Category: SLCR Guidance

COVID Related Information

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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 Aging.  The 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

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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

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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.

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 2021 Provider Feedback Survey by June 30, 2021 at https://www.surveymonkey.com/r/CFY7N9T.

CMS Memo QSO-21-19-NH: Interim Final Rule – COVID-19 Vaccine Immunization Requirements for Residents and Staff

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Interim Final Rule – COVID-19 Vaccine Immunization Requirements for Residents and Staff

CMS has issued QSO-21-19-NH, which outlines the Interim Final Rule – COVID-19 Vaccine Immunization Requirements for Residents and Staff. This rule establishes Long-Term Care (LTC) Facility Vaccine Immunization Requirements for Residents and Staff. This includes new requirements for educating residents or resident representatives and staff regarding the benefits and potential side effects associated with the COVID-19 vaccine, and offering the vaccine. Furthermore, LTC facilities must report COVID-19 vaccine and therapeutics treatment information to the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN). Please read through the memo carefully for facility actions and effective dates.

See the memo or visit https://www.cms.gov/files/document/qso-21-19-nh.pdf for complete details.

SLCR Life Safety Code Information Series

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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 kind of documentation should a facility provide to the surveyor when on a fire watch?

Most facilities have one fire watch policy. If a facility has one policy, then the policy must have all the items in Chapter 15 within NFPA 25, 2011 edition. If the facility has two separate policies, the sprinkler system fire watch policy is required to include all the items in Chapter 15.

NFPA 25, 2011 edition:
Minimum Requirements
15.1.1.1 This chapter shall provide the minimum requirements for a water-based fire protection system impairment program.
15.1.1.2 Measures shall be taken during the impairment to ensure that increased risks are minimized and the duration of the impairment is limited.
Impairment Coordinator
15.2.1 The property owner or designated representative shall assign an impairment coordinator to comply with the requirements of this chapter.
15.2.2 In the absence of a specific designee, the property owner or designated representative shall be considered the impairment coordinator.
Tag Impairment System
15.3.1 A tag shall be used to indicate that a system, or part thereof, has been removed from service.
15.3.2 The tag shall be posted at each fire department connection and the system control valve, and other locations required by the authority having jurisdiction, indicating which system, or part thereof, has been removed from service.
Impaired Equipment
15.4.1 The impaired equipment shall be considered to be the water-based fire protection system, or part thereof, that is removed from service.
15.4.2 The impaired equipment shall include, but shall not be limited to, the following: Sprinkler systems, Standpipe systems, Fire hose systems, Underground fire service mains, Fire pumps, Water storage tanks, Water spray fixed systems, Foam-water systems, Fire service control valves
Preplanned Impairment Programs
15.5.1 All preplanned impairments shall be authorized by the impairment coordinator.
15.5.2 Before authorization is given, the impairment coordinator shall be responsible for verifying that the following procedures have been implemented:

(1) The extent and expected duration of the impairment have been determined.
(2) The areas or buildings involved have been inspected and the increased risks determined.
(3) Recommendations have been submitted to management or the property owner or designated representative.
(4) Where a required fire protection system is out of service for more than 10 hours in a 24-hour period, the impairment coordinator shall arrange for one of the following:

(a) Evacuation of the building or portion of the building affected by the system out of service
(b) An approved fire watch
(c) Establishment of a temporary water supply
(d) Establishment and implementation of an approved program to eliminate potential ignition sources and limit the amount of fuel available to the fire

(5) The fire department has been notified.
(6) The insurance carrier, the alarm company, property owner or designated representative, and other authorities having jurisdiction have been notified.
(7) The supervisors in the areas to be affected have been notified.
(8) A tag impairment system has been implemented. (See Section 15.3.)
(9) All necessary tools and materials have been assembled on the impairment site.

Emergency Impairments
15.6.1 Emergency impairments shall include, but are not limited to, system leakage, interruption of water supply, frozen or ruptured piping, and equipment failure.
15.6.2 When emergency impairments occur, emergency action shall be taken to minimize potential injury and damage.
15.6.3 The coordinator shall implement the steps outlined in Section 15.5.
15.7 Restoring Systems to Service
When all impaired equipment is restored to normal working order, the impairment coordinator shall verify that the following procedures have been implemented:

(1) Any necessary inspections and tests have been conducted to verify that affected systems are operational. The appropriate chapter of this standard shall be consulted for guidance on the type of inspection and test required.
(2) Supervisors have been advised that protection is restored.
(3) The fire department has been advised that protection is restored.
(4) The property owner or designated representative, insurance carrier, alarm company, and other authorities having jurisdiction have been advised that protection is restored.
(5) The impairment tag has been removed.

Missouri Guidance for Long-Term Care Facilities

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DHSS has updated its guidance to reflect recent changes to CMS’ visitation guidance and to clarify and provide examples of those considered outside health care workers, which includes hospice workers (all disciplines). The changes include:

Visitor Vaccination Status
When both the resident and all of their visitors are fully vaccinated and while alone in a resident’s room or the designated visitation room, residents and their visitor(s) can choose to have close contact (including touch) and to not wear source control. Visitors should wear source control and physically distance from other healthcare personnel and other residents/visitors that are not part of their group at all other times while in the facility.

Visitors shall be given the opportunity to disclose their vaccination status to determine if the visitor may have close contact (including touch) and not wear source control while alone in a resident’s room or the designated visitation room, however the facility may not require visitors to disclose their vaccination status or to show proof of vaccination. Visitors that decline to disclose their vaccination status should adhere to the infection control principles of COVID-19 infection prevention for unvaccinated persons.

Outside Health Care Workers
Clarified and provided examples of outside health care workers and the expectation that outside healthcare workers must be permitted to come into the facility. Health care workers who are not employees of the facility, such as hospice workers (all disciplines), Emergency Medical Services (EMS) personnel, dialysis technicians, laboratory technologists, radiology technologists, social workers, clergy, etc., but provide direct care to the facility’s residents, must 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.

Communal Dining and Group Activities
Fully vaccinated residents can participate in communal dining and group activities without use of source control or physical distancing. If unvaccinated residents are present, all residents should use source control when not eating and unvaccinated residents should continue to remain at least 6 feet from others.

Revised CMS Memos

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The Centers for Medicare and Medicaid Services release two revised QSO memos today. Below is a summary of the major revisions in each memo. Please read each in its entirety for all revisions. DHSS guidance will be updated to reflect the revisions in the CMS Visitation memo, however all facilities may begin using this revised guidance immediately.

CMS QSO-20-38-NH Revised – Updated Guidance Regarding Testing
The major revision to this document is regarding routine testing of staff. Routine testing of unvaccinated staff should be based on the extent of the virus in the community. Fully vaccinated staff do not have to be routinely tested. Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency.

CMS QSO-20-29-NH Visitation
The major revision to this document is regarding group activities and communal dining. The CDC has provided additional guidance on activities and dining based on resident vaccination status. For example, residents who are fully vaccinated may dine and participate in activities without face coverings or social distancing if all participating residents are fully vaccinated; if unvaccinated residents are present during communal dining or activities, then all residents should use face coverings when not eating and unvaccinated residents should physically distance from others. See the CDC guidance Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination for information on communal dining and activities.

Alert: Postcard Disguised as Official Office of Civil Rights (OCR) Communication

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OCR has been made aware of postcards being sent to health care organizations informing the recipients that they are required to participate in a “Required Security Risk Assessment” and they are directed to send their risk assessment to www.hsaudit.org. The link directs individuals to a non-governmental website marketing consulting services.

Please be advised that this postcard notification did not come from OCR or the U.S. Department of Health and Human Services. This communication is from a private entity – it is NOT an HHS/OCR communication. HIPAA covered entities and business associates should alert their workforce members to this misleading communication. Covered entities and business associates can verify that a communication is from OCR by looking for the OCR address or email address, which will end in @hhs.gov, on any communication that purports to be from OCR, and asking for a confirming email from the OCR investigator’s hhs.gov email address. The addresses for OCR’s HQ and Regional Offices are available on the OCR website at https://www.hhs.gov/ocr/about-us/contact-us/index.html, and all OCR email addresses will end in @hhs.gov. If organizations have additional questions or concerns, please send an email to: OCRMail@hhs.gov.

Suspected incidents of individuals posing as federal law enforcement should be reported to the Federal Bureau of Investigation.

Missouri Vaccinators to Resume Janssen/J&J Vaccine

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The CDC and FDA lifted the pause on the Janssen/J&J vaccine, and use of the vaccine will resume in Missouri. Please follow the links below to updated information for Missouri.

SLCR Life Safety Code Information Series

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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:

The facility must test receptacles (outlets) annually.

    1. What are the four test needed on non-hospital grade outlets?
    2. Are facilities required to document each electrical outlet annually?
    3. What documentation should the facility retain for each electrical receptacle?
    4. What happens if an outlet fails the inspection?
    5. What inspections does the facility need for hospital-grade outlets?

NFPA 99, 2012 edition:
6.3.3.2 Receptacle Testing in Patient Care Rooms.
6.3.3.2.1 The physical integrity of each receptacle shall be confirmed by visual inspection.
6.3.3.2.2 The continuity of the grounding circuit in each electrical receptacle shall be verified.
6.3.3.2.3 Correct polarity of the hot and neutral connections in each electrical receptacle shall be confirmed.
6.3.3.2.4 The retention force of the grounding blade of each electrical receptacle (except locking-type receptacles) shall be not less than 115 g (4 oz.).

The facility needs to document every outlet in the patient areas. The inspection report needs to show every outlet tested and includes areas such as resident rooms. The facility staff need to complete all four tests annually. These inspections may be a pass/fail for the four tests; however, the pass/fail must be for each specific test (e.g. grounding, polarity), and the pass/fail cannot just be for the outlet.

If the facility does not label every outlet, then there needs to be a system so everyone reading the documentation will know which outlet was tested. An example could be starting at the entrance, going around the room clockwise/counter clockwise, and naming the first outlet A, the second B and so on, until all outlets are recorded on the inspection sheet. The facility needs to document their system and use the same system throughout the facility. If one or more of the outlets in a room/area are hospital grade, the facility staff may document it on the form to show why annual testing did not occur (if applicable).

When an outlet fails any of the four tests, the facility needs to replace the outlet with a hospital grade outlet and staff need to document they replaced the outlet on the inspection sheet.

For any hospital grade outlet, the facility must create a system to complete a risk assessment and decide how often they want to complete the maintenance/testing, which can be longer than annually. The risk assessment system must be in place as soon as the facility has a hospital grade outlet. When due for an inspection and testing, these outlets must also be individually itemized on the documentation.

 

 

 

 

 

 

 

 

NFPA 99, 2012 edition:
10.3 Testing Requirements – Fixed and Portable.
10.3.1* Physical Integrity. The physical integrity of the power cord assembly composed of the power cord, attachment plug, and cord-strain relief shall be confirmed by visual inspection.
10.3.2* Resistance.
10.3.2.1 For appliances that are used in the patient care vicinity the resistance between the appliance chassis, or any exposed conductive surface of the appliance, and the ground pin of the attachment plug shall be less than 0.50 ohm under the following conditions:

(1) The cord shall be flexed at its connection to the attachment plug or connector.
(2) The cord shall be flexed at its connection to the strain relief on the chassis.

10.3.2.2 The requirement of 10.3.2.1 shall not apply to accessible metal parts that achieve separation from main parts by double insulation or metallic screening or that are unlikely to become energized (e.g., escutcheons or nameplates, small screws).
10.3.3* Leakage Current Tests.
10.3.3.1 General.
10.3.3.1.1 The requirements in 10.3.3.2 through 10.3.3.4 shall apply to all tests.
10.3.3.1.2 Tests shall be performed with the power switch ON and OFF.
10.3.3.2 Resistance Test. The resistance tests of 10.3.3.3 shall be conducted before undertaking any leakage current measurements.
10.3.3.3* Techniques of Measurement. The test shall not be made on the load side of an isolated power system or separable isolation transformer.
10.3.3.4* Leakage Current Limits. The leakage current limits in 10.3.4 and 10.3.5 shall be followed.
10.3.4 Leakage Current – Fixed Equipment.
10.3.4.1 Permanently wired appliances in the patient care vicinity shall be tested prior to installation while the equipment is temporarily insulated from ground.
10.3.4.2 The leakage current flowing through the ground conductor of the power supply connection to ground of permanently wired appliances installed in general or critical care areas shall not exceed 10.0 mA (ac or dc) with all grounds lifted.
10.5.2.1 Testing Intervals.
10.5.2.1.1 The facility shall establish policies and protocols for the type of test and intervals of testing for patient care–related electrical equipment.
10.5.2.1.2 All patient care–related electrical equipment used in patient care rooms shall be tested in accordance with 10.3.5.4 or 10.3.6 before being put into service for the first time and after any repair or modification that might have compromised electrical safety.
10.3.5.4 Touch Leakage Test Procedure. Measurements shall be made using the circuit, as illustrated in Figure 10.3.5.4, with the appliance ground broken in two modes of appliance operation as follows:

(1) Power plug connected normally with the appliance on
(2) Power plug connected normally with the appliance off (if equipped with an on/off switch)

Standing Orders for Naloxone and COVID-19 Vaccination and Testing

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With the appointment of Acting Director of Health and Senior Services Robert J. Knodell, the Department has issued identical orders and standing orders as to what was in place prior to this transition. The only differences are the date and signatories. As Acting Director Knodell is not a physician, those medical standing orders that may only be authorized by a physician have been re-issued under the authority of the DHSS State Epidemiologist, Dr. George Turabelidze who has held an unrestricted physician license in Missouri since 1996. These updated orders cover COVID-19 vaccination and testing needs as well as Naloxone administration and are intended to mitigate any challenges associated with transition.

For purposes of administration needs, the following information is provided for the purpose of execution of the established orders in an appropriate authorized manner:

Dr. George Turabelidze
NPI Number: 1750496246

The revised orders may be found at the following links:
https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/statewide-orders.php
https://health.mo.gov/data/opioids/pdf/naloxone-standing-order.pdf

COVID-19 FREE Testing

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The Missouri Department of Health and Senior Services continues to offer FREE COVID-19 testing. Individuals seeking a free testing opportunity are not required to pre-register or have an appointment, simply show up to one of the events below to receive the test. A government issued ID is not a requirement for this testing, but having one available onsite speeds up the registration process. Testing is still a very important tool in fighting the COVID-19 pandemic.

Event information can always be found at www.health.mo.gov/communitytest. Additional sites (with regular or one-time opportunities) may be added as indicators suggest the need for additional testing.

Updated Guidelines for the Anti-SARS-CoV-2 Monoclonal Antibody Treatment of COVID-19

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Health Advisory 4-13-22

SARS-CoV-2, virus causing coronavirus disease 2019 (COVID 19), has been evolving over time, resulting in genetic variation in the population of circulating viruses across the world, including the United States. Some of those variations in viral genome can cause resistance to one or more of the monoclonal antibodies (mAb) therapies authorized to treat COVID-19. The ongoing surveillance of human and sewage samples by the Missouri Department of Health and Senior Services (DHSS) indicates rise in variant SARS-CoV-2 in Missouri, similar to other states. This DHSS Health Advisory urges health care providers in Missouri to follow newly updated COVID-19 mAB treatment guidelines issued by the National Institute of Health (NIH).

Please view the full Health Advisory for all details – Updated Guidelines for the Anti-SARS-CoV-2 Monoclonal Antibody Treatment of COVID-19 (4.13.21).

Missouri Pauses J&J COVID-19 Vaccine Administration

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Johnson & Johnson’s Janssen COVID-19 vaccine administration is being paused in Missouri until further notice.

“In an abundance of caution and as per federal guidelines, we are pausing vaccination with Johnson & Johnson’s Janssen vaccine until further notice in Missouri,” said Dr. Randall Williams, director of the Department of Health and Senior Services (DHSS). “We anticipate having more information shortly to make further decisions about overall vaccine distribution in light of this new development and will continue to update citizens who have been vaccinated with the J&J vaccine after the advisory committee meets at the federal level tomorrow.”

A new standing order for this vaccine has been issued by DHSS and is effective immediately.

People who have received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider. Patients with other clinical questions should contact their health care provider or call the COVID-19 hotline at 877-435-8411.

Providers are asked to keep any on-hand J&J vaccine in the appropriate storage unit and label it “quarantine-do not use” until further notice.

As the State of Missouri receives more information, it will be made available.

Long-Term Care Facility Regulatory Waiver Updates

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On 5/1/2021, the following long-term care facility waivers will either end or implementation guidance has been revised. See the implementation guidance(s) below for full details.

Effective 05/01/2021, the following regulatory waivers will end for all facilities (including Medicare/Medicaid certified):

Residential Care Facilities and Assisted Living Facilities
19 CSR 30-86.022(3) fire extinguisher inspections/maintenance
19 CSR 30-86.022(4)(A) and (C) range hood extinguishing system testing
19 CSR 30-86.022(9)(C) and (D) fire alarm system inspections/certification
19 CSR 30-86.022(11)(D),(E) and (F) and §198.074.2-4 RSMo., sprinkler system inspections/certification
19 CSR 30-86.032(13) electrical inspections
19 CSR 30-86.042(37) residential care facility documentation of the resident’s current medical status and any special orders or procedures
19 CSR 30-86.047(26) assisted living facility documentation of a physical examination prior to admission

Skilled Nursing Facility and Intermediate Care Facility (certified and state licensed only)
19 CSR 30-85.022(8) fire extinguisher inspections/maintenance
19 CSR 30-85.022(9) range hood extinguishing system testing
19 CSR 30-85.022(10)(C) fire alarm system inspections/certification
19 CSR 30-85.022(11)(A) sprinkler system inspections/certification
19 CSR 30-85.032(31)(B) electrical inspections
19 CSR 30-85.042(7) written agreements with outside resources used to provide services to the residents.
19 CSR 30-85.042(21) comprehensive orientation program within sixty (60) days of employment with nursing assistants who have not successfully completed the state-approved training program.

Adult Day Care Programs
19 CSR 30-90.050(8)(D)3.C- orders concerning treatments and medications
19 CSR 30-90.070(2)(A) annual written approval from the appropriate local fire safety officials, certifying that the facility complies with local fire codes
19 CSR 30-90.070(2)(C) fire extinguisher inspections/maintenance

Effective 05/01/2021, the following regulatory waiver implementation guidance has been amended for all facilities (including Medicare/Medicaid certified):

RCF-ALF-ICF-SNF and ADC
Tuberculosis testing: 19 CSR 30-85.042 (27), 19 CSR 30-86.042 (17) and (18), 19 CSR 30-86.047(18) and (19), and 19 CSR 30-90.040(7)

SNF
Regular visiting hours: 19 CSR 30-85.042 (11)

 

19 CSR 30-86.022 and 86.032 Waivers revised eff 5-1-2021
19 CSR 30-86.042 RCF waivers effective 5-1-21
19 CSR 30-86.047 ALF waivers effective 5-1-2021
19 CSR 30-85 SNF-ICF Waiver eff 5-1-2021
19 CSR 30-85.042-27 SNF-TB testing revised eff 5-1-2021
19 CSR 30-90 ADC waivers effective 5-1-2021