Missouri Long-Term Care Information Update

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

CMS Memo: QSO-20-25-NH

2019 Novel Coronavirus (COVID-19) Long-Term Care Facility Transfer Scenarios

CMS has released QSO 20-25, which provides supplemental information related to transferring or discharging residents between facilities for the purpose of cohorting residents based on COVID-19 status (i.e., positive, negative, unknown/under observation).

Please see the memo for details.

New QIPMO Newsletter – April 2020

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls – Volume 7, Issue 3.

In this issue:

  • Be a Nurse!
  • Your Role in Infection Prevention
  • Nursing Care to Manage Respiratory Distress/Illness
  • Environmental Cleaning and Disinfecting in a COVID-19 World
  • Staying Social while Social Distancing

Please visit QIPMO’s website here for this and other previous newsletters.

A Message of Hope from MC5

To All Missourians from the Regional Representatives and Board of Directors of MC5…

This year represents our 15th anniversary. Needless to say, this isn’t how we intended to roll out the new logo, ideas, and celebrate with you all. But upon reflection, it’s ironically appropriate. For many years, culture change coalitions like MC5 and the Pioneer Network have worked hard to define person-directed care and place value on those who depend on us in healthcare. Whether that be veterans, skilled nursing facilities, assisted livings, residential care, those in hospice or in group homes, people with developmental disabilities, and even our own family members–we’ve talked about creating that home-like environment and changing the language. We’ve created Green houses and new dining standards, and tools like the artifacts of culture change.

But in March of 2020, all that progress came to a halt. For the simple safety of our residents and staff, we had to lock front doors, isolate to rooms, stop group activities, and scatter people around the dining room. But as this virus rages through our country and hits our most vulnerable populations, we’re seeing something that years of programs, conferences, and webinars could never produce. We’re seeing humanity, and that is the heart of culture change. No longer are our residents seen by some as a byproduct of a forward-moving society. Instead, they are a living testament that in the face of adversity, life goes on!

MC5 wants to thank all of our friends and partners for a wonderful 15 years, with a special recognition of the MO Department of Health and Senior Services (DHSS), the Missouri Healthcare Association (MHCA), the Missouri Assisted Living Association (MALA), the Missouri League for Nursing (MLN), the Ombudsman program, and Missouri Leading Age, as well as those corporations, DMEs, hospice companies, food suppliers, pharmaceutical companies, and so many, many more that have helped us bring education throughout the state.

We are honored to continue to fight alongside you. Stay in, stay safe, stay strong. Thank-you.

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Check out our Facebook page for inspiring stories of Missourians making a difference during COVID-19.
#COVIDcan’ttouchthis
MC5 Facebook.com/MC5

HQIN: COVID-19 Focused Survey Readiness Book & Office Hours Call

As your CMS-funded Quality Innovation Network – Quality Improvement Organization (QIN-QIO), the Health Quality Innovation Network (HQIN) offers resources to help you deliver the best possible care to your residents. To prepare your facility for the COVID-19 Focused Survey, we have created a “COVID-19 Focused Survey Readiness Book,” a comprehensive checklist intended to help facilitate a smoother survey. This three-page resource outlines the required entrance documents as well as additional resources that may be requested during the survey. Having these documents in-hand before the survey is initiated will ensure you are well prepared for the visit.

HQIN will be hosting a COVID-19 Focus Survey Preparedness “Office Hours” call on Wednesday, April 15 from 1:00-2:00 p.m. CT. Click here to register.

We encourage you to submit questions in advance to aspangler@hqi.solutions with “Office Hours” in the subject line. There will also be a live Q&A.