Missouri Long-Term Care Information Update

New CMS Audio Series Delves into Health Care Quality

Thank you for your continued partnership in improving the health and well-being of one of our most vulnerable populations.

In line with our efforts to promote COVID vaccinations to nursing home teams and residents, the Centers for Medicare & Medicaid Services (CMS) has released a new audio series. Conversations with the Centers for Medicare & Medicaid Services Chief Medical Officer provides nursing homes with the facts on COVID-19 vaccines and therapeutics that support better resident outcomes. In these conversations with Dr. Lee Fleisher, the CMS CMO, nursing home leaders will hear from Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) experts.

As part of this audio series, titled Quality Improvement (QI) Voices: Improving COVID-19 Outcomes in Nursing Homes Across America, each episode gives listeners a closer look at the projects and the people who are improving health care quality and outcomes. These brief conversations include detailed show notes for even more insights into the process behind health care quality improvement – and how listeners might adapt these to their own organizations.

Three episodes, each under 15 minutes long, have been released: The Facts Behind the Updated COVID-19 Vaccine: Safety and Efficacy, Long-term Care Treatment Options for COVID-19 and CDC Programs for COVID-19 Infection Prevention and Vaccination in Nursing Homes. I encourage you to take full advantage of this cadre of information and resources.

Health Education Unit Updates

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

January 31, 2023: Instructor Info Meet Up Meeting
February 7, 2023: Instructor Info Meet Up Meeting
February 14, 2023: Instructor Info Meet Up Meeting
February 21, 2023: Instructor Info Meet Up Meeting
February 28, 2023: Instructor Info Meet Up Meeting

 

Series of the Month Webinar
February 9, 2023: Regional Test Sites Vs. Closed Test Sites
2:00-3:00 p.m.

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

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

Medicare from Start to Finish

January 17, 2023: Live Virtual Workshop
March 22, 2023: In-Seat Workshop
July 12, 2023: In-Seat Workshop
September 13, 2023: In-Seat Workshop
November 8, 2023: Live Virtual Workshop

This workshop will review the SNF QRP reports from CASPER that provides information about the Medicare Part A stays in your SNF. It will also explore factors impacting SNF PPS assessment schedule, PDPM basics, and consolidating billing that can impact the financial facet of the facility. It also explains Medicare eligibility, coverage, and skilling criteria. The completion of the MDS is becoming more difficult and confusing, this workshop will help clear up the confusion surrounding this process. This workshop is geared towards those individuals working in long‐term care who have a leadership role such as ADM, DON, ADON, or MDS Coordinator.

Free Mental Health Education

January 19, 2023 (1:00 p.m.): Registration
January 26, 2023 (9:30 a.m.): Registration

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 such as: 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. Information presented at each training will be the same and is being offered two different dates for convenience.

Presenter: Kathleen Deppeler, Director of Positive Supports
Target Audience: Anyone interested in learning more about Tools of Choice

Action Pact – Conversations with Carmen

January 20, 2023: Back to Food = Love, Life, Health and Wellbeing = Compliance and Culture Change

This is the first in the 2023 series, Back to the Future: Moving Dining Forward.

From token to true choice, using regulations and standards to help people living in long-term care to eat what they want to eat, and to live the lives they want to live.

Come out of the pandemic better. Take advantage of this time and do it different. Learn how to shift your culture to honor each individual and get back to normal, to HOME, particularly in all things dining and vibrant daily living.

Each webinar will be framed by culture change practices, the Dining Practice Standards, leaning into CMS requirements and the Artifacts of Culture Change 2.0, the domains of wellbeing embedded in the CMS RoPs, and Kitwood’s basic human needs.

RAI Process from Start to Finish

February 7-8, 2023: Live Virtual Workshop
April 4-5, 2023: In-Seat Workshop
August 8-9, 2023: In-Seat Workshop
October 17-18, 2023: In-Seat Workshop
December 5-6, 2023: Live Virtual Workshop

This workshop will look at the RAI process from beginning to end and at each item of the MDS. The MDS is used for both a clinical and a financial assessment and will discuss the rules on scheduling these assessments and meeting the clinical & financial requirements. This includes a basic understanding of PDPM and how it correlates within the RAI process. This workshop reviews how to gain access to and read the MDS reports from CASPER to self-audit your RAI process and look at your QMs. This workshop is designed for the MDS Coordinator and Care Plan Coordinator, or for the DON or ADM who needs a better understanding of the complexity of the RAI Process.

COVID and Flu A/B Test Kits

  • ALERT: DHSS 30-Day Pause of PPE and Test Kit Shipping Operations on January 31, 2023

DHSS will pause shipping operations on January 31, 2023 for up to 30 days to complete inventory and transition warehouse operations to a new platform. Orders for PPE and Flow Flex Antigen Test Kits will need to be placed prior to January 27, 2023 for shipment on January 30, 2023. Please ensure your last order will cover PPE and Antigen Test Kit needs through March 1, 2023. During the pause, orders will not be processed or shipped. However, once shipping resumes March 1, 2023, PPE and Antigen Test Kits will be shipped daily upon approval and order processing.

 

  • FREE COVID-19/Flu A&B TEST KITS

DHSS is now offering free lifeSign Status COVID-19/Flu A&B Test kits to long-term care facilities.  These testing supplies are currently in limited supply, therefore, LTC facilities should continue to use COVID-19 antigen testing supplies as indicated. Orders may be placed now. Shipping will begin on Tuesday, January 17, 2023.

Application for Status COVID-19/Flu A&B Test Kits

When to use Flow Flex COVID-19 antigen test kit VS Status COVID-19/Flu A&B Test kit:

  1. Use Flow Flex for residents with known COVID-19 exposure
  2. Use Flow Flex for residents during the facility COVID-19 outbreak, or high COVID community level
  3. Use Status test kit if COVID exposure is unknown or unlikely
  4. Use Status test during the facility influenza outbreak, or high influenza activity in the community
  5. Do not use Status test for COVID detection if patient symptomatic for more than 5 days

Long Term Care Facilities must add to the facility’s CLIA certificate:

Adding lifeSign Status COVID-19/Flu A&B Test kits to Your CLIA Test Menu

The CLIA program has developed an email template that you can copy and paste, fill in the blanks, and email to CLIA@health.mo.gov to update your test menu to include lifeSign Status COVID-19/Flu A&B.

Email Subject line: Add COVID-19 Testing to existing CLIA Certificate for [FACILITY NAME]

Lab/Facility Name:

  

Existing CLIA Waived Lab #:

  

Lab Director Name:

  

Which COVID-19/ SARS-CoV-2 Waived Test system added?
Check [X] all that may apply.

[    ] Abbott BinaxNOW COVID-19 Ag Card
[    ] Acon FlowFlex
[    ] Quidel Sofia 2 SARS-CoV-2 Antigen assay
[    ] Becton Dickinson Veritor™ Plus Antigen test kit
[    ] Abbott ID Now
[ X ] OTHER Waived test(s) approved by FDA EUA (specify below): lifeSign Status COVID-19/Flu A&B Test kits

As the Laboratory Director or administrator/owner’s agent of record for the CLIA facility holding a Waived Certificate identified above, I wish to append my facility’s existing CLIA# to include additional testing for COVID-19. I attest that my facility will provide reasonable assurances that:

  1. All testing personnel for COVID-19 will be provided adequate and documented training
  2. All Manufacturer’s Instructions for Use (IFU) will be strictly adhered to

All tests results (both positive and negative) will be reported to the proper public health entities under federal and state requirements. See MO DHSS link regarding reporting: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/how-to-report-lab-results.php
 

 

Reporting Positive Influenza Results

As a reminder, all influenza results must be reported on a weekly basis, in aggregate, to your LPHA using the Laboratory-Confirmed Influenza Weekly Worksheet for Reporters.

For additional information about influenza, including Missouri’s reporting rules, please see https://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/cdmanual/pdf/Influenza.pdf or contact MO DHSS, Bureau of Communicable Disease and prevention at (573) 751 -6113.

 

Reporting Positive COVID-19 Tests

Facilities performing their own COVID-19 testing (antigen testing) must report positive results through one of the following portals:

  1. Missouri Disease Reporting Online Portal (MODROP)
  2. In bulk via HL7 or CSV file using the DHSS- Electronic Lab Reporting process
  3. National Healthcare Safety Network (NHSN) or the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) Platform.

Facilities using an external laboratory (PCR testing) must enter positive case information into MODROP.

The Missouri Disease Reporting Online Portal (MODROP). MODROP can be accessed directly from https://modrop.health.mo.gov/ or by using the existing ECD-1 link at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/case-reporting.php and selecting the MODROP button.

NOTE: The recommended browser for use of MODROP is Google Chrome. Other browsers may cause issues with MODROP.

Facilities will need to register for a MODROP account the first time they use the new portal. MODROP allows reporting of only COVID-19 cases. Reports of other reportable conditions may be faxed to 573-751-6417.

If you have any questions or encounter any issues utilizing MODROP or for questions about HL7 or CSV reporting, please reach out to the EpiTrax Help Desk via e-mail at epitrax@health.mo.gov.

Please see the FAQ and thank you for your efforts to provide complete and accurate COVID-19 data to public health.

TB Testing

There has been confusion regarding whether the IGRA (T-SPOT) blood test is acceptable for residents of LTC facilities. There was a revision to state statute 199.290 in 2013 that allows for the use of IGRA for healthcare facility workers. However, a revision was not made to 19 CSR 20.100, which states residents must be tested using the two-step TST.

We received clarification from DCPH that residents can be tested using the IGRA blood test, which is in alignment with CDC guidelines. DCPH staff indicated they are looking at revisions to 19 CSR 20-20.100 but did not give a timeframe on when this might occur. This means IGRA is acceptable for residents and staff. Our TB Flowsheets reflect this on our website (https://health.mo.gov/seniors/nursinghomes/providerinfo.php).

Virtual MC5 Meeting

January 17, 2023: Changing the Culture of Aging Through Meaningful Engagement
Presenter: Joan Devine, RN, Former Director of Education, Pioneer Network

Historically as we age, society has told us that our days of contributing are over and it’s time to sit back, relax and become the receiver of care and services. Based on this belief, the goal for many providers of senior services has been to design passive activities, things to keep people busy; to help pass the time. Communities around the country and around the world have heard the voice of Elders, and that voice is telling them that keeping busy is not enough!

It’s about engagement, meaning and purpose, and a chance to contribute to the greater good. What communities are learning is that when Elders are part of a “community commitment”, it not only benefits them and their senior living community, it sends a message that Elders are still valuable members of society.

This virtual session will explore what active engagement looks like based on the principles of the Citizenship Model as well as by the stories of nursing homes and assisted living communities that were recipients of the Pioneer Network’s Community Commitment Awards.

LeadingAge Webinar Series – Essentials of the LTC Director of Nursing Role

January 18-19, 2023: Essentials of the LTC Director of Nursing Role

LeadingAge Missouri is pleased to offer a joint education with LeadingAge Iowa in a virtual series that will aid in developing the Director of Nursing (DON) role in nursing homes. Elements of this series will focus on budgeting and quality assurance; survey processes and regulations; and human resources, customer service, and leadership.

This is meant to be an ongoing education series and each segment of this series is designed to provide in-depth information and discussion on each topic without taking the series in a sequential order or taking all three sections of the series. By making each of the three segments standalone, you can better address succession planning by having individuals attend as their nurse leadership skills are identified. Additional sections in this series will be added to the events calendar in March and June.

LeadingAge Management Strategies for Workers Compensation in Today’s Long Term Care Environment

February 15, 2023: Day 1 Registration
February 16, 2023: Day 2 Registration

June 7, 2023: Day 1 Registration
June 8, 2023: Day 2 Registration

August 9, 2023: Day 1 Registration
August 10, 2023: Day 2 Registration

October 11, 2023: Day 1 Registration
October 12, 2023: Day 2 Registration

Learn the elements of Total Safety Management, a comprehensive behavior-based safety program, to reduce employee injury and minimize workers compensation expense. Learn about claims management and the HCFM workers compensation insurance trust.

 

Click on the Zoom link above for both days of the desired session to register.

LEGISLATION NOTICE UPDATE: Compassionate Care Visitation Act (191.1400, RSMo.)

House Bill (HB) 2116 (merged with Senate Bill 710) known as the “Compassionate Care Visitation Act” and “No Patient Left Alone Act” became law on August 28, 2022. This legislation requires a health care facility (HCF) defined as a hospital, hospice, or long-term care facility to allow a resident, patient, or guardian of such, to permit in-person contact with a compassionate care visitor during visiting hours. A compassionate care visitor may be the patient’s or resident’s friend, family member, or other person requested by the patient or resident. The compassionate care visitation is a visit necessary to meet the physical or mental needs of the patient or resident, including end-of-life care, assistance with hearing and speaking, emotional support, assistance with eating or drinking, or social support. Section 191.1400, RSMo, outlines the provisions for the Compassionate Care Visitation Act.

As a result of this legislation and by January 1, 2023, the Department of Health and Senior Services (DHSS) is required to develop informational material for patients, residents, and their legal guardians regarding the provisions of the Compassionate Care Visitation Act. HCF’s are required by statute to make this informational material accessible upon admission or registration and on the primary website of a HCF.

Compassionate Care Visitation Guidance – This handout developed by the DHSS is to be used by a HCF to meet the required informational material requirement. The handout is posted to the following webpages:

You can review the Compassionate Care Visitation Act statute 191.1400, RSMo, in its entirety at https://revisor.mo.gov/main/OneSection.aspx?section=191.1400&bid=51115&hl.

Financial Planning Webinar for Older Missourians

January 24, 2023: Financial Planning Webinar for Older Adults

Financial planning is for everyone. This includes taking the steps necessary to ensure that your desires regarding the future of your personal care, medical care, property, and resources are accurately recorded for your loved ones to follow.

Latasha Barnes with Legal Services of Eastern Missouri will discuss how you can use simple estate planning tools to plan for the future.

Health Education Unit Updates

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

Please see the link to join these weekly meetings provided on our CNA Registry webpage (in the announcements towards the bottom of the homepage).

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

Take Aim at a Healthy New Year Stakeholder Packets

According to the CDC, older adults are more likely to get very sick from COVID-19. This could mean hospitalization, intensive care, a ventilator to help them breathe, or possibly death. The risk increases as we age and those 85 years and older are the most likely to get very sick.

Our best defense against COVID-19 is vaccination. Vaccines reduce hospitalizations and deaths for those 65 and older. The Health Quality Innovation Network (HQIN) recently launched a campaign to improve vaccination rates among our most vulnerable populations. As part of our Take Aim at a Healthy New Year initiative, we have developed an electronic informational package (below) to help you spread the word about vaccinations and how they can help keep us all healthier.

If you have any questions about this initiative, please contact the HQIN team at 1-877-731-4746 or email LTC@hqi.solutions.

Thank you for your commitment to our shared goals. We wish you a healthy new year!

7 Questions About the COVID Bivalent Vaccine
COVID Vaccine Encouragement Signature and Instructions
COVID Vaccine Social Media Messaging

Health Education Update

Attention all CNA’s going inactive in January 2023

Please log into TMU at Welcome | MO TMU (tmutest.com) and renew your certification. If you have never logged into TMU and entered a current email address, you will need to call the Health Education at 573-526-5686 or Headmaster D & S at 800-393-8664 for assistance.

After accessing your profile and updating your demographics, please see the attached step-by-step instructions on the process in TMU to renew your certification. Please ensure you have the required documentation to upload into TMU.

The regulation is shown below:

19CSR30-84.010 (18)(B) CNAs shall submit 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 to maintain active status. Documentation shall be submitted to the department approved third party test administrator and a fee will be assessed for each renewal.

**NOTE- If you are a CMT, please remember that you still need to renew your CNA to remain active.

New options for employment verification for CNA renewals coming soon, please watch for the announcement!

You may contact the Health Education Unit at 573-526-5686 for questions or email us at CNARegistry@health.mo.gov.

Facility Reported Incidents (Self-Reports)

The Section for Long Term Care Regulation (SLCR) has developed two new forms for all long-term care providers to utilize when reporting Facility Reported Incidents. Providers are not required the use these forms. However, the forms will be especially helpful for certified facilities to ensure they have met the reporting requirements under F609 for the Initial Report and the Follow-Up Investigation Report.

The FRI Initial Reporting Form can be sent to the Adult Abuse and Neglect Hotline fax number (listed on the form) or to the regional office.

The FRI Follow-Up Investigation Form will be sent directly to the regional office.

**Please note: Information sent via email is not secure unless it is encrypted. Sending the FRI Initial Reporting Form to the fax number at the Adult Abuse and Neglect Hotline or the regional office will ensure the information is secure.

Infection Control and Assessment and Response (ICAR)

QIPMO has formed an Infection Control and Assessment and Response (ICAR) team with a primary goal to assist Missouri Long-Term Care Facilities navigate the challenges of the COVID-19 pandemic and other infectious diseases.

Members of the ICAR Team are available for voluntary, no cost visits (virtual and/or in-person) to any residential care, assisted living, and skilled nursing facility in Missouri. These visits are intended to consultative and collaborative in nature with a non-regulatory focus to evaluate inflection control practices. Visits will consist of:

  • completion of a standardized assessment of infection control processes, focusing on highly-transmittable infectious diseases
  • observations of infection control practices
  • preliminary feedback with supplemental educational resources

See flyer for full details.

Reporting Positive COVID-19 Tests

Facilities performing their own COVID-19 testing (antigen testing) must report positive results through one of the following portals:

  1. Missouri Disease Reporting Online Portal (MODROP)
  2. In bulk via HL7 or CSV file using the DHSS- Electronic Lab Reporting process
  3. National Healthcare Safety Network (NHSN) or the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) Platform.

Facilities using an external laboratory (PCR testing) must enter positive case information into MODROP.

The Missouri Disease Reporting Online Portal (MODROP). MODROP can be accessed directly from https://modrop.health.mo.gov/ or by using the existing ECD-1 link at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/case-reporting.php and selecting the MODROP button.

NOTE: The recommended browser for use of MODROP is Google Chrome. Other browsers may cause issues with MODROP.

Facilities will need to register for a MODROP account the first time they use the new portal. MODROP allows reporting of only COVID-19 cases. Reports of other reportable conditions may be faxed to 573-751-6417.

If you have any questions or encounter any issues utilizing MODROP or for questions about HL7 or CSV reporting, please reach out to the EpiTrax Help Desk via e-mail at epitrax@health.mo.gov.

Please see the FAQ and thank you for your efforts to provide complete and accurate COVID-19 data to public health.

Personal Protective Equipment

Missouri has limited PPE reserves to assist in filling critical needs and prioritize healthcare providers providing direct care to confirmed or suspected COVID patients. Note requests should only be submitted after all normal supply chains, including the Missouri COVID Supply Solution, have been exhausted and you have a supply of twenty-one days or less on hand as the quantities and types of PPE available through the state are limited.

https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/ppe.php

Free COVID-19 Antigen Test Kits

DHSS offers TWO different types of rapid antigen test kits. DHSS offers ACON Flow Flex antigen test kits under the state CLIA waiver for testing in congregate care settings (In-Office) by testing personnel. DHSS also offers iHealth antigen test kits for At-Home testing.

Rapid Antigen Test Kit Application Portal (arcgis.com)

Long Term Care Facilities must make sure the ACON Flow Flex are added to the facility’s CLIA certificate:

Adding ACON Flow Flex to Your CLIA Test Menu

The CLIA program has developed an email template that you can copy and paste, fill in the blanks, and email to CLIA@health.mo.gov to update your test menu to include ACON Flow Flex.

Email Subject line: Add COVID-19 Testing to existing CLIA Certificate for [FACILITY NAME]

Lab/Facility Name:

  

Existing CLIA Waived Lab #:

  

Lab Director Name:

  

Which COVID-19/ SARS-CoV-2 Waived Test system added?
Check [X] all that may apply.

[    ] Abbott BinaxNOW COVID-19 Ag Card
[    ] Acon FlowFlex
[    ] Quidel Sofia 2 SARS-CoV-2 Antigen assay
[    ] Becton Dickinson Veritor™ Plus Antigen test kit
[    ] Abbott ID Now
[    ] OTHER Waived test(s) approved by FDA EUA (specify below):

As the Laboratory Director or administrator/owner’s agent of record for the CLIA facility holding a Waived Certificate identified above, I wish to append my facility’s existing CLIA# to include additional testing for COVID-19. I attest that my facility will provide reasonable assurances that:

  1. All testing personnel for COVID-19 will be provided adequate and documented training
  2. All Manufacturer’s Instructions for Use (IFU) will be strictly adhered to

All tests results (both positive and negative) will be reported to the proper public health entities under federal and state requirements. See MO DHSS link regarding reporting: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/how-to-report-lab-results.php

 

Long-Term Care/Hospice Coordination of Care Form and Training Video

After three years of collaboration, review, discussion, and hard work, the Long-Term Care/Hospice Coordination of Care form and training video are complete, and available. The collaboration on this project was wonderful and we are so thankful to all of the partners who assisted and offered input.

The Bureau of Home Care and Rehabilitative Standards has a link to the form as well as more information on their Hospice web page. There is also a link via HQIN for an educational video featuring examples of health care personnel implementing the Long-Term Care & Hospice Coordinated Task Form Tool.

Long Term Care and Hospice Coordination of Care Form
Video – Long Term Care & Hospice Coordination of Care

Health Education Unit – CNA Testing Results

The Health Education Unit would like to share pass/fail results of CNA tests taken over the last three months. The CNA test consists of two parts, the Knowledge Test and Skills Test. Also included below are the most missed skills and vocabulary words.

Knowledge Test
September – 151 passed/101 failed
October – 186 passed/116 failed
November – 186 passed/96 failed

Skills Test
September – 187 passed/37 failed
October – 186 passed/22 failed
November – 186 passed/32 failed

Most missed skills: taking blood pressure, pulse and respirations
Most missed vocabulary words: diet and ischemia

** Please remember to use the Headmaster Student Handbook for preparation of the knowledge and skills exam. The handbook contains information such as the ID requirements, examples of test questions, audio and virtual options for the knowledge test, testing policies, vocabulary words and test results. The handbook on Headmaster’s website can be found at D&S – Missouri Nurse Aide (hdmaster.com).