Category: SLCR Guidance

Enhanced Barrier Precautions (EBP) Resource

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The Association for Professionals in Infection Control and Epidemiology along with American Association of Post-Acute Care Nursing, has released a practice guidance tool and resource guide to help implement EBP in skilled long-term care facilities. The practice guidance tool outlines when EBP should be implemented for residents, provides infection control recommendations for routine care activities, and includes case study examples with a self-quiz to help reinforce learning. The resource guide also provides a comprehensive list of infection control websites and references. More information including the guide can be found here.

Updated COVID Reporting Info

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Special Information Related to COVID-19 Reporting:

  • Facilities performing their own COVID-19 testing must report positive results to DHSS unless they are reporting lab tests via the National Healthcare Safety Network (NHSN) or the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) Platform.
  • Submitters preferring to send COVID-19 testing records in bulk via HL7 instead of using MODROP should contact the Missouri Data Exchange Team to be onboarded for bulk reporting. This e-mail account is monitored from 8AM-5PM CST Monday-Friday.
  • All entities ordering COVID-19 tests from an external laboratory should enter positive case information into MODROP/ShowMe WorldCare.

The original MODROP portal was developed in conjunction with the EpiTrax application. DHSS transitioned from EpiTrax to the ShowMe WorldCare application on August 26, 2024. A new version of MODROP is now available through ShowMe WorldCare: The Missouri Disease Reporting Online Portal (MODROP).

Active users of the earlier version of MODROP were notified of the system transition via the email address linked to their MODROP account. These users were provided with new account credentials prior to the launch of ShowMe WorldCare in August 2024. If an individual needs to utilize MODROP and has not already received this information via email, a new request for an account must be submitted.

Use this link for more information on electronic laboratory reporting and electronic case reporting for reportable conditions: Electronic Laboratory Reporting and Electronic Case Reporting for Reportable Conditions in ShowMe WorldCare.

For the state regulations regarding reporting infectious, contagious, communicable, or dangerous diseases go to Missouri Secretary of State: Code of State Regulations.

NOMNC

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SLCR recently had an opportunity to meet with Livanta, the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) that receives the appeals of non-coverage (SNF ABN and NOMNC) required in F582. A couple items to note- the required forms are updated periodically- so please make sure the most recent forms are being used. The most recent forms and instructions for their use can be found here: Beneficiary Notices Initiative (BNI) | CMS. Changes were made in November 2024 and additional changes will be effective beginning January 1, 2025.

SLCR has heard recent concerns from facilities and residents regarding Medicare Advantage beneficiaries being denied services or delays in services. If you hear these concerns, please share with Medicare Advantage residents and/or families that the NOMNC has been modified to reflect regulations providing enrollees additional fast-track appeal rights when they untimely request an appeal to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), or still wish to appeal after they end services on or before the planned termination date (See: CMS-4205-F, p. 30827).

These notices should be provided timely to beneficiaries whose Medicare covered services will end to inform them of their rights and protections related to financial liability and appeals under the Fee-for-Service Medicare and Medicare Advantage (MA) programs.

Additionally, facilities and beneficiaries can find contact information for Missouri’s BFCC-QIO, Livanta, here: https://www.livantaqio.cms.gov/en/states/missouri.

An Engaged Medical Director: A Real Asset to a LTCF Webinar Presentation

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DHSS Section for Long Term Care would like to say thank you to all that were able to take time out of their busy schedules to attend the webinar, “An Engaged Medical Director: A Real Asset to a LTCF,” on 11/20/2024, presented by Dr. Michael Nash. We would like to extend this thank you to Dr. Nash for sharing his wealth of knowledge and passion with us at DHSS, LTCF staff, educators, and providers. We believe the insights shared will be greatly beneficial for long-term term care facilities and Medical Directors.

This recorded presentation is now available on demand, along with the slides from the presentation.
Recording Link: “An Engaged Medical Director: A Real Asset to a LTCF”
Presentation Slides: Engaged Medical Director Presentation for MO DHSS 11-20-24 v2 MN edits

COMRU Update

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During the Summer of 2024, COMRU implemented several enhancements to the online application system. To test the effectiveness of those enhancements, on September 1, 2024, COMRU began reviewing newly submitted applications as well as reviewing applications submitted prior to September 1.

COMRU is current with reviewing newly submitted applications and has made significant progress in reviewing applications submitted prior to September 1. Only applications submitted July 22 to August 31, 2024, are pending review. COMRU expects to have all applications submitted prior to September 1 reviewed by the end of the calendar year.

Please note: Applications returned to the submitter for correction will be deleted from the online application system if corrections are not made and resubmitted to COMRU within 60 days. he submitter may access the online application at any time to check the status of a pending application. Training on how to check the status of an application can be located on COMRU’s webpage (Under Trainings/WebEx Training – Level One Online Form Feb 2024).

 

Tips and Reminders

  • All attachments to the online application must be in PDF format – please do not include web links. Applications including web links will be returned for correction. All application documents are scanned by COMRU for retention purposes; web links are not stable and cannot be scanned.
  • For Level 1 applications, attachments should be a limited number of pages and only include the information requested. For example, if an applicant is in the hospital, the submitter must either type in the date/reason for hospitalization or attach a hospital H&P that includes this information. The entire H&P from the hospital is not necessary – only those pages that include the date/reason for hospitalization are required.
  • Please review all diagnoses for the applicant including those on the diagnosis list and those listed in any other attachments and answer the application questions accordingly. The most common errors related to diagnoses are:
    • Section D, Question 6: Does the individual have a diagnosis of Major Neurocognitive Disorder (MDNC), i.e., dementia or Alzheimer’s?
    • Section E, Question 2a: Does the individual have a suspected diagnosis or history of an Intellectual Disability/Related Condition?

Many applications have one of these diagnoses listed and this question is answered “no” when the answer should be “yes”. When the question is marked “yes” follow-up questions populate; marking “no” results in an incomplete application which will be returned for correction.

For additional information and answers to frequently asked questions, please review the online training posted on the COMRU webpage.

Life Safety Code Regulation Info

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Sometimes it can be difficult to find a Life Safety Code regulation. Are you aware most of code references used by surveyors are printed on the bottom of the tags in the 2786R? This document also serves as a quick reference to all of the Life Safety Code tags.

Emergency preparedness requirements are found in Appendix Z. SNFs are required to review and update their emergency preparedness policies and procedures at least annually. It is always a good idea to look at Appendix Z during this time not only to ensure compliance, but you may also get some other ideas from the text which includes multiple examples.

COMRU PASRR and Level of Care Orientation Training

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The Central Office Medical Review Unit (COMRU) has scheduled monthly orientation training to review the requirements of the Pre-Admission and Resident Review (PASRR) and Nursing Facility Level of Care (LOC) application process. These on-line trainings will be one-hour in length and hosted by Ammanda Ott, RN Supervisor for COMRU. Each training is limited to 50 individuals, so register soon!

Webinar series registration link: https://stateofmo.webex.com/webappng/sites/stateofmo/webinar/webinarSeries/register/cc01ce6f1d64435db3a716b6c489bf51

Upcoming Training Dates/Times

November 5, 2024: 11:00 am
December 10, 2024: 11:00 am
January 14, 2025: 11:00 am
February 11, 2025: 11:00 am
March 11, 2025: 11:00 am

 

Why We Are Conducting These Trainings?
• The LOC/PASRR process is complex and can be overwhelming if individuals do not receive sufficient training. We want to make it easier for you!
• Approximately 50% of applications are returned for corrections. This results in delays to the review and approval process – which directly impacts Medicaid payment to nursing facilities and can result in prolonged hospital stays.
• COMRU receives an average of 30-40 calls per day – many of the answers to the questions asked are contained in information accessible online. A decrease in phone calls will allow additional time for COMRU to review pending applications.

Training Agenda
• Overview of the PASRR and LOC requirements.
• Review of the application process from application submission to approval, including recent enhancements made to the online application system.
• Review of common errors that result in the application being returned for correction.
• Discussion of critical information needed to determine whether the application triggers for a Level 2 evaluation and the impact to the nursing facility and hospital.

Who Should Attend
• Individuals who are new to completing the LOC/PASRR application.
• Individuals who want a refresher of the requirements.

Benefits of Attending
• Familiarity with the process and information included online to assist with completing the application.
• Decrease in returned applications and reduction of processing times.

Prior to attending, please review both on-line trainings (New LOC Webex Training Oct 2021 and Level One Online Form Training Feb 2024) located on COMRU’s webpage https://health.mo.gov/seniors/nursinghomes/pasrr.php.

Please see the flyer

CNA Training Reimbursement Opportunity for SNFs

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Did you know… skilled nursing facilities can receive reimbursement for CNA training?

The Health Education Unit hosted a webinar along with Mo HealthNet to provide information regarding the amount of reimbursement, instructions related to the submission and important data to consider for reimbursement.

Didn’t get to attend? No problem, watch it now!

For questions, contact the Health Education Unit at 573-526-5686 or email at CNARegistry@health.mo.gov.

Antimicrobial Stewardship for LTCF

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NEW FREE RESOURCE

The Healthcare-Associated Infections/Antimicrobial Resistance (HAI/AR) Program has created a free antimicrobial stewardship playbook made for long-term care facilities (LTCF). This playbook includes background information on the state of antimicrobial stewardship in LTCF in Missouri and includes 17 ready-to-use tools and templates to help with antimicrobial stewardship efforts within your facility. Please share this playbook with anyone in your facility that is involved with antimicrobial stewardship activities and efforts.

A link to the playbook is provided here: https://health.mo.gov/professionals/antibiotic-stewardship/pdf/asp-playbook-ltc.pdf.

A link to the MODHSS LTC Antimicrobial Stewardship webpage is provided here: https://health.mo.gov/professionals/antibiotic-stewardship/tools-ltc.php.

Also of news, the HAI/AR program now has an antimicrobial stewardship pharmacist on staff to help answer questions, provide educational content, and help collaborate with antimicrobial stewardship projects and initiatives within your facilities, along with all healthcare facility types in the state. This can also be a great opportunity to participate in a free, non-regulatory assessment of your stewardship program efforts to try and meet antimicrobial stewardship requirements.

If you are interested in hearing more about this, or have questions about healthcare-associated infections, Candida auris, or other multidrug-resistant organisms, please reach out to the DHSS HAI/AR program for more information.

HAI/AR Program Contact Information
Phone: 573-751-6113
Email: HAI_Reporting@health.mo.gov

Mouthcare Without a Battle ~Free Webinar~

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“Mouth Care Without a Battle” is an evidence-based program designed to educate healthcare staff on providing effective oral healthcare for residents with dementia and other chronic illnesses. Providing daily oral healthcare is crucial for maintaining overall health and well-being in long-term healthcare facilities. Good oral hygiene can prevent infections, reduce the risk of chronic diseases, and improve the quality of life for residents.

Please join the Section for Long-Term Care Regulation along with the Office of Dental Health, on August 20, 2024 at 10:00 a.m. for this FREE webinar. A link will be sent to the email address given at registration. Please register by 5:00 p.m. August 16, 2024 in order to get your link prior to this webinar.

Senior Day at the State Fair

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August 14, 2024
9:00 a.m. – 3:00 p.m.
Mathewson Building

Join DHSS and the Missouri Area Agencies on Aging on the Missouri State Fairgrounds. Senior Day festivities include FREE BINGO, line dance lessons, and much more! The dance contest, open to those aged 60+, has cash prizes for the top three places in each of the categories of Missouri Waltz, Polka, Jitterbug, Two-Step and Line Dancing.

For more information, please visit our website at health.mo.gov/seniorday.

COMRU System Enhancements

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We are currently testing enhancements to the COMRU online submission system which will result in some newer applications being reviewed ahead of older applications. These enhancements are aimed at reducing the number of returned applications for corrections, resulting in faster processing times. Please do not reach out to COMRU staff if you have a newer application reviewed and have older applications that have not been reviewed – this will only slow down processing times.

Some of the enhancements made to the system include:

  • The “Submit” button will be removed from the online application once COMRU has done a preliminary review to determine if the application is a Level 1 or Level 2.
  • On the Level 1 form, Section D, if one of the diagnoses are marked, an error message will populate if the question is not answered YES.
  • A reminder message will populate if the application has a point count under the mandated 18-point requirement for SNF placement.
  • On the Level of Care form, Section D, the comment area below the “Treatment” section will be required to be answered if 6 points is indicated.

In order to assist COMRU with decreasing the amount of time to process submitted applications, please review the online training posted on the COMRU webpage https://health.mo.gov/seniors/nursinghomes/pasrr.php.

Health Education Unit – Upcoming Trainer Info Meet Ups

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The SLCR Health Education Unit will be conducting Instructor Information Meet Ups.

July 11, 2024: Online Programs
August 8, 2024: Certified vs. Licensed Facility
September 12, 2024: Scheduling a Test & Students
October 10, 2024: Clarifying 17 hours orientation vs. 16 hours OTJ hours
November 14, 2024: Train the Trainer Info
December 12, 2024: Discuss CMT Process

Please see the CNA Registry webpage for past meetings and more information.

If you have questions, please call our office at 573-526-5686.

CNA Training Reimbursement Opportunity for Skilled Facilities

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CNA Training Reimbursement Opportunity for Skilled Facilities

Please join us as the Health Education Units hosts an informative webinar with MO HealthNet on July 10, 2024.

You will not want to miss this!! We welcome Carl Meyer and Lee Gerloff from MO HealthNet to be our guest and provide helpful information on what, when and how to submit for reimbursement. HEU will also be available for information regarding regulatory requirements and information related to the training reimbursement.

July 10, 2024: CNA Reimbursement Webinar

Please stay tuned to our CNA Registry webpage for more info and registration to come.

Please contact the Health Education Unit for any questions at the CNARegistry@health.mo.gov.

Health Education Unit News – CNA Renewals

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Missouri currently has 975 CNA’s that have not renewed as of June 1, 2024.

Please check the registry for your status at MO TMU.

All CNAs are required to renew their certification every 24 months. Each renewal requires 8 hours of nursing services to be provided for every 24-month period. Proof of the nursing service can include a W2 or paystub from your employer.

All renewals are now electronic through our online registry (TMU) and a $20.00 fee is required.

If you have never logged into TMU Registry to setup your profile, then you will first need to contact the Health Education Unit at 573-526-5686 or CNARegistry@health.mo.gov for assistance. After your profile is setup, a text message and email will be sent to you 60 days prior to your inactive date, during your renewal period. This notification will prevent any delay in keeping your certification active.

If you already have setup your profile, then please see the renewal instructions at https://health.mo.gov/safety/cnaregistry/pdf/how-renew-cna-certification.pdf.

If you have any questions, please contact the Health Education Unit at 573-526-5686 or CNARegistry@health.mo.gov.

Medicaid Resource Limit/Spenddown Amount

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Effective July 1, 2024, the Resource Limit/Spenddown Amount will increase from $5,726.00 to the new amount of $5,909.25. Facilities are required to notify the resident/financial guardian of the need to spend down when the resident reaches $200 less that amount to ensure Medicaid will not be affected.

For more information, please visit https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf.

Feel free to contact Lynn Gilmore, Lead Auditor, at 573-508-4150 if you have any questions.

World Elder Abuse Awareness Day

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Saturday, June 15th, marks a very special day – World Elder Abuse Awareness Day (WEAAD). This is a global awareness day officially introduced by the International Network for the Prevention of Elder Abuse and the World Health Organization at the United Nations on this day in 2006. This important day is in support of the United Nations International Plan of Action which recognizes the significance of elder abuse as a public health and human rights issue. It is observed every year to provide an opportunity for communities around the world to promote a better understanding and increased awareness of the cultural, social, economic, and demographic processes affecting elder abuse and neglect. We know that no community or country in the world is immune from the mistreatment of older adults. In Missouri, the Department of Health and Senior Services (DHSS) receives and investigates reports of abuse, neglect, bullying and exploitation of the elderly and disabled. Last year, DHSS received and investigated 43,862 reports, an average of about 120 each day. The National Center on Elder Abuse estimates for every case of elder abuse or neglect reported to the authorities, as many as 23 cases go unreported.

Missouri’s Department of Health and Senior Services (DHSS) invites you to wear purple anytime throughout the month of June to commemorate this important event and raise awareness of elder abuse, neglect, bullying, and exploitation in later life. The color purple has been adopted as the symbol to raise awareness of elder abuse and the effects of abuse, neglect, bullying, and exploitation in later life.

For more information, please visit https://health.mo.gov/seniors/weaad.php.