Licensure Requirements

PURPOSE: This rule establishes the general licensure and application procedures, fees and the rights of applicants for licensure of adult day care programs. (1) Any person who establishes, maintains or operates an adult day care program, or advertises or holds himself or herself out as being able to perform any adult day care service, shall obtain the proper license from the division, except as provided in section (5) of this rule. (2) An applicant shall submit the following documents to the division for each proposed associated or freestanding adult day care program: (A) A fully completed, properly signed and notarized Application for License to Operate an Adult Day Care Program, included herein; and (B) The required licensure fee. (3) Every adult day care program that includes an Alzheimer’s special care unit or program as defined in section 198.505, RSMo, shall submit to the division, as part of the licensure application or renewal, the following: (A) A completed Alzheimer’s Special Care Services Disclosure form (MO Form 886-3548), available at http://www.oa.state. mo.us/gs/form/fm_indiv.htm, stating how the care is different from the rest of the program in the following areas: 1. The Alzheimer’s special care unit’s or program’s written statement of its overall philosophy and mission which reflects the needs of participants afflicted with dementia; 2. The process and criteria for placement in, or discharge from, the program; 3. The process used for assessment and establishment of the plan of care and its implementation, including the method by which the plan of care evolves and is responsive to changes in condition; 4. Staff training and continuing education practices; 5. The physical environment and design features appropriate to support the functioning of cognitively impaired participants; 6. The frequency and types of participant activities; 7. The involvement of families and the availability of family support programs; 8. The costs of care and any additional fees; and 9. Safety and security measures; and (B) A document approved by the division which contains, but is not limited to, updated information on selecting an Alzheimer’s special care unit or program. (4) A nonrefundable fee shall accompany each adult day care program application for license according to the following schedule for licensed capacity which is the number of program participants who may be present at any one time: (A) For eight (8) participants or fewer, the fee is twenty-five dollars ($25); (B) For nine through sixteen (9–16) participants, the fee is fifty dollars ($50); (C) For seventeen through twenty-four (17–24) participants, the fee is seventy-five dollars ($75); and (D) For twenty-five (25) or more participants, the fee is one hundred dollars ($100). (5) Unless the program has voluntarily submitted to licensure in accordance with section 660.409, RSMo, adult day care licensure requirements shall not apply to any: (A) Adult day care program operated by a person in which care is offered for no more than two (2) hours per day; (B) Adult day care program maintained or operated by the federal government except where care is provided through a management contract; (C) Person who cares solely for persons related to the adult day care provider or who has been designated as guardian of that person; (D) Adult day care program which cares for no more than four (4) persons who are not related to the adult day care provider as defined in 19 CSR 30-90.010; (E) Adult day care program licensed by the Department of Mental Health under Chapter 630, RSMo, which provides care, treatment and habilitation exclusively to adults who have a primary diagnosis of mental disorder, mental illness, mental retardation or developmental disability; or (F) Adult day care program administered or maintained by a religious not-for-profit organization serving a social or religious function if the adult day care program does not hold itself out as providing the prescription or usage of physical or medical therapeutic activities or as providing or administering medicines or drugs. (6) The division shall review each application and investigate each applicant and adult day care program to determine if they comply with the adult day care licensure law and these regulations and to insure that the health and safety of the participants are protected. (7) If the adult day care program and the applicant are found to be in compliance, a regular license will be issued for a period not to exceed two (2) years for the premises and persons named in the application. (8) If an adult day care program is not currently meeting all of the requirements for licensure but demonstrates the potential capacity to meet the full requirements for licensure, a provisional license may be issued if there is no detriment to the health, safety and welfare of the participants in the program. The provisional license is nonrenewable and will be valid for a maximum of six (6) months. Any regular license issued subsequent to a provisional license will be valid for a period not to exceed two (2) years from the date that the provisional license was issued. (9) Licensure renewal applications will be sent to adult day care providers at least sixty (60) days prior to the expiration date of the current license. Renewal applications must be accompanied by the required nonrefundable fee and be postmarked at least thirty (30) days prior to the expiration date of the current license. (10) A regular or provisional license may be revoked or suspended for failure to comply with statutory or regulatory requirements. The division may revoke or suspend a license in any case in which it finds that the adult day care provider: (A) Failed to comply with any lawful request from the division to inspect the premises or investigate any complaint to determine compliance with sections 660.403 through 660.420, RSMo; (B) Falsified documents, records or any relevant information relating to the operation of the adult day care program; (C) Placed participants in immediate danger whether or not the adult day care program or adult day care provider corrected the situation which placed participants in immediate danger; or (D) Failed to achieve substantial compliance with statutory and regulatory requirements after being given a reasonable opportunity and period of time in which to correct the deficiencies cited by the division. (11) If any person is refused a license, or a license is suspended or revoked, or other official action by the division is detrimental to the provider of an adult day care program, a determination from the Administrative Hearing Commission may be requested pursuant to provisions of section 621.045, RSMo et seq. This action must be taken within thirty (30) calendar days of official notification of the adverse action taken by the division. (12) The license, or provisional license, issued to the adult day care provider, shall not be transferable when there is a change of ownership or when the program is moved to another location, building or premises. (13) The application for an adult day care program license shall be signed by the applicant’s owner, chairman of the board or chief executive officer and shall be notarized. (14) The division may, subject to the considerations noted below, grant exceptions for specified periods of time to any rule imposed by the division if the division determines that the exception to the rule would not potentially endanger the health, safety or welfare of any participant in the adult day care program. (A) The owner or operator of the adult day care program shall make requests for exceptions in writing to the director of the division. The requests shall contain: 1. If the exception request is being made due to a deficiency being cited, a copy of the latest Letter of Notification which indicates the violation; 2. The section number and text of the rule for which the exception is being requested; 3. Specific reasons why compliance with the rule would impose an undue hardship on the operator, including an estimate of any additional cost that might be involved; 4. An explanation of the relevant or extenuating factors; and 5. A complete description of the individual characteristics of the premises, program, participants or other factors that would safeguard the health, safety and welfare of the participants if the exception were granted. (B) The division shall issue a written decision stating the reasons for approval or denial of the request for an exception. If approved, the length of time the exception will be in effect and any additional corrective factors upon which the exception is granted shall be stated in the decision. (C) The division shall only grant exceptions to licensure requirements set out in rules imposed by the division and cannot grant exceptions to requirements established by state statutes, federal regulations or state regulations of other state agencies. AUTHORITY: sections 660.050, RSMo Supp. 2003 and 660.418, RSMo 2000.* This rule was originally filed as 13 CSR 15-8.020. Original rule filed Oct. 15, 1984, effective Jan. 11, 1985. Moved to 19 CSR 30-90.020, effective Aug. 28, 2001. Amended: Filed Sept. 14, 2004, effective March 30, 2005. *Original authority: 660.050, RSMo 1984, amended 1988, 1992, 1993, 1994, 1995, 2001 and 660.418, RSMo 1984, amended 1993, 1994.