COVID-19

COVID-19 Information Update

Hospice Staff Curfew Letter (please show if you get stopped by police after hours)

Brochure Caring for a sick person at Home – Coronavirus 

Link to the National Coalition of Hospice & Palliative Care page https://www.nationalcoalitionhpc.org/covid19/

You can now view the COVID-19 Provider Billing/Telehealth Presentation on the MO HealthNet training information page.

For provider and policy issues regarding MHD Clinical Services Programs, including Pharmacy, The Missouri Rx Plan (MORx), Psychology, Exceptions, and Medical Precertifications, email us at: clinical.services@dss.mo.gov.

Questions and comments regarding any other issues should be directed to: ask.MHD@dss.mo.gov

The COVID-19 hotline number is 877-435-8411.

Missouri Medicaid has offered for MHPCA to answer any questions you may have about Hospice Medicaid during the time of COVID. These questions should be COVID specific and questions should come to MHPCA at my email: jane@mohospice.org. I will send a completed list to MO Medicaid to respond. The answers will be placed on the MHPCA website with a link from our newsletter. A good reason to open the newsletter! I hope you all take advantage if you need something answered.

MHPCA and MAHC made a Waiver Request to DHSS around State Statue Section 195.060

This is the response we received from DHSS:
LTCFs can ask for pharmacies to send them hospice “comfort packs” in advance.
The pharmacy sends it over as emergency stock for the emergency supply—and no patient name or prescription is needed.
If and when it is needed, the LTCF gets a physician’s permission, and then administers from the E-kit stock.
Un-used supplies after COVID can be returned to the pharmacy.

See BNDD Regulation 19 CSR 30-1.052 below:
19 CSR 30-1.052
(1) Long-term care facilities (LTCFs) and their suppliers shall maintain written records
of transfers of controlled substances from the supplier to the LTCF emergency kit.

(2) The records shall include the date of transfer; the name of each controlled substance,
the strength, dosage form and quantity; the name, address and controlled substance
registration number of the supplier and the name, address and controlled substance
registration number of the LTCF. Federal Drug Enforcement Administration (DEA)
official order forms shall not be used to record transfers of controlled substances to
LTCF emergency kits.

(3) No physician’s order or prescription shall be used for initial stocking or replacement of
controlled substances in the emergency kit. Controlled substances contained in the kit
shall be obtained from a pharmacy, hospital or practitioner who holds a controlled substances
registration.

(4) The administration and medical staff of the LTCF, in conjunction with the primary
supplier, shall designate in written protocols and procedures who may have access to the
emergency kit, who may administer controlled access to or administer controlled substances
from the emergency kit.

(5) Each administration of controlled substances from the emergency kit shall be based
upon a practitioner’s order and shall be recorded in an administration record separate
from the patient’s medical record. This administration record shall include: the date,
patient’s name, drug name, drug strength, dosage, ordering practitioner’s name and
name of the person administering the controlled substance.

AUTHORITY: sections 195.050 and 195.195, RSMo 1994.* Original rule filed April 14,
2000, effective Nov. 30, 2000. *Original authority: 195.050, RSMo 1939, amended 1971,
1989 and 195.195, RSMo 1957, amended 1971, 1989, 1993.

CONTACT REGION 7 for Individual Waiver regarding F2F

If you are unable to meet the F2F requirement due to inability to get in place audio AND video consider applying for an individual waiver with CMS. Our President just spoke with CMS Region 7 about this issue. She was told by Region 7 to ask for an individual waiver if you are experiencing this issue.

To apply:

In order for us to further process individual 1135 waivers as quickly as possible, please make sure it contains the following information:
Provider Name/Type
Full Address (including county/city/town/state) CCN (Medicare provider number)
Contact person and his or her contact information for follow-up questions should the Region need additional clarification
Brief summary of why the waiver is needed. For example: CAH is sole community provider without reasonable transfer options at this point during the specified emergent event (e.g. flooding, tornado, fires, or flu outbreak). CAH needs a waiver to exceed its bed limit by X number of beds for Y days/weeks (be specific).
Consideration – Regulatory requirements or regulatory reference that the requestor is seeking to be waived.
To keep up with the important work CMS is doing in response to COVID-19, please visit the Current Emergencies Website.
If you would like to submit an individual 1135 waiver, please send to: CMD@cms.hhs.gov. Once received, we can send your request for processing.

COVID-19 Response News Alert: CMS Issues Key Protective Mask Guidance for Healthcare Workers

Mar 10, 2020

The Centers for Medicare & Medicaid Services (CMS) took additional action to ensure America’s healthcare workers are prepared to fight the spread of Novel Coronavirus 2019 (COVID-19). Specifically, CMS sent a memorandum to State Survey Agencies (SAs), which are responsible for inspecting nursing homes and other healthcare facilities serving Medicare and Medicaid beneficiaries. The memo clarifies the application of CMS policies in light of recent Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) guidance expanding the types of facemasks healthcare workers may use in situations involving COVID-19 and other respiratory infections. These are proactive steps to take as part of the White House Task Force’s efforts to ensure a maximum supply of facemasks and respirators are available to enable healthcare providers to safely treat patients without exposing themselves or others to COVID-19.

“CMS is working in lockstep with the CDC, FDA, and other Trump Administration partners to protect both patients and the dedicated healthcare workers who are battling the spread of Coronavirus,” said CMS Administrator Seema Verma. “Today we provided practical information to state inspectors and healthcare facilities on the range of facemasks that can be temporarily used. CMS has been rapidly adapting our guidance to strengthen our nation’s defense against Coronavirus, and today’s action is no exception. We’re working to make sure the healthcare system has the equipment it needs to keep patients and healthcare workers safe.”

The memo CMS issued today aligns CMS policy with recent changes to CDC and FDA facemask and respirator guidance in light of COVID-19 and supply demands. To help reduce burden on healthcare facilities at this time, the CMS memo implements CDC guidance by stating that facemasks, which protect the wearer from splashes and sprays, are an acceptable temporary alternative to respirators, which filter the air, for most medical services until demand for respirators lessens.

Due to the updated CDC guidance on allowable facemasks and respirators, CMS is also alerting state surveyors that they are not required – on a temporary basis – to validate the date of a facility’s last annual test of the fit of N95 masks worn by workers in Medicare- and Medicaid-certified facilities. CMS is temporarily suspending surveyor validation of the test to minimize the discarded masks associated with such testing.

Additionally, the FDA approved a CDC request for an emergency use authorization (EUA) to allow healthcare workers to use certain industrial respirators during the COVID-19 outbreak in healthcare settings. The FDA concluded that respirators approved by the National Institute for Occupational Safety and Health (NIOSH), but not currently meeting the FDA’s requirements, may be effective in preventing healthcare workers from airborne exposure to serious or life-threatening disease, including COVID-19. This FDA approval allows healthcare personnel to use the NIOSH-approved respirators not currently regulated by the FDA. As a result, in addition to N95 respirator masks, healthcare personnel have other masks at their disposal in order to safely treat patients without exposing themselves or others to COVID-19.

The CMS memo on facemask and respirator guidance issued today, and earlier CMS actions in response to the COVID-19 virus, are part of ongoing White House Task Force efforts. To keep up with the important work CMS is doing in response to COVID-19, please visit the Current Emergencies Website.

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