Please see the ICAR team’s flyer for facilities related to current COVID guidance.
Category: SLCR Guidance
New QIPMO Newsletter – November 2024
The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls (Volume 12, Issue 1).
In this issue:
- Staffing Updates
- The Ever-Changing RAI
- ICAR Corner
- Get to Know Your ICAR Team
- Brains or Burnout
Resident Rights
The Centers for Medicare and Medicaid Services (CMS) has issued a letter clarifying and reinforcing the Federal requirements regarding resident rights in long-term care facilities. The Department of Health and Senior Services has issued a companion memo addressing State requirements.
20240918-CMS-Public Administration letter
Resident Rights 11-6-2024
Top Deficiencies Report – 3rd Quarter 2024
Please see the most frequently cited deficiencies report from the third quarter of 2024.
Life Safety Code Regulation Info
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
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
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.
Mouthcare Without a Battle Webinar
The presentation co-hosted by the Section for Long-Term Care Regulation and the Office of Dental Health, on August 20, 2024 is now available for viewing online under Trainings on the Provider Information webpage.
Antimicrobial Stewardship for LTCF
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
Notice of Spam Emails
The Licensure and Certification Unit has been notified of administrators receiving spam emails. The subject line contains the name MO DHSS and the emails are from a Yahoo email account. The emails also include a .pdf attached titled License Document. Please do not open the emails and notify your IT staff at once.
Top Deficiencies Report – 2nd Quarter 2024
Please see the most frequently cited deficiencies report from the second quarter of 2024.
Mouthcare Without a Battle ~Free Webinar~
“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
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
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
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
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
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
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
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.
2024 Provider Feedback Survey
The Section for Long-Term Care Regulation is again seeking input from providers we work with. We are asking for your help in identifying areas in our Section where excellent customer service is provided and areas where we need to focus on improving our customer service experience.
Please take a couple minutes to complete our 2024 Provider Feedback Survey by June 25, 2024 at https://www.surveymonkey.com/r/KZXSKB7.
2024 SLCR Annual Provider Meetings
Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation
Thank you to all that attended one of the 2024 Provider Meetings.
There is no cost to attend any of these meetings.
New this Year – Online Registration!
Earn up to 5 CEUs (2.75 Admin/2.25 PC).
September 4, 2024: Region 2 Agenda
Location: Drury Plaza Hotel & Convention Center, Cape Girardeau
September 5, 2024: Region 7 Agenda
Location: Crowne Plaza St. Louis Airport, Bridgeton
September 18, 2024: Region 1 Agenda
Location: Oasis Hotel & Convention Center, Springfield
September 24, 2024: Region 6 Agenda
Location: Special Olympics Missouri, Jefferson City
September 26, 2024: Region 5 Agenda
Location: Moberly Municipal Auditorium, Moberly
October 1, 2024: Region 4 Agenda
Location: Stoney Creek Hotel, St. Joseph
October 2, 2024: Region 3 Agenda
Location: Adams Pointe Conference Center, Blue Springs
Handouts
1. Activities for Special Populations
2. Supporting Well Being A Foundation for Person-Centered Care
3. Missouri Medicaid Case Mix
4. Survey Success Tips and Pearls for Excellence in LTC Compliance
4b. 7 Week Survey Prep
5. Region 2 Section Update
5. Region 7 Section Update
5. Region 1 Section Update
5. Region 6 Section Update
5. Region 5 Section Update
5. Region 4 Section Update
5. Region 3 Section Update
7. Enhanced Barrier Precautions
NSHN Reporting Essentials for LTC Webinar
HQI presented a webinar for all Nursing Homes in MO, free of charge, on March 13th in cooperation with MHCA and MANHA regarding the top citation F884 titled: Don’t Get Tagged: NHSN Reporting Essentials for Long-Term Care Facilities.
You can find the slides for the webinar and recording here: Don’t Get Tagged: NHSN Reporting Essentials for Long-Term Care Facilities | HQIN.
Adult Day Care Program Manual Updated
The Adult Day Care Program Manual has been updated and posted under the Laws, Regulations & Manuals page.
The following changes were made:
- DSDS and DHSS regional maps were updated.
- Broken hyperlinks were updated to reflect web address changes.
Health Education Unit News
CNA Testing
Headmaster D & S is now offering the knowledge portion of the CNA exam in Spanish.
This change is effective for those scheduling after 5/22/24. Please stay tuned for the updated Candidate Handbook to be added to the DHSS CNA Registry webpage.
For questions, please reach out to Headmaster D & S at 800-393-8664 or the DHSS Health Education Unit at 573-526-5686.
Notice of SPAM Emails
The Board of Nursing Home Administrators has been notified of administrators receiving spam emails. The subject line contains the name BNHA and the emails are from an AOL email account. Please do not open the emails and notify your IT staff at once.