Health Care

PURPOSE: This rule sets forth the procedures for health care, emergency medical care, dental care, psychiatric and psychological care, and medicine and drugs. (1) Health Care Procedure. (A) The agency shall have a written health care plan which shall address preventive medical, eye, hearing and dental care for any child(ren) in the custody of the agency. (B) The agency’s health care plan shall include examinations upon entering agency care, subsequent examinations, nursing care, first-aid procedures, dispensing of medicine and basic remedial treatment and the training of basic principles of communicable disease prevention. (C) The agency shall obtain written authorization for each child from the parent(s), guardian or legal custodian for emergency medical care, emergency surgical care, necessary immunizations and general medical care upon entering care. (D) A complete physical examination by a licensed physician, a certified nurse practitioner, advanced practice nurse in a collaborative agreement with a licensed physician or a registered nurse who is under the supervision of a licensed physician shall be given to each child under the age of three (3) within seventy-two (72) hours after entering care, unless being discharged directly from a medical facility. For any child over age three (3) the physical examination shall be given within thirty (30) days prior to placement, or within seventy-two (72) hours after entering care. The findings of the examination shall be recorded on a form prescribed by the division, or one containing the equivalent information. Children shall otherwise receive medical examinations in accordance to the periodicity of the Missouri Medicaid Healthy Children and Youth Schedule for Physical and Developmental Examinations available through the division. (E) If a child shows overt signs of highly infectious disease or other evidence of ill health, the agency shall make arrangements for an immediate examination by a licensed physician. (F) Any child who has not received primary immunizations prior to placement shall be immunized according to the Department of Health’s current guidelines. (G) A current immunization history shall be maintained for each child. (H) Booster shots shall be administered to children as needed, and at time intervals recommended by the agency physician or by the Department of Health’s current guidelines. (I) Each child under twelve (12) years of age shall be given an annual eye examination. Children twelve (12) years of age and older shall be given an eye examination on an asneeded basis. Corrective treatment shall be provided as prescribed. (J) Upon discharge, a copy or summary of the child’s health and dental records shall be provided to the person or agency responsible for the future planning or care of the child. (2) Emergency Medical Procedure. (A) At least one (1) foster care provider shall be qualified/certified to administer first aid, including cardiopulmonary resuscitation (CPR). (B) A first-aid kit shall be readily available. (C) Authorization for nonemergency surgery, even though provided before admission, shall be used only when the parent(s), guardian or legal custodian is unavailable to reaffirm the authorization. (D) An agency shall contact a child’s parent(s), guardian or legal custodian within twenty-four (24) hours when a serious illness, a serious injury or hospitalization of the child occurs. (E) In the event of the death of a child, the parent(s), guardian or legal custodian and the division shall be notified immediately. (3) Dental Care. (A) An agency shall provide for annual dental examinations, and for reexaminations and treatment, as necessary. (B) Upon transfer of the child, a copy or summary of the child’s dental record shall be provided to the person or agency responsible for the future planning for the child. (4) Psychiatric and Psychological Care. (A) When the agency’s service plan for a child indicates a need for professional care by a psychiatrist or a psychologist, the specialized treatment shall be provided, or arranged for, by the agency. (B) Psychiatrists and psychologists shall be appropriately qualified, certified and/or licensed as appropriate to the nature of the service. (5) Medicine and Drugs. (A) All medication shall be prescribed by a licensed physician. (B) All medicine and drugs shall be kept in a safe place and shall only be accessible to and dispensed by the care giver. (C) All medication shall be labeled to indicate the name of the child, the type and dosage of medication and shall be dated. (D) Medication prescribed for one (1) child shall not be administered to another. (E) No child shall self-administer medication unless the practice is approved by a licensed physician, or a registered nurse with approval of a licensed physician, and the administrator. The approval shall be documented in the child’s medication record and social service plan. (F) When medications which are approved by a physician’s order are prescribed, continued, discontinued or changed, an entry shall be made in the child’s records. Entries shall be evaluated at least every sixty (60) days to determine if medication shall be continued, discontinued or changed. (G) When medications are discontinued, they shall be destroyed. (H) Upon transfer of a child, medications which are prescribed shall be provided to the person responsible for the future planning or care of the child. (6) All dietary changes for children under one (1) year should be approved by a licensed physician. AUTHORITY: sections 210.481–210.536, RSMo (1994) and (Cum. Supp. 1996).* This rule originally filed as 13 CSR 40-73.055. Original rule filed Feb. 6, 1997, effective July 30, 1997. Moved to 13 CSR 35-73.055, effective June 30, 2018. *Original authority: Please see the Missouri Revised Statutes 1994 and Cumulative Supplement 1996.