Missouri Long-Term Care Information Update

Funding Opportunity for Residential Care and Assisted Living Facilities

The Missouri Department of Health and Senior Services (DHSS) is excited to announce a reimbursement opportunity available to Residential Care Facilities (RCF) and Assisted Living Facilities (ALF). Beginning, September 1, 2022, operators may apply for reimbursement for expenses incurred between April 1, 2021 and March 31, 2022, directly related to preparing, preventing, and responding to the COVID-19 pandemic.

If you operated a residential care facility or assisted living facility licensed with DHSS between April 1, 2021 and March 31, 2022, you are eligible for reimbursement for allowable expenses.

Before operators can complete an application for reimbursement:

  1. Operators must be registered as a vendor with the State of Missouri and must have provided their Federal Employer ID Number (FEIN) to DHSS.
  2.    If not already registered, complete the Vendor Input Form located here. Completed forms must be sent to the Office of Administration by fax at 573-526-9813 or by mail to PO Box 809, Jefferson City, MO 65102.
  3. The address used in registering as a vendor must be the same address used on the reimbursement application. Be sure to register only the operating entity and not all individual facilities owned by the same company.
  4. Email registered name and FEIN to LTCARPAReimbursements@health.mo.gov.

For your convenience, you will find a Frequently Asked Questions and an Application Checklist attached to this communication. These documents can also be found online at https://moarpa.mo.gov/required-forms-program-application-instructions/ under Operators of Residential Care / Assisted Living Facilities.

Funding for this initiative has been made available through the American Rescue Plan Act (ARPA). Missouri’s ARPA funding opportunities are located here: https://moarpa.mo.gov/available-funding-opportunities/.

ARPA Funds FAQ 2022 0829 final
ARPA Funds Checklist 2022 0829 final

Nursing Home Staffing Study Blog and Stakeholder Listening Session

CMS published a blog describing the multi-faceted approach the agency is taking to determine a minimum staffing level for nursing homes in order to ensure safe and quality care.

Also included in the blog is a registration link for an upcoming Stakeholder Listening Session that CMS is conducting for the public, scheduled for Monday, August 29, at 12:00-1:30 pm (central).

Online Course for CNA Instructor Required 4-Hour Update

MANHA and MHCA provided in-seat update training in 6 locations earlier this year. We are now offering the update training online. To access you can go to www.staffdevelopmentsolutions.com click on Course Groups. You will find the “CNA Instructor 4 Hour required update” under Train the Trainer course group. Once you complete you will NOT need to do anything else if course is 100% complete. August 30th we will report all RNs who have completed the training to DHSS, Health Education Unit and you will be updated on the registry.

The objectives of this course will meet the elements of the required training to include:

  1. Instruction on how to complete form DHSS-DRL-111 (08-20), Classroom and On-the-Job Training Record;
  2. Instruction on the fundamentals of adult learning;
  3. Instruction in at least one (1) area regarding standards of practice in long term care such as pressure ulcer prevention, dining practices, or resident rights issues;
  4. Instruction on providing care for cognitively impaired residents;
  5. Review of the Nursing Assistant Training Program regulations contained in 19 CSR 30-84.010; and
  6. Review of the administration and resident care requirements contained in 19 CSR 30-85.042.

Any instructor who has not completed the required four (4) hour update training by August 30, 2022, and every five (5) years thereafter shall be removed from the department-approved list of instructors. If removed from the department’s list, the instructor shall attend and successfully complete the Nursing Assistant Instructor Workshop in order to be reinstated to act as an instructor.

Free Resources Can Help Boost Vaccine Confidence

Health Quality Innovation Network (HQIN), the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Missouri, recently released three new tools in the fight against COVID-19.

The Why Wait? Vaccines Can Keep Us Healthy video and the Is It Time to Get Your Booster? video are both under two minutes long. They can be shown in reception areas, common spaces and through electronic communications with staff, residents and families.

Additionally, the Direct Exposure Infographic poster displays the differences in COVID-19 illness and death among those unvaccinated, vaccinated and fully vaccinated. It can be shared electronically or printed and displayed in high-traffic areas.

Check out and share these free tools to help spread education, rather than the virus.

CNA Instructor 4-Hour Update Training Requirement – Due 8/31/22

As of 12/30/21, the new CNA regulations require the CNA instructor to take a four-hour update training every five years. Please see below the regulatory language:

19CSR-84.010 (15)(C)

Any instructor who has not completed the required four (4) hour update training by August 31, 2022, and every five (5) years thereafter shall be removed from the department-approved list of instructors. If removed from the department’s list, the instructor shall attend and successfully complete the Nursing Assistant Instructor Workshop in order to be reinstated to act as an instructor

All current instructors who have not taken the instructor 4 hour update training by August 31, 2022, will be removed as a CNA Instructor from the registry.

*The four hour update training is still required to be completed by August 31, 2022 even if you have recently taken the Train the Trainer course (unless the four hour update training was included) to become a CNA instructor.

If you have any questions, please contact the Health Education Unit at CNARegistry@health.mo.gov or call us at 573-526-5686.

COVID-19 Boosters – Customizable Package Encourages Staff, Residents, Families and Visitors to Share Their “Why”

Health Quality Innovation Network (HQIN), the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Missouri, recently released a new tool in the fight against COVID-19.

The Vaccine Champion Social Media Package can help your facility boost vaccine confidence by encouraging staff, residents, families and visitors to share their “why” for getting the COVID-19 vaccine. The customizable package includes pages you can print and display for staff, residents, families and visitors to add their reason for getting vaccinated. It includes instructions and suggestions to promote their positive messages on social media channels.

Download the package and customize it for your team to help spread the word, rather than the virus.

SNF Quality Reporting Program (QRP) Submission

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS and NHSN data for 1/1/22 through 3/31/22 must be submitted no later than 11:59 p.m. on August 15, 2022.

The Minimum Data Set (MDS) 3.0 must be transmitted to the Centers for Medicare & Medicaid Services (CMS) through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). Data for the National Healthcare Safety Network (NHSN) measures must be submitted to the Centers for Disease Control and Prevention (CDC). No additional data submission is required for the claims-based measures.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 4/1/22 through 6/30/22 is due August 14, 2022.

Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center no later than the Friday before the submission deadline, as the Service Center will be unavailable to assist on the weekend.

More information about PBJ can be found on the following webpages:

CMS Memo: QSO-22-19-NH: Revised Long-Term Care Surveyor Guidance: Revisions to Surveyor Guidance for Phases 2 & 3, Arbitration Agreement Requirements, Investigating Complaints & Facility Reported Incidents, and the Psychosocial Outcome Severity Guide

  • Clarifications and technical corrections of Phase 2 guidance issued in 2017 in certain areas, such as abuse and neglect, admission, transfer, and discharge, and improving care for individuals with mental health or substance use disorder needs, Payroll Based Journal, visitation, and inaccurate diagnoses of schizophrenia.
  • New guidance for Phase 3 requirements which went into effect in November 28, 2019, including guidance related to Infection Preventionist requirements.
  • Guidance for other Phase 3 requirements, such as Trauma Informed Care, Compliance and Ethics, and Quality Assurance Performance Improvement (QAPI). The revisions can be found in Appendix PP of the SOM.
  • Arbitration requirements and guidance which went into effect in September 16, 2019. Changes in the Psychosocial Severity Guide.
  • Revised guidance in Chapter 5 and related exhibits of the State Operations Manual (SOM) to strengthen the oversight of nursing home complaints and Facility Reported Incidents (FRIs).

Effective date: The effective dates for all requirements is October 24, 2022. The implementation date for the Chapter 5 revised guidance will be announced at a later date. CMS will establish a target implementation date for State Agencies (SAs) depending on the status of the PHE, and/or unique circumstances occurring in the SAs. The Implementation date will be communicated through the listserv.

SLCR will be providing a high-level overview of the requirements at the annual Provider Meetings; however, we encourage all homes to view the QSEP trainings below developed by CMS prior to the Provider Meetings. The trainings are titled:

Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/revised-long-term-care-surveyor-guidance-revisions-surveyor-guidance-phases-2-3-arbitration.

DHSS Supply Chain Assessment Survey

Missouri DHSS is conducting a survey to assess healthcare supply chain integrity and is requesting your input. The survey is designed to assess the current status of the healthcare supply chain while also capturing lessons learned from the COVID-19 pandemic. As part of the Hospital Preparedness Program, we are required to complete a supply chain assessment to examine supply chain vulnerabilities to guide future planning efforts. The information collected will also help statewide assets and stockpile realignment with respect to location, number and contents of caches, as well as to identify gaps for future investments.

This survey is 52 questions and divided into 5 sections: facility information, background information, preparedness, purchasing/operations, and future planning. It is recommended that facilities have emergency preparedness staff and procurement staff work together to complete the survey. Thank you in advance for participating in this collaborative effort regarding the healthcare supply chain.

https://survey123.arcgis.com/share/e9b6ec9e7bcd4aaeb3ee1755aecb8075

The survey will close COB August 5, 2022.

Infection Prevention & Control in the Long-Term Care Setting: Cleaning and Disinfection

Long-term care (LTC) settings are communities where residents congregate closely in shared spaces, and equipment is used between residents, staff, visitors, and vendors who enter and leave frequently. This makes LTC an ideal environment for germs to spread and risks the lives and well-being of residents and staff.

Proper cleaning and disinfection is crucial to preventing and controlling the spread of any infection. Like many processes, cleaning and disinfection must be done correctly to be effective. This resource will provide all staff in the long-term care setting with information to help them understand and perform the steps required to clean and disinfect properly.

Medicaid Spend-Down Limit Changes

Effective 07/01/22, the Medicaid Resource (Spend-Down) Limit increased to $5,301.85. Please see the link https://dssmanuals.mo.gov/wp-content/uploads/2022/06/mhabd-appendix-j.pdf.

Please note that for Medicaid/Medicare certified facilities, F569 states the facility must notify each resident/legal guardian that receives Medicaid benefits when the amount in the resident’s account reaches $200 less than the SSI resource limit. This means certified facilities should notify the resident/legal guardian when the resident’s personal funds are $5,101.85 or higher.

Feel free to contact Lynn Gilmore, Lead Auditor, at 573-508-4150 if you have any questions.

RAI Manual Update

CMS released a PDF file labeled “MDS3.0RAIManualv1.17R.Errata.v2.July.15.2022,” available in the Downloads section of the MDS 3.0 RAI Manual webpage. This file contains revisions to pages in Chapter 3, Section I, of the MDS 3.0 RAI Manual v1.17.1R that clarifies the need for a detailed evaluation and appropriate diagnostic information to support a diagnosis, such as for a mental disorder, prior to coding the diagnosis on the MDS, and the steps that may be necessary when a resident has potentially been misdiagnosed. An example of when a diagnosis should not be coded in Section I due to lack of a detailed evaluation and appropriate diagnostic information to support the diagnosis has also been added to this section. Changed manual pages are I-12 and I-16 and are marked with the footer “October 2019 (R).”

Discharge Letters

Do Your Facility’s Discharge Letters Have the Right Contact Information for the Appeals Unit?

Failure to provide the appropriate appeal contact information can result in the appeals unit setting aside a discharge. Requests for a discharge hearing are required to be sent to:

Department of Health and Senior Services Appeals Unit
P.O. Box 570
912 Wildwood Drive 3rd floor
Jefferson City, Missouri 65102-0570
Phone: (573) 522-1699
Fax (573) 751-0247
Email: DHSS.Appeals@health.mo.gov

Discharge regulations can be found here: https://s1.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c30-82.pdf.

Quality Reporting Program: Non-Compliance Letters for FY 2023 APU

CMS is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2021, which will affect their FY 2023 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were placed into SNFs’ CASPER folders in QIES on July 13, 2022. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 11, 2022.

If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notice of non-compliance and on the SNF Quality Reporting Reconsideration and Exception & Extension webpage.

2022 Missouri Tiered Supports Summit

July 16, 2022 & July 27-28, 2022: Nurturing Healthy Communities

Includes presentations from change agents and behavior analysts from across the country.

Family Sessions

Saturday, July 16, 2022: 10:30 – 2:00

Family Sessions are an ideal opportunity for parents, grandparents, caregivers, and the behavioral health professionals who support them to learn more about positive practices and at home implementation of Tiered Supports.

Professional Sessions

July 27-28, 2022: 9:30-12:30

Professional Sessions provide an opportunity for agency administrators, supervisors, agency team members, coaches, DMH team members, family caregivers, and other behavioral health professionals to learn more about positive practices and implementation of Tiered Supports.

FREE CEUs available for RBTs, BCaBAs, and BCBAs – Click to Register

MO Tiered Supports is a state multi-tiered positive behavior support consultation service system. The MMTSS team focuses on teaching and coaching agency teams so they can better serve the individuals in their care. You can click on these underlined links to direct you to more information on Tiered supports: Multi-Tiered Systems of Support and Understanding Missouri Multi-Tiered Supports Webinar

For information on this summit, please visit https://dmh.mo.gov/dev-disabilities/tiered-support-summit/2022.

RAI Process from Start to Finish

August 2-4, 2022: RAI Process from Start to Finish
December 6-8, 2022: RAI Process from Start to Finish

This virtual 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 virtual 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.

Medicare from Start to Finish

September 13-14, 2022: Medicare from Start to Finish
November 8-9, 2022: Medicare from Start to Finish

This virtual 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.

LeadingAge Missouri Annual Meeting & EXPO

September 26-28, 2022: MOMENTUM
Location: The Chase Park Plaza Royal Sonesta, St. Louis

It’s time to reconnect at LeadingAge Missouri Annual Meeting & EXPO at the beautiful Chase Park Plaza Hotel in Saint Louis.

LeadingAge Missouri’s members are eager to connect with you at our Annual Conference & EXPO! This year’s events will offer a wider variety of marketing opportunities sure to suit your goals and budget. The 2022 conference will provide you with a dynamic opportunity to put your life-changing products and services in front of aging services leaders from across Missouri. We are dedicated to helping you to stand out from your competition.

2022 MALA Fall Conference

October 9-11, 2022: Don’t Get Tricked. Grab the Treat!
Location: Margaritaville, Osage Beach

The tentative conference agenda is now available and includes several speakers and presentations over a three-day period. The option to attend all or just one day is included on the registration form.

Please see the conference link for further details.

American Rescue Plan Act (ARPA) Funding Opportunity for RCF and ALF

The Department of Health and Senior Services (DHSS) is excited to announce an upcoming reimbursement opportunity available to Residential Care Facilities (RCF) and Assisted Living Facilities (ALF). Through Missouri’s State Fiscal Recovery Funds, operators may seek reimbursement for expenses incurred directly related to preparing, preventing, and responding to the COVID-19 pandemic.

DHSS will begin accepting applications for reimbursement on September 1, 2022. In the coming weeks, additional details about the reimbursement process, reimbursement amounts, eligible expenses, and supporting documentation will be provided. Our goal is to simplify this process for facility administrators as much as possible.

In preparation of the launch of the application, you are urged to take steps now to prepare. If you operate an RCF or ALF and are interested in this funding opportunity, please ensure you are registered as a vendor to receive payment from the State of Missouri. Before operators can complete an application for this opportunity, they must register as a vendor with the state’s financial system – SAM II. If the operating entity is already registered as a vendor with the State of Missouri, you do not need to re-register.

The SAM II registration Vendor Input Form can be found at https://oa.mo.gov/sites/default/files/vendor_input_ach_eftd.pdf. The completed Vendor Input Form must be sent directly to the Office of Administration by fax at 573-526-9813 or by mail to Office of Administration/Accounting, PO Box 809, Jefferson City, MO 65102.

Operator Tips in Registering as a Vendor with the State of Missouri:

  • Be sure to register only the legal operating entity and not all individual facilities owned by the same operating entity.
  • Be sure the address used in the State’s financial system is the same address that will be used as the operator’s address on the application and any accounts payable documentation.

We will keep you updated with more information regarding the RCF/ALF funding opportunity via this listserv.

Funding for this initiative has been made available through the American Rescue Plan Act (ARPA). Missouri’s ARPA funding opportunities are located here: https://moarpa.mo.gov/available-funding-opportunities/.

Top Deficiencies Report – 2022

Please see the most frequently cited deficiencies report. This report covers a six-month period with the resumption of survey and inspection activities.

Free Dementia Training – Changing Talk: Online Training (CHATO) to Reduce Behavioral Symptoms in Dementia

CHAT educates staff about reducing elderspeak (infantilizing communication) and results in reduced behavioral symptoms and need for psychotropic medication for residents with dementia. The new online version (Changing Talk: Online Training (CHATO)) consists of 3; one-hour interactive online modules that provide flexible and accessible access for staff.

There is no cost, direct-care staff can earn 3 contact hours, and all staff get a Certificate of Completion for their file.

Benefits to you, your staff, and your residents include:

  • A person-centered approach.
  • Education about elderspeak and better communication strategies.
  • Reduction in resistiveness to care and other behavioral symptoms in residents with dementia.
  • Reduction in the need for psychotropic medication.
  • Convenient, online educational format for busy nursing homes.
  • Qualifies for CMS dementia care training hours requirements.
  • A free, nonpharmacological, evidence-based intervention is an excellent addition to a Quality Improvement Plan.

Here is also a one-page summary of the study.

Please see the website to learn more about CHATO and view our training resources or

Access the Google drive to download the NEW pilot research and CHATO National Trial information.

Interested parties can email Carissa Coleman (below) or complete the interest form on the website.

Carissa K. Coleman, PhD, MA
Research Assistant Professor
University of Kansas School of Nursing
t: 970-270-6839 | ccoleman3@kumc.edu

Prospective Reimbursement Plan for Nursing Facility and HIV Nursing Facility Services Reimbursement Rates Methodology

The MO HealthNet Division (MHD) is modifying the reimbursement plan for nursing facility and HIV nursing facility services to provide for the transformation of MO HealthNet nursing facility reimbursement rates by establishing a new reimbursement methodology, effective for dates of service beginning July 1, 2022. The primary changes from the current reimbursement include updating the cost base for the rates (i.e., rebasing), applying an acuity adjustment or Case Mix Index (CMI) to patient care costs, and providing quality based incentives or Value Based Purchasing (VBP) add-ons to the rate when the facility meets specified quality measures.

The following documents can be found at the MO HealthNet Alerts and Public Notices webpage:

An additional resource, The Missouri Medicaid Nursing Facility Reimbursement Methodology Summary for Fiscal Year 2023, created by MO HealthNet, provides a summary of the changes for the reimbursement plan found in the Prospective Reimbursement Plan for Nursing Facility and HIV Nursing Facility Services document.