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.

CMS Memo QSO 20-39-NH: Nursing Home Visitation – COVID-19 (Revised 11-12-2021)

CMS has issued updated visitation guidance for visitation in nursing homes. The new guidance includes that visitation is now allowed for all residents at all times. DHSS will be updating its guidance as well and it will be consistent with the CMS guidance. Long-term care facilities certified for Medicare and Medicaid are required to follow the CMS memo. All long-term care communities (SNF, ICF, ALF and RCF) may utilize the CMS guidance until the DHSS guidance is updated.

Please see the full memo at https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf.

General Licensure Requirements – REGULATION UPDATE NOTICE

19 CSR 30-82.010 General Licensure Requirements

The Department of Health and Senior Services, Section for Long-Term Care Regulation has drafted emergency and proposed amendments for regulation set 19 CSR 30-82.010 in order to create a temporary closure procedure for those Medicare and Medicaid federally certified facilities (intermediate care facilities and skilled nursing facilities) licensed in Missouri which experience staffing shortages from the COVID-19 vaccine mandate issued by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services emergency regulation 42 CFR part 483.

The emergency amendment for 19 CSR 30-82.010 was filed on November 10, 2021, with an effective date of November 29, 2021, and expiration of May 27, 2022. The emergency amendment can currently be viewed at: https://www.sos.mo.gov/CMSImages/AdRules/main/EmergenciesforInternet/19c30-82.010IE.pdf. The proposed amendment covering this same material will also be published in the same issue of the Missouri Register. The Register publication date is December 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 amendment will be from December 15, 2021 – January 14, 2022. 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/.

2021 Annual SLCR Provider Meeting

The 2021 Annual Section for Long-Term Care Regulation Provider Meeting was held virtually on November 10, 2021.

The recorded videos are available at https://missouri.qualtrics.com/jfe/form/SV_ehWffJkM2r7WSHk.

 

Many questions asked during presentation were asked and have been compiled into a document with answers in the attached Provider Meeting Q&A.

In response to some specific questions, please see this medical marijuana presentation that was given by SLCR.

 

Please see the agenda here.

PowerPoint Handouts
1. Welcome & Section Updates
2. Division Introductions
3. Nursing Home Discharges
4. The New CNA Testing Process
5. Immediate Jeopardy and Past Noncompliance
6. Psychosocial Impact
7. Oral Health
8. ICAR Project
9. Life Safety Code Presentation

 

Level of Care Transformation (webinar posted)

Exciting transformation is coming for the Level of Care (LOC) process effective 10/31/2021! Our current LOC Process (many of us have referred to as the DA124 A/B forms) is undergoing major changes!

Here are some of the highlights:

The application process will all be ELECTRONIC. You will fill out and submit forms online on the COMRU website at https://health.mo.gov/seniors/nursinghomes/pasrr.php. For example, the forms will be able to be sent from the hospital to the nursing home to COMRU, all in one system. This electronic link will be available starting October 29, 2021. COMRU will not process these application until November 1, 2021.

The process of evaluating Level of Care will also change. New areas will be evaluated and previous areas will be changed in order to provide the best assessment for determining Level of Care. You can read about the new process in the proposed Regulation at 19 CSR 30-81.030, https://health.mo.gov/about/proposedrules/, which will go into effect on 10/31/2021.

To help facilities prepare for these changes, COMRU hosted a webinar on 10/28/2021. The recorded version of the New LOC Webex Training may be found on the COMRU webpage. A Q & A document from this webinar is also available.

Additionally, COMRU will be hosting a follow-up Webex training for the LOC Transformation. Details below:

November 19, 2021 at 10:00 a.m.

When it’s time, join your Webex meeting here – Join meeting

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Abbott BinaxNOW Expiration Dates

You can access the most information related to Abbott of BinaxNOW tests that have been authorized to have their expiration dates extended by accessing information directly from Abbott’s website.  Use the instructions to see the letter and listing of BinaxNOW™ COVID-19 Ag Card lots which qualify for this expiry extension. Please pay close attention to the lot number, currently labeled kit expiry, and new kit expiry date. The image below helps you to locate the lot number of the Abbott BinaxNOW test kits.

Evaluation and Assessment Measures for Title XIX Recipients and Applicants – REGULATION UPDATE NOTICE

The Department of Health and Senior Services, Section for Long-Term Care Regulation has drafted emergency and proposed amendments regarding adding the level-of-care evaluation and assessment requirements back that were effective prior to October 31, 2021, in order for those individuals who would have qualified for Title XIX funded services prior to October 31, 2021, to be eligible to receive services funded through the American Rescue Plan Act (temporary enhanced federal medical assistance percentage). Therefore, a second level-of-care determination will be utilized from October 29, 2021, until the funding from the American Rescue Plan Act has been expended.

The emergency amendment for 19 CSR 30-81.030 was filed on October 15, 2021, with an effective date of October 29, 2021, and expiration of April 26, 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 November 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 amendment will be from November 15, 2021 – December 15, 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/.

Level of Care Transformation

Exciting transformation is coming for the Level of Care (LOC) process effective 10/31/2021! Our current LOC Process (many of us have referred to as the DA124 A/B forms) is undergoing major changes!

Here are some of the highlights:

The application process will all be ELECTRONIC. You will fill out and submit forms online on the COMRU website at https://health.mo.gov/seniors/nursinghomes/pasrr.php. For example, the forms will be able to be sent from the hospital to the nursing home to COMRU, all in one system. This electronic link will be available starting October 29, 2021. COMRU will not process these application until November 1, 2021.

The process of evaluating Level of Care will also change. New areas will be evaluated and previous areas will be changed in order to provide the best assessment for determining Level of Care. You can read about the new process in the proposed Regulation at 19 CSR 30-81.030, https://health.mo.gov/about/proposedrules/, which will go into effect on 10/31/2021.

To help facilities prepare for these changes, COMRU will be hosting a webinar. Additional trainings to follow.

Thursday, October 28, 2021 at 10:00 a.m.

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2021 Annual SLCR Provider Meeting – SAVE the DATE

Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation in partnership with MU Sinclair School of Nursing, this year’s SLCR Provider Meeting will be held virtually.

Wednesday, November 10, 2021

With the meeting being conducted virtually this year, registration will be required. The link to register along with session information will be coming soon. Please stay tuned to the LTC Information Update for more details.

CNA Testing Update

Beginning 09/01/2021 all full CNA tests are done through Headmaster D & S. Please see the information on Testing Updates In Missouri for clarification on how to proceed with setting up the final examination for students.

For up to date information or any questions, feel free to visit the Health Education Unit webpage or you may call 573-526-5686 or email at cnaregistry@health.mo.gov.

CMS Memo QSO-20-38-NH: Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements

Long-Term Care (LTC) Facility COVID-19 Testing Requirements (QSO 20-38-NH, revised 9/10/2021)

Please read the memo carefully. CMS has revised testing requirements for nursing homes including testing of symptomatic residents and staff, and routine testing of staff. Two major changes are:

  • Facilities now have two options to conduct outbreak testing, through either a contact tracing or broad-based testing approach. See Table 1.
  • Routine staff testing is now based on the facility’s county level of community transmission instead of county test positivity rate. The link to determine county level of community transmission is in the memo. The frequency of testing has also been updated. See Table 2.

 

Table 1: Testing Summary

Testing Trigger

Staff

Residents

Symptomatic individual identified

Staff, vaccinated and unvaccinated, with signs or symptoms must be tested.

Residents, vaccinated and unvaccinated, with signs or symptoms must be tested.

Newly identified COVID- 19 positive staff or resident in a facility that can identify close contacts

Test all staff, vaccinated and   unvaccinated, that had a higher-risk exposure with a COVID-19 positive individual.

Test all residents, vaccinated and unvaccinated, that had close contact with a COVID-19 positive individual.

Newly identified COVID- 19 positive staff or resident in a facility that is unable to identify close contacts

Test all staff, vaccinated and unvaccinated, facility-wide or at a group level if staff are assigned to a specific location where the new case occurred (e.g., unit, floor, or other specific area(s) of the facility).

Test all residents, vaccinated and unvaccinated, facility-wide or at a group level (e.g., unit, floor, or other specific area(s) of the facility).

Routine testing

According to Table 2 below

Not generally recommended

 

Table 2: Routine Testing Intervals by County COVID-19 Level of Community Transmission

Level of COVID-19 Community

Transmission

Minimum Testing Frequency of

Unvaccinated Staff+

Low (blue)

Not recommended

Moderate (yellow)

Once a week*

Substantial (orange)

Twice a week*

High (red)

Twice a week*

+Vaccinated staff do not need to be routinely tested.

 

Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/interim-final-rule-ifc-cms-3401-ifc-additional-policy-and-regulatory-revisions-response-covid-19-0.

New Enrichment Booklet for Residents

National Consumer Voice for Quality Long-Term Care has a NEW Enrichment Booklet offers residents a variety of activities to keep them entertained and active. This book includes puzzles, word searches and crosswords; prompts for residents to write about the connections in their lives; trivia questions, which can be done alone or with others; and more!

Download and print the Enrichment Booklet for free or purchase hard copies of the booklet from the online store.