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.

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. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.

1. (1) Licensing Authority.

   1. (A) Any person who develops, establishes, maintains, or operates a residential treatment agency for children and youth, other than persons exempt from licensure requirements under section 210.516, RSMo, must apply for and receive a license from the division 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, sections 210.1250–210.1286, RSMo, and these rules.

2. (2) Application Procedures.

   1. (A) To apply for a license to operate a Licensed Residential Care Facility (LRCF) in Missouri the person, or the persons legally authorized designee, shall file an application with the division on forms provided by the division.

      1. 1. The application forms are published on the division’s

website and are incorporated by reference and made a part of this rule as published by the Department of Social Services, Children’s Division, 205 Jefferson Street, 10th Floor, PO Box 88, Jefferson City, MO 65102, and available at: https://www. dss.mo.gov/provider-services/children/residential-program/ licensed.htm, October 1, 2021. This rule does not incorporate any subsequent amendments or additions. The person shall attach all additional supplementary materials and documentation that may be necessary to complete the required application. The person shall submit the form with supplementary materials to the division by email at the following email address: CDaskRPU@dss.mo.gov.

1. 2. The application form shall be signed by the person or

the person’s legally authorized designee. The division will accept e-signatures.

1. (B) The application shall contain the following information:

   1. 1. The name, street address, mailing address, fax number,

and phone number of the residential care facility;

1. 2. The name, street address, mailing address, email address,

and phone number of the director, owner, and operator of the LRCF;

1. 3. The name, street address, mailing address, email

address, phone number, and job title of the individual or individuals who are designated to submit the application on behalf of the residential care facility. This individual shall be an individual who is legally authorized to act on behalf of the residential care facility and to legally bind the residential care facility to the statements made and information provided in support of the application;

1. 4. The name and description of the person operating the

residential care facility, including a statement as to whether the person operating the residential care facility is a firm, corporation, benevolent association, partnership, association, agency, or an incorporated or unincorporated organization, regardless of the name used. If the owner or operator of the residential care facility is incorporated, a corporation shall state the type of corporation, the state in which the corporation was incorporated, and the date of incorporation;

1. 5. The name and address of the sponsoring organization of

the residential care facility, if applicable;

1. 6. The name and address of every school attended by, or

to be attended by, the children served by the residential care facility;

1. 7. A certification that officers, managers, contractors,

volunteers with access to children, employees, and other support staff of the residential care facility, and owners who will have access to the facilities have, or will have, completed background checks and have been found eligible as required in section 210.493, RSMo, and 13 CSR 35-71.015.

1. (C) The residential care facility shall submit the additional documentation and information in support of the application as provided in this subsection. This information may be submitted on a form or forms provided by the division, or it may be submitted separately as attachment(s) to the application.

   1. 1. Local health department inspection certificates.

      1. A. The residential care facility shall successfully complete

and obtain any and all local health department inspection certificates required in the jurisdiction in which the facility operates. If the residential care facility operates in more than one (1) county or local jurisdiction, then the residential care facility shall obtain the required certificates for each facility in each location.

1. B. The residential care facility shall submit a copy of

all local health department inspection certificates with the application, and shall indicate the date of the inspection and the date that each certificate expires, if any.

1. C. If there is no local or county government health

department in which the residential care facility is located, or if the local or county health department will not perform a health inspection, the residential care facility shall request that decision in writing and submit that information with the application.

1. D. If the residential care facility is unable, after exercising

diligent efforts, and due to no fault of its own, to obtain a local inspection certificate, then the residential care facility shall submit a statement describing the efforts made to obtain the certificate(s) and the reason why the residential care facility was unable to obtain the certificate. The residential care facility shall attach copies of any correspondence from any state, county, or local jurisdictions declining to conduct the inspection.

1. 2. Proof that medical records are maintained for each child.

The division will accept copies of the LRCF’s administrative policy regarding the maintenance of medical records as prima facie proof that the LRCF is maintaining medical records for purposes of submitting an application. However, proof that the LRCF is maintaining medical records on each child will be the subject of verification and monitoring. The LRCF shall provide the division access to the facility upon request to inspect the medical records maintained by the LRCF on the children served by the LRCF in order to verify that the medical records are being kept.

1. 3. Evidence of compliance with local building and zoning

requirements.

1. 4. A floor plan of the proposed site in which the specific

use of each room is identified.

1. 5. A signed and dated copy of the civil rights agreement.

This form is included with the application forms referenced in paragraph (2)(A)1.

1. 6. A chart depicting the agency’s organizational structure

and lines of supervision.

1. 7. 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. 8. A copy of the articles of incorporation or organization,

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

1. 9. A proposed budget for a period of not less than one (1)

year, including sources of income and/or fund raising methods.

1. 10. Verification of availability of not less than three (3)

months’ operating capital.

1. 11. A copy of the residential care facility’s written intake

policy.

1. 12. Written identification of specific program models or

designs which shall include the methods of care and treatment to be provided.

1. 13. The job title, job description, and minimum

qualifications for all staff.

1. 14. A projected staffing plan for the anticipated capacity.
2. 15. Written child abuse and neglect reporting policy.
3. 16. Written personnel practices, including staff training

and orientation.

1. 17. Written discipline policy.
2. 18. Written visitation policy.
3. 19. Written health care policy.
4. 20. Written restraint policy utilizing a recognized and

approved physical restraint program.

1. 21. 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. 22. Evidence of compliance with fire safety requirements

of the State Fire Marshal.

1. 23. A certification that all individuals who are required

to complete a background check and be found eligible for employment or presence at the LRCF as provided in section 210.493, RSMo, and 13 CSR 35-71.015.

1. 24. Verification of the education, licensing credentials, and

experience for all professional staff.

1. 25. A copy of the resume for all professional and

administrative staff.

1. 26. Written description of the recreational program, and

the manner in which staff are qualified and prepared to create, organize, and supervise them.

1. 27. A copy of the annual written staff training plan.
2. 28. A copy of the personnel manual for the agency.
3. 29. A copy of the program manual for the agency.
4. 30. For any agency operating a swimming pool on grounds,

documentation that the pool is operated and maintained in accordance with all applicable ordinances and/or state guidelines.

1. 31. 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. 32. Written volunteer policies.
2. 33. Written confidentiality policy.
3. 34. Written policy for the use of locked isolation.
4. 35. Written instructions for fire, severe weather, and other

emergency evacuations.

1. 36. Written description of the agency’s religious

requirements and practices.

1. 37. Written policy governing the use of medications,

including psychotropic medications.

1. 38. A copy of any newsletter, brochure, or flyer used by the

agency for fundraising or marketing purposes.

1. 39. Documentation of insurance for the agency for

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

1. (D) Upon receipt of the application form and supporting documentation, the division will send a request to the State Fire Marshal to conduct a fire and safety inspection and provide the LRCF and the division with a copy of the approved fire and safety certificate.
2. (E) The application will be complete when the residential care facility submits a completed application with all of the required supporting documents and information to include all required inspection certificates.

1. (3) Licensing Assessment.

   1. (A) When the application is complete the division will conduct a thorough assessment of the residential care facility to determine whether the residential care facility meets all of the requirements for licensure in 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, or if the division issues a provisional license and the residential care facility does not achieve full compliance within six (6) months of the date of the issuance of the provisional license, the application will 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) An LRCF 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 LRCF 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 LRCF;
      3. 3. Change in the capacity, gender served, and/or age range

of children; or

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

1. (6) Licensing Renewal.

   1. (A) The LRCF shall complete and return the application for license renewal to the division at least ninety (90) days prior to the expiration of the current license. The LRCF shall utilize the forms indicated in paragraph (2)(A)1. of this regulation to initiate the license renewal process. The LRCF shall attach all additional supplementary materials and documentation that may be necessary to complete the required application. The LRCF shall submit the form with supplementary materials by email to CDaskRPU@dss.mo.gov. The application form shall be signed by the director of the LRCF or the director’s legally authorized designee. The division will accept e-signatures.
   2. (B) The division shall initiate action on the completed application packet prior to the expiration of the existing licensure period.

   3. (C) In addition to the completed application form, the residential care facility shall submit the following documents with the application for license renewal:

      1. 1. A current board roster, including the mailing address

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

1. 2. A summary of any significant changes to programs and

copies of any resulting policies or policy changes;

1. 3. A copy of a current organizational chart;
2. 4. Certification that all individuals who are required

to submit to a background check have completed their background checks and have been found eligible by the division for employment or presence at the LRCF as provided in section 210.493, RSMo, and 13 CSR 35-71.015;

1. 5. Annual results of a check of the family care safety

registry for all staff, as well as interns, volunteers, and contractors. For individuals who reside outside of Missouri who are subject to the background check requirements provided for in section 210.493, RSMo, the LRCF shall require all officers, managers, contractors, volunteers with access to children, employees, other support staff, and owners of the LRCF who will have access to the facilities of the LRCF to successfully complete an annual background screening which shall consist of a check of the child abuse and neglect registry and a criminal background check of the state or jurisdiction in which the individual resides. LRCFs shall further implement and apply policies which require all personnel who are otherwise required to submit to a background check pursuant to section 210.493, RSMo, to immediately notify the LRCF if they are listed in a state or local government registry as a perpetrator of child abuse or neglect, or if they were arrested or charged with any crime listed in section 210.493, RSMo;

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;

1. 10. A copy of the annual written staff training plan;
2. 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 swimming 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 administrative 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 self-disclosure of tax liabilities, including but not limited to, all employee withholding taxes.

1. (D) Division staff may review the results of employee background screenings, along with family care safety registry during routine record reviews.
2. (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: sections 207.020, 210.506, and 660.017, RSMo 2016, and sections 210.493 and 210.1286, RSMo Supp. 2021.* 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. Emergency amendment filed Sept. 17, 2021, effective Oct. 1, 2021, expired March 29, 2022. Amended: Filed Sept. 17, 2021, effective March 30, 2022.

*Original authority: 207.020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986, 1993, 2014; 210.493, RSMo 2021; 210.506, RSMo 1982, amended 1993, 1995; 210.1286, RSMo 2021; and 660.017, RSMo 1993, amended 1995.