Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment removes the requirement for a
face-to-face consultation with a community support specialist.
(1) The department designates the minimum
geographic boundaries for CPR service areas throughout the state. Exceptions to
the designated service areas may be granted by the department.
(A) The CPR program shall operate with-in its
designated service area and provide services to eligible individuals to the
extent adequate program capacity allows.
(B) Policies and procedures shall ensure
eligible individuals have access to CPR services throughout the twelve (12)
months of the year and to other services/resources beyond the scope of the
program.
(C) Community support
services shall be available to meet individual needs, which may include
evenings and weekends.
(D)
Community support and crisis intervention services shall be available to
eligible individuals in their home and other locations apart from the CPR
offices/facilities.
(E) Policies
and procedures shall ensure eligible individuals are not required to visit a
pre-selected site to receive needed services, other than medication, physician
consultation, and psychosocial rehabilitation (PSR). Individuals shall have a
choice in the location where they receive CPR services, to the extent program
capacity and the treatment plan allows.
(2) The CPR program shall have written
policies and procedures defining its service delivery process, including
screening, eligibility determination, admission, assessment, treatment and
recovery planning, and discharge for individuals served.
(A) Policies and procedures shall ensure
admission to services within ten (10) business days of the date of eligibility
determination for individuals with serious mental illness or serious emotional
disturbance.
(B) Individuals shall
not be denied admission to a CPR program based on eligibility for Medicaid
benefits or other sources of reimbursement for services.
(3) Policies and procedures shall ensure all
CPR services are provided under the direction of a physician/physician extender
and are medically necessary and reasonable for the treatment of the
individual's mental illness or disorder.
(A)
Emergency and crisis intervention services shall be provided prior to
completion of the initial comprehensive assessment for individuals determined
to need immediate assistance.
(B) A
physician/physician extender must be available for emergency and crisis
intervention services twenty-four (24) hours per day, seven (7) days per
week.
(4) The CPR program
shall implement written policies and procedures to ensure eligible individuals
are admitted to treatment within ten (10) days of the date of eligibility
determination.
(A) CPR services shall be
prioritized for individuals who-
1. Have been
discharged from inpatient psychiatric hospitalization programs within the last
ninety (90) days;
2. Are residents
of supervised or semi-independent apartments, psychiatric group homes, or
community residential programs;
3.
Have been committed by court order under provisions of section
632.385,
RSMo;
4. Have been conditionally
released under section
552.040,
RSMo;
5. Are homeless or considered
homeless in accordance with the following criteria:
A. Persons who are sleeping in places not
meant for human habitation such as cars, parks, sidewalks, and abandoned
buildings;
B. Persons who are
sleeping in emergency shelters or doubled up (unable to maintain their housing
situation and forced to stay with a series of friends and/or extended family
members, paying no rent, and uncertain as to how long they will be able to
stay);
C. Persons who are from
transitional or supportive housing for homeless persons who originally came
from streets or emergency shelters;
D. Persons who are being evicted within the
week from a private dwelling unit, no subsequent residence has been identified,
and they lack the resources and support networks needed to obtain access to
housing;
E. Persons who are being
discharged within the week from facilities in which they have been a resident
for more than ninety (90) consecutive days, no subsequent residence has been
identified, and they lack the resources and support networks needed to obtain
access to housing; and
F. Persons
who are fleeing or attempting to flee domestic violence, have no other
residence, and lack the resources or support networks to obtain other permanent
housing;
6. Are having a
current episode of acute crisis or being referred from the crisis
system;
7. Have used a hospital
emergency room related to a psychiatric illness two (2) or more times during
the prior year;
8. Have attempted
suicide;
9. Are high utilizers of
Medicaid services with co-occurring behavioral health and other chronic health
conditions; and
10. Children and
adolescents at risk of disruption from a preferred living environment due to
symptoms of a serious emotional disturbance.
(5) The CPR program may refuse admission when
an individual poses an imminent threat of harm to self or others, or the
program is operating at full capacity (a level previously determined by
organizational leadership). The program shall implement policies and procedures
to monitor capacity
(6) Eligibility
criteria for admission to a CPR program shall include:
(A) Disability-there is clear evidence of
serious and/or substantial impairment in the individual's ability to function
at an age or developmentally appropriate level due to serious psychiatric
disorder in each of the following two (2) areas of behavioral functioning as
indicated by the eligibility determination and comprehensive assessment:
1. Social role functioning/family life-the
ability to sustain functionally the role of a worker, student, homemaker,
family member, or a combination of these; and
2. Daily living skills/self-care skills-the
ability to engage in personal care (such as grooming, personal hygiene) and
community living (handling individual finances, using community resources,
performing household chores), learning ability/self-direction and activities
appropriate to the individual's age, developmental level, and social role
functioning.
(B)
Diagnosis-a licensed diagnostician certifies a primary diagnosis based on the
Diagnostic and Statistical Manual of Mental Disorders Fifth Edition
(DSM-5) published by and available from the American Psychiatric
Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-3901 or the
International Classification of Diseases Tenth Revision
(ICD-10) published by and available from the World Health
Organization, 525 23rd Street N.W., Washington, DC 20037. The diagnosis may
coexist with other psychiatric diagnoses. Specific diagnoses for eligibility
can be found in the MO HealthNet CPR Provider Manual published
by and available from the Missouri Department of Social Services, 615 Howerton
Court, PO Box 6500, Jefferson City, MO 65102-6500. The referenced documents do
not include any later revisions or updates.
(C) Duration-rehabilitation services shall be
provided for individuals whose mental illness is of sufficient duration as
evidenced by one (1) or more of the following:
1. Received psychiatric treatment more
intensive than outpatient more than once in a lifetime (crisis services,
alternative home care, partial hospital, inpatient);
2. Experienced an occurrence of continuous
residential care, other than hospitalization, for a period long enough to
disrupt the normal living situation;
3. Exhibited the psychiatric disability for
one (1) year or more; or
4.
Treatment of the psychiatric disorder has been or will be required for longer
than six (6) months.
(D)
For adults and children age six (6) and above a functional assessment may be
used to establish eligibility for CPR services, including results from a
standardized assessment prescribed by the department.
(E) Individuals currently enrolled in a CPR
program for youth are automatically eligible for admission to an adult CPR
program when the transfer is determined to be clinically appropriate and
documented in the record.
(7) Children and youth under the age of
eighteen (18) may be provisionally admitted to a CPR program based on the
following:
(A) Disability-there is clear
evidence of serious and/or substantial impairment in the child's ability to
function at an age or developmentally appropriate level due to serious
psychiatric disorder in each of the following two (2) areas of behavioral
functioning as indicated by the eligibility determination and comprehensive
assessment:
1. Social role functioning/family
life-the child is at risk of out-of-home or out-of-school placement;
and
2. Daily living
skills/self-care skills-the child is unable to engage in personal care, such as
grooming and personal hygiene, and in community living such as performing
school work or household chores, learning, self-direction or activities
appropriate to the individual's age, developmental level, and social role
functioning.
(B)
Diagnosis-if a child is exhibiting behaviors or symptoms consistent with a
non-established CPR eligible diagnosis, he/she may be provisionally admitted
for further evaluation. There may be insufficient clinical information because
of rapidly changing developmental needs to determine if a CPR diagnosis is
appropriate without an opportunity to observe and evaluate the child's
behavior, mood, and functional status. In such cases documentation must clearly
support the individual's level of functioning based on disability as defined in
paragraph (A) of this rule.
(C)
Duration-there must be documented evidence of the child's functional disability
as defined in subsection (A) of this section for a period of ninety (90) days
prior to provisional admission.
(D)
Provisional admission shall not exceed ninety (90) days. Immediately upon
completion of the ninety (90) days, or sooner if the individual has been
determined to have an eligible diagnosis as indicated in subsection (A) of this
section, the diagnosis must be documented and he/she may continue to receive
services in the program.
(E) If a
child who was provisionally admitted is determined to be ineligible for CPR
services, staff shall directly assist the individual and/or family in arranging
follow-up services needed. Arrangements for follow-up services must be
documented in the discharge summary.
(F) All admission documentation is required
for those provisionally admitted with the exception of the comprehensive
assessment which may be deferred for ninety (90) days.
(8) The CPR program shall ensure individuals
receive the most appropriate care and treatment available. Transferring an
individual to another service, from a community program to a hospital, hospital
to a community program, or to another CPR program consistent with individual
needs, may be considered to obtain necessary care and treatment.
(A) Written procedures shall ensure exchange
of information within five (5) days when an individual is referred or
transferred to another service component within the organization or to an
outside provider for services. Policies and procedures must ensure-
1. Applicable records, portions of records,
and other information are readily transferable and handled in compliance with
state and federal confidentiality regulations; and
2. Timely follow-up is made with the
alternate CPR program or service provider.
(B) Policies and procedures stipulate the
conditions under which referrals are made, such as the need for special
services not provided by the current CPR program or the need for ancillary
services which will contribute to the well-being of the individual.
(C) Policies and procedures shall assure
continuity of care among referring providers including prior inpatient
hospitalization, residential support, and outpatient psychiatric and/or
substance use disorder treatment.
(D) A current resource directory of area
community service agencies must be readily available to individuals and family
members/ natural supports for referral purposes and upon request by the
public.
(9) The CPR
program shall coordinate with providers of inpatient psychiatric care to assure
continuity of services for eligible individuals returning to the community.
This includes active participation of community support staff in discharge
planning for the individual.
(A) Policies and
procedures shall ensure individuals engaged in CPR have a documented
consultation with a community support specialist within five (5) days of
discharge from inpatient psychiatric care, including active follow-up within
five (5) days for individuals who fail to keep their appointment.
(10) The CPR program shall
implement written policies and procedures to ensure individuals who miss a
scheduled appointment for services or whose absence is unanticipated are
contacted by a community support specialist or other staff person providing
their services/supports. The procedures shall establish time frames for
contacting individuals, consistent with clinical needs and the seriousness of
their disability, not to exceed forty-eight (48) hours.
(11) The CPR program shall provide equal
opportunity to individuals with disabilities in accordance with the Americans
with Disabilities Act.
(12) The
program shall have policies and procedures to ensure individuals determined
ineligible for CPR services are referred to other programs and services in the
community for which they may be eligible.
(13) The CPR program shall only admit
individuals who will benefit from services available. Individuals who have not
received services for a six- (6-) month period should be discharged from the
program.
(14) The CPR program shall
participate in coordination and liaison activities with the adult and juvenile
justice systems to-
(A) Promote effective
relationships with local law enforcement systems (including courts) through
training, education, and consultation;
(B) Educate law enforcement and court
officials, juvenile officers, and probation/parole personnel about services
offered by the CPR program; and
(C)
Provide CPR services, as capacity allows, to persons with serious mental
illness who are on probation/parole or in forensic aftercare by working with
probation/parole and juvenile officers and department forensic case monitors
within the limits of confidentiality.
(15) The CPR program shall participate in
coordination and liaison activities with federal, state, and local public
assistance agencies, housing agencies, and employment/vocational support
agencies to-
(A) Promote effective
relationships through training, education, and consultation;
(B) Educate staff about services offered by
the CPR provider; and
(C) Assist
individuals in seeking public benefits to expedite the application process and
maintain/regain their eligibility for assistance within the limits of
confidentiality.
