Category: Training

Updated Versions of the Final MDS 3.0 Item Sets and Final MDS 3.0 RAI User’s Manual Now Available

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On September 23, 2025, CMS posted the final Minimum Data Set (MDS) 3.0 Item Sets version (v)1.20.1v4 which can be found in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. This final version of the MDS v1.20.1 item sets (v4) will go into effect October 1, 2025.

On September 24, 2025, CMS posted an updated final MDS 3.0 RAI User’s Manual version (v)1.20.1 which can be found in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. This final version of the MDS 3.0 RAI User’s Manual v1.20.1 will go into effect October 1, 2025.

DMH Free Webinars – Tools for Everyone

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Tools of Choice is an evidence-based program focused on the implementation of universal positive practices. This two-hour introductory training is open to community members, parents, and professionals. It covers key concepts of the Tools of Choice curriculum, including What is behavior, building positive relationships, and how to increase desirable behavior. Join the Positive Support Consultants in learning strategies to make positive change by implementing universal positive practices.

Registration is available on the DMH Webinars page.

Nursing Facility Level of Care (LOC) Process Changes

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In July 2025, the Department of Health and Senior Services Central Office Medical Review Unit (COMRU) and the Department of Mental Health (DMH) made changes to the processing of Pre-Admission Screening and Resident Review (PASRR) Level 1 applications that indicated a Level 2 evaluation should be completed. The goal of these changes was to streamline the process and to decrease the review time for these applications. This goal was accomplished, and applications are currently being reviewed by COMRU and sent to DMH within two working days of receipt.

To further enhance the efficiency of the process, effective October 1, 2025, Bock Associates, the DMH contractor that completes the Level 2 evaluation, will also begin conducting the level of care (LOC) on applications that indicate a Level 2 evaluation is needed. The LOC for these applications is currently conducted by COMRU following the Level 2 evaluation. In addition to further streamlining the process, this change will enhance the quality of the review as most of the Level 2 evaluations are conducted in person. In addition, any issues, questions, or corrections can be addressed immediately without the back-and-forth process that is currently in place. COMRU will work closely with DMH and Bock Associates to ensure a smooth transition.

COMRU will continue to conduct the LOC review for Level 1 applications, applications DMH determines “No Level 2 Required” (NL2R), applications Bock Associates determines did not meet the federal requirement, and Special Admission Category (SAC) applications. The change to the process will also improve the timeliness of these reviews.

This change will have no impact on the application or on the submission process.

 

Tips and Reminders

COMRU does receive several applications that do not indicate a Level 2 evaluation based on the responses on the application, however a review of the application and attachments/supporting documentation shows the application should have indicated a Level 2 evaluation. Often, the individual has already been admitted to a nursing home and payment to the nursing home may be delayed until the Level 2 evaluation is complete. A good refresher on the conditions that indicate a Level 2 evaluation can be found here. Please ensure a thorough review of the application and supporting documentation when making admission decisions. An additional tool that will aid in decision-making is a review of the information in CyberAccess. CyberAccess offers many services to providers, such as where Medicaid clients have been receiving services, billed diagnosis and much more. To register for CyberAccess, please contact 888-581-9797.

Section D – Level One Screening Criteria for Serious Mental Illness

  • Question 2 – Depression is often listed under this question, but it should not be included. A diagnosis of depression is different from a diagnosis of major depressive disorder.
  • Question 6 – Please review carefully to ensure this question is answered correctly. Incorrect answers will be returned for correction.

Section E – Level One Screening Criteria for Intellectual Disability or Related Condition

  • Question 2a – Thoroughly review all diagnoses listed, including those in purple text. In addition, diagnoses of traumatic subdural hemorrhage, traumatic subarachnoid hemorrhage and anoxic brain damage should be listed under head injury/traumatic brain injury (TBI). Please review carefully to ensure this question is answered correctly. Incorrect answers will be returned for correction.

Nursing Facility Level of Care Assessment

The LOC application is used across different settings, including approval for Home and Community based services. The application is an evaluation of the applicant’s current needs. Questions regarding Eating, Meal Preparation and Medication Management should be answered based on the applicant’s ability to complete these tasks, not on what services the nursing home provides. While residents of nursing homes do not normally prepare meals or manage their medications, the appropriate evaluation of these items is required. When answering these questions, it may be helpful to review the assistance needed in other areas, including other ADLs and the applicant’s cognitive status, to determine the most appropriate answer.

Section C – Recent Medical Incidents

  • All attachments must be in PDF format.
  • The applicant’s name must be listed on all attachments.
  • It is not necessary to list diagnoses if a diagnosis list is attached.
  • For Level 1 applications, it is not necessary to attach a H&P if the date and reason for hospitalization is explained in the comment section.
  • For Level 1 applications, the H&P should be limited to the date/reason for hospitalization. Applications that indicate a Level 2 require additional information.

Section D – Assessed Needs

  • Behavioral:
    • “Date of last consult…” is a psychiatric consult, if conducted. This should not be completed for a medical visit.
    • If behavior symptoms are checked, please review response – this would be either 3 (past) or 6 (current) points.
  • Mobility:
    • Describe the assistance required, rather than simply listing mode of locomotion. For example, do not just list wheelchair/walker.
  • Rehabilitative Services:
    • Scoring should be all frequencies added together.
  • Safety:
    • This question is a two-tiered evaluation. First, a preliminary score is determined based on vision impairment, fall history (within the last 90 days), and problems with balance. After the preliminary score is determined, additional points are given for prior institutionalization (within the last 5 years) and age of 75 years and over. No points are given for the current nursing home admission and the dates for the current admission should not be listed.

For additional information, including training opportunities, visit the COMRU Website.

E4 Center Updated Toolkit

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The E4 Center has just updated our Building and Sustaining Effective Behavioral Health Care for Older Adults: Strategies and Considerations toolkit! The new toolkit reflects developments in Medicare coverage of behavioral health services and with further emphasis on select care considerations – check it out!

Specifically, the toolkit revisions incorporate the following updates on Medicare coverage expansions:

  • Newly recognized workforces
  • Newly covered services
  • Newly covered settings

You can access the full 2025 Updated Building and Sustaining Effective Behavioral Health Care for Older Adults: Strategies and Considerations toolkit here.

Additionally, if you’d like more information on these changes, reviewing the E4 Center’s most recent webinar titled, “The Changing Medicate Landscape: What Behavioral Health Providers Need to Know,” presented by Kate Krajci, LCSW and Bonnie Ewald, MA on July 2nd, 2025 is recommended.

Hopefully this toolkit is a useful reference for you in your efforts to build and sustain effective behavioral health care for older adults! Please reach out to us at E4Center@rush.edu with any questions or comments!

2025 SLCR Annual Provider Meetings

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

If you attended one of our meetings, we encourage you to take a minute to fill out the evaluation. We look forward to your feedback.

2025 SLCR Provider Meeting Online Evaluation

 

Meeting Handouts
The Evolving Role of the Nursing Home Medical Director
Person Directed Care – Getting Back to the Basics
Section Update
Enhancing Care – The Role of Long-Term Care Pharmacies in Supporting SNFs, ICFs, ALFs, and RCFs
QAPI – Endurance & Sustainability

 

 

COMRU PASRR and Level of Care Orientation Training

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The Central Office Medical Review Unit (COMRU) has scheduled monthly orientation training to review the requirements of the Pre-Admission and Resident Review (PASRR) and Nursing Facility Level of Care (LOC) application process. These on-line trainings will be one-hour in length and hosted by Ammanda Ott, RN Supervisor for COMRU. Each training is limited, so register soon!

Please see the registration link here for complete details and ongoing dates.

2025 Enhanced Leadership Development Academy for LTC Leaders

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Do you…..

❍ need a leadership course that addresses the unique challenges SNF leaders face?

❍ want to feel inspired and passionate about leading your SNF?

❍ want to connect with other SNF leaders and have access to free professional development, tools, and resources?

❍ want free CE credit without sacrificing quality and practical application?

❍ want to have the flexibility to learn at the pace and place the works best for you?

If you answer YES to any of these questions, this course may be for YOU!
Take the survey now to see if you qualify for FREE registration.

For more details, please visit the website.

Course ends: October 31, 2025

Center of Excellence – Behavioral Health Action Network 2025 Series Opportunities

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FREE THREE-PART VIRTUAL SERIES

All staff in CMS-certified nursing facilities across the U.S. are invited to join this three-part learning series to enhance skills in person-centered care, engaging with residents, and de-escalation with expert guidance and peer support.

More information including topics and specific dates for each can be found here.

MDS Documentation Requirements Refresher Training

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Myers and Stauffer conducted a MDS Documentation Requirements Refresher training on December 17, 2024, which can be found at https://myersandstauffer.com/client-portal/missouri/. Under “Helpful Downloads for Nursing Facilities MDS and Rate Setting” and “MDS Refresher Training – December 2024” you can find the training recording, slide deck, and FAQ document.

Winter Weather Planning

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Snow and ice are a mainstay of Missouri winter weather. Because of the variety of weather conditions as well as other events, facilities must have an emergency preparedness plan and be ready to act in an emergency to ensure they are to adequately prepared to meet the needs of patients, clients, residents, and participants during disasters and emergency situations.

If your facility experiences a loss of a necessary service (electricity, water, gas, phone, etc.), contact SLCR via the Regional Office emergency phone line and keep them informed of their status. If, for some reason, the facility cannot contact SLCR staff through the regional office phone number, you should contact the hotline. The emergency protocol is located here.

When you call, be prepared to answer to the following:

Facility name

  • Census, including staff assessment of current needs of the residents and monitoring of the ill.
  • Contact person and emergency contact number that is not the facility main line.
  • Has the facility called the fire department and central monitoring company if phones, alarm systems are down?
  • Generator: Y/N
    • If yes, what equipment does the generator serve (fire alarm, HVAC systems)?
    • If yes, amount of fuel onsite and/or system for delivery? How long will fuel last?
    • If no, what is fire watch plan?
    • If no, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner?
      • Obtain generator- is the home set up to receive generator power once delivered? Estimated time for delivery? Estimated time when generator power will be established.
      • Evacuation- Where is facility relocating to, distance from facility, transportation to get there, staffing, sufficient supplies/medications, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner (does the location have a functional emergency generator?) If relocating to a SNF – will the home be over capacity? Is there sufficient beds/space in the receiving facility to house the extra residents?
    • Documentation may be requested, including:
      • If evacuated, a list of residents and were they went
      • Room temperature logs
      • Fire watch documentation

Here are a few things to consider in examining your emergency preparedness plan, specifically as it relates to snow, ice, and power outages.

  • If there is a loss of the primary power, how will the facility ensure adequate temperatures of the facility will be maintained during the emergency situation?
  • Is the plan feasible?
    • Plan for the worst. Most events do not occur on a sunny Tuesday afternoon and the plan should account for things such as poor weather, road conditions, weekends/holidays, evenings, staff ability to travel to work, and other obstacles that may cause issue during the actual emergency.
  • Are staff knowledgeable of the plan and have access to what is needed in order to implement the plan?
    • Phone numbers, contact persons, contracts.
  • Do staff know what to do during an emergency and know who is in charge? If the administrator is not onsite, who is in charge and does that person know all their duties?
    • This may be the DON, but it may also be a charge nurse (or another designated onsite staff) if the event happens in the “middle of the night”. Depending on when the administrator or someone higher up on the order of succession can arrive at the facility, that person (i.e. night charge nurse) may be in charge for an extended amount of time.
  • Is the plan detailed enough?
    • Is there a detailed plan that describes when the residents will evacuate during an emergency? If loss of power, does the plan instruct the staff to start the evacuation prior to the point when the facility is below appropriate air temperatures and to maximize their safety during travel? What is the distance to the emergency evacuation site? What types of roads do they have to traverse, such as “side roads”, bridges, or interstates; all of these roads can have their challenges. Does the facility have more than one contracted emergency site?
      • Is it likely that emergency events will also impact the surrounding areas? It is also possible that the evacuation site may be so far away, residents may not be able to get there when road conditions are less than optimal. Does the contracted site meet all the criteria to allow the residents to shelter in place at that location?
    • Is there a contract for transportation and will that transportation be able to get the residents to and from their current location to the contracted emergency location in a snow/ice storm? If the services have other contracted uses, such as school buses, will they be available at 3:00 P.M. on a school day or can they get drivers at 3:00 A.M. on a Wednesday?
  • Does the facility have a generator?
    • Is there enough fuel, a contract to get more fuel, and a list of what it does and does not operate?
      • Facilities (and the staff in charge) need to know in advance, what their generator will operate. At a minimum, this listing must include whether it runs: Life safety equipment (such as E-lights and fire alarm system(s)), magnetic door locks/door alarms (where applicable for safety), HVAC systems, cooking systems, what outlets residents and staff will be able to be use, and computer equipment/Wi-Fi (if electronic medical records (EMR) are utilized).
      • This list needs to be detailed so staff will know specifically what items will and will not work during a power outage. Many generators will run every second or third ceiling light for emergency lighting, but not all lights in the facility will work during a power outage. This needs to be listed so all staff will know that information.
    • If a facility does not have a generator, what are the plans when it may not be easily able to evacuate due to poor road conditions or other factors that may prohibit a smooth transition from a facility to another location?
      • If the facility plans to have a generator delivered during a loss of power, does the facility have a contract with the generator company to deliver one to them? This contract should include the size of the generator that the facility will need in order to ensure the safety and care needs of the residents are met during the emergency.
        • The building will need to be wired and ready to accept the generator in advance. The facility will not be able to install a generator during the emergency event unless the wiring for the generator has already been completed.
      • Facilities must maintain at least their fire safety equipment (E-lights, fire alarm, sprinkler system, range hood (if any cooking occurs), food, water, heating and cooling, and sewage disposal to shelter in place.
        • There must be a plan of how this will be achieved, emergency supplies, the detailed list of what the generator will run, and any contracts that will be needed during the emergency to ensure these services can continue during the emergency event.
          • Sometimes trucks will not be able to run regular schedules and it may take several days before the facility can get their first delivery after an emergency starts; depending on the extent and severity of the disaster.
        • A power outage may be as simple as a blip, may last for hours, or may last for days – depending on the extent of the power grid damage and when the crews can access the problem(s).
          • The facility needs a plan of when, how, and where they will evacuate if they cannot provide at least the components of the previous bullet point.

During a disaster is the least ideal time to learn an emergency plan will not work or to search for a contracted service. All contracted services including, but not limited to, transportation, fuel needs, evacuation location, food, and water needs to be in the emergency plan. The emergency preparedness team needs to consider and plan all services and contract prior to an actual emergency. During an emergency, it may be very difficult or impossible to get a contracted service due to volume of request, road conditions, and/or other factors.

Thank you for preparing in advance and keeping us informed!

Center of Excellence – Webinar Opportunity

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Center of Excellence for Behavioral Health in Nursing Facilities – Webinar Opportunity

Holiday Seasonal Depression: Ways to Support Nursing Facility Residents

The holidays can be tough for both residents and those who support them. The Center of Excellence of Behavioral Health in Nursing Facilities is hosting a live virtual event on 12/17/24 @ 1:00 PM CST to talk about the fundamentals of Seasonal Affective Disorder (SAD) and its effects on holiday depression. This training FREE, available to residential care, assisted living, skilled nursing, Ombudsman, and state survey agency team members. It is designed to provide participants with a basic understanding of depression, seasonal onset, symptoms, and treatments to support residents experiencing challenges from SAD. Register today- as space may be limited.

MDS Documentation Requirements Refresher

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Myers and Stauffer to conduct MDS Documentation Requirements Refresher

Please see the attached flier for the MDS Documentation Requirements Refresher scheduled for December 17, 2024 from 9:00 AM – 10:30 AM CST. Please click the link within the flier (or below) to register for the webinar. Registration is required.

Link to Register: https://mslc.webex.com/weblink/register/rc0eb002a1e79b4ee18d8f94400fe85b4

The training materials and recorded webinar will be available for download after the training should you be unable to attend the live session. Please direct any questions to MO_MDSINFO@mslc.com.

COMRU Update

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During the Summer of 2024, COMRU implemented several enhancements to the online application system. To test the effectiveness of those enhancements, on September 1, 2024, COMRU began reviewing newly submitted applications as well as reviewing applications submitted prior to September 1.

COMRU is current with reviewing newly submitted applications and has made significant progress in reviewing applications submitted prior to September 1. Only applications submitted July 22 to August 31, 2024, are pending review. COMRU expects to have all applications submitted prior to September 1 reviewed by the end of the calendar year.

Please note: Applications returned to the submitter for correction will be deleted from the online application system if corrections are not made and resubmitted to COMRU within 60 days. he submitter may access the online application at any time to check the status of a pending application. Training on how to check the status of an application can be located on COMRU’s webpage (Under Trainings/WebEx Training – Level One Online Form Feb 2024).

 

Tips and Reminders

  • All attachments to the online application must be in PDF format – please do not include web links. Applications including web links will be returned for correction. All application documents are scanned by COMRU for retention purposes; web links are not stable and cannot be scanned.
  • For Level 1 applications, attachments should be a limited number of pages and only include the information requested. For example, if an applicant is in the hospital, the submitter must either type in the date/reason for hospitalization or attach a hospital H&P that includes this information. The entire H&P from the hospital is not necessary – only those pages that include the date/reason for hospitalization are required.
  • Please review all diagnoses for the applicant including those on the diagnosis list and those listed in any other attachments and answer the application questions accordingly. The most common errors related to diagnoses are:
    • Section D, Question 6: Does the individual have a diagnosis of Major Neurocognitive Disorder (MDNC), i.e., dementia or Alzheimer’s?
    • Section E, Question 2a: Does the individual have a suspected diagnosis or history of an Intellectual Disability/Related Condition?

Many applications have one of these diagnoses listed and this question is answered “no” when the answer should be “yes”. When the question is marked “yes” follow-up questions populate; marking “no” results in an incomplete application which will be returned for correction.

For additional information and answers to frequently asked questions, please review the online training posted on the COMRU webpage.

COMRU PASRR and Level of Care Orientation Training

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The Central Office Medical Review Unit (COMRU) has scheduled monthly orientation training to review the requirements of the Pre-Admission and Resident Review (PASRR) and Nursing Facility Level of Care (LOC) application process. These on-line trainings will be one-hour in length and hosted by Ammanda Ott, RN Supervisor for COMRU. Each training is limited to 50 individuals, so register soon!

Webinar series registration link: https://stateofmo.webex.com/webappng/sites/stateofmo/webinar/webinarSeries/register/cc01ce6f1d64435db3a716b6c489bf51

Upcoming Training Dates/Times

November 5, 2024: 11:00 am
December 10, 2024: 11:00 am
January 14, 2025: 11:00 am
February 11, 2025: 11:00 am
March 11, 2025: 11:00 am

 

Why We Are Conducting These Trainings?
• The LOC/PASRR process is complex and can be overwhelming if individuals do not receive sufficient training. We want to make it easier for you!
• Approximately 50% of applications are returned for corrections. This results in delays to the review and approval process – which directly impacts Medicaid payment to nursing facilities and can result in prolonged hospital stays.
• COMRU receives an average of 30-40 calls per day – many of the answers to the questions asked are contained in information accessible online. A decrease in phone calls will allow additional time for COMRU to review pending applications.

Training Agenda
• Overview of the PASRR and LOC requirements.
• Review of the application process from application submission to approval, including recent enhancements made to the online application system.
• Review of common errors that result in the application being returned for correction.
• Discussion of critical information needed to determine whether the application triggers for a Level 2 evaluation and the impact to the nursing facility and hospital.

Who Should Attend
• Individuals who are new to completing the LOC/PASRR application.
• Individuals who want a refresher of the requirements.

Benefits of Attending
• Familiarity with the process and information included online to assist with completing the application.
• Decrease in returned applications and reduction of processing times.

Prior to attending, please review both on-line trainings (New LOC Webex Training Oct 2021 and Level One Online Form Training Feb 2024) located on COMRU’s webpage https://health.mo.gov/seniors/nursinghomes/pasrr.php.

Please see the flyer

CNA Training Reimbursement Opportunity for SNFs

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Did you know… skilled nursing facilities can receive reimbursement for CNA training?

The Health Education Unit hosted a webinar along with Mo HealthNet to provide information regarding the amount of reimbursement, instructions related to the submission and important data to consider for reimbursement.

Didn’t get to attend? No problem, watch it now!

For questions, contact the Health Education Unit at 573-526-5686 or email at CNARegistry@health.mo.gov.

Infection Prevention and Control Office Hours

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Sessions Begin on September 18 at 12 p.m. ET

Register now to join free virtual Infection Prevention and Control Office Hours, which address topics concerning respiratory virus season.

The focus will be on COVID-19 and strategies to decrease transmission among nursing home residents and staff. This series is tailored specifically for long-term care facilities, providing valuable support in areas such as COVID-19 prevention, immunization strategies and strategies to stay healthy. These sessions will help you discover ways to enhance care for both residents and staff.

Please see this flyer for details and registration