Category: SLCR Guidance

SLCR New Region 7 Manager

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SLCR New Region 7 Manager

The Section for Long Term Care Regulation is pleased to announce that Lisa Sommerhauser will be the new Region 7 Manager. Lisa has a Bachelor Science in Nursing and a Master of Public Health & Certificate in Biosecurity. She has been a registered nurse for over 30 years, has experience in multiple areas of nursing and many years of experience in management and strategic planning. Most recently, Lisa has been a Facility Advisory Nurse with the complaint team in Region 7. Lisa’s first day as the Region 7 Manager will be October 1, 2017. Congratulations, Lisa!

Influenza Vaccination Requirements

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Influenza Vaccination Requirements

There has been legislation passed in the last couple years regarding influenza vaccination requirements.  Homes should be implementing these requirements as applicable.

198.053.  Assisted living facilities, notification of posting of latest Vaccine Informational Sheet. — No later than October first of each year, in accordance with the latest recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, each assisted living facility, as such term is defined in section 198.006, shall notify residents and staff where in the facility that the latest edition of the Vaccine Informational Sheet published by the Centers for Disease Control and Prevention has been posted. Nothing in this section shall be construed to require any assisted living facility to provide or pay for any vaccination against influenza, allow the department of health to promulgate any rules to implement this section, or cite any facility for acting in good faith to post the Vaccine Informational Sheet.

198.054.  Influenza vaccination for employees, facilities to assist in obtaining. — Each year between October first and March first, all long-term care facilities licensed under this chapter shall assist their health care workers, volunteers, and other employees who have direct contact with residents in obtaining the vaccination for the influenza virus by either offering the vaccination in the facility or providing information as to how they may independently obtain the vaccination, unless contraindicated, in accordance with the latest recommendations of the Centers for Disease Control and Prevention and subject to availability of the vaccine. Facilities are encouraged to document that each health care worker, volunteer, and employee has been offered assistance in receiving a vaccination against the influenza virus and has either accepted or declined.

2017 PROVIDER MEETINGS

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Please plan now to join us for one of the 2017 Annual Long Term Care Provider Meetings.  
Location Flyer – 2017 Provider Meeting Locations Flyer

Region 1 – September 27, 2017 
Region 1 Agenda

Region 2 – October 24, 2017
Region 2 Agenda

Region 3 – October 11, 2017
Region 3 Agenda

Region 4 – October 12, 2017
Region 4 Agenda

Region 5 – October 5, 2017
Region 5 Agenda

Region 6 – October 16, 2017
Region 6 Agenda

Region 7 – October 25, 2017
Region 7 Agenda

 

The Provider Meetings will continue to be held in two sessions, the first session will be for Residential Care Facilities/Assisted Living Facilities, and the second session will be for Skilled Nursing Facilities/Intermediate Care Facilities. This year in order to avoid repetition in the program we will conduct a combined session for all provider types to cover topics of interest relevant to all levels of care. The combined session will run from 10:15 until noon. Registration is not required. CEU’s will be available for Nursing Home Administrators.

 

Presentation handouts – As in previous years, handouts will not be provided at each meeting.  It is your responsibility to print them and bring them to the meeting if you desire.

Most Frequently Cited Deficiencies

Safe and Effective Medication System

Inspecting the Kitchen

Fire Watch

Survey Process/ CMS Updates  UPDATED 10/5/17

Complaints by the Numbers

Emergency Preparedness  UPDATED 10/5/17

EMS – Region 1-Springfield

EMS – Region 2-Cape Girardeau

EMS – Region 3-Independence

EMS – Region 4-St. Joseph

EMS – Region 5-Macon

EMS – Region 6-Jefferson City

EMS – Region 7-Bridgeton

Crimes Against Persons List

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Crimes Against Persons List

  • Crimes Against Persons List

On January 1, 2017, revisions to the Revised Statutes of Missouri (RSMo) resulted in changes to the list of disqualifying crimes.

 

For example:

Involuntary Manslaughter, prior to January 1, 2017, could have been a Class A or B felony under Chapter 565, making it a disqualifying crime. On January 1, 2017, the classification of Involuntary Manslaughter was changed to a C or E felony, making it no longer disqualifying. Any A or B felony conviction of Involuntary Manslaughter prior to January 1, 2017 remains disqualifying.

 

Criminal Water Contamination was listed as a disqualifying crime in RSMo Chapter 569 prior to January 1, 2017. On January 1, 2017, it was moved to RSMo Chapter 577, making it no longer disqualifying. However, convictions prior to January 1, 2017, remain disqualifying.

 

Because of the potential confusion, SLCR is removing the list of disqualifying crimes from the website. Providers must review the criminal background check to determine if the crime is disqualifying. Disqualifying crimes are any A or B felony violation of Chapter 565, 566 or 569, RSMo, or any violation of subsection 3 of section 198.070, RSMo, or of section 568.020, RSMo.

 

  • Good Cause Waiver

An individual who has been disqualified from employment with any Long Term Care provider type has the right to apply for a Good Cause Waiver (GCW), which, if granted, would not correct or remove the finding, but would remove the hiring restriction and allow the individual to be employed. This includes those individuals who have committed a disqualifying crime and thus have been disqualified from employment in a regulated nursing home. More information about Good Cause Waivers can be found on the DHSS website at:  http://health.mo.gov/safety/goodcausewaiver/.

 

If a provider has a question about a disqualifying crime or Good Cause Waivers, please feel free to contact the Section at 573-522-6228.

IRF, LTCH, SNF QRP: Registration Open for Review and Correct Reports Provider Training – Live Webcast on May 2, 2017

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IRF, LTCH, SNF QRP: Registration Open for Review and Correct Reports Provider Training – Live Webcast on May 2, 2017

CMS is hosting a live webcast for Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs) on Tuesday, May 2, 2017, from 2:00 to 3:30  p.m. ET.

 

This training will assist providers in better understanding how Review and Correct Reports fit within the overall Quality Reporting Programs. Additionally, the training will provide information about re-submitting data to correct errors prior to the quarterly submission deadlines to ensure the accuracy of the data which will ultimately be publicly displayed.

Visit the following webpages for more information and to register:

 

IRF Quality Reporting Training:  https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting/IRF-Quality-Reporting-Training.html

 

LTCH Quality Reporting Training webpage

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Quality-Reporting-Training.html

 

SNF Quality Reporting Training webpage

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Training.html

S&C Memo: 17-25-NH: Electronic Staffing Submission – Payroll-Based Journal Update

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S&C Memo: 17-25-NH: Electronic Staffing Submission – Payroll-Based Journal Update

Memorandum Summary

  • Mandatory staffing data submission through the Payroll-Based Journal began July 1, 2016. Providers are reminded that they have until the 45th day after the end of each quarter to submit data.
  • To help providers improve their submissions, the Centers for Medicare & Medicaid Services (CMS) is providing feedback on each facility’s data through their monthly Provider Preview reports.
  • The Nursing Home Compare website now reflects whether providers have submitted data by the required deadline. Additionally, providers that have not submitted any data for two consecutive deadlines will have their overall and staffing star ratings suppressed.
  • We are updating the data submission requirements related to hire and termination dates, and converting three job codes as optional for submission.

Please see the memo attached for more details or visit https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-17-25.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending.

Farewell to Kristen Edwards

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Farewell to Kristen Edwards

Kristen Edwards has accepted a position outside state government and will be leaving the Section on May 1.  We will definitely miss Kristen and appreciate the fine work she has done for us.  Shelly Williamson will serve as the Section’s Interim Administrator until the position is filled.

New Vulnerable Citizens Services Unit Within Securities Division

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New Vulnerable Citizens Services Unit Within Securities Division

Secretary of State Jay Ashcroft announced that the Securities Division of the Office of the Secretary of State is boosting investor protection and education through the formation of its new Vulnerable Citizens Services unit.

 

Please see the Securities Release attached for more details.

S&C 17-22-ALL: Save the Date- Medicare Learning Network (MLN) Conference Call National Provider Call (NPC) for Emergency Preparedness Requirements for Medicare & Medicaid Participating Providers and Suppliers Final Rule

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S&C 17-22-ALL: Save the Date- Medicare Learning Network (MLN) Conference Call National Provider Call (NPC) for Emergency Preparedness Requirements for Medicare & Medicaid Participating Providers and Suppliers Final Rule

  • The Centers for Medicare & Medicaid Services (CMS) MLN will host a NPC for the Emergency Preparedness Requirements for Medicare & Medicaid Participating Providers and Suppliers Final Rule.
  • The calls are open to providers, suppliers, State Survey Agencies (SAs), Regional Offices (ROs) and the general public.
  • CMS has received multiple requests by providers, suppliers, States and associations to present at annual conferences regarding the new final rule for Emergency Preparedness Requirements for Medicare & Medicaid Participating Providers and Suppliers. Due to the large number of speaking requests, CMS is offering an additional learning session through the MLN. During the additional session, we will provide an overview of the final rule and discuss the requirements for meeting the training and testing requirements by the implementation date of November 15, 2016.

Date: Thursday, April 27, 2017

Time: 2:30pm-3:30pm ET

Topic: Review of provisions and focus on Training and Testing Requirements

 

Please see the attached memo or you may visit https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-17-22.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending.

S&C 17-21-ALL: Information to Assist Providers and Suppliers in Meeting the New Training and Testing Requirements of the Emergency Preparedness Requirements for Medicare & Medicaid Participating Providers and Suppliers Final Rule

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S&C 17-21-ALL: Information to Assist Providers and Suppliers in Meeting the New Training and Testing Requirements of the Emergency Preparedness Requirements for Medicare & Medicaid Participating Providers and Suppliers Final Rule

  • Information for Implementation: The Centers for Medicare & Medicaid Services (CMS) is providing information to assist providers and suppliers in meeting the Training and Testing requirements of the new Emergency Preparedness Final Rule that was published on September 16, 2016 (81 FR 63860) and became effective on  November 15, 2016.

 

Please see the S&C attached or you may visit https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-17-21.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending.

 

NFPA Notes

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NFPA Notes

All areas of the building shall be accessible:  All areas of the facility must be accessible during all shifts by the charge nurse (or another designated staff, i.e. security) so that in the case of a fire, staff (including emergency response staff) can find and fight the fire (when possible). Reports show that recently facilities in varying areas of the country have had fires in areas that were locked (such as laundry rooms or the kitchen) during the evening/night shifts. When the fire alarm system sounded, staff did not have a key accessible to gain entry into the locked areas causing a delay in the response time.

 

  • NFPA 2012 101, 19.7.2.1.1

For health care occupancies, the proper protection of patients shall require the prompt and effective response of health care personnel.

 

  • NFPA Standard: 2012 NFPA 101, 19.1.1.3.1

All health care facilities shall be designed, constructed, maintained, and operated to minimize the possibility of a fire emergency requiring the evacuation of occupants.

 

  • NFPA 101 2012, 4.8.2.1

Emergency plans shall include the following:

(1) Procedures for reporting of emergencies

(2) Occupant and staff response to emergencies

(3) Evacuation procedures appropriate to the building, its occupancy, emergencies, and hazards (see Section 4.3)

(4) Appropriateness of the use of elevators

(5) Design and conduct of fire drills

(6) Type and coverage of building fire protection systems

(7) Other items required by the authority having jurisdiction

 

  • NFPA 2012 101, 7.2.1.1.3.2

Where means of egress doors are locked in a building that is not considered occupied, occupants shall not be locked beyond their control in buildings or building spaces, except for lockups in accordance with 22.4.5 and 23.4.5, detention and correctional occupancies, and health care occupancies.

Fire Reporting

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Fire Reporting

19 CSR 30-85.022 (2) (F) for Skilled Nursing Facilities/Intermediate Care Facilities (SNFs/ICFs) and 19 CSR 30-86.022 (2)(C) for Residential Care Facilities (RCFs) and Assisted Living Facilities (ALFs) require that all facilities shall notify the department immediately after the emergency is addressed if there is a fire in the facility or premises and shall submit a complete written fire report (attached) to the department within seven (7) days of the fire, regardless of the size of the fire or the loss involved.

 

The Section for Long-Term Regulation defines fire as used in relation to fire/safety requirements as follows:  Fire is the active principle of burning, characterized by combustion.  This energy is evident when heat and/or smoke and/or light are present as the result of combustion.  Smoke is a product of combustion, and any time smoke is given off, combustion has occurred whether or not there has been a visible flame. Besides the obvious, some often-overlooked examples of fire include but are not limited to the following:

  • Smoking air conditioner unit or heater (whether or not the fire department responded);
  • Smoking pads or mop heads in the dryer (whether or not the fire department responded); and
  • Smoking trash in a waste receptacle (whether or not the fire department responded).

 

The facility submitted fire report must include the following:

  • A brief narrative of the event in the comments section of the report or in an attachment;
  • Documentation regarding whether or not the fire alarm and/or sprinkler system activated (if applicable) and if/when the system was back in service (if applicable);
  • In addition, the narrative must show whether or not fire extinguishers were used, and if so, when they were recharged or replaced;
  • A copy of the fire department report if the fire department responded; and
  • If a fire can be attributed to a particular person, the report must include identifying information for that person.

Expiring Administrator Licenses

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Expiring Administrator Licenses

Administrator licenses expiring June 30, 2017 are up for license renewal. License renewal notifications were sent via email to the email address on file. Please note that once the renewal is complete, an electronic license will be issued via email. The Board office will no longer mail paper licenses.

 

Please visit the Missouri Board of Nursing Home Administrator’s web page for the renewal instructions and renewal application at http://health.mo.gov/bnha. Remember to notify the Board office at BNHA@health.mo.gov with changes in your contact information, especially the email address.

Regulation Unit: Exceptions & Second Businesses – Email Correspondence

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Regulation Unit: Exceptions & Second Businesses – Email Correspondence

The  Regulation Unit is issuing all approval letters, approval certificates, reminder letters, and any other correspondence related to exceptions and second businesses via email. This email process will be the primary mode of communication, when possible. The Regulation Unit staff will contact facility administrators/operators to obtain a viable email address in order to issue correspondence by email. Original approval letters/certificates will no longer be mailed.

 

For approvals received via email, the facility administrator/operator must complete the following for:

  • Exception approval letters/certificates: Facility administrators/operators must print the approval certificate and post it alongside the facility license as required by regulation.  The approval letter must be made available to SLCR staff, upon request. 

 

  • Second business approval letters: Facility administrators/operators must make the approval letter available to SLCR staff, upon request.

 

Should you have any questions about this process, please contact the Regulation Unit at (573) 526-8523 or email RegulationUnit@health.mo.gov.

HHS OIG Hotline Scam

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HHS OIG Hotline Scam

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently confirmed that the HHS OIG Hotline telephone number is being used as part of a telephone spoofing scam targeting individuals throughout the country. These scammers represent themselves as HHS OIG Hotline employees and can alter the appearance of the caller ID to make it seem as if the call is coming from the HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477). The perpetrator may use various tactics to obtain or verify the victim’s personal information, which can then be used to steal money from an individual’s bank account or for other fraudulent activity. HHS OIG takes this matter seriously. We are actively investigating this matter and intend to have the perpetrators prosecuted.

 

It is important to know that HHS OIG will not use the HHS OIG Hotline telephone number to make outgoing calls and individuals should not answer calls from 1-800-HHS-TIPS (1-800-447-8477). We encourage the public to remain vigilant, protect their personal information, and guard against providing personal information during calls that purport to be from the HHS OIG Hotline telephone number. We also remind the public that it is still safe to call into the HHS OIG Hotline to report fraud.  We particularly encourage those who believe they may have been a victim of the telephone spoofing scam to report that information to us through the HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477) or spoof@oig.hhs.gov. Individuals may also file a complaint with the Federal Trade Commission 1-877-FTC-HELP (1-877-382-4357).

 

More information is available on the OIG Consumer Alerts webpage.

Licensure and Certification Unit Update

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Licensure and Certification Unit Update

Effective immediately the Licensure and Certification Unit will be conducting business primarily by email. Licensure and Certification Unit staff will be contacting facilities and/or operators to obtain email addresses. Items that will be emailed to providers include the facility license, relicensure application reminder letters, and any other correspondence when possible. Facility administrators/operators shall print the facility license and post as required in Chapter 198.015.5, RSMo., “Licenses shall be posted in a conspicuous place on the licensed premises”, as copies will not be mailed. If you have any questions about this process, please email ltcapplication@health.mo.gov.

CMS Direction Regarding IDR’s

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CMS Direction Regarding IDR’s

The Section for Long Term Care had a conversation with CMS in 2016 regarding the IDR/IIDR Review Release Process. CMS Regions V and VII recently provided guidance on this topic. The Missouri IDR process for certified homes has been to send the Primaris decision letter along with our own letter upon review and completion of the IDR process. We have been instructed by CMS that the third party (Primaris) decision and rationale can no longer be shared with the providers. Following is an excerpt of this guidance. The S&C referenced below is attached for your review.

 

S&C Memo 12-08-NH provided Interim Advance Guidance for IIDRs and provided some information that is one of the bases for our decision to take this approach: “[T]he documents and written report created by the Independent IDR entity, the State and CMS, other than the final decision of the Independent IDR process, are pre-decisional and deliberative, and therefore are protected from disclosure under the deliberative process privilege. See EPA v. Mink, 410 U.S. 73, 88 (1973); see also 5 U.S.C. § 522(b)(5) (inter-agency and intra-agency memoranda and letters generated before adoption of final agency policy or decision are protected from disclosure under Exemption 5 of the Freedom of Information Act).” (Please note the correct U.S. Code citation is actually 5 U.S.C § 552(b)(5).) Therefore, CMS asserts this privilege to not disclose documents used in our deliberative processes. Although the quoted language from the S&C Memo is not in SOM Chapter 7, the rationale remains sound.

 

We have communicated with the IDR Contractor about this change. Primaris will no longer prepare a letter to the provider and will simply provide their decision and rationale through memo format. Our office will continue to review the Primaris information and prepare a letter to the providers with the final decision.  The Section will then forward the SLCR Decision letter to the provider. At no time can we disclose the Primaris decision and rationale. This change applies only to certified facilities. The process will not change for those facilities that are state-licensed only.

2017 Annual Provider Meetings Input

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2017 Annual Provider Meetings Input

It’s a new year and your 2017 Provider Meetings are already in the works!  The Quality Assurance and Education Unit staff are currently in the planning phase and are considering the best topics to provide the most beneficial information.  We would like to hear from you about what LTC related topics you believe would be helpful, informative, and  ‘worth the drive’.  If you’ve also been thinking- Gee I wish they would do a presentation on……., then you are cordially invited to be part on our planning team!  Please feel free to forward your suggestions to:

Emergency Protocol Update/Reminder

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Emergency Protocol Update/Reminder

SLCR developed a protocol for communication between long-term care homes and the Section for Long-Term Care Regulation (SLCR), in the event a disaster occurs that results in a loss of a necessary service (electricity, water, gas, telephone, etc.). This protocol was established to streamline communication so that homes can focus on what is most important – the safety and well-being of the residents.

 

The phone number for Region 5 (Macon) has changed. This is the only change to the document attached.