PURPOSE: This rule establishes the general licensure and application procedures, fees and the rights of applicants for licensure of adult day care programs.

1. (1) Any person who establishes, maintains or operates an adult day care program, or advertises or holds him/herself out as being able to perform any adult day care service, shall obtain the proper license from the division, except for the following:

   1. (A) Any adult day care program operated by a person in which care is offered for no more than two (2) hours per day;
   2. (B) Any adult day care program maintained or operated by the federal government except where care is provided through management contract;
   3. (C) Any person who cares solely for persons related to the provider or who has been designated as guardian of that person;
   4. (D) Any adult day care program which cares for no more than four (4) persons who are not related within the fourth degree of consanguinity or affinity to the adult day care provider;
   5. (E) Any adult day care program licensed by the Department of Mental Health under 19 CSR 30-90

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 as defined; or

1. (F) Any adult day care program administered or maintained by a religious not-forprofit 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.

1. (2) An application shall be submitted to the division for each proposed associated or freestanding adult day care program on forms supplied by the Division of Aging.

2. (3) 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:

   1. (A) For eight (8) participants or fewer, the fee is twenty-five dollars ($25);
   2. (B) For nine through sixteen (9–16) participants, the fee is fifty dollars ($50);
   3. (C) For seventeen through twenty-four (17–24) participants, the fee is seventy-five dollars ($75); and
   4. (D) For twenty-five (25) or more participants, the fee is one hundred dollars ($100).
3. (4) The division shall review each application and investigate each applicant and adult day care program to determine that they comply with the adult day care licensure law and these rules and to insure that the health and safety of the participants are protected.
4. (5) 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.
5. (6) 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 threat to the health and safety 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. SENIOR SERVICES
6. (7) Licensure renewal applications will be sent to adult day care providers at least sixty
7. (60) days prior to the expiration of the current license. Renewal applications must be accompanied by a nonrefundable fee and be postmarked at least thirty (30) days prior to expiration date of the current license. The nonrefundable fee is identified in the fee schedule in section (3) of this rule.
8. (8) A regular or provisional license may be revoked or suspended for failure to cooperate with the division or failure to comply with statutory or regulatory requirements.
9. (9) 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 161.272, RSMo. This action must be taken within thirty (30) calendar days of official notification of the adverse action taken by the division.
10. (10) 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 or facility.
11. (11) 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.

AUTHORITY: sections 660.050, RSMo Supp. 1992 and 660.418, RSMo 1986.* This rule 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. *Original authority: 660.050, RSMo 1984, amended 1988, 1992 and 660.418, RSMo 1984. Application for License to Operate an Adult Day Care Program FEE SCHEDULE Check licensed capacity requested: G 8 or fewer $ 25.00 G 9 through 16 $ 50.00 G 17 through 24 $ 75.00 G 25 or more $100.00 1. In accordance with the requirements of sections 660.400 through 660.420, RSMo (1986) and 13 CSR 15-8.010 through 13 CSR 15-8.080 an application is hereby made for license to establish, conduct or maintain an adult day care program as: (check one) G Freestanding Adult Day Care Program G Associated Adult Day Care Program _____________________________________________________________________________ 2. Name of the adult day care program __________________________________________________________________________________ Address __________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________ (City) 3. If a change of ownership, former name of adult day care program ________________________________________________________________________________________ _________________________________________________________________________________________________________________ 4. Type of provider of the adult day care program: (check one) Governmental G City G County G State 5. Name of provider __________________________________________________________________________________________________ Address _______________________________________________________________________________________________________________________________________________________________ (Street, RFD, Box Number) _________________________________________________________________________________________________________________ (City) 6. Name, address and percentage of ownership of any individual or entity who owns an interest of five percent (5%) or more in the land, structure(s), mortgage or other obligation, or lease on which an adult day care program is being conducted. Indicate whether this ownership involves land, structure, mortgage or lease. _____________________________________________________________________________ _________________________________________________________________________________________________________________ 7. Name of the adult day care program director _________________________________________________________________________________________________________________ 8. Has the program director or any corporate officers, directors or holders of five percent (5%) or more stock or ownership ever been convicted of a misdemeanor relating to the operation of an adult day care program, long-term care facility or of any felony G Yes G No If yes, list the person’s name and type of conviction _____________________________________________________________________ 9. For all initial applications, provide a diagram of the building that houses the adult day care program if it is freestanding. This diagram shall be labeled to show exits; fire extinguishers; smoke detectors and room use, such as dining, crafts, quiet room, therapy or offices. This diagram shall give exact measurements of the area to be used for the adult day care program. Department of Social Services Missouri Division of Aging (Name of Associated Organization) (Street, RFD, Box Number) (State) Not-for-profit G Religious organization G Corporation G Other _________________________ (State) DO NOT WRITE IN THIS SPACE Application No.______________________________________ Original ______________ Relicensure ___________________ License Fee Received _________________________________ Receipt No. _________________________________________ Provisional License No. _______________________________ Issued _____________________________________________ Regular License No. __________________________________ Issued _____________________________________________ Effective Date _______________________________________ Expiration Date ______________________________________ (Zip Code) (Area Code/Phone No.) (Zip Code) 19 CSR 30-90 (Area Code/Phone No.) (County) Proprietary G Individual G Partnership G Corporation (County) SENIOR SERVICES 10. For all initial applications, provide a diagram of the designated space for the adult day care program if it is an associated facility. This diagram shall show the portion set aside for the adult day care program including office, dining, quiet area, craft area, general adult day care meeting area or therapy. This diagram shall give exact measurement of the area used for the adult day care program and also show exits or entrances for day care, fire extinguishers and other fire safety features, such as pull stations and smoke detectors. 11. The fee must be submitted with this application. Enclose a check or money order only, payable to the Director of Revenue, Missouri Department of Revenue. I hereby affirm that I as an individual, or that the operating corporation or partnership for which I sign, have adequate financial resources to properly construct, equip and operate the facility referred to in this application. I further affirm that I am familiar with the requirements of the adult day care licensure law (1986) and the regulations of the Division of Aging established thereunder. I further affirm that I understand that I am eligible for a license only if the program and the provider are in compliance with the law and the regulations thereunder, and that a license may be revoked at any time that the facility or the operator fails to comply with such law and regulations. I further affirm under the penalties of perjury, that all documents and information required by the division to be filed pursuant to this appli- cation are true and correct to the best of my knowledge and belief, that the statements contained in this application and any attached information are true and correct to the best of my knowledge and belief and that all required documents are either included with the application or are currently on file with the division. ________________________________________________________________________________________ Date: ______________________________________________ (Applicant (Owner/Chairman of Board/Chief Executive Officer) Signed and sworn to before me this ________________ day of _______________________________, 19________ _____________________________________________________ (Notary Public or Other Officer Authorized to Administer Oaths) My commission expires ___________________________________________, 19__________