Missouri Code of State Regulations
Title 9 - DEPARTMENT OF MENTAL HEALTH
Division 45 - Division of Developmental Disabilities
Chapter 5 - Standards for Community-Based Services
Section 9 CSR 45-5.010 - Certification of Home and Community-Based Providers Serving Persons with Intellectual and Developmental Disabilities
Universal Citation: 9 MO Code of State Regs 45-5.010
Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule defines terms, establishes principles, and sets out the process by which agencies providing individualized supported living (ISL), group home, shared living, day habilitation, individualized skills development, community networking, out-of-home respite, intensive therapeutic residential habilitation, and employment services to individuals with intellectual and developmental disabilities through the Medicaid Home and Community-Based Waiver (HCBS) attain certification.
PUBLISHER'S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.
(1) The Division of Developmental Disabilities (division) establishes procedures under which a provider of Medicaid home and community-based waiver services to individuals with intellectual or developmental disabilities attains certification. In establishing those procedures, the division makes the following assumptions:
(A) An individual with an intellectual or
developmental disability and the individual's family can best determine the
services the individual wants and needs;
(B) The division and the provider collaborate
to provide quality services and supports that effectively and efficiently meet
needs of individuals with intellectual or developmental disabilities within the
contexts of the individual's expressed needs;
(C) Through ongoing monitoring, individuals
with intellectual or developmental disabilities and their families are best
positioned to determine the quality of the individual's services and supports
and the effectiveness of the services and supports in meeting their
needs;
(D) The certification
process is flexible and person-centered and serves three (3) critical purposes-
1. To determine how well providers fulfill
their responsibilities to individuals with intellectual or developmental
disabilities;
2. To determine
systems changes and practices needed so that the provider will be more
responsive to the individual's needs; and
3. To enhance inclusion and
self-determination of individuals with intellectual or developmental
disabilities as valued members of their communities;
(E) Providers shall subscribe to and meet all
principles in this rule. The division shall enforce those principles;
and
(F) A residential or day
program that attains certification from the division to deliver Medicaid Home
and Community-Based Waiver services is not subject to the requirements of 9 CSR
40-1 Licensing Rules.
(2) Terms defined in sections 630.005 and 633.005, RSMo, are incorporated by reference for use in this rule. As used in this rule, unless the context clearly indicates otherwise, the following terms also mean-
(A) Department-unless otherwise specified,
the Department of Mental Health (DMH);
(B) Individual-a person who has been found
eligible for services with the Division of Developmental Disabilities;
and
(C) Provider-any entity or
person under contract or applying for a contract with the Department of Mental
Health (DMH) to serve individuals with intellectual or developmental
disabilities funded by general revenue or through home and community-based
waivers administered by DMH.
(3) Providers certified under this rule shall comply with 42 CFR 441.301, January 2014, hereby incorporated by reference and made a part of this rule as published by and available in the Code of Federal Regulations, Office of Federal Register, National Archives and Records Administration, 7 G Street NW, Suite A-734, Washington, DC 20401, (201) 741-6000. 42 CFR 441. 301 ensures individuals served have full access to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree of access as individuals not receiving Medicaid HCBS. This rule does not incorporate any subsequent amendments or additions to this publication.
(4) This section prescribes eight (8) sets of principles for providers serving participants of any HCBS waiver operated by DMH.
(A)
Individuals are integrated in and have access to the greater community.
1. Individual's decisions are
respected.
2. Individuals are
supported in being active participants in the community.
3. Individuals have knowledge of or access to
information regarding age-appropriate activities reflective of their interests,
needs, and preferences.
4.
Individuals are supported in participating in nondisability-specific
activities/functions that are not limited to individuals with
disabilities.
5. Individuals are
supported in participating in cultural and ethnic activities that reflect their
interests and preferences.
6.
Individuals are supported in learning to use and have ready access to public
transportation, if available in their community.
7. Individuals are supported in attending
religious services and worshiping as they choose.
8. Individuals are supported in regularly
receiving and visiting family, friends, or other community members.
9. Individuals are supported by persons who
are knowledgeable and respectful of their wants, needs, and
preferences.
10. Individuals are
able to come and go in the community in accordance with their wants, needs, and
preferences.
11. Individuals are
supported in their efforts to further their education and skill development, in
the area and manner of their choice.
(B) Individuals are provided with
opportunities to seek employment and work in competitive integrated settings,
engage in community life, and control personal resources.
1. Individuals are supported in participating
in competitive integrated employment opportunities of their choice within the
community.
2. Individuals are
assisted in obtaining employment in a setting that is non-disability-specific
and fully integrated into the community.
3. Individuals are supported in obtaining
employment in a setting that is located among other private businesses and
facilitates integration with the greater community.
4. Individuals are supported in obtaining
employment in a setting which encourages interaction with the public.
5. Individuals who work in provider owned and
controlled employment settings have knowledge of or access to information
regarding competitive work outside of the setting.
6. Individuals are supported in obtaining
employment in settings physically accessible and which do not limit
individuals' mobility or freedom of movement in the workplace, including access
to bathrooms and break rooms.
7.
Individuals are supported in self-advocacy activities in the
workplace.
8. Individuals are
supported in making decisions and exercising autonomy to the greatest extent
possible. Individual's decisions are respected.
9. Individuals are supported in obtaining
employment with wages and benefits, including but not limited to medical
benefits, annual leave, sick leave, and retirement programs, to the same extent
as individuals not receiving Medicaid-funded HCBS.
10. Individuals seeking employment services
are given informed choice of available providers and setting options from which
to choose.
11. Employment services
are provided in a manner and setting that reflects the individual's wants,
assessed needs, and preferences, taking into account the individual's skills,
capabilities, and aptitudes.
12.
Individuals are supported in developing and maintaining relationships with
coworkers.
13. Individuals are
supported by staff who are knowledgeable about the individual's capabilities,
interests, preferences, and needs related to employment.
14. Individuals are supported in making a
budget, which takes into account the individual's financial goals.
15. Individuals are supported in making
informed choices related to working, earning, spending, and saving.
16. Individuals are supported in controlling
their personal finances/resources.
17. Individuals are supported in becoming
financially independent.
(C) Individuals receive services in the
community to the same degree of access as individuals not receiving
Medicaid-funded HCBS.
1. Individuals who
receive specialized supports receive them in a place or manner typical for all
other community members.
2.
Individuals are supported in living, working, and participating in activities
located in settings that are integrated into the community and consistent with
their interests.
3. Individuals are
provided community options in order to make informed choices of how and where
they receive their services and their choices are honored.
4. Individuals are supported in finding
living arrangements that are non-disability-specific and fully integrated into
the community, which they can afford with their own income.
5. Individuals are supported in learning
transportation skills and are transported safely.
6. Individuals' environments are secure,
stable, and physically accessible to the individual.
(D) The residence is selected by the
individual from among setting options including non-disability specific
settings.
1. Individuals are supported and
given informed choice in selecting settings to receive Medicaid Waiver services
that are reflective of the individual's wants, needs, and
preferences.
2. Individuals are
given the opportunity and choice to reside in community settings with
individuals not receiving Medicaid Home and Community-Based Services.
3. The setting is physically accessible
without obstructions that limit individual mobility in the setting.
4. Individuals own, rent, or occupy, under a
legally enforceable agreement, their own specific unit/dwelling. A copy of the
lease, residency agreement, or other written agreement is maintained.
5. Individuals' residences are
located among other residences that facilitate integration with the greater
community.
6. Individuals'
residences are indistinguishable from other residences, for example the use of
yard signs or other advertisement should not be used which distinguish the
setting as disability specific.
7.
Individuals are supported in opening their homes to interact with community
members of their choice.
8.
Individuals have freedom to move about inside and outside of their residence
and are not restricted to or from any areas or rooms within their
residence.
9. Individuals have full
access to the typical facilities in a home such as a kitchen, dining area,
laundry, bathroom, and living room.
10. Individuals have choice with whom they
live and how to furnish and decorate their home.
(E) Individuals are assured the right of
privacy, respect, and freedom from coercion and restraint.
1. Individuals' right to personal privacy,
dignity, and respect is ensured and supported.
2. Provider policy, procedure, and practices
shall protect and promote the rights of each individual.
3. Each individual's privacy is respected in
their sleeping or living unit, as determined by the individual.
4. In provider owned and/or controlled
residential settings, the following applies:
A. Units have entrance doors lockable by the
individual, with only appropriate staff having keys to doors; and
B. Individuals sharing units have a choice of
housemates in that setting.
5. Individuals are informed both orally and
in writing, in a manner that the individual understands, of their rights in
accordance with sections
630.110 and
630.115, RSMo, and
9 CSR
45-3.030, and responsibilities and advocacy resources,
documented in writing and signed by the individual or guardian, as applicable.
Notification is made prior to or upon receiving services and annually
thereafter. Receipt is acknowledged in writing.
6. Individuals are supported by staff who are
knowledgeable and trained annually, with documentation of the training, on
individual rights in accordance with sections
630.110 and
630.115, RSMo, and
9 CSR
45-3.030.
7. Annually, individuals shall be given
information written or communicated in a format understood by the individual on
how to file a grievance with the provider or complaint with the
department.
8. Individuals are
supported by not having limitations imposed on their rights without due
process, as required by
9 CSR
45-3.030.
9. Individuals are supported in an
environment where they are free to communicate privately with whom they
choose.
10. Individuals have access
to telephones appropriate to their needs and accessible at all times.
Individuals are able to make and receive calls privately.
11. Individuals who are unable to open or
read their own mail are supported by staff to whom they have given
consent.
12. Individuals are
supported by staff who are trained annually in identifying, preventing,
detecting, and reporting abuse and neglect.
13. Abuse and neglect are prohibited by
provider policy and procedures. Providers follow their policies and procedures
and ensure action is taken to protect individuals who report abuse or
neglect.
14. Individuals are
supported in planning and participating in discussions regarding their
lives.
15. Individuals are
supported by staff who are knowledgeable of the provider policies on
confidentiality and the Privacy Rule of Health Insurance Portability and
Accountability Act of 1996 (HIPAA) Health Information Protection. Staff shall
maintain all information about individuals in confidence and shall not share
information about individuals without consent.
16. Individuals have access to their records
and are supported in maintaining their records where they choose. Staff shall
assist them as needed in reviewing records and answering questions.
17. Individuals are supported in environments
that support their dignity. Signs shall not be posted in easily visible areas
describing information about the individual that is private or
confidential.
18. Individuals are
supported in their activities of daily living in a manner that is dignified and
respectful;
19. Individuals are
supported in making decisions and not persuaded through the use of
intimidation, force, or threats;
20. Individuals are not treated differently
or retaliated against for exercising his/her rights.
21. Individuals are free from mechanical,
physical, and chemical restraints.
(F) Individual initiative, autonomy, and
independence are optimized in making life choices.
1. Individuals' needs and preferences are
honored. Individuals' right to choice and self-determination are
respected.
2. Individuals are
supported in a manner that meets the individual's expressed wants, needs, and
preferences.
3. Individuals
determine the quality and the effectiveness of the services and supports in
meeting their needs.
4. Individuals
are supported in their efforts to be active members of the community.
5. Individuals are encouraged to interact
with members of the community both inside and outside their home.
6. Individuals are supported in dressing and
grooming consistent with personal preferences.
7. Individuals are supported in carrying out
activities of daily living, including dressing, eating, and grooming, in a
manner that enhances their self-esteem and self-worth.
8. Individuals receive supports in a manner
that promotes positive involvement in the community.
9. Individuals have the option to participate
in political activities of their choice in the community.
10. Individuals have the freedom and support
to control their own schedules and activities and have access to food at any
time.
11. Individuals are
supported, and assistance provided as needed, to furnish and decorate their
sleeping and living units as they choose.
12. Individuals are encouraged and supported
in developing and sustaining friendships and family relationships.
13. Individuals are supported in developing
intimate relationships of their choice.
14. Individuals are supported in their
efforts to have social contact with the same people and have repeated
opportunities for social contact with the same people or groups of
people.
15. Individuals are
supported in their efforts to be involved in activities at times which take
into consideration their wants, needs, and preferences.
16. Individuals are supported by staff who
emphasize to others their abilities and interests.
17. Individuals are able to have visitors of
their choosing at any time.
18.
Individuals have the option to join and be supported in assuming roles in
community organizations.
19.
Individuals have the option to join and be supported in assuming roles in
religious organizations.
20.
Individuals have the option to and are supported in volunteering and helping in
the community.
21. Individuals are
informed and assisted in determining how they would like to make decisions
about their health care, and whether or not they would like anyone else to be
involved in those decisions.
22.
Individuals with limited ability to communicate are supported by persons
knowledgeable of how they communicate physical needs, how they communicate
emotional and psychological needs.
23. Individuals are supported in an
environment where individuals engage in positive, acceptable
interactions.
24. Individuals are
self-aware and use personal competencies; and
25. Individuals are offered training and
ongoing support in developing their self-advocacy skills.
(G) Individuals are supported in making
choices regarding services and supports and who provides them.
1. Individuals choose the services and
supports they want and need.
2.
Individuals are provided options in a manner that allows informed choice in
selecting who their provider of services will be and their choices are
honored.
3. Individuals are
provided options in manner that allows informed choice in selecting settings to
receive Medicaid waiver services that are reflective of the individual's wants,
needs, and preferences, and their choices are honored.
4. Individuals have choice in selecting their
own health care providers to meet their needs.
5. Individuals participate in making
decisions about their health care and their decisions are recognized and
supported.
6. Individuals' personal
preferences are supported.
(H) Individuals are assured their basic needs
will be met.
1. Individuals are supported by
staff who are knowledgeable of, have access to, and who provide services in
accordance with their current Individualized Support Plan (ISP).
2. Individuals have the right to receive
physical, emotional, and mental health care from the practitioner of their
choice.
3. Individuals obtain
routine medical and preventative medical care at intervals typical for the
individual's gender, age, and condition.
4. Individuals obtain dental, hearing, and
vision exams, and follow-up treatment as recommended by their
practitioner.
5. Individuals
requiring specialized medical services have access to specialists.
6. Individuals are supported in accessing
their physician or medical care consistent with their wants, needs, and
preferences.
7. Individuals are
supported in eating a diet which honors individual choice and meets nutritional
needs.
8. Individuals who have a
specialized diet, prescribed to meet identified healthcare needs of the
individual, are informed of the reason for the diet and consent to the diet.
Orders for specialized diets are reviewed at least annually by a registered
dietician, the individual's physician, physician assistant, or advanced
practical nurse (APN). Direct care staff shall be trained by either a dietician
or registered nurse in the preparation and implementation of the diet prior to
providing independent direct care services. Individual choice shall be honored.
Providers may elect to have management staff trained as a trainer for non-nurse
delegated diets.
9. Individuals are
educated about and supported in choosing to participate in wellness activities
and fitness programs, both in their home and in their community.
10. Individuals' health is protected through
measures typically taken to prevent communicable diseases for persons with
similar health status. Individuals shall be supported by persons who are
knowledgeable of infection control practices through annual training.
11. Individuals are educated about the
purpose, benefits, risks, and side effects of all prescribed medications and
treatments, to assist them in making informed choices about their health care.
Individuals are respected in their decision to refuse medication and
treatment.
12. Individuals are
supported in taking medications, receiving treatments, and utilizing adaptive
equipment as prescribed.
13.
Individuals are encouraged and supported in learning to safely manage and
self-administer their medications as reflected in their ISP.
14. Individuals' medications are reviewed
annually by their physician to determine their continued effectiveness. The
provider shall develop an effective system of medication administration,
including monthly review of the medication system by a registered
nurse.
15. Staff who assist in the
system of medication administration shall be certified as a DD Medication Aide
or be a licensed nurse or pharmacist. Individuals and staff shall be
knowledgeable of the individuals' medical conditions and possible side effects
of medication.
16. Individuals
receive the necessary services, supports, and degree of supervision consistent
with the personal abilities of the individual and in accordance with their
ISP.
17. Individuals' homes and
other environments are clean, safe, and well maintained.
18. Individuals are supported in obtaining
living arrangements that are safe and take into account their physical
abilities.
19. Individuals' homes
and environments are modified and/or adapted to meet identified needs as
described in ISPs and are based upon assessments to ensure safety and
mobility.
20. Individuals' homes
and other environments comply with federal, state, and local building and
environmental codes.
21.
Individuals' safety is assured through preventive maintenance of vehicles,
equipment, and buildings.
22.
Individuals have the opportunity to assist in maintaining their home.
23. The temperature of individuals' homes is
determined by the individuals who live there. Homes shall have heating and air
conditioning equipment capable of maintaining temperatures within a comfortable
range for the individual.
24. In
situations in which individuals do not have the ability to regulate water
temperatures or have a physical or health condition that makes self-regulation
unsafe, water temperatures are not to exceed 120 degrees Fahrenheit at the
point of use.
25. Individuals are
supported in responding to emergencies in a safe manner.
26. Individuals are supported by staff
knowledgeable about emergency procedures, as included in the provider's written
procedures and any additional expectations as indicated in the individual's
ISP.
27. Individuals participate in
emergency drills (tornado, earthquake, intruder) occurring during daytime,
evening, and sleep hours at least four (4) times annually. Individuals
participate in fire drills at least four (4) times annually, including one
during sleep hours. Documentation of drills shall be maintained.
28. Individuals shall have access to adequate
evacuation exits which are appropriate to their abilities and an unobstructed
path of egress to safety.
29.
Individuals shall have access to at least one (1) fire extinguisher on each
floor of the home. At least one (1) fire extinguisher shall be accessible in or
near the kitchen area. All fire extinguishers shall have an expiration date or
maintenance tag/documentation and indicator of charge. The fire extinguisher
shall have directions for use on the equipment and shall be within the
expiration date.
30. Individuals'
homes shall have operable smoke detectors on each level of the home, including
basements. Detectors shall be located in or near each bedroom and in proximity
to the area where an individual or staff sleep. Smoke detectors shall be placed
in the home according to manufacturer's recommendations.
31. Individuals have adaptive emergency alarm
systems based upon need.
32.
Individuals' homes which utilize gas appliances and/ or have an attached garage
shall have operable carbon monoxide detectors on each level of the home,
including basements.
33.
Individuals have the option to take first aid and cardiopulmonary resuscitation
training and have access to basic first aid supplies.
34. Staff shall maintain current first aid
and cardiopulmonary resuscitation (CPR) certification for healthcare providers
through training using curricula that is comparable to National Safety Council,
American Red Cross, or American Heart Association. Training shall include
hands-on practice and in-person skills assessment. Online-only certification is
not acceptable. Individuals are provided first aid and cardiopulmonary
resuscitation by knowledgeable staff, in accordance with their written advance
directive.
35. Each provider shall
have written policies and procedures approved by the department regarding
medical emergencies. Such policies and procedures shall include-
A. Protocol for initiating 911 emergency
call;
B. Protocol for use of CPR
and first aid;
C. Instructions for
staff and individuals on how to respond to an incapacitated person;
and
D. A system for ensuring
emergency response drills on the emergency protocol are conducted at least
every six (6) months for all staff.
36. Individuals experiencing events that meet
reportable event criteria shall have those events reported to the department,
per 9 CSR
10-5.206.
37. Individuals and staff who support them
have access to current contact information for family, guardians, or other
interested parties identified by the individual.
38. Storage of materials necessary for
household maintenance should be stored according to safety standards for the
item itself as well as according to supports specified in the ISP. If there are
restrictions, the individual shall be given due process.
39. Staff use and individuals are supported
to use safe and sanitary practices in food storage, preparation, and
cleanup.
40. Individuals who need
assistance to eat are provided needed supports and adaptations, as identified
in the ISP.
41. Individuals use
mechanical supports only as prescribed. Individuals are supported by staff who
are knowledgeable of use of the supports as addressed in the ISP.
42. Individuals are supported in the use and
maintenance of adaptive, corrective, mobility, orthotic, and prosthetic
equipment, as addressed in the ISP. Individuals and staff are trained in
purpose, use, and maintenance of the equipment.
(5) Every two (2) years, all agencies shall seek certification under this section except that agencies accredited by nationally recognized accrediting bodies approved by the division shall not be required to seek certification. The division director shall issue two- (2-) year certificates to agencies successfully completing the process and requirements.
*Original authority: 630.655, RSMo 1980.
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
