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.

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.

HQI presented a webinar for all Nursing Homes in MO, free of charge, on March 13^th 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.

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.

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.

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.

The process to submit a change in condition is now online.

DMH will no longer accept the Change in Condition PDF through the PASRR email. Any forms submitted by PDF will receive a message directing them to the online form to complete. This will optimize the process making it more efficient and effective, similar to the online process for the Level I/Level. Please use the following link for the online Change in Condition form: Resident Review of Change in Condition: Nursing Facility Notification to Missouri Department of Mental Health (redcapdd.azurewebsites.net). This will also be at the DMH website at Pre-Admission Screening and Resident Review (PASRR) | http://dmh.mo.gov.

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

Long-Term Care Facilities (all levels of care) are strongly encouraged to complete an electronic survey weekly to report how many beds they have available, and which residents they can serve, i.e., memory care, behavioral health, bariatric, etc. This information is used to generate a dashboard that is beneficial to facilities, families, hospital discharge planners and the general public to determine bed availability and services throughout the state. Please access the survey at this link: survey. To view the dashboard access this link: dashboard.

If you have any questions about the survey, please contact the Long-Term Care Ombudsman Program via email LTCOmbudsman@health.mo.gov or call 800-309-3282.

This is a great opportunity to share what your facility has to offer!

We have recently received in influx of questions related to the qualifications for director of food and nutrition services in skilled nursing facilities. The federal regulation (F801) requires one of the following qualifications (if a qualified dietician or other clinically qualified nutrition professional is not employed full-time):

1. A certified dietary manager; or
2. A certified food service manager; or
3. Has similar national certification for food service management and safety from a national certifying body; or
4. Has an associate’s or higher degree in food service management or in hospitality, if the course study includes food service or restaurant management, from an accredited institution of higher learning; or
5. Has 2 or more years of experience in the position of director of food and nutrition services in a nursing facility setting and has completed a course of study in food safety and management, by no later than October 1, 2023, that includes topics integral to managing dietary operations including, but not limited to, foodborne illness, sanitation procedures, and food purchasing/receiving.

CMS has noted that the approved certifications and course requirements would be the equivalent of a ServSafe Food Manager certification. Additional food manager courses we have found to meet the requirements include: AAA Food Handler, Learn2Serve, and State Food Safety.

Please see the most frequently cited deficiencies report from the fourth quarter of 2023.

The online application link (Level 1 form/Level of Care) for applications submitted prior to 07/16/2023 (green link) will no longer be available after 02/01/2024.

Skilled Nursing Facilities will want to ensure they have printed/saved a copy of the processed Level 1 form/Level of Care form and Level 2 screening (if applicable) for resident records as these are required per regulation and may be requested during the state survey process.

• Additionally, please remember that all processed applications are to be deleted from the COMRU online application system 60 days after completion.

COMRU website: https://health.mo.gov/seniors/nursinghomes/pasrr.php.

Should you have any questions, please contact COMRU via email (COMRU@health.mo.gov).