Admissions to Adult Community Residential Settings

PURPOSE: This rule prescribes eligibility and admission criteria, the application process, and notification procedures for adult community residential settings funded by the Division of Behavioral Health (DBH). This rule applies to administrative agents, affiliates, and community residential settings. (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 (DBH) residential services contract clearly requires otherwise, the following other terms, as 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) Affiliate, an organization that is contracted with the department to provide specific community psychiatric rehabilitation (CPR) services for adults in a designated geographic area; (C) Applicant, an individual for whom admission to a community residential setting has been requested; (D) Charged consumer, an individual who has been permanently determined to lack capacity to understand the proceedings against him/her or to assist in his/her own defense under section 552.020, RSMo, for offenses the individual would otherwise have been required to register as an offender on or after January 1, 1995, under sections 589.400 to 589.425, RSMo; (E) Charged consenting consumer, a charged consumer whose guardian has given consent to the DBH regional community operations office to disclose such legal charges against his/her ward to other individuals (guardian, if appointed) who may or will be residing with the charged consumer; (F) 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 their affiliates are responsible for providing these services to eligible individuals in their designated service area(s); (G) DBH-funded community residential setting (used interchangeably in this rule with residential setting), living arrangements in the community designated for adults who meet the admission criteria specified in this rule. These settings include, but are not limited to, Psychiatric Individualized Supported Living (PISL), Intensive Residential Treatment Settings (IRTS), clustered apartments, residential care facilities, assisted living facilities, and intermediate care facilities; (H) Forensic client, a person who is a client of the Division of Behavioral Health pursuant to sections 552.030 and 552.040, RSMo; (I) General notification, written notification to an individual (guardian, if appointed) receiving DBH funding in a residential setting or other community dwelling, such as an apartment setting, of the potential to reside with a registered offender or charged consumer; (J) Regional community operations, the DBH office responsible for overseeing DBHfunded community residential settings in assigned regions of the state; (K) Registered offender, a person who is registered or will be registered by law enforcement upon discharge from a DBHoperated inpatient psychiatric facility or correctional facility pursuant to sections 589.400 to 589.425, RSMo; and (L) Specific notification, written notification to an individual (guardian, if appointed) receiving DBH funding in a residential setting or other community dwelling, such as an apartment setting, when a registered offender or charged consenting consumer has been referred for admission to the same setting, as well as when a registered offender or charged consenting consumer currently resides in the same setting, regardless of whether the offender or charged consenting consumer requires DBH funding. Specific notification is managed by the DBH regional community operations office. Specific notification of a registered offender includes the name of the offender, physical description, registerable offense(s), associated date(s) of offense(s), and the name of the residential setting where the offender is referred to or resides. The specific notification of a charged consenting consumer includes the name of the charged consumer, offense(s) and associated date(s) of offense(s), and the name of facility the charged consenting consumer is referred to or resides. (2) Forensic Clients. All forensic clients shall have priority for admission to a DBH-funded residential setting appropriate to their service and support needs. (3) Individuals in DBH Inpatient Psychiatric Facilities. All adults being served in a DBH inpatient psychiatric facility who are referred to an administrative agent/affiliate shall receive priority consideration for admission to a DBH-funded residential setting appropriate to their service and support needs. (4) Other Eligibility Criteria. An applicant who does not meet the criteria of section (2) or (3) of this rule shall meet all of the following criteria to be eligible for admission to a residential setting: (A) Be at least eighteen (18) years of age; (B) Qualify for admission to a CPR program as specified in 9 CSR 30-4.005(6); and (C) Have a mental disorder that constitutes substantial impairment in social role functioning and daily living skills based upon the clinical judgment of the administrative agent/affiliate, which must include documentation that the individual cannot function successfully outside a mental health facility without appropriate services and supports in a community residential setting. Substantial impairment may include, but is not limited to, the following behavioral characteristics: 1. Substantial need for mental health treatment and social services; 2. History of inability or unwillingness to participate in treatment, including taking medications as prescribed; 3. Inadequate living skills to provide for basic necessities of food, clothing, shelter, safety, personal care, and health care without assistance; 4. Inadequate social skills, which may be exhibited in aggressive or withdrawn behavior; 5. Frequent personal crises requiring emergency treatment or support and assistance; 6. Inability to effectively access community services and supports; 7. Lack of a personal support system (for example, family or other natural supports) to assist in accessing services/supports; and 8. Lack of sustained employment. (5) Ineligible Applicants. The administrative agent/affiliate’s staff shall consider an applicant ineligible for admission to a residential setting if— (A) The primary diagnosis is a substance use disorder, intellectual disability, or developmental disability; (B) Medical needs supersede the psychiatric disorder and require considerable supervision and ongoing treatment for a medical condition; (C) Risk of harm to self or others is not manageable according to clinical judgment; (D) The primary diagnosis is dementia; or (E) Appropriate services have been established that are otherwise available through alternative resources. (6) Screening. Applicants for admission to a residential setting shall be screened by the administrative agent/affiliate to determine eligibility. Screenings shall be conducted in settings that ensure privacy and confidentiality for individuals served. (7) Eligibility Determination. The administrative agent/affiliate shall determine if an applicant is eligible for admission to a residential setting. Priority shall be given to individuals identified in sections (2) and (3) of this rule. (A) The administrative agent/affiliate shall communicate acceptance or denial of the application to the referral source. Notification shall be documented and a record of the communication shall be maintained by the administrative agent/affiliate. (B) If an individual (guardian, if appointed) disagrees with a decision of ineligibility for admission, he/she shall be informed of the grievance process of the administrative agent/affiliate managing the referral. (8) Appropriate Residential Setting. Prior to admitting an individual to a residential setting, the administrative agent/affiliate shall ensure the setting meets the individual’s needs. (A) Each of the following shall be considered to ensure the proposed residential setting is appropriate: 1. The best interest of the individual; 2. The least restrictive environment for care and treatment, consistent with needs of the individual; 3. The capacity of the proposed residential setting to provide necessary care and treatment for the individual; 4. The relationships of the individual to family, guardian, friends, and other natural supports and the ability to maintain those relationships and encourage visits beneficial to the individual; and 5. The preferences of the individual (guardian, if appointed) in the residential setting chosen. (B) If a residential care facility, assisted living facility, or intermediate care facility is determined to be the appropriate residential setting for the individual, the facility must be licensed by the department and the Department of Health and Senior Services as specified in 9 CSR 40-1.055. (9) Release of Information. The administrative agent/affiliate staff shall obtain appropriate releases of referral information signed by the individual (guardian, if appointed). The administrative agent/affiliate staff shall submit the referral information to the proposed residential setting including appropriate psychiatric, medical, and social information. (10) Admissions. The administrative agent/affiliate shall follow DBH procedures to manage admissions to residential settings. (11) Notification Procedures. Department requirements shall be followed for notifying individuals (guardians, if appointed) referred to a residential setting who may reside with or may themselves be a registered offender under sections 589.400 to 589.425, RSMo, or charged consumer under section 552.020, RSMo, for offenses they would otherwise have been required to register as an offender under sections 589.400 to 589.425, RSMo. (A) The following procedures shall be followed when an individual requiring DBH funding for housing or Intensive CPR (ICPR) services is referred to or residing in a residential setting or other community living arrangement, such as a single or multiple occupancy dwelling: 1. Prior to admission, a query with the Missouri State Highway Patrol shall be completed by the administrative agent/affiliate or DBH regional community operations office to verify the referred individual’s status as a registered offender. If the administrative agent/affiliate manages the query, staff must comply with department policies and procedures related to the offender query process; 2. Prior to admission, general notification must be provided to each individual (guardian, if appointed) referred to inform him/her of the potential to reside with a registered offender(s) or charged consumer(s). A. General notification to the individual (guardian, if appointed) referred shall be issued by the administrative agent/affiliate or DBH regional community operations office. If the administrative agent/affiliate manages the general notification, staff must comply with department policies and procedures related to the general notification process. The general notice must be received by the individual (guardian, if appointed) prior to admission to the residential setting; 3. Specific notification involving a registered offender will be issued by the DBH regional community operations office. A. The administrative agent/affiliate shall notify the DBH regional community operations office that specific notification is required when they refer a registered offender requiring DBH funding to a residential setting, or the individual being referred will be residing in the same residential setting as a registered offender. B. Specific notification will be issued by the DBH regional community operations office prior to the admission of each individual (guardian, if appointed) referred who requires DBH funding and will be residing in the same setting as a registered offender, regardless of whether the registered offender receives DBH funding. C. Specific notification is also issued by the DBH regional community operations office prior to admission of each individual (guardian, if appointed) requiring DBH funding in a residential setting or dwelling when a registered offender is referred for admission to the same setting, regardless of whether the referred offender requires DBH funding. D. Individuals who require DBH funding shall not be admitted to the residential setting or dwelling until the DBH regional community operations office completes the specific notification process and notifies the administrative agent/affiliate that the individual can be admitted; and 4. Specific notification of a charged consenting consumer shall be issued by the DBH regional community operations office to each individual (guardian, if appointed) referred who requires DBH funding and will be residing in the same setting as a charged consenting consumer, regardless of whether the charged consenting consumer receives DBH funding. A. The administrative agent/affiliate shall notify the DBH regional community operations office that specific notification is required if the administrative agent/affiliate is aware the referred individual is a charged consumer, or if the referred individual will be residing in the same setting as a charged consenting consumer. B. The DBH regional community operations office will determine if the charged consumer (guardian, if appointed) consents to release information of his/her charged status to DBH-funded individuals residing in the residential setting or dwelling, including the individual’s name and nature and date(s) of the crime(s) for which the charged consumer would have been required to register if he/she had been convicted. (I) Regardless of whether consent to disclose these charges is obtained, the charged consumer may be admitted to the residential setting or dwelling. (II) If consent is obtained, the DBH regional community operations office will send specific notification to DBH-funded individuals referred to or residing in the residential setting or dwelling. C. Individuals who require DBH funding shall not be admitted to the residential setting or dwelling until the DBH regional community operations office completes the specific notification process and notifies the administrative agent/affiliate that the individual may be admitted. (B) Offender notification procedures shall be followed by DBH-contracted residential settings prior to admitting a registered offender or charged consumer who does not receive services from an administrative agent/affiliate or funding from DBH. 1. When a residential setting intends to admit a registered offender, and the individual is not involved with an administrative agent/affiliate and does not require DBH funding, staff of the residential setting shall notify the DBH regional community operations office. The notification must be prior to the individual’s admission if DBH-funded individuals currently reside at the residential setting. The DBH regional community operations office will verify the registered offender’s criminal offense(s) and date(s) for which registration is required with the Missouri State Highway Patrol. 2. When the residential setting intends to admit a charged consumer, and the individual is not involved with an administrative agent/affiliate and does not require DBH funding, staff of the residential setting shall notify DBH. The DBH regional community operations office will obtain records to verify the charged consumer’s name and nature of the crime(s) for which the charged consumer would have been required to register if he/she had been convicted. Following verification of individual’s charged crime(s) and date(s), the DBH regional community operations office will request consent of the charged consumer (guardian, if appointed) to disclose his/her name and nature of the crime(s) to individuals requiring DBH funding who are referred to or residing at the residential setting. If consent is obtained, the individual is considered a charged consenting consumer. 3. If there are individuals funded by DBH who are referred to or residing at the residential setting, specific notification procedures as specified in this rule must be completed by the DBH regional community operations office prior to the admission of a registered offender or charged consenting consumer. 4. Registered offenders or charged consumers shall not be admitted to the residential setting until the DBH regional community operations office completes the specific notification process and notifies staff of the residential setting that the individual may be admitted. A. If there are no individuals referred to or residing at the residential setting who require DBH funding, notifications are not required and the registered offender, charged consumer, or charged consenting consumer may be admitted to the residential setting. B. Staff of the residential setting shall notify the DBH regional community operations office of the registered offender or charged consumer’s admission and discharge date. The department will provide this information to the administrative agent/affiliate in the service area where the residential setting is located. (C) The administrative agent/affiliate shall maintain a record of all DBH-funded and/or contracted residential settings in their service area(s) where registered offenders and charged consenting consumers are residing in order to inform DBH regional community operations staff when specific notification is required. (D) The administrative agent/affiliate shall maintain a record of individuals receiving DBH funding in residential settings and dwellings. (12) Prescribed Medication. At the time of admission to a residential setting, the administrative agent/affiliate shall ensure the individual has access to his/her prescribed medication. (13) Bedrooms. Individuals receiving DBH funding to live in a community residential setting shall not share a bedroom with more than one (1) person unless the administrative agent/affiliate provides adequate justification for other arrangements to the DBH regional community operations office and prior approval is granted for such arrangements. (A) Single occupancy bedrooms are required for clustered apartments, Intensive Residential Treatment Settings (IRTS), and Psychiatric Individualized Supported Living (PISL). (B) Further restrictions regarding sharing of bedrooms may be required based on individual needs, preferences, and least restrictive environment considerations. (14) Discharge. DBH funding for an individual’s personal needs and room and board shall be discontinued if there are other sufficient financial resources to cover these costs. AUTHORITY: section 630.050, RSMo 2016.* Original rule filed July 3, 1986, effective Dec. 15, 1986. Amended: Filed July 17, 1995, effective March 30, 1996. Amended: Filed Jan. 31, 2006, effective Aug. 30, 2006. Amended: Filed Feb. 9, 2021, effective Aug. 30, 2021. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008.