Category: SLCR Guidance

CMS QSO Memo Regarding Prioritization of Survey Activities

Posted on

CMS Memo QSO-20-20-ALL: https://www.cms.gov/files/document/qso-20-20-all.pdf

Infection Control Survey Checklist

CMS is prioritizing surveys by authorizing modification of timetables and deadlines for the performance of certain required activities, delaying revisit surveys, and generally exercising enforcement discretion for three weeks. During this three-week timeframe, beginning March 20, 2020, only the following types of surveys will be prioritized and conducted:

  • Complaint/facility-reported incident surveys: State survey agencies (SSAs) will conduct surveys related to complaints and facility-reported incidents (FRIs) that are triaged at the Immediate Jeopardy (IJ) level. A streamlined Infection Control review tool will also be utilized during these surveys, regardless of the Immediate Jeopardy allegation.
  • Targeted Infection Control Surveys: Federal CMS and State surveyors will conduct targeted Infection Control surveys of providers identified through collaboration with the Centers for Disease Control and Prevention (CDC) and the HHS Assistant Secretary for Preparedness and Response (ASPR). They will use a streamlined review checklist to minimize the impact on provider activities, while ensuring providers are implementing actions to protect the health and safety of individuals to respond to the COVID-19 pandemic.

CMS is disseminating the Targeted Infection Control Survey checklist developed by CMS and CDC so facilities can educate themselves on the latest practices and expectations. CMS expects facilities to use this new process, in conjunction with the latest guidance from CDC, to perform a voluntary self-assessment of their ability to prevent the transmission of COVID-19. The checklist is attached.

Though the contents of the memo and checklist are provided by CMS, DHSS is adhering to the same requirements for all facilities. All facilities should complete the infection control self-assessment.

Child Care Needs Assessment

Posted on

A state-wide team is working to develop a list of childcare needs for healthcare and other critical staff across the state to ensure that those individuals are able to work. The intent is to try to see if local school districts are able to provide the care. 

The next step is to develop a list of childcare needs from the critical employees. The link below will take people to an online form to fill out if they need childcare in order to be able to work.

https://stateofmissouri.wufoo.com/forms/m1cs1vfl1dde8dt/

Once we have the information gathered, we will create a list of needs by school district to send to each district and see if they are able to help provide care. At this point this is information gathering to see what options might be available.

Please ensure all long term care employees submit this form if they have a need.

SLCR Guidance on Residents Leaving the Facility – Updated March 17, 2020 (Additions in red text)

Posted on

This is guidance from SLCR; it is not a mandate but rather provides facilities with an avenue to protect the health and safety of residents.

It is appropriate for facilities to ask residents not to leave the facility, unless for a necessary medical reason that cannot be addressed in the facility. For those insistent on taking residents out of the facility, SLCR recommends the following:

  • Only legally authorized persons may remove a resident from the facility. This may be a durable power of attorney for healthcare (if the DPOA has been enacted), a legal guardian or the resident themselves.
  • Before a resident leaves, the facility should follow the discharge regulations to the extent possible so that the resident receives appropriate care while away from the facility.
  • Upon leaving the facility, the resident, their legal representative and all those required by regulation should be given a written emergency discharge notice. It is imperative that the notice contain the required elements stated in regulation, including the reason for discharge (as permitted in regulation) and the location to which the resident is being discharged.
  • Those taking the resident out of the facility are to be informed that the resident will not be permitted to return until the restrictions currently in place are lifted. When appropriate, residents may be required to obtain clearance from their medical provider which may include proof of a negative COVID-19 screening.

For residents, primarily in RCFs and ALFs, who leave the facility on a frequent basis, the facility will need to determine at what point those outings pose a risk to the health and safety of the residents in the facility. This includes, but is not limited to, the location the resident is going, whether there are positive COVID-19 cases in the community, whether there is community transmission of the virus, etc. This guidance does not require facilities to issue an emergency discharge notice every time a resident leaves a facility. The resident and their legal guardian, when applicable, should discourage outings, attempt to meet the needs of residents without them leaving the facility, clearly communicate the expectations to residents (including any screening required upon return) and work together should the need arise to give an emergency discharge notice.  

PPE resource request for accessing state cache assets posted: Accepting requests Monday, March 16, 2020

Posted on

The resource requesting process for PPE in our state cache was posted to the DHSS website this at this link:

https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/professionals.php.

All resource requests must go through the respective healthcare coalition (maps and contact information are on the website). The healthcare coalition then submits to the Missouri Department of Health and Senior Services for review, approval and processing. All shipments will occur from Jefferson City and be sent via either Federal Express (FedEx) or United Parcel Service (UPS).

Visitation Guidance for Facilities

Posted on

Please see Department of Health and Senior Services guidance regarding visitation restrictions in all long term care facilities including residential care facilities, assisted living facilities, intermediate care facilities, skilled nursing facilities, and intermediate care facilities for persons with intellectual disabilities.

This guidance along with similar guidance from the Centers for Medicare and Medicaid Services should be implemented immediately.

These documents will also be posted to the Department’s COVID-19 website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/ under the Health Care Professionals tab.

LTCF Webinar: Coronavirus Disease 2019

Posted on

This video includes information from the Department of Health and Senior Services regarding guidance and education surrounding COVID-19. The focus is on the basics of COVID-19 (symptoms, who is at most risk), the types of coronavirus, how long term care communities can prepare and testing protocols.

The LTCF Video is available at https://youtu.be/u-OZNQ3A-fs.

Please note information is changing rapidly so please check the Department’s COVID-19 website frequently for updated information.

Supporting Coronavirus Prevention in LTC Facilities

Posted on

Some LTC homes will make the difficult decision to limit and/or restrict entry of family and friends into their care settings. To help family and friends understand restrictions being put into place by many LTC providers, Consumer Voice, a national Ombudsman program resource, has put together a webpage: https://theconsumervoice.org/issues/other-issues-and-resources/covid-19.

News Release: Missouri opens novel coronavirus information hotline

Posted on

JEFFERSON CITY, MO –The Missouri Department of Health and Senior Services (DHSS) activated a statewide public hotline for citizens or providers needing guidance regarding the novel coronavirus, or COVID-19. At 8 a.m. today, the hotline opened and can be reached at 877-435-8411. The hotline is being operated by medical professionals and is available 24 hours a day, 7 days a week.

“Communication is vital to our response to this rapidly-evolving situation,” said Dr. Randall Williams, director of DHSS. “For several weeks, our COVID-19 webpage has been and continues to be a great resource for the public, but having the hotline as an additional resource will likely be invaluable as citizens seek guidance for their concerns.”

To date, 46 patients in Missouri have been tested for the virus that causes COVID-19; one of those has tested positive.

“It is important to know what to do if you have concerns about an illness during this outbreak,” said Williams. “For those who may be at risk for COVID-19, we encourage them to utilize this hotline or call their health care provider or local public health agency to inform them of their travel history and symptoms. They’ll be instructed on how to receive care without exposing others to the possible illness.”

Simple preventive actions that help prevent the spread of all types of respiratory viruses include:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

For more information, visit www.health.mo.gov/coronavirus or the CDC’s COVID-19 website.

# # #

Past Missouri COVID-19 news releases:

About the Missouri Department of Health and Senior Services: The department seeks to be the leader in protecting health and keeping people safe. More information about DHSS can be found at http://health.mo.gov or find us on Facebook and Twitter @HealthyLivingMo

CMS Memo: QSO-20-17-ALL: Guidance for use of Certain Industrial Respirators by Health Care Personnel

Posted on

Guidance for use of Certain Industrial Respirators by Health Care Personnel

  • The Centers for Medicare & Medicaid Services (CMS) CMS is committed to taking critical steps to ensure America’s health care facilities are prepared to respond to the threat of the Coronavirus Disease 2019 (COVID-19) and other respiratory illnesses.
  • The memo clarifies the application of CMS policies in light of recent Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) guidance expanding the types of facemasks healthcare workers may use in situations involving COVID-19 and other respiratory infections.

Please see the memo for further details.

 

For additional information, please visit the Department’s website at health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/. This site also contains a link specific to long-term care communities.

CMS Memo: QSO-20-14-NHL: Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes (REVISED)

Posted on

Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes (REVISED)

  • CMS is committed to taking critical steps to ensure America’s health care facilities and clinical laboratories are prepared to respond to the threat of the COVID-19.
  • Guidance for Infection Control and Prevention of COVID-19 – CMS is providing additional guidance to nursing homes to help them improve their infection control and prevention practices to prevent the transmission of COVID-19, including revised guidance for visitation.
  • Coordination with the Centers for Disease Control (CDC) and local public health departments – We encourage all nursing homes to monitor the CDC website for information and resources and contact their local health department when needed (CDC Resources for Health Care Facilities: https://www.cdc.gov/coronavirus/2019- ncov/healthcare-facilities/index.html) .
  • Following the Food and Drug Administration’s (FDA) emergency use authorization (EUA) expanding the use of certain industrial respirators to health care personnel, CMS is clarifying that such use is appropriate in Medicare/Medicaid certified providers and suppliers.

 Please see the memo for further details.

For additional information, please visit the Department’s website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/.

DHSS Long-Term Care COVID-19 Webinar

Posted on

DHSS Long Term Care COVID-19 Webinar

Monday, March 9, 2020 10:00 am

Representatives from the Department of Health and Senior Services will be hosting a webinar to provide information, guidance and education surrounding COVID-19. The webinar will focus on the basics of COVID-19 (symptoms, who is at most risk), the types of coronavirus, how long term care communities can prepare, testing protocols and coordination with healthcare coalitions.

Please join us for this important webinar.

Webex Event Registration
https://stateofmo.webex.com/stateofmo/onstage/g.php?MTID=eacb119d9cc214df93ea6e8e3e4c294fb.
After registration, you will receive a confirmation email with further instructions including the webinar link.

If you prefer to join via audio conference:
Call-in toll number (US/Canada): 1-650-479-3207
Event number (access code): 801 063 245

For additional information, please visit the Department’s website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/. This site also contains a link specific to long-term care communities.

CMS Memo: QSO-20-09-ALL

Posted on

Information for Healthcare Facilities Concerning 2019 Novel Coronavirus Illness (2019-nCoV)

  • Information Regarding Patients with Possible Coronavirus Illness: the U.S. Centers for Disease Control and Prevention (CDC) has issued information on the respiratory illness caused by the 2019 Novel Coronavirus (2019-nCoV). Links to these documents are provided.
  • Healthcare Facility Expectations: CMS strongly urges the review of CDC’s guidance and encourages facilities to review their own infection prevention and control policies and practices to prevent the spread of infection.

Please see the full memo download at www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/information-healthcare-facilities-concerning-2019-novel-coronavirus-illness-2019-ncov.

Questions about this memorandum should be addressed to QSOG_EmergencyPrep@cms.hhs.gov.

Questions about the 2019-nCoV guidance/screening criteria should be addressed to the State Epidemiologist or other responsible state or local public health officials in your state.

Coronavirus Update

Posted on

As you are likely aware, the response to the 2019 Novel Coronavirus (2019-nCoV) outbreak is rapidly evolving. On January 18, 2020, the Missouri Department of Health and Senior Services (DHSS) disseminated a Centers for Disease Control and Prevention (CDC) Health Update on this outbreak. The CDC Health Update includes recommendations for health care providers pertaining to 2019-nCoV (https://health.mo.gov/emergencies/ert/alertsadvisories/pdf/cdc-update1-17-20.pdf). The specific topics covered include patient evaluation, reporting, specimen collection, testing, and recommendations for infection control.

For the most up-to-date information regarding the outbreak of 2019-nCoV, please continue to check the CDC website (https://www.cdc.gov/coronavirus/2019-ncov/index.html). Please be aware that guidance for health care and public health professionals is subject to change, and that updated guidance will be disseminated through the CDC website and the Missouri Health Alert Network (HAN). All HAN documents are archived and available on the DHSS website at: https://health.mo.gov/emergencies/ert/alertsadvisories/index.php.

New Training Unit and HEU Manager

Posted on

With the retirement of Hellen Adrian, SLCR is pleased to announce the promotion of Angela Duvall as the RN Manager for the Training Unit and Health Education Unit in Central Office. Angela has been with SLCR for 12 years, with the last five years as a State Training Coordinator/FAN III. Angela has been a Registered Nurse for 24 years and is a certified CNA Instructor. Please join us in welcoming Angela to her new role!

Informal Dispute Resolution (IDR) Changes

Posted on

Section 198.545, RSMo requires the department of health and senior services to contract with the federally designated Medicare Quality Improvement Organization (QIO) in this state to conduct IDR conferences. To comply with this requirement, the department contracted with TMF Health Quality Institute (the federally designated Medicare QIO) who subcontracted with Primaris Healthcare Solutions to conduct IDR conferences.

Effective November 8, 2019, CMS awarded the federally designated Medicare Quality Improvement Organization contract for Missouri to Health Quality Innovators (HQI). Because of this change, the department’s contract with TMF automatically terminated. The department is discussing a possible contract with HQI, but at this point there is no contract for IDR services. Should a facility request an IDR during this time, two options are available: 1) The department will conduct the IDR conference, or 2) The facility can delay the conference until a permanent solution is determined.

If you have any questions regarding this change in process, please contact Shelly Williamson at Shelly.Williamson@health.mo.gov or at 573-526-4872.

Online Reporting Now Available for Adult Abuse, Neglect and Financial Exploitation

Posted on

In Missouri, during fiscal year 2019, the Department of Health and Senior Services (DHSS) received and investigated 39,144 reports of abuse, neglect, and exploitation involving seniors and adults with disabilities living in the community and in long-term care facilities.

The Department proudly announces the integration of a new online reporting system for mandated reporters which will ensure all concerns of abuse, neglect and financial exploitation of the elderly and adults with disabilities are reported quickly.

The new Adult Abuse and Neglect Hotline online reporting system will allow for secure electronic submission of adult abuse, neglect and exploitation report information, from mandated reporters and public citizens into a secure, encrypted database available 24/7 on a web-based platform as an alternative to calling the Adult Abuse and Neglect Hotline.

We ask all mandated reporters to please partner with us by entering reports online and allowing greater accessibility to the hotline for the public. In partnership, the Department would like to share the Online Reporting Flyer with you and encourage you to display it where it will serve as a reminder to mandated reporters.

The Adult Abuse Hotline is operational from 7 a.m. until midnight, seven days a week, 365 days a year. If you suspect abuse, neglect or financial exploitation of the elderly or an adult with a disability call the Adult Abuse Hotline at (800) 392-0210 or visit www.health.mo.gov/abuse to report online. The online reporting system is available 24/7; however, it is only monitored by intake staff during the hotline’s hours of operation.

If you have any questions regarding online reporting, please reach out to the Department at (573)751-2413 or DSDSOfficeofConstituentServices@health.mo.gov.

CMS Memo: QSO-20-03-NH

Posted on

Updates and Initiatives to Ensure Safety and Quality in Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) is announcing updates and initiatives aligning with the CMS strategic initiative to Ensure Safety and Quality in Nursing Homes. These updates and initiatives include:

  • Phase 3 Interpretive Guidance: CMS will be releasing updated Interpretive Guidance and training for the Requirements for Participation for Long-Term Care (LTC) However, this guidance will not be released by the November 28, 2019 implementation date of the regulations. We will be releasing the guidance in the second quarter of calendar year 2020, along with information on training and implementing related changes to The Long Term Care Survey Process (LTCSP). While the regulations will be effective, our ability to survey for compliance with these requirements will be limited until the Interpretive Guidance is released.
  • Medicare and Medicaid Programs; Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements: On July 18, 2019, the Department of Health and Human Services (HHS) published a final rule establishing requirements related to the use of binding arbitration agreements. This final rule amends the requirements that Long-Term Care (LTC) facilities must meet to participate with Medicare and Medicaid. The final rule can be found at: govinfo.gov/content/pkg/FR-2019-07-18/pdf/2019-14945.pdf
  • Actions to Improve Infection Prevention and Control in LTC Facilities: CMS has created a nursing home antibiotic stewardship program training; updated the Nursing Home Infection Control Worksheet as a self-assessment tool for facilities; and is reminding facilities of available infection control resources.
  • Release of Toolkit 3, “Guide to Improving Nursing Home Employee Satisfaction”: CMS has created a toolkit that helps facilities improve employee satisfaction.

Please see the full memo download at www.cms.gov/updates-and-initiatives-ensure-safety-and-quality-nursing-homes.

Pioneer Network’s Hot Topics: Culture Change in Action

Posted on

November 21, 2019: Creating Daily Pleasures in Outdoor Spaces: Making It Happen in All Seasons
Guide: Maggie Calkins, PhD, EDAC, Ideas Institute

Panelists: Betsy Miller, Director of Resident Services & Hilary Boucher, Life Enrichment Manager, White Horse Village, Newtown Square, PA and Barbra Hileman, Activity Director, Garvey Manor & Our Lady of the Alleghenies Residence, Hollidaysburg, PA

For you and me, spending time outdoors is a normal part of life, and something we miss when weather and circumstances keep us indoors for extended periods of time. But for residents living in nursing homes and assisted living communities, and even for elders living in their own homes, opportunities to enjoy outdoor living are often rare, even in ideal weather, but certainly when conditions are less than ideal due to cold, heat, snow or rain.

In this webinar, Maggie Calkins, will share WHY being able to enjoy time outdoors is important and HOW caregivers and families can support making it happen. She will discuss the health benefits of spending time outdoors in terms of stress, mood, concentration, sleep and more. She will also explore the differences in designing for active and passive use of outdoor spaces and share creative ideas for non-traditional outdoor elements, from green houses to hydroponic gardening to fishing, golfing and yerts.

And then team members from two Communities will share stories of how they are making it happen, how outdoor living is a part of life for the residents in their homes.