Missouri Veterans Homes Program

PURPOSE: This rule defines terms and explains the operation of the Missouri Veterans Homes Program under sections 42.100 to 42.130, RSMo. (1) As used herein, unless the text clearly indicates otherwise, the following terms shall mean: (A) Resident—a Veteran who receives skilled nursing care and resides at a Missouri Veterans Home; (B) Per diem—a rate established by the United States Department of Veterans Affairs and paid to the state based on the actual number of days a Veteran occupies a bed in a Missouri Veterans Home; (C) Applicant—a citizen of Missouri who applies for placement in a Missouri Veterans Home and meets the admissions eligibility criteria set forth in this rule; (D) Skilled nursing care—care and oversight for individuals by licensed personnel twenty-four (24) hours per day; (E) Waiting list—the list of applicants awaiting admission into a Missouri Veterans Home; and (F) Hardship—a reduced monthly room and care fee for a Missouri Veterans Home resident who does not have adequate financial resources to pay the monthly room and care fee set by the commission. (2) Admissions. (A) Eligibility criteria. In order to be eligible for admission as a resident to a Missouri Veterans Home, a person must— 1. Be a citizen of Missouri who has maintained physical residency in Missouri for one hundred eighty (180) days prior to application for placement in a Missouri Veterans Home; 2. Meet the criteria established by the United States Department of Veterans Affairs for veteran status, or have an honorable discharge from the National Guard with preference given to the Missouri National Guard; 3. Require skilled nursing care within the capabilities of the Missouri Veterans Home at the time of application for admission as determined by the Missouri Veterans Home; 4. Have adequate financial resources available to defray the costs of their care as contemplated by section 42.110, RSMo, or qualify for a hardship rate in accordance with the procedures set forth in this rule; 5. Not appear on any sex offender registry; 6. Not have a criminal history including a conviction for, or a plea of guilty or nolo contendre to, a Class A or B felony in the state of Missouri, or an offense in another jurisdiction which would be a Class A or B felony if committed in the state of Missouri; 7. Has not been previously discharged from a Missouri Veterans Home in accordance with this rule; and 8. Be ready to admit to the facility upon notification from the Missouri Veterans Home. (B) Admissions waitlist. Applicants eligible for admission to a Missouri Veterans Home shall be placed on an admissions waitlist until such time as a placement opportunity is available. The priority of applicants on a waiting list shall be established according to the following criteria: 1. Priority one: applicants with a singular or combined rating of seventy percent (70%) or more based on one (1) or more service-connected disabilities as defined by the United States Department of Veterans Affairs, and/or has been determined to be in need of skilled care for a Department of Veterans Affairs adjudicated service-connected disability, and/or has a rating of total disability based on individual unemployability; and 2. Priority two: all remaining eligible applicants. (3) Hardships. (A) Threshold. 1. When the State of Missouri is providing thirty-five percent (35%) or more of the funding necessary for the care of those veterans who are not deemed full cost of care by the U.S. Department of Veterans Affairs, the Missouri Veterans Commission (MVC) will maintain an allocation cap of approximately five hundred thousand dollars ($500,000) dedicated to hardships, which may be allocated to residents or applicants of any or all of its Veterans Homes. 2. Once the five hundred thousand dollar ($500,000) hardship threshold is met, MVC will continue to accept hardship applications within its Veterans Homes, but will not admit applicants requesting a hardship until such time as MVC is below the five hundred thousand dollar ($500,000) hardship threshold. 3. When MVC returns to below the five hundred thousand dollar ($500,000) hardship threshold, MVC will consider outstanding hardship applications in the order that they were received. MVC reserves the right to request updated information from hardship applicants as necessary to determine the applicant’s current need for a hardship. (B) Determinations. 1. All hardship requests will be reviewed by the Missouri Veterans Home Program Hardship Review Team (HRT). 2. The HRT shall convene within ten (10) business days of receipt of each hardship application and all required supporting documentation. 3. The HRT will consist of the following MVC personnel: the director of Homes Program, the director of Budget and Finance, and the director of Veterans Services Program, or their respective designees. The home administrator, admissions coordinator, and accounts supervisor of the applicable Missouri Veterans Home will present the hardship application to the HRT during the meeting. 4. In collaboration with the HRT, the director of Homes Program will make the final decision on each hardship application and direct that a letter be sent to the hardship applicant notifying him/her of that decision. The letter notifying the hardship applicant of the final decision shall specifically state the decision and, if the hardship is not granted, the process to appeal the decision. If applicable, the letter notifying the hardship applicant of the final decision shall also state that full payment for all outstanding room and care expenses is due by the tenth of the following month. (C) Appeals. 1. Hardship applicants wishing to appeal the denial of their request must submit their appeal request in accordance with the appeals process set forth in section (5) of this rule. (4) Involuntary Discharge from a Missouri Veterans Home. (A) Residents of Missouri Veterans Homes may be involuntarily discharged from the facility in which they reside for any of the following reasons: 1. The resident’s welfare and the resident’s needs cannot be met in the facility; 2. The resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility; 3. The safety of individuals in the facility is endangered by the resident’s continued residency in the facility; 4. The health of individuals in the facility would be endangered by the resident’s continued residency in the facility; 5. The resident has failed, after reasonable and appropriate notice, to pay for his or her care or stay at the facility; or 6. The facility ceases to operate. (B) Documentation. When a Missouri Veterans Home discharges a resident involuntarily, the facility’s medical director must document the reason for such discharge in the resident’s clinical record. (C) Notice of discharge. Before a resident is discharged from a Missouri Veterans Home, the facility must— 1. Notify the resident or legal representative of the discharge and the reasons for the discharge in writing and in a language and manner they understand; 2. Record the reasons for the discharge in the resident’s clinical record; and 3. Include in the notice the following items: A. The reason(s) for discharge; B. The effective date of the discharge; C. The location to which the resident will be discharged; D. A statement that the resident has the right to appeal the action to the director of the Missouri Veterans Homes Program; and E. The name, address, and telephone number of the local office of the state long-term care ombudsman. (D) Timing of the notice. The notice of discharge required under this rule must be made by the facility at least thirty (30) days before the resident is discharged, except in cases of emergency discharges as provided for in this rule. 1. Emergency discharges. In cases where the director of the Missouri Veterans Homes Program determines the resident poses an imminent risk to the health and safety of him or herself, or to that of the facility’s staff or other residents by continued residence in the facility, the director of the Missouri Veterans Homes Program may authorize the use of emergency discharge procedures in which the resident may be discharged from the facility as soon as practicable. In such cases, the Missouri Veterans Home need not provide thirty (30) days notice of the discharge, but must adhere to the remaining notice requirements set forth in this rule. (E) Orientation for transfer or discharge. Missouri Veterans Home facility management must ensure sufficient preparation and orientation is available to residents to ensure safe and orderly discharge from the facility. (F) Discharge summary. Prior to discharging a resident, Missouri Veterans Home facility management must prepare a discharge summary that includes— 1. A recapitulation of the resident’s stay; 2. A summary of the resident’s status at the time of the discharge to include a comprehensive assessment conducted or coordinated by a registered nurse with the participation of appropriate healthcare professionals, including at least one (1) physician, the registered nurse, and one (1) social worker. The registered nurse must sign and certify the assessment. The comprehensive assessment is to determine the care, treatment, and services that will meet the resident’s initial and continuing needs. The assessment must be an objective evaluation of the resident’s health and functional status, describing the resident’s capabilities and impairments in performing activities of daily living, strengths, and needs; and 3. A post-discharge plan of care developed with the participation of the resident and his or her family, which will assist the resident to adjust to his or her new living environment. (5) Appeals from Adverse Decisions Rendered Under This Rule. (A) An applicant or resident who is aggrieved by the decision of the Missouri Veterans Home to deny admission to the facility, deny granting a hardship rate, or to involuntarily discharge a resident from the Missouri Veterans Home shall have the right to an administrative review of the Missouri Veterans Home’s decision. (B) The applicant or resident may appeal the decision of the Missouri Veterans Home to deny admission to the facility, deny granting a hardship rate, or to involuntarily discharge a resident from the Missouri Veterans Home by filing a written request for administrative review with the MVC executive director within fifteen (15) calendar days of the date of the notice of denial or discharge. The request for administrative review shall set forth the basis of the applicant or resident’s objection to the Missouri Veterans Home’s decision. (C) The MVC executive director shall consult with appropriate MVC executive staff on each appeal. The executive director may attempt to resolve the issue with an informal meeting with the aggrieved party, or independently review the case and issue a written decision thereon. (D) The MVC executive director’s administrative review shall consist of a review of all written materials relevant to the decision being appealed. Aggrieved parties may submit any documentary evidence they choose with their request for an administrative review of the adverse decision so long as it is received by the executive director within fifteen (15) calendar days of the date of the notice of denial or discharge. Aggrieved parties are not entitled to an evidentiary hearing on the decision being appealed. (E) The MVC executive director shall give written notice of his or her decision and the basis thereof by delivering or mailing such notice to the applicant, resident, legal representative or, if applicable, to his or her attorney of record. (F) The decision of the MVC executive director shall be the final decision of the Missouri Veterans Commission. (6) Missouri Veterans Homes Program Administration. The executive director shall hire a director of the Homes Program. The director of the Homes Program shall have the authority and responsibility for the planning, implementation, and operation of the Homes Program. The director of the Homes Program shall— (A) Maintain a current Missouri nursing home administrator’s license; (B) Develop fiscal policies and procedures that assure accountability of all facility revenues, expenditures, and inventories of the home including the determination of the resident rate as approved by the commission; (C) Hire an administrator, who shall maintain a current Missouri nursing home administrator’s license, for each Missouri Veterans Home in order to operate each facility licensed by the commission; and (D) Adjudicate appeals in accordance with this rule. (7) Missouri Veterans Home Administration. Each home administrator shall hire professional, technical, and support staff necessary to operate the home. Each home administrator shall maintain an environment that produces quality skilled nursing care and ensure compliance with Department of Veterans Affairs laws and regulations. AUTHORITY: sections 42.100–42.130 and 536.023(3), RSMo 2016.* Original rule filed March 22, 1990, effective June 28, 1990. Amended: Filed Jan. 23, 1992, effective June 25, 1992. Amended: Filed March 13, 1992, effective Aug. 6, 1992. Amended: Filed April 18, 1995, effective Sept. 30, 1995. Amended: Filed June 11, 2013, effective Dec. 30, 2013. Amended: Filed March 9, 2023, effective Sept. 30, 2023. *Original authority: 42.100–42.130, see Missouri Revised Statutes 2016 and Missouri Revised Statutes Cumulative Supplement 2023, and 536.023, RSMo 1975, amended 1976, 1997, 2004.