Missouri Long-Term Care Information Update

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. The following data must be submitted no later than 11:59 p.m. on August 15, 2023:

  • MDS data for 1/1/23 through 3/31/23;
  • NHSN data for COVID-19 Vaccination Coverage Among Healthcare Personnel for 1/1/23 through 3/31/23;

The Minimum Data Set (MDS) 3.0 must be transmitted to the Centers for Medicare & Medicaid Services (CMS) through the Internet Quality Improvement and Evaluation System (iQIES). Data for the National Healthcare Safety Network (NHSN) measures must be submitted to the Centers for Disease Control and Prevention (CDC). No additional data submission is required for the claims-based measures.

As a reminder, it is recommended that providers run applicable MDS reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:
CMS SNF QRP Data Submission Deadlines webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Data-Submission-Deadlines
CMS SNF QRP Help webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-QRP-Help
CMS SNF QRP Measures and Technical Information webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Measures-and-Technical-Information
CMS SNF QRP Training Webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Training

VOYCE’s Upcoming Education Events

August 30, 2023: For the Love of Quality Care: Implementing Innovative Education

Advocates for quality care, caregivers, family and friends, and aging care professionals; this webinar is truly for everyone! Training and education on dementia, meaningful activities, and person-centered care should be practice-focused and brief. Join VOYCE to learn about the practice videos and modules available and how to disseminate them, and you’ll be one step closer to ensuring quality care for all! Saint Louis University’s Geriatric Workforce Enhancement Program, along with Memory Care Home Solutions, has developed brief practice videos and modules on topics important for professionals in long-term care and other care settings. They include topics like loneliness and isolation, polypharmacy, infection, meaningful activities, geriatric assessment, dementia, and more. This presentation will provide insight into the use of these resources and the positive impact they have on training and outcomes for consumers. This event is free and open to all who are interested.

 

October 10, 2023: Summit to Protect Older Adults and Adults with Disabilities

VOYCE will host a series of four stakeholder summits to hear from the community and professional stakeholders about their experiences with Missouri’s abuse response system. October’s summit is the second in the series. The summits are open to everyone, as we are all stakeholders in responding to abuse, neglect, and exploitation. We hope to use this time to gather pain points from the community and learn how the system can be improved. The input received from the Stakeholders Summit will be used to create our final project- a strategic plan for restructuring and improving the system. Please register in advance to join.

 

Monoclonal Antibody and Oral Antiviral Treatment of COVID in Nursing Homes

The American Medical Association has released information related to use of Monoclonal Antibody and Oral Antiviral Treatment of COVID in Nursing Homes. The study shows that although oral antiviral use has been found to be greater in nursing homes than the community, overall use among nursing home residents has been low and may not be commensurate with residents’ elevated risk. See the attached information from the AMA and this article from US News.

Nursing Homes Used COVID Meds Less Than Expected During Pandemic (usnews.com)

Solving our Workforce Challenges by Successfully Recruiting and Retaining Immigrant Healthcare Staff

August 23, 2023: Solving our Workforce Challenges by Successfully Recruiting and Retaining Immigrant Healthcare Staff
Presenters: Bill Lowe, President & CEO, Chicago Methodist Services; Chona Lucila, John Knox Village; and Joe Mulligan, Managing Director, Cain Brothers

With the workforce crisis continuing and our aging population growing, organizations are having to look beyond our borders to find the caregiving workers needed. Please join LeadingAge during this webinar to learn how visa-acquired healthcare workers are an answer and how you may become involved in recruiting and retaining them within your organization. Hear trends and data about the workforce shortage impact, forecast, and what you can do to weather the storm. This session will cover various work visa categories and the employer-sponsored visa application process.

2023 MALA Fall Conference

October 15-17, 2023: Smooth Cruising with MALA
Location: Margaritaville, Osage Beach

The conference agenda and registration is now available and includes several speakers and presentations over a three-day period. The option to attend all or just one day is included on the registration form.

Please see the conference link for further details.

COMRU Survey Access Code

COMRU is providing the following guidance regarding the online application entitled “Application started prior to 07-16-2023” (the green link).

COMRU will be providing you with a “Survey Access Code”; please note this is different from the return code.

  • The “Survey Access Code” will allow the submitter to access the application to check the status.
  • If the submitter clicks “Submit- Ready for Processing by COMRU” or “Save and Return Later”, the submitter will be provided with a “Return Code”. At this point, the “Survey Access Code AND the “Return Code” will be needed to access the application in the future.
  • Please do not click the “Start Over” button, as this will DELETE the Entire Application. (COMRU will not be able to retrieve the application if this occurs).

Please do not hesitate to contact COMRU at 573-522-3092 for any questions.

Missouri Nursing Facility Strike Team and Infrastructure Reimbursement Opportunity

The Strike Team has made an informative webinar for SNF/LTC and Other facilities describing the Missouri Nursing Facility Strike Team and Infrastructure Reimbursement Opportunity. This webinar reviews; how to get to the site where they can find the application, the Application Guidance and Frequently Asked Questions, steps needed to apply, and other useful information. This webinar has been posted to the Health Care Professionals page on the DHSS website.

Essentials of the LTC Director of Nursing Role – Part 1

August 9 & 10, 2023: Essentials of the LTC Director of Nursing Role – Part 1
Virtual: August 9 (12:15pm-4pm) & August 10 (1pm-4pm)

LeadingAge Missouri in partnership with LeadingAge Iowa is pleased to announce a virtual series that will take place in three segments over the second half of 2023 that will aid in developing the Director of Nursing (DON) role in nursing homes. Elements of this series will focus on understanding CMS programs that impact reimbursement and quality assurance; survey processes and regulations; and human resources, customer service, and leadership.

Each segment of this series is designed to provide in-depth information and discussion on each topic without taking the series in a sequential order or taking all 3 sections of the series. By making each of the 3 segments standalone, you can better address succession planning by having individuals attend as their nurse leadership skills are identified. Additional sections in this series will be added to the events calendar in September and December.

Senior Day at the MO State Fair

August 16, 2023: Senior Day at the State Fair
Location: Mathewson Building, Missouri State Fairgrounds, Sedalia

The Annual Missouri State Fair is right around the corner! As in years’ past, Senior Day at the State Fair is sponsored by the Department of Health and Senior Services and Missouri Association of Area Agencies on Aging. This yearly tradition at the State Fair honoring Missouri’s most valuable resource, senior citizens, typically draws over 800 people.

LeadingAge Missouri Annual Conference & EXPO

September 18-20, 2023: The Greater Good
Location: The Chase Park Plaza, St. Louis

Welcome to the 2023 LeadingAge Missouri Annual Meeting + EXPO. We have incorporated some changes to our planning to support everyone’s mission of collaboration, networking, and sharing. You’ll find an open exhibit hall for ease of access for attendees, exclusivity times, CEU approval for exhibitor visits, a social reception for all, and the opportunity to be part of the Innovation Café. We have expanded education to be inclusive of the entire spectrum of long-term care in Missouri. The greater good is more than a theme, it’s part of a mission. We all continue to be the greater good through learning and collaboration; Missouri is a leader in the field of compassion, togetherness, and Midwest values.

This is where GREATER GOOD begins – and you need to be a part of it.

COMRU Return Codes

We have some good news and some bad news!

The bad news….due to a required change in the database platform, the COMRU online applications for Level 1/Level 2 (old DA124s) forms will no longer be accessible by your CURRENT RETURN CODES after Friday, July 14, 2023.

The good news…you can still access the online applications and COMRU can continue to process applications you submitted! However, as of MONDAY, JULY 17, a NEW RETURN CODE will be required to access all applications entered prior to July 17, 2023.

Please note – this change will not affect any application initiated after July 17, 2023. You will continue to receive a valid return code for all new applications submitted to COMRU after July 17, 2023.

What do I need to do?!

If you recently submitted the application (before July 17) – a new return code will be provided to you when COMRU reviews your application. Otherwise, if you need to make a change or need to receive the new code for applications initiated prior to July 14, 2023, please email the following to COMRU (COMRU@health.mo.gov):

Name of Individual
DCN or SSN
Name of Facility
Admission Date (if admitted to SNF)

We appreciate your patience during this transition process and apologize for any inconvenience.

NH Providers Login Credentials Maintenance

The purpose of this communication is to remind Nursing Home Providers to ensure you maintain accurate contact information and login credentials in the QIES system even though all Minimum Data Set (MDS) information is now being submitted via the Internet Quality Improvement and Evaluation System (iQIES) system. You will continue to receive important information regarding any findings of noncompliance with the requirement to report COVID-19 data to the Centers for Disease Control and Prevention (CDC) through the National Healthcare Safety Network (NHSN) in your CASPER Shared Folder. This means that facilities will need to continue to maintain two sets of login credentials, one set to access the CASPER Reporting application [CMS Network (CMSNet) and QIES Login credentials] and the HARP login credentials to continue submission of MDS records and accessing reports in iQIES.

Below is the link for the CASPER login. Please be sure that you are successfully logged into the CMS Network (CMSNet) prior to trying to access the CASPER link below.

https://web.qiesnet.org/qiesmds/mds_home.html

See below to find your CASPER Shared Folder:

Image 1. Welcome to CASPER

 

 

 

 

 

 

 

Image 2. CASPER folders.

 

 

 

 

 

 

 

 

 

iQIES Service Center

For questions regarding your CASPER Shared Folder, please contact the QIES/iQIES Service Center by phone at (800) 339-9313 or send an email.

CMS Memo: QSO-23-18-NH: Posting of Nursing Home Ownership/Operatorship Affiliation Data on Nursing Home Care Compare Website and data.cms.gov

Memorandum Summary

  • Posting Nursing Home Affiliation on Nursing Home Care Compare: CMS will include ownership and operatorship affiliation information on our Nursing Home Care Compare website.
  • Posting Aggregate Nursing Home Performance Data on data.cms.gov: CMS will publish combined inspection, staffing, quality, and other performance metrics across groups of nursing homes with shared ownership and operatorship on data.cms.gov.

Please see the full memo for complete details at https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationgeninfo/policy-and-memos-states/1519889558/posting-nursing-home-ownership/operatorship-affiliation-data-nursing-home-care-compare-website-and.

LeadingAge – Free Webinar

July 11, 2023: Mastering QAPI
Presenter: Ralph Peterson, owner and operator of Ralph Peterson, LLC, a Management Development Company that specializes in helping Senior Care organizations REINVENT the way they do business

LeadingAge Missouri in partnership with LeadingAge Nebraska are excited to bring a new webinar!  Ralph Peterson will be sharing with us a hands-on & practical webinar on developing a QAPI program in senior living.

DESCRIPTION: Are you looking to improve the quality of care at your senior care center? Do you want to create a culture of excellence that will enhance the lives of your residents and their families? If so, then our 60-minute webinar on creating an effective Quality Assurance, Performance Improvement (QAPI) program is perfect for you!

In this webinar, we will explore the key elements of a successful QAPI program and how it can benefit your senior care center. We will use storytelling and analogies to make the concepts more relatable and memorable, and we will provide you with real-world examples to help you implement the program in your own center.

During this session, you will learn:

  • The importance of creating a culture of quality and how it can enhance the lives of your residents
  • The key components of a QAPI program, including data collection, analysis, and improvement planning
  • How to identify areas for improvement in your center and develop a plan to address them
  • How to engage your staff in the QAPI program and create a collaborative team environment
  • How to use performance data to drive positive outcomes for your residents and your center

By the end of this webinar, you will have the knowledge and tools to create an effective QAPI program that will enhance the quality of care at your senior care center. You will also have the opportunity to ask questions and share your own experiences with the group.

Free Trainings from the Department of Mental Health

Tools for Everyone!

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. Please register at the links below.

July 6, 2023: 9:30 am https://stateofmo.webex.com/weblink/register/r7b512064c968d2329638c65be13b6c7e
July 13, 2023: 1:00 pm https://stateofmo.webex.com/weblink/register/r35a043c5b76d1f68f066862680747a4c
July 20, 2023: 1:00 pm https://stateofmo.webex.com/weblink/register/r2e46c3cc93a6135dc0c455b994ff1726
July 26, 2023: 10:00 am https://stateofmo.webex.com/weblink/register/r8e0a26526488dba1f1f8246349e59a9d
August 2, 2023: 9:00 am https://stateofmo.webex.com/weblink/register/r435dfdd07bee3f1eaa1e5754ce8e023e
August 10, 2023: 1:00 pm https://stateofmo.webex.com/weblink/register/r731db903594e3704ea91cfa7f406acc4
August 16, 2023: 10:00 am https://stateofmo.webex.com/weblink/register/r123055bad864686c0af10f7375a9a903

Additional Free Training:

Introduction to Trauma – Dr. Patsy Carter
Research has revealed that the prevalence of trauma is high particularly in specific target populations. This webinar will introduce viewers to the definition and prevalence of trauma, as well as examining the social, biological and health impact.

A Taste of Mental Health First Aid – Jermine Alberty and Rita McElhany
Have you ever wondered what it would be like to take a Mental Health First Aid Class? MHFA-USA National trainer, Jermine Alberty offers a brief “Taste Of Mental Health First Aid.”

Mental Health First Aid is a skills-based training course that teaches participants about mental health and substance-use issues.
If you would like to take the class or get more information visit mhfamissouri.org.

Updated Missouri Nurse Aid Candidate Handbook

The DHSS Health Education Unit and Headmaster D & S would like to announce some revisions to the skills portion of the CNA exam shown in the Candidate Handbook effective July 1, 2023. Please see the new updated version at Missouri Nurse Aide Candidate Handbook (hdmaster.com) for the changes.

Please contact the DHSS Health Education Unit at 573-526-5676 and/or Headmaster D & S at 800-393-8664 for any questions.

Dangerous Heat Warnings for Missouri

The National Weather Service has issued a heat advisory for portions of Missouri for Thursday, June 29 and Friday, June 30. As temperatures rise this summer, it is important to prioritize heat related safety measures. Heat-related illnesses can have serious consequences, but with some precautions and awareness, we can create a safer work environment.

Heat-related illnesses often affect the very young, the elderly and the chronically ill, but summer temperatures can also take a toll on healthy young and middle-aged adults. In 2022, 23 people died from heat exposure in Missouri, ranging in age from 2-83 years.

During prolonged periods of high temperatures, using air conditioning – either at home or by seeking shelter in a local cooling center – is the best preventive measure.

“Heat and humidity can place a lot of stress on the body,” said DHSS Director Paula Nickelson. “Heat exhaustion can come on suddenly, with little warning, and lead to heatstroke which becomes a very dangerous situation.”

During excessive heat, Nickelson urges Missourians to check on friends and neighbors, especially those who are elderly and chronically ill. To report a senior citizen or an adult with disabilities who is in need of assistance due to the heat, call the state’s toll-free abuse and neglect hotline at 1-800-392-0210, or make a report online. Medications, as well as use of drugs or alcohol, can impair a body’s response to heat, making one more vulnerable to the heat.

Never leave a child or pet alone in a vehicle. Four of Missouri’s heat-related deaths in 2022 were individuals in vehicles. Even on a cooler day, the temperature inside a vehicle can rise by 20 degrees in 10 minutes and pose a real threat to anyone left inside. Stress, distraction and being out of a normal routine can all contribute to forgetting a child in a car seat. Check the back seat each time you exit your vehicle.

There are a number of steps individuals can take to stay cool including:

  • Stay hydrated. Drink plenty of water regardless of your activity level, and do not wait until you are thirsty to do so. Avoid sugary and alcoholic beverages; these actually cause you to lose body fluids.
  • Wear appropriate clothing. Wear lightweight, breathable, and loose-fitting clothing that allows air circulation. When outside, consider wearing a hat and sunglasses to protect yourself from the sun.
  • Stay cool indoors. Stay in air-conditioned places as much as possible. Find a local cooling center if needed.
  • Schedule outdoor activities carefully. Try to plan outdoor activity for morning or evening hours when the temperature is coolest.
  • Pace yourself. Reduce exercise or physical activity during the hottest part of the day, and take frequent breaks in the shade or in an air-conditioned place.
  • Wear sunscreen. Sunburn affects your body’s ability to cool down and can make you dehydrated.
  • Prepare your home. Change air conditioner filters, and cover windows that receive morning or afternoon sun with drapes or shades.
  • Stay informed. Pay attention to weather forecasts and heat advisories. Stay informed about the local heat index and adjust safety measures accordingly.

Knowing the signs and symptoms of heat related illness and how treat them is also important. Signs of heat exhaustion may include muscle cramps; heavy sweating; cold, pale and clammy skin; dizziness; headache; nausea or vomiting; and fainting or passing out. If you think you or a loved one are experiencing heat exhaustion, you should stop physical activity move to a cool place – preferably air-conditioned, loosen clothing, and sip cool water. Seek medical attention immediately if you are throwing up, your symptoms get worse or symptoms last longer than one hour.

Signs of heat stroke may include high body temperature (103°F or higher); hot, red, dry or damp skin; fast, strong pulse; headache; dizziness; nausea; confusion; or loss of consciousness. If you think you or a loved one are experiencing heat stroke you should call 911 immediately. Heat stroke is a medical emergency. Move the person to a cool place – preferably air-conditioned. Help lower the person’s body temperature with cool cloths or a cool bath until medical personnel arrive. Do not give the person anything to drink.

For more information regarding heat-related illness and prevention, visit the websites of DHSS or the CDC.

Missouri Nursing Facility Strike Team and Infrastructure Reimbursement Opportunity

On March 1, 2023, the Missouri Department of Health and Senior Services (DHSS) released information about the Missouri Nursing Facility Strike Team and Infrastructure Award, a reimbursement opportunity available to Skilled Nursing Facilities (SNF) and Long Term Care and Other Nursing Facilities (LTC).

Beginning March 1, facility owners and operators may apply for reimbursement for expenses incurred between July 1, 2022 and August 31, 2023, directly related to preparing, preventing, and responding to the COVID-19 pandemic. The intention of this funding is to provide supplemental support to Missouri’s skilled nursing, other long-term care and other nursing facilities during their response to SARS-CoV-2 infections, and also to build and maintain the infection prevention infrastructure necessary to support resident, visitor, and facility healthcare personnel safety. If you operated a Skilled Nursing Facilities or Long Term Care and Other Nursing Facilities licensed with DHSS between July 1, 2022 and August 31, 2023, you are eligible for reimbursement for allowable expenses.

After the application period was opened March 1, 2023, the program was made aware of additional federal administrative requirements that impact the implementation of the program. These requirements do not change the eligibility criteria for facilities or the allowable cost categories but do identify that expenditures for activities that were previously paid or reimbursed by federal funds are not allowed for reimbursement through this award. Only expenses that have not been reimbursed by another federal fund source are allowable for reimbursement from this opportunity.

A very few additional facilities have also been made eligible for this opportunity. This does slightly impact the eligible amount per licensed bed for both skilled nursing facilities (SNF) and long-term care and other nursing facilities (LTC/Other), but the impact is less than a percentage point different in each type of facility.

Facility operators that have already applied for these funds do not need to do anything to adjust their applications, but do need to be aware of the additional guidance and revised amounts, and be prepared to assure that costs submitted for reimbursement meet the federal requirements. DHSS will provide additional information to existing applicants and will advise if any adjustments or additional information are needed on a case-by-case basis.

Updated guidance and eligible amounts are posted on the DHSS website for COVID-19 Health Care Professionals under the heading “Information for Long-Term Care Facilities” at the following link: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/professionals.php.

All questions should be directed to the DHSS Strike Team via email at LTCStrikeTeam@health.mo.gov.

This program is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award ending May 10, 2024 totaling $14,994,016 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

MHCA Annual Convention

August 27-30, 2023: Celebrating 75 Years of Caring!
Location: Branson Convention Center, Branson

The Missouri Health Care Association is excited to bring you another year of the most requested and up-to-date educational sessions available. Each day is scheduled to offer a wide range of education to meet the needs of the entire staff. More information as well as a proposed schedule is included at the link above and a complete schedule with seminar details will be available soon. Don’t miss the opportunity to tour the Trade Show, widely regarded as the leading long-term care trade show in Missouri with over 150 booths.

2023 Provider Feedback Survey

The Section for Long-Term Care Regulation is again seeking input from providers we serve. We are asking for your help in identifying areas in our Section where excellent customer service is provided and areas where we need to focus on improving our customer service experience. Please take a couple minutes to complete our 2023 Provider Feedback Survey by July 5, 2023 at https://www.surveymonkey.com/r/6K86SF6.

Medicaid Spend-Down Limit Changes

Effective July 1, 2023, the Medicaid Resource (Spend-Down) Limit increased to $5,726.00. Please see the link https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf.

Please note that for Medicaid/Medicare certified facilities, F569 states the facility must notify each resident/legal guardian that receives Medicaid benefits when the amount in the resident’s account reaches $200 less than the SSI resource limit. This means certified facilities should notify the resident/legal guardian when the resident’s personal funds are $5,526.00 or higher.

Feel free to contact Lynn Gilmore, Lead Auditor, at 573-508-4150 if you have any questions.

Rule Change Effective June 30, 2023

19 CSR 73-2.130 Notice of Change of Contact Information and Missouri Administrator Employment

PURPOSE: This rule describes the conditions and procedures for reporting change of address.

(1) Each administrator shall notify the board office of his/her current contact information within ten (10) calendar days of change for any of the following:

(A) Personal contact information, which shall include administrator license number, personal mailing address, email, and telephone number(s); and
(B) Missouri administrator employment, which shall include, administrator license number, facility name, mailing address, telephone number(s), and employment dates.

AUTHORITY: section 344.070, RSMo 2016. *This rule was previously filed as 13 CSR 73-2.130. Original rule filed May 13, 1980, effective Aug. 11, 1980. Amended: Filed Oct. 17, 1985, effective March 14, 1986. Moved to 19 CSR 73-2.130, effective March 3, 2003. Amended: Filed June 15, 2011, effective Jan. 30, 2012. Amended: Filed Nov. 28, 2022, effective June 30, 2023.

A direct link to the Rules for the Missouri Board of Nursing Administrators can be found at https://s1.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c73-2.pdf. The rule referenced above is located on the last page.