CMS Updated Medical Coverage Requirements

The Centers for Disease Control and Prevention (CDC) has issued new recommendations for the pneumococcal vaccine in adults over the age of 65.  The CDC recommends that providers now use two pneumococcal vaccines for adults aged ≥65.  These vaccinations are 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23).  The CDC recommendations are located at www.cdc.gov/vaccines/vpd-vac/pneumo/default.htm.

CMS has updated the Medicare coverage requirements to align with this recommendation.  These Medicare coverage requirements were implemented on February 2, 2015 as posted in the MLN Matters document: MM9051.

Please visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9051.pdf to see that specific MLN Matters document.

CMS has instructed providers to continue to code item O0300 as instructed in the current RAI User’s Manual.

New QIPMO Newsletter – April 2015

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls – Volume 2, Issue 3.  Topics in this issue include MDS Spotlight: Did You Know?; What People are Saying; Validation Reports; IMPACT Act; Nicky Martin’s Questions from the Field; Medication Errors; and Advanced Care Planning.  Please visit QIPMO’s website here for this and other previous newsletters.

Bed Classification Forms – SLCR Process Change

Effective immediately the survey and inspection teams will no longer have facilities complete or verify their Licensed and Certified Bed Classification forms (DA 113) at the time of inspection/survey.  Instead, we will ask facilities to review and verify the accuracy of the most recent approved bed listing that we have on file during the relicensure-application process every two years.  The most recent approved listing will be provided to facilities in their relicensure packet for easy reference.

We hope this change will make it easier to verify the continued accuracy of our records and it will be one less thing to worry about during the onsite survey process for you and our staff.

Cardiopulmonary Resuscitation (CPR) in Nursing Homes – Updated Guidance Clarification Addressing Transportation

 (see bolded, italicized information below)

The Section for Long-Term Care Regulation (SLCR) wants to make certified providers aware that updated guidance from CMS (S&C: 14-01-NH) now requires “certification” of some nursing home staff as part of the nursing home’s compliance with regard to CPR.  Previously, if a question arose during a federal regulatory process regarding whether someone could perform CPR properly, a surveyor may have needed to ask for an explanation of appropriate technique from some available staff member to verify compliance with that requirement, but verifying the certification of a particular staff member typically was not necessary.

This most recent memo states that “certification” of some staff members is mandatory, but the memo does not clarify which certifying agencies are acceptable (i.e., American Heart Association).  SLCR and the Kansas City Regional CMS office requested a clarification of this point.

We have received guidance indicating that the purpose of this memo was to, “…ensure that facilities do not implement facility-wide ‘no CPR’ policies and that facilities have CPR-certified staff available at all times,” but that CMS does not intend to review or approve all certification agencies.

A wide range of organizations offer CPR certification – some are based online and some are conducted in-person.  To this point, CMS has clarified that while S&C: 14-01-NH does not require the use of any specific certifying agency, there are two components that are required with regard to CPR certification:

  • The certification must be designed for healthcare providers (therefore, CPR courses for laypersons which teach chest compressions, but not mouth breathing, are not sufficient); and
  • Nursing home policies should address how staff members should maintain and document their CPR certification.

The American Heart Association certification is acceptable under this guidance, but it is not the only acceptable certification.  Many homes in Missouri are currently obtaining CPR certification through the American Safety & Health Institute (ASHI), which is also acceptable, as are others, as long as they are designed for professional healthcare providers.

In addition, this guidance also applies to nursing home residents who are being transported or accompanied by facility staff to various appointments, outings or events.  Nursing homes will need to ensure that staff who are CPR certified accompany residents during such transports.

You may view the memo here: CMS Memo S&C: 14-01-NH, or visit

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-01.html?DLPage=4&DLSort=2&DLSortDir=descending.

View all CMS Memos at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.

New Generations Quarterly Newsletter – Spring 2014

The Section for Long-Term Care Regulation has published New Generations – Volume 12, Issue 2, Spring 2014.

A complimentary color copy will be distributed via regular mail to each licensed home in Missouri. The spring issue is now available on the Department’s website, along with an archive of previous issues.  Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

MC5 Regional Meetings – May / June 2014

Please visit the Missouri Coalition Celebrating Care Continuum Change (MC5) website at www.momc5.com/regional-meetings.html, or click on the regional area links below.

MAY

May 7, 2014:  Southwest

Webinar #3: Security is More Than an Alarm System

MC5 and Primaris Learning Collaborative

MC5 Southwest May 7, 2014

Location:  The Library Center, 4653 S. Campbell Ave., Springfield, Mo.

 

May 9, 2014:  East

Through the Looking Glass

MC5 East May 9, 2014

Location:  Brentwood Community Center, 2505 S. Brentwood Blvd., Brentwood, Mo.

 

May 20, 2014:  East Central

MDS & QAPI

MC5 and Primaris Learning Collaborative

MC5 East Central May 20, 2014

Location: The Centre, 1200 Holloway Rd., Rolla, Mo.

 

May 21, 2014:  Northwest

Phishing for Memories: Helping Reel in the Catch!

MC5 Northwest May 21, 2014

Location:  East Hills Library, 502 N. Woodbine Rd., St. Joseph, Mo.

 

May 23, 2014:  Poplar Bluff

Person Centered Care in Activities

MC5 Poplar Bluff May 23, 2014

Location: DHSS, 2875 James Blvd., Poplar Bluff, Mo.

 

JUNE 

CENTRAL – Columbia

June 3, 2014:  De Minner will not be able to present “Dementia Care Mapping” on June 3. Culture Change for Surveyors will be presented by DHSS State Culture Change Coordinator Sam Plaster.

Not only is Culture Change the right thing to do, it is required by regulations. Come learn how State long-term care surveyors are taught to apply Culture Change concepts to the regulatory process.

FREE Administrator (2A) and Social Worker CEUs available!

Location: The Neighborhoods by Tiger Place, Community Room, 3003 Falling Leaf Court, Columbia, Missouri. There is no charge to attend, but registration in advance would be appreciated. RSVP to Beth at bbusseau@cmaaa.net or 573-443-5823.

 

SOUTHEAST – Cape Girardeau

June 6, 2014:  Developing Foundational Tools for Change: A Discussion of four Organizational Practices, presented by Julie Ballard, R.N., Director of Culture Change, Health Systems Inc.
This session will focus on lessons learned from the Pioneer Network Learning Collaborative which MC5 participated in over 2012-2013. Many useful tools were created from this Collaborative and are now part of the “Pioneer Network Starter Toolkit: Engaging Staff in Individualized Care.” The four foundational organizational practices of dedicated assignment, huddles, CNAs in care planning, and quality improvement closest to the resident will be highlighted.
FREE Administrator and Social Worker CEUs Available!

Location: Cape Girardeau Public Library, 711 North Clark St., Cape Girardeau, Missouri. RSVP to John Langley at cypress@americareusa.net.

 

NORTH CENTRAL – Chillicothe

June 12, 2014:  Staff Retention and Stability

Presented by Primaris Program Manager Kent McGeeney, LNHA, MPA, MSE.

 

EAST CENTRAL – Rolla

June 17, 2014:  MC5 and Primaris Learning Collaborative – It Takes a Team to Provide High Quality Individualized Care

Utilizing the Pioneer Network National Learning Collaborative Webinar Series on Using MDS 3.0 as an Engine for High Quality Individualized Care.  Monthly meetings will be facilitated by Primaris Program Manager Nursing Home Services Alexis Roam, MSN, RN.

New High School Equivalency is Acceptable Prerequisite to Enroll in CMT Training Programs

January 1, 2014 was the deadline for passing the GED® High School Equivalency (HSE) exam.  The Missouri Department of Elementary and Secondary Education has replaced the GED® with a new HSE exam, the HiSET™.  To learn more about the new exam, please visit http://dese.mo.gov/alrs/hse/.

Regulation 19 CSR 30-84.020 Certified  Medication Technician Training Program (6) (A) 1., indicates that a high school diploma or General Education Development (GED) Certificate is required to be eligible to enroll in the course.  Since the HiSET™ exam has replaced the GED® exam in Missouri, passing the HiSET™ exam is also acceptable.

If you have any questions, please contact the Section for Long-Term Care Regulation, Health Education Unit at 573-526-5686.

End-of-Life Care Manual: Online Questionnaire

A committee has formed to revise and improve the manual titled “Guidelines for End-of-Life Care in Long-Term Care Facilities.”  The current manual is available at http://health.mo.gov/seniors/nursinghomes/lawsregs.php.

The committee values your input!  Would you help to improve this manual by taking a minute to complete a short online questionnaire?  Please visit www.surveymonkey.com/s/MOEOLC.

If you have any questions, please contact Rita Summers, Missouri Long-Term Care Ombudsman Program, at rita.summers@health.mo.gov or 573-751-6335.

Cardiopulmonary Resuscitation (CPR) in Nursing Homes – Guidance Clarification Update

Guidance Clarification Update February 21, 2014

CMS Memo S&C: 14-01-NH

The Section for Long-Term Care Regulation (SLCR) wants to make certified providers aware that updated guidance from CMS (S&C: 14-01-NH) now requires “certification” of some nursing home staff as part of the nursing home’s compliance with regard to CPR.  Previously, if a question arose during a federal regulatory process regarding whether someone could perform CPR properly, a surveyor may have needed to ask for an explanation of appropriate technique from some available staff member to verify compliance with that requirement, but verifying the certification of a particular staff member typically was not necessary.

This most recent memo states that “certification” of some staff members is mandatory, but the memo does not clarify which certifying agencies are acceptable (i.e., American Heart Association).  SLCR and the Kansas City Regional CMS office requested a clarification of this point.

We have now received guidance indicating that the purpose of this memo was to, “…ensure that facilities do not implement facility-wide ‘no CPR’ policies and that facilities have CPR-certified staff available at all times,” but that CMS does not intend to review or approve all certification agencies.

A wide range of organizations offer CPR certification – some are based online and some are conducted in-person.  To this point, CMS has clarified that while S&C: 14-01-NH does not require the use of any specific certifying agency, there are two components that are required with regard to CPR certification:

  • The certification must be designed for healthcare providers (therefore, CPR courses for laypersons which teach chest compressions, but not mouth breathing, are not sufficient); and
  • Nursing home policies should address how staff members should maintain and document their CPR certification.

The American Heart Association certification is acceptable under this guidance, but it is not the only acceptable certification.  Many homes in Missouri are currently obtaining CPR certification through the American Safety & Health Institute (ASHI), which is also acceptable, as are others, as long as they are designed for professional healthcare providers.

You may view the memo here: CMS Memo S&C: 14-01-NH, or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.

New Generations Quarterly Newsletter – Winter 2014

The Section for Long-Term Care has published New Generations – Volume 12, Issue 1, Winter 2014.  This issue is now available on our website, along with an archive of previous newsletters.  Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

MDS and Flu Season

CMS posts the public Quality Measures on Nursing Home Compare, and consumers are able to view the percentage data that your nursing home offered and administered the flu vaccine during the current or most recent influenza season.

The 3.0 Resident Assessment Instrument (RAI) manual does not provide specific dates for influenza season.  This has prompted Missouri facilities to ask what dates are considered the influenza season in Missouri, in order to correctly code the MDS, which will be reflected in their Quality Measures.  Seasonal flu monitoring and reporting to the CDC in Missouri begins in early October and extends well in to the month of May.

For MDS coding purposes, if the resident is not in the facility between October 1 and May 31, you should code in Section O:  “Resident not in facility during this year’s flu season.”  For residents who are in the facility from October 1 through the last week of May, the facility is required to offer the flu vaccine as long as it is “reasonably available,” which means that it is still available to be ordered from your local pharmacy or supplier.

If you have any questions, you may contact Joan Brundick, State RAI Coordinator, at 573-751-6308 or email joan.brundick@health.mo.gov.

Health Advisory: pH1N1 Influenza

Health Advisory:  Pandemic pH1N1 Virus-Associated Illnesses and the Influenza Season in Missouri (12.26.13)

CDC Health Advisory:  Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season (12.24.13)

Health Alerts, Advisories, and Updates are available on the Department of Health and Senior Services website.  For the most current information, please visit: http://health.mo.gov/emergencies/ert/alertsadvisories/index.php.

Flu Season is Here

Homes are required to offer the flu vaccine to all of their residents.  Vaccination of your healthcare workers, although not mandated, is also important in preventing the spread of flu in your home.  Encouraging your staff to receive the vaccination can also help reduce absenteeism due to illness and reduce the costs of care associated with ill residents. 

Flu season information is available on the CDC website at www.cdc.gov/flu/index.htm.

Safety Reminders: Holiday Decorations

It is that time of year when people are decorating their homes and businesses with festive décor and anticipating upcoming holiday celebrations.  Residents and staff in your care home also look forward to festivities and enjoy holiday decorations.  It is important for residents, staff and visitors to carry on traditions and to feel a sense of joy and peace we all want this time of year.

The Section for Long-Term Care Regulation (SLCR) wants to help you and your residents have a safe holiday season by sending out the following safety tips, references and regulatory reminders.

Fires or other accidents are not something anyone wants! 

Safe decorations include:

  • Artificial Christmas trees, and decorations that are non-combustible or flame retardant.
  • UL approved decorative lighting (use in supervised areas and turn off when not in use).
  • UL approved outdoor lighting.
  • Holiday decorations, including evergreen wreaths, ornaments, photos, etc. can be used on resident’s doors, and in hallways, as long as they do not exceed 3 ½” in depth and they are not blocking the entrances or exits.*

*Any combustible decorations hung from doors or walls in corridors may be used with a waiver.  Non-rated combustible decorations cannot exceed 20% of the wall space in an exit egress corridor.

SLCR published an article regarding holiday decorating in the winter 2011 edition of the quarterly newsletter.  Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

Although the 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) is the official reference, the 2012 Edition contains some less restrictive requirements.  Please refer to the CMS memo regarding waivers here: CMS Memo S&C 13-58-LSC 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) Waivers, or visit the CMS website at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.

Prohibited decorations include displays, hangings, and other decorations that block exits, visibility of exits, or fire protection appliances.  Never hang decorations from fire sprinkler heads or pipes.

NFPA 101, Section 19.7.5.4:  Combustible decorations shall be prohibited in any health care occupancy unless they are flame retardant.

NFPA 101, Section 7.1.10.1:  Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency.

NFPA 101, Section 7.1.10.2.1:  No furnishings, decorations, or other objects shall obstruct exits, access thereto, egress therefrom, or visibility thereof.

 

Please note, some county or city local ordinances may also require compliance with more restrictive standards, including the International Fire Code (IFC).

 

  • F323:  Electrical Safety – Any electrical device, whether or not it needs to be plugged into an electric outlet, can become hazardous to the residents through improper use or improper maintenance.  Electrical equipment such as electrical cords can become tripping hazards.  Halogen lamps or heat lamps can cause burns or fires if not properly installed away from combustibles in the resident environment.  The Life Safety Code prohibits the use of portable electrical space heaters in resident areas.

 

 

  • Can candles be used in nursing homes under supervision, in sprinklered facilities?

CMS Memo S&C-07-07:  Nursing Home Culture Change Regulatory Compliance Questions and Answers

Answer: Regarding the request to use candles in sprinklered facilities under staff supervision, National Fire Protection Association data shows candles to be the number one cause of fires in dwellings.  Candles cannot be used in resident rooms, but may be used in other locations where they are placed in a substantial candle holder and supervised at all times while they are lighted.  Lighted candles are not to be handled by residents due to the risk of fire and burns.

This holiday season, consider using battery-operated flameless candles.  They look and smell real!  Learn more about candle fire safety from the U.S. Fire Administration at www.usfa.fema.gov/citizens/home_fire_prev/holiday-seasonal/holiday.shtm.

If you have any questions regarding the Life Safety Code, please contact SLCR at 573-526-8524.  We wish you a wonderful and safe holiday season.

Tuberculin Skin Test Antigen Available – Shortage Resolved

The national shortage of TUBERSOL® used in the administration of PPD tuberculin skin tests appears to be resolved and is now widely available.  Providers should administer PPD tuberculin skin tests that were deferred due to the shortage.  Please make every effort to complete all deferred testing within the next 30 days.  If you are unable to meet this timeframe, please work with your Regional Office to establish an acceptable timeframe to complete your deferred testing.  If you have any questions, you may also contact Joan Brundick at 573-751-6308 or send an email to joan.brundick@health.mo.gov.

posted December 6, 2013

 

The Missouri Coalition Celebrating Care Continuum Change

The Missouri Coalition Celebrating Care Continuum Change (MC5)

by Sam Plaster, State Culture Change Coordinator 

The Patient Protection and Affordable Care Act passed by Congress in 2010 requires that all nursing homes develop Quality Assurance and Performance Improvement (QAPI) programs, ensuring that homes continuously identify and correct quality deficiencies as well as sustain performance improvement.  While the Center for Medicare & Medicaid Services (CMS) has yet to promulgate the specific regulatory requirements, many homes are already initiating or improving their QAPI processes… to read more and view photos click here: MC5