Missouri Long-Term Care Information Update

First Phase of “Show Me Strong Recovery” Plan and Economic Reopening Order

Goes into effect at 12:01 a.m., Monday, May 4, 2020
Statewide Stay-at-Home Order still applies until then.

We have received several questions regarding the impact the Economic Reopening Order has on long-term care communities. The order addresses long-term care communities, specifically in paragraph #3 of the order, which states, “In accordance with the guidelines from the President, the CDC, and the Centers for Medicaid and Medicare Services, people shall not visit nursing homes, long-term care facilities, retirement homes, or assisted living homes unless to provide critical assistance or in end-of-life circumstances. Elderly or otherwise vulnerable populations should take enhanced precautionary measures to mitigate the risks of contracting COVID-19.”

The guidance below issued by the Department on March 13th and March 17th continues to be in place.
LTC Memo
LTC Leaving Facility

CMS QSO Memo Release – QSO 20-28-NH

Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, and Frequently Asked Questions

  • Nursing Home Compare website & Nursing Home Five Star Quality Rating System: The inspection domain will be held constant temporarily due to the prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers.
  • Posting of surveys: CMS will post a list of the surveys conducted after the prioritization of certain surveys, and their findings, through a link on the Nursing Home Compare website.
  • Nursing Home Staff: CMS is publishing a list of the average number of nursing and total staff that work onsite in each nursing home, each day. This information can be used to help direct adequate personal protective equipment (PPE) and testing to nursing homes.
  • Frequently Asked Questions (FAQ): CMS has released a list of FAQs to clarify certain actions we have taken related to visitation, surveys, waivers, and other guidance.

Please see the memo for further details.

CMP Application Process for Communicative Technology

CMS has created a process to enable states to approve requests for communicative technology that meet CMS parameters. The parameters are detailed in the instructions portion of the application template (below). This template and process will reduce the amount of time for approval of CMP funds for technology that allows residents to engage in virtual social and telehealth visits as restrictions have been placed on visitors to prevent the spread of COVID-19.

The application is for nursing homes certified to participate in Title 18 and Title 19 of the Social Security Act. We encourage companies that operate more than one home to complete one application for all certified homes to the extent possible. This will reduce the number of applications and will help expedite the approval process.

Applications should be submitted to slcr@health.mo.gov. Questions regarding the application process may be sent to this address as well.

Once an application is approved, SLCR will contact each applicant to explain the payment process.

COVID-19 Application Template Final
COVID-19 Application FAQ

State Waiver for Intermediate Care and Skilled Nursing Facilities – Testing for Tuberculosis

SLCR has issued guidance for the implementation of state waivers related to tuberculosis testing for employees and staff. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
Intermediate Care and Skilled Nursing Facilities – Testing for Tuberculosis 4-23-20
TB Testing – 85.042-27- 4-23-20

Fusion Cell Day 16 – DHSS Press Release on Testing/Follow-up to PPE Marketplace

The Department of Health and Senior Services issued a news release today explaining “Increased testing capacity allows Missouri to expand criteria for patient testing”.

The full press release is available here https://health.mo.gov/news/newsitem/uuid/912934b4-fa13-408b-a9b7-627db5c1c1e1/increased-testing-capacity-allows-missouri-to-expand-criteria-for-patient-testing.

Also, great news, as of yesterday almost 400 providers had signed up for Missouri PPE Marketplace. Remember to access that source through the Department of Economic Development’s website https://ded.mo.gov/.

Thanks so much for everyone who has entered information. This will inform the PPE need across the state as well as help identify new suppliers and manufacturers of PPE. Remember you have to use Edge, Chrome, Firefox, or Opera as your Internet browser. Also, we have heard that emails to complete the registration are going to junk or spam email folders. This is being addressed, but please check those folders if you have started the registration process and have not gotten your email.

**Special Note for Multi-Facility Organizations**
If you are part of a larger organization and would like to submit a request as one corporate entity instead of each facility, please email supplysolution@ded.mo.gov to make a request to register as one corporation. You will be required to put a Missouri facility address in the registration.

State Waivers for Fire Safety and Emergency Preparedness Standards for Residential Care and Assisted Living Facilities

SLCR has issued guidance for the implementation of state waivers related to Fire Safety and Emergency Preparedness Standards for Residential Care and Assisted Living Facilities. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
RCF ALF 86.022 Waiver Implementation Guidance 4-23-2020
Residential Care and Assisted Living Facilities 4-23-20

Physical Plant Requirements for Intermediate Care, Skilled Nursing, Residential Care and Assisted Living Facilities

The Department of Health and Senior Services has issued waivers related to physical plant requirements:

  • Physical Plant Requirements for all levels of care regarding the two year electrical certification. This waiver allows the required written certification by a qualified electrician to be delayed. Facilities have until two (2) months after the state of emergency has concluded to be current with the required maintenance of electrical systems.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachment below for details.
Physical Plant Requirements for Intermediate Care Skilled Nursing Residential Care and Assisted Living Facilities 4-22-20

Updated 1135 Waiver information related to Pre-Admission Screening and Resident Review (PASRR)

On April 21, 2020, CMS issued a COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, which extends the PASRR approval through the end of the emergency declaration.

Effective April 2, 2020 and through the end of the Federal Emergency Declaration, certified Skilled Nursing Facilities and Intermediate Care Facilities will continue to follow the process outlined in the PASRR 1135 Waiver Implementation 4-22-20 for new admissions into Medicaid-certified beds.

Questions regarding this process should be directed to COMRU@health.mo.gov.

Rural Communities and COVID-19

In the past few weeks Missouri has seen an increasing spread of COVID-19 from population centers to more rural communities. This is concerning as rural areas tend to have more limited access to health care and populations that are older and have more chronic health conditions. During this time that we all have a role in protecting our communities and limiting the spread of this disease. Whether you have COVID 19, are a caregiver of an individual with COVID 19 , or just going out in public places, there are actions that you should be taking.

See the tip sheet for more information.

Economic Impact Payments/Stimulus Checks

The Treasury Department says that the first recipients of stimulus checks have been given to taxpayers that have already filed their 2019 (or 2018) tax returns and have provided direct deposit information to the IRS.

The stimulus money should be treated the same way as the Circuit Breaker Checks/Rent Rebate Checks.  Stimulus money should be used for the resident’s current or foreseeable needs.

In order for the facility to recoup the funds, the facility must have:

  • A signed admission agreement stating for residents that owe back Room & Board, the facility may recoup the additional funds; AND
  • The resident owes back Room & Board to the facility; AND
  • The resident or the resident’s guardian/conservator gives written authorization at the time of the withdrawal.

Please keep in mind:

  • Review the Resident’s Trust Fund balance to ensure the resident does not reach the Medicaid Spenddown Limit amount. The amount is currently $4,000 and will increase to $5,000 as of 07/01/20.
  • All Resident Funds must be kept separate from the facility’s funds.
  • The facility may keep in a petty cash fund up to $50 for each resident for whom the facility is managing funds.

Feel free to contact Lynn Gilmore, SLCR Sr. Auditor, at Lynn.Gilmore@health.mo.gov or 573-508-4150 if you have any questions.

Suicide Prevention Training

May 11, 2020: Suicide Lifeguard – Suicide Prevention Training (12:30 pm to 3:30 pm – Online)
Presenter: Katie Ellison, MA, Project Director for the Safer Homes Collaborative with the Missouri Institute of Mental Health at UMSL

This training is developed for behavioral health professionals who are required to meet licensure and re-licensure continuing education hours in suicide assessment, referral, intervention and management skills.

Objectives:

  • Develop skills to ask clients about suicide
  • Assess for suicide using evidence-based tools
  • Collaborate with clients in the development of a safety and treatment plan

Please see the link above for more information including registration.

Long Term Care Facilities Exception to Licensure Requirements and Second Business Waiver

The Department of Health and Senior Services has issued waivers related to current exceptions and second business approvals:

  • Existing exceptions to state regulations for all levels of care will continue beyond the time specified in the approval notice. Facilities shall have until two (2) months after the state emergency has ended to submit renewal requests to the department.
  • Existing second business approvals to continue beyond the time specified in the approval notice. Facilities shall have until two (2) months after the state emergency has ended to submit renewal requests.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
Long Term Care Facilities Exception to Licensure Requirements and Second Business Waiver 4-22-20
Residential Care and Assisted Living Facilities – Second Business Waiver 4-17-20

Missouri COVID Supply Solution – Message to Health Care Providers

The State of Missouri has been actively engaged in outreach to businesses in an effort to open up new supply chains for PPE and other critical medical supplies. In an effort to streamline this process, we are very excited to announce the Missouri COVID Supply Solution is live and ready for your use. This application is designed to match health care providers to suppliers of PPE and other medical supplies.

To participate, please go to the Missouri COVID Supply Solution to register as a health care provider using Edge, Chrome, Firefox, or Opera as your internet browser (https://ppe-supply.uk.r.appspot.com/#/). Once your registration is complete, you can immediately begin adding your current PPE inventory and amounts you want to purchase. Once you complete this step, you can begin searching PPE suppliers. In order for the state to understand demand for PPE supplies, please update your PPE inventory amounts every three days within the solution.

Thank you for your participation in the Missouri COVID Supply Solution.

CMS QSO 20-26-NH

Upcoming Requirements for Notification of Confirmed COVID-19 (or COVID-19 Persons under Investigation) Among Residents and Staff in Nursing Homes

  • Communicable Disease Reporting Requirements: To ensure appropriate tracking, response, and mitigation of COVID-19 in nursing homes, CMS is reinforcing an existing requirement that nursing homes must report communicable diseases, healthcare-associated infections, and potential outbreaks to State and Local health departments. In rulemaking that will follow, CMS is requiring facilities to report this data to the Centers for Disease Control and Prevention (CDC) in a standardized format and frequency defined by CMS and CDC. Failure to report cases of residents or staff who have confirmed COVID -19 and Persons under Investigation (PUI) could result in an enforcement action. This memorandum summarizes new requirements which will be put in place very soon.
  • Transparency: CMS will also be previewing a new requirement for facilities to notify residents’ and their representatives to keep them up to date on the conditions inside the facility, such as when new cases of COVID-19 occur.

Please see the memo for details.

State Waivers For Skilled Nursing Facilities and Intermediate Care Facilities

SLCR has issued guidance for the implementation of state waivers related to skilled and intermediate care facilities. Please read through this important guidance.

Questions regarding these waivers should be directed to RegulationUnit@health.mo.gov.

Please see the attachments below for details.
SNF-ICF Waiver Implementation 4-17-20
Intermediate Care and Skilled Nursing 4-14-20
Intermediate Care and Skilled Nursing Facilities 4-14-20
Intermediate Care and Skilled Nursing Facilities 4-15-20
Intermediate Care and Skilled Nursing Facilities (2) 4-15-20

Residential Care Facility II Waivers

SLCR has issued guidance for the implementation of state waivers related to homes who are licensed as Residential Care Facilities (II) and comply with Administrative, Personnel and Resident Care Requirements under 19CSR30-86.043. Please read through this important guidance.

Questions related to these waivers can be emailed to RegulationUnit@health.mo.gov.

Please see the documents below for details.
RCF II Waiver Implementation Guidance 4-17-20
Residential Care Facility II Requirements 4-14-20
Residential Care Facility II Requirements 4-16-20

Important Information Regarding State Waiver Implementation for the Insulin Administration Training Program

SLCR has issued guidance for the implementation of state waivers related to the insulin administration program. Please read through this important guidance. Questions regarding these waivers should be directed to CNARegistry@health.mo.gov.

Please see the documents below for details.
Insulin Administration Program Waiver Implementation 84.040
Insulin Administration Training Program 4-14-20