The draft Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) User’s Manual version (v)1.18.11 is now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The MDS 3.0 RAI User’s Manual v1.18.11 will be effective beginning October 01, 2023.

This version of the MDS 3.0 RAI Manual contains substantial revisions related to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which requires that standardized assessment items be collected across post-acute care (PAC) settings. Standardized data will enable cross-setting data collection, outcome comparison, exchangeability of data, and comparison of quality within and across PAC settings. Additionally, the language of the manual has been updated throughout to be gender neutral. Guidance and examples in numerous chapters and appendices have been revised for clarification and to reflect current regulations and best practices. Due to the scope of the revisions, CMS will not issue Replacement Pages for v1.18.11; those wishing to continue using a physical copy of the manual are encouraged to print the new version.

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.

April 11, 2023: Instructor Info Meet Up Meeting
April 18, 2023: Instructor Info Meet Up Meeting
April 25, 2023: Instructor Info Meet Up Meeting

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

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

May 23, 2023: Alzheimer’s Disease and Dementia Care Seminar
Location: The Sarah Community, Bridgeton
Trainer: Madisen Mendez, MOT, OTR/L, MSCS, CDP, CADDCT, CMDCP

The prevalence of dementia is on the rise. Successful dementia care in skilled nursing facilities, residential communities, and the home setting requires an understanding of the disease process, communication techniques, and possible causes of unwanted behaviors in persons living with dementia. The Alzheimer’s Disease and Dementia Care Seminar is a National Council of Certified Dementia Practioners (NCCDP) curriculum and will provide fundamental education on dementia care to enhance the quality of life of those living with cognitive dysfunction and their caregivers. In addition, this course will provide participants with approaches for daily activities, unmet needs, behavioral care, and interdisciplinary support.

REGISTRATION is LIMITED. No Refunds will be given, however substitutions can be made.

Memorandum Summary

  • CMS has rescinded memorandum QSO-20-31-ALL, the Enhanced Enforcement for Infection Control Deficiencies, and replaced it with memorandum QSO-23-10-NH, revised guidance for Strengthened Enhanced Enforcement for Infection Control Deficiencies. This revised guidance strengthens enforcement efforts for noncompliance with infection control deficiencies. The enhanced enforcement actions are more stringent for infection control deficiencies that result in actual harm or immediate jeopardy to residents. In addition, the criteria for enhanced enforcement on infection control deficiencies that result in no resident harm has been expanded to include enforcement on noncompliance with Infection Prevention and Control (F880) combined with COVID-19 Vaccine Immunization Requirements for Residents and Staff (F887).
  • CMS is providing guidance to the State Survey Agencies and CMS locations on handling enforcement cases before and after the revisions of Enhanced Enforcement for Infection Control Deficiencies.
  • Quality Improvement Organizations have been strategically refocused to assist nursing homes in combating COVID-19 through such efforts as education and training, creating action plans based on infection control problem areas, and recommending steps to establish a strong infection control and surveillance program.

Please see the full memo for complete details at

There has been some confusion on where providers should send the FRI Initial Reporting Form and FRI Follow-Up Investigation Form.

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 should be sent directly to the regional office. Please do not send the follow-up investigation to the Adult Abuse and Neglect Hotline.

***Please Note: If you have already completed iQIES/HARP onboarding, no further action is required. Please also note, Payroll Based Journal (PBJ) submissions will continue to be submitted to QIES. ***

The transition to the Internet Quality Improvement and Evaluation System (iQIES) for MDS submission and reports will occur on April 17, 2023. To properly prepare for the transition, all users must create an account and establish credentials in the Healthcare Quality Information System (HCQIS) Access Roles and Profile (HARP) system, followed by requesting User Role access to iQIES. Please note that failure to obtain access prior to April 17, 2023 will impact your ability to submit MDS assessments following QIES Assessment Submission and Processing (ASAP) system for MDS submissions shutoff on Thursday, April 13 at 8:00 p.m. ET.

Register for an iQIES Account
To gain access to iQIES, please follow the steps outlined below.

  1. Create an account in the HARP system using your corporate email address* at: Note: HARP User IDs cannot be adjusted. As such, please refrain from using facility names or any special characters (such as # or &) when creating the HARP User ID. *If the facility handles 2 or fewer providers and does not have a corporate email domain, a personal email address may be used.
  2. Access iQIES at: and log in with your HARP credentials (completed in step 1) to complete the process to request your User Role for your provider’s CMS Certification Number (CCN).
  3. Once the user role request has been submitted AND approved by the Provider Security Official (PSO), you will receive a notification via email informing you that your iQIES account access request has been approved. Note: Due to increased role request volume, role request approvals or rejections may take up to 24 hours for the status to be reflected.

***IMPORTANT:  If your organization has not yet identified and registered a Provider Security Official (PSO), you will not be able to complete a user role request. Nursing home and Swing bed providers who are required to submit data to CMS must have at least one staff person assigned and approved as the facility Provider Security Official (PSO), who is responsible for approving all other users for their facility.***

Please refer to the following iQIES documents for more information, located at

  • iQIES Onboarding Guide for step-by-step instructions to request a user role
    iQIES User Role Matrix for a listing of user category descriptions and role privileges

For more information on HARP or iQIES, please refer to the following resources:



iQIES Service Center
If you have questions or require assistance, please contact the iQIES Service Center at or by phone at (800) 339-9313.

Seminar: Public Health Emergency Ending – What’s Next?

April 6, 2023: Holiday Inn Route 66, St. Louis
April 13, 2023: Courtyard by Marriott, Columbia
April 26, 2023: Stoney Creek Hotel & Conference Center, Independence

The Public Health Emergency (PHE) is scheduled to end as of May 11, 2023. Moving forward it will be essential to apply pandemic lessons learned to maintain and improve processes that will benefit residents/families, staff and facility leadership.

April 26-27, 2023: 2023 Missouri Immunization Conference
Location: Holiday Inn Executive Center, Columbia

The 2023 Missouri Immunization Conference brings together bright minds to give talks that are action-oriented on a wide range of subjects related to immunizations to foster learning and inspiration, as well as provoke conversations that matter and actions that lead to increased vaccination rates for Missourians. The theme of this year’s conference is Vaccines: The Building Blocks of Better Health

June 4-7, 2023: Surfing the Waves of Success with MANHA
Location: Camden on the Lake, Lake Ozark

Missouri Association of Nursing Home Administrators is pleased to invite you to attend the 2023 Annual Convention. The goal of this conference is to provide meaningful, forward thinking, and real-time education to pave the path forward while acknowledging the past and working together.

March 31, 2023: Fitzgibbon Hospital, Marshall
April 12, 2023: Heisinger Bluffs Western Campus, Jefferson City
April 27, 2023: DHSS Regional Office, Poplar Bluff
April 28, 2023: Cape Girardeau Public Library, Cape Girardeau
May 2, 2023: Comfort Inn and Suites, Macon
May 25, 2023: Maranatha Village Community Center, Springfield

Regional Respiratory Fit Testing Train-the-Trainer sessions are being offered throughout Missouri by the Health Quality Innovation Network (HQIN), which is the Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network – Quality Improvement Organization (QIN-QIO) for the state, and the Quality Improvement Program for Missouri (QIPMO) Infection Control and Assessment Response (ICAR) Team. The training is to ensure long-term care facilities have qualified staff to provide respirator fit testing. In addition, the attendee can train others in the proper procedures for fit testing. This training is for qualitative testing using a hood and not quantitative testing.

See flyer for information on Fit Testing Training sessions.

Memorandum Summary

  • Dialysis Services in a Long-Term Care (LTC) Facility: In 2018, CMS issued guidance that addressed care at home provisions for nursing home residents that were receiving home dialysis. Since that time, CMS has received questions, comments, and feedback from the state survey agencies, the dialysis provider community, as well as other Federal and non-Federal stakeholders. This memorandum addresses those questions and incorporates the feedback that we received.
  • Survey Process for Evaluation of Home Dialysis in an LTC Facility: The End-Stage Renal Disease (ESRD) Core Survey Process has been updated to include additional survey activities which evaluate dialysis services provided by an ESRD facility to residents in an LTC facility.
  • Attachments: Included as an attachment to this memorandum is an advance copy of the survey procedures for ESRD surveyors reviewing dialysis in nursing homes.

Please see the full memo for complete details at

What does the Missouri Certificate of Need Program (CONP) do? The CONP reviews proposals for new and additional long-term care beds, major medical equipment, and new hospitals. Approval by the Missouri Health Facilities Review Committee is required before an applicant may proceed with their proposal or obtain licensure. CONP also collects LTC occupancy every quarter.

You can view CON applications filed with DHSS on our website here under the Upcoming Meetings section. This section also includes details about an upcoming CON meeting and agenda items, and additional documentation received regarding a project. Any person or facility may submit written support, neutral, or opposing letters on a CON project up to three (3) business days before a scheduled CON meeting. Written support/neutral/opposition may be emailed to or mailed to 3418 Knipp Drive, Jefferson City, Mo 65102. Any person may also testify in support, neutral, or opposition at an in-person CON meeting. Questions can be emailed to

Employer Profile for “New” Option to Renew CNA’s Coming Soon!

If you are interested setting up your facility employer profile to verify and electronically pay for your CNA renewals, please contact Headmaster D & S at 800-393-8664 and ask for the Missouri Team. Details will be coming!


Training Programs

Please confirm your CNA Training Programs are active and has not expired when providing the CNA course. In order to remain active a renewal application and an onsite visit to the facility must be completed every two years. The renewal application should be submitted 30 days before expiration and can be found on our website under Application for Approval as a Nursing Assistant Training Agency.

Please contact HEU with any questions at 573-526-5686 or

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!

Open to RNs, NHAs and LPNs!

For more information visit our web site, download the postcard or contact Todd Winterbower at

Take the survey now to see if you qualify for FREE registration.

April 4, 2023: Registration
April 12, 2023: Registration
April 17, 2023: Registration
April 25, 2023: Registration

Presenter: Kathleen Deppeler, Director of Positive Supports

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.

April 5, 2023: Trauma Informed Care Across the Lifespan
Location: MC5 West Central Region, Methodist Church, The Celebration Center, Sedalia

This training will define what trauma is and understand its prevalence in our clients, define PTSD and provide an overview of the brain and body physiology of the impact of trauma. This training will also discuss the impact of trauma at various stages in life and the prolonged effects as well as generational and cultural trauma. Participants will be able to take tools/methods with them to cope with client crisis and trauma related triggers.

September 11-13, 2023: Show Me Summit on Aging and Health 2023
Location: Holiday Inn Executive Center, Columbia

The 18th Show Me Summit on Aging & Health returns to Columbia, MO September 11th to 13th, 2023. Our theme this year is Expanding the Possibilities. With the Governor launching a statewide Master Plan on Aging, Missouri’s 1.1 million adults ages 60 and older take center stage in Missouri. Join us this fall to learn innovative ideas in aging services and to exchange best practices with fellow professionals in Missouri’s growing field of aging services.

Please share your expertise and experience with your AAA and aging network colleagues across the state! We week session proposals that highlight leading-edge tactics, innovative program ideas, and new and diverse thoughts. This is a great way to share your experience with your colleagues and leaders in aging from all across Missouri. We look forward to showcasing your subject-matter expertise, fresh thinking, and best practices as a presenter.

Submit your proposal by April 30, 2023. Notifications will be in May 2023.

The Health Quality Innovation Network (HQIN), the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), has released a brief Sepsis Learning Module Series to help frontline staff recognize and treat sepsis.

The series includes four modules:

  • Act Fast! Early Detection of Sepsis Requires Fast Action
  • It Takes Teamwork to Beat Sepsis
  • Effective Communication is Critical for Rapid Sepsis Intervention
  • The Transition Home: Stop, Look and Listen for Sepsis

The modules average three minutes in length and the series webpage includes free downloadable resources to accompany the information. The modules can be accessed via the link above or visit the HQIN Resource Center to access the series and supplementary resources, which include printable wallet cards and a poster.

Join members of the team from MC5 and special guests the 4th Wednesday of each month as we share stories and best practices, explore challenges faced, and together re-envision what Person-Directed Care can look like for seniors in Missouri, especially for those living and working in Missouri’s Long-Term Care and Assisted Livings communities.

Using Zoom, the format will be casual – a conversation – with special guests inviting participants to share, ask questions, explore, and plan for how through MC5, we can re-imagine and “move the movement” forward as we come out of the pandemic.

March 22, 2023: Re-Imaging Person-Directed Culture: It Starts with a Conversation
Special Guest: Julie Wilson, RN, Regulatory Compliance Manager ICF/IID Unit & COMRU Unit, Section for Long-Term Care Regulation, Division of Regulation and Licensure, DHSS
Conversation Starter: One of MC5’s founders and past board President, Julie will give us a glimpse into the successes and challenges faced over the years as she shares the story of MC5 and the Culture Change Movement in Missouri. A look at the past to help guide us as we envision the future.

April 26, 2023: Save the Date
Special Guest: Sheila Winchester, Regulatory Compliance Manager, Quality Assurance and Education, Section for Long-Term Care Regulation at Missouri DHSS
Conversation: Providers and regulators share a common vision as evidenced by the Person-centered philosophy and practices that are incorporated into and supported by regulations, both Federal and State. Sheila will share ways that regulators and providers can work together as we move forward following the pandemic.

May 24, 2023: Save the Date
Special Guest: Penny Cook, Chief Culture Officer, Center for Innovation (CFI) / Pioneer Network
Conversation Starter: A goal of CFI/PN is to help support and grow state culture change coalitions. Penny will share what is happening at coalitions around the country as well as through initiatives such as the Moving Forward Coalition.

March 22, 2023: FREE Missouri Open Door (MOD) Workshop Series: Self-Advocacy and Assistive Technology

During this workshop, David Forbes will share his experiences in using Charting the LifeCourse tools and approaches to help him plan in his own life. The workshop will also provide information on how assistive technology can assist people with self-advocacy skills and increase self-determination.

The goals of this workshop are to provide a focus on:

  • Providing immediate-use ideas for how people can implement Charting the LifeCourse and Assistive Technology
  • Strengthening everyday knowledge around technology
  • Incorporating and understanding local service and support strategies

The DHSS Health Education Unit encourages you to check the certification status of your CNA staff. CNA’s are required to renew their certification every 24 months to remain “active” on the registry.

Please see the link to login: MO TMU (

Please note: If a CNA has never logged into the TMU registry, they will need to call HEU at 573-526-5686 the first time for assistance.

HEU is very excited to announce a new option for CNA Renewals coming soon!!! This new feature will allow employers to verify employment and pay for multiple CNA staff electronically. Please stay tuned for the official announcement and details.

The Long-Term Care Ombudsman Program invites you to follow them on Facebook. The page includes information relevant to long-term care, national information and advocacy work, updates about the Ombudsman Program and so much more! Feel free to share the Facebook posts with others. Visit us on Facebook

Originally developed by Pioneer Network in collaboration with CMS, The Artifacts of Culture Change was revised in 2020. Artifacts of Culture Change 2.0 (ACC) is an internal implementation, inspiration, and self-assessment tool available for both SNF and AL and is a great tool to help re-ignite your person-centered journey.

Artifacts of Culture Change (Be sure to check out the drop-down menu on the left side of the page for more information, resources and On-Demand Videos)
Self-Assessment for Nursing Homes
Self-Assessment for Assisted Living Communities