Monoclonal Antibody Infusion Medication Information

There has been a significant change in the ordering process for monoclonal antibody infusion medications. If you are currently utilizing these medications, please review the attached notice and plan on attending the webinar tomorrow. Also attached is information on reporting usage through the Teletracking system. Reporting through this system is highly encouraged as the usage reported will determine future amounts allocated to the state.

 Status Update re: Monoclonal Antibody (mAb) Infusion Medication Ordering:

Missouri Department of Health and Senior Services (DHSS) was notified by U. S. Department of Health and Human Services (HHS) yesterday, September 14, 2021, that effective immediately the states are responsible to review and approve all monoclonal antibody medication orders. This includes orders for REGEN-COV (casirivimab and imdevimab) and the Eli Lilly cocktail of bamlanivimab/etesevimab through AmeriSource Bergen. This was DHSS’ first notification of this change. We had no prior information to allow for planning, development of platforms for ordering/approvals or procedures, or messaging. Thus, all of this is occurring currently and as quickly as possible. Information on this change is still forthcoming from HHS, thus we may have process implementation delays at the state level as a result.

mAb Request Process Implementation and Timeline:

DHSS will host a webinar to introduce the state’s new mAb request process, details are below:

Friday, September 17, 2021

10:30-11:30 a.m.

Join from the meeting link

https://stateofmo.webex.com/stateofmo/j.php?MTID=mcb62b527fff05778bd574584e06c8b6d

 

Join by meeting number

Meeting number (access code): 2462 582 1044

Meeting password: pcGjudFE679

 

Tap to join from a mobile device (attendees only)
+1-650-479-3207,,24625821044## Call-in toll number (US/Canada)
+1-312-535-8110,,24625821044## United States Toll (Chicago)

Transfer and Discharge Procedures – REGULATION UPDATE NOTICE

The Department of Health and Senior Services, Section for Long-Term Care Regulation has drafted emergency and proposed amendments affecting the transfer and discharge hearings referenced in regulation set 19 CSR 30-82.050.

The emergency amendment for 19 CSR 30-82.050 was filed on September 1, 2021, with an effective date of September 16, 2021 and expiration of March 14, 2022. The emergency amendment can currently be viewed at https://www.sos.mo.gov/adrules/EmergenciesforInternet/emergency. The proposed amendment covering this same material will also be published in the same issue of the Missouri Register. The Register publication date is October 1, 2021 for the emergency and proposed amendments and can be found at http://www.sos.mo.gov/adrules/moreg/moreg.asp.

NOTE: The public comment period for the proposed amendments will be from October 1, 2021 – October 31, 2021. The Department will be accepting comments during the comment period by mailing the comments to: Carmen Grover-Slattery, Regulation Unit Manager, Section for Long-Term Care Regulation, Division of Regulation and Licensure, PO Box 570, Jefferson City, MO 65102-0570 or by emailing to: RegulationUnit@health.mo.gov.

The proposed amendment can be reviewed on our website at: https://health.mo.gov/about/proposedrules/.

LTC Bed Availability Portal Reminder

Reminder: After submitting the initial survey, a confirmation email will be provided for a link to update your survey each day (instead of submitting a new survey). Submitting a new 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.

DHSS COVID-19 Vaccination Booster Doses Survey

The Department of Health and Senior Services is planning for the upcoming approval of booster COVID-19 vaccination doses and long-term care facilities will be a priority. The federal pharmacy program used to administer first and second doses will not be available, so it is important to ensure long-term care facilities receive the needed support for the administration of booster doses. We are asking for your feedback regarding your facility’s readiness to administer booster doses. https://www.surveymonkey.com/r/VTT296F

For those SNFs (Medicaid/ Medicare certified) that already completed the NHSN survey, we already have your results no further action is needed.

For questions regarding this survey, please contact Lana Hudanick at Lana.hudanick@heatlh.mo.gov or 314-982-8260. Please reply by September 15, 2021.

COVID-19 After Action Report (AAR) Survey – Deadline Extended

The deadline to complete the DHSS COVID-19 After Action Report (AAR) Survey has been extended to Friday, September 3, 2021. Your assistance in helping us gather this important data is greatly appreciated. Please feel free to share the link with your state, regional, and local partners in the following categories:

  • Public Health/LPHA
  • Hospital
  • EMS
  • Emergency Management
  • Behavioral Health
  • Healthcare Coalition Leadership
  • State Agency Partners

https://survey123.arcgis.com/share/d20126ad3a05496d87dbf3b4b65d7592?portalUrl=https://mophep.maps.arcgis.com

Please let us know if you have any questions or difficulties with the survey.
John Whitaker – John.Whitaker@health.mo.gov
Brendan Bagby – Brendan.Bagby@health.mo.gov

Changes to Missouri’s Adult Abuse and Neglect Hotline Hours of Operation

The Department of Health and Senior Services (DHSS) is revising the hours of operation for the Missouri Adult Abuse and Neglect Hotline to 7:00 a.m. to 8:00 p.m., 365 days a year, effective September 1, 2021. The Hotline’s former hours of operation were 7:00 a.m. to midnight, 365 days a year. This change will allow the Department to better serve those who need to report concerns of abuse, neglect, and exploitation of vulnerable individuals 60 and older and people with disabilities between 18 and 59.

During fiscal year 2020, DHSS received and investigated 40,714 community and facility reports of abuse, neglect, bullying, and exploitation, involving seniors and adults with disabilities. That amounts to an average of over 111 reports every day. The number of cases continues to rise, but still vastly understates the extent of the problem as experts believe that for every case of adult abuse or neglect reported, as many as 23 cases go unreported.

In November of 2019, DHSS implemented the Adult Abuse and Neglect Hotline online reporting system allowing concerned citizens and mandated reporters to electronically submit reports of abuse, neglect, and exploitation in an efficient, secure, and confidential manner on a web-based platform. The online reporting portal is available 24 hours a day, 7 days per week and provides an alternative to calling the Adult Abuse and Neglect Hotline both during and outside of normal business hours. Since the implementation of online reporting, approximately one-third of all reports are submitted this way. While online reporting has helped to ease the Adult Abuse and Neglect Hotline’s call volume demands, additional efforts are still needed to ensure that no call goes unanswered. The new operational hours for the Hotline will allow for increased staffing during times of highest call volume. This will help reduce wait times for those reporting and make it easier to reach a trained intake professional between 7:00 a.m. and 8:00 p.m. Please note that 9-1-1 should be accessed for emergencies as the Adult Abuse and Neglect Hotline online reporting system is not intended for emergency response.

If you suspect abuse, neglect or financial exploitation of the elderly or an adult with a disability, you may call the Adult Abuse and Neglect Hotline toll-free at (800) 392-0210 or visit www.health.mo.gov/abuse/ to make a report online.

If you have any questions regarding the change in the hours of operation for the Adult Abuse and Neglect Hotline, please reach out to the Department at 573/526-3625 or DSDSOfficeofConstituentServices@health.mo.gov.

Public Health: Better Health. Better Missouri.

Onsite Clinical and On the Job Training for Students Entering Health Care (Nurses, Nurse Aides, Therapy)

SLCR has received questions regarding whether or not Skilled Nursing Facilities can be a clinical or on the job training sight for students entering health care fields. The quick answer is YES! Long-term care facilities can use the guidance from CMS memo QSO 20-39-NH and DHSS visitation guidance as a way to say “YES” to hosting schools who are training our next workforce in long-term care. Students can be considered health care workers who are not employees of the facility but provide direct care to the facility’s residents. They can be permitted to come into the facility as long as they are not subject to a work exclusion due to an exposure to COVID-19 or showing signs or symptoms of COVID-19 after being screened. Facilities should work with the schools to ensure they are aware of infection control policies and procedures and to whom questions can be addressed.

The most recent visitation guidance from CMS and DHSS can be accessed on our website: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/professionals.php.

For questions related to this, please contact Angela.Duvall@health.mo.gov.

Updated Standing Orders and Affidavits for Third Dose of COVID-19 Vaccine

Following recent announcements from the US Food and Drug Administration and the Centers for Disease Control and Prevention, certain immunocompromised individuals can begin receiving third doses of COVID-19 vaccine in Missouri.

A third dose of the PfizerNBioTech or Moderna vaccines may be administered to moderately to severely immunocompromised people due to a medical condition or combination of immunosuppressive medication or treatments including but not limited to the following:

  • Immunocompromised due to solid organ transplant and taking immune suppressing medications
  • Immunocompromised due to active treatment for solid tumor and hematologic malignancies
  • Immune compromised due to Receipt of CAR-T cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Moderate to severe primary immunodeficiency (eg., DiGeorge, Wiskott-Aldrich Syndromes)
  • Immunocompromised due to Advanced or untreated HIV infection
  • Immunocompromised due to “Active treatment with high-dose corticosteroids or other drugs that may suppress immune response: high dose corticosteroids (ie.,≥ 20 mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blocker or other biologic agents that are immunosuppressive or immunomodulatory”

Individuals who do not meet the criteria for “moderately to severely immunocompromised” do not need a third dose at this time.

In line with federal guidelines, Missouri will use a self-attestation model for people who are moderately to severely immunocompromised. Individuals will not be required to provide documentation of their health status, and they can get third doses at all venues where first and second doses are available.

This guidance does not apply to those who received the Janssen/Johnson & Johnson vaccine. For people who received either Pfizer-BioNTech or Moderna’s COVID-19 vaccine series, a third dose of the same mRNA vaccine should be used. A person should not receive more than three mRNA vaccine doses at this time. If the mRNA vaccine product given for the first two doses is not available or is unknown, either mRNA COVID-19 vaccine product may be administered. Individuals should wait at least 28 days between their second and third doses.

Announcements from federal health officials came after the analysis of studies demonstrating that immunosuppressed people are more likely to get severely ill from COVID-19, are at higher risk for prolonged infection, are more likely to transmit the virus, and experience lower vaccine effectiveness.

Additional information regarding this guidance can be found on the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html.

Interim clinical considerations for use of COVID-19 vaccines can be found at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.

Missouri’s revised standing orders can be found at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/statewide-orders.php.

DHSS COVID After Action Report Survey

Below is a link to the Missouri Department of Health and Senior Services COVID-19 after action survey. This survey is designed to gather feedback from a variety of healthcare and public health partners and organizations. Please respond by selecting the discipline that reflects your organization and submit one survey per organization, excluding state agency partners. Your responses to this survey should be based on your organizations role and perspective of the COVID response. Receiving input from a variety of stakeholders, at all levels of the response, will help us better identify our strengths and weakness of the public health and medical services emergency Support function.

https://survey123.arcgis.com/share/d20126ad3a05496d87dbf3b4b65d7592?portalUrl=https://mophep.maps.arcgis.com

Please see this FAQs for more information. Thank you in advance for your participation!

Smoke Zones vs. Fire Zones

 

We have recently noticed several facilities that have used their fire alarm zones as part of their evacuation plan. The fire alarm zones are the zones on the fire alarm panel used to help staff identify the location of the fire. These are different from smoke zones, which are the zones in the building created to prevent the spread of smoke and fire and allow staff time to complete a full evacuation of the building. Many facilities have fire alarm zones that do not match the smoke zones in the facility. Often times there are more fire zones to help staff identify the location of a fire.

To start a smoke zone evacuation, it may be necessary to evacuate multiple fire alarm zones at the same time. The evacuation plans need to have these smoke zones clearly labeled and all staff need to know where they will move the residents in the event of a fire. The facility cannot base their evacuation plans on the fire alarm zones.

In this example, the facility has eight fire alarm zones (Fire Zones 1-8). The facility has a smoke barrier wall that divides the facility into two smoke zones (Smoke Zones A and B). The facility also has a secured unit, but the controlled egress doors (locked keypad doors) are not a part of the smoke barrier wall, so the secured unit is part of Smoke Zone A.

If a fire occurs in Fire Zone 4, it means that an evacuation of all residents would need to occur throughout Smoke Zone B, which would include all residents in Fire Zones 3, 4, and 5. The evacuation plan may mention things like room number, dining rooms, etc., but should avoid using fire zones to describe the smoke zones. Although it is important to know which smoke zone activated the fire alarm system, staff cannot move the residents from Fire Zone 4 to Fire Zone 5, as they are still within Smoke Zone B. Staff must completely move the residents out of Smoke Zone B.

In addition, it is significant to note if a fire occurred in Smoke Zone A (i.e. Fire Zones 1 or 6), the staff would need to move residents in the secured unit from Smoke Zone A. Staff cannot leave the residents in the secured unit since a smoke barrier wall does not protect the secured unit and it is not its own smoke zone.

The facility must have the evacuation plans posted on at least every floor of the facility [19 CSR 30-85.022 (33)(B)(2)] which directs all staff, residents, and visitors where to go in the event of a facility evacuation. The policy and procedure for evacuations also needs to be in the emergency preparedness manual.

NFPA 99, 2012 edition
15.7.4.3.1: Where buildings are required to be subdivided into smoke compartments, fire alarm notification zones shall coincide with one or more smoke compartment boundaries or shall be in accordance with the facility fire plan.

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 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 on July 15th, so any homes that have not submitted data since the reset occurred will need to submit an initial survey – old update links will no longer work. Homes that have submitted data since the reset can continue to submit using the update link.

 Reminder: After submitting the initial survey, a confirmation email will be provided for a link to update your survey each day (instead of submitting a new survey). Submitting a new 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.

Personal Protective Equipment (PPE)

Missouri has limited PPE reserves to assist in filling these critical needs and will prioritize healthcare providers providing direct care to confirmed or suspected COVID patients. Note requests should only be submitted after all normal supply chains, including the Missouri COVID Supply Solution, have been exhausted and providers have a supply of twenty-one days or less on hand.

Please be sure to describe the urgent need for PPE and your situation in the comments on the form.
https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/ppe.php

COVID Related Information

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 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 is being reset and all previous data is being deleted, so all communities 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 a new survey). Submitting a new 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.

 

Abbott BinaxNOW Testing Supplies

To order Abbott BinaxNOW from the state (one time shipments):

Missouri Long Term Care Facilities (RCF, ALF, ICF, and SNF), private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID), and Adult Day Care programs may order free Abbott BinaxNOW Testing Supplies from DHSS and SEMA via the following link: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php.Then scroll down under BinaxNOW Testing to the BinaxNOW hub and click on that link – then scroll to the icon for long-term care facilities and click on that icon. It takes you to a gray colored page that says to click ‘here’ to re-order; from that re-order form, click on Facility Type in the upper right hand corner and choose LTCF from the drop down box; then click on the your facility’s name in the drop down box entitled Facility Name.

The re-order form should then auto populate your contact information into the form and you simply tell us how many tests you need toward the bottom of that form, then click submit.

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 this can take up to 2 weeks to begin receiving shipments again.

 

DHSS guidance related to COVID-19 outbreaks, visitation, reporting, waivers, etc.- can be found on our website:

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

 

COVID-19 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 Point of Care (POC) and PCR testing.

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

Within 24 hours of positive result

2

Long Term Care Facility COVID-19 Outbreak Testing Data Reporting

REDCap: DHSS

Reporting portal for outbreak testing dates, number of residents and staff tested.

Yes, for all SNF, ICF, RCF, ALF, and ICF-IID.

Within 24 hours of testing

3

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

4

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 5

Within 24 hours of result of POC test

5

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 4

Within 24 hours of result of POC test

 

Archived Listserv messages can be found on our blog site: https://ltc.health.mo.gov/

Recall Class 1 High Priority: Tyson Frozen RTE Chicken Products Potentially Associated with Listeria

Missouri Department of Health and Senior Services Recall Alert

To:         Local Public Health Agencies
From:    Dusty Johnson
Date:     07/06/2021

CLASS:  Class I High Priority

This announcement is distributed to Environmental staff and LPHA Administrators.

  • Please notify the affected facilities in your jurisdiction ASAP.
  • Conduct follow-up checks within 2 working days.
  • See attached distribution information.
  • See the original announcement for examples of labels.

 Necessary Information:

 Tyson Foods Inc., a Dexter, Mo. establishment, is recalling approximately 8,492,832 pounds of ready-to-eat (RTE) chicken products that may be adulterated with Listeria monocytogenes, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The frozen, fully cooked chicken products were produced between December 26, 2020 and April 13, 2021. The products that are subject to recall are listed here. View the labels here.

The products subject to recall bear establishment number “EST. P-7089” on the product bag or inside the USDA mark of inspection. These items were shipped nationwide to retailers and institutions, including hospitals, nursing facilities, restaurants, schools and Department of Defense locations.

On June 9, 2021, FSIS was notified of two persons ill with listeriosis. Working in conjunction with the Centers for Disease Control and Prevention (CDC) and state public health partners, FSIS determined there is evidence linking the Listeria monocytogenes illnesses to precooked chicken produced at Tyson Foods Inc. The epidemiologic investigation identified three listeriosis illnesses, including one death, between April 6, 2021 and June 5, 2021. During routine sample collection, FSIS collected two precooked chicken samples from two establishments that are closely related genetically to Listeria monocytogenes from ill people. One of the samples was collected at Tyson Foods Inc. FSIS is continuing to work with federal and state public health partners to determine if there are additional illnesses linked to these products.

Additional information on the investigation may be found on the Centers for Disease Control and Prevention website.

Consumption of food contaminated with L. monocytogenes can cause listeriosis, a serious infection that primarily affects older adults, persons with weakened immune systems, and pregnant women and their newborns. Less commonly, persons outside these risk groups are affected.

Listeriosis can cause fever, muscle aches, headache, stiff neck, confusion, loss of balance and convulsions sometimes preceded by diarrhea or other gastrointestinal symptoms. An invasive infection spreads beyond the gastrointestinal tract. In pregnant women, the infection can cause miscarriages, stillbirths, premature delivery or life-threatening infection of the newborn. In addition, serious and sometimes fatal infections in older adults and persons with weakened immune systems. Listeriosis is treated with antibiotics. Persons in the higher-risk categories who experience flu-like symptoms within two months after eating contaminated food should seek medical care and tell the health care provider about eating the contaminated food.

FSIS is concerned that some product may be in consumer and institutional freezers. Consumers should not eat these products. Institutions should not serve these products. These products should be thrown away or returned to the place of purchase.

FSIS routinely conducts recall effectiveness checks to verify recalling firms notify their customers of the recall and that steps are taken to make certain that the product is no longer available to consumers. When available, the retail distribution list(s) will be posted on the FSIS website at www.fsis.usda.gov/recalls.

Members of the media who have questions regarding the recall can contact Derek Burleson, Communications Manager, Tyson Foods, at (479) 290-6466 or derek.burleson@tyson.com. Consumers who have questions can contact Tyson Foods customer relations, at (855) 382-3101.

Consumers with food safety questions can call the toll-free USDA Meat and Poultry Hotline at 1-888-MPHotline (1-888-674-6854) or live chat via Ask USDA from 10 a.m. to 6 p.m. (Eastern Time) Monday through Friday. Consumers can also browse food safety messages at Ask USDA or send a question via email to MPHotline@usda.gov. For consumers that need to report a problem with a meat, poultry, or egg product, the online Electronic Consumer Complaint Monitoring System can be accessed 24 hours a day at https://foodcomplaint.fsis.usda.gov/eCCF/.

 Additional Information:

When to contact the Engineering Consultation Unit

We have received questions regarding when communication with Engineering Consultation Unit (ECU) is needed. When completing any of the activities listed below, please reach out to the ECU for review.

  • Additions to existing licensed facilities or premises
  • Major remodeling
  • Equipment replacement (mechanical, generator, fire alarm components)
  • Relocation of any resident use areas (physical therapy, dining rooms, conversion of rooms to resident bedrooms)
  • Creation of designated units (memory care units and special care units)
  • Removal or construction of ANY walls, doors, and ceilings – even if not located in a rated wall
  • Changing the use of existing rooms
  • Exterior changes to the building that include addition of structures (canopy, gazebo, trellis), site work such as sidewalk revisions at exit paths and lighting
  • Adding locking hardware to exit doors including interior and exterior doors
  • Roof replacement
  • Some interior finish work such as flooring and wallcovering may need to be reviewed to determine the fire rating classification.

When is ECU approval not required?

  • Interior finish work (painting, flooring, ceiling tiles)

ECU does not charge any fees to review projects.
If uncertain whether a review is needed, please contact the ECU at ECU@health.mo.gov.
Please retain all ECU correspondence with other facility records.

David East and Carrie (Brixey) Schaumburg
ECU@health.mo.gov

2021 Provider Meeting

We are currently in the planning phase to host a virtual provider meeting this year and are considering the best topics to provide the most beneficial information. We would like to hear from you about what LTC related topics and info you believe would be helpful and educational!

Please take a moment to answer complete a short questionnaire by July 15, 2021 at https://www.surveymonkey.com/r/83YX6GZ.

Nursing Assistant Training Program – REGULATION UPDATE NOTICE

The Department of Health and Senior Services, Section for Long-Term Care Regulation has drafted emergency and proposed amendments affecting the nursing assistant training program referenced in regulation sets 19 CSR 30-84.010 and 19 CSR 30-85.042.

The emergency amendment for 19 CSR 30-84.010 was filed on June 14, 2021, with an effective of June 28, 2021 and expiration of December 24, 2021. The emergency amendment can currently be viewed at: https://www.sos.mo.gov/adrules/EmergenciesforInternet/emergency. The proposed amendment covering this same material will also be published in the same issue of the Missouri Register. The Register publication date is July 15, 2021 for the emergency and proposed amendments and can be found at: http://www.sos.mo.gov/adrules/moreg/moreg.asp.

NOTE: The public comment period for the proposed amendments will be from July 15, 2021 – August 14, 2021. The Department will be accepting comments during the comment period by mailing the comments to: Carmen Grover-Slattery, Regulation Unit Manager, Section for Long-Term Care Regulation, Division of Regulation and Licensure, PO Box 570, Jefferson City, MO 65102-0570 or by emailing to: RegulationUnit@health.mo.gov.

The emergency and proposed amendments can be reviewed on our website at: https://health.mo.gov/about/proposedrules/.

Missouri DHSS Urges Continued Vaccination as Close Monitoring of Delta Variant Continues

Missouri is experiencing a rise in individuals contracting the Delta variant (B.1.617.2, first detected in India) of the virus that causes COVID-19, SARS-CoV-2. It was announced by the Centers of Disease Control and Prevention yesterday that the Delta variant has been reclassified as a “variant of concern” in the United States. The Missouri Department of Health and Senior Services (DHSS) has been closely monitoring these developments and has been on the national leading edge of aggressive wastewater testing for variants of concern.

The Delta variant joins the B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma), B.1.427/B.1.429 (Epsilon) variants circulating in the United States which are already classified as variants of concern.

Deemed highly transmissible, the Delta virus has been already detected in over 70 countries of the world, and is projected to become dominant worldwide. It is also causing more serious illness and hospitalizations among those who have not been vaccinated.

Monitoring the spread of emerging variants in the United States relies on widespread, rapid sequencing. While this national effort is still somewhat limited, it is clear that the variant has become prevalent in communities throughout Missouri. In February, the Missouri Department of Health and Senior Services (DHSS) began testing wastewater samples to look for the presence of these variants. These testing results are displayed in a new layer of the COVID-19 sewershed surveillance StoryMap.

The unpredictability of emerging variants is cause for continuation of infection prevention precautions.

“Our greatest concern in Missouri is areas with lower vaccine uptake,” said Robert Knodell, Acting Director of the Missouri Department of Health and Senior Services (DHSS). “With this variant being easier to spread and possibly causing more severe illnesses among unvaccinated people of all ages, vaccinations are the best way to stop this virus in its tracks.”

This recent rise of the highly transmissible Delta variant underscores the importance of continued testing for COVID-19 of all those with related symptoms, as well as those who have been exposed to the virus but may not have symptoms.

Social distancing and appropriate masking remain important and effective public health countermeasures. Vaccination is the most effective and long-lasting tool for protection from this infection. DHSS continues to encourage anyone age 12 and up to get vaccinated against COVID-19. Get the facts about COVID-19 vaccines and where to get vaccinated at MOStopsCovid.com.

Proposed Changes to the CNA Rules

The Health Education Unit is excited to announce our new changes to the CNA Rules – COMING SOON!

Along with the new implementation of the new CNA testing process, our rules are being updated and include proposed changes to the curriculum, reciprocity for out of state CNA’s coming to work in Missouri, and the requirement for our instructors to attend a four-hour update training every five years, as well as several others.

We invite you to attend one of our Q and A sessions to learn more about these changes. Our third party test administrator, Headmaster, will also join and be available to answer questions. Please access our website at https://health.mo.gov/safety/cnaregistry/ for log in information.

The scheduled dates and times are listed below:

June 16, 2021: DHSS/D & SDT Headmaster Q & A Webex Meeting
Time: 12:00 p.m.
Meeting number (access code): 177 675 4909 Meeting password: urUBZCPC265

Join from a video system or application
Dial 1776754909@stateofmo.webex.com
You can also dial 173.243.2.68 and enter your meeting number. Tap to join from a mobile device (attendees only)
+1-650-479-3207, 1776754909## Call-in toll number (US/Canada)
+1-312-535-8110, 1776754909## United States Toll (Chicago)

Join by phone
1-650-479-3207 Call-in toll number (US/Canada)
+1-312-535-8110 United States Toll (Chicago)
Global call-in numbers

June 22, 2021: DHSS/D & SDT Headmaster Q & A Webex Meeting
Time: 3:30 p.m.
Meeting number (access code): 177 961 7383 Meeting password: VHvmrBY3Z83

Join from a video system or application
Dial 1779617383@stateofmo.webex.com
You can also dial 173.243.2.68 and enter your meeting number. Tap to join from a mobile device (attendees only)
+1-650-479-3207, 1779617383## Call-in toll number (US/Canada)
+1-312-535-8110, 1779617383## United States Toll (Chicago)

Join by phone
1-650-479-3207 Call-in toll number (US/Canada)
+1-312-535-8110 United States Toll (Chicago)
Global call-in numbers

June 30, 2021: DHSS/D & SDT Headmaster Q & A Webex Meeting
Time: 10:00 a.m.
Meeting number (access code): 177 278 8445 Meeting password: 3fdQsTPs8X2

Join from a video system or application
Dial 1772788445@stateofmo.webex.com
You can also dial 173.243.2.68 and enter your meeting number. Tap to join from a mobile device (attendees only)
+1-650-479-3207, 1772788445## Call-in toll number (US/Canada)
+1-312-535-8110, 1772788445## United States Toll (Chicago)

Join by phone
1-650-479-3207 Call-in toll number (US/Canada)
+1-312-535-8110 United States Toll (Chicago)
Global call-in numbers

DHSS teams up with Missouri Developmental Disabilities Council to launch COVID-19 plain language guide for the disability community

The Missouri Department of Health and Senior Services (DHSS) along with the Missouri Developmental Disabilities Council released a new resource, the “Missouri Plain Language Guide for People with Disabilities, their Families and Caregivers,” on COVID-19 and the vaccine.

Through this partnership, the new guide will ensure that important information related to COVID-19 and vaccine access is more accessible to people with intellectual and developmental disabilities, and others with disabilities affecting reading, comprehension and other cognitive functions.

“After reading this new Missouri Plain Language Guide, I was very impressed with two very important things: 1) the amount of important and vitally necessary information that it contains; and 2) how plain and understandable the format is, that was used to present it, without diluting any of the valuable information that it conveys to the reader. I believe that this will prove to be a very valuable tool for persons with disabilities and many others,” said Cathy Enfield, Chairperson and Self-Advocate, Missouri Developmental Disabilities Council.

“There is so much information available about COVID-19 and vaccines, that it could be hard to navigate through the information. We value the collaboration with DHSS, to provide accurate information in a plain language format that is accessible to so many who experience disabilities. We look forward to continuing this important work to ensure the disability community has information to make decisions about their health,” said Vicky Davidson, Executive Director, Missouri Developmental Disabilities Council.

People with disabilities, their family members and caregivers have been eligible to receive the COVID-19 vaccine in the earliest phases of Missouri’s vaccine rollout. Currently, any Missourian age 12 and older is eligible to receive the COVID-19 vaccine. Since the beginning of 2021, DHSS and the Missouri Advisory Committee on Equitable COVID-19 Vaccine Distribution have been focused on deploying new strategies and resources to meet the disability community where they are – this new guide is a resource to support Missouri’s disability community and those individuals, family members and caregivers who support them.

“Since day one at DHSS, our goal has been to ensure Missouri’s most vulnerable, people with disabilities and those who support them (i.e., their families, caregivers and disability service providers) were at the front of the line to receive the free vaccine throughout our vaccine roll-out process. Throughout the year, we have also been working to deploy new strategies and resources to meet the disability community where they are. Our new plain language guide is an additional resource for Missourians with disabilities and those who support them,” said Sara Hart Weir, co-chair of the Missouri Advisory Committee on Equitable COVID-19 Vaccine Distribution.

Enfield added, “We simply need information to be supplied in a clear, plain and understandable way. As Chair of the Missouri Developmental Disabilities Council, I am proud of the work that our members and staff did on the document. I applaud their efforts and the efforts of all those who were involved.”

If you or someone you know is unable to visit a COVID-19 vaccination clinic without assistance, please call the COVID-19 Hotline at 877-435-8411 and press option 4 to be routed directly to your local Area Agency on Aging to make a vaccine appointment. You can also register individuals for the vaccine by visiting Missouri’s COVID-19 website, MOStopsCovid.com. COVID-19 Hotline hours of operation are Monday-Friday 7:30 a.m.-5:30 p.m. and Saturday 8 a.m.-2 p.m. (Hotline is open on Saturdays through until June 11.) Individuals are encouraged to call soon to ensure their names are added to the list.

BinaxNOW Recoupment – Ending Friday June 11th

DHSS will cease recoupment of excess Abbott BinaxNOW cards effective Friday, June 11 – meaning any recoupment requests must be received by 5:00 p.m. on Friday, June 11 in order to be sent a mailing label. As before, we will only accept unopened boxes and box lots that have at least 30 days or more to expiration, please refer to the most recent extension expiry letter from Abbott. After that date, the recoupment form will be removed from the DHSS website.

If your facility has an excess of Abbott BinaxNow Cards, which you are unable to use prior to them expiring, please provide your information on the recoupment form link: https://mophep.maps.arcgis.com/apps/opsdashboard/index.html#/1913bb3c639843c49b74350a4652d750.

SEMA will send you UPS shipping labels and the tests will be sent to the state warehouse for redistribution- so they do not expire before they can be used.

Please note the following:

  • Unless you have specifically ordered the tests from DHSS via an online ordering portal- the tests you are returning were from FEDERAL.
  • SEMA is unable to accept tests that are 30 days or less until expiration date (this can be within the new expiry date). With less than 30 days, they are unable to recoup and redistribute those tests to another user in a timeframe that allows the new user time to incorporate into their testing regimen.
  • Abbott’s guidance for unused kits is that all components of this kit should be discarded as Biohazard waste.

CANCELLING DIRECT SHIPMENTS

  • If there are facilities in your state receiving direct allocations of Abbott Binax NOW that would like to cancel those allocations, please submit the cancellation request to ARDxUSGovernmentSupport@abbott.com. Note: this is a cancellation not a pause. Pausing allocations is not an option. Once received allocations can be transferred to other facilities within the state.

Missouri partnerships ensure access to COVID-19 vaccines for homebound residents

The Missouri Department of Health and Senior Services (DHSS) announced a partnership between the Area Agencies on Aging, local public health agencies, and Emergency Medical Services (EMS) to ensure homebound adults have a streamlined and accessible vaccination experience across the state. Understanding that various communities have already developed a plan for vaccinating homebound individuals in their area, the partnerships established by the State are to merely supplement and allow these efforts to continue at the local level.

COVID-19 vaccination of homebound persons presents unique challenges to ensure the appropriate vaccine storage, temperatures, handling, and administration to ensure safe and effective vaccination.  Both CDC and CMS define homebound persons as those that need the help of another person or medical equipment such as crutches, a walker, or a wheelchair to leave their home, or their medical provider believes that their health or illness could get worse if they leave their home, and they typically do not leave their home. 

The homebound referral process begins with the Area Agencies on Aging who are experts in discerning homebound status. Adults who are homebound and want to be vaccinated in their home can register through their local Area Agency on Aging or through the Missouri Vaccine Navigator registry by indicating they are homebound. Individuals reaching out to the State COVID-19 Hotline seeking vaccination for a homebound individual will be directed to their local Area Agency on AgingThe homebound individual, their caregiver, family member, or healthcare provider can make the referral. 

The Area Agency on Aging makes contact with the homebound individual to obtain consent and gather the pertinent information to coordinate the vaccination in their home.  In some cases, caregivers and other household members may also be vaccinated at the same time as the homebound individual to prevent vaccine wastage. The Area Agency on Aging turns over the list of registered homebound individuals to their local public health agency or EMS provider who then schedules the in-home appointments. The AAA may also provide the homebound individual with courtesy appointment reminders via phone as many do not have internet or email access. 

The City of St. Louis Department of Health teamed up with the St. Louis Fire Department, Team Rubicon and the St. Louis City Area Agency on Aging to provide their homebound residents COVID-19 vaccination opportunity.

“This program will provide much-needed protection against COVID-19 for clients who may find it difficult to visit a vaccine clinic,” says Dr. Fredrick Echols, Acting Director of Health for the City of St. Louis. “By bringing the vaccine to them, we remove the barrier of travel and ensure these clients are not left behind in the vaccination process.”

[View Photo]  James Thompson, EMS Supervisor, and Mary Sullivan with Team Rubicon vaccinate a homebound resident of St. Louis City.

Kansas City’s homebound vaccination strategy involves a partnership between the Mid-America Region Council (MARC) Area Agency on Aging, the local health departments of Cass, Clay and Platte Counties and Kansas City, as well as multiple EMS and fire districts.

Chief Chip Portz of Central Jackson County Fire District said, “By partnering with our local health department and by taking advantage of reimbursement opportunities, the Central Jackson County Fire Protection District is able to provide this vital community service to a very vulnerable population without using emergency crews who would normally be protecting the rest of our citizens. We use off-duty paramedics in a non-emergency role to ensure our emergency response capacity is not diminished or compromised.”

[View Photo]  Central Jackson County Fire District, Captain Paramedic, Nathan Manley is providing vaccination to a homebound resident.

Lee’s Summit Assistant Fire Chief, Dan Manley, who has been instrumental in regional emergency planning, arranged a vaccine event for MARC Aging and Adult Services staff as well as their community partner who is delivering meals to self-isolating congregate and homebound older adults during COVID.

“Having our staff and volunteers vaccinated protects our most vulnerable homebound residents that we serve,” said Manley.

If you or someone you know is homebound or unable to visit a COVID-19 vaccination clinic without assistance, please call the COVID-19 Hotline at 877-435-8411 and press option 4 to be routed directly to your local Area Agency on Aging to make a vaccine appointment. You can also register homebound individuals for the vaccine by visiting Missouri’s COVID-19 website, MOStopsCovid.com. COVID-19 Hotline hours of operation are Monday-Friday 7:30 a.m.-5:30 p.m. and Saturday 8 a.m.-2 p.m. Individuals are encouraged to call soon to ensure their names are added to the list.  

News Release: State adds five additional language options to Missouri Vaccine Navigator

The Missouri Department of Health and Senior Services (DHSS) has launched the Missouri Vaccine Navigator in five additional languages for non-English speaking individuals. Already available in English and Spanish, Vaccine Navigator now also allows individuals to register and find vaccination appointments throughout Missouri in Chinese, French, Korean, Portuguese and Russian.

All individuals over the age of 12 are now eligible to get a COVID-19 vaccine in Missouri, regardless of their citizenship. (Pfizer is the only vaccine authorized for those ages 12-17).

Approximately 775,000 individuals are currently registered in Missouri Vaccine Navigator, which is powered by Qualtrics. The system allows individuals to register and schedule an appointment for a COVID-19 vaccine by viewing vaccination events throughout the state.

In addition to helping individuals register for a vaccine, the Missouri Vaccine Navigator will remind registrants when it is time to schedule their second dose. Two of the vaccines currently authorized for use (Pfizer and Moderna) require two doses, and the second dose is critical to ensure individual and community protection.

The Missouri Vaccine Navigator also integrates with ShowMeVax, the state’s immunization database for providers. Vaccination events using the Missouri Vaccine Navigator for scheduling enables  coordinators to quickly load vaccination administration data into the system and avoid cumbersome data entry.

Once an individual is registered with Missouri Vaccine Navigator, the scheduling platform becomes available and can be accessed as often as needed or until vaccination is achieved.

Those with online accessibility issues are encouraged to call the COVID-19 hotline at 877-435-8411 for registration assistance. Language translation and other services are available to callers.

COVID-19 vaccines are completely free for everyone in the U.S. Get the facts at  MOStopsCovid.com.

SLCR Life Safety Code Information Series

The Section for Long-Term Care Regulation will be releasing a series of Life Safety Code Information. You may also view the entire Life Safety Code document for reference.

Today’s subject is:

What if a sprinkler head gets paint on it or has corrosion?

No one can successfully remove paint or corrosion from a sprinkler head and the facility must replace those sprinkler heads. There is currently not any UL listed paint remover.

NFPA 25, 2011 edition:
5.2.1.1 Sprinklers shall be inspected from the floor level annually.
5.2.1.1.1 Sprinklers shall not show signs of leakage; shall be free of corrosion, foreign materials, paint, and physical damage; and shall be installed in the correct orientation (e.g., upright, pendent, or sidewall).
5.2.1.1.2 Any sprinkler that shows signs of any of the following shall be replaced:

(1) Leakage
(2) Corrosion
(3) Physical damage
(4) Loss of fluid in the glass bulb heat responsive element
(5) Loading
(6) Painting unless painted by the sprinkler manufacturer

5.2.1.1.3 Any sprinkler that has been installed in the incorrect orientation shall be replaced.
5.2.1.1.4 Any sprinkler shall be replaced that has signs of leakage; is painted, other than by the sprinkler manufacturer, corroded, damaged, or loaded; or is in the improper orientation.
5.2.1.1.5 Glass bulb sprinklers shall be replaced if the bulbs have emptied.