Recovery Support Programs

PURPOSE: This rule describes the certification and service delivery requirements for recovery support programs. 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) Program Description. Recovery support programs offer individuals recovery support services such as care coordination, spiritual and group counseling, life skills training, recovery housing, and transportation assistance, before, during, after, or independent of substance use disorder treatment provided by an organization certified by the department. These services are offered in a multitude of settings including, but not limited to, community support groups, faith-based organizations, and self-help and peer recovery groups. Recovery support programs are person-centered, allowing individuals the opportunity to direct his/her recovery process. (2) Types of Programs. Certification is available for the following types of recovery support programs and services: (A) Care coordination. Care coordination consists of assisting individuals with accessing the network of services and other community resources available to facilitate retention in substance use disorder treatment and/or sustained recovery. This may include, but is not limited to, consultation with the individual’s treatment provider, procurement of medication for a mental and/or substance use disorder through charitable programs, assistance in finding and securing permanent housing, development of a social support system, and when funded by the department, bus passes to eligible individuals. A care coordination service provider shall meet the following requirements: 1. Services shall be provided by recovery support program staff; 2. Services shall include, but are not limited to: A. Arranging, referring, and when necessary, advocating for quality services to which the individual is entitled; B. Monitoring provider service delivery and ensuring communication among service providers; C. Locating and coordinating services specific to crisis resolution; and D. Training in resource acquisition; (B) Peer recovery drop-in center. Peer recovery drop-in center service emphasizes building peer relationships to help support personal choice(s), respect, and recovery. A peer recovery drop-in center shall meet the following requirements: 1. Each center shall be managed by a Missouri Recovery Support Specialist or Missouri Recovery Specialist – Peer as designated by the Missouri Credentialing Board; 2. Each center shall be staffed with a minimum of eighty percent (80%) staff and volunteers who are in recovery from a substance use disorder or co-occurring mental and substance use disorder; 3. The drop-in center shall create a home-like environment, including a living room type space with chairs, couches, and lighting for informal conversation, and a separate space for group meetings; 4. The drop-in center shall provide coffee, tea, or other free or low-cost beverages and may offer free or low-cost healthy food items; 5. The drop-in center shall offer recreational activities that induce social interaction, such as playing cards and other games, as well as the opportunity to participate in formal peer counseling and structured life-skill building groups; 6. The drop-in center shall provide a physically and emotionally safe environment that is accessible on foot or through public transportation; otherwise, the program shall provide or arrange for alternative transportation; 7. The drop-in center hours of operation shall be geared to the needs of individuals and include evening and weekend hours, at a minimum five (5) days per week for four (4) hours per day; 8. Drop-in center services shall be voluntary, free of charge, and free of expectations of length of participation; 9. A calendar of groups meetings, educational opportunities, and recreational activities shall be posted and updated at least monthly; and 10. Drop-in center services shall provide information on and coordination with social service support agencies in the community, as well as traditional behavioral health and physical health care service providers; (C) Recovery coaching. Recovery coaching offers the individual support to develop proactive recovery-oriented problem solving skills for the future. A recovery coaching program shall meet the following requirements: 1. Recovery coaching shall be offered before, after, or concurrently with any department-funded certified substance use disorder treatment program; 2. Recovery coaching shall be a one-to-one service delivered face-to-face or, with department approval, through telehealth; 3. Recovery coaching shall not be considered a substitute for services delivered by a certified substance use disorder treatment program; 4. Recovery coaching shall be provided by a Missouri Recovery Support Specialist or a Missouri Recovery Support Specialist - Peer as designated by the Missouri Credentialing Board; and 5. Recovery coaching services and activities shall include, but are not limited to: A. Helping individuals connect with peers and their communities to develop a network for information and support; B. Sharing experiences of recovery, including the use of recovery tools, and modeling successful recovery behaviors; C. Helping individuals make independent choices and taking a proactive role in their recovery; D. Assisting individuals with identifying strengths and personal resources to aid in setting and achieving recovery goals; and E. Conducting periodic recovery management check-ups and assessing victories, strengths, challenges, and setbacks; 6. Wellness coaching is recovery coaching that focuses on the relevant physical health factors previously identified by the individual as problematic, including: A. Low levels of physical activity/sedentary lifestyle; B. Use of tobacco and other addictive substances; C. Lack of nutrition and dietary education; D. Diet and glucose monitoring for diabetes prevention and management; E. Oral hygiene/dental health practices; and/or F. Use of medications which contribute to metabolic syndrome, obesity, and other health conditions; 7. Employment coaching is recovery coaching that assists individuals in finding and maintaining competitive and gainful employment and may include, but is not limited to: A. Assisting in identifying tasks and activities geared toward career exploration and planning; B. Assisting with job searching and preparation; and/or C. Assisting in the development of self-management skills, interpersonal skills for the workplace, social and communication skills, and job maintenance; (D) Spiritual counseling. Spiritual counseling helps individuals explore problems and conflicts from a spiritual perspective. Spiritual counseling shall meet the following requirements: 1. Services shall be provided by qualified clergy. A qualified clergy is defined as an ordained clergy by a recognized religious organization with at least one (1) of the following credentials: A. Missouri Recovery Support Specialist (MRSS); B. Missouri Recovery Support Specialist-Peer (MRSS-P); C. Certified Alcohol Drug Counselor (CADC); D. Certified Reciprocal Alcohol Drug Counselor (CRADC); E. Certified Reciprocal Advanced Alcohol Drug Counselor (CRAADC); F. Recognized Substance Abuse Professional (RSAP); G. Certified Criminal Justice Professional (CCJP); H. Physician; I. Licensed Professional Counselor (LPC); J. Licensed Marriage and Family Therapist (LMFT); K. Licensed Clinical Social Worker (LCSW); or L. Licensed Psychologist; 2. Religious organization shall mean that defined in 352.400.1(5), RSMo. 3. The individual’s spiritual beliefs, morals, ideas, values, and conflicts shall be explored in a safe and non-judgmental manner; and 4. Spiritual counseling services shall include one (1) or more of the following: A. Establishing or re-establishing a relationship with a higher power; B. Developing personal connectedness with a spiritual, religious, or faith-based entity; C. Acquiring skills needed to cope with life-changing incidents; D. Adopting positive values or principles; E. Identifying a sense of purpose and mission for one’s life; F. Achieving serenity and peace of mind; G. Finding life purpose; H. Overcoming emotional, social, mental, or physical obstacles; and/or I. Putting pain and grief into perspective; (E) Support, educational, or life-skills groups. Support, educational, or life-skills groups provide support for individuals in recovery by offering encouragement and connections with others who share similar experiences. Support, educational, or life-skills groups shall meet the following requirements: 1. Group services shall address recovery, employment, spiritual, and/or wellness issues relevant to the needs of the individuals served; 2. Groups may be formed around shared identity such as common cultural or religious affiliation, shared experiences, and/or goals such as community re-entry following incarceration, HIV status, or challenges in parenting; 3. Group sessions may consist of the presentation of general information and application of the information to participants through group discussion designed to promote recovery and enhance social functioning; 4. Support group services shall include, but are not limited to: A. Classroom-style didactic lecture to present information about a topic and its relationship to substance use disorders and recovery; B. Presentation of educational audiovisual materials with required follow-up discussion; C. Promotion of discussion and questions about the topic presented to the individuals in attendance; D. Generalization of the information and demonstration of its relevance to recovery and enhanced functioning; E. Facilitating disclosure of issues that permits generalization of the issue to the larger group; F. Promoting positive help-seeking and supportive behaviors; and G. Encouraging and modeling productive and positive interpersonal communication; 5. A support, educational, or life-skills group session shall include a qualified facilitator and at least two (2) but no more than thirty (30) individuals per group in order to promote participation; (F) Transportation. Transportation services assist individuals enrolled in a certified recovery support program or substance use disorder treatment program in achieving and sustaining recovery goals when they do not have the means to provide personal transportation. Transportation services shall meet the following requirements: 1. Transportation shall be limited to specific destinations and/or appointments as defined by the department. Allowable transportation services shall include: A. To and from a certified substance use disorder treatment program; B. To and from a certified recovery support program; C. To and from a doctor’s appointment, dental appointment, or appointment with other healthcare providers; D. To and from probation and parole, court, or other criminal justice agencies; and E. To and from employment-seeking activities and/or active employment; 2. Staff or volunteers who provide transportation services shall meet the background screening requirements in 9 CSR 10-5.190 and hold a class E chauffeur’s license, or if transporting more than fifteen (15) passengers, a CDL license; 3. The vehicle used for transportation shall be currently licensed, properly insured, and provide safe and reliable transportation for individuals served; 4. Staff or volunteers who provide transportation shall have access to a communication device in the vehicle at all times; (G) Recovery housing. Recovery housing is a direct service that provides supervised, short-term housing to individuals with substance use disorders or co-occurring mental and substance use disorders. Recovery housing services shall meet the following requirements: 1. To be eligible for recovery housing, the individual shall be participating in a department certified and funded substance use disorder treatment program or recovery support program; 2. Recovery housing levels of support and supervision shall include one (1) of the following: A. Peer-run: At least weekly house meetings facilitated by staff; or B. Monitored: At least a daily monitoring visit by staff; or C. Supervised: twenty-four- (24-) hour supervision of individuals by staff, with a minimum of three (3) different staff members providing supervision per twenty-four- (24-) hour period; 3. Each recovery housing provider that offers the selfpay option to individuals served shall have written rental agreement policies and procedures that include, but are not limited to: A. An explanation of the housing arrangements shall be posted in all housing units; B. The grounds for termination of the rental agreement; C. The terms of the agreement shall be established and explained to each individual at admission to housing services; and D. If an individual enters into a rental agreement for housing with the recovery support organization, a signed copy of that rental agreement shall be kept in the individual record; 4. Recovery housing properties shall— A. Provide proof of an initial successful Housing Quality Standards (HQS) inspection conducted by an HQS inspector; B. Provide proof of a successful annual fire inspection; and C. Provide proof of meeting all local government occupancy/safety requirements such as an occupancy permit, zoning approval, and/or other correspondence showing approval from the local municipal or county governing body; 5. Recovery housing properties inspected and approved as meeting standards of a state/local/regional/national provider organization such as the National Association of Recovery Residences shall be exempt from requirements in paragraph (2)(G)4. of this rule. (3) Specialized Services. Recovery support programs that specialize in serving minority or other populations with unique recovery needs may tailor individual and group services to address specific needs. These specialized populations, services, and philosophies may be combined in multiple ways to include, but not be limited to: (A) Employment; (B) Faith and spiritual beliefs; (C) Housing; (D) Offender re-entry; (E) Peer supports; and (F) Wellness. (4) Program Certification. Certification is required for a recovery support organization to obtain and maintain a contract with the department, to participate in department programs eligible for Medicaid reimbursement, and to serve individuals whose referral sources require the provider to be certified by the department. Organizations accredited under standards of care for recovery support services by the National Association of Recovery Residences (NARR), the Council on Accreditation of Peer Recovery Support Services (CAPRSS), the local affiliates of NARR or CAPRSS, or other entity recognized by the department may be eligible for certification through deeming. Certification or deemed status does not constitute an assurance or guarantee that the department or other entity will fund or utilize designated services or programs. (A) An organization seeking certification or deemed status as a recovery support program shall comply with certification requirements set forth in 9 CSR 10-7.130, as well as all department rules and standards contained herein. (B) The following core rules for psychiatric and substance use disorder treatment programs shall be met by recovery support programs: 1. 9 CSR 10-7.010 Treatment Principles and Outcomes; 2. 9 CSR 10-7.020 Rights, Responsibilities, and Grievances; 3. 9 CSR 10-7.040 Quality Improvement; 4. 9 CSR 10-7.050 Research; 5. 9 CSR 10-7.060 Behavior Management; 6. 9 CSR 10-7.070 Medications; 7. 9 CSR 10-7.080 Dietary Service; 8. 9 CSR 10-7.090 Governing Authority and Program Administration; 9. 9 CSR 10-7.100 Fiscal Management; 10. 9 CSR 10-7.110 Personnel; 11. 9 CSR 10-7.120 Physical Plant and Safety; 12. 9 CSR 10-7.130 Procedures to Obtain Certification; 13. 9 CSR 10-7.140 Definitions. (C) The following general program procedures shall be met by recovery support programs: 1. 9 CSR 10-5.190 Background Screening for Employees and Volunteers; 2. 9 CSR 10-5.200 Report of Complaints of Abuse, Neglect, and Misuse of Funds/Property; 3. 9 CSR 10-5.206 Report of Events; 4. 9 CSR 10-5.210 Exceptions Committee Procedures; 5. 9 CSR 10-5.220 Privacy Rule of Health Insurance Portability and Accountability Act of 1996 (HIPAA); and 6. 9 CSR 10-5.230 Hearings Procedures. (D) The following department rules and standards shall be waived for recovery support programs unless the department determines that a specific requirement is applicable due to the unique circumstances and service delivery methods of a particular recovery support program: 1. 9 CSR 10-7.030 Service Delivery Process and Documentation; 2. 9 CSR 30-3.100 Service Delivery Process and Documentation; and 3. 9 CSR 30-3.110 Service Definitions and Staff Qualifications. (5) Staff. Qualified staff shall be available in sufficient numbers to ensure effective service delivery. (A) All staff and volunteers of recovery support programs shall meet background screening requirements in 9 CSR 10-5.190. The Missouri Department of Health and Senior Services Family Care Registry or other department-approved background screening service shall be used. (B) All staff and volunteers who have contact with individuals receiving services shall, at a minimum, meet departmentapproved qualifications and complete six (6) hours of annual training on ethics and professional boundaries. The six (6) hours of annual ethics and boundaries training shall apply to the required thirty-six (36) hours of training, every two (2) years, for personnel as referenced in 9 CSR 10-7.110(2)(E)1. (C) Training activities shall be documented in each employee’s personnel file and shall include the training topic, name of instructor, date(s) of training, certification/continuing education units, and location. (D) Former recipients of services who transition to staff and volunteer roles shall have been in continuous personal recovery from a substance use disorder or co-occurring mental and substance use disorder for a period equal to or greater than twelve (12) months. Continuous personal recovery shall mean the individual— 1. Has not used any illegal drugs; 2. Has not used any physician-prescribed medication in a non-prescribed way; 3. Has not used any over-the-counter medication except for its intended use; 4. Has abstained from all use of alcohol; and 5. Is successfully managing their mental illness. (E) All staff and volunteers of a certified recovery support program shall adhere to the Missouri Recovery Support Specialist (MRSS) Code of Ethics, or if functioning in a peer role, Missouri Recovery Support Specialist - Peer (MRSS-P) Code of Ethics, January, 2016, incorporated by reference, without any later amendments or additions, as published by the Missouri Credentialing Board, 428 E. Capitol Avenue, Jefferson City, MO 65101. (F) The recovery support program shall establish and consistently implement policies and procedures to guide the roles and activities of volunteers and staff in an organized and productive manner. (G) Minimum qualifications for supervision of staff and volunteers include holding any of the following credentials: qualified substance abuse professional (QSAP) as defined in 9 CSR 10-7.140(2)(RR); Licensed Professional Counselor (LPC); Licensed Marriage and Family Therapist (LMFT); Licensed Clinical Social Worker (LCSW); Licensed Psychologist; qualified clergy as defined in paragraph (2)(D)1. of this rule; or a director of a certified recovery support program. Acceptable supervision shall include a minimum of one (1) hour every month of face-to-face individual or group supervision. (6) Admission Criteria. The criteria for admission to a recovery support program shall include at least one (1) of the following: (A) The individual has a current substance use disorder or co-occurring mental and substance use disorder as identified in the screening and assessment process outlined in section (8) of this rule; (B) The individual is in recovery from a substance use disorder or co-occurring mental and substance use disorder and in need of services as identified in the screening and assessment process outlined in section (8) of this rule; or (C) The individual is re-entering the community from a correctional facility and has a prior history of a substance use disorder or co-occurring mental and substance use disorder. (7) Treatment Goals. Successful outcomes for individuals participating in recovery support services include, but are not limited to: (A) Obtaining and maintaining sobriety; (B) Minimizing the risk of relapse; (C) Improving family, natural support, and social relation ships; (D) Improving employment/educational functioning; (E) Promoting productive use of time; (F) Developing social support; (G) Developing spiritual support; (H) Developing safe and stable housing; (I) Complying with all legal, court, probation, or parole requirements; (J) Minimizing harmful social or behavioral risk; and/or (K) Improving physical health and wellness. (8) Screening, Assessment, and Recovery Plan. Each individual participating in recovery support services, as defined in this rule, shall be subject to a screening, an assessment, and the development of an individualized recovery plan. (A) Screening. Each individual requesting a recovery support service(s) shall have prompt access to a screening to determine eligibility, substance use and/or co-occurring mental and substance use disorder history, and recovery needs. The screening shall— 1. Be conducted by a recovery support program and/or substance use disorder treatment program certified by the department; 2. Be conducted by trained staff; 3. Be responsive to the individual’s requests and needs; and 4. Include written notice to the individual regarding service eligibility and an initial course of action. If indicated, the individual shall be linked to other appropriate services and resources in the community. Referrals to other community resources shall include active care coordination to ensure the individual accesses appropriate supports. (B) Assessment. Each individual requesting a recovery support service(s) shall participate in a recovery-oriented assessment that identifies his/her needs and goals, guides the development of an individualized recovery plan, and ensures engagement in appropriate recovery services. The participation of family and other natural supports and collateral parties (e.g., referral source, employer, other community agencies) in the assessment and development of the recovery plan shall be encouraged, as appropriate, and based upon the wishes of the individual. 1. The assessment shall be conducted by an organization certified by the department as a substance use disorder treatment program or a recovery support program. 2. The assessment shall be completed by a person who meets established criteria for a qualified substance abuse professional (QSAP) as defined in 9 CSR 10-7.140(2)(RR). 3. The assessment shall be completed within thirty (30) days of initial contact with the recovery support program. This time period does not include weekends and holidays observed by the state of Missouri. A. If an individual is determined to have active or a severe substance use disorder, mental illness, or co-occurring mental and substance use disorder, presents symptoms of intoxication, impairment or withdrawal, cannot achieve abstinence without close monitoring, or requires structured support and daily supervision, he or she shall be referred to a certified substance use disorder treatment program or certified community mental health center for services. B. The recovery support program may provide interim services for individuals with severe substance use, mental illness, or a co-occurring mental and substance use disorder while he/she is waiting for higher intensity services. 4. Documentation of the screening and assessment shall include, but is not limited to, the following: A. Demographic and identifying information; B. Needs, goals, and expectations from the person requesting services; C. Presenting situation/problem and referral source; D. History of previous and current psychiatric and/or substance use disorder treatment; E. Wellness screening; F. Current medications and medication allergies; G. Alcohol and drug use history, including duration, patterns, and consequences of use; H. Current psychiatric symptoms; I. Family, social, legal, vocational and educational status, and functioning; J. Current use of resources and services from other community agencies; and K. Personal strengths, including family and other natural supports, social, peer, and recovery history. 5. The recovery support program shall actively coordinate other services and make appropriate referrals to ensure the safety and well-being of individuals with severe substance use, mental illness, physical health conditions, or other basic needs. (C) Individualized Recovery Plan. The individualized recovery plan shall reflect the person’s unique needs and goals with a focus on integration and inclusion in his/her community, building healthy relationships with family and other natural supports systems, and accessing other community supports. Services may begin before the assessment is completed and the recovery plan is fully developed. 1. Each individual participating in a recovery support program shall actively participate in the creation of a recovery plan within thirty (30) days of admission to the recovery support program. A qualified substance abuse professional and other member(s) of the individual’s recovery team shall also participate in development of the recovery plan. 2. The recovery plan shall guide ongoing service delivery and shall be signed by the individual. 3. The recovery plan shall be based on the individual’s initial screening and assessment as well as an assisted selfassessment of his or her goals and the strengths and capacities that he or she will use or rely upon to achieve these goals. 4. Service needs beyond the scope of the recovery support program that are being addressed by referral to or coordination with another community organization shall be included in the recovery plan. 5. Progress toward achievement of recovery goals shall be reviewed on a periodic basis to ensure the plan reflects current issues and maintains relevance for the individual. Each individual shall directly participate in regular reviews and updates of their recovery plan and shall sign the review. (9) Organized Record System. Each recovery support program shall have an organized record system for each individual that receives recovery support services. (A) Records shall be maintained in a manner that ensures confidentiality and security. The organization shall abide by all local, state, and federal laws and regulations concerning the confidentiality of records. (B) If records are maintained on a computer system, there shall be a backup process in place to safeguard records in the event of operator or equipment failure and to ensure security from inadvertent or unauthorized access. (C) The recovery support program shall retain individual records for at least six (6) years from the date of service or until all litigation, adverse audit findings, or both, are resolved. (D) The recovery support program shall assure ready access to all records, including computerized records, by authorized staff and other authorized parties including department staff. (10) Documentation. Services funded by the department shall be entered in the department-approved electronic record system. Services documented shall be legible, clear, complete, accurate, and recorded in a timely fashion not to exceed twenty-four (24) hours from service delivery with indelible ink, print, or approved electronic record system. (A) Entries shall be dated and authenticated by the staff member providing the service, including name and title. Any errors on paper documentation shall be marked through with a single line, initialed, and dated. (B) There shall be documentation of services provided and results accomplished. (C) Individual service notes and group logs shall include: 1. Description of the specific service provided; 2. The date and actual time (beginning and ending times) the service was rendered; 3. Name and title of the person who rendered the service; 4. The setting in which the service was rendered; 5. The relationship of the services to the recovery plan; and 6. Description of the individual’s response to the service provided. (D) Where applicable, the record shall also include documentation of referrals to other services or community resources and the outcome of those referrals, signed authorization to release confidential information, missed appointments and efforts to re-engage the individual, urine drug screening or other toxicology reports, and crisis or other significant events that may impact the recovery process. AUTHORITY: section 630.050, RSMo Supp. 2013, and section 630.055, RSMo 2000.* Original rule filed on April 4, 2016, effective Oct. 30, 2016. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008 and 630.055, RSMo 1980.