PURPOSE: This rule sets forth standards to be met by any agency which contracts with the Missouri Department of Social Services, Division of Aging for provision of in-home services.

1. (1) The Department of Social Services, Division of Aging’s payment to the provider is made on behalf of an eligible client as an act of indirect or third-party reimbursement and is not made as a payment for the purchase of a service. However, only those services authorized by the Division of Aging shall be reimbursable to the provider.
2. (2) The in-home service provider shall deliver services in compliance with the standards set forth in this rule.
3. (3) Failure of the provider to comply with the terms of the contract and these standards may constitute a breach of contract.

4. (4) In accordance with the protective service mandate (Chapter 660, RSMo), the Division of Aging may take immediate action to protect clients from providers who are found to be out of compliance with the requirements of this rule and of any other rule applicable to the in-home services program, when such noncompliance is determined by the Division of Aging to create a risk of injury or harm to clients. Evidence of such risk may include: unreliable or inadequate provider documentation of services or training due to falsification or fraud; the provider’s failure to deliver services in a reliable and dependable manner; or use of in-home service workers who do not meet the minimum training standards of this rule. Immediate action may include, but is not limited to:

   1. (A) Removing the provider from any list of providers, and for clients who request the unsafe and noncomplainant provider, informing the clients of the determination of noncompliance after which any informed choice will be honored by the Division of Aging; or
   2. (B) Informing current clients served by the provider of the provider’s noncompliance and that the division has determined the provider unable to deliver safe care. Such clients will be allowed to choose a different provider from the list maintained by the Division of Aging which will then be immediately authorized to provide service to them.

5. (5) Respite care services are maintenance and supervisory services provided to a client in the individual’s residence to provide temporary relief to the usual caregiver(s). Respite care services shall include, at a minimum, the following activities:

   1. (A) Supervision—The respite care worker will provide personal oversight of the client for the duration of the service period. Personal oversight includes making a reasonable effort to assure the safety of the client and to assist the client in meeting his/her own essential human needs. Sleeping is permitted when the client is asleep. The worker must be in close proximity to the client during a sleeping period;
   2. (B) Companionship—The worker will provide companionship during the client’s waking hours and attempt to make the client as comfortable as possible; and
   3. (C) Direct Client Assistance—The worker will provide direct client assistance as needed to meet needs usually provided by the regular caregiver.

6. (6) Advanced respite care services are maintenance and supervisory services provided to a client with special needs in that individual’s residence for the purpose of temporary relief to a caregiver who lives with the client. Clients appropriate for this service include persons with special needs approved by the Division of Aging. The advanced respite care services are similar to those specified in subsections (5)(A), (B) and (C); however, the client’s requirements for personal oversight are higher.

   1. (A) An initial on-site evaluation of the client’s condition and identification of special training needs for the advanced respite care worker shall be made by the provider RN prior to initiation of service.
   2. (B) A monthly nurse visit will be authorized for each advanced respite care client for each month advanced respite care is authorized. This visit will evaluate the adequacy of the authorized services to meet the needs and condition of the client.
   3. (C) For clients receiving ongoing advanced respite care services, it is required that onsite visits by an RN be conducted at six (6) month intervals. During these visits, the RN shall conduct an evaluation of the client’s condition and the adequacy of the care plan.

7. (7) Homemaker services are general household activities provided by a trained homemaker when the client is unable to manage the home and care for him/herself or others in the home or when the individual (other than the client) who is regularly responsible for these activities is temporarily absent. Homemaker services shall include, at a minimum, the following activities:

   1. (A) Plan and prepare meals, including special diet menus; cleanup after meals;
   2. (B) Wash dishes, pots, pans and utensils;
   3. (C) Clean kitchen counters, cupboards and appliances, including oven, surface burners and inside refrigerator;
   4. (D) Clean bathroom fixtures;
   5. (E) Make beds and change sheets;
   6. (F) Sweep, vacuum and scrub floors;
   7. (G) Tidy and dust the home;
   8. (H) Launder clothes and linens;
   9. (I) Iron and mend clothes;
   10. (J) Wash inside windows and clean venetian blinds that are within reach without climbing;
   11. (K) Bag trash inside the home and put it out for pick up;
   12. (L) Shop for essential items (for example, groceries, cleaning supplies, etc.);
   13. (M) Perform essential errands (for example, obtain food stamps, pick up medication, post mail, etc.);
   14. (N) Read and write essential correspondence for blind, illiterate or physically impaired clients; and
   15. (O) Instruct the client in ways to become self-sufficient in performing household tasks.

8. (8) Optional homemaker services are household tasks necessary to maintain a safe and habitable home environment provided intermittently as needed by a trained homemaker. Optional homemaker services include the following activities:

   1. (A) Wash walls and woodwork;
   2. (B) Clean closets, basements and attics;
   3. (C) Shampoo rugs;
   4. (D) Air mattresses and bedding;
   5. (E) Spray for insects within the home with over-the-counter supplies;
   6. (F) Provide rodent control within the home (for example, setting traps and putting out over-the-counter supplies);
   7. (G) Wash or change curtains, drapes, or both;
   8. (H) Wash inside windows, clean blinds, or both, which require climbing; and
   9. (I) Bag outside trash.
9. (9) The range of homemaker and respite activities the in-home worker provides is mutually determined by the provider agency and the client.
10. (10) Basic personal care services are maintenance services provided to a client in the 13 CSR 15-7

individual’s residence to assist with the activities of daily living. Regulations for personal care are filed at 13 CSR 70-91.010.

1. (11) Advanced personal care services are maintenance services provided to a recipient in the individual’s home to assist with activities of daily living when this assistance requires devices and procedures related to altered body functions. Regulations for advanced personal care are filed at 13 CSR 70-91.010.
2. (12) Authorized nurse visits are skilled nursing services of a maintenance or preventive nature provided to clients with stable chronic conditions. They are provided at the client’s residence and prior-authorized by the Division of Aging case manager. These services are not intended primarily as treatment for an acute health condition. Authorized nurse visit services may be provided by a licensed practical nurse under the direction of a registered nurse. Regulations for authorized nurse visits are filed at 13 CSR 70-91.010.

3. (13) The in-home service provider shall not perform and shall not be reimbursed for the following activities:

   1. (A) Providing therapeutic/health-related activities that should be performed by a registered nurse, licensed practical nurse or home health aide under Titles XVIII or XIX home health programs;
   2. (B) Providing transportation services;
   3. (C) Administering over-the-counter or prescribed medications;
   4. (D) Performing household services not essential to the client’s needs; and
   5. (E) Providing friendly visiting.

4. (14) Prior to approval by the division for a Division of Aging funded in-home services contract and subsequent enrollment as a Medicaid personal care provider under 13 CSR 70-91.010(3), in addition to the contract, after August 1, 1998, all providers must—

   1. (A) Designate to the division the manager who will be responsible for the provider’s day-to-day operation. This manager shall be a policy maker and direct the provider’s record keeping, service delivery verification, hiring and firing practices and staff training;
   2. (B) Ensure that the designated manager successfully completes (or has completed) a Division of Aging provider certification course offered (quarterly or as needed) in a central location at no charge. Attendees shall be responsible for their own expenses, including but not limited to travel, meal and lodging costs they may incur in attending this course;
   3. (C) Be responsible for maintaining documentation of attendance and requiring attendance by new managers within six (6) months of hire; and
   4. (D) Once approved, providers are required to cooperate with the division to require managers to attend the certification course if the division requires attendance to improve operations of providers found to be substantially noncompliant.

5. (15) Clients shall be accepted for care on the basis of a reasonable expectation that the client’s maintenance care needs can be met adequately by the agency in the client’s place of residence. Services shall follow a written state-approved service plan developed in collaboration with and signed by the client.

   1. (A) The service plan shall consist of an identification of the services and tasks to be provided, frequency of services, the maximum number of units of service per month, functional limitations of the client, nutritional requirements if a special diet is necessary, medications and treatments as appropriate, any safety measures necessary to protect against injury and any other appropriate items.
   2. (B) A new in-home assessment and service plan may be completed by the Division of Aging as needed to redetermine the need for in-home services or to adjust the monthly amount of authorized units. In collaboration with the client, the provider agency may develop a new or revised set of service tasks, and weekly schedule for service delivery which shall be forwarded to the Division of Aging. The service provider must always have, and provide services in accordance with, a current service plan. Only the Division of Aging, not the service provider, may increase the maximum number of units for which the individual is eligible per month.
   3. (C) The client will be informed of the option of services available to him/her in accordance with the level-of-care determination and assessment findings.

6. (16) The following policies and procedures for discontinuing in-home services shall be followed:

   1. (A) Services for a client shall be discontinued by a provider agency under the following circumstances:

      1. 1. When the client’s case is closed by

the Division of Aging;

1. 2. When the provider learns of circum-

stances that require the closure of a case: for reasons including, but not limited to, death, entry into a nursing home, client no longer needs service. In these circumstances, the provider shall notify the Division of Aging case manager in writing and request that the client’s services be discontinued;

1. 3. When the client is noncompliant with

the agreed upon plan of care. Noncompliance requires persistent actions by the client or family which negate the services provided by the agency. After all alternatives have been explored and exhausted, the provider shall notify the Division of Aging case manager in writing of the noncompliant acts and request that the client’s services be discontinued;

1. 4. When the client or client’s family

threatens or abuses the in-home service worker or other agency staff to the point where the staff’s welfare is in jeopardy and corrective action has failed. The provider shall notify the Division of Aging case manager of the threatening or abusive acts and may request that the service authorization be discontinued;

1. 5. When a provider is unable to contin-

ue to meet the maintenance needs of a client. In these circumstances, the provider shall notify the Division of Aging case manager in writing and request that the client’s services be discontinued; or

1. 6. When a provider is unable to contin-

ue to meet the maintenance needs of a client whose plan of care requires advanced personal care or advanced respite services. In these circumstances, the provider shall provide written notice of discharge to the client or client’s family and the Division of Aging case manager at least twenty-one (21) days prior to the date of discharge. During this twenty-one (21)-day period, the Division of Aging case manager shall make appropriate arrangements with the client for transfer to another agency, institutional placement or other appropriate care. Regardless of circumstances, the provider must continue to provide care in accordance with the plan of care for these twenty-one (21) days or until alternate arrangements can be made by the case manager, whichever comes first.

1. (B) Discontinuing services for a client

still in need of assistance shall occur only after appropriate conferences with the Division of Aging case manager, client and client’s family.

1. (17) A unit of in-home service is one (1) hour (sixty (60) minutes) of direct service provided to the client in the client’s home by a trained in-home service worker, including time spent on completing documentation of service units provided and obtaining the client’s signature. No units are reimbursed except as authorized by the Division of Aging.

   1. (A) Time spent for travel, lunch, breaks or administrative activities, such as completing other reports or paperwork, shall not be included.

   2. (B) Partial units are reimbursable as follows:

      1. 1. For monthly invoicing purposes, units

and partial units of a particular service provided in the course of the month shall be added together and billed in whole units with no rounding up to the next whole unit when totaling units for each client;

1. 2. Partial units may be accumulated over

the billing cycle, but are not reimbursable in a subsequent month or billing cycle; and

1. 3. Partial units may not be carried over

to the next month.

1. (C) Advanced respite care is authorized in one (1)-hour units, six to eight (6-8)-hour blocks and twenty-four (24)-hour blocks.
2. (D) The monthly invoice submitted to the Division of Aging for in-home service shall not exceed actual delivered units of services.

1. (18) The in-home service provider shall meet, at a minimum, the following administrative requirements:

   1. (A) Employ and train the staff necessary to provide the required services and make staff available to serve in all sections of the provider’s designated service area;
   2. (B) Successfully contact at least two (2) references for each employee within thirty

2. (30) calendar days of the date of employment. References shall be former employers or other knowledgeable persons, excluding relatives of the employee. The documentation shall include the name of the employer and the individual giving the reference, the date, the response given when the reference was obtained by telephone and the signature of the person receiving the reference;

   1. (C) Monitor a current copy of the Department of Social Services’ Employee Disqualification List to ensure that no current or prospective employee’s name, who is in direct contact with clients, appears on the list and take the appropriate action once it is discovered by the provider that the employee is on the Employee Disqualification List;
   2. (D) Have the capability to provide service outside of regular business hours, on weekends and on holidays as authorized by the Division of Aging;
   3. (E) Protect the Department of Social Services and its employees, agents or representatives from any and all liability, loss, damage, cost and expense which may accrue or be sustained by the Department of Social Services, its officers, agents or employees as a result of claims, demands, costs, suits or judgments against it arising from the loss, injury, destruction or damage, either to person or property, sustained in connection with the performance of the in-home service;
   4. (F) Maintain bonding coverage and personal and property liability insurance coverage on all employees who are connected with the delivery and performance of in-home services in the client’s home;
   5. (G) Furnish adequate identification (ID) to employees of the provider. This ID shall be carried by the employee and presented to the client upon request. A permanent ID including the provider’s name, employee’s name and title shall be considered adequate ID. At the time of employment, an ID shall be issued which will meet the ID requirement. The provider shall require the return of the ID from each employee upon termination of employment;
   6. (H) Ensure that no in-home services worker is a member of the immediate family of the client being served by that worker. An immediate family member is defined as a parent; sibling; child by blood, adoption, or marriage; spouse; grandparent or grandchild;
   7. (I) Notify the Division of Aging central office and regional manager of any changes in location, telephone number, administrative or corporate status;

   8. (J) Have and enforce a written code of ethics which is distributed to all employees and clients. The code of ethics shall allow use of the bathroom facilities, and, with the client’s consent, eat the lunch, provided by the worker, in the client’s home. The code of ethics shall include, at a minimum, the following prohibitions:

      1. 1. Use of client’s car;
      2. 2. Consumption of client’s food or drink

(except water);

1. 3. Use of client’s telephone for personal

calls;

1. 4. Discussion of own or other’s person-

al problems, religious or political beliefs with the client;

1. 5. Acceptance of gifts or tips;
2. 6. Bringing other persons to the client’s

home;

1. 7. Consumption of alcoholic beverages,

or use of medicine or drugs for any purpose, other than medical, in the client’s home or prior to service delivery;

1. 8. Smoking in client’s home;
2. 9. Solicitation or acceptance of money

or goods for personal gain from the client;

1. 10. Breach of the client’s privacy and

confidentiality of information and records;

1. 11. Purchase of any item from the client

even at fair market value;

1. 12. Assuming control of the financial or

personal affairs, or both, of the client or of his/her estate including power of attorney, conservatorship or guardianship;

1. 13. Taking anything from the client’s

home; and

1. 14. Committing any act of abuse,

neglect or exploitation;

1. (K) Deliver the in-home service within seven (7) calendar days of receipt of the service authorization from the Division of Aging case manager or on the beginning date specified by the authorization, whichever is later, and on a regular basis after that in accordance with the service plan. The date of receipt must be recorded on each service authorization by the provider. If service is not initiated within the required time period, detailed written justification must be sent to the Division of Aging case manager with a copy maintained in the client’s file;
2. (L) Recommend, in writing, if the client has an ongoing need for service activities which may require more or fewer units than the amount specified in the service plan, that the plan of care be revised. Either the inhome services worker or the supervisor shall make this recommendation;
3. (M) Keep documentation of undelivered services by client. The reason for this failure to deliver authorized units shall be recorded in this documentation;
4. (N) Be aware that in-home service provided shall not be reimbursed unless authorized in writing by the Division of Aging;
5. (O) Ensure that all subcontractors comply with all standards;

6. (P) Shall give a written statement of the client’s rights to each client and primary caregiver, when appropriate, at the time service is initiated, which includes, at a minimum, the right to:

   1. 1. Be treated with respect and dignity;
   2. 2. Have all personal and medical infor-

mation kept confidential;

1. 3. Have direction over the services pro-

vided, to the degree possible, within the plan of care authorized;

1. 4. Know the provider’s established

grievance procedure and how to make a complaint about the service and receive cooperation to reach a resolution, without fear of retribution;

1. 5. Receive service without regard to

race, creed, color, age, sex or national origin; and

1. 6. Receive a copy of the provider’s code

of ethics under which services are provided; 13 CSR 15-7

1. (Q) Have a system through which clients may present grievances concerning the operation of the in-home service program;
2. (R) Report all instances of potential abuse, neglect, exploitation of a client, or any combination of these, to the Division of Aging Elderly Abuse and Neglect Hotline (1-800- 392-0210), including all instances which may involve an employee of the provider agency;
3. (S) Copayment, as determined by the Division of Aging case manager, shall be collected monthly from non-Medicaid clients. Liability levels for copayment are based on a sliding fee schedule on the Client Assessment form or other documentation as determined by the Division of Aging. The money collected as copayment replaces the amount withheld from reimbursement by the automated payment system. Prompt and reasonable attempts to collect from the client, the client’s guardian or estate shall be made by the provider. Failure to collect copayment, when determined to be a condition of participation, shall be reported to the Division of Aging. Failure to comply with copayment requirements may result in termination of services. Unsuccessful attempts to collect from the estate of a deceased client are to be referred to the home and community based services deputy director of the Division of Aging;
4. (T) Implement a contribution system which accounts for contributions received from clients for in-home services. Clients shall be informed of their right to voluntarily contribute no more than quarterly and no less than every six (6) months. Services shall not be denied to any client based on failure to make a contribution. Monthly reporting by county shall be made to each home and community services regional manager of contributions balance on hand at the beginning of the month, contributions received, contributions used for Division of Aging authorized services and month ending balance;
5. (U) Understand that both program and fiscal monitoring of the in-home service program shall be conducted by the Division of Aging or its designee. Monitoring visits may be announced or unannounced;
6. (V) Shall not solicit, nor cause to be solicited, through agents or employees of the in-home service provider, any person to become a client if that person is currently receiving services from any provider authorized by the Division of Aging. Solicitation means seeking out or initiating contact with another provider agency’s clients, in person or by mail, for the purpose of persuading them to choose another provider. Solicitation, as used in this subsection, does not include media advertising directed toward the general public; nor does it include presentations to the general public, organizations or other interested groups regarding the services available; and
7. (W) Providers must establish, enforce and implement a policy whereby all contents of the personnel files of its employees are made available to Department of Social Services employees or representatives when requested as part of an official investigation of abuse, neglect, financial exploitation, misappropriation of client’s funds or property, or falsification of documentation which verifies service delivery.

1. (19) In-home service providers shall meet, at a minimum, the following personnel requirements:

   1. (A) A supervisor shall be designated by the provider to supervise the day-to-day delivery of in-home service. Each supervisor shall meet the following requirements:

      1. 1. Be at least twenty-one (21) years of

age; and

1. 2. Be a registered nurse who is current-

ly licensed in Missouri or have at least a bachelor of science or bachelor of arts degree; or be a licensed practical nurse who is currently licensed in Missouri with at least one (1) year of experience with the direct care of the elderly, disabled and infirm; or have at least three (3) years of experience with the direct care of the elderly, disabled and infirm;

1. (B) All in-home service workers employed by the provider shall meet the following requirements:

   1. 1. Be at least eighteen (18) years of age;
   2. 2. Be able to read, write and follow

directions; and

1. 3. Have at least six (6) months paid

work experience as any agency homemaker, nurse aide, maid or household worker; or at least one (1) year’s experience, paid or unpaid, in caring for children or for sick or aged individuals. Successful completion of formal training in nursing arts or as a nurse aide or home health aide can substitute for the qualifying experience;

1. (C) All advanced personal care aides and advanced respite care workers employed by the provider shall be—

   1. 1. A licensed practical nurse; or
   2. 2. Certified nurse assistant; or
   3. 3. A competency evaluated home health

aide as required by the Missouri Department of Health 42 CFR 484.36; or

1. 4. Documented to have worked success-

fully for the provider for a minimum of three (3) consecutive months while working at least fifteen (15) hours per week as an in-home aide that has received personal care training;

1. (D) All individuals employed to deliver authorized nurse visits are currently licensed to practice as a registered nurse or a licensed practical nurse in Missouri; and

2. (E) In-home service providers must evaluate health conditions of all in-home employees who have direct client contact—

   1. 1. Establish, implement, and enforce a

policy governing communicable diseases that prohibits provider staff contact with clients when the employee has a communicable condition, including colds or flu; and

1. 2. Assure that reporting requirements

governing communicable diseases, including hepatitis and tuberculosis, as set by the Missouri Department of Health are carried out.

1. (20) The in-home service administrative supervisor’s responsibilities shall include, at a minimum, the following functions:
2. (A) Monitoring the provision of services by the in-home services worker to assure that services are being delivered in accordance with the service plan. This shall be primarily in the form of an at least monthly review and comparison of the worker’s record of provided services with the service plan. Documentation must be kept on clients with a delivery rate of less than eighty percent (80%) of the authorized units of in-home service. For each client with a delivery rate less than eighty percent (80%) of the authorized units of in-home services authorized for the time period being reviewed, the number of units of service delivered and the non-delivery code will be sent to the Division of Aging regional manager monthly on a form acceptable to the regional manager. Discrepancies for these clients concerning the frequency of delivered services and/or the in-home service tasks delivered, the corrective action taken, will be signed and dated by the supervisor and be readily available for monitoring or inspection;
3. (B) Designating a trainer(s) to perform the sessions required as part of the basic training. The designated trainer(s) may be the supervisor or an experienced aide who has been employed by the provider agency at least six

1. (6) months. A list of designated trainers must be available for monitoring;

   1. (C) Evaluating, in writing, each in-home service aide’s performance at least annually. The evaluation shall be based in part on at least one (1) on-site visit. The aide must be present during the visit. The evaluation will include, in addition to the aide’s performance, the adequacy of the service plan, including review of the service plan with the client. The written report of the evaluation shall contain documentation of the visit, including the client’s name, the date and time of the visit, the aide’s name and the supervisor’s observations and notes from the visit. The evaluation shall be signed and dated by the supervisor who prepared it and by the aide. If the required evaluation is not performed or not documented, the aide’s qualifications to provide the services may be presumed inadequate and all payments made for services by that aide may be recouped; and
   2. (D) Communicating with the Division of Aging case manager regarding changes in any client’s condition, changes in scope or frequency of service delivery and recommending changes in the number of units of service per month including written documentation of that communication.
2. (21) Registered nurse supervisory requirements for personal care and advanced personal care shall follow 13 CSR 70-91.010.

3. (22) The in-home service provider shall have a written plan for providing training for new aides, respite care workers and homemakers which shall include, at a minimum, the following requirements:

   1. (A) Twenty (20) hours of orientation training for in-home service workers, including at least two (2) hours orientation to the provider agency and the agency’s protocols for handling emergencies, within thirty (30) days of employment.

      1. 1. Eight (8) hours of classroom training

will be provided prior to the first day of client contact.

1. 2. Twelve (12) hours of required orien-

tation training may be waived for aides and homemakers with adequate documentation in the employee’s records that s/he has received similar training during the current or preceding fiscal year or has been employed at least half-time for six (6) months or more within the current or preceding fiscal year.

1. 3. May waive all orientation training,

except the required minimum of two (2) hours’ provider agency orientation to the provider agency, with documentation, placed in the aide’s personnel record, that the aide is a licensed practical nurse, registered nurse or certified nurse assistant. The documentation shall include the employee’s license or certification number current at the time the training was waived;

1. (B) Ten (10) hours of in-service training annually are required after the first twelve

1. (12) months of employment; and

   1. (C) Additional training for advanced respite workers is determined and provided by the provider agency RN following assessment of the client’s condition and needs.
2. (23) The in-home service provider shall have written documentation of all basic and in-service training provided which includes, at a minimum, a report of each employee’s training in that employee’s personnel record. The report shall document the dates of all classroom or on-the-job training, trainer’s name, topics, number of hours and location, the date of the first client contact and shall include the aide’s signature. If a provider waives the in-service training, the employee’s training record shall contain supportive data for the waiver.

3. (24) The in-home service provider shall maintain, at a minimum, the following records in a central location for five (5) years and provide them to the Department of Social Services staff or designees upon request:

   1. (A) Individual client case or clinical records including records of service provision. These are confidential and shall be protected from damage, theft and unauthorized inspection and shall include, at a minimum, the following:

      1. 1. The authorization for services forms

(LTACS Client Report) from the Division of Aging which documents authorization for all units of service provided;

1. 2. Individual worker’s record that lists

the client’s name, dates of service delivery, time spent on each day, activities performed, aide’s signature and the client’s signature verifying each date(s) of service. If the client is unable to sign, another responsible person present in the home during service delivery may sign to verify the time and activities reported or the client may make his/her mark (x) which shall be witnessed by a minimum of one (1) person who may be the aide or homemaker. If these documents are not maintained in the client’s case record, they must be readily available for monitoring or inspection;

1. 3. Copies of the supervisory monitoring

log explaining discrepancies between authorized and delivered services including a description of corrective action taken, must be maintained in a central location and available for monitoring or inspection by the Department of Social Services;

1. 4. Any registered nurse clinical notes

concerning the client;

1. 5. Documentation of all correspondence

and contacts with the client’s physician or other care providers;

1. 6. Copies of written communication

transmitted to and from the Division of Aging case manager; and

1. 7. Any other pertinent documentation

regarding the client; 13 CSR 15-7

1. (B) Individual personnel record for each employee which is a confidential record and shall be protected from damage, theft and unauthorized inspection and shall include, at a minimum, the following:

   1. 1. Employment application with the

employee’s signature showing requirements met for age, education, work experience and the dates employed and terminated by the service provider;

1. 2. Documentation of at least two (2) ref-

erences successfully contacted;

1. 3. Documentation concerning all train-

ing and certification received;

1. 4. Documentation for any waiver of

employment or training requirements;

1. 5. Annual performance evaluation which

includes observations from one (1) on-site visit;

1. 6. A signed statement verifying that the

employee received and reviewed a copy of the client’s rights, the code of ethics and that the service provider’s policy regarding confidentiality of client information was explained prior to service delivery;

1. 7. A signed statement verifying that the

supervisor received and reviewed a copy of the in-home service standards;

1. 8. Statement identifying the employee’s

position, including whether the employee performs administrative duties for the provider or delivers services to clients;

1. 9. Returned permanent ID for a termi-

nated employee or documentation of why it is not available; and

1. 10. Verification of the current Missouri

certified nurse assistant, licensed practical nurse or registered nurse license including, at least, the license or certificate number;

1. (C) Written plans for basic and in-service training; and
2. (D) Accurate records documenting dates and amount of contributions received and expended. Records of contributions received should list the name of each contributor and the date and amount of the contribution. The contribution expenditure records should list the name and amount of the contribution. The contribution expenditure records should list the name and address of each client, dates of service delivery, time spent on each date, activities performed, aide’s name and the client’s signature for each date of service.

AUTHORITY: sections 536.023 and 660.050, RSMo Supp. 1997.* Original rule filed Sept. 1, 1994, effective April 30, 1995. Amended: Filed Dec. 15, 1997, effective July 30, 1998.

*Original authority: 536.023, RSMo 1975, amended 1976 and 660.050, RSMo 1984, amended 1988, 1992, 1993.