Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This amendment updates the admission process
for children's supported community living.
PURPOSE: This rule prescribes admissions criteria,
the application process, and placement procedures for Children's Supported
Community Living (SCL) funded by the Division of Behavioral Health. This rule
applies to administrative agents.
(1) Definitions. Terms defined in sections
630.005 and
632.005, RSMo, shall
be used in the interpretation and enforcement of this rule. Unless the Division
of Behavioral Health's (DBH) supported community living (SCL) contract clearly
requires otherwise, the following other terms used in this rule shall mean:
(A) Administrative agent, an organization and
its approved designee(s) authorized by the department as an entry and exit
point into the state mental health service delivery system for a geographic
service area defined by the department;
(B) Applicant, a minor for whom placement services in
SCL has been requested;
(C) Chief
of Children's Community Operations (CCCO), DBH staff who oversee services and
supports for children and youth in assigned regions of the state;
(D) Community psychiatric rehabilitation
(CPR), an array of community-based, outpatient mental health services for
children, youth, and adults who have been diagnosed with a severe, disabling
mental illness or serious emotional disturbance. Administrative agents or
affiliates are responsible for providing these services to eligible individuals
in their designated service area(s);
(E) Domicile administrative agent, the
service area in which a child's legal guardian resides or, if the child is
under the jurisdiction of a juvenile court, the service area of the juvenile
court that has assumed jurisdiction of the child;
(F) Regional community operations, the DBH
office responsible for processing SCL placement funds for the administrative
agent(s) in that region; and
(G)
SCL placement, placement of a child/youth who has a diagnosed serious emotional
disturbance (SED) into an out-ofhome setting when determined clinically
necessary by staff of the referring administrative agent. These settings
include Professional Parent Homes (PPH), Treatment Family Homes (TFH), and
residential treatment facilities where services are provided to address the
psychosocial and medical needs of youth with the goal of moving them into a
less restrictive level of care.
(2) Application for SCL. The application for
placement in SCL shall be made by the child's parents/legal guardian by
completing the application form included herein. The application shall be
submitted to the administrative agent overseeing the child's care.
(3) Eligibility Criteria. Children's SCL is a
time-limited placement resource for children/youth under the age of eighteen
(18) who have been determined by administrative agent staff to be eligible for
clinical treatment services in a PPH, TFH, or residential treatment facility
due to a demonstrated inability to function in any less restrictive setting.
(A) Exceptions for SCL services for
individuals up to age twenty-one (21) may be granted by the CCCO in the
domicile county/region where the youth resides.
(B) Children/youth requiring SCL shall have
been diagnosed with a SED as specified in
9 CSR
30-4.005(7) unless an exception is
granted by the CCCO. These children may be unable to consistently function in a
public school, may present a chronic runaway risk, and may present a history of
emotional dysregulation which may include physical aggression toward self
and/or others.
(4)
Ineligible Applicants. Children/youth shall be considered ineligible for SCL
if-
(A) There is no primary psychiatric
diagnosis as specified in
9 CSR
30-4.005(6);
(B) The child has a medical condition that
requires considerable supervision and ongoing treatment which inhibits
effective clinical treatment for his/her psychiatric disorder;
(C) It has been established that appropriate
services are otherwise available through alternative resources;
(D) The application is submitted solely for
the purpose of securing residential placement for a school-aged child as
defined in Chapter 162, RSMo, to receive an appropriate education; or
(E) The child's symptoms meet acute
definition.
(5)
Screening. Applicants for admission to SCL shall be screened by staff of the
administrative agent to determine eligibility for services and placement need,
if any. Screenings shall be conducted in settings that ensure privacy and
confidentiality for individuals served.
(6) Registered Sex Offenders and Youth
Identified on the Juvenile County Registry.
(A) Youth who are identified on the Missouri
State Highway Patrol Sex Offender Registry shall not be placed in a youth
residential treatment facility. Placement in a TFH or PPH may be considered if
other children residing in the home, in any capacity, are over the age of
eighteen (18) and do not have a diagnosed intellectual or developmental
disability. Requirements for the proximity of the TFH or PPH to a school,
childcare facility, public park, or public swimming pool as defined in the
department's out-of-home placement protocol shall be followed.
(B) For a youth who is identified as a
juvenile sex offender on the juvenile county registry, placement in a TFH or
PPH may be considered if all of the other individuals residing in the home, in
any capacity, are over the age of eighteen (18) and do not have a diagnosed
intellectual or developmental disability. There shall be no one under the age
of eighteen (18) in the home, including the provider's natural, adopted, or
other children living in the home. Placement can be made in a residential
facility as long as the requirements in the department's out-of-home placement
protocol are followed and clinical judgment is exercised.
(C) If a registered sex offender or
identified juvenile sex offender is being considered for SCL, the
administrative agent shall comply with the department's established out-of-home
placement protocol and notification procedures.
(7) Notification to the Applicant. The
administrative agent shall communicate acceptance or denial of the application
to the child's parent/guardian. Notification shall be documented and a record
of the communication shall be maintained by the administrative agent.
(A) If the parent/guardian disagrees with a
decision of ineligibility for admission, they shall be informed of the
grievance process of the administrative agent managing the referral.
(8) Appropriate Placement. Before
placing a child in SCL, the administrative agent shall consider each of the
following:
(A) The best interest of the
child;
(B) The least restrictive
environment for care and treatment consistent with needs and conditions of the
child;
(C) The capacity of the
proposed residential setting to provide necessary care and treatment for the
child which is of comparable quality to existing care and treatment based upon
investigation of the alternative facility and its program of care and
treatment; and
(D) The relationship
of the child to family, guardian, or friends/natural supports and the ability
to maintain those relationships and encourage visits beneficial to the child.
(9) Consent for
Placement.
(A) If the applicant is a minor or
has a legal guardian, the administrative agent shall obtain consent of the
parent or guardian before placement.
(B) If the application is for a child who is
an involuntary commitment under Chapter 211 or Chapter 632, RSMo, the
administrative agent shall notify the court of competent jurisdiction of the
proposed placement and allow ten (10) working days for the court to object.
(C) Notwithstanding the provisions
of sections
211.151,
211.161,
and
211.181,
RSMo, and any other provision of law contrary to this section, the juvenile
court may not order that children be detained by, committed to, or otherwise
placed in the Department of Mental Health for periods longer than thirty (30)
days except as provided in sections
211.201
to
211.207,
RSMo.
(10) Release of
Information. The administrative agent shall obtain appropriate releases of
referral information signed by the parent or guardian. The referral information
shall include appropriate psychiatric, medical, and social
information.
(11) Admission
Procedures. If the administrative agent approves the applicant for admission
into children's SCL, staff shall follow DBH procedures for admission.
(A) A staff person of the administrative
agent shall be assigned to coordinate services with the child and his or her
parents/guardian, family members/natural supports, and other agencies, as
appropriate.
(B) Administrative
agent staff shall assist the child's parent/guardian in applying for Medicaid
and submitting verification of the application to the designated DBH regional
community operations office.
(C)
Selection of the SCL provider shall be coordinated with the child's
parent/guardian, including an interview and pre-place-ment visit with the
proposed provider, as appropriate.
(D) The administrative agent shall maintain
documentation in the child's record regarding his/her placement in SCL
including, but not limited to:
1. Signed
acknowledgement of notice of privacy and practices;
2. SCL application form;
3. Results of the comprehensive clinical
assessment;
4. Evaluation including
diagnosis, IQ test results (if available), current level of functioning,
recommended services/sup-ports and psychosocial history within the past six (6)
months performed by a qualified mental health professional;
5. Educational evaluation and school records,
including cumulative record, diagnostic summary, individualized education plan
(IEP) or 504 plan, or documentation from the home school district that the
child does not have an IEP or 504 plan;
6. Immunization record;
7. Physical examination by a licensed
healthcare provider within the past six (6) months, including any laboratory
tests or imaging ordered;
8.
Document of legal guardianship or copy of birth certificate, divorce decree, or
court order verifying custody, as applicable;
9. Completed and scored standard means
test;
10. Notice of cost;
11. Consent agreement for SCL services (must
be signed by the parent/legal guardian and staff of the administrative agent
managing the placement);
12.
Notification of change report, including any co-payment from any other
source(s) and/or ancillary funds associated with the placement such as personal
spending allowances, transportation assistance, or special needs (must be
submitted to the designated DBH regional community operations office within
five (5) calendar days after the placement is made); and
13. Juvenile sex offender background check
and Missouri State Highway Patrol sex offender background check.
(E) Copies of the documentation
specified in paragraph (11)(D)1.-13. of this rule shall be sent to the SCL
provider prior to or at the time of the child's admission to the program. This
information shall be available for review by department staff and other
authorized representatives upon request.
(F) Within five (5) calendar days of the
child's placement in SCL, the administrative agent shall provide the DBH
regional community operations office with completed copies of the SCL
application, consent and agreement to SCL, notice of change, standard means
test, notice of cost, and face sheet, including the child's demographic
information and diagnosis.
(12) Out-of-Region Placements. All referrals
and placements with a children's SCL provider outside the administrative
agent's designated service area shall be managed by the domicile administrative
agent, including funding for such placements.
(A) Staff of the domicile administrative
agent shall provide continued monitoring of the child to ensure appropriate
services are provided, including participating in monthly treatment team
meetings, reviewing assessment/evaluation information and progress reports, and
participating in discharge planning to ensure continuity of services when the
child is placed back into his/her domicile region.
(B) The administrative agent shall notify the
DBH domicile region CCCO of any out-of-region placements to ensure the SCL
provider is addressing the child's needs and meeting department contract
requirements.
(C) The domicile
administrative agent shall send the documentation specified in paragraph
(11)(D)1.-13. of this rule to the out-of-region SCL provider prior to or at the
time of the child's admission to the program.
(13) Inpatient Psychiatric Placements.
Referrals to a DBH inpatient psychiatric facility shall be made directly by the
domicile administrative agent.
(A) The
administrative agent shall inform the DBH domicile region CCCO when such
referrals are made.
(B) Upon
placement into the DBH facility, the domicile CCCO shall notify the CCCO in the
region where the inpatient psychiatric facility is located.
(C) Staff of the domicile administrative
agent shall monitor the child's clinical care by participating in monthly
treatment team meetings, reviewing assessment/evaluation information and
progress reports, and participating in discharge planning to ensure continuity
of services when the child is placed back into his/her domicile
region.
(14) Service
Delivery. Responsibilities of the administrative agent overseeing the child's
care and treatment while in SCL shall include, but are not limited to:
(A) Ensuring the child's parent/guardian is
advised of all appropriate services and placement resources in order to give
informed parental consent, including the opportunity to interview staff and
tour residential treatment programs;
(B) Facilitating and participating in
development of the child's treatment plan for residential services to ensure
the plan includes measurable goals, participating in treatment plan reviews and
discharge planning, and maintaining a copy of the treatment plan in the
administrative agent's clinical record;
(C) Documenting the child's progress on a
monthly basis, at a minimum, to ensure he/she is safe, healthy, and progressing
in clinical treatment, including the addition of measureable actions and steps
to address any concerns noted in regard to his/her achievement of treatment
goals;
(D) Assuring appropriate
services are provided to the child;
(E) Communicating with the parent/guardian,
court, and/or other agency staff involved in the child's services and supports,
as applicable;
(F) Coordinating and
assisting in securing necessary clothing, personal items, and transportation,
if needed, in accordance with personal spending guidelines;
(G) Coordinating and assisting in obtaining
needed services, such as medical care and outpatient psychiatric
services;
(H) Arranging for
hospitalization for appropriate psychiatric services, if needed;
(I) Arranging for transfer to another
residential treatment provider, if needed;
(J) Reporting any issues or concerns to the
DBH regional CCCO;
(K) Ensuring
personal spending is consistent with the child's needs as identified in the
treatment plan;
(L) Ensuring there
is progress toward achievement of individual and family-based goals identified
in the treatment plan, which may include pursuing other treatment options if
progress is not occurring; and
(M)
Ensuring discharge planning begins at the time of admission and the discharge
plan has clear objectives consistent with the overall goals identified in the
individual treatment plan, and that necessary coordination and linkages with
appropriate family members/natural supports and community resources are
included and documented in the plan.
(15) Funding. Funding for SCL will be
approved by the CCCO or designee for an applicant based on the-
(A) Applicant's acceptance by a proposed SCL
provider; and
*Original authority: 630.050, RSMo 1980, amended 1993, 1995
and 630.705, RSMo 1980, amended 1982, 1984, 1985, 1990.
