Admissions to Children’s Supported Community Living

PURPOSE: This rule prescribes admissions criteria, the application process, and placement procedures for Children’s Supported Community Living (SCL) funded by the Division of Behavioral Health. This rule applies to administrative agents. (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’s (DBH) supported community living (SCL) contract clearly requires otherwise, the following other terms 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) Applicant, a minor for whom placement services in SCL has been requested; (C) Chief of Children’s Community Operations (CCCO), DBH staff who oversee services and supports for children and youth in assigned regions of the state; (D) 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 affiliates are responsible for providing these services to eligible individuals in their designated service area(s); (E) Domicile administrative agent, the service area in which a child’s legal guardian resides or, if the child is under the jurisdiction of a juvenile court, the service area of the juvenile court that has assumed jurisdiction of the child; (F) Regional community operations, the DBH office responsible for processing SCL placement funds for the administrative agent(s) in that region; and (G) SCL placement, placement of a child/youth who has a diagnosed serious emotional disturbance (SED) into an out-ofhome setting when determined clinically necessary by staff of the referring administrative agent. These settings include Professional Parent Homes (PPH), Treatment Family Homes (TFH), and residential treatment facilities where services are provided to address the psychosocial and medical needs of youth with the goal of moving them into a less restrictive level of care. (2) Application for SCL. The application for placement in SCL shall be made by the child’s parents/legal guardian by completing the application form included herein. The application shall be submitted to the administrative agent overseeing the child’s care. (3) Eligibility Criteria. Children’s SCL is a time-limited placement resource for children/youth under the age of eighteen (18) who have been determined by administrative agent staff to be eligible for clinical treatment services in a PPH, TFH, or residential treatment facility due to a demonstrated inability to function in any less restrictive setting. (A) Exceptions for SCL services for individuals up to age twenty-one (21) may be granted by the CCCO in the domicile county/region where the youth resides. (B) Children/youth requiring SCL shall have been diagnosed with a SED as specified in 9 CSR 30-4.005(7) unless an exception is granted by the CCCO. These children may be unable to consistently function in a public school, may present a chronic runaway risk, and may present a history of emotional dysregulation which may include physical aggression toward self and/or others. (4) Ineligible Applicants. Children/youth shall be considered ineligible for SCL if— (A) There is no primary psychiatric diagnosis as specified in 9 CSR 30-4.005(6); (B) The child has a medical condition that requires considerable supervision and ongoing treatment which inhibits effective clinical treatment for his/her psychiatric disorder; (C) It has been established that appropriate services are otherwise available through alternative resources; (D) The application is submitted solely for the purpose of securing residential placement for a school-aged child as defined in Chapter 162, RSMo, to receive an appropriate education; or (E) The child’s symptoms meet acute definition. (5) Screening. Applicants for admission to SCL shall be screened by staff of the administrative agent to determine eligibility for services and placement need, if any. Screenings shall be conducted in settings that ensure privacy and confidentiality for individuals served. (6) Registered Sex Offenders and Youth Identified on the Juvenile County Registry. (A) Youth who are identified on the Missouri State Highway Patrol Sex Offender Registry shall not be placed in a youth residential treatment facility. Placement in a TFH or PPH may be considered if other children residing in the home, in any capacity, are over the age of eighteen (18) and do not have a diagnosed intellectual or developmental disability. Requirements for the proximity of the TFH or PPH to a school, childcare facility, public park, or public swimming pool as defined in the department’s out-ofhome placement protocol shall be followed. (B) For a youth who is identified as a juvenile sex offender on the juvenile county registry, placement in a TFH or PPH may be considered if all of the other individuals residing in the home, in any capacity, are over the age of eighteen (18) and do not have a diagnosed intellectual or developmental disability. There shall be no one under the age of eighteen (18) in the home, including the provider’s natural, adopted, or other children living in the home. Placement can be made in a residential facility as long as the requirements in the department’s out-of-home placement protocol are followed and clinical judgment is exercised. (C) If a registered sex offender or identified juvenile sex offender is being considered for SCL, the administrative agent shall comply with the department’s established out-ofhome placement protocol and notification procedures. (7) Notification to the Applicant. The administrative agent shall communicate acceptance or denial of the application to the child’s parent/guardian. Notification shall be documented and a record of the communication shall be maintained by the administrative agent. (A) If the parent/guardian disagrees with a decision of ineligibility for admission, they shall be informed of the grievance process of the administrative agent managing the referral. (8) Appropriate Placement. Before placing a child in SCL, the administrative agent shall consider each of the following: (A) The best interest of the child; (B) The least restrictive environment for care and treatment consistent with needs and conditions of the child; (C) The capacity of the proposed residential setting to provide necessary care and treatment for the child which is of comparable quality to existing care and treatment based upon investigation of the alternative facility and its program of care and treatment; and (D) The relationship of the child to family, guardian, or friends/natural supports and the ability to maintain those relationships and encourage visits beneficial to the child. (9) Consent for Placement. (A) If the applicant is a minor or has a legal guardian, the administrative agent shall obtain consent of the parent or guardian before placement. (B) If the application is for a child who is an involuntary commitment under Chapter 211 or Chapter 632, RSMo, the administrative agent shall notify the court of competent jurisdiction of the proposed placement and allow ten (10) working days for the court to object. (C) Notwithstanding the provisions of sections 211.151, 211.161, and 211.181, RSMo, and any other provision of law contrary to this section, the juvenile court may not order that children be detained by, committed to, or otherwise placed in the Department of Mental Health for periods longer than thirty (30) days except as provided in sections 211.201 to 211.207, RSMo. (10) Release of Information. The administrative agent shall obtain appropriate releases of referral information signed by the parent or guardian. The referral information shall include appropriate psychiatric, medical, and social information. (11) Admission Procedures. If the administrative agent approves the applicant for admission into children’s SCL, staff shall follow DBH procedures for admission. (A) A staff person of the administrative agent shall be assigned to coordinate services with the child and his or her parents/guardian, family members/natural supports, and other agencies, as appropriate. (B) Administrative agent staff shall assist the child’s parent/guardian in applying for Medicaid and submitting verification of the application to the designated DBH regional community operations office. (C) Selection of the SCL provider shall be coordinated with the child’s parent/guardian, including an interview and pre-placement visit with the proposed provider, as appropriate. (D) The administrative agent shall maintain documentation in the child’s record regarding his/her placement in SCL including, but not limited to: 1. Signed acknowledgement of notice of privacy and practices; 2. SCL application form; 3. Results of the comprehensive clinical assessment; 4. Evaluation including diagnosis, IQ test results (if available), current level of functioning, recommended services/supports, and psychosocial history within the past six (6) months performed by a qualified mental health professional; 5. Educational evaluation and school records, including cumulative record, diagnostic summary, individualized education plan (IEP) or 504 plan, or documentation from the home school district that the child does not have an IEP or 504 plan; 6. Immunization record; 7. Physical examination by a licensed healthcare provider within the past six (6) months, including any laboratory tests or imaging ordered; 8. Document of legal guardianship or copy of birth certificate, divorce decree, or court order verifying custody, as applicable; 9. Completed and scored standard means test; 10. Notice of cost; 11. Consent agreement for SCL services (must be signed by the parent/legal guardian and staff of the administrative agent managing the placement); 12. Notification of change report, including any co-payment from any other source(s) and/or ancillary funds associated with the placement such as personal spending allowances, transportation assistance, or special needs (must be submitted to the designated DBH regional community operations office within five (5) calendar days after the placement is made); and 13. Juvenile sex offender background check and Missouri State Highway Patrol sex offender background check. (E) Copies of the documentation specified in paragraphs (11)(D)1.–13. of this rule shall be sent to the SCL provider prior to or at the time of the child’s admission to the program. This information shall be available for review by department staff and other authorized representatives upon request. (F) Within five (5) calendar days of the child’s placement in SCL, the administrative agent shall provide the DBH regional community operations office with completed copies of the SCL application, consent and agreement to SCL, notice of change, standard means test, notice of cost, and face sheet, including the child’s demographic information and diagnosis. (12) Out-of-Region Placements. All referrals and placements with a children’s SCL provider outside the administrative agent’s designated service area shall be managed by the domicile administrative agent, including funding for such placements. (A) Staff of the domicile administrative agent shall provide continued monitoring of the child to ensure appropriate services are provided, including participating in monthly treatment team meetings, reviewing assessment/evaluation information and progress reports, and participating in discharge planning to ensure continuity of services when the child is placed back into his/her domicile region. (B) The administrative agent shall notify the DBH domicile region CCCO of any outof-region placements to ensure the SCL provider is addressing the child’s needs and meeting department contract requirements. (C) The domicile administrative agent shall send the documentation specified in paragraphs (11)(D)1.–13. of this rule to the outof-region SCL provider prior to or at the time of the child’s admission to the program. (13) Inpatient Psychiatric Placements. Referrals to a DBH inpatient psychiatric facility shall be made directly by the domicile administrative agent. (A) The administrative agent shall inform the DBH domicile region CCCO when such referrals are made. (B) Upon placement into the DBH facility, the domicile CCCO shall notify the CCCO in the region where the inpatient psychiatric facility is located. (C) Staff of the domicile administrative agent shall monitor the child’s clinical care by participating in monthly treatment team meetings, reviewing assessment/evaluation information and progress reports, and participating in discharge planning to ensure continuity of services when the child is placed back into his/her domicile region. (14) Service Delivery. Responsibilities of the administrative agent overseeing the child’s care and treatment while in SCL shall include, but are not limited to: (A) Ensuring the child’s parent/guardian is advised of all appropriate services and placement resources in order to give informed parental consent, including the opportunity to interview staff and tour residential treatment programs; (B) Facilitating and participating in development of the child’s treatment plan for residential services to ensure the plan includes measurable goals, participating in treatment plan reviews and discharge planning, and maintaining a copy of the treatment plan in the administrative agent’s clinical record; (C) Documenting the child’s progress on a monthly basis, at a minimum, to ensure he/she is safe, healthy, and progressing in clinical treatment, including the addition of measureable actions and steps to address any concerns noted in regard to his/her achievement of treatment goals; (D) Assuring appropriate services are provided to the child; (E) Communicating with the parent/guardian, court, and/or other agency staff involved in the child’s services and supports, as applicable; (F) Coordinating and assisting in securing necessary clothing, personal items, and transportation, if needed, in accordance with personal spending guidelines; (G) Coordinating and assisting in obtaining needed services, such as medical care and outpatient psychiatric services; (H) Arranging for hospitalization for appropriate psychiatric services, if needed; (I) Arranging for transfer to another residential treatment provider, if needed; (J) Reporting any issues or concerns to the DBH regional CCCO; (K) Ensuring personal spending is consistent with the child’s needs as identified in the treatment plan; (L) Ensuring there is progress toward achievement of individual and family-based goals identified in the treatment plan, which may include pursuing other treatment options if progress is not occurring; and (M) Ensuring discharge planning begins at the time of admission and the discharge plan has clear objectives consistent with the overall goals identified in the individual treatment plan, and that necessary coordination and linkages with appropriate family members/natural supports and community resources are included and documented in the plan. (15) Funding. Funding for SCL will be approved by the CCCO or designee for an applicant based on the— (A) Applicant’s acceptance by a proposed SCL provider; and (B) Availability of funds. AUTHORITY: sections 630.050 and 630.705, RSMo 2016.* Original rule filed Feb. 29, 1988, effective July 25, 1988. Amended: Filed March 30, 1992, effective Jan. 15, 1993. Amended: Filed July 17, 1995, effective March 30, 1996. Amended: Filed Feb. 9, 2021, effective Aug. 30, 2021. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008 and 630.705, RSMo 1980, amended 1982, 1984, 1985, 1990, 2000, 2011, 2014.