Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment updates requirements for
certification as a Community Psychiatric Rehabilitation (CPR)
program.
PURPOSE: This rule describes procedures to obtain
certification as a Substance Use Disorder Treatment Program, Comprehensive
Substance Treatment and Rehabilitation Program (CSTAR), Institutional Treatment
Center, Gambling Disorder Treatment Program, Prevention Program, Recovery
Support Program, Substance Awareness Traffic Offender Program (SATOP), Required
Education Assessment and Community Treatment Program (REACT), Community
Psychiatric Rehabilitation (CPR) Program, or Outpatient Mental Health Treatment
Program.
(1) Certification
Standards. Under sections
376.779.3 and 4,
630.010,
and 630.655, RSMo, the department is mandated to develop certification
standards and to certify an organization's level of services as necessary and
applicable for it to operate, receive funds from the department, and
participate in department programs eligible for Medicaid reimbursement.
Certification does not constitute an assurance or guarantee the department will
fund designated services or programs.
(A) A
key goal of certification is to enhance the quality of care and services with a
focus on the needs and outcomes of persons served.
(B) The primary function of the certification
process is assessment of an organization's compliance with the department's
standards of care. A further function is to identify and encourage
developmental steps toward improved program operations, satisfaction with
services, and successful outcomes for individuals served.
(2) Under section
630.050,
RSMo, the department shall certify each community psychiatric rehabilitation
(CPR) provider's rehabilitation program services as a condition of
participation in the CPR program.
(3) Organizations must meet criteria as
specified below to be eligible for certification as a CPR provider.
(A) The organization must meet a minimum of
one (1) of the following:
1. Meets the
eligibility requirements for receipt of federal mental health block grant funds
for the provision of clinical treatment services;
2. Has a current and valid contract for the provision
of clinical treatment services with the department pursuant to 9 CSR 25-2;
or
3. Has been certified as a CPR
provider at least once prior to November 7, 1993, and has maintained
certification continuously since November 7, 1993.
(B) Organizations that meet at least one (1)
of the requirements specified in paragraphs (3)(A)1.- 3. of this rule must meet
all of the following requirements:
1. Has
maintained compliance with department outpatient mental health certification
requirements as specified in
9 CSR
30-4.190 for one (1) certification cycle;
2. Complies with 9 CSR 10-5, 9 CSR 10-7, and
9 CSR 30-4, as applicable;
3. Has
the capacity to provide in-person, face-to-face services from a physical
location in the state of Missouri;
4. Is accredited to provide behavioral health
services by the Commission on Accreditation of Rehabilitation Facilities (CARF)
International, The Joint Commission, Council on Accreditation, or other entity
recognized by the department;
5.
Has the capacity to collect, analyze, and report outcome and other data related
to the population served to the department in accordance with established
protocol; and
6. Incorporate
evidence-based, best, and promising practices into its service array. At a
minimum, the organization shall employ or have a formal contract with the
following:
A. Licensed and credentialed
professionals with expertise and specialized training in the treatment of
trauma-related disorders;
B.
Licensed and credentialed professionals with expertise and specialized training
in the treatment of cooccurring disorders (substance use and mental
illness);
C. Licensed
psychiatrists;
D. Certified Peer
Specialists and Certified Family Support Providers who are credentialed by the
Missouri Credentialing Board;
E.
Clinical staff who have completed department-approved training on suicide
prevention; and
F. Clinical staff
who have completed department-approved training on smoking cessation.
(4) The
department shall certify, as a result of a certification survey or deeming,
each CPR program as designated and eligible to serve children and youth under
the age of eighteen (18).
(5) To be
eligible to serve children and youth under the age of eighteen (18), a
certified or deemed-certified CPR program shall:
(A) Have a current and valid contract for
services with the department pursuant to 9 CSR 25-2;
(B) Meet the eligibility requirements for
receipt of federal mental health block grant funds;
(C) Provide a comprehensive array of
psychiatric services to children and youth including, but not limited to:
1. Crisis intervention mobile
response;
2. Screening and
assessment;
3. Medication services;
and
4. Intensive case management
consistent with state plan approved services; and
(D) Have experience and expertise in
delivering a department-approved home-based crisis intervention program of
psychiatric services for children and youth.
(6) A certified or deemed-certified CPR
program in each designated service area may serve transition-age youth, age
sixteen (16) and older, meeting the diagnostic eligibility requirements in
9 CSR
30-4.042 without the certification specified in
paragraphs (4) and (5) of this rule. The clinical record must include
documentation it is clinically and developmentally appropriate to serve the
individual in an adult program.
(7)
Application Process and Fees. An organization may request certification by
completing the application form as required by the department for this purpose,
and submitting the application and any specified documentation to: Department
of Mental Health, PO Box 687, Jefferson City, MO 65102.
(A) The application must include a current
written description of the program(s) and service(s) for which the organization
is seeking certification from the department.
(B) A new applicant shall not use a name
which implies a relationship with another organization, government agency, or
judicial system when a formal organizational relationship does not
exist.
(C) Department staff review
each application to determine whether the applicant meets the criteria for
certification.
(D) An organization
that submits an incomplete application will receive written notice from the
department. A complete application must be resubmitted to the department in
order to be considered for certification. If the resubmitted application is
determined to be incomplete, the organization will receive written notification
from the department. The department may deny the applicant from reapplying for
a period of up to one (1) year from the date of notification.
(E) A certification fee is required for the
Substance Awareness Traffic Offender Program (SATOP). The fee structure is
based on the number of individuals served by the agency as follows:
1. The fee is one hundred twenty-five dollars
($125) if less than two hundred fifty (250) individuals were served by the
agency during the prior survey year;
2. The fee is two hundred fifty dollars
($250) if the agency served at least two hundred fifty (250) individuals but no
more than four hundred ninety-nine (499) individuals during the prior survey
year;
3. A fee of five hundred
dollars ($500) is required if at least five hundred (500) individuals were
served by the agency during the prior survey year.
(F) The SATOP fee schedule may be adjusted
annually by the department.
(G)
Each organization is responsible for monitoring the expiration date of their
certification and applying for renewal of certification. The application form
and required documentation must be submitted to the department at least sixty
(60) calendar days prior to expiration of the existing certificate.
1. Applications for renewal of certification
received after the expiration date or organizations that do not reapply, are
subject to termination of certification status and may be required to resubmit
an application for certification to the department.
2. Organizations that choose not to renew
certification must provide written notification to the department sixty (60)
calendar days prior to the expiration date on the certificate.
(H) Organizations may withdraw an
application at any time during the certification process, unless otherwise
required by law.
(I) The
organization agrees, by act of submitting an application, to allow and assist
department representatives in fully and freely conducting any survey procedures
and to provide department representatives reasonable and immediate access to
premises, individuals, staff, and requested information.
(J) The organization must provide information
and documentation to the department that is accurate and complete.
Falsification or fabrication of any information used to determine compliance
with requirements may be grounds to deny issuance of or to revoke
certification.
(8)
Certification Process. The department grants certification based on its review
of an organization's compliance with standards of care for behavioral health
services.
(A) For nationally accredited
organizations that do not provide opioid treatment-
1. The department may grant a certificate to
organizations that have obtained accreditation for services provided from CARF
International, The Joint Commission, Council on Accreditation, or other entity
recognized by the department. Certification from the department will be
equivalent to the period of time granted by the accrediting body.
2. Organizations seeking deemed certification
status from the department must complete the application for accredited
organizations and submit it to the department. The application must include
documentation of current accreditation status, the accrediting body's survey
report of findings, and the behavioral health services for which the
organization is accredited.
3. The
department will review the accrediting body's program accreditation to
determine if it is equivalent to the department's program certification. The
department, at its option, may visit the organization's program site(s) solely
for the purpose of clarifying information contained in the organization's
application and its description of programs and services, and/or determining
those programs and services eligible for certification by the
department.
4. Notice of any change
in an organization's accreditation status must be provided in writing to the
department within seven (7) calendar days of notification from the accrediting
body.
5. The department may rescind
certification if an organization loses its accreditation.
(B) For non-accredited organizations, the
department will conduct a survey to determine compliance with applicable
sections of department certification standards.
1. The department provides advance written
notice of routine, planned surveys including date(s), procedures, and an agreed
upon schedule of activities. Survey procedures may include, but are not limited
to:
A. Interviews with staff, individuals
served, and other interested parties;
B. Tour and inspection of program
sites;
C. Review of administrative
records to verify compliance with requirements;
D. Review of personnel records;
E. Review of service documentation;
F. Observation of program activities;
and
G. Review of data regarding
practice patterns and outcome measures, as available.
2. The surveyor(s) will hold an entrance and
exit conference with staff of the organization to discuss survey arrangements
and survey findings, respectively.
3. A surveyor will immediately cite any
serious area of non-compliance which could result in actual jeopardy to the
safety, health, or welfare of persons served. The surveyor will not leave the
program until an acceptable plan of correction is presented by staff which
assures the surveyor there is no further risk of jeopardy to persons
served.
4. Within thirty (30)
calendar days after the exit conference, the department will send a written
survey report to the organization's director and governing body president,
including any areas of noncompliance as applicable. The report shall be
available for review by staff and the public, upon request.
A. Within thirty (30) calendar days of
receipt of a notice of noncompliance, a plan of correction must be submitted to
the department.
B. The plan of
correction must address each area of non-compliance, action steps to correct
each area of noncompliance, staff responsible for each action step, target date
for completion, and where and how corrections will be verified.
C. Within fifteen (15) calendar days of
receipt of a plan of correction, the department will notify the organization of
its decision to approve, disapprove, or require revisions to the proposed plan
of correction.
D. At the
department's discretion, a follow-up survey may be conducted to review the
areas of noncompliance and ensure the organization fully complies with
applicable standards of care. The organization will receive advance, written
notice of the survey date(s) and procedures.
E. If all areas of noncompliance are
corrected and no other deficiencies are found on the follow-up survey,
certification may be granted.
F. If
all areas of noncompliance are not corrected on the follow-up survey, or new
areas of noncompliance are cited, the application for certification will be
denied and the organization will be required to reapply for certification by
submitting a new application to the department. The department may deny
certification to an organization for a period of up to one (1) year from the
date of notification of noncompliance.
G. In the event the organization has not
submitted an acceptable plan of correction to the department within ninety (90)
calendar days of the date of the initial notice of noncompliance, it shall be
subject to expiration or denial of certification.
(C) Organizations determined to be
in compliance with certification standards may be awarded certification by the
department.
1. The department has the
authority to determine an organization's time period for certification based on
its performance, survey findings, and existing certification status, as
applicable.
2. Certification will
be valid until the expiration date shown on the certificate issued by the
department unless the certificate is modified, revoked, suspended, or the
department grants the organization a temporary certification status.
(9) Certification
Status. The department grants certification on a deemed, temporary,
provisional, conditional, or compliance status. In determining certification
status, the department considers patterns and trends of performance identified
during the survey.
(A) Deemed status. Deemed
status acknowledges a behavioral health services provider is monitored and held
accountable by a recognized national accrediting body and the department
accepts the organization's "good standing" as sufficient to meet its standards
of care.
(B) Temporary status.
Temporary certification may be granted to a certified organization if the
survey process has not been completed prior to the expiration of an existing
certificate and the applicant is not at fault for failure or delay in
completing the survey process.
1. The time
period for temporary certification is determined by the department based upon
progression of the survey process, including situations in which an
organization is required to submit a plan of correction to address areas of
noncompliance with standards. Consideration will be given to an organization's
request for an extension of their existing certificate.
(C) Provisional status. The department may
grant provisional certification to an organization applying for initial
certification when the results of the survey determine the organization has not
yet demonstrated full compliance with standards related to ongoing program
activities, but is compliant with standards of care related to the following:
1. Governing authority;
2. Policies and procedures;
3. Physical plant and safety; and
4. Personnel and staffing patterns sufficient
to provide services.
A. Provisional
certification status will not exceed a six (6) month time period. Within six
(6) months of granting provisional certification, the department will conduct a
comprehensive site survey and make a further determination of the
organization's certification status.
(D) Conditional status. Conditional
certification may be granted to an organization when survey findings indicate
areas of noncompliance with standards that may affect quality of care for
individuals served, but there is reasonable expectation the organization can
achieve compliance within a stipulated time period.
1. Conditional certification may be granted
for a six (6) month time period.
2.
The department may monitor progress, require the organization to submit
progress reports, or both.
3. The
organization will be expected to correct all areas of noncompliance prior to
the expiration of the conditional certification status.
4. The department may conduct a follow-up
survey prior to expiration of the conditional certification status to review
the areas of noncompliance and ensure the organization fully complies with
applicable standards of care.
A. If all areas
of noncompliance are corrected and no other deficiencies are found,
certification may be granted for a one (1) to three (3) year period.
B. If all areas of noncompliance are not
corrected on the follow-up survey, or new areas of noncompliance are cited,
conditional certification status will expire and the organization will be
required to reapply for certification by submitting a new application to the
department. The department, at its discretion, may deny the applicant for a
period of up to one (1) year from the date of notice of
noncompliance.
(E) Compliance status. The department may
award compliance status to an organization for a period of one (1) to three (3)
years when survey findings indicate the organization meets applicable standards
of care.
(F) The department, at its
discretion, may issue an extension of an organization's certification
status.
(10)
Investigations. The department, at its discretion, may investigate any written
complaint regarding the operation of a certified program or service.
(11) Scheduled and Unscheduled Surveys. The
department may conduct a scheduled or unscheduled survey of an organization at
any time to monitor ongoing compliance with applicable standards of care. If
any survey finds conditions that are not in compliance with applicable
certification standards, the department may require corrective action steps and
may change the organization's certification status consistent with procedures
set out in this rule.
(12)
Organizational Changes. A certificate is the property of the department and
applies solely to the organization named in the application. The certificate is
valid only as long as the organization meets standards of care and is not
transferable to another entity without prior, written approval from the
department.
(A) The organization shall keep
the certificate issued by the department in a readily available and visible
location.
(B) The department must
be notified a minimum of thirty (30) calendar days in advance if a certified
organization-
1. Is sold or changes
ownership;
2. Is discontinued and
ceases business operations;
3.
Leases some or all operations at its certified address(es) to another
entity;
4. Moves to a different
location;
5. Appoints a new
director; or
6. Changes programs or
services offered.
(C)
Failure to notify the department as required may result in administrative
sanctions or revocation of certification.
(D) A new application for certification is
required for a change in ownership and the addition of a program/service which
the organization is not certified by the department to provide.
1. In the event of a change in ownership, the
organization must be certified under the new ownership prior to beginning
operations under the new title.
2.
Certification under previous ownership becomes null and void if the new
owner(s) fail to submit an application for certification from the
department.
3. A certified
organization that establishes a new program or type of service must request and
obtain certification from the department for the new program or service and
comply with applicable standards.
(E) At the discretion of the department, the
thirty- (30-) calendar day prior notification required in subsection (12)(B) of
this rule may be waived in the event of an emergent or catastrophic situation.
In the event of such a situation, the certified organization must provide
written notice to the department as soon as possible, but no later than seven
(7) calendar days after becoming aware of the need for the change in the
organization.
(13)
Subcontracts. Certified or deemed organizations may subcontract for services
covered under their certificate in accordance with
9 CSR
10-7.090(6).
(14) Denial or Revocation of Certification.
The department may deny issuance of and may revoke certification based on a
determination that-
(A) The nature of the
deficiencies results in substantial probability of or actual jeopardy to
individuals being served;
(B)
Serious or repeated incidents of abuse, neglect, and/or misuse of
funds/property, or violation of individual rights have occurred;
(C) Fraudulent fiscal practices have
transpired or significant and repeated errors in billings to the department
have occurred;
(D) Information used
to determine compliance with requirements was falsified or
fabricated;
(E) The nature and
extent of deficiencies results in the failure to conform to the basic
principles and requirements of the program or service being offered;
(F) Compliance with standards has not been
attained by an organization upon expiration of provisional or conditional
certification.
(15)
Program Monitor. The department, at its discretion, may place a monitor at a
program if there is substantial probability of or actual jeopardy to the
safety, health, and/or welfare of individuals being served.
(A) The cost of the monitor shall be charged
to the organization at a rate which recoups all reasonable expenses incurred by
the department.
(B) The department
will remove the monitor when a determination is made that the safety, health,
and/or welfare of individuals served is no longer at risk.
(C) The department may take other action to
ensure and protect the safety, health, and/or welfare of individuals being
served.
(16) Appeal
Process. An organization which has had certification denied or revoked may
appeal to the director of the department within thirty (30) calendar days
following receipt of the notice of denial or revocation. The director of the
department conducts a hearing under procedures set out in Chapter 536, RSMo,
and issues findings of fact, conclusions of law, and a decision which will be
final.
(17) Administrative
Sanctions. The department may impose administrative sanctions.
(A) The department may suspend the
certification process pending completion of an investigation when an applicant
for certification or staff of the organization are under investigation for
fraud, misuse of funds/property, abuse and/or neglect of persons served, or
improper clinical practices.
(B)
The department may administratively sanction a certified organization that has
been found to have committed fraud, misuse of funds/property, abuse and/or
neglect of persons served, or improper clinical practices, or had reason to
know its staff were engaged in such practices.
(C) Administrative sanctions include, but are
not limited to, suspension of certification, clinical review requirements,
suspension of new admissions, denial or revocation of certification, or other
actions as determined by the department.
(D) The department may refuse to accept an
application for certification from an organization for a period of up to
twenty-four (24) months if certification is denied or revoked, or the
organization has been found to have committed fraud, misuse of funds/property,
abuse and/or neglect of persons served, improper clinical practices, or whose
staff and/or clinicians were engaged in improper practices.
(E) An organization may appeal these
sanctions pursuant to section (16) of this rule.
(18) Request for Exception. An organization
may request the department's exceptions committee to waive a requirement for
certification if the director of the organization provides evidence that a
waiver is in the best interest of individuals served.
(A) A request for a waiver must be submitted
in accordance with 9 CSR 10-5.210, Exceptions
Committee Procedures.
*Original authority: 630.050, RSMo 1980, amended 1993, 1995
and 630.055, RSMo 1980.
