Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This amendment removes the department's
obsolete supported community living offices and stipulates the responsibilities
of administrative agents and affiliates for processing referrals and managing
admissions to adult community residential settings.
PURPOSE: This rule prescribes eligibility and
admission criteria, the application process, and notification procedures for
adult community residential settings funded by the Division of Behavioral
Health (DBH). This rule applies to administrative agents, affiliates, and
community residential settings.
(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 (DBH) residential services contract clearly requires
otherwise, the following other terms, as 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) Affiliate, an organization that is
contracted with the department to provide specific community psychiatric
rehabilitation (CPR) services for adults in a designated geographic
area;
(C) Applicant, an individual
for whom admission to a community residential setting has been requested;
(D) Charged consumer, an
individual who has been permanently determined to lack capacity to understand
the proceedings against him/her or to assist in his/her own defense under
section
552.020,
RSMo, for offenses the individual would otherwise have been required to
register as an offender on or after January 1, 1995, under sections
589.400
to
589.425,
RSMo;
(E) Charged consenting
consumer, a charged consumer whose guardian has given consent to the DBH
regional community operations office to disclose such legal charges against
his/her ward to other individuals (guardian, if appointed) who may or will be
residing with the charged consumer;
(F) 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 their
affiliates are responsible for providing these services to eligible individuals
in their designated service area(s);
(G) DBH-funded community residential setting
(used interchangeably in this rule with residential setting), living
arrangements in the community designated for adults who meet the admission
criteria specified in this rule. These settings include, but are not limited
to, Psychiatric Individualized Supported Living (PISL), Intensive Residential
Treatment Settings (IRTS), clustered apartments, residential care facilities,
assisted living facilities, and intermediate care facilities;
(H) Forensic client, a person who is a client
of the Division of Behavioral Health pursuant to sections
552.030
and
552.040,
RSMo;
(I) General notification,
written notification to an individual (guardian, if appointed) receiving DBH
funding in a residential setting or other community dwelling, such as an
apartment setting, of the potential to reside with a registered offender or
charged consumer;
(J) Regional
community operations, the DBH office responsible for overseeing DBH-funded
community residential settings in assigned regions of the state;
(K) Registered offender, a person who is
registered or will be registered by law enforcement upon discharge from a
DBH-oper-ated inpatient psychiatric facility or correctional facility pursuant
to sections
589.400
to
589.425,
RSMo; and
(L) Specific
notification, written notification to an individual (guardian, if appointed)
receiving DBH funding in a residential setting or other community dwelling,
such as an apartment setting, when a registered offender or charged consenting
consumer has been referred for admission to the same setting, as well as when a
registered offender or charged consenting consumer currently resides in the
same setting, regardless of whether the offender or charged consenting consumer
requires DBH funding. Specific notification is managed by the DBH regional
community operations office. Specific notification of a registered offender
includes the name of the offender, physical description, registerable
offense(s), associated date(s) of offense(s), and the name of the residential
setting where the offender is referred to or resides. The specific notification
of a charged consenting consumer includes the name of the charged consumer,
offense(s) and associated date(s) of offense(s), and the name of facility the
charged consenting consumer is referred to or resides.
(2) Forensic Clients. All forensic clients
shall have priority for admission to a DBH-funded residential setting
appropriate to their service and support needs.
(3) Individuals in DBH Inpatient Psychiatric
Facilities. All adults being served in a DBH inpatient psychiatric facility who
are referred to an administrative agent/affiliate shall receive priority
consideration for admission to a DBH-funded residential setting appropriate to
their service and support needs.
(4) Other Eligibility Criteria. An applicant
who does not meet the criteria of section (2) or (3) of this rule shall meet
all of the following criteria to be eligible for admission to a residential
setting:
(A) Be at least eighteen (18) years
of age;
(B) Qualify for admission
to a CPR program as specified in
9 CSR
30-4.005(6); and
(C) Have a mental disorder that constitutes
substantial impairment in social role functioning and daily living skills based
upon the clinical judgment of the administrative agent/affiliate, which must
include documentation that the individual cannot function successfully outside
a mental health facility without appropriate services and supports in a
community residential setting. Substantial impairment may include, but is not
limited to, the following behavioral characteristics:
1. Substantial need for mental health
treatment and social services;
2.
History of inability or unwillingness to participate in treatment, including
taking medications as prescribed;
3. Inadequate living skills to provide for
basic necessities of food, clothing, shelter, safety, personal care, and health
care without assistance;
4.
Inadequate social skills, which may be exhibited in aggressive or withdrawn
behavior;
5. Frequent personal
crises requiring emergency treatment or support and assistance;
6. Inability to effectively access community
services and supports;
7. Lack of a
personal support system (for example, family or other natural supports) to
assist in accessing services/sup-ports; and
8. Lack of sustained employment.
(5) Ineligible
Applicants. The administrative agent/affiliate's staff shall consider an
applicant ineligible for admission to a residential setting if-
(A) The primary diagnosis is a substance use
disorder, intellectual disability, or developmental disability;
(B) Medical needs supersede the psychiatric
disorder and require considerable supervision and ongoing treatment for a
medical condition;
(C) Risk of harm
to self or others is not manageable according to clinical judgment;
(D) The primary diagnosis is dementia;
or
(E) Appropriate services have
been established that are otherwise available through alternative
resources.
(6)
Screening. Applicants for admission to a residential setting shall be screened
by the administrative agent/affiliate to determine eligibility. Screenings
shall be conducted in settings that ensure privacy and confidentiality for
individuals served.
(7)
Eligibility Determination. The administrative agent/affiliate shall determine
if an applicant is eligible for admission to a residential setting. Priority
shall be given to individuals identified in sections (2) and (3) of this rule.
(A) The administrative agent/affiliate shall
communicate acceptance or denial of the application to the referral source.
Notification shall be documented and a record of the communication shall be
maintained by the administrative agent/affiliate.
(B) If an individual (guardian, if appointed)
disagrees with a decision of ineligibility for admission, he/she shall be
informed of the grievance process of the administrative agent/affiliate
managing the referral.
(8) Appropriate Residential Setting. Prior to
admitting an individual to a residential setting, the administrative
agent/affiliate shall ensure the setting meets the individual's needs.
(A) Each of the following shall be considered
to ensure the proposed residential setting is appropriate:
1. The best interest of the
individual;
2. The least
restrictive environment for care and treatment, consistent with needs of the
individual;
3. The capacity of the
proposed residential setting to provide necessary care and treatment for the
individual;
4. The relationships of
the individual to family, guardian, friends, and other natural supports and the
ability to maintain those relationships and encourage visits beneficial to the
individual; and
5. The preferences
of the individual (guardian, if appointed) in the residential setting
chosen.
(B) If a
residential care facility, assisted living facility, or intermediate care
facility is determined to be the appropriate residential setting for the
individual, the facility must be licensed by the department and the Department
of Health and Senior Services as specified in
9 CSR
40-1.055.
(9) Release of Information. The
administrative agent/affiliate staff shall obtain appropriate releases of
referral information signed by the individual (guardian, if appointed). The
administrative agent/affiliate staff shall submit the referral information to
the proposed residential setting including appropriate psychiatric, medical,
and social information.
(10)
Admissions. The administrative agent/affiliate shall follow DBH procedures to
manage admissions to residential settings.
(11) Notification Procedures. Department
requirements shall be followed for notifying individuals (guardians, if
appointed) referred to a residential setting who may reside with or may
themselves be a registered offender under sections
589.400
to
589.425,
RSMo, or charged consumer under section
552.020,
RSMo, for offenses they would otherwise have been required to register as an
offender under sections
589.400
to
589.425,
RSMo.
(A) The following procedures shall be
followed when an individual requiring DBH funding for housing or Intensive CPR
(ICPR) services is referred to or residing in a residential setting or other
community living arrangement, such as a single or multiple occupancy dwelling:
1. Prior to admission, a query with the
Missouri State Highway Patrol shall be completed by the administrative
agent/affiliate or DBH regional community operations office to verify the
referred individual's status as a registered offender. If the administrative
agent/affiliate manages the query, staff must comply with department policies
and procedures related to the offender query process;
2. Prior to admission, general notification
must be provided to each individual (guardian, if appointed) referred to inform
him/her of the potential to reside with a registered offender(s) or charged
consumer(s).
A. General notification to the
individual (guardian, if appointed) referred shall be issued by the
administrative agent/affiliate or DBH regional community operations office. If
the administrative agent/affiliate manages the general notification, staff must
comply with department policies and procedures related to the general
notification process. The general notice must be received by the individual
(guardian, if appointed) prior to admission to the residential
setting;
3. Specific
notification involving a registered offender will be issued by the DBH regional
community operations office.
A. The
administrative agent/affiliate shall notify the DBH regional community
operations office that specific notification is required when they refer a
registered offender requiring DBH funding to a residential setting, or the
individual being referred will be residing in the same residential setting as a
registered offender.
B. Specific
notification will be issued by the DBH regional community operations office
prior to the admission of each individual (guardian, if appointed) referred who
requires DBH funding and will be residing in the same setting as a registered
offender, regardless of whether the registered offender receives DBH
funding.
C. Specific notification
is also issued by the DBH regional community operations office prior to
admission of each individual (guardian, if appointed) requiring DBH funding in
a residential setting or dwelling when a registered offender is referred for
admission to the same setting, regardless of whether the referred offender
requires DBH funding.
D.
Individuals who require DBH funding shall not be admitted to the residential
setting or dwelling until the DBH regional community operations office
completes the specific notification process and notifies the administrative
agent/affiliate that the individual can be admitted; and
4. Specific notification of a charged
consenting consumer shall be issued by the DBH regional community operations
office to each individual (guardian, if appointed) referred who requires DBH
funding and will be residing in the same setting as a charged consenting
consumer, regardless of whether the charged consenting consumer receives DBH
funding.
A. The administrative
agent/affiliate shall notify the DBH regional community operations office that
specific notification is required if the administrative agent/affiliate is
aware the referred individual is a charged consumer, or if the referred
individual will be residing in the same setting as a charged consenting
consumer.
B. The DBH regional
community operations office will determine if the charged consumer (guardian,
if appointed) consents to release information of his/her charged status to
DBH-funded individuals residing in the residential setting or dwelling,
including the individual's name and nature and date(s) of the crime(s) for
which the charged consumer would have been required to register if he/she had
been convicted.
(I) Regardless of whether
consent to disclose these charges is obtained, the charged consumer may be
admitted to the residential setting or dwelling.
(II) If consent is obtained, the DBH regional
community operations office will send specific notification to DBH-funded
individuals referred to or residing in the residential setting or
dwelling.
C. Individuals
who require DBH funding shall not be admitted to the residential setting or
dwelling until the DBH regional community operations office completes the
specific notification process and notifies the administrative agent/affiliate
that the individual may be admitted.
(B) Offender notification procedures shall be
followed by DBH-contracted residential settings prior to admitting a registered
offender or charged consumer who does not receive services from an
administrative agent/affiliate or funding from DBH.
1. When a residential setting intends to
admit a registered offender, and the individual is not involved with an
administrative agent/affiliate and does not require DBH funding, staff of the
residential setting shall notify the DBH regional community operations office.
The notification must be prior to the individual's admission if DBH-funded
individuals currently reside at the residential setting. The DBH regional
community operations office will verify the registered offender's criminal
offense(s) and date(s) for which registration is required with the Missouri
State Highway Patrol.
2. When the
residential setting intends to admit a charged consumer, and the individual is
not involved with an administrative agent/affiliate and does not require DBH
funding, staff of the residential setting shall notify DBH. The DBH regional
community operations office will obtain records to verify the charged
consumer's name and nature of the crime(s) for which the charged consumer would
have been required to register if he/she had been convicted. Following
verification of individual's charged crime(s) and date(s), the DBH regional
community operations office will request consent of the charged consumer
(guardian, if appointed) to disclose his/her name and nature of the crime(s) to
individuals requiring DBH funding who are referred to or residing at the
residential setting. If consent is obtained, the individual is considered a
charged consenting consumer.
3. If
there are individuals funded by DBH who are referred to or residing at the
residential setting, specific notification procedures as specified in this rule
must be completed by the DBH regional community operations office prior to the
admission of a registered offender or charged consenting consumer.
4. Registered offenders or charged consumers
shall not be admitted to the residential setting until the DBH regional
community operations office completes the specific notification process and
notifies staff of the residential setting that the individual may be admitted.
A. If there are no individuals referred to or
residing at the residential setting who require DBH funding, notifications are
not required and the registered offender, charged consumer, or charged
consenting consumer may be admitted to the residential setting.
B. Staff of the residential setting shall
notify the DBH regional community operations office of the registered offender
or charged consumer's admission and discharge date. The department will provide
this information to the administrative agent/affiliate in the service area
where the residential setting is located.
(C) The administrative agent/affiliate shall
maintain a record of all DBH-funded and/or contracted residential settings in
their service area(s) where registered offenders and charged consenting
consumers are residing in order to inform DBH regional community operations
staff when specific notification is required.
(D) The administrative agent/affiliate shall
maintain a record of individuals receiving DBH funding in residential settings
and dwellings.
(12)
Prescribed Medication. At the time of admission to a residential setting, the
administrative agent/affiliate shall ensure the individual has access to
his/her prescribed medication.
(13)
Bedrooms. Individuals receiving DBH funding to live in a community residential
setting shall not share a bedroom with more than one (1) person unless the
administrative agent/affiliate provides adequate justification for other
arrangements to the DBH regional community operations office and prior approval
is granted for such arrangements.
(A) Single
occupancy bedrooms are required for clustered apartments, Intensive Residential
Treatment Settings (IRTS), and Psychiatric Individualized Supported Living
(PISL).
(B) Further restrictions
regarding sharing of bedrooms may be required based on individual needs,
preferences, and least restrictive environment considerations.
(14) Discharge. DBH funding for an
individual's personal needs and room and board shall be discontinued if there
are other sufficient financial resources to cover these costs.
*Original authority: 630.050, RSMo 1980, amended 1993,
1995.
