Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule implements a revision to section
630.210,
RSMo requiring the department to promulgate a rule waiving the Standard Means
Test for a child in need of mental health services.
(1) Definitions.
(A) The terms defined in
9 CSR
10-31.011 Standard Means Test are incorporated by
reference as though set out in this rule.
(B) A "child in need of mental health
services," as used in this rule, is any child who qualifies to receive services
from the Department of Mental Health under Chapters 630, 631, 632 or 633,
RSMo.
(2) Request for
Waiver. At the time of initial application of the Standard Means Test (SMT) for
a child in need of mental health services, and at the time of any subsequent
reapplication, the provider shall inform the financially responsible person
that the SMT may be waived.
(A) The provider
shall make available to the financially responsible person information on how
to submit a request for SMT waiver.
(B) The financially responsible person shall
submit the request in writing to the department director, with a copy to the
provider.
(C) For the initial
waiver request made on behalf of a child, the provider shall not charge the
monthly rate as determined by application of the SMT for services provided
during any month in which the request is under review or appeal. This provision
applies only to the first waiver request made on behalf of the child.
(D) A waiver may be approved, or approved
with conditions, for up to one (1) year. It is the responsibility of the
financially responsible person to notify the provider of any significant change
in financial status. A waiver may be reevaluated at the initiative of the
department director due to any significant change in financial
status.
(3) Review of
Request for Waiver. Upon receipt of a request for SMT waiver the department
director shall designate an individual or individuals to review the request.
The designee or designees shall approve, approve with conditions, or deny the
request within seven (7) working days of receipt of the written request. The
designee or designees shall provide notice of the decision to the requestor by
certified mail with copy to the provider.
(4) Consideration of Request. In making the
decision to approve, approve with conditions, or deny the request, the designee
or designees will consider information presented by the requestor. The
requestor may, but is not required to, include information regarding one or
more of the items listed below, or any other information in support of their
request:
(A) The recommendation of the local
care team, or other designated local or regional children's mental health
authority that waiving the SMT will contribute to the therapeutic needs of the
child by allowing the child to remain in the custody of the parent or
custodian;
(B) History of the child
being in state custody due exclusively to the need for mental health
services;
(C) Statement from the
financially responsible person that their primary motivation for requesting the
waiver is to avoid loss of custody because they are unable to pay the monthly
amount as determined by application of the Standard Means Test;
(D) Past efforts of the financially
responsible person to obtain needed medical care, and expenses incurred by the
financially responsible person for the treatment of the mental health condition
or for the physical health of the child necessitated by the onset of the mental
health condition;
(E) The parent or
custodian's history of insurance benefits expended for physical and mental
health treatment of the child and their current attempts to obtain commercial
or government sponsored insurance coverage; and
(F) The parent or custodian's overall
wherewithal to pay for the child's mental health treatment needs at the time of
requesting the waiver, including gross income, medical expenses, assets,
liabilities, and financial responsibility for other dependents in the
home.
(5) Denial of
Request. A request for waiver shall be denied when the request for waiver
(A) Is not submitted in writing;
(B) Does not raise factual issues sufficient
to show that inappropriate transfer of custody to the Children's Division is
likely to occur absent the waiver; or
(C) Does not present persuasive, factual
evidence that the financially responsible person cannot afford to pay the
monthly amount required by the application of the Standard Means
Test.
(6) Appeal of
Denial. Within seven (7) working days of receipt of notice of approval with
conditions or denial of a request, the financially responsible person may
appeal the approval with conditions or denial in writing to the department
director, with copy to the provider.
(7) Review of Appeal. Within seven (7)
working days of receipt of the written appeal, and upon completion of review,
the department director shall issue a decision which may alter the approval
with conditions or denial. The department director shall provide notice of the
decision by certified mail to the financially responsible person with copy to
the provider. The decision of the department director shall be the final
decision of the department.
*Originalauthority: 630,050, RSMo 1980, amended 1993, 1995
and 630.210, RSMo 1980, amended 1981, 1982, 1993,
2004.
