March 21-22, 2022: Federal Review Course for Nursing Home Administrator Exam (Hybrid Workshop)
The Federal Review Course is to help attendees prepare for the nursing home administrator federal licensure exam. Review course materials have been revised and updated to reflect the structure of the current examination.
April 5, 2022: Jefferson City, MO
April 6, 2022: Springfield, MO
April 7, 2022: Independence, MO
April 19, 2022: Cape Girardeau, MO
April 20, 2022: Maryland Heights, MO
April 21, 2022: Chillicothe, MO
MANHA and MHCA are proud to provide the required four-hour update training for Missouri CNA Instructors. This requirement is contained in the new CNA rules for the state. The training must be offered by a certified training agency to be accepted by the state.
April 8, 2022: Dementia Hacks: Solutions for Every Stage
This all-day virtual education event will guide learners to develop refined observational and analytical skills to recognize hallmarks of early, moderate, and late-stage dementia. Learners will gain skills in matching their own care approaches to the person with dementia’s and care partner’s needs at each stage according to their abilities and strengths.
The Food and Drug Administration (FDA) has authorized an expiry extension for BinaxNOW tests for three months from the current expiration date listed on the external box. The expiration date to reference is the one on the outside of the box by the hourglass icon. Individual components inside the box will have varying expiration dates, do not pay attention to those dates – only the expiration date on the outside of the box beside the hour glass icon.
Any organizations with tests currently expired are encouraged to check expiration dates as this FDA announcement allows use of expired tests up to three months from current expiration date.
Below is an attachment from Abbott including the box lot #s that have been extended.
COL-03031 v03 BinaxNOW™ COVID-19 Ag Card Product Expiry Update (002)
The guidance in this memorandum specifically applies to the following states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming.
Please read the memo in its entirety. Some key points in the memo:
Within 30 days after the issuance of the memorandum, if a facility demonstrates:
Within 60 days after the issuance of the memorandum if a facility demonstrates:
Within 90 days and thereafter following issuance of the memorandum, facilities failing to maintain compliance with the 100% standard may be subject to enforcement action.
A reminder the emergency amendment regarding 19 CSR 30-82.050 Transfer And Discharge Procedures is still in effect. The amendment indicates transition of transfer and discharge hearings from the Department of Social Services to the Department of Health and Senior Services and provides a new mailing address/fax number/phone number/email address where to send transfer or discharge appeals and motions and where to contact the Department of Health and Senior Services.
The emergency amendment can be viewed at https://www.sos.mo.gov/CMSImages/AdRules/moreg/2021/v46n19Oct1/v46n19a.pdf.
The proposed amendment can be reviewed on our website at https://health.mo.gov/about/proposedrules/. It will be published in the Code of State Regulations on February 28, 2022.
SLCR has received several questions recently regarding visitation in long-term care facilities. All previous guidance provided by DHSS regarding visitation is no longer in effect. No state waivers are in place regarding regulatory or statutory requirements related to visitation. Section 198.088.6(K), RSMo states, “Each resident admitted to the facility may communicate, associate and meet privately with persons of his choice, unless to do so would infringe upon the rights of other residents.” State regulations also require facilities to follow appropriate infection control procedures. To balance these two requirements, all long-term care facilities (RCF, ALF, ICF and SNF) should follow CDC guidance related to visitors: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html#anchor_1631030962190. The CDC guidance points facilities to CMS’ memo for additional information related to visitation. Certified facilities are required to follow CMS guidelines. Although state licensed only facilities are not required to follow the requirements in QSO 20-39 NH, DHSS highly encourages them to use the memo and FAQs as a standard of practice to ensure safe visitation occurs in their long-term care community.
CMS has developed a Frequently Asked Questions document to address the questions received regarding visitation in Nursing Homes. This additional information is provided to help residents, families and providers ensure that safe visitation can occur. The FAQs can be found on the cms.gov emergencies page here and also in QSO-20-39-NH REVISED.
National Healthcare Safety Network Users:
Recently, some NHSN users were unable to use the COVID-19 vaccination data tracking worksheet for surveillance weeks in 2022. The vaccination data tracking worksheets for the COVID-19 Vaccination Modules have been updated, and facilities can now enter data for 2022 in the worksheets. You can find the updated vaccination data tracking worksheets on the following CDC NHSN webpages under the “Data Tracking Worksheets” section:
Long-term care facilities reporting COVID-19 vaccination data on residents and healthcare personnel:
LTC Weekly HCP & Resident COVID-19 Vaccination
Inpatient and dialysis facilities reporting COVID-19 vaccination data on healthcare personnel:
Non-LTC Weekly HCP COVID-19 Vaccination
Dialysis facilities reporting COVID-19 vaccination data on patients:
Dialysis Weekly Patient COVID-19 Vaccination
The proposed amendments affecting the nursing assistant training program referenced in regulation sets 19 CSR 30-84.010 Nursing Assistant Training Program and 19 CSR 30-85.042 Administration and Resident Care Requirements for New and Existing Intermediate Care and Skilled Nursing Facilities, were published in the Code of State Regulations on November 30, 2021 and are effective December 30, 2021. This replaces the emergency amendment that was previously in effect.
The new regulations can be found on the Secretary of State’s website at: https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c30-84.pdf.
What does this mean?
Reciprocity: Certified Nurse Aides who are certified and active in another state, may submit a request to be added to the Missouri registry. Note: A temporary CNA status is not recognized in Missouri. To learn more about reciprocity and the process to submit a request for reciprocity, use the following link: https://health.mo.gov/safety/cnaregistry/pdf/cna-reciprocity.pdf.
CNA Renewals/Work Updates: When a CNA passes the final examination, the individual’s name is placed on the CNA active registry. For nurse aide certification to remain active, CNAs are required to submit documentation (e.g., pay stubs, W-2, letter from employer, etc.) of their work in nursing or nursing related services for at least one (1) day (e.g. eight (8) hours) within each twenty-four- (24-) consecutive month time-period. Documentation shall be submitted to the department approved third party test administrator and a fee will be assessed for each renewal.
How to Renew Your CNAs via TMU
Inactive Status-CNA Challenge
A CNA who has been inactive on the registry for less than five (5) years and cannot provide documentation (e.g., pay stubs, W-2, letter from employer, etc.) of work in nursing or nursing related services for at least one (1) day (e.g. eight (8) hours) within each twenty-four- (24-) consecutive month period- shall challenge the final examination in accordance with section (8) of this rule before the CNA is reinstated to the active registry.
A CNA who has been inactive on the registry for more than five (5) years and cannot provide documentation (e.g., pay stubs, W-2, letter from employer, etc.) of work in nursing or nursing related services for at least one (1) day (e.g. eight (8) hours) within each twenty-four- (24-) consecutive month period is not eligible to challenge the final examination and shall successfully complete the entire basic course before the CNA is reinstated to the active registry.
Challenge Exams: As of December 30, 2021, all Challenge exams will be administered through Headmaster. Request for approval to challenge the exam should be sent to the Health Education Unit at CNARegistry@health.mo.gov.
Instructor 4-Hour Update every 5 years:
Instructors are required to attend a four (4) hour update training provided by a certifying agency every five (5) years. Any instructor who has not completed the required four (4) hour update training by August 31, 2022, and every five (5) years thereafter will be removed from the department-approved list of instructors. If removed from the department’s list, the instructor is required to attend and successfully complete the Nursing Assistant Instructor Workshop in order to be reinstated to act as an instructor.
To all facilities that utilize 3G cellular communicators on a fire alarm system, those cell devices must be upgraded. Please see the link below to plan for the phase out of 3G cell networks and services ahead of the announced date.
https://www.fcc.gov/consumers/guides/plan-ahead-phase-out-3g-cellular-networks-and-service
This year Carmen Bowman will be hosting and presenting the Proactive Practices to Prevent Falls series.
Action Pact has exhausted the same old list of “interventions.” Replace old, institutional “interventions” with individualized approaches and proactive practices. Learn how to create a proactive fall reduction culture by all. Teach everyone they have the SUPERPOWER to help prevent falls.
January 28, 2022: Moving from the same old “interventions” to Proactive Practices to Prevent Falls
February 18, 2022: Proactive Practice to Prevent Falls: Anticipating Needs, particularly bathroom needs, by all
March 18, 2022: Proactive Practice to Prevent Falls: Proactively checking in with residents by all
Missouri has received no new supply from Abbott in the last two weeks and was not notified of a pause from the manufacturer until DHSS inquired this week. All states are experiencing a similar situation, and availability at the state level has been decreasing since the White House announced a federal expansion of at-home testing for Americans. Since then, President Biden announced that hundreds of millions of at-home tests will be made available to Americans in January. With the increase in cases due to high Omicron transmissibility, this issue is being closely monitored as supply and demand changes daily. Missouri is placing a pause on fulfilling re-orders. This pause is due only to the current constrained supply, and we will resume the purchase of antigen tests, once they become available. Our team has identified several options that we are exploring and pursuing now to meet the current testing needs of our existing users as well as the long-term needs.
Effective immediately:
Because the antigen tests are not widely/easily available at this time- you will want to take into consideration creating a testing plan that includes both antigen and PCR testing. The State of Missouri is continuing to reimburse homes for PCR testing related to outbreaks.
Reimbursement for OUTBREAK Testing
A reminder that in order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the State of Missouri has made some funds from the Coronavirus Relief Fund available to Missouri Long-Term Care facilities with COVID-19 Outbreaks. These funds are available to Long-Term Care facilities that experience an outbreak (one or more positive cases) and are conducting base-line facility testing and some immediate follow-up testing in order to contain outbreaks. For more information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.
If you have difficulty obtaining swabs and media from your laboratory- you can order them from Missouri State Public Health Laboratory (MSPH). Your contracted laboratory would still process the samples- not MSPH.
The healthcare continuum is again becoming strained with the number of positive cases across the state. This portal was originally established in November, 2020 to improve communication across the care continuum to assist in ensuring Missourians have access to the right care in the right setting.
We are renewing our request for long-term care communities to complete a brief survey each day in order to identify available beds for potential admissions. Participation in the bed availability survey is voluntary. The survey may be accessed at https://arcg.is/1rjKy8.
The dashboard was reset at 9:00 today, January 6, so homes will need to submit an initial survey – old update links will no longer work.
Reminder: After submitting the initial survey, a confirmation email will be provided for a link to update your survey each day (instead of submitting an initial survey). Submitting an initial survey results in multiple surveys showing on the map with different bed numbers. This makes it difficult to know which totals are current. Please use the link emailed after the initial submission to edit facility bed availability. Please do not submit an “initial” submission more than once. If information does not change from day to day, the submitter can simply update the date and submit – the prior day’s information will populate.
The survey information will populate an accompanying dashboard that will be available to hospitals to use as a tool in finding placement for those patients who would be best served in a long-term care setting.
This dashboard may be accessed at https://mophep.maps.arcgis.com/apps/opsdashboard/index.html#/f1e0745f93fe46b482d8ff4585f821bf.
To view instructions on utilizing the dashboard, click on ‘Instructions’ under the map for information.
Please see the CDC Health Advisory, number 461, dated 12/31/2021, entitled “Using Therapeutics to Prevent and Treat COVID-19.”
Missouri healthcare providers – please contact your Local Public Health Agency or the Missouri Department of Health and Senior Services’ (DHSS’) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7) with questions regarding this CDC Health Advisory.
Governor Parson announced on December 30, 2021 the expiration of Executive Order 21-09 (EO 21-09) that declared a State of Emergency related to COVD-19 on December 31, 2021. Since the outset of this public health emergency, the Governor has exercised a legal means by which we have waived certain statutory and regulatory requirements that could have inhibited the state’s response to the public health emergency. However, with the expiration of EO 21-09, the statutory and regulatory waivers also expire.
For long-term care facilities, there are two waivers that had extended timeframes to allow for compliance. These two waivers are listed below.
Facility Employees/Healthcare Personnel
All Residential Care Facilities, Assisted Living Facilities, Intermediate Care Facilities, Skilled Nursing Facilities should follow current Centers for Disease Control and Prevention (CDC) Guidelines related to managing healthcare personnel who have tested positive or an exposure to COVID-19.
For Certified SNF/ICF providers, current CMS guidance QSO 20-38 states “If COVID-19 is confirmed, staff should follow Centers for Disease Control and Prevention (CDC) guidelines “Criteria for Return to Work for Healthcare Personnel with SARSCoV2 Infection”, therefore, homes can immediately change policies and procedures to incorporate the updated changes from the CDC.
General Population/Visitors
All Residential Care Facilities, Assisted Living Facilities, Intermediate Care Facilities, Skilled Nursing Facilities should follow current Centers for Disease Control and Prevention (CDC) Guidelines related to quarantine and isolation for visitors. Facilities should be aware of and follow the updated quarantine/isolation guidelines for visitors in your communities as well.
For Certified SNF/ICF providers, current CMS guidance QSO 20-39 states “Visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or currently meet the criteria for quarantine, should not enter the facility. Facilities should screen all who enter for these visitation exclusions. Homes can immediately change policies and procedures to incorporate the updated changes from the CDC.
State Orders for Abbott BinaxNOW Tests
Missouri is experiencing constrained supplies of the BinaxNOW COVID antigen test cards. Thus, effective September 9, 2021, DHSS is implementing a revised BinaxNOW test ordering cadence in order to conserve supply and assure the optimum availability of BinaxNOW COVID antigen tests for all users. Until further notice, please order no more than two weeks supply of BinaxNOW tests for use by your facility or organization. If our supply allows larger quantities to be ordered, we will modify this process accordingly at that time and notify all users. https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php
To Reinstate Direct Shipments of Abbott BinaxNOW from the Federal government:
Providers should email their facility information, shipping address and the BinaxNOW delivery Point of Contact for the facility and request to be added back onto the direct shipment list to Binax.Team@hhs.gov. Please be aware reinstatement depends upon available supply of tests to the Federal government and this can take several weeks to begin receiving shipments again.
Reimbursement for OUTBREAK Testing
A reminder that in order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the State of Missouri has made some funds from the Coronavirus Relief Fund available to Missouri Long-Term Care facilities with COVID-19 Outbreaks. These funds are available to Long-Term Care facilities that experience an outbreak (one or more positive cases) and are conducting base-line facility testing and some immediate follow-up testing in order to contain outbreaks. For more information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.
The updated guidance for healthcare worker isolation and quarantine guidance has been updated on CDC’s website:
CDC Releases Updated Healthcare Worker Isolation and Quarantine Guidance to Prepare for Anticipated Increase in Omicron Cases
With the growing number of COVID-19 cases from the Omicron variant, and consistent with current understanding of the disease trajectory, CDC is releasing updated guidance (Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2) for isolation and quarantine for healthcare workers, decreasing their isolation time after infection with COVID-19. Additionally, CDC is releasing an update to guidance (Strategies to Mitigate Healthcare Personnel Staffing Shortages) for contingency and crisis management in the setting of significant healthcare worker shortages. These updates provide healthcare facilities with the strategies to limit the effects of staff shortages caused by COVID-19 on patient care and note that:
Isolation relates to behavior after a confirmed infection, and quarantine is following exposure to the virus but without a confirmed infection.
These guidelines apply only to the healthcare workforce and may be revised to continue to protect both healthcare workers and patients as additional information on the Omicron variant becomes available to inform recommended actions. Additional information will be published as guidance on CDC’s website soon and shared with healthcare organizations and provider groups. CDC continues to evaluate isolation and quarantine recommendations for the broader population as we learn about the Omicron variant and will update the public as appropriate. CDC strongly encourages COVID-19 vaccination for everyone 5 and older and boosters for everyone 16 and older – vaccination is the best way to protect yourself and our healthcare system from the impact of COVID-19.
The following is attributable to CDC Director, Dr. Rochelle Walensky:
“As the healthcare community prepares for an anticipated surge in patients due to Omicron, CDC is updating our recommendations to reflect what we know about infection and exposure in the context of vaccination and booster doses. Our goal is to keep healthcare personnel and patients safe, and to address and prevent undue burden on our healthcare facilities. Our priority, remains prevention – and I strongly encourage all healthcare personnel to get vaccinated and boosted.”
CMS has developed a Frequently Asked Questions document to address the questions received regarding visitation in Nursing Homes. This additional information is being provided to help residents, families and providers ensure that safe visitation can occur, especially during the holiday season. The FAQs can be found on the cms.gov emergencies page here and also in QSO-20-39-NH REVISED.
The proposed amendments affecting the nursing assistant training program referenced in regulation sets 19 CSR 30-84.010 Nursing Assistant Training Program and 19 CSR 30-85.042 Administration and Resident Care Requirements for New and Existing Intermediate Care and Skilled Nursing Facilities were published in the Code of State Regulations on November 30, 2021. The official new rules can be found on the Secretary of State’s website at: http://www.sos.mo.gov/adrules/csr/current/19csr/19csr.asp.
The rules are located under Division 30 in Chapter 84 and Chapter 85. The effective date for the rules will be December 30, 2021.
If you have any questions regarding implementation of the rules, please contact the Section for Long-Term Care Regulation at 573-526-8524.
Regional Ombudsman Director, Donna Wobbe is retiring in January from Aging Best (formerly Central MO AAA). Donna has been a strong advocate and passionate about empowering residents. She has truly made a difference for so many long-term care residents and families throughout her ombudsman career. We wish Donna a Happy Retirement! Many of you know Ronda Giger who has worked at Aging Best alongside Donna. Ronda has promoted to the Regional Ombudsman Director role for Aging Best. Congratulations to Ronda!
January 12, 2022: Train the Trainer
March 2, 2022: Train the Trainer
May 4, 2022: Train the Trainer
July 6, 2022: Train the Trainer
September 7, 2022: Train the Trainer
November 2, 2022: Train the Trainer
Participants must receive approval in order to attend this workshop. Those wishing to attend must submit the application and all other necessary paperwork to MALA at least two weeks prior to the workshop date.
February 2-4, 2022: Reeling in Change – Get Hooked with MANHA
Location: Oasis Hotel and Convention Center, Springfield
Missouri Association of Nursing Home Administrators is pleased to invite you to attend our Winterfest Convention and Trade Show. The goal of this conference is to provide long-term care administrators and their staff practical and inspirational education hours along with the opportunity to network and socialize with colleagues. It is also the only MANHA sponsored conference that provides you a chance to view the latest technology, products, and services offered by suppliers.
March 2-4, 2022: 31st Annual Nursing Home Administrator Conference
Location: Virtual
The 31st Annual Nursing Home Administrators Conference will be held virtually. During these challenging times when person to person interaction is limited, the goal is to not only provide education but to also maintain connections and facilitate the networking that is part of a live event.
After registration, attendees will be sent a personal link and details regarding how to access and participate through the online event.
March 14-16, 2022: ALF Assessment Training
As required by 198.005 RSMo and 19 CSR 30-86.047, residents of Assisted Living Facilities are required to undergo a community based assessment performed by an appropriately trained and qualified individual. This individual must complete a DHSS approved 24-hour training program prior to performing resident assessments. The MALA ALF Assessment Training satisfies this regulatory requirement.