CMS Direction Regarding IDR’s

The Section for Long Term Care had a conversation with CMS in 2016 regarding the IDR/IIDR Review Release Process. CMS Regions V and VII recently provided guidance on this topic. The Missouri IDR process for certified homes has been to send the Primaris decision letter along with our own letter upon review and completion of the IDR process. We have been instructed by CMS that the third party (Primaris) decision and rationale can no longer be shared with the providers. Following is an excerpt of this guidance. The S&C referenced below is attached for your review.


S&C Memo 12-08-NH provided Interim Advance Guidance for IIDRs and provided some information that is one of the bases for our decision to take this approach: “[T]he documents and written report created by the Independent IDR entity, the State and CMS, other than the final decision of the Independent IDR process, are pre-decisional and deliberative, and therefore are protected from disclosure under the deliberative process privilege. See EPA v. Mink, 410 U.S. 73, 88 (1973); see also 5 U.S.C. § 522(b)(5) (inter-agency and intra-agency memoranda and letters generated before adoption of final agency policy or decision are protected from disclosure under Exemption 5 of the Freedom of Information Act).” (Please note the correct U.S. Code citation is actually 5 U.S.C § 552(b)(5).) Therefore, CMS asserts this privilege to not disclose documents used in our deliberative processes. Although the quoted language from the S&C Memo is not in SOM Chapter 7, the rationale remains sound.


We have communicated with the IDR Contractor about this change. Primaris will no longer prepare a letter to the provider and will simply provide their decision and rationale through memo format. Our office will continue to review the Primaris information and prepare a letter to the providers with the final decision.  The Section will then forward the SLCR Decision letter to the provider. At no time can we disclose the Primaris decision and rationale. This change applies only to certified facilities. The process will not change for those facilities that are state-licensed only.

S&C: 17-17-ALL: Recommendations to Providers Regarding Cyber Security

Recommendations for Providers and Suppliers for Cyber Security: The Centers for Medicare & Medicaid Services (CMS) is reminding providers and suppliers to keep current with best practices regarding mitigation of cyber security attacks. We have outlined resources to assist facilities in their reviews of their cyber security and IT programs.


Please see the attached for more information.  The S&C can also be found at

Music Therapy in Mental Health Treatment

  • January 27, 2017:  “Let’s Express Ourselves”: An Overview of Music Therapy in Mental Health Treatment
  • Location: CenterPointe Hospital Gym, St. Charles
  • Presenters:  Teresa Stamey, MT-BC and Catherine Decker, MA, MT-BC

Music is a powerful, non-threatening tool that can be used to help individuals of all ages who struggle with mental health issues. It can be used to explore personal feelings and therapeutic issues such as self-esteem or personal insight. It can help make positive changes in mood and emotional states. It can also give individuals a sense of control over life through successful experiences. During our time together we will explore music and the therapeutic benefits it has on the human spirit.


For more information, please see the event site here. Online registration is also available here.

Conversations with Carmen

  • February 10, 2017:  The New CMS Dementia Care-Focused Survey:  Create a Proactive, Preventive Culture – Part 2
  • Guest Host:  Megan Mannan, Action Pact Consultant

This CMS survey ascertains a community’s compliance with Care and Services for a Resident with Dementia, Unnecessary Drugs, Assessment and Care Planning. Become familiar with the survey, surveyor worksheets and how both have been integrated into the survey process. Most importantly, ensure you know best practices both recognized by CMS and the culture change movement. Learn to view “behaviors” as communication; recognize dementia-related communications; be individual-centered, not institution-centered as CMS requires; offer meaningful engagement by all staff all day to reduce antipsychotics. It’s time to create a proactive, preventive, individualized, resident -focused dementia care culture.


Please see the Action Pact event for more information including registration.

2017 Annual Provider Meetings Input

It’s a new year and your 2017 Provider Meetings are already in the works!  The Quality Assurance and Education Unit staff are currently in the planning phase and are considering the best topics to provide the most beneficial information.  We would like to hear from you about what LTC related topics you believe would be helpful, informative, and  ‘worth the drive’.  If you’ve also been thinking- Gee I wish they would do a presentation on……., then you are cordially invited to be part on our planning team!  Please feel free to forward your suggestions to:

Staffing Data Submission Reminder

Staffing Data Submission Reminder: As of July 1, 2016, electronic submission of staffing data through the Payroll-Based Journal (PBJ) is mandatory for all Long Term Care Facilities. You have up to 45 days after the end of the quarter to submit data for Federal Fiscal Quarter 1 (October 1, 2016-December 31, 2016.) The final submission file for this quarter is due on February 14, 2017.  Submit early to avoid system delays.


Please note that an updated policy manual and FAQ are now posted on the PBJ website.


For questions related to software or technical requirements, please email


For questions related to PBJ policies, please email


PBJ website link:

Leadership in Long-Term Care

A leader’s actions can shape the culture of an organization. Strategy 1 of the National Nursing Home Quality Care Collaborative’s “Change Package” stresses the expectation for excellence in leadership, strong mission and values, and an accepting non-punitive culture. Click on the following links to learn more.