Provider Requirements and Program Structure

PURPOSE: This rule specifies the licensing and program requirements for family living arrangements (FLA). (1) Regulations. In addition to the requirements of this rule, providers of family living arrangements (FLA) shall comply with 9 CSR 40-1 unless specified otherwise in this rule. (2) Licensure Requirements. Applicants for licensure to provide services and supports in a FLA must have documentation of ownership of their home or, if renting, documentation of a current lease agreement and approval from the landlord to provide family living arrangements. (A) Each applicant must— 1. Be twenty-five (25) years of age or older; 2. Have at least a high school diploma or equivalent certificate; 3. Successfully complete all background screenings required by the department, including out-of-state background screenings and/or reference checks, if he or she has resided in Missouri for less than five (5) years; 4. Submit to a home study, an interview and selection process, and licensure by the department; and 5. Have safe, reliable transportation and appropriate insurance as required by Missouri laws. (B) Providers must complete specialized training required by the department. Training must be documented as specified in 9 CSR 40-1.060(4)(E). (3) Fire Safety. FLA providers shall comply with 9 CSR 40-1.090 Fire Safety and Emergency Preparedness, with modifications as specified: (A) Subsection (1)(A), Division of Fire Safety inspection is waived; (B) Subsection (1)(D), evacuation routes do not need to be posted in the home. Documented training and education on safe exit from the home shall be provided for individuals served. Training and education must be documented, including dates and signature of provider; and (C) Subsection (1)(M), notification and documentation from the local fire authority is waived. (4) Program Structure. FLA providers will be trained, supervised, and supported by staff of the referring/administering agency. FLA providers may serve one (1) to three (3) individuals in the home. (A) FLA providers have a primary role in the therapeutic interventions and supports provided to the individual(s) served and will be responsible for implementing the individual treatment plan (ITP) or individual support plan (ISP). (B) Placement, duration, and intensity of services and supports will be based on admission criteria established by the department. (C) Individuals served shall have the opportunity to participate in daily family and community life, including services and activities such as religious affiliation (if desired), physical activities, shopping, and volunteering in accordance with their ITP or ISP. (D) Supervision of individuals served shall be provided as specified in their ITP or ISP. (E) Services and supports provided must be documented as required by the department. (F) Providers shall maintain contact with staff of the administering/referring agency and the individual’s parents/ guardian and other family members/natural supports as specified in the ITP or ISP and as required by the department. (G) Provider(s) shall participate in pre-placement meetings and ongoing meetings with the individual’s support team or treatment team, including development of the ITP or ISP and updating the plan as required by the department and/or referring/administering agency. (H) A copy of each individual’s current ITP or ISP and crisis prevention plan or safety crisis plan, as applicable, shall be maintained in a manner so they are readily accessible. (I) Staff from the referring/administering agency will regularly monitor each individual’s progress and provide adjunctive services in accordance with his or her ITP or ISP. (5) Dietary Requirements. 9 CSR 40-1.080 Dietary Services is waived. FLAs shall ensure the following dietary requirements are met: (A) Proper diet and food preparation shall be addressed as part of the individualized planning process; (B) Individuals who prepare their own meals or help with meal preparation shall be assisted, as needed; (C) Individuals shall be supported in developing meal plans and grocery lists and educated and assisted, as needed, in order to meet any special dietary requirements; (D) Individuals shall be assisted and educated about purchasing, preparing, and safely storing food and drinks in a manner that prevents spoilage and contamination; (E) Documented consultation with a licensed dietitian or registered nurse must take place at least annually for individuals with special diets; (F) Documented staff training regarding specialized diets, as applicable; (G) A balanced variety of healthy foods and drinks, with opportunities for choice, shall be available to individuals each day, and ready access to nutritious snacks shall be available at all times; (H) Consideration shall be given to the food habits, personal, cultural, religious preferences, and medical needs of individuals served, including provisions for special diets for medical reasons; (I) When individuals require blended food, the food shall be prepared, measured, and served individually and not mixed together; (J) The consistency and texture of food shall meet each individual’s needs. Individuals shall not be fed in a prone position; (K) Individuals requiring liquid or soft diets shall be provided with nourishing, supplementary food between meals to meet their nutritional needs; (L) Meals may be served family style to provide a home-like atmosphere; (M) A sufficient number of appliances and equipment shall be available for food preparation including but not limited to a stove and refrigerator, dishes, cookware, and utensils to meet the needs of individuals served. All equipment must be in safe and good operating condition and food preparation areas, appliances, and equipment shall be cleaned and sanitized after each use; and (N) The temperature of hot water at all faucets accessible to individuals served must be controlled by a thermostatic mixing valve or other means so the water temperature does not exceed one hundred twenty degrees Fahrenheit (120°F), unless individuals served can self-regulate water temperature. AUTHORITY: sections 630.050 and 630.705, RSMo 2016.* Original rule filed May 14, 2020, effective Dec. 30, 2020. Amended: Filed Sept. 14, 2023, effective March 30, 2024. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008, and 630.705, RSMo 1980, amended 1982, 1984, 1985, 1990, 2000, 2011, 2014.