CNA Upcoming Testing

The following are updated CNA Testing sites.

Note: These are not the only test sites available. Please contact Headmaster D&S if you are need a different testing location.

Headmaster D & S: 1-800-393-8664 – Please ask for the Missouri Team!

All Regional dates are viewable on the online calendar at https://mo.tmutest.com/calendar.

To help with scheduling your testing event, contact Headmaster a few days after the CNA course starts.

Gladstone

      • March 24
      • April 7
      • April 17
      • April 21
      • April 28

St John/ St. Louis Area

      • April 9
      • April 12
      • April 23

Bolivar

      • March 23

Kirkwood

      • March 24

Kansas City

      • March 21
      • March 24
      • March 25
      • March 29
      • March 31
      • April 1

Trenton

      • April 13
      • May 14

Medicaid Resource (Spend-Down) Limit

The Medicaid Resource (Spend-Down) Limit has been increased to $5,035 as of 07/01/21. Please see the link https://dssmanuals.mo.gov/wp-content/uploads/2018/10/appendix_j.pdf.

F569 states the facility must notify each resident/legal guardian that receives Medicaid benefits when the amount in the resident’s account reaches $200 less than the SSI resource limit.

The current $200 amount would be at $4,835 or higher.

Feel free to contact Lynn Gilmore, Lead Auditor, at 573-508-4150 if you have any questions.

New Updates to the Headmaster Student Handbook and Mock Skills for CNA Testing

Please see the updated Headmaster Student Handbook and Mock Skills including key step changes for those students testing March 15, 2022 and after.

Please visit Headmaster’s website for those changes at https://hdmaster.com/testing/cnatesting/missouri/MO_CNA_Home.htm.

For questions regarding the changes, please call the Health Education Unit at 573-526-5686 or email us at CNARegistry@health.mo.gov. You may also call Headmaster and ask for the Missouri Team at 1-800-201-0462.

Governor Parson Announces Paula Nickelson to Lead Missouri Department of Health and Senior Services

During a press conference at the State Capitol, Governor Mike Parson announced that he has selected Paula Nickelson to serve as the Acting Director of the Missouri Department of Health and Senior Services (DHSS), effective March 1, 2022.

“Today, we are excited to announce Paula Nickelson as the new DHSS Acting Director,” Governor Parson said. “Paula was a key player in Missouri’s COVID-19 response efforts and has been a valued member at DHSS for more than 22 years. We are confident in her abilities and proud to welcome her to our Cabinet as we move forward from the COVID pandemic and prepare for what comes next in public health.”

Nickelson, a Missouri native, has served within DHSS for more than 22 years and has a distinguished career in public health and health care management. For most of her time with the Department, she has been a leader in several program areas, including maternal-child health, chronic disease prevention, and emergency preparedness and response.

Nickelson was also involved in the state’s H1N1 response and planning efforts following the 9/11 attacks. Most recently, she was instrumental in a number of COVID-19 response efforts.

Over the past two years, Nickelson has put her vast experience to work as a reliable, calming, and realistic leader to implement game-changing solutions during COVID-19. She helped establish the state’s first PPE warehouse, led an interagency team that implemented the “box it in” COVID mitigation strategy for long-term care facilities, oversaw the state’s antigen testing program, and led the implementation of the state’s decontamination system for N95 masks for health care workers when resources were still scarce.

Nickelson also developed strategies to establish state-funded monoclonal antibody infusion sites and was part of the team responsible for providing health care staffing support during two separate occasions.

“It is a great privilege to be asked to lead the Missouri Department of Health and Senior Services,” said DHSS Acting Director Paula Nickelson. “I am committed to enhancing our collaborative work with our local public health partners, our health care and behavioral health partners and all community partners. We will be focusing on the state’s leading causes of morbidity and mortality; prioritizing health equity; and ensuring updated data systems, performance management, and operational excellence tools are in place so we can serve Missourians in the best ways possible.”

Nickelson earned a Bachelor of Science in psychology from the University of Central Missouri and a Master of Education in counseling psychology at the University of Missouri-Columbia.

COVID-19 Reporting Changes

Effective 2/26/2022, facilities (RCF, ALF, SNF, ICF, and ICF-IID) no longer need to report the aggregate number of residents and staff tested during outbreak testing to the DHSS redcap portal. Below is a chart which outlines current reporting requirements.

 

Reporting Process/Form

System

Purpose/Description

Required?
For Whom?

Time Frame

1

Electronic COVID-19 Case Reporting

REDCap: DHSS

Reporting form for all positive case results, including staff and residents. This includes POC and PCR testing.**

Yes, for all SNF, ICF, RCF, ALF, ICF-IID and Adult Day Care

Within 24 hours of positive result

2

NHSN LTCF COVID-19 Module

Web Portal: Managed by NHSN

NHSN-required fields solely for certified nursing homes (SNF/NFs).

Yes, for all certified SNF/NF. Voluntary for any state licensed only facility (RCF/ALF/Adult Day Care) or ICF-IID.

Weekly, with a preference for submission on the same day each week

3

NHSN Point of Care Laboratory Reporting Tool

Web Portal: NHSN

POC test reporting that includes both positive and negative POC test results (even if potentially a false positive).

Yes, for any facility not reporting to DHSS in Row 4

Within 24 hours of result of POC test

4

Electronic COVID-19 Laboratory Reporting

Secure File Transfer/CSV file: DHSS

POC test reporting that includes both positive and negative POC test results (even if potentially a false positive).

Yes, for any facility not reporting to NHSN in Row 3

Within 24 hours of result of POC test

 

**Effective 2/25/2022, the Electronic COVID-19 Case Reporting System now requires entry of laboratory (testing) information when Positive Test for COVID-19 is selected as the Reason for Reporting. This change will allow for the data to more easily be ingested into Epitrax and readily available to Local Public Health Agencies- reducing follow-up contacts and calls to facilities to obtain the information.

 

CMP Applications for Portable Fans and Portable Room Air Cleaners

CMS has authorized the use of federal Civil Money Penalty (CMP) Reinvestment funds to purchase portable fans and portable room air cleaners with high-efficiency particulate air (HEPA, H-13 or – 14) filters to increase or improve air quality. A maximum use of $3,000 per facility including shipping costs may be requested. This opportunity is for facilities certified to participate in the Medicare and/or Medicaid programs. Since these are federal CMP funds, Residential Care and Assisted Living Facilities may not apply.

COVID-19_In-Person Visitation Application FAQ
COVID-19_In-Person Visitation Application Template

Please send completed applications to slcrcmp@health.mo.gov.

COMRU Upcoming Q & A Sessions

Please join COMRU (Central Office Medical Review unit) for a Q & A session via WebEx.

February 18, 2022
Time: 10:00 a.m.

Meeting number (access code): 2460 218 4769
Meeting password: MfVVW7asP23

Join from the meeting link: https://stateofmo.webex.com/stateofmo/j.php?MTID=m39c2a820985815deeedb03d8a797224d

Join from a video system or application: Dial 24602184769@stateofmo.webex.com

You can also dial 173.243.2.68 and enter your meeting number.

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CNA Testing Events

Needing to schedule a CNA test? The following are dates and locations are already set. Please call Headmaster to register.

February 12, 2022: Cape Girardeau
February 14, 2022: Farmington (opens to public 48 hours prior)
February 17, 2022: Macon
February 19, 2022: St. Charles Community College (opens to public 48 hours prior)
February 22, 2022: Friendship Village, St. Louis
March 7, 2022: Nichols Career Center, Jefferson City
March 9, 2022: North Central College, Trenton
April 4, 2022: Nichols Career Center, Jefferson City
May 9, 2022: Nichols Career Center, Jefferson City

Other dates and locations may be available. Please call Headmaster at 1-800-393-8664 and ask for the Missouri Team.

State Antigen Testing Supply Portal Re-Opening Soon –

Please Read Information Below Carefully!

The Missouri Department of Health and Senior Services (DHSS) is pleased to announce that effective Thursday, February 10, 2022 at 8:00 a.m., we are reopening our antigen testing program! As you are aware, due to a nation-wide shortage of antigen tests and issues with receipt of tests from our distributor, it was necessary for us to suspend that program indefinitely in early January. For awareness, although Friday, February 11, 2022 is a state holiday, we will be accepting requests for tests, but no tests will be shipped on that day.

We have subsequently identified two distributors with adequate supply of ACON Flow Flex rapid antigen tests to allow us to reopen our antigen testing program. Information about ACON Flow Flex can be found here.

The transition to this different rapid antigen test requires the establishment of a new state-wide CLIA (although organizations with their own CLIA can continue to use their own) and thus verification of locations of testing and validation of training of all test administrators. Thus, it is not possible to simply transition existing BinaxNOW users to ordering for ACON Flow Flex – all existing users will need to re-apply to receive ACON Flow Flex, take the required training and provide verification of that training, resubmit a test plan inclusive of the infectious waste disposal plan, and provide the locations of testing in order to be approved to receive tests. Note: For organizations using their own CLIA, please be sure to add ACON Flow Flex to your CLIA waiver by contacting the state CLIA program (see additional information below).

New standing physician’s orders specific to ACON Flow Flex have been established for all tests users previously under a DHSS standing physician’s order. These new orders are available at: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php.

The DHSS Rapid Antigen Test Kit Application and Resource web page includes the initial application and a subject index to answer questions we received during the previous distribution of antigen tests. The page also provides information about where to direct specific questions that test users may encounter. If a test user is unsure of where to direct a question, please contact antigentesting@health.mo.gov.

The DHSS Rapid Antigen Test Kit Application and Resource Page for ACON Flow Flex will be open effective 8:00 a.m. on Thursday, February 10, 2022 at: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php.

Thank you for your continued work to fight COVID!

 

Adding ACON Flow Flex to Your CLIA Test Menu

The CLIA program has developed an email template that you can copy and paste, fill in the blanks, and email to CLIA@health.mo.gov to update your test menu to include ACON Flow Flex.

Email Subject line: Add COVID-19 Testing to existing CLIA Certificate for [FACILITY NAME]

Lab/Facility Name:  
Existing CLIA Waived Lab #:  
Lab Director Name:  
Which COVID-19/ SARS-CoV-2 Waived Test system added?
Check [X] all that may apply.

[    ] Abbott BinaxNOW COVID-19 Ag Card
[    ] Acon FlowFlex
[    ] Quidel Sofia 2 SARS-CoV-2 Antigen assay
[    ] Becton Dickinson Veritor™ Plus Antigen test kit
[    ] Abbott ID Now
[    ] OTHER Waived test(s) approved by FDA EUA (specify below):

As the Laboratory Director or administrator/owner’s agent of record for the CLIA facility holding a Waived Certificate identified above, I wish to append my facility’s existing CLIA# to include additional testing for COVID-19. I attest that my facility will provide reasonable assurances that:

  • All testing personnel for COVID-19 will be provided adequate and documented training
  • All Manufacturer’s Instructions for Use (IFU) will be strictly adhered to

All tests results (both positive and negative) will be reported to the proper public health entities under federal and state requirements. See MO DHSS link regarding reporting: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/how-to-report-lab-results.php

Updated CDC Guidance

On February 2, 2022, CDC updated the following healthcare infection prevention and control (IPC) guidance documents: Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC and Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes | CDC.

Updates were made in these guidance documents to align with prior updates made for healthcare personnel with higher-risk exposures in the Interim Guidance for Managing Healthcare Personnel with SARS-COV-2 Infection or Exposure to SARS-CoV-2, which was released on December 23, 2021.

A review of the updates was given on a recent Clinician Outreach and Communication Activity (COCA) Call, which was recorded and is accessible here: Webinar January 13, 2022 – Updates to CDC’s COVID-19 Quarantine and Isolation Guidelines in Healthcare and Non-healthcare Settings. Additionally, a brief summary of the updates can be found below. Please consult the guidance documents for the full recommendations.

Vaccination status

Use of N-95 respirators

*Please see complete guidance for full personal protective equipment recommendations

  • CDC continues to recommend gown, gloves, eye protection and a NIOSH-approved N95 or equivalent or higher-level respirator when caring for patients known or suspected to be infected with SARS-CoV-2.
  • In counties with substantial to high community transmission, a NIOSH-approved N95 or equivalent or higher-level respirator is also recommended instead of a facemask when caring for patients not known or suspected to have SARS-CoV-2 infection in the following higher-risk situations:
    • All aerosol-generating procedures;
    • Higher-risk surgical procedures;
    • These respirators can also be used by HCP in situations where additional risks for infection are present, such as caring for a patient who is not up to date with all recommended COVID-19 vaccine doses, the patient is not able to wear source control, and the area is poorly ventilated. They may also be used if healthcare-associated SARS-CoV-2 transmission is identified.

 Viral testing

  • CDC continues to emphasize that anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test as soon as possible.
  • Asymptomatic patients with close contact with someone with SARS-CoV-2 infection, regardless of vaccination status, should have a series of two viral tests for SARS-CoV-2 infection.
    • Generally, test immediately (but not earlier than 24 hours after the exposure) and, if negative, again 5-7 days after the exposure.
  • Testing is not generally necessary for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 90 days; however, if tested, an antigen test instead of a nucleic acid amplification test (NAAT) is recommended as some people may remain NAAT positive after they are no longer infectious.

Criteria to end isolation for patients with SARS-CoV-2 infection cared for in a healthcare facility

  • Asymptomatic patients or those with mild to moderate illness and who are not moderately to severely immunocompromised: manage with recommended precautions for 10 days after their symptoms first appeared.
  • Patients with severe to critical illness and who are not moderately to severely immunocompromised: manage with recommended precautions until at least 10 days and up to 20 days have passed since symptoms first appeared.
  • Symptomatic and asymptomatic patients who are moderately to severely immunocompromised: a test-based strategy and (if available) consultation with an infectious disease specialist or other expert is recommended to determine when these patients can be released from isolation.

Quarantine for patients:

  • Empiric use of Transmission-Based Precautions (quarantine) is recommended for patients who have had close contact with someone with SARS-CoV-2 infection if they are not up to date with all recommended COVID-19 vaccine doses. Duration of quarantine is described in the guidance.
  • Quarantine is not generally needed following close contact with someone with SARS-CoV-2 infection for asymptomatic patients who are up to date on all recommended COVID-19 vaccine doses or who have recovered from infection in the prior 90 days. Potential exceptions are described in the guidance.

Visitation

  • Even if they have met community criteria to discontinue isolation or quarantine, visitors should not visit if they have any of the following and have not met the same criteria used to discontinue isolation and quarantine for patients (typically until 10 days after last exposure or onset of symptoms has passed):

1) A positive viral test for SARS-CoV-2,
2) Symptoms of COVID-19, or
3) Close contact with someone with SARS-CoV-2 infection

  • If visitation cannot be postponed the visitor might be subject to additional precautions.

This guidance on infection prevention and control will continue to be refined as additional information becomes available.

Life Support and Life Safety Code

There has been some confusion about the definition of “life support”, specifically related to the type of generator required. Life support refers to any function performed by equipment, which if stopped, could result in loss of human life or serious injuries. NFPA 99, 2012 edition: 3.3.42 defines Electrical Life Support Equipment as an electrically powered equipment whose continuous operation is necessary to maintain a patient’s life.

Life support is not limited to a ventilator. For example, it can be a BiPAP or suctioning machine. Facility staff should receive clarification from the physician prior to admission as to whether or not the equipment is necessary to maintain the resident’s life.

If a facility accepts a resident who requires life support, it is important to ensure all the following requirements are met per NFPA 99 and 110:

  • The facility must have a definition of life support;
  • The admission agreement must state the facility will accept a resident on life support;
  • The generator must comply with the standards of a Type 1 Essential Electrical System (ESS) (a Type 1 EES has the most stringent requirements for providing continuity of electrical service – the Acceptance Testing paperwork will show the type), complying with the National Fire Protection Association (NFPA);
  • Testing and maintenance must be maintained as outlined in the NFPA;
  • Depending on the generator, the power must be split into two or three branches, that would include critical care, life safety and mechanical;
  • There must be plans to show which rooms/areas are supported by the life support electrical system;
  • All outlets must be marked (such as a red outlet cover) to show which plugs will support life support functions.

NFPA 110, 2010 edition:

4.4-Level. This standard recognizes two levels of equipment installation, performance, and maintenance.

4.4.1-Level 1 systems shall be installed where failure of the equipment to perform could result in loss of human life or serious injuries.

4.4.2-Level 2 systems shall be installed where failure of the EPSS to perform is less critical to human life and safety.

4.4.3-All equipment shall be permanently installed.

K915

 Electrical Systems – Essential Electric System Categories

Critical care rooms (Category 1) in which electrical system failure is likely to cause major injury or death of patients, including all rooms where electric life support equipment is required, are served by a Type 1 EES.

CNA Upcoming Q & A Sessions

Please join the Health Education Unit and Headmaster D&S for a Q & A session via WebEx.

February 24, 2022
Time: 3:00 p.m.

Meeting number (access code): 2469 473 6547
Meeting password: XmZzZpGU333

Join from the meeting link: https://stateofmo.webex.com/stateofmo/j.php?MTID=m435f25d8d4673f8a5751b9a947ca7d99

Join from a video system or application: Dial 24694736547@stateofmo.webex.com

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March 2, 2022
Time: 10:00 a.m.

Meeting number (access code): 2461 178 6617
Meeting password: 8PrkA9XGZD6

Join from the meeting link: https://stateofmo.webex.com/stateofmo/j.php?MTID=m2652b2befd6a4e2b64bf3da2581863b3

Join from a video system or application: Dial 24694736547@stateofmo.webex.com

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**Winter Weather Planning**

Snow and ice are a mainstay of Missouri winter weather. Because of the variety of weather conditions as well as other events, facilities must have an emergency preparedness plan and be ready to act in an emergency to ensure they are to adequately prepared to meet the needs of patients, clients, residents, and participants during disasters and emergency situations.

If your facility experiences a loss of a necessary service (electricity, water, gas, phone, etc.), contact SLCR via the Regional Office emergency phone line and keep them informed of their status. If, for some reason, the facility cannot contact SLCR staff through the regional office phone number, you should contact the hotline. The emergency protocol is located here.

 When you call, be prepared to answer to the following:

 Facility name

    • Census, including staff assessment of current needs of the residents and monitoring of the ill.
    • Contact person and emergency contact number that is not the facility main line.
    • Has the facility called the fire department and central monitoring company if phones, alarm systems are down?
    • Generator: Y/N
      • If yes, what equipment does the generator serve (fire alarm, HVAC systems)?
      • If yes, amount of fuel onsite and/or system for delivery? How long will fuel last?
      • If no, what is fire watch plan?
      • If no, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner?
        • Obtain generator- is the home set up to receive generator power once delivered? Estimated time for delivery? Estimated time when generator power will be established.
        • Evacuation- Where is facility relocating to, distance from facility, transportation to get there, staffing, sufficient supplies/medications, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner (does the location have a functional emergency generator?) If relocating to a SNF – will the home be over capacity? Is there sufficient beds/space in the receiving facility to house the extra residents?
      • Documentation may be requested, including:
        • If evacuated, a list of residents and were they went
        • Room temperature logs
        • Fire watch documentation

 

Here are a few things to consider in examining your emergency preparedness plan, specifically as it relates to snow, ice, and power outages.

  • If there is a loss of the primary power, how will the facility ensure adequate temperatures of the facility will be maintained during the emergency situation?
  • Is the plan feasible?
    • Plan for the worst. Most events do not occur on a sunny Tuesday afternoon and the plan should account for things such as poor weather, road conditions, weekends/holidays, evenings, staff ability to travel to work, and other obstacles that may cause issue during the actual emergency.
  • Are staff knowledgeable of the plan and have access to what is needed in order to implement the plan?
    • Phone numbers, contact persons, contracts.
  • Do staff know what to do during an emergency and know who is in charge? If the administrator is not onsite, who is in charge and does that person know all their duties?
    • This may be the DON, but it may also be a charge nurse (or another designated onsite staff)if the event happens in the “middle of the night”. Depending on when the administrator or someone higher up on the order of succession can arrive at the facility, that person (i.e. night charge nurse) may be in charge for an extended amount of time.
  • Is the plan detailed enough?
    • Is there a detailed plan that describes when the residents will evacuate during an emergency? If loss of power, does the plan instruct the staff to start the evacuation prior to the point when the facility is below appropriate air temperatures and to maximize their safety during travel? What is the distance to the emergency evacuation site? What types of roads do they have to traverse, such as “side roads”, bridges, or interstates; all of these roads can have their challenges. Does the facility have more than one contracted emergency site?
      • Is it likely that emergency events will also impact the surrounding areas? It is also possible that the evacuation site may be so far away, residents may not be able to get there when road conditions are less than optimal. Does the contracted site meet all the criteria to allow the residents to shelter in place at that location?
    • Is there a contract for transportation and will that transportation be able to get the residents to and from their current location to the contracted emergency location in a snow/ice storm? If the services have other contracted uses, such as school buses, will they be available at 3:00 P.M. on a school day or can they get drivers at 3:00 A.M. on a Wednesday?
  • Does the facility have a generator?
    • Is there enough fuel, a contract to get more fuel, and a list of what it does and does not operate?
      • Facilities (and the staff in charge) need to know in advance, what their generator will operate. At a minimum, this listing must include whether it runs: Life safety equipment (such as E-lights and fire alarm system(s)), magnetic door locks/door alarms (where applicable for safety), HVAC systems, cooking systems, what outlets residents and staff will be able to be use, and computer equipment/Wi-Fi (if electronic medical records (EMR) are utilized).
      • This list needs to be detailed so staff will know specifically what items will and will not work during a power outage. Many generators will run every second or third ceiling light for emergency lighting, but not all lights in the facility will work during a power outage. This needs to be listed so all staff will know that information.
    • If a facility does not have a generator, what are the plans when it may not be easily able to evacuate due to poor road conditions or other factors that may prohibit a smooth transition from a facility to another location?
      • If the facility plans to have a generator delivered during a loss of power, does the facility have a contract with the generator company to deliver one to them? This contract should include the size of the generator that the facility will need in order to ensure the safety and care needs of the residents are met during the emergency.
        • The building will need to be wired and ready to accept the generator in advance. The facility will not be able to install a generator during the emergency event unless the wiring for the generator has already been completed.
      • Facilities must maintain at least their fire safety equipment (E-lights, fire alarm, sprinkler system, range hood (if any cooking occurs), food, water, heating and cooling, and sewage disposal to shelter in place.
        • There must be a plan of how this will be achieved, emergency supplies, the detailed list of what the generator will run, and any contracts that will be needed during the emergency to ensure these services can continue during the emergency event.
          • Sometimes trucks will not be able to run regular schedules and it may take several days before the facility can get their first delivery after an emergency starts; depending on the extent and severity of the disaster.
        • A power outage may be as simple as a blip, may last for hours, or may last for days – depending on the extent of the power grid damage and when the crews can access the problem(s).
          • The facility needs a plan of when, how, and where they will evacuate if they cannot provide at least the components of the previous bullet point.

During a disaster is the least ideal time to learn an emergency plan will not work or to search for a contracted service. All contracted services including, but not limited to, transportation, fuel needs, evacuation location, food, and water needs to be in the emergency plan. The emergency preparedness team needs to consider and plan all services and contract prior to an actual emergency. During an emergency, it may be very difficult or impossible to get a contracted service due to volume of request, road conditions, and/or other factors.

Thank you for preparing in advance and keeping us informed!

Guidance for the Interim Final Rule – Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination

https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/guidance-interim-final-rule-medicare-and-medicaid-programs-omnibus-covid-19-health-care-staff-1

The guidance in this memorandum specifically applies to the following states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming.

Please read the memo in its entirety. Some key points in the memo:

Within 30 days after the issuance of the memorandum, if a facility demonstrates:

  • Policies and procedures are developed and implemented for ensuring all facility staff, regardless of clinical responsibility or resident contact are vaccinated for COVID-19, including all required components of the policies and procedures specified below (e.g., related to tracking staff vaccinations, documenting medical and religious exemptions, etc.); and
  • 100% of staff have received at least one dose of COVID-19 vaccine or have a pending request for, or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the CDC, the facility is compliant under the rule.

Within 60 days after the issuance of the memorandum if a facility demonstrates:

  • Policies and procedures are developed and implemented for ensuring all facility staff, regardless of clinical responsibility or resident contact are vaccinated for COVID-19, including all required components of the policies and procedures specified below (e.g., related to tracking staff vaccinations, documenting medical and religious exemptions, etc.); and
  • 100% of staff have received the necessary doses to complete the vaccine series (i.e., one dose of a single-dose vaccine or all doses of a multiple vaccine series) or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the CDC, the facility is compliant under the rule.

 Within 90 days and thereafter following issuance of the memorandum, facilities failing to maintain compliance with the 100% standard may be subject to enforcement action.

19 CSR 30-82.050 Transfer And Discharge Procedures – REMINDER – ENTITY/ADDRESS CHANGE FOR HEARING/APPEALS

A reminder the emergency amendment regarding 19 CSR 30-82.050 Transfer And Discharge Procedures is still in effect. The amendment indicates transition of transfer and discharge hearings from the Department of Social Services to the Department of Health and Senior Services and provides a new mailing address/fax number/phone number/email address where to send transfer or discharge appeals and motions and where to contact the Department of Health and Senior Services.

The emergency amendment can be viewed at https://www.sos.mo.gov/CMSImages/AdRules/moreg/2021/v46n19Oct1/v46n19a.pdf.

The proposed amendment can be reviewed on our website at https://health.mo.gov/about/proposedrules/. It will be published in the Code of State Regulations on February 28, 2022.

  • (4)(B) That a request for a hearing should be sent to Department of Health and Senior Services Appeals Unit, P.O. Box 570, 912 Wildwood Drive 3rd floor, Jefferson City, Missouri 65102-0570; by fax to (573) 751-0247 or by email to Appeals@health.mo.gov and the phone number for the appeals unit is (573) 522-1699.
  • (6) Any resident of a facility who receives notice of discharge from the facility in which he/she resides may file an appeal of the notice with the Department of Health and Senior Services Appeals Unit, P.O. Box 570, 912 Wildwood Drive 3rd floor, Jefferson City, Missouri 65102-0570; by fax to (573) 751-0247 or by email to Appeals@health.mo.gov within thirty (30) days of the date the resident received the discharge notice from the facility.

Certified Nurse Aide Regulation Update

The proposed amendments affecting the nursing assistant training program referenced in regulation sets 19 CSR 30-84.010 Nursing Assistant Training Program and 19 CSR 30-85.042 Administration and Resident Care Requirements for New and Existing Intermediate Care and Skilled Nursing Facilities, were published in the Code of State Regulations on November 30, 2021 and are effective December 30, 2021. This replaces the emergency amendment that was previously in effect.

The new regulations can be found on the Secretary of State’s website at: https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c30-84.pdf.

 

What does this mean?

Reciprocity: Certified Nurse Aides who are certified and active in another state, may submit a request to be added to the Missouri registry. Note: A temporary CNA status is not recognized in Missouri. To learn more about reciprocity and the process to submit a request for reciprocity, use the following link: https://health.mo.gov/safety/cnaregistry/pdf/cna-reciprocity.pdf.

 

CNA Renewals/Work Updates: When a CNA passes the final examination, the individual’s name is placed on the CNA active registry. For nurse aide certification to remain active, CNAs are required to submit documentation (e.g., pay stubs, W-2, letter from employer, etc.) of their work in nursing or nursing related services for at least one (1) day (e.g. eight (8) hours) within each twenty-four- (24-) consecutive month time-period. Documentation shall be submitted to the department approved third party test administrator and a fee will be assessed for each renewal.

  • If you are a CNA needing to renew your certification and work in a facility: Log into your profile in TMU and enter your employment under the employment tab, the software will then ask for payment. After the payment is processed, the software will send an email to your employer with a link to confirm your work in the last 24 months. After the employer clicks the link in the email to confirm employment your certification will be show active on the registry.
  • If you are a CNA needing to renew your certification with out of state employment: Log into your profile and select “out of state employment” and send an email from your employer with name, date of birth, employment dates and hours worked to missouri@hdmaster.com.
  • If you are CNA working private duty: Log into your profile in TMU and select private duty from a drop down menu. You will need to process the payment then email the proof of work documents to missouri@hdmaster.com. After work is confirmed, your certification will show active on the registry.
  • If you are a facility wanting to pay for multiple CNA’s renewal: Headmaster is working on a process but until it is available you may email them at missouri@hdmaster.com or call at 800-393-8664 and ask for the Missouri team.

How CNAs Renew on TMU in MO

How to Renew Your CNAs via TMU

 

Inactive Status-CNA Challenge

A CNA who has been inactive on the registry for less than five (5) years and cannot provide documentation (e.g., pay stubs, W-2, letter from employer, etc.) of work in nursing or nursing related services for at least one (1) day (e.g. eight (8) hours) within each twenty-four- (24-) consecutive month period- shall challenge the final examination in accordance with section (8) of this rule before the CNA is reinstated to the active registry.

A CNA who has been inactive on the registry for more than five (5) years and cannot provide documentation (e.g., pay stubs, W-2, letter from employer, etc.) of work in nursing or nursing related services for at least one (1) day (e.g. eight (8) hours) within each twenty-four- (24-) consecutive month period is not eligible to challenge the final examination and shall successfully complete the entire basic course before the CNA is reinstated to the active registry.

 

Challenge Exams: As of December 30, 2021, all Challenge exams will be administered through Headmaster. Request for approval to challenge the exam should be sent to the Health Education Unit at CNARegistry@health.mo.gov.

 

Instructor 4-Hour Update every 5 years:

Instructors are required to attend a four (4) hour update training provided by a certifying agency every five (5) years. Any instructor who has not completed the required four (4) hour update training by August 31, 2022, and every five (5) years thereafter will be removed from the department-approved list of instructors. If removed from the department’s list, the instructor is required to attend and successfully complete the Nursing Assistant Instructor Workshop in order to be reinstated to act as an instructor.

State Supply of Abbott BinaxNOW Tests

Missouri has received no new supply from Abbott in the last two weeks and was not notified of a pause from the manufacturer until DHSS inquired this week. All states are experiencing a similar situation, and availability at the state level has been decreasing since the White House announced a federal expansion of at-home testing for Americans. Since then, President Biden announced that hundreds of millions of at-home tests will be made available to Americans in January. With the increase in cases due to high Omicron transmissibility, this issue is being closely monitored as supply and demand changes daily. Missouri is placing a pause on fulfilling re-orders. This pause is due only to the current constrained supply, and we will resume the purchase of antigen tests, once they become available. Our team has identified several options that we are exploring and pursuing now to meet the current testing needs of our existing users as well as the long-term needs.

Effective immediately:

  •         DHSS will not accept new applications from existing test user types. For example, if a facility or organization has not previously received COVID antigen tests – BinaxNOW – through the state warehouse, that facility or organization will not be approved as a new applicant until further notified. We will maintain any new applications received for future potential approval.
  •         Fulfillment of reorders are temporarily being paused until there is clear information regarding the availability of COVID antigen test shipments. DHSS does not know how long this pause may be necessary, but will communicate promptly when the pause is rescinded. This pause was effective with reorders placed 1/3/2022 and subsequently.
  •         During this pause in fulfilment of re-orders, DHSS will prioritize fulfillment of re-orders for any outbreaks. If your facility or organization has a COVID outbreak, please place your reorder and email Kayla.Purnell@health.mo.gov to indicate the outbreak status. To assure prompt processing, please indicate in the e-mail subject line: ‘Outbreak Testing: insert the name of your facility/organization’.

Because the antigen tests are not widely/easily available at this time- you will want to take into consideration creating a testing plan that includes both antigen and PCR testing. The State of Missouri is continuing to reimburse homes for PCR testing related to outbreaks.

 

Reimbursement for OUTBREAK Testing

A reminder that in order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the State of Missouri has made some funds from the Coronavirus Relief Fund available to Missouri Long-Term Care facilities with COVID-19 Outbreaks. These funds are available to Long-Term Care facilities that experience an outbreak (one or more positive cases) and are conducting base-line facility testing and some immediate follow-up testing in order to contain outbreaks. For more information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.

If you have difficulty obtaining swabs and media from your laboratory- you can order them from Missouri State Public Health Laboratory (MSPH). Your contracted laboratory would still process the samples- not MSPH.

State of Missouri (arcgis.com)

LTC Bed Availability Portal

The healthcare continuum is again becoming strained with the number of positive cases across the state. This portal was originally established in November, 2020 to improve communication across the care continuum to assist in ensuring Missourians have access to the right care in the right setting.

We are renewing our request for long-term care communities to complete a brief survey each day in order to identify available beds for potential admissions. Participation in the bed availability survey is voluntary. The survey may be accessed at https://arcg.is/1rjKy8.

The dashboard was reset at 9:00 today, January 6, so homes will need to submit an initial survey – old update links will no longer work.

Reminder: After submitting the initial survey, a confirmation email will be provided for a link to update your survey each day (instead of submitting an initial survey). Submitting an initial survey results in multiple surveys showing on the map with different bed numbers. This makes it difficult to know which totals are current. Please use the link emailed after the initial submission to edit facility bed availability. Please do not submit an “initial” submission more than once. If information does not change from day to day, the submitter can simply update the date and submit – the prior day’s information will populate.

The survey information will populate an accompanying dashboard that will be available to hospitals to use as a tool in finding placement for those patients who would be best served in a long-term care setting.

This dashboard may be accessed at https://mophep.maps.arcgis.com/apps/opsdashboard/index.html#/f1e0745f93fe46b482d8ff4585f821bf.

To view instructions on utilizing the dashboard, click on ‘Instructions’ under the map for information.

Governor Parson Announces COVID-19 Related State of Emergency to Expire on December 31

Governor Parson Announces COVID-19 Related State of Emergency to Expire on December 31 | Governor Michael L. Parson (mo.gov)

Governor Parson announced on December 30, 2021 the expiration of Executive Order 21-09 (EO 21-09) that declared a State of Emergency related to COVD-19 on December 31, 2021. Since the outset of this public health emergency, the Governor has exercised a legal means by which we have waived certain statutory and regulatory requirements that could have inhibited the state’s response to the public health emergency. However, with the expiration of EO 21-09, the statutory and regulatory waivers also expire.

For long-term care facilities, there are two waivers that had extended timeframes to allow for compliance.  These two waivers are listed below.

  • Individuals working as nurse aides will have 90 days (until April 1st, 2022) to complete the approved nurse aide training program, as required in Section 198.082.1 and 4, RSMo.
  • Regulation 19 CSR 30-84.010(11)(B)4 had been waived to the extent the provisions require a nurse assistant to perform nurse services for monetary compensation for at least one (1) day in a twenty-four (24) consecutive month time period in order to keep his/her certificate valid. The waiver allowed nurse assistants to provide proof of nursing services after the twenty-four (24) month consecutive period has passed. DHSS will tack on the amount of time the COVID-19 response was ongoing plus two (2) months. Nurse assistants must provide proof of performing nursing services by March 1, 2022 to be in good standing.

UPDATED CDC Guidelines for Isolation/Quarantine

Facility Employees/Healthcare Personnel

All Residential Care Facilities, Assisted Living Facilities, Intermediate Care Facilities, Skilled Nursing Facilities should follow current Centers for Disease Control and Prevention (CDC) Guidelines related to managing healthcare personnel who have tested positive or an exposure to COVID-19.

Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 | CDC

For Certified SNF/ICF providers, current CMS guidance QSO 20-38 states “If COVID-19 is confirmed, staff should follow Centers for Disease Control and Prevention (CDC) guidelines “Criteria for Return to Work for Healthcare Personnel with SARS­CoV2 Infection”, therefore, homes can immediately change policies and procedures to incorporate the updated changes from the CDC.

 

General Population/Visitors

All Residential Care Facilities, Assisted Living Facilities, Intermediate Care Facilities, Skilled Nursing Facilities should follow current Centers for Disease Control and Prevention (CDC) Guidelines related to quarantine and isolation for visitors. Facilities should be aware of and follow the updated quarantine/isolation guidelines for visitors in your communities as well.

CDC Updates and Shortens Recommended Isolation and Quarantine Period for General Population | CDC Online Newsroom | CDC

For Certified SNF/ICF providers, current CMS guidance QSO 20-39 states “Visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or currently meet the criteria for quarantine, should not enter the facility. Facilities should screen all who enter for these visitation exclusions. Homes can immediately change policies and procedures to incorporate the updated changes from the CDC.

COVID Testing Resources

State Orders for Abbott BinaxNOW Tests

Missouri is experiencing constrained supplies of the BinaxNOW COVID antigen test cards. Thus, effective September 9, 2021, DHSS is implementing a revised BinaxNOW test ordering cadence in order to conserve supply and assure the optimum availability of BinaxNOW COVID antigen tests for all users. Until further notice, please order no more than two weeks supply of BinaxNOW tests for use by your facility or organization. If our supply allows larger quantities to be ordered, we will modify this process accordingly at that time and notify all users. https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php

 

To Reinstate Direct Shipments of Abbott BinaxNOW from the Federal government:

Providers should email their facility information, shipping address and the BinaxNOW delivery Point of Contact for the facility and request to be added back onto the direct shipment list to Binax.Team@hhs.gov. Please be aware reinstatement depends upon available supply of tests to the Federal government and this can take several weeks to begin receiving shipments again.

 

Reimbursement for OUTBREAK Testing

A reminder that in order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the State of Missouri has made some funds from the Coronavirus Relief Fund available to Missouri Long-Term Care facilities with COVID-19 Outbreaks. These funds are available to Long-Term Care facilities that experience an outbreak (one or more positive cases) and are conducting base-line facility testing and some immediate follow-up testing in order to contain outbreaks. For more information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.

19 CSR 30-84.010 Nursing Assistant Training Program and 19 CSR 30-85.042 Administration and Resident Care Requirements for New and Existing Intermediate Care and Skilled Nursing Facilities – REGULATION UPDATE NOTICE

The proposed amendments affecting the nursing assistant training program referenced in regulation sets 19 CSR 30-84.010 Nursing Assistant Training Program and 19 CSR 30-85.042 Administration and Resident Care Requirements for New and Existing Intermediate Care and Skilled Nursing Facilities were published in the Code of State Regulations on November 30, 2021. The official new rules can be found on the Secretary of State’s website at: http://www.sos.mo.gov/adrules/csr/current/19csr/19csr.asp.

The rules are located under Division 30 in Chapter 84 and Chapter 85. The effective date for the rules will be December 30, 2021.

If you have any questions regarding implementation of the rules, please contact the Section for Long-Term Care Regulation at 573-526-8524.

CMS Updates to the COVID-19 Public Health Emergency 1135 Blanket Waiver

CMS has updated the COVID-19 Public Health Emergency 1135 Blanket Waiver on 11/29/21.

The only change in this blanket waiver is for nursing homes for Food and Nutrition Services effective 11/26/21. This waiver applies to 42 CFR 483.60(a)(1) and 483.60(a)(2) under Food and Nutrition Services. This is a waiver for the qualifications of the qualified dietitian or other similarly qualified nutrition professional and the director of food services or the grace period.

The following requirements are waived:

  • Dietitians hired or contracted with prior to November 28, 2016, to meet the specified requirements no later than 5 years after November 28, 2016, or as required by state law; and
  • To designate a person to serve as the director of food and nutrition services who, for designations prior to November 28, 2016, meets the specified requirements no later than 5 years after November 28, 2016, or no later than 1 year after November 28, 2016, for designations after November 28, 2016.

Please see the CMS Public Health Emergency Blanket Waiver -11 29 2021.

CMS Memo QSO-22-04-ALL: Vaccination Regulation: Enforcement of Rule Imposing Vaccine Requirement for Health Care Staff in Medicare-and Medicaid-certified Providers and Suppliers is Suspended so Long as Court Ordered Injunctions Remain in Effect

Survey and Enforcement of the Vaccine Requirement for Health Care Staff in Medicare-and Medicaid-certified Providers and Suppliers Suspended While Court Ordered Injunctions are in Effect: The Centers for Medicare & Medicaid Services (CMS) will not enforce the new rule regarding vaccination of health care workers or requirements for policies and procedures in certified Medicare/Medicaid providers and suppliers (including nursing facilities, hospitals, dialysis facilities and all other provider types covered by the rule) while there are court-ordered injunctions in place prohibiting enforcement of this provision.

Please see the full memo or https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/vaccination-regulation-enforcement-rule-imposing-vaccine-requirement-health-care-staff-medicare-and for details.