PURPOSE: This rule describes the procedures for application for licensure, the licensing investigation and provisions for continued licensing investigations after the initial license is granted.

1. (1) Licensing Authority.

   1. (A) Any person who desires to develop, establish, maintain or operate, or both, a residential treatment agency for children and youth, except for those persons exempt from licensing pursuant to section 210.516, RSMo, must file an application for licensure form with the division and must receive a license prior to accepting any child for care.
   2. (B) Before a license may be granted, an agency must be in compliance with sections 210.481–210.536, RSMo and these rules.

2. (2) Application for Licensure.

   1. (A) An agency shall submit the following documents in duplicate to the division—

      1. 1. Application for licensure signed and

dated by the applicant;

1. 2. Evidence of compliance with local

building and zoning requirements;

1. 3. A floor plan of the proposed site in

which the specific use of each room is identified;

1. 4. A signed and dated copy of the civil

rights agreement;

1. 5. A chart depicting the agency’s orga-

nizational structure and lines of supervision;

1. 6. Written policies and procedures

established by the board of directors which clearly set forth the authority and the responsibilities delegated to the executive director;

1. 7. A copy of the articles of incorpora-

tion, bylaws, and board roster, including the mailing address and place of employment of each member, and a list of board officers;

1. 8. A proposed budget for a period of not

less than one (1) year, including sources of income and/or fund raising methods;

1. 9. Verification of availability of not less

than three (3) months’ operating capital;

1. 10. A written intake policy;
2. 11. Written identification of specific pro-

gram models or designs which shall include the methods of care and treatment to be provided;

1. 12. Job title, job description, and mini-

mum qualifications for all staff;

1. 13. A projected staffing plan for the

anticipated capacity;

1. 14. Written child abuse and neglect

reporting policy;

1. 15. Written personnel practices, includ-

ing staff training and orientation;

1. 16. Written discipline policy;
2. 17. Written visitation policy;
3. 18. Written health care policy;
4. 19. Written restraint policy utilizing a

recognized and approved physical restraint program;

1. 20. A needs assessment conducted and

submitted as evidence of need for the type and scope of program proposed. This written assessment shall include, but is not limited to:

1. A. An identification and survey of

potential referral sources, existing resources, and unmet community needs;

1. B. A business plan that details the

agency’s proposed venture explaining the vision, mission, current status, expected needs, defined markets, and projected results;

1. C. A description of how treatment will

be provided and documented and how the proposed operating site meets therapeutic needs;

1. D. A description of how the agency

will be financed and how fiscal viability will be maintained; and

1. E. A description of the results of a

meeting planned and hosted by the agency with key community participants with the intent of enhancing communication, gathering information for the needs assessment, addressing interaction with community resources, and addressing community questions and comments regarding the proposed residential treatment agency for children and youth;

1. 21. Evidence of compliance with fire

safety requirements of the State Fire Marshal;

1. 22. Documentation that the agency’s

water supply and sewage disposal system is currently in compliance with the requirements of the Department of Health and Senior Services if not an approved public source;

1. 23. Verification of a medical examination

that includes tests for communicable diseases including, but not limited to, tuberculosis and hepatitis when recommended by a licensed physician for all staff, completed by a licensed physician, certified nurse practitioner, advanced practice nurse in a collaborative practice agreement with a licensed physician, or a registered nurse who is under the supervision of a licensed physician, shall be submitted within thirty (30) days of initial licensure using the form prescribed by the division;

1. 24. Results of a check of the family care

safety registry for all staff, as well as interns, volunteers, and contractors. Any employee who resides in another state and works in the state of Missouri, or who has relocated to the state of Missouri within the last five (5) years, shall provide documentation of child abuse/neglect and criminal background screening check(s) from those states. When an employee who lived in another state or states within the last five (5) years now resides in the state of Missouri, the documentation of child abuse/neglect and criminal background screening check(s) from the previous state(s) only needs to be completed upon initial employment. If the employee continues to reside in another state, the out-of-state check shall be done annually. Results of employee medical examinations and background screenings, along with family care safety registry documentation may be viewed by division licensing staff on site during routine record reviews;

1. 25. Verification of the education, licens-

ing credentials, and experience for all professional staff;

1. 26. A copy of the resume for all profes-

sional and administrative staff;

1. 27. Written description of the recre-

ational program, and the manner in which staff are qualified and prepared to create, organize, and supervise them;

1. 28. A copy of the annual written staff

training plan;

1. 29. A copy of the personnel manual for

the agency;

1. 30. A copy of the program manual for

the agency;

1. 31. For any agency operating a swim-

ming pool on grounds, documentation that the pool is operated and maintained in accordance with all applicable ordinances and/or state guidelines;

1. 32. Documentation that each operating

site’s food service is in compliance with the requirements of the Department of Health and Senior Services and/or any local applicable ordinances;

1. 33. Written volunteer policies;
2. 34. Written policy for the use of visiting

resources;

1. 35. Written confidentiality policy;
2. 36. Written policy for the use of locked

isolation;

1. 37. Written instructions for fire, severe

weather, and other emergency evacuations;

1. 38. Written description of the agency’s

religious requirements and practices;

1. 39. Written policy governing the use of

medications, including psychotropic medications;

1. 40. A copy of any newsletter, brochure,

or flyer used by the agency for fundraising or marketing purposes;

1. 41. Documentation of insurance for the

agency for professional and commercial liability, worker’s compensation insurance, fire and disaster insurance, and agency vehicle insurance; and

1. 42. A completed, signed, and dated copy

of the agency self study on a form prescribed by the division.

1. (3) Licensing Assessment.

   1. (A) A thorough assessment of the agency shall be made by the division, including a review of the documents required in this rule and visits to the agency to determine compliance with the licensing law and applicable rules.
   2. (B) If an applicant for licensure is determined not to be in compliance with the licensing law and applicable rules, and/or if compliance is not achieved within a six- (6-) month period, the application may be denied. A new application for licensure must be filed if the agency desires to pursue licensure.

2. (4) The License.

   1. (A) Upon determination of compliance with the licensing law and applicable rules, the director shall issue a license for an initial six- (6-) month probationary term.
   2. (B) Following the probationary period, upon determination of continued compliance with Missouri statutes and applicable licensing rules, the director shall extend the term of the license for a period not to exceed two (2) years.
   3. (C) The license shall be posted in a conspicuous place on the premises of the operating site.
   4. (D) The number, sex, and age range of children an agency is authorized to accept for care shall be specified on the license and shall not be exceeded.
   5. (E) The license shall not be transferable.
   6. (F) A licensed residential treatment agency for children and youth may request a temporary variance from one (1) or more of the licensing requirements for a specified period of time on a form prescribed by the division that is approved or denied by the division. Approval may be granted by the division only in unusual situations when the division determines that the variance will not negatively impact child health and safety and is not under the purview of another regulatory entity. Examples may include, but are not limited to, time limited deviations in licensed capacity and age range. No variance will be granted for any licensing requirements which involve the health, safety, and welfare of children. Examples include, but are not limited to, compliance with fire and sanitary codes, food safety, building occupancy requirements, and other requirements imposed by law. In the event the licensed residential treatment agency for children and youth does not agree with the decision of the division, it may request administrative review pursuant to 13 CSR 35-71.030.

3. (5) License Amendment.

   1. (A) An agency shall file an application for amendment with the division on a form prescribed by the division at least sixty (60) days prior to—

      1. 1. Relocation and/or address change;
      2. 2. Change in the name of the agency;
      3. 3. Change in the capacity, gender served,

and/or age range of children; or

1. 4. Any major change in the program. 13 CSR 35-71
2. (B) These changes shall be approved by the division prior to implementation.

1. (6) Licensing Renewal.

   1. (A) An application for licensure shall be mailed by the division to the agency.
   2. (B) The agency shall complete and return the application to the division at least ninety

2. (90) days prior to the expiration of the current license.

   1. (C) The division shall initiate action on the completed application packet prior to the expiration of the existing licensure period.

   2. (D) In addition to the completed application, the following documents shall be submitted:

      1. 1. Verification of a medical examination

that includes tests for communicable diseases including, but not limited to, tuberculosis and hepatitis when recommended by a licensed physician, completed by a licensed physician, certified nurse practitioner, advanced practice nurse in a collaborative practice agreement with a licensed physician, or a registered nurse who is under the supervision of a licensed physician, for all staff working directly with children shall be submitted utilizing the form prescribed by the division;

1. 2. A current board roster, including the

mailing address and place of employment of each member and a list of board officers;

1. 3. A summary of any significant changes

to programs and copies of any resulting policies or policy changes;

1. 4. A copy of a current organizational

chart;

1. 5. Annual results of a check of the fam-

ily care safety registry for all staff, as well as interns, volunteers, and contractors. Any employee who resides in another state and works in the state of Missouri, or who has relocated to the state of Missouri within the last five (5) years, shall provide documentation of child abuse/neglect and criminal background screening check(s) from those states. When an employee who lived in another state or states within the last five (5) years now resides in the state of Missouri, the documentation of child abuse/neglect and criminal background screening check(s) from the previous state(s) only needs to be completed upon initial employment. If the employee continues to reside in another state, the outof-state check shall be done annually. Results of employee medical examinations and background screenings, along with family care safety registry documentation may be viewed by division licensing staff on site during routine record reviews;

1. 6. Evidence of current compliance with

the fire and safety requirements of the State Fire Marshal;

1. 7. A record of monthly drills for fire and

emergency evacuations which are held at different times of the day and night;

1. 8. Documentation that each operating

site’s water supply and sewage disposal system is currently in compliance with the requirements of the Department of Health and Senior Services if not an approved public source;

1. 9. A copy of the most recent financial

audit and/or financial review pursuant to 13 CSR 35-71.040(5)(B);

1. 10. A copy of the annual written staff

training plan;

1. 11. Documentation that each operating

site food service is currently in compliance with requirements of the Department of Health and Senior Services or any local applicable ordinance;

1. 12. A copy of the current personnel

and/or program manual for the agency if there have been changes since last submitted to the licensing unit;

1. 13. For any agency operating a swim-

ming pool on grounds, documentation that the pool is operated and maintained in accordance with all applicable local ordinances and/or state guidelines;

1. 14. A copy of the resume of all admin-

istrative and professional staff, if not previously submitted to the licensing unit;

1. 15. Documentation of insurance for the

agency for professional liability and commercial liability, worker’s compensation insurance, fire and disaster insurance, and agency vehicle insurance; and

1. 16. Documentation of form 990 for all

non-profit agencies and Internal Revenue Service return for for-profit agencies and selfdisclosure of tax liabilities, including but not limited to, all employee withholding taxes.

1. (E) Upon determination of compliance with the licensing law and applicable rules, the director shall issue a license for a period not to exceed two (2) years.

1. (7) License Supervision.

   1. (A) Division licensing consultants may make supervisory on site contacts which may or may not be scheduled to determine compliance with the licensing rules.
   2. (B) Division licensing consultants may review personnel files including, but not limited to, criminal/child abuse/neglect background screening documentation during on site reviews.

AUTHORITY: section 210.516, RSMo 2000.* This rule originally filed as 13 CSR 40- 71.020. Original rule filed Nov. 9, 1978, effective Feb. 11, 1979. Rescinded: Filed Oct. 13, 1982, effective Jan. 13, 1983. Emergency rule filed Nov. 1, 1993, effective Nov. 12, 1993, expired March 11, 1994. Emergency rule filed March 2, 1994, effective March 12, 1994, expired July 9, 1994. Readopted: Filed Nov. 1, 1993, effective June 6, 1994. Emergency amendment filed July 25, 2008, effective Aug. 4, 2008, expired Jan. 30, 2009. Moved to 13 CSR 35-71.020 and amended: Filed July 25, 2008, effective Jan. 30, 2009. Amended: Filed Dec. 16, 2013, effective June 30, 2014. *Original authority: 210.506, RSMo 1982, amended 1993, 1995.