PURPOSE: This rule is a description of the organization and general courses and methods of the Missouri Division of Aging’s operation and the methods and procedures where the public may obtain information or make submissions or requests.

PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. Therefore, the material which is so incorporated is on file with the agency who filed this rule, and with the Office of the Secretary of State. Any interested person may view this material at either agency’s headquarters or the same will be made available at the Office of the Secretary of State at a cost not to exceed actual cost of copy reproduction. The entire text of the rule is printed here. This note refers only to the incorporated by reference material.

1. (1) General Provisions and Powers. The Missouri Division of Aging was created within the Department of Social Services by Executive Order of the Governor on January 31, 1979. Actual operation by the division began on October 1, 1979. The 82nd Session of the Missouri General Assembly, then granted statutory authority to the division through passage of House Bill 1131, effective August 13, 1984. The Division of Aging is the unit of state government charged with the responsibilities of carrying out the duties, powers and functions relating to—regulation and licensing of all long-term care facilities under Chapter 198, RSMo; certification and review of intermediate care facilities, skilled nursing facilities and intermediate care facilities/mental retardation (ICF/MR) participating in the Title XIX (Medicaid) and Title XVIII (Medicare) reimbursement programs; medical review activities and level of care determination for eligibility for Title XIX long-term care services; Board of Nursing Home Administrators under Chapter 344, RSMo; Older Americans Act of 1965 pertaining to the Office of Aging, section 251.070, RSMo; vendor payments for purchased services and provision of direct services for elderly or handicapped adults under Title XX (Social Services Block Grant) of the Social Security Act, 42 U.S.C. 1397 and from other funding sources as available; preadmission screening and case management for Title XIX long-term care services; licensing of adult day care facilities; and services and responsibilities authorized under sections 660.250–660.295, RSMo. Social Services Block Grant services provided by the Division of Aging are limited to persons who are sixty (60) years and older or handicapped adults eighteen (18) years or older who require services available under the programs and who are in the greatest social or economic need. Persons shall be sixty (60) years or over to receive the Title III services administered through the local area agencies on aging and these services shall also be directed toward those in the greatest social or economic need. Persons participating in the Title V program shall be fifty-five (55) years or over and meet the federally stipulated income guidelines for participation.

2. (2) Central Operations. The director of the division, the deputy director of management services and the deputy director of alternative services are located at the Division of Aging Office, 615 Howerton Court, P.O. Box 1337, Jefferson City, MO 65102. Telephone: (314) 751-3082. The deputy director of institutional services and the executive secretary of the Board of Nursing Home Administrators are located at 615 Howerton Court, P.O. Box 1337, Jefferson City, MO 65102. Telephone for institutional services is (314) 751-2712 and for the Board of Nursing Home Administrators is (314) 751-3511.

   1. (A) Director. The director of the division is responsible for developing and coordinating the division budget and working as a liaison with the Department of Social Services and other divisions within the department, other departments and divisions of state government, various legislative committees, the Governor’s Advisory Council and outside associations and organizations concerned with service and care provided to the elderly to assure that the full range of services for the elderly can be obtained from multiple funding sources. Other responsibilities include serving as a member of the Board of Nursing Home Administrators and exercising supervision over the deputy directors, the administrative officer and the principal assistant who supervises staff involved with special projects, for example, Silver Haired Legislature, Silver Discount Program, Older Volunteer Service Bank.
   2. (B) The Management Services Section. Under the supervision of the deputy director of management services, this section is in charge of fiscal operations of the division, 13 CSR 15-1

staff training, program and advocacy planning, legal services, research and analysis, administration of the employment program for older adults under Title V, development of the state plan for administration of Title III funds under the Older Americans Act and preparing grants to the Area Agencies on Aging for Older American Act moneys, the United States Department of Agriculture (USDA) commodity and commodity cash programs and Social Service Block Grant funds for nutrition and transportation. The unit also monitors the accountability of Area Agencies on Aging from a fiscal point of view and provides technical assistance in this regard.

1. (C) Institutional Services Section. Under the supervision of the deputy director of institutional services this subsection is responsible for— the regulation and licensing of longterm care facilities including residential care facilities I and II, intermediate care facilities and skilled nursing facilities as defined under Chapter 198, RSMo; certification and review of facilities participating in the Title XIX (Medicaid) and Title XVIII (Medicare) reimbursement programs; medical review for appropriate level of care of individuals receiving federal or state inpatient financial assistance; and investigation of complaints regarding care in long-term care facilities. The institutional services section consists of specialized staff dealing with administrative and enforcement activities directly supervised by the deputy director, as well as two (2) units: a field operations unit and a licensure and certification unit. The field operations unit is supervised by the field operations manager and includes staff who review and validate inspections and surveys done by field staff, a central office medical review unit, anICF/MR unit, a Centralized Record Unit and inspection and survey teams in seven (7) regions supervised by regional managers. The teams consist of institutional advisory nurses, boarding home surveyors, medical social workers and environmental sanitarians who inspect and recommend for licensure all long-term care facilities; investigate complaints regarding long-term care facilities; survey and recommend for certification facilities participating in the Title XVIII and Title XIX programs; and review for medical eligibility and appropriate level of care and individuals receiving federal or state financial assistance in skilled nursing or intermediate care facilities. The licensure and certification unit handles all matters related to application or reapplication for licensure or certification including review of financial capability to operate; issues licenses and notices of certification or recommendation for certification; and maintains statistical data related to licensure and certification of long-term care facilities.
2. (D) The Alternative Services Section. Under the supervision of the deputy director of alternative services, this section is responsible for planning and administering programs which serve elderly and handicapped adults throughout the state of Missouri who are not in an institutional environment. There are three (3) units: the program management unit, the field operations unit and the central services support unit. The program management unit, located in the central office, includes staff of the elderly abuse central registry unit, a long-term care ombudsman, an adult day care coordinator and other management support staff who administer the Title XIX preadmission screening and case management programs designed to delay or prevent placement in nursing homes. The unit is supervised by the alternative services administrator who arranges for contracts for inhome and counseling services under the Social Service Block Grant and supervises the field operations unit. The field operations unit includes social service workers assigned to every county, area supervisors and regional managers responsible for ten (10) regions. The workers investigate abuse, neglect and exploitation reports received by the central registry unit hotline; providing protective services to abused, neglected or exploited elderly; perform pre-admission screening activities; and provide other direct services such as information and referral, counseling, placement assistance and case management to persons age sixty (60) or over and handicapped persons age eighteen through fiftynine (18–59). Through case management, field staff conduct an assessment of individual needs, develop care plans and authorize participation in various programs such as personal care, homemaker/chore services, adult day health care, respite care and counseling services which are purchased from contract agencies. The central services support unit is responsible for monitoring Social Services Block Grant funds for transportation and home delivered and congregate meals allocated to the Area Agencies on Aging; provides technical assistance to the Area Agencies on Aging; monitors services delivered by those agencies to assure compliance with stated objectives in their area plans and assesses the overall effectiveness of service delivery. The unit also provides support to the Governor’s Advisory Council on Aging and assists with other special projects.
3. (E) The Board of Nursing Home Administrators, established under Chapter 344, RSMo, consists of ten (10) members and the director of the Division of Aging. An executive secretary supervises the office staff and handles all matters at the direction of the board. The Board of Nursing Home Administrators is responsible for reviewing eligibility and testing candidates for licensure as nursing home administrators, reviewing and approving continuing education programs for nursing home administrators, taking action related to revocation or denial of licenses, investigating complaints against nursing home administrators, maintaining records of continuing education programs, maintaining records of continuing educational status and maintaining other records related to the licensure and relicensure of nursing home administrators.

AUTHORITY: Executive Order 77-9 of the Governor filed Jan. 31, 1979, effective Sept. 28, 1979, Chapter 198 and sections 207.020 and 208.152, RSMo Supp. 1993, 251.070 and 536.023, RSMo 1986.* Emergency rule filed Aug. 13, 1979, effective Oct. 1, 1979, expired Jan. 25, 1980. Original rule filed Aug. 13, 1979, effective Dec. 13, 1979. Emergency amendment filed Oct. 15, 1980, effective Oct. 25, 1980, expired Feb. 26, 1981. Amended: Filed Nov. 10, 1980, effective Feb. 12, 1981. Amended: Filed Oct. 7, 1981, effective Dec. 11, 1981. Amended: Filed Nov. 12, 1982, effective Feb. 11, 1983. Amended: Filed Nov. 9, 1984, effective Feb. 11, 1985. *Original authority: Chapter 198 see the Revised Statutes of Missouri 1986 and 1993; 207.020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986, 1993; 208.152, RSMo 1967, amended 1969, 1971, 1972, 1973, 1975, 1977, 1978, 1978, 1981, 1986, 1988, 1990, 1992, 1993; 251.070, RSMo 1967; and 536.023, RSMo 1975, amended 1976.