Category: SLCR Guidance

FREE Resource! Center of Excellence for Behavioral Health In Nursing Facilities

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The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) was established in September 2022 by the Substance Abuse and Mental Health Services Administration (SAMHSA) in collaboration with the Centers for Medicare and Medicaid Services (CMS). It provides mental health and substance use training, customized technical assistance and resources to certified Medicare and Medicaid nursing facility staff who care for residents with a variety of behavioral health conditions at absolutely no cost to certified nursing facilities. They help nursing facilities to improve the quality of life and care provided for residents who are experiencing a variety of behavioral health disorders, with a focus on Serious Mental Illness (SMI), Substance Use Disorder (SUD), Co-Occurring Disorders (COD) and Serious Emotional Disturbance (SED).

Online resources are also available free for other providers too! Find out more: Home – COE-NF (nursinghomebehavioralhealth.org)

Administrator Update Information Changes

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New Rule Change – effective 06/30/23

19 CSR 73-2.130 – Notice of Change of Contact Information and Missouri Administrator Employment

  1. Each administrator shall notify the board office of his/her current contact information within ten (10) calendar days of change for any of the following:
    1. Personal contact information, which shall include administrator license number, personal mailing address, email, and telephone number(s); and
    2. Missouri administrator employment, which shall include, administrator license number, facility name, mailing address, telephone number(s), and employment dates.

Please visit https://health.mo.gov/bnha/contactupdate.php for the online form for BNHA.

Please note: The Board of Nursing Home Administrators and the Section for Long Term Care Regulation (SLCR) each have requirements for reporting a Change of Administrator/Manager in a Long Term Care Facility. Please be sure to follow the requirements for each Section.

For SLCR, please submit the change of administrator or manager via a letter or by using the online form. Forms/letters can be submitted via email to LTCApplication@health.mo.gov or by mail to Department of Health and Senior Services, Section for Long-Term Care Regulation, Licensure and Certification Unit, PO Box 570, 920 Wildwood, Jefferson City, MO 65102.

COMRU Survey Access Code

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COMRU is providing the following guidance regarding the online application entitled “Application started prior to 07-16-2023” (the green link).

COMRU will be providing you with a “Survey Access Code”; please note this is different from the return code.

  • The “Survey Access Code” will allow the submitter to access the application to check the status.
  • If the submitter clicks “Submit- Ready for Processing by COMRU” or “Save and Return Later”, the submitter will be provided with a “Return Code”. At this point, the “Survey Access Code AND the “Return Code” will be needed to access the application in the future.
  • Please do not click the “Start Over” button, as this will DELETE the Entire Application. (COMRU will not be able to retrieve the application if this occurs).

Please do not hesitate to contact COMRU at 573-522-3092 for any questions.

Missouri Nursing Facility Strike Team and Infrastructure Reimbursement Opportunity

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The Strike Team has made an informative webinar for SNF/LTC and Other facilities describing the Missouri Nursing Facility Strike Team and Infrastructure Reimbursement Opportunity. This webinar reviews; how to get to the site where they can find the application, the Application Guidance and Frequently Asked Questions, steps needed to apply, and other useful information. This webinar has been posted to the Health Care Professionals page on the DHSS website.

COMRU Return Codes

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We have some good news and some bad news!

The bad news….due to a required change in the database platform, the COMRU online applications for Level 1/Level 2 (old DA124s) forms will no longer be accessible by your CURRENT RETURN CODES after Friday, July 14, 2023.

The good news…you can still access the online applications and COMRU can continue to process applications you submitted! However, as of MONDAY, JULY 17, a NEW RETURN CODE will be required to access all applications entered prior to July 17, 2023.

Please note – this change will not affect any application initiated after July 17, 2023. You will continue to receive a valid return code for all new applications submitted to COMRU after July 17, 2023.

What do I need to do?!

If you recently submitted the application (before July 17) – a new return code will be provided to you when COMRU reviews your application. Otherwise, if you need to make a change or need to receive the new code for applications initiated prior to July 14, 2023, please email the following to COMRU (COMRU@health.mo.gov):

Name of Individual
DCN or SSN
Name of Facility
Admission Date (if admitted to SNF)

We appreciate your patience during this transition process and apologize for any inconvenience.

Updated Missouri Nurse Aid Candidate Handbook

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The DHSS Health Education Unit and Headmaster D & S would like to announce some revisions to the skills portion of the CNA exam shown in the Candidate Handbook effective July 1, 2023. Please see the new updated version at Missouri Nurse Aide Candidate Handbook (hdmaster.com) for the changes.

Please contact the DHSS Health Education Unit at 573-526-5676 and/or Headmaster D & S at 800-393-8664 for any questions.

Dangerous Heat Warnings for Missouri

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The National Weather Service has issued a heat advisory for portions of Missouri for Thursday, June 29 and Friday, June 30. As temperatures rise this summer, it is important to prioritize heat related safety measures. Heat-related illnesses can have serious consequences, but with some precautions and awareness, we can create a safer work environment.

Heat-related illnesses often affect the very young, the elderly and the chronically ill, but summer temperatures can also take a toll on healthy young and middle-aged adults. In 2022, 23 people died from heat exposure in Missouri, ranging in age from 2-83 years.

During prolonged periods of high temperatures, using air conditioning – either at home or by seeking shelter in a local cooling center – is the best preventive measure.

“Heat and humidity can place a lot of stress on the body,” said DHSS Director Paula Nickelson. “Heat exhaustion can come on suddenly, with little warning, and lead to heatstroke which becomes a very dangerous situation.”

During excessive heat, Nickelson urges Missourians to check on friends and neighbors, especially those who are elderly and chronically ill. To report a senior citizen or an adult with disabilities who is in need of assistance due to the heat, call the state’s toll-free abuse and neglect hotline at 1-800-392-0210, or make a report online. Medications, as well as use of drugs or alcohol, can impair a body’s response to heat, making one more vulnerable to the heat.

Never leave a child or pet alone in a vehicle. Four of Missouri’s heat-related deaths in 2022 were individuals in vehicles. Even on a cooler day, the temperature inside a vehicle can rise by 20 degrees in 10 minutes and pose a real threat to anyone left inside. Stress, distraction and being out of a normal routine can all contribute to forgetting a child in a car seat. Check the back seat each time you exit your vehicle.

There are a number of steps individuals can take to stay cool including:

  • Stay hydrated. Drink plenty of water regardless of your activity level, and do not wait until you are thirsty to do so. Avoid sugary and alcoholic beverages; these actually cause you to lose body fluids.
  • Wear appropriate clothing. Wear lightweight, breathable, and loose-fitting clothing that allows air circulation. When outside, consider wearing a hat and sunglasses to protect yourself from the sun.
  • Stay cool indoors. Stay in air-conditioned places as much as possible. Find a local cooling center if needed.
  • Schedule outdoor activities carefully. Try to plan outdoor activity for morning or evening hours when the temperature is coolest.
  • Pace yourself. Reduce exercise or physical activity during the hottest part of the day, and take frequent breaks in the shade or in an air-conditioned place.
  • Wear sunscreen. Sunburn affects your body’s ability to cool down and can make you dehydrated.
  • Prepare your home. Change air conditioner filters, and cover windows that receive morning or afternoon sun with drapes or shades.
  • Stay informed. Pay attention to weather forecasts and heat advisories. Stay informed about the local heat index and adjust safety measures accordingly.

Knowing the signs and symptoms of heat related illness and how treat them is also important. Signs of heat exhaustion may include muscle cramps; heavy sweating; cold, pale and clammy skin; dizziness; headache; nausea or vomiting; and fainting or passing out. If you think you or a loved one are experiencing heat exhaustion, you should stop physical activity move to a cool place – preferably air-conditioned, loosen clothing, and sip cool water. Seek medical attention immediately if you are throwing up, your symptoms get worse or symptoms last longer than one hour.

Signs of heat stroke may include high body temperature (103°F or higher); hot, red, dry or damp skin; fast, strong pulse; headache; dizziness; nausea; confusion; or loss of consciousness. If you think you or a loved one are experiencing heat stroke you should call 911 immediately. Heat stroke is a medical emergency. Move the person to a cool place – preferably air-conditioned. Help lower the person’s body temperature with cool cloths or a cool bath until medical personnel arrive. Do not give the person anything to drink.

For more information regarding heat-related illness and prevention, visit the websites of DHSS or the CDC.

2023 Provider Feedback Survey

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The Section for Long-Term Care Regulation is again seeking input from providers we serve. We are asking for your help in identifying areas in our Section where excellent customer service is provided and areas where we need to focus on improving our customer service experience. Please take a couple minutes to complete our 2023 Provider Feedback Survey by July 5, 2023 at https://www.surveymonkey.com/r/6K86SF6.

Medicaid Spend-Down Limit Changes

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Effective July 1, 2023, the Medicaid Resource (Spend-Down) Limit increased to $5,726.00. Please see the link https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf.

Please note that for Medicaid/Medicare certified facilities, 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. This means certified facilities should notify the resident/legal guardian when the resident’s personal funds are $5,526.00 or higher.

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

QIPMO’s Educational Events

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The Quality Improvement Program for Missouri (QIPMO) is a cooperative service between the MU Sinclair School of Nursing and the Missouri Department of Health and Senior Services. The program is entirely separate from the state survey and enforcement process. Nursing facility participation in the program is voluntary and confidential.

The program puts together multiple meetings. For more information, see their webpages containing Past Educational Webinars & Recordings as well as Upcoming Educational Webinars.

2023 SLCR Annual Provider Meetings

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Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation

Advanced registration is not required. There is no cost to attend any of these meetings. Please see the flyer.

Earn up to 6 CEUs (3 Admin/3 PC).

September 6, 2023: Region 7
Location: Crowne Plaza St. Louis Airport, Bridgeton

September 7, 2023: Region 2
Location: Drury Plaza Hotel & Convention Center, Cape Girardeau

September 13, 2023: Region 1
Location: Oasis Hotel & Convention Center, Springfield

September 14, 2023: Region 6
Location: Special Olympics Missouri, Jefferson City

September 27, 2023: Region 5
Location: Moberly Municipal Auditorium, Moberly

October 4, 2023: Region 4 Agenda
Location: Stoney Creek Hotel, St. Joseph

October 5, 2023: Region 3 Agenda
Location: Adams Pointe Conference Center, Blue Springs

Handouts
Handouts will not be provided at the meetings. You may choose to either have them available during the meeting on an electronic device or print them.

1. Quality Improvement and Evaluation System (QIES), Certification and Survey Provider Enhanced Reports (CASPER) & SNF Quality Reporting Program (QRP)
2. Free from Abuse & Neglect – Peeling back the Regulatory Layers for Investigating and Reporting Abuse
3. Section Update
4. Oral Health for Older Adults
5. Guardians, Resident Rights, DPOAs, and Discharges
6. Emergency Preparedness
7. Environmental Considerations in LTC
8. Artifacts of Culture Change – More than a Measurement Tool

iQIES Minimum Data Set (MDS) Submission and Reports is Now Available

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On April 17, 2023, the Centers for Medicare & Medicaid Services (CMS) transitioned to the Internet Quality Improvement and Evaluation System (iQIES) for Minimum Data Set (MDS) record submissions and reports.

All MDS submissions that were performed in the QIES Assessment Submission And Processing (ASAP) system prior to April 13 at 8:00 p.m. ET were processed in that system. As part of the migration, MDS data accepted into the ASAP system prior to the start of the migration were moved into iQIES. All new, modification, or inactivation records must be submitted in iQIES, even if the original record to be corrected was accepted into the QIES ASAP system.

As part of the migration, users are now able to access and run the user-requested reports in iQIES. User’s access to the reports is similar to the access in the Certification and Survey Provider Enhanced Reporting (CASPER) Reporting application, so long as their new HCQIS Access Roles and Profile (HARP) role allows access to generate and view reports. Users are only allowed to run reports for the providers to which they have access.

Register for an iQIES Account

For information and instructions to register for an iQIES account, please visit: https://qtso.cms.gov/news-and-updates/action-required-register-iqies-account.

User Manuals

Video Tutorials

Additionally, the iQIES Team has developed video tutorials to provide an overview of the MDS functionalities in iQIES. The video tutorials can be found on QTSO and are not mandatory: https://qtso.cms.gov/training-materials/iqies-training-videos

  • Upload an Assessment for MDS Users
  • How to Run Reports

iQIES Service Center

  • If you have questions or require assistance, please contact the QIES/iQIES Service Center by phone at (800) 339-9313 or send an email.

2023 SLCR Annual Provider Meeting Topics

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We are currently in the planning phase to host in-person provider meetings in all regions 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 complete a one-question survey by May 10, 2023 at https://www.surveymonkey.com/r/2C82YVN.

COMRU Training

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COMRU will be hosting a webinar/Q&A session regarding the online process and the ending of the COVID 19 waiver via WebEx.

April 24, 2023: Join Meeting Here
Time: 10:00 a.m.

Join by meeting number
Meeting number (access code): 2460 830 8201
Meeting password: 67tMfa2hU6R

Tap to join from a mobile device (attendees only)
+1-650-479-3207,,24608308201## Call-in toll number (US/Canada)
+1-312-535-8110,,24608308201## United States Toll (Chicago)

MO HealthNet Personal Funds Account Balance Report Updated

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The Mo HealthNet Personal Funds Account Balance Report was updated in March of 2023. Please use the following link to access the updated report when reporting expired residents to the MO HealthNet Division: https://manuals.momed.com/forms/Personal_Funds_Account_Balance_Report.pdf.

Please note, while the MO HealthNet Personal Funds Account Balance Report form states the completed form must be submitted within 60 days of the resident’s death, federal requirements for certified nursing facilities require the notification within 30 days of the resident’s death. Refer to F569 of the State Operations Manual. For state regulations, please refer to 19 CSR 30-88.020 (11).

Also note, the only resident funds that can be withdrawn prior to completing the Personal Funds Account Balance Report is for basic funeral expenses.

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

Health Education Unit Announcements

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Knowledge tests for 1/1/23-4/5/23 show students passed at 64.11%

These areas are below 80%:

  • Aging Process and Restorative Care – 79%
  • Basic Nursing Skills – 78%
  • Disease Process – 78%
  • Role Responsibility – 77%
  • Communication – 80%

*If your students have failed a test, please have your students review their tests so they know what areas that need more attention before retesting.

Skills tests given from 1/1/23-4/5/23 show students passed at 79.05%

Students scored the lowest on the areas below:

  • Blood Pressure – 78.85%
  • Feeding a Dependent Resident – 85.45%

NOTE: HEU and Headmaster met with our Test Advisory Panel in March to address some changes in the skills test and knowledge test. These changes will be effective on July 1, 2023 so please check the Missouri Headmaster Website for the most recent version of the Candidate Handbook.

 

CNA Live Renewals Coming Soon

HEU is excited to announce the “new” process for CNA Renewals as it is close to going “LIVE” on May 1, 2023.

Please email Headmaster at missouri@hdmaster.com if you have not setup your employer profile. This will give the employer the option to verify employment and pay for the renewal for their CNA staff. This process will increase efficiency and time as it is all done electronically for the CNA and the employer. We have included a link to review the process in a “How To Guide” and will be offering several Q & A webinars. Please see below:

Instructor Info Meet Up Meetings

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The DHSS Health Education Unit is conducting Weekly Instructor Info Webinars/Q&A Meet-Ups. These sessions will be held same day and time each week – Tuesdays at 2:00 p.m.

April 11, 2023: Instructor Info Meet Up Meeting
April 18, 2023: Instructor Info Meet Up Meeting
April 25, 2023: Instructor Info Meet Up Meeting

Please see the CNA Registry webpage for past meetings and more information.

If you have questions, please call our office at 573-526-5686.

Missouri Certificate of Need Program

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What does the Missouri Certificate of Need Program (CONP) do? The CONP reviews proposals for new and additional long-term care beds, major medical equipment, and new hospitals. Approval by the Missouri Health Facilities Review Committee is required before an applicant may proceed with their proposal or obtain licensure. CONP also collects LTC occupancy every quarter.

You can view CON applications filed with DHSS on our website here under the Upcoming Meetings section. This section also includes details about an upcoming CON meeting and agenda items, and additional documentation received regarding a project. Any person or facility may submit written support, neutral, or opposing letters on a CON project up to three (3) business days before a scheduled CON meeting. Written support/neutral/opposition may be emailed to CONP@health.mo.gov or mailed to 3418 Knipp Drive, Jefferson City, Mo 65102. Any person may also testify in support, neutral, or opposition at an in-person CON meeting. Questions can be emailed to CONP@health.mo.gov.

CNA Certification Status & Renewals

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The DHSS Health Education Unit encourages you to check the certification status of your CNA staff. CNA’s are required to renew their certification every 24 months to remain “active” on the registry.

Please see the link to login: MO TMU (tmutest.com)

Please note: If a CNA has never logged into the TMU registry, they will need to call HEU at 573-526-5686 the first time for assistance.

HEU is very excited to announce a new option for CNA Renewals coming soon!!! This new feature will allow employers to verify employment and pay for multiple CNA staff electronically. Please stay tuned for the official announcement and details.

Funding Opportunity for Missouri Nursing Facility Strike Team and Infrastructure Award

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The Missouri Department of Health and Senior Services (DHSS) is excited to announce the Missouri Nursing Facility Strike Team and Infrastructure Award, a reimbursement opportunity available to Skilled Nursing Facilities (SNF) and Long Term Care and Other Nursing Facilities (LTC). Beginning March 1, 2023, facility owners and operators may apply for reimbursement for expenses incurred between July 1, 2022 and August 31, 2023, directly related to preparing, preventing, and responding to the COVID-19 pandemic.

If you operated a Skilled Nursing Facilities or Long Term Care and Other Nursing Facilities licensed with DHSS between July 1, 2022 and August 31, 2023, you are eligible for reimbursement for allowable expenses.

Owner/operator applicant must be registered as a vendor with the State of Missouri prior to submitting an application. If not already registered, visit https://missouribuys.mo.gov/registration. Vendor name and address used in registering as a vendor must be the same vendor name address used on the reimbursement application. Be sure to register only the operating entity and not all individual facilities owned by the same company.

Please see the attached Frequently Asked Questions and Application Checklist documents below.

Missouri Nursing Facility Strike Team and Infrastructure Award FAQ Checklist
Missouri Nursing Facility Strike Team and Infrastructure Award Application
Missouri Nursing Facility Strike Team and Infrastructure Award Eligible Facilities

All questions should be directed to the DHSS Strike Team via email at LTCStrikeTeam@health.mo.gov.

Public Health Emergency (PHE) 1135 Waivers: Updated Guidance for Providers

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On February 9, the Department of Health and Human Services (HHS) announced the Public Health Emergency (PHE) for COVID-19 will end on May, 11, 2023. COVID-19 remains a significant priority for the Biden-Harris Administration and over the next several months, the Centers for Medicare & Medicaid Services (CMS) will work to ensure a smooth transition. During the PHE, CMS has used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure easier access to care during the PHE for health care providers and their beneficiaries.

Some of the flexibilities that were created during the pandemic were recently expanded by the Consolidated Appropriations Act, 2023. Others, while critical during our initial responses to COVID-19, are no longer needed. CMS has made further updates to our CMS Emergencies Page with useful information for providers – specifically around major telehealth and individual waivers – that were initiated during the Public Health Emergency (PHE).

Please reference the following guidance in response to the PHE ending May 11, 2023:

Provider-specific fact sheets about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers

CMS COVID-19 Waivers and Flexibilities for Providers include:

  • Physicians and Other Clinicians
  • Hospitals and CAHs (including Swing Beds, DPUs), ASCs and CMHCs
  • Teaching Hospitals, Teaching Physicians and Medical Residents
  • Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)
  • Home Health Agencies
  • Hospice
  • Inpatient Rehabilitation Facilities
  • Long Term Care Hospitals & Extended Neoplastic Disease Care Hospitals
  • Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
  • Laboratories
  • Medicare Shared Savings Program
  • Durable Medical Equipment, Prosthetics, Orthotics and Supplies
  • Medicare Advantage and Part D Plans
  • Ambulances
  • End Stage Renal Disease (ESRD) Facilities
  • Participants in the Medicare Diabetes Prevention Program
  • Intermediate Care Facility for Individuals with Intellectual Disabilities

 Department of Health & Human Services Fact Sheet: https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html

In the coming weeks, CMS will be hosting stakeholder calls and office hours to provide additional information. Please continue to visit the CMS Emergencies Page for continuous updates regarding PHE sunsetting guidance as information becomes available to the public.