The Department of Health and Senior Services (DHSS) is pleased to announce the availability of Electronic COVID-19 Case Reporting. All entities currently required to complete a Communicable Disease Case Report (CD-1) should begin reporting positive COVID-19 cases via the new system*. This system will replace the paper CD-1 process and allow for more timely, appropriate, and accurate data for COVID-19 case reporting.

The new system also fulfills the requirement for residential congregate facilities to report COVID-19 cases under the Congregate Facility Reporting Order. Congregate facilities will no longer need to enter positive case information into the former system, which has been taken down.

The Electronic COVID-19 Case Reporting System can be found on DHSS’ main COVID-19 webpage: www.health.mo.gov/coronavirus. Please do not enter lab result information unless you are a reporting laboratory or you are entering on behalf of the laboratory.

Testing spreadsheets should continue to be provided by facilities to the Division of Regulation and Licensure. Testing spreadsheets can be uploaded at: https://health.mo.gov/safety/longtermcare.php.

*If your organization has already developed an electronic reporting process with DHSS, please continue to follow this process. The Electronic Reporting System is a replacement for those entities currently emailing, faxing or mailing a CD-1 form for COVID-19 case information.

In order to allow for more accurate submission of your data on the Electronic COVID 19 Case Reporting form, please note the following:
      -When you hit the “Submit” button on page 5 of the form make sure you add today’s date.
      -Make sure you choose Resident, Staff, Contracted Staff or “No” on page 2 of the form.

As of July 15^th, 192 qualifying Medicaid & CHIP eligible providers in Missouri have applied for the Medicaid & CHIP Provider Relief Fund distribution out of the 5,725 providers identified in the data that your team supplied to CMS. Of these, 93 Medicaid & CHIP providers have been paid from this distribution. To ensure that all qualifying providers are aware of the opportunity, as well as the new application deadline, we are requesting that states reach out to your medical, dental, and long-term services and supports (LTSS) providers to remind them that they can begin the application process here. 

The application deadline has been further extended to offer providers additional opportunity to apply for funding. You must act by Friday, Aug. 28, 2020 at 11:59 p.m. ET to be considered for payment from this distribution. Read more about the extension here.

To support these efforts, included below some resources that the HRSA team has released on the Provider Relief Fund to share:

• Program Overview:
  The bipartisan Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act provide $175 billion in relief funds to hospitals and other health care providers, including those on the front lines of the coronavirus response. A portion of these funds, under the Medicaid and Children’s Health Insurance Program (CHIP) Provider Distribution, provide help for providers and clinicians who treat our most vulnerable populations, including low-income and minority patients. This is allocated for eligible providers that participate in state Medicaid and CHIP Programs and that did not receive a payment from the Provider Relief Fund General Allocation. The payment to each provider will be approximately 2 percent of reported gross revenue from patient care.

• Fact Sheet
  The Health Resources & Services Administration (HRSA) released a Fact Sheet for Medicaid and CHIP Providers that is now available on the Provider Relief Fund website.

• Recorded Webcast
  A recording of the June 25 webcast is now available at https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html.

• Frequently Asked Questions (FAQs)
  In order to better address your most important concerns, HRSA has updated their FAQs to address common questions, including those submitted during the previous webcasts. The FAQs include expanded information on eligibility, application, payment process, and more.

• Application Instructions
  Medicaid and CHIP Provider Distribution Instructions and the Medicaid and CHIP Provider Distribution Application Form are available at hhs.gov/providerrelief. HRSA recommends downloading and reviewing these documents to help you complete the process through the Enhanced Provider Relief Fund Payment Portal.

• Additional Information
  For additional information, please call the Provider Support Line at (866) 569-3522; for TTY, dial 711. Hours of operation are 7 a.m. to 10 p.m. Central Time, Monday through Friday. Service staff members are available to provide real-time technical assistance, as well as service and payment support.

Many long-term care facilities have begun reporting COVID-19 data into the CDC’s NHSN Long-term Care Component. In an effort to have a more complete representation of COVID-19 data for the State of Missouri, we are asking facilities who are not yet reporting (SNF, ICF, ALF, RCF, ICF/IID) to consider reporting data through the CDC’s NHSN Module and those facilities that are currently reporting to begin sharing their data (conferring rights) with DHSS. In order to share the data you enter into the CDC’s NHSN site, you must join the “Missouri Group” within NHSN and select the option to “Confer Rights”.

Once you have completed the NHSN enrollment process and received your acceptance notification from NHSN, you can login to the NHSN site to:

1. Access the COVID-19 Module within the Long-Term Care Component
2. Join the Missouri Group (using the guidance below)
3. Confer rights to grant the state health department access to your facility’s information.

How do I join the Missouri Group and confer rights to the department?

NHSN website provides instructions – https://www.cdc.gov/nhsn/pdfs/groups-startup/JoinGroup-current.pdf.

The document is titled: NHSN Data Sharing: Joining a Group and Accepting the Confer Rights Template.

Please use the following information to join the Missouri group:
Group ID: 20503
Use password: MHIRS29

DHSS is also encouraging facilities to report each day. This will allow more accurate and timely data that could be used for increased allocation of resources for facilities that start to see increased cases, rather than responding up to a week later when outbreaks are identified.

A Frequently Asked Questions document is now available on the NHSN LTCF COVID-19 Module website. The document was developed to answer the most common questions received from facility and group users participating in the NHSN LTCF COVID-19 Module. The questions are organized by the four COVID-19 Module pathways, as well as enrollment, groups, the CMS rule, and data entry and analysis. Additionally, at the end of the document, there are examples of how to count data for reporting.

An updated list of laboratories on state contract has been placed on the DHSS website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/cares-act-funding.php under the Word document titled State and Community-Based COVID-19 Testing Qualified Vendor List.

This Qualified Vendor List has information regarding daily testing capacity, specimen types, billing, turn-around-time, etc., for the laboratories on state contract. The pricing is for work completed at the state/local government’s request, but may be honored for private entities at the lab’s discretion.

This information is being provided to assist with completing testing either for an outbreak situation or for reopening purposes. There are laboratories not listed on the qualified vendor list that conduct testing as well. There is no requirement to utilize a laboratory on this list.

The Board of Nursing Home Administrators has put forth guidance regarding 2021 license renewal changes. Please see the memo for details.

In efforts to continue support of the nation’s COVID-19 response, the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) is excited to announce the following updates to the COVID-19 Module for Long-Term Care Facilities (LTCF):

1. An NHSN COVID-19 Module Dashboard for LTCFs is now available for participating groups and The dashboard provides a summary of data entered in the COVID-19 Module and includes an interactive chart display where a user may customize data views. This first edition of the dashboard is concentrated on the Resident Impact and Facility Capacity pathway. However, we’ve already started working on the next edition, which will continue additional pathways and analysis options!! Guidance documents for groups and facilities to assist with navigating and understanding the features are available on the NHSN LTCF COVID-19 Web-page.

2. You asked, and we listened! We recognize that many SNFs are setting up COVID-19 units to receive transfers from other LTCFs, such as Assisted Living Residences. These transfers result in increased demand on the receiving LTCFs. Therefore, the count for “Admissions” has been revised to include admissions and readmissions of residents who were previously diagnosed with COVID-19 from another facility. For additional information, please review the revised data collection form and accompanying instructions for the Resident Impact and Facility Capacity Note: LTCFs may update previously entered “Admissions” counts, but this is not a requirement.

3. We aim to improve the quality of the COVID-19 data being reported. Users will notice Pop-up alerts as a reminder of potential data entry errors. For example, if a user attempts to enter more COVID-19 Deaths than Total Deaths, a pop-up alert will appear to remind user of the definitions. As a reminder, “COVID-19 Deaths” counts must be included in the Total Deaths count since Total Deaths is defined as the number of residents who died for any reason in the LTCF or another location since the last time “Total Deaths” counts were collected for reporting in the NHSN COVID-19 Module. For both counts, only include the NEW deaths since the last time the counts were collected for reporting in the Module, as the intent is to capture incidence.

4. Non-modifiable fields have been added to each of the four pathway screens. Users will notice that each pathway now has three additional pieces of information displayed at the top of each pathway: Date Created, Facility CCN, and Facility Type.

The purpose of Date Created is to display the first date and time of data entry (manual or CSV file upload) for a selected calendar date and pathway. The date and time will automatically save and cannot be modified by the user.

The Facility CCN and Facility Type will also populate for each facility, allowing users to quickly verify the information associated with the data being submitted to CMS. These two variables may be edited by a facility user with NHSN Administrative rights; however, edits must be done outside of the COVID-19 Module by accessing Facility Info on the left navigation panel. Guidance documents are attached to this e-mail, as well as available under Facility Resources on the NHSN LTCF COVID-19 Web-page, which can be accessed through the following link – https://www.cdc.gov/nhsn/ltc/covid19/index.html (you may need to copy and paste web-link into Internet browser).

Be sure to check-out the July NHSN LTCF newsletter for additional information and exciting updates! If you have questions, please send them to nhsn@cdc.gov and include LTCF in the subject line.

Division of Community and Public Health (DCPH) recently reached out to the CDC for guidance regarding long-term care facility (LTCF) residents attending routine off-site appointments and received the following response:

CDC does not recommend LTCF residents who go off-site for routine appointments (such as hemodialysis or other routine appointments or treatments) be kept in observation, in part because the observation period could be permanent for residents who have to leave more than once every two weeks. Additionally, LTCF residents who leave and return for appointments should not be considered new admissions or be housed in a COVID-19 care unit in the LTCF when they return. Placing LTCF residents who return in the observation or COVID area within the facility could put them at higher risk of exposure to COVID-19. While not a CDC recommendation, some LTCFs have opted to manage residents who go off-site for routine appointments as potentially exposed and use full Transmission-Based Precautions and/or have cohorted these residents together into the same area of the building. In these examples, it is very important to ensure these residents, who may be at increased risk of acquiring COVID-19, are NOT being placed into a dedicated COVID-19 unit or with others who are symptomatic/have increased risk of having COVID-19. Doing so would increase the risk of exposing these residents who go off-site to others at even higher risk of COVID. We have also heard about significant challenges with moving residents repeatedly and recognize that determining exposures can be challenging. Additional recommendations: Residents going off-site for dialysis or other appointments should wear a cloth face covering (or facemask) for source control when they leave the LTCF and ideally in the LTCF if they are leaving their room. Regular communication between the dialysis facilities/medical offices where appointments occur and the LTCFs (in both directions) is essential to help identify patients with fever or symptoms consistent with COVID-19 before they enter the facilities and facilitate resident care. Social distancing measures should be implemented, such as minimizing movement of these residents within the facility as much as possible. LTCFs should comply with the infection prevention and control guidance for nursing homes and LTCFs.

The guidance has been updated to request facilities bill Medicare first, if applicable, for testing costs and to provide contact information when submitting invoices. In addition, for SNFs only, updates have been made to the attestation form and information regarding costs being capped per facility.

Please see Updated LTC Guidance Invoicing Process (06222020) for additional information.

Since Feb. 3, Missouri hospitals have been reporting daily data to establish situational awareness of hospital capacity while preparing for and responding to the spring outbreak of the SARS-CoV-2 virus. Using these data, the Missouri Hospital Association has distributed a daily statewide dashboard of the current impact and capacity of COVID-19 in Missouri hospitals. A copy of today’s dashboard is included.

Information from the daily dashboard has supported local, state and federal officials in gaining day-to-day awareness of Missouri’s hospital capacity. The reports also have been used by the media to keep the public updated on hospital response.

Throughout the spring, more data that offer additional detail and trends have become available. To keep the report current, it has been modified several times to capture these new data elements. However, as we move from our initial response to the surge to our current status of recovery, it is critical we look at data trends in different ways to help us better understand the impact of the pandemic on our state and individual communities, and detect possible future trends. Today, MHA and the Hospital Industry Data Institute are pleased to introduce new, weekly COVID-19 dashboards providing regional trends and models of predicted cases. Concurrently, the aforementioned daily, situational awareness dashboard will be phased out. Daily situational awareness will remain available on the Missouri Department of Health and Senior Services’ website.

These regional dashboards have been developed in partnership with Missouri state agencies, hospital leaders and researchers at the Institute for Public Health at Washington University, and are included below for your review.

• Kansas City Region
• St. Louis Region
• Northeast Region
• Northwest Region
• Central Region
• Southeast Region
• Southwest Region

The new dashboards were designed with the intent to serve a larger audience. As Gov. Parson continues to lead the Show Me Strong Recovery plan, government officials at all levels, along with local businesses, schools, churches and other organizations, will need access to innovative monitoring tools to help manage their reopening efforts. These dashboards – with state and regional focus, along with the element of predictive understanding – will serve as a tool to help you and the leaders in your organization have better awareness of the pandemic. Further, the regional dashboards will complement other information currently used for COVID-19 planning and decision-making.

Correction to the link to order testing supplies from the state public health laboratory: The below message has been updated to reflect a change in the link to order testing supplies from the state public health laboratory.

Facility-wide testing for all residents and staff is included in the most recent DHSS guidance (https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/ltcf.php) for communities that have a positive COVID-19 case. We are encouraging all communities to be prepared for this possibility so that should this occur, there will be no delay in testing implementation.

There are several coordination points that are necessary in order to have a successful testing plan. This includes having access to testing kits (both swabs and media – must have both), the ability to collect the specimens onsite, and establishing an agreement with a lab to process the specimens. To assist in this preparation, testing kits may be ordered through the state public health laboratory at https://health.mo.gov/lab/index.php or https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/specimen-collection-supplies.php. The state public health laboratory recently received testing combination kits that contain both the swabs and media. These kits are listed as “Swab/Media Combo – Remel MicroTest M4RT Transport 3ml vial with Nasopharyngeal swab” and are available for any long-term care community. We encourage all to take advantage of this current testing kit supply and to order enough supply to complete two rounds of facility-wide testing. The test kits do not expire until April 2021, so they are acceptable for use for several months.

**UPDATE – The specific kits referenced above are now out of stock. There are other testing supplies available to any long-term care community. Please ensure when ordering testing supplies, both swabs and media are needed for a complete testing kit. Please do not order every item on the list of supplies and keep in mind the number of testing kits needed for your community.

Long Term Care facilities, including Assisted Living facilities, Residential Care facilities, Intermediate Care facilities, and Skilled Nursing Facilities (LTCs) that experience an outbreak (one or more positive case) of COVID-19 are working with the state to conduct base-line facility testing and some immediate follow-up testing in order to contain the outbreaks. In order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the state is making some funds from the Coronavirus Relief Fund available to LTCs, so that cost is not a barrier to this important testing. Questions regarding this process should be submitted to COVID19invoice@dss.mo.gov.

LTC Guidance Invoicing Process