Licensing Procedures

PURPOSE: This rule describes the application and licensing process for community residential programs and day programs subject to licensure from the department, including Residential Care Facilities (RCF) and Assisted Living Facilities (ALF) dually licensed by the Department of Health and Senior Services (DHSS). 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) As set out in section 630.705, RSMo, each community residential program (hereafter referred to as residential program) or day program serving individuals with mental illness, intellectual disabilities, or developmental disabilities (IDD) shall have a license or program license from the department unless specifically exempted under section 630.705.3., RSMo. (2) The department issues the following types of licenses: (A) A license to operate a day program when the program serves individuals with a diagnosed mental illness or IDD; (B) A license to operate a residential program, including a group home or family living arrangement, when individuals with a mental illness or IDD diagnosis are being served in the program; (C) A program license to a residential program that is licensed under Chapter 198, RSMo, as a Residential Care Facility (RCF) or Assisted Living Facility (ALF) that serves any individual with an IDD or a majority of individuals with a mental illness diagnosis; and (D) A reciprocal license to a residential program licensed by the Department of Social Services (DSS) as a Residential Treatment Agency for Children and Youth. (3) Residential programs and day programs located at the same physical address, but separately licensed by the department, may share staff as long as each program independently meets applicable staffing requirements for the population being served. (4) A day program that is part of a Community Psychiatric Rehabilitation (CPR) program and is certified or deemed certified by the department under 9 CSR 10-7.130 and 9 CSR 30-4, will not be separately licensed by the department’s Office of Licensure and Certification. (5) An agency or individual may request to be licensed by completing the application form included herein and submitting the application and other documentation as specified. The application form can be downloaded from the department’s website https://dmh.mo.gov/media/pdf/applicationlicensure. Completed applications must be mailed to: Department of Mental Health, Office of Licensure and Certification, PO Box 687, Jefferson City, MO 65102, fax (573) 751-7815, or emailed to: DMHOLC@dmh.mo.gov. (6) An application for an initial license must be submitted not less than thirty (30) days prior to the opening date for a new residential program or day program. The application must be approved by department staff prior to a Division of Fire Safety inspection or department license inspection being scheduled. A diagram of the interior of the building(s), in approximate scale, and a narrative indicating how each area of the building will be used is required for first-time applicants. (A) Prior to new construction, remodeling an existing structure(s), or any structural alterations to an existing building, a copy of the plans must be submitted to the Office of Licensure and Certification for review and approval, including an explanation for utilizing each area of the building. The architect or contractor shall certify in writing the plans are in compliance with these licensing regulations. 1. Construction shall not begin until the plans have been reviewed and approved by the Division of Fire Safety. All plans for new construction, remodeling, and additions must comply with the 2010 Americans with Disabilities Act Standards for Accessible Design, hereby incorporated by reference and is published by and available from the U.S. Department of Justice, Civil Rights Division, 950 Pennsylvania Avenue NW, Washington, DC 20530, available at: https://www.ada.gov/regs2010/2010ADAStandards/2010ADAstandards.htm. This rule does not incorporate any subsequent amendments or additions to the regulations listed above. This rule does not prohibit programs from complying with regulations set forth in newer versions of the incorporated by reference material listed in this paragraph of this rule. 2. During the construction or remodeling process, an inspection of the framing, wiring, and rough-in wiring for the fire alarm system must be conducted by the Division of Fire Safety before the walls are enclosed. Failure to have these inspections constitutes cause for disapproval by the Division of Fire Safety. 3. An existing residential program or day program shall not increase the capacity of any room or total capacity of any building without meeting new construction requirements as specified in this rule. (7) The department issues a license to operate a residential program or day program serving any individual with an IDD or a majority of individuals with a mental illness if the applicant— (A) Has applied for a license from the department and paid the application fee; (B) Has not had a license or program license denied or revoked by the department; and (C) Is in compliance with applicable state laws and regulations, including the regulations established by the department pursuant to section 630.710, RSMo. (8) The department will issue a program license to a residential program that has a current, valid license from the Department of Health and Senior Services (DHSS) under Chapter 198, RSMo, as an ALF or RCF when the program serves any individual with an IDD or a majority of individuals with a mental illness, if the applicant— (A) Has applied for a license from the department and paid the application fee; (B) Has not had a license or program license denied or revoked by DHSS or the department; and (C) Is in compliance with applicable state laws and department licensing regulations as specified in 9 CSR 40-1.060 Program Administration and 9 CSR 40-1.075 PersonCentered Services. (9) The department will issue a reciprocal license to a residential program that has a current valid license as a Residential Treatment Agency for Children and Youth from the DSS under 13 CSR 40-71, if the applicant has applied for a license from the department and paid the application fee. (A) The department delegates its survey authority to the DSS, Children’s Division, for compliance with licensing rules as a Residential Treatment Agency for Children and Youth under 13 CSR 40-71. (10) The department recognizes and deems as licensed any residential program that is— (A) An Intermediate Care Facility (ICF) for Individuals with Intellectual Disabilities (ICF/IID) certified under Title XIX of the Social Security Act, 42 U.S.C. section 1396, and the regulations contained in 42 CFR part 442, as long as the facility remains certified; and (B) An ICF or Skilled Nursing Facility (SNF) licensed under Chapter 198, RSMo, and certified under Title XIX of the Social Security Act, 42 U.S.C. section 1396, and the regulations contained in 42 CFR part 442, as long as the facility remains certified. (C) The department does not issue a license to a residential program that meets the criteria for deemed status as specified in this section of this rule. (11) The department recognizes and deems as licensed a residential program or day program that maintains accreditation from CARF International, The Council on Quality and Leadership, The Joint Commission, or other accrediting body recognized by the department. (A) Accredited agencies must— 1. Submit a copy of the accrediting body’s survey report to the department within thirty (30) days of receipt, including verification of the accreditation time period and programs/services that are accredited; 2. Notify the department of any investigation by the accrediting body related to a complaint; 3. Notify the department of any changes in accreditation status during the time period of accreditation and resurvey; and 4. Ensure they are compliant with all department licensing regulations pertaining to service delivery and fire safety. (B) Deemed status may be revoked by the department if an agency fails to comply with the requirements outlined in paragraph (11)(A)1.-4. of this rule. (C) The department does not issue a license to an agency that meets the criteria for deemed status as specified in this section of this rule. (12) Agencies that are deemed as licensed by the department are not exempt from monitoring of service delivery practices, individual safety, or environmental conditions through other functions conducted by the department. (13) License fees are as follows and must be included with the individual/agency’s application for licensure from the department: (A) Ten dollars ($10) for residential programs and day programs that admit more than three (3) but less than ten (10) individuals; (B) Fifty dollars ($50) for residential programs and day programs that admit ten (10) or more individuals; (C) The fee is based on the total available capacity of the residential program or day program, not the number of individuals currently being served. The license fee is nonrefundable; and (D) The license fee does not apply to residential programs or day programs applying for a licensed capacity of three (3) or fewer individuals or to residential programs or day programs owned and operated by a government entity. (14) The department considers an application for licensure to be active for no more than for Community Residential Programs and Day Programs one (1) year. If the department does not issue a license or program license within one (1) year from the date of application, the applicant must submit a new application with the applicable fee, if necessary, to be considered for licensure. (15) A license is issued for a period of one (1) year unless it is revoked by the department prior to the expiration date. The department provides each licensee with a renewal notice at least one hundred twenty (120) business days prior to expiration of the existing valid license. (16) The licensee shall submit the application for a license for a succeeding year to the department at least ninety (90) business days before the expiration date of its current license. (17) If the licensee does not apply for a renewal license within at least ninety (90) business days before the expiration date of the license, the department will notify the director of the program that it is not authorized under Missouri law to serve individuals with mental illness or IDD without a license. (18) If an application for a license is not submitted to the department at least thirty (30) business days prior to the expiration of an existing valid license, department staff will notify the program director that the program will not be licensed after the expiration date of the license. A copy of the letter will be provided to applicable areas of the department and to any state or local government agencies with the potential to be affected by the program’s non-licensed status. (19) If the department has reasonable grounds to believe a residential program or day program required to be licensed under sections 630.705–630.760, RSMo, is operating without a license, the department will attempt to investigate to determine whether a license is required. If department staff are not permitted access to inspect the program, or if the program director refuses to permit access for an inspection, the department will apply to the circuit court of the county in which the program is located for an order authorizing entry for such inspection. (20) If the department has not completed its license inspection before the expiration date of a current license and the applicant is not at fault for the delay, a temporary operating permit, not to exceed ninety (90) business days, will be issued by the department in order to complete the survey. (A) An applicant seeking license renewal is at fault for reasons including, but not limited to: 1. The licensee did not apply for a new license or program license at least thirty (30) days prior to the expiration date of the existing license; 2. The department found the licensee to be out of compliance with its licensing requirements and the director of the program failed to achieve compliance prior to expiration of the license; and/or 3. The licensee refused to allow a license inspection by the department or otherwise to cooperate with the licensing survey team. (21) The department considers a change in agency ownership to have occurred under any of the following circumstances: (A) An individual licensee incorporates or forms a partnership; (B) A change in the majority interest of the partners, with respect to a licensee which is a general partnership; (C) A change in the majority interest of the general partners or in the majority interest of limited partners, with respect to a licensee which is a limited partnership; or (D) A change in the person(s) who owns, holds, or has the power to vote the majority of any class of stock issued by the corporation, with respect to a licensee which is a corporation. (22) The department may grant a temporary operating permit for a specified period of time, not to exceed ninety (90) business days, under the following circumstances: (A) To authorize continuity of services and allow department staff to evaluate an application for a license or program license as a result of any change in ownership of a residential program or day program; or (B) To determine compliance with applicable state laws and regulations, including the standards established by the department pursuant to section 630.710, RSMo, if the applicant— 1. Has applied for a license and paid the appropriate application fee; 2. Has not had a license or program license denied or revoked by the department; or 3. Is licensed by DHSS as defined in Chapter 198, RSMo, as an ALF or RCF, if applicable. (23) Each application for licensure must include the name and contact information of the director of the agency and the staff person in charge of administration of the residential program or day program. (24) The director of the residential program or day program shall cooperate with and assist authorized department staff or its representatives in making announced and unannounced licensing surveys by allowing access to the program’s premises, records, staff, and individuals served. (25) After receiving a complete application for an initial license or renewal license, department staff will conduct an on-site inspection of the residential program or day program to assess compliance with these licensing regulations. This may include, but is not limited to, interviews with agency and/or program staff and individuals served, a review of agency records, and observation of program activities and environmental conditions. (A) At the conclusion of the on-site license inspection, department staff will hold an exit conference with the program director and other relevant staff to discuss results of the inspection. (B) If the department determines the program is in compliance with the provisions of sections 630.705 through 630.760, RSMo, and these licensing regulations, a license or program license will be issued. (26) If the department determines an applicant or existing licensee is not in compliance with these licensing regulations at the time of the inspection, the applicant will be notified as follows: (A) The program director will be informed of the area(s) of noncompliance during the exit conference with department staff; (B) Within twenty (20) business days after completion of the on-site license inspection, a written report will be sent to the program director explaining the area(s) of noncompliance; (C) The licensing report will require the program director to submit a plan of correction to the department within twenty (20) business days of receipt; (D) The plan of correction shall address each deficiency cited in the report and include action steps and time frames for achieving compliance, including: 1. How program staff will identify individuals served, other staff, and/or maintenance areas potentially affected by the deficient practice(s); 2. How program staff will monitor corrective action taken, including measures or systemic changes to ensure the deficient practice(s) do not reoccur; for Community Residential Programs and Day Programs 3. The date when full compliance with licensing regulations will be achieved; and 4. The staff person(s) responsible for implementing the plan of correction in the program; (E) Within ten (10) business days following receipt of the program’s plan of correction, the department will issue written approval or disapproval of the plan to the program director; (F) Department staff will reinspect the program within sixty (60) business days after the original inspection to determine if deficiencies are being corrected as required in the approved plan of correction or any subsequent authorized modification. The reinspection may be conducted through a desk audit at the department’s discretion. 1. If the department determines the program is in compliance with licensing regulations, a license will be issued to the program. 2. If the department determines the program has not achieved compliance with licensing regulations or the program director is not correcting the noted areas of noncompliance in accordance with the approved plan of correction, the department will issue written notice of noncompliance to the program director by certified mail/return receipt requested; (G) The notice of noncompliance will inform the program director that the department may seek the imposition of any of the sanctions and remedies provided for in section 630.755, RSMo, or any other action authorized by law; and (H) The program director may choose to enter into a consent agreement with the department to obtain a probationary license. The consent agreement will include a provision that the program director shall voluntarily surrender the license if compliance is not reached in accordance with the terms and deadlines established under the consent agreement. The agreement will specify the stages, actions, and time span to achieve compliance with licensing regulations. (27) New applicants not licensed by the department and not currently serving individuals with mental illness or IDD that fail to correct a deficieny(cies) and submit a plan of correction or otherwise cooperate with the licensing process, will not be formally denied a license. The application will be allowed to expire and considered withdrawn. (28) The department license is issued for the residential program or day program location and the individual, partnership, association, corporation, or governmental entity named on the application. The license is not valid for programs operated by the same agency that are located on different premises. (29) The license issued by the department to the day program or residential program must be posted in a conspicuous place on the premises. (30) The department maintains a directory of all licensed residential programs and day programs and posts the directory on its public website. (31) The department or its authorized representatives may conduct announced or unannounced inspections during a licensure year to determine compliance with its licensing regulations in identified areas of focus. If the residential program or day program is found to be out of compliance with department licensing requirements, the license or program license will be revoked if the program does not achieve compliance as specified by the department. (32) The department may deny a new application or a renewal application for licensure or revoke an existing license if a residential program or day program fails to comply with sections 630.705—630.760, RSMo, and corresponding licensing regulations and fails to submit and/or implement an approved plan of correction as described in section (26) of this rule. (A) Prior to the formal notice of license denial or revocation, the department will send a written notice of its intent to deny/revoke and the reasons for such action to the program director by certified mail/return receipt requested. The program director shall have ten (10) business days from the date of receipt to request a review by the department’s hearing administrator. The review shall occur within fifteen (15) business days of the department’s receipt of the request for a hearing from the program director. (B) The review by the department’s hearing administrator is not applicable when a license was denied or revoked due to substantiated abuse, neglect, or misuse of funds/property pursuant to 9 CSR 10-5.200, 9 CSR 10-5.206, and 19 CSR 30-88.010. (C) The written notice of license revocation or denial shall be effective not less than thirty (30) business days from the date of mailing by certified mail/return receipt requested or of personal service of the notice upon the licensee. The effective date of license revocation or denial will be included in the department’s notice to the program director. (D) The notice of revocation or denial shall inform the applicant or licensee of the right to seek a determination of the revocation or denial by the Administrative Hearing Commission as set out in sections 621.045, 621.189, and 621.193, RSMo, and the right to stay the department’s action pending the determination under rules promulgated by the Administrative Hearing Commission unless, upon application of the department, the commission finds that continued operation before final determination by the commission would present an imminent danger to the health, safety, or welfare of any individual, or likelihood that death or serious injury would result. (E) The department will notify DHSS and DSS within ten (10) business days of revoking or denying a program license. (33) As set out in section 630.750, RSMo, if the department finds a licensed residential program or day program is not in compliance with any licensing regulation(s) which presents either an imminent danger to the health, safety, or welfare of any individual or a substantial probability that death or serious physical harm would result, and the area(s) of noncompliance is not immediately corrected, the department director shall issue a notice of noncompliance to the program director and initiate the procedures set out in section (32) of this rule to deny or revoke the program’s license. (34) The director of a residential program or day program may withdraw an application for a license or program license any time during the inspection process by submitting written notification to the department attesting it does not meet the criteria for licensing. (35) At any time after a department licensing inspection is conducted, the director of a residential program or day program may choose to enter into a consent agreement with the department to obtain a probationary license. The consent agreement shall include a provision that the program director shall voluntarily surrender the license if compliance is not reached in accordance with the terms and deadlines established under the agreement. The agreement shall specify the actions and time schedule to achieve compliance with these licensing regulations. (36) A residential program or day program may ask for a waiver of a licensing requirement(s) by submitting a request to the department’s Exceptions Committee as specified in for Community Residential Programs and Day Programs AUTHORITY: sections 630.050, 630.135, and 630.705, RSMo 2016.* Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed March 14, 1984, effective Aug. 15, 1984. Amended: Filed July 15, 1985, effective Feb. 1, 1986. Amended: Filed March 18, 1987, effective Aug. 15, 1987. Amended: Filed Jan. 2, 1990, effective June 11, 1990. Emergency amendment filed Sept. 15, 1992, effective Oct. 1, 1992, expired Jan. 28, 1993. Amended: Filed Sept. 15, 1992, effective April 8, 1993. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, effective March 30, 1996. Amended: Filed May 14, 2020, effective Dec. 30, 2020. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008; 630.135, RSMo 1980; and 630.705, RSMo 1980, amended 1982, 1984, 1985, 1990, 2000, 2011, 2014.