Health Education Unit News – CNA Renewals

Missouri currently has 975 CNA’s that have not renewed as of June 1, 2024.

Please check the registry for your status at MO TMU.

All CNAs are required to renew their certification every 24 months. Each renewal requires 8 hours of nursing services to be provided for every 24-month period. Proof of the nursing service can include a W2 or paystub from your employer.

All renewals are now electronic through our online registry (TMU) and a $20.00 fee is required.

If you have never logged into TMU Registry to setup your profile, then you will first need to contact the Health Education Unit at 573-526-5686 or for assistance. After your profile is setup, a text message and email will be sent to you 60 days prior to your inactive date, during your renewal period. This notification will prevent any delay in keeping your certification active.

If you already have setup your profile, then please see the renewal instructions at

If you have any questions, please contact the Health Education Unit at 573-526-5686 or

Improving Resident Relationships in Long-Term Care (IRRL): A Train-the-Trainer Opportunity

The IRRL is an evidence-based intervention to prevent resident-to-resident aggression (RRA). The program educates staff on recognizing and managing behaviors. It empowers staff to help prevent RRA to create a safer community for residents and reduce staff stress.

Join to learn the tools needed to support staff to recognize, manage, and reduce negative resident interactions.

September 27, 2023:
September 28, 2023:

Please see the flyer for more details.

QIPMO Staffing Workshops

What You Do Matters: Applying Lessons Learned from the Pandemic to Staff Stability and Resident Safety
QIPMO Staffing Workshops | Three-Part Series

June 2, 2022: Register HERE
June 20, 2022: Register HERE
May 16, 2022: Review the recording HERE | Download the handouts HERE
Presenters: David Farrell, MSW, LNHA, Alameda County Public Health Department; Cathie Brady, MS, and Barbara Frank, MPA, B&F Consulting

COVID has highlighted the dedication and courage of long-term care staff, the fragility of residents, and the impact of good leadership. With so much happening outside of leaders’ control, we found that leaders’ practices and decisions about how to communicate with and support staff, residents, and families made the difference. Attendees will take home low-cost, practical strategies that support staff and create the conditions for stability and good outcomes. This three-part series includes action steps in between sessions, to apply person-centered leadership practices immediately. We ask that you please encourage any corporate leaders to attend as well!

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:


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:


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
  • 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 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 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


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.

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

Healthcare Staffing Contract with SLS Health

The Department of Health and Senior Services has entered into a contract with SLS Health to assist with staffing needs for healthcare facilities, including long-term care facilities. The contract will allow skilled nursing, intermediate care, assisted living or residential care facilities to access the contract to secure healthcare staffing according to a firm, fixed rate. Payment for the staffing costs will be borne by the respective facility. Please see below attachments for additional information about the contract, how to access staffing resources, and applicable rates.

Missouri’s COVID-19 Healthcare Augmentation LTC slides
Attachment B

MC5 – Special Virtual Meeting

September 22, 2021: Finding and Keeping Great Co-Workers
Presenter: Clint Maun, CSP

Healthcare Providers have taken the needed action to fight a global pandemic and have established the required systems to contain and prevent the spread of the Corona Virus. The never-before-seen challenges we have experienced in 2020 has made it more vital than effort to have superior staff in all roles in 2021. We know healthcare professionals and staff can work together to achieve amazing success at workforce stabilization which will also benefit our customers. Join Clint Maun for an overview of proven teaming strategies during this time of opportunity, including processes to build workforce resilience and reduce burnout.

Join us for this important Virtual meeting.

CNA Update Training – Staffing Series 2: Take off on the Journey to Improve Staffing

September 14, 2021: Staffing
Location: Ameristar Hotel, St. Charles

September 15, 2021: Staffing
Location: Oasis Hotel, Springfield

September 28, 2021: Staffing
Location: Stoney Creek Hotel & Conference Center, Independence

September 29, 2021: Staffing
Location: Comfort Inn, Macon

CNA Training Update in Missouri

We have been waiting a long time and finally we see the results coming at us from our efforts to update and improve the training of Missouri CNA’s. The process has changed significantly effective August 31, 2021 “technically”. Administrators, DON’s, RN Instructors, HR Staff and CNA Training Organizations will want to understand how these changes affect them and their programs. The CNA Registry process for verification of employment in the last 24 months has also changed and will be handled through a third party site. You should already be registered as an employer and your CNA’s in the new system. This session will review all the new regulations, the new forms and the new testing/registry process through TMU Headmaster.

Staffing Series 2: Take off on the Journey to Improved Staffing

In Series 1, we explored Staffing Turnover and Retention and formulated a Roadmap to take us on a journey to improve staffing, increasing stability and quality of care, life and service for our residents. In this series we will take off on the journey and concentrate on the areas that Series 1 attendants identified as needing the most work; Recruitment and On-Boarding/Training. We will rethink where we are spending recruiting dollars, share ideas for improving landing quality applications and then build on reducing turnover and improving retention with improved and best practice ideas for Staff on-boarding/Orientation and training. Administrators and HR Staff will benefit from this interactive session. If you missed the first session, you can view it on-line on SDS Training site through MANHA.

Virtual Healthcare Job Fair

April 6, 2021: Virtual Healthcare Job Fair

The Missouri Office of Workforce Development is hosting another healthcare virtual job fair to support the needs of the healthcare industry across the state on April 6, 2021. Employers may now engage with job-seekers through the chat feature, or initiate video chat sessions.

The deadline to register is March 26, 2021. Please register at

The Missouri Office of Workforce Development will promote the virtual job fairs and recruit job seekers who may be interested in a healthcare career. Job seekers register at

Healthcare Team Member Recruitment and Job Fair



We are all aware of the dire need to recruit new team members into our healthcare system. As a result, healthcare organizations across Missouri have joined together and are conducting a statewide recruitment campaign. The flyer above will be used to attract job seekers and explain our needs while also directing them to, an on-line resource of job board sites used by many of our healthcare providers. You are encouraged to participate by posting your positions on the job board platforms that best fit your organization. In addition, a recruitment campaign is being conducted for the month of December, referring job seekers to the newly created website.

There will also be a healthcare specific job fair focusing on entry-level clinical and non-clinical positions to connect with Missouri’s job seekers across the state. The virtual job fair will take place on December 22nd, from 10 a.m.-2 p.m. Participate in this fair by completing the Employer Registration form before December 16th. Employer registration is best used with Google Chrome. Click on “Register Now” and be sure to select the “Dec 22nd-Healthcare Industry Fair.”

These virtual job fairs are more than just a place to post your open positions. You’ll be able to meet job candidates through an online text to chat, share information about your organization, and review resumes through our virtual fair platform. List your open positions and get access to a list of job seekers interested in your company after each event.

This upcoming job fair presents a great opportunity not only to meet and interview interested job seekers, but also to strengthen the state’s economy and help us get Missourians back to work to support our in-demand healthcare industry.

All healthcare industry employers are invited to participate!

Nursys e-Notify®

From time to time, the MO State Board of Nursing will find a nurse who has been practicing on an expired license. Employers can prevent this from occurring by setting up a Nursys e-Notify® institution account at Click on “Learn More” in the first pane that says Nursys e-Notify®. Then click on “as an institution.” Watch the overview video, create an institution account and enroll your licensed nurses. This system will send you license renewal alerts and alerts if a license becomes disciplined or deactivated due to compact rules.

The information about a nurse’s license is only valid the day you retrieve it. A license can expire or be disciplined at any time. The only way to receive real-time alerts of that information is by creating an institution account and enrolling your nurses. Facilities should not rely solely on the Board of Nursing newsletter as information may be regarding incidents that occurred 3+ months ago. DONs/Supervisors/Lead nurses may also sign up with Nursys e-Notify® as a group in order to closely monitor a group of nurses that they may be responsible for on a daily basis following similar instructions as above.

Level I Medication Aide (LIMA) Biennial Training and Inactive Status

State regulations require Level I Medication Aides (LIMAs) to complete training every two years and submit documentation of the training to the Health Education Unit (HEU), in order to remain on the registry as an active LIMA. If biennial training documentation is not received, the individual’s certification is placed in “inactive” status. Individuals who have not completed the required biennial training and are inactive, are not eligible to be employed as a LIMA in a RCF or an ALF.

If an individual is off the active LIMA registry for more than five (5) years, the individual must retake the LIMA course, unless they meet the eligibility criteria to challenge the examination.

LIMA certificate holders who went inactive on or before September 30, 2012 have until November 1, 2019 to complete the biennial training update and submit the required documentation to HEU to become active. After November 1, 2019, individuals who went inactive on or before September 30, 2012 and who have not completed the required biennial training update, must complete a LIMA training program course, including a minimum of 16 hours of integrated formal instruction and practice sessions directly supervised by an approved instructor, and final written and practicum examinations.

Individuals who are inactive on the LIMA registry are also inactive for insulin certification. When biennial training updates are received by HEU to reinstate a LIMA to active status or in the case where an individual has to retake the entire course due to being off the active registry for more than five (5) years, insulin certification also becomes active.

Level I Medication Aide (LIMA) webpage
Biennial Update Form

RN License Renewal

RN licenses are required to be renewed by April 26, 2019 and there is NO grace period to renew. If a license expires, the nurse will have to apply for reinstatement which includes submitting to fingerprint background checks and paying a higher fee ($110) in addition the fingerprint fees. The reinstatement process takes about two weeks.

RN’s are encouraged to renew prior to April 26, 2019.

NCSBN hosts webinars regarding the nurse licensure compact (NLC). The next two are April 9 and May 10. See this link for more details:

CMS Launches Nationwide Effort to Improve Quality of Care in Nursing Homes

Nationwide Effort to Improve Quality of Care in Nursing Homes

As part of its continued commitment to the nation’s most vulnerable populations, the Centers for Medicare & Medicaid Services (CMS) has launched the Civil Money Penalty Reinvestment Program (CMPRP), a three-year effort to reduce adverse events, improve staffing quality and improve dementia care in nursing homes. This effort is funded by the Federal portion of CMPs to conduct activities that support and protect nursing home residents.

Through this program, CMS and its contractor will develop and implement evidence-based interventions, activities tools, and resources help to improve dementia care, reduce adverse events, and improve staffing quality. Staffing quality includes areas such as reducing turnover, improving tenure, and enhancing general staff performance. Additionally, the CMPRP will support projects for resident and family councils, develop and maintain the ability to provide temporary management of a nursing home, and support activities to protect residents during facility closures. Lastly, this program will support efforts to administer, monitor, and evaluate the effectiveness of CMP projects implemented throughout the country.

For more information, visit:



In just a few minutes, nurses can self-enroll into Nursys e-Notify for free and take advantage of a quick and convenient way to keep up-to-date with their professional licenses. They can receive licensure status updates, track license verifications for endorsement and create and manage multiple license expiration reminders. Keeping on top of license status can help nurses prevent fraudulent licenses or certificates being issued in their names.


If you only have one license, you may question why you need to do this. We have had cases come before the board where a nurse unknowingly practiced while his/her license was expired. This system will notify you before your license expires and when it expires. It is also possible that your license could be suspended for failure to comply with the tax law. You would receive a notification any time any discipline is attached to your license. Missouri is a member of the nurse licensure compact. Your multi-state license is tied to your primary state of residence. A change to your primary state of residence could change your multi-state license status. This system will notify you if that status changes. When you apply to renew your license or submit your license renewal online, your license is not automatically renewed. If you enroll in this system, you will be notified when your license is renewed. Those are just a few examples of how enrolling yourself in this system will protect the license you have worked so hard to obtain. This system pushes notification of changes to you rather than you having to continually re-query the system.


Creating an account is quick and easy. Enroll at and select “As a Nurse” to complete the registration process. Learn more about Nursys e-Notify by viewing an introductory video or visiting the Nursys website. For questions, contact


Nursys is the only national database for licensure verification for registered nurses (RNs), licensed practical/vocational nurses (LPN/VNs) and advanced practice registered nurses (APRNs). Nursys is designated as a primary source equivalent database through a written agreement with participating boards of nursing (BONs). Nursys is live and dynamic, and all updates to the system are reflected immediately, pushed directly from participating BON databases through frequent, secured data updates.

MANHA’s Staffing Turnover Seminar

Staffing Turnover:  Tackle it before it Tackles you in Five-Star

  • October 4, 2016:  Stoney Creek Conference Center, Independence
  • October 11, 2016:  Ramada Oasis Hotel, Springfield
  • October 18, 2016:  Comfort Inn, Macon
  • October 19, 2016:  Embassy Suites, St. Charles

Please find the registration brochure and more information on MANHA’s webpage here.

October is National Residents’ Rights Month

The theme for Residents’ Rights Month 2014 is, “Better Staffing: The Key to Better Care” with the goal of encouraging residents and others to be educated about staffing and long-term care.  Each year, the Consumer Voice develops a packet to help you plan your Residents’ Rights events.  The packet is completely downloadable and features ready-to-use items, including promotional materials, activities to celebrate Residents’ Rights Month, training tools and resources.  Visit

MC5 Regional Meetings – July 2014

Please visit the Missouri Coalition Celebrating Care Continuum Change (MC5) website at or click on the regional links below to view upcoming meetings near you!

Central (Jefferson City/Columbia)
East (St. Louis)
East Central (Rolla)
North Central (Chillicothe)
Northeast (Macon)
Northwest (St. Joseph)
Poplar Bluff
Route 71 (Nevada)
Southeast (Cape Girardeau)
Southwest (Springfield)
West (Independence)
West Central (Sedalia)


New PEPPER Release for Skilled Nursing Homes – May 2014

A new release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) is now available for skilled nursing homes.  PEPPERs will no longer be mailed to providers who previously received their PEPPERs by mail.  They will now be able to access them through a secure website portal,

Those providers who have been receiving their PEPPERs through QualityNet will continue to do so.  The Chief Executive Officer, President, or Administrator of the provider can obtain their PEPPER.  Information on accessing and downloading the PEPPER is available in the Secure PEPPER Access Guide.

Training and Resources are available on the website:

PEPPER Training Update (May 2014): is the official site for information, training and support.  If you have questions about the PEPPER reports, you may submit questions on this website through the Help/Contact Us tab.  Please do not contact your state QIO or state survey agency for assistance with PEPPER.