-19 (symptoms, who is at most risk), the types of coronavirus, how long term care communities can prepare and testing protocols.
The LTCF Video is available at https://youtu.be/u-OZNQ3A-fs.
Please note information is changing rapidly so please check the Department’s COVID-19 website frequently for updated information.
Some LTC homes will make the difficult decision to limit and/or restrict entry of family and friends into their care settings. To help family and friends understand restrictions being put into place by many LTC providers, Consumer Voice, a national Ombudsman program resource, has put together a webpage: https://theconsumervoice.org/issues/other-issues-and-resources/covid-19.
JEFFERSON CITY, MO –The Missouri Department of Health and Senior Services (DHSS) activated a statewide public hotline for citizens or providers needing guidance regarding the novel coronavirus, or COVID-19. At 8 a.m. today, the hotline opened and can be reached at 877-435-8411. The hotline is being operated by medical professionals and is available 24 hours a day, 7 days a week.
“Communication is vital to our response to this rapidly-evolving situation,” said Dr. Randall Williams, director of DHSS. “For several weeks, our COVID-19 webpage has been and continues to be a great resource for the public, but having the hotline as an additional resource will likely be invaluable as citizens seek guidance for their concerns.”
To date, 46 patients in Missouri have been tested for the virus that causes COVID-19; one of those has tested positive.
“It is important to know what to do if you have concerns about an illness during this outbreak,” said Williams. “For those who may be at risk for COVID-19, we encourage them to utilize this hotline or call their health care provider or local public health agency to inform them of their travel history and symptoms. They’ll be instructed on how to receive care without exposing others to the possible illness.”
Simple preventive actions that help prevent the spread of all types of respiratory viruses include:
For more information, visit www.health.mo.gov/coronavirus or the CDC’s COVID-19 website.
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Past Missouri COVID-19 news releases:
About the Missouri Department of Health and Senior Services: The department seeks to be the leader in protecting health and keeping people safe. More information about DHSS can be found at http://health.mo.gov or find us on Facebook and Twitter @HealthyLivingMo
Guidance for use of Certain Industrial Respirators by Health Care Personnel
Please see the memo for further details.
For additional information, please visit the Department’s website at health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/. This site also contains a link specific to long-term care communities.
Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes (REVISED)
Please see the memo for further details.
For additional information, please visit the Department’s website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/.