The Family Support Division (FSD), Department of Health and Senior Services Central Office Medical Review Unit (DHSS COMRU), and the MO HealthNet Division (MHD) have collaborated to create a new resource for nursing facility providers. We are excited to announce, Nursing Home Reimbursement: Beginning to End.

This resource will walk a provider through the process of nursing home reimbursement from the very beginning of an individual applying for coverage, through the Preadmission Screening and Resident Review (PASRR) process, to billing and receiving payment for services. The resource includes step-by-step instructions for each process, definitions, contact information, and more.

For additional training opportunities, check out the below:

• MHD offers an interactive webinar for nursing home providers quarterly. This training covers navigating MO HealthNet provider resources, proper billing methods, procedures for claim filing via eMOMED, and more. This training includes an opportunity to ask questions in real-time. Review the MHD Provider Training Calendar here.
• COMRU PASRR and Level of Care (LOC) Orientation Training, hosted by COMRU, has a monthly orientation training to review the requirements of the PASRR and the Nursing Facility LOC application process.

For additional resources, refer to the Education and Training Resources page and/or sign up for a live webinar by accessing our Provider Training Calendar. For more information, email MHD.Education@dss.mo.gov.

The Department of Health and Senior Services (DHSS) and Missouri Area Agencies on Aging have published the draft of the Master Plan on Aging: Missourians Aging with Dignity and are seeking comments from the public before the plan is finalized. The comment period is open now through Sept. 15.

A Master Plan on Aging is a cross-sector, state-led strategic resource that can help transform the infrastructure and coordination of services for Missouri’s rapidly aging population. The plan helps build bridges across government agencies, facilitate collaboration with diverse stakeholders, promote equity, raise awareness among policymakers and the public, establish statewide priorities, and incorporate an aging and disability lens across state priorities beyond traditional health care and community.

There are currently more than 1.1 million Missourians over the age of 60. Estimates suggest that older adults will outnumber minors for the first time by 2030 and older adults will greatly outnumber minors by 2060, and the older adult population is also becoming more diverse. These demographic shifts will have a profound impact on the volume and types of services and support that states provide to older adults and people with disabilities, as well as family caregivers. Additionally, approximately 15 percent of the state’s residents have a disability, the most common of which is mobility disabilities. As the population ages, the number of individuals with disabilities is expected to increase.

Aging with Dignity: Missouri’s Master Plan on Aging is a 10-year forward-facing plan that will begin in 2026 and run through 2035. It was established by Governor Parson through executive order in January 2023. The following activities to gain community input have occurred since then:

• An advisory council convened to guide the process of creating the plan. Seven subcommittees comprised of subject matter experts from diverse communities of practice and constituents met regularly to assess the resources and services currently available in the state, find areas of duplication or gaps in service, and determine possible areas for growth.
• A series of town hall meetings throughout the state was held to gather feedback from local individuals who know about challenges in their own communities. These results were analyzed and provided to the advisory council, seven subcommittees and local agencies.
• To gain further insight, the needs assessment was launched in 2024. The effort began with the mailing of over 130,000 postcards to randomly selected residents from all counties of the state. The survey was open to anyone in Missouri who wished to share their needs and wants as the State continued the process of developing the Master Plan on Aging.

“The amount of participation and support we have seen from Missourians across the state over the past two years has been inspiring,” said Mindy Ulstad, who leads the Bureau of Senior Programs within DHSS. “We feel confident that the plan, which is the result of an immense amount of collaboration and active listening, will encompass the needs and wants for all Missourians as we age.”

Community participation has been vital to the process of developing the Master Plan on Aging. Missourians are invited to provide feedback on the draft Master Plan on Aging by submitting comments by emailing MOStatePlanOnAging@health.mo.gov. The draft will be available for public comment until Sept. 15. After public comments, the final plan will be delivered to Governor Kehoe before the end of the calendar year.

The overarching goal of the Master Plan on Aging is that all Missourians, regardless of age or ability, will have access to person-centered programs and services necessary to help them age in their environment of choice in a safe and healthy manner. Learn more about Aging with Dignity.

Please see the most frequently cited deficiencies report from the first quarter of 2025.

We are excited to announce that Headmaster D & S has released the NEW option for employers to renew their CNA employee’s certification in TMU.

Just a reminder that it is required that CNAs renew their certification every 24 months to remain active. This new function allows employers to renew through their TMU Employer account, choose their CNA employee, provide the required documentation and pay the renewal fee.

Please see the link below for the “How To” guide: EMPLOYER: How to Renew Employee Certificates.

Don’t have an employer account in TMU???

Fill out the Request to Become Employer application in TMU or contact Headmaster D & S for directions or questions at 888-401-0465.

Effective July 1, 2025, the Resource Limit/Spenddown Amount will increase from $5,909.25 to the new amount of $6,068.80. 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.

Please see the attached Letter to Administrators and Transfer Discharge Tip Sheet-Certified 4.28.25 from the Long-Term Care Ombudsman’s office to clarify newly issued guidance, provided via CMS QSO-25-14-NH, regarding expectations of permitting residents to return to the Nursing Home, referenced herein as the “facility,” following transfer to an acute care setting. This correspondence clarifies the requirements for when the facility transfers or discharges a resident under any circumstances and documentation required for transfers or discharges, and the email address to where a facility is to send copies of discharge notices to the Long-Term Care Ombudsman Program. To support this information, enclosed are a Question and Answer guide and a document that lists county-specific contact information for the Long-Term Care Ombudsman Program.

There has been some recent confusion regarding hot water temperatures in federally certified nursing facilities. CMS released an initial draft of the critical element pathway (CEP) for Accidents that showed shower temperatures should be at 100 degrees; however, that specificity was removed from the final draft of the CEP that went into effect in April 2025. CMS does not require specific water temperatures for showers. Facilities may allow for resident preference as long as temperatures are maintained at safe levels to prevent burns and within the state regulation (19 CSR 30-85.012(97)) parameters of 105 degrees and 120 degrees.

The Family Support Division has created a new e-mail box for nursing home providers to send all email inquiries to. This box was set up to provide one e-mail to contact instead of the four different e-mail address previously utilized. Effective immediately please start using this new address to send e-mail inquiries to FSD.IM.Vendor.Inquiries@dss.mo.gov.

See the full notification memo from FSD at: NH-E-mail-Letter-4-25-25.pdf.

Please see the most frequently cited deficiencies report from the first quarter of 2025.

A reminder that residents may choose the pharmacy of their choice. State regulation that applies to all levels of care states:

19 CSR 30-88.010(40) Each resident shall be allowed the option of purchasing or renting goods or services not included in the per diem or monthly rate from a supplier of his or her own choice, provided the quality of goods or services meets the reasonable standards of the facility. Each resident shall be allowed the option of purchasing his or her medications from a pharmacy of his or her choice, provided the quality of the medications and packaging meets reasonable standards of the facility.

Please see the most frequently cited deficiencies report from the fourth quarter of 2024.