SLCR has issued guidance for the implementation of state waivers related to tuberculosis testing for employees and staff. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
Intermediate Care and Skilled Nursing Facilities – Testing for Tuberculosis 4-23-20
TB Testing – 85.042-27- 4-23-20

The Department of Health and Senior Services issued a news release today explaining “Increased testing capacity allows Missouri to expand criteria for patient testing”.

The full press release is available here https://health.mo.gov/news/newsitem/uuid/912934b4-fa13-408b-a9b7-627db5c1c1e1/increased-testing-capacity-allows-missouri-to-expand-criteria-for-patient-testing.

Also, great news, as of yesterday almost 400 providers had signed up for Missouri PPE Marketplace. Remember to access that source through the Department of Economic Development’s website https://ded.mo.gov/.

Thanks so much for everyone who has entered information. This will inform the PPE need across the state as well as help identify new suppliers and manufacturers of PPE. Remember you have to use Edge, Chrome, Firefox, or Opera as your Internet browser. Also, we have heard that emails to complete the registration are going to junk or spam email folders. This is being addressed, but please check those folders if you have started the registration process and have not gotten your email.

**Special Note for Multi-Facility Organizations**
If you are part of a larger organization and would like to submit a request as one corporate entity instead of each facility, please email supplysolution@ded.mo.gov to make a request to register as one corporation. You will be required to put a Missouri facility address in the registration.

SLCR has issued guidance for the implementation of state waivers related to Fire Safety and Emergency Preparedness Standards for Residential Care and Assisted Living Facilities. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
RCF ALF 86.022 Waiver Implementation Guidance 4-23-2020
Residential Care and Assisted Living Facilities 4-23-20

The Department of Health and Senior Services has issued waivers related to physical plant requirements:

• Physical Plant Requirements for all levels of care regarding the two year electrical certification. This waiver allows the required written certification by a qualified electrician to be delayed. Facilities have until two (2) months after the state of emergency has concluded to be current with the required maintenance of electrical systems.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachment below for details.
Physical Plant Requirements for Intermediate Care Skilled Nursing Residential Care and Assisted Living Facilities 4-22-20

On April 21, 2020, CMS issued a COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, which extends the PASRR approval through the end of the emergency declaration.

Effective April 2, 2020 and through the end of the Federal Emergency Declaration, certified Skilled Nursing Facilities and Intermediate Care Facilities will continue to follow the process outlined in the PASRR 1135 Waiver Implementation 4-22-20 for new admissions into Medicaid-certified beds.

Questions regarding this process should be directed to COMRU@health.mo.gov.

In the past few weeks Missouri has seen an increasing spread of COVID-19 from population centers to more rural communities. This is concerning as rural areas tend to have more limited access to health care and populations that are older and have more chronic health conditions. During this time that we all have a role in protecting our communities and limiting the spread of this disease. Whether you have COVID 19, are a caregiver of an individual with COVID 19 , or just going out in public places, there are actions that you should be taking.

See the tip sheet for more information.

The Treasury Department says that the first recipients of stimulus checks have been given to taxpayers that have already filed their 2019 (or 2018) tax returns and have provided direct deposit information to the IRS.

The stimulus money should be treated the same way as the Circuit Breaker Checks/Rent Rebate Checks.  Stimulus money should be used for the resident’s current or foreseeable needs.

In order for the facility to recoup the funds, the facility must have:

• A signed admission agreement stating for residents that owe back Room & Board, the facility may recoup the additional funds; AND
• The resident owes back Room & Board to the facility; AND
• The resident or the resident’s guardian/conservator gives written authorization at the time of the withdrawal.

Please keep in mind:

• Review the Resident’s Trust Fund balance to ensure the resident does not reach the Medicaid Spenddown Limit amount. The amount is currently $4,000 and will increase to $5,000 as of 07/01/20.
• All Resident Funds must be kept separate from the facility’s funds.
• The facility may keep in a petty cash fund up to $50 for each resident for whom the facility is managing funds.

Feel free to contact Lynn Gilmore, SLCR Sr. Auditor, at Lynn.Gilmore@health.mo.gov or 573-508-4150 if you have any questions.

SLCR has issued guidance for the implementation of state waivers related to adult day care programs. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
ADC Waiver Implementation Guidance 4-22-20
Adult Day Care Requirements 4-22-20

The Department of Health and Senior Services has issued waivers related to current exceptions and second business approvals:

• Existing exceptions to state regulations for all levels of care will continue beyond the time specified in the approval notice. Facilities shall have until two (2) months after the state emergency has ended to submit renewal requests to the department.
• Existing second business approvals to continue beyond the time specified in the approval notice. Facilities shall have until two (2) months after the state emergency has ended to submit renewal requests.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
Long Term Care Facilities Exception to Licensure Requirements and Second Business Waiver 4-22-20
Residential Care and Assisted Living Facilities – Second Business Waiver 4-17-20

SLCR has issued guidance for the implementation of state waivers related to assisted living facilities. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
Assisted Living Waiver Implementation Guide
Assisted Living Facilities Requirements 4-14-20
Assisted Living Facilities Requirements 4-17-20

SLCR has issued guidance for the implementation of state waivers related to residential care facilities. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
RCF Waiver Implementation 4-17-20
Residential Care Facilities 4-14-20
Residential Care Facilities 4-16-20

SLCR has issued guidance for the implementation of state waivers related to skilled and intermediate care facilities. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
SNF-ICF Waiver Implementation 4-17-20
Intermediate Care and Skilled Nursing 4-14-20
Intermediate Care and Skilled Nursing Facilities 4-14-20
Intermediate Care and Skilled Nursing Facilities 4-15-20
Intermediate Care and Skilled Nursing Facilities (2) 4-15-20

This guidance has been updated to include additional information on readmitting residents from a hospital who have a positive COVID-19 diagnosis as well as expended signs and symptoms to include in resident monitoring.

Please see the document below for details.
COVID-19 LTCF Guidance 4.17.20

Please see the health guidance below for healthcare facilities that have employees returning to work after COVID-19 illness.

4-17-20 HG COVID-19 Return to Work

SLCR has issued guidance for the implementation of state waivers related to homes who are licensed as Residential Care Facilities (II) and comply with Administrative, Personnel and Resident Care Requirements under 19CSR30-86.043. Please read through this important guidance.

Questions related to these waivers can be emailed to RegulationUnit@health.mo.gov.

Please see the documents below for details.
RCF II Waiver Implementation Guidance 4-17-20
Residential Care Facility II Requirements 4-14-20
Residential Care Facility II Requirements 4-16-20

SLCR has issued guidance for the implementation of state waivers related to the insulin administration program. Please read through this important guidance. Questions regarding these waivers should be directed to CNARegistry@health.mo.gov.

Please see the documents below for details.
Insulin Administration Program Waiver Implementation 84.040
Insulin Administration Training Program 4-14-20

SLCR has issued guidance for the implementation of state waivers related to the certified medication technician training program. Please read through this important guidance. Questions regarding these waivers should be directed to CNARegistry@health.mo.gov.

Please see the documents below for details.
CMT Waiver Implementation 4-9-20
Certified Medication Technician Training Program 4-9-20

SLCR has issued guidance for the implementation of state waivers related to the Level I Medication Aide training program. Please read through this important guidance. Questions regarding these waivers should be directed to CNARegistry@health.mo.gov.

Please see the documents below for details.
LIMA Waiver Implementation 4-9-20
Level I Medication Aide 4-9-20

SLCR has issued guidance for the implementation of federal and state waivers related to the training and certification of nurse aides. Please read through this important guidance. Questions regarding these waivers and the nurse aide certification process should be directed to CNARegistry@health.mo.gov.

Please see the Nurse Aide Registry Waiver Implementation 4-7-2020 for details.

The Department of Health and Senior Services issued guidance regarding reporting of confirmed and presumptive COVID-19 cases. The guidance can be found at: https://health.mo.gov/emergencies/ert/alertsadvisories/index.php.

Effective immediately, long term care communities must report these cases directly to DHSS utilizing the Disease Case Report (CD-1 Form). The CD-1 form can be accessed at https://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/cdmanual/pdf/CD-1.pdf.

There are two methods of communicating this information: fax or Secure File Transfer Protocol (SFTP). The information reported will be communicated with the Local Public Health Agency (LPHA). Long term care communities may continue to reach out directly to their respective LPHA as well.

Please see the Health Update for details.