Procedures to Obtain Certification

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 traumarelated disorders; B. Licensed and credentialed professionals with expertise and specialized training in the treatment of co-occurring 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 departmentapproved training on suicide prevention; and F. Clinical staff who have completed departmentapproved training on smoking cessation. (4) The department shall certify, as a result of a certification MENTAL HEALTH 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 sections (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; and 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; and 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 noncompliance, 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. MENTAL HEALTH 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 twentyfour (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. AUTHORITY: sections 630.050 and 630.055, RSMo 2016.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001. Amended: Filed Sept. 25, 2002, effective April 30, 2003. Amended: Filed March 3, 2003, effective Sept. 30, 2003. Amended: Filed Nov. 5, 2018, effective June 30, 2019. Amended: Filed April 11, 2023, effective Oct. 30, 2023. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008, and 630.055, RSMo 1980.