PURPOSE: This rule describes individual rights, the orientation process, and grievance procedures applicable to Comprehensive Substance Treatment and Rehabilitation Programs (CSTAR), Gambling Disorder Treatment Programs, Institutional Treatment Centers, Opioid Treatment Programs, Recovery Support Programs, Substance Awareness Traffic Offender Programs (SATOP), Required Education Assessment and Community Treatment Programs (REACT), Substance Use Disorder Treatment Programs, Community Psychiatric Rehabilitation Programs (CPR), and Outpatient Mental Health Treatment Programs.

1. (1) General Policy and Practice. The organization demonstrates through its policies, procedures, and practices an ongoing commitment to the rights, dignity, and respect of the individuals it serves. In addition to the requirements of this rule, the organization must also comply with 9 CSR 10-5.200, Procedures for Reporting Complaints of Abuse, Neglect, and Misuse of Funds/Property.

2. (2) Information and Orientation. Each individual served shall receive an orientation about what to expect while receiving services and his or her role in treatment. The orientation is provided in a timely manner based on the individual’s presenting condition and type of services he or she will receive. The orientation must be understandable to the person served and available in written form. Written acknowledgement of receipt of the orientation must be documented.

   1. (A) An individual who is admitted to a program on a voluntary basis is expected to give written, informed consent to care and treatment.

   2. (B) As applicable to the individual, the orientation shall include, but is not limited to, an explanation of—

      1. 1. Program rules and participation requirements, rights,

responsibilities, and behavioral expectations;

1. 2. Available services and supports, including crisis

assistance;

1. 3. Complaint and appeal procedures;
2. 4. Ways in which input can be given;
3. 5. The organization’s confidentiality policies;
4. 6. Continuing recovery planning;
5. 7. Discharge criteria and procedures;
6. 8. Access to after-hour services;
7. 9. Reporting requirements for individuals mandated to

participate in services;

1. 10. Financial obligations, fees, and financial arrangements

for services provided by the organization;

1. 11. Health and safety policies including, but not limited

to, the use of emergency safety interventions, use of tobacco products, illegal or legal substances brought into the program, prescription medication brought into the program, and weapons brought into the program;

1. 12. Layout of the premises including emergency exits and/

or shelters;

1. 13. Education regarding advance directives when indicated;
2. 14. The assessment process and the individual’s role in

developing his/her treatment plan and personal goals for recovery/resiliency, the course of services, expectations for legally required appointments, sanctions, or court notifications; and

1. 15. Composition of the treatment team.
2. (C) Each individual shall be informed of the process to make an inquiry, file a complaint, or report a violation of his/her rights to the department. Written information regarding these processes is readily accessible to individuals at all times and reasonable assistance from staff is available, if necessary.
3. (D) When appropriate, family members and other natural supports, parents/guardians, or other caregivers are provided with information to promote their participation in relevant services or decisions about the care and treatment of the individual being served.

1. (3) Rights Which Cannot Be Limited. Each individual has basic rights to humane care and treatment that cannot be limited under any circumstances.

   1. (A) The following rights apply to all settings:

      1. 1. To receive prompt evaluation, care and treatment;
      2. 2. To receive services in the least restrictive environment;
      3. 3. To receive services in a clean and safe setting;
      4. 4. To receive services without discrimination based on

race, ethnicity, gender, gender identity, gender expression, sexual orientation, creed, marital status, national origin, disability, or age;

1. 5. To confidentiality of information and records in

accordance with federal and state law and regulation;

1. 6. To be treated with dignity and be addressed in a

respectful, age appropriate manner;

1. 7. To be free from verbal, sexual, and physical abuse,

neglect, corporal punishment, and other mistreatment such as humiliation, threats, or exploitation;

1. 8. To be the subject of an experiment or research only

with one’s informed, written consent, or the consent of an individual legally authorized to act, and to decide to withdraw at any time;

1. 9. To medical care and treatment in accordance with

accepted standards of medical practice, if the certified organization offers medical care and treatment; and

1. 10. To consult with a private, licensed practitioner at one’s

own expense.

1. (B) The following additional rights apply to individuals receiving residential support, and where otherwise applicable, shall not be limited under any circumstances:

   1. 1. To a nourishing, well-balanced, varied diet;
   2. 2. To attend or not attend religious services;
   3. 3. To communicate by sealed mail or otherwise with the

department and, if applicable, legal counsel and court of jurisdiction;

1. 4. To receive visits from one’s attorney, physician, or clergy

in private at reasonable times; and

1. 5. To be paid for work unrelated to treatment, except

an individual may be expected to perform limited tasks and chores within the program that are designed to promote personal involvement and responsibility, skill-building, or peer support. Any tasks and chores beyond routine care and cleaning of activity or bedroom areas within the program must be directly related to recovery and treatment plan goals developed with the individual.

1. A. An individual receiving services may perform labor

that contributes to the operations and maintenance of a facility/ program, which would otherwise require the organization to employ staff, as long as the individual is compensated at a rate derived from the value of the work performed and in accordance with applicable federal and state minimum wage laws.

1. (4) Rights Subject to Limitation. Each individual shall have further rights and privileges which can be limited only if the program director or designee determines it is necessary to ensure personal safety or the safety of others.

   1. (A) Any limitation due to safety considerations shall occur only if it is—

      1. 1. Applied on an individual basis;
      2. 2. Authorized by the organization’s director or designee;
      3. 3. Documented in the individual’s record;
      4. 4. Justified by sufficient documentation;
      5. 5. Reviewed on a regular basis; and
      6. 6. Rescinded at the earliest clinically appropriate time.
   2. (B) In all care and treatment settings, each individual has the right to see and review his/her record, except specific information the program director determines would be detrimental to the individual or records provided by other individuals or agencies may be excluded from such review. Any restrictions must be documented and include specific rationale for the decision. The organization may require a staff member to be present whenever an individual accesses the record.

   3. (C) The following additional rights and privileges apply to individuals receiving residential support and where otherwise applicable:

      1. 1. To wear one’s own clothes and keep and use one’s own

personal possessions;

1. 2. To keep and be allowed to spend a reasonable amount

of one’s own funds;

1. 3. To have reasonable access to a telephone to make and to

receive confidential calls;

1. 4. To have reasonable access to current newspapers,

magazines, and radio and television programming;

1. 5. To be free from seclusion and restraint;
2. 6. To have opportunities for physical exercise and outdoor

recreation;

1. 7. To receive visitors of one’s choosing at reasonable hours;

and

1. 8. To communicate by sealed mail with individuals outside

the facility.

1. (5) Other Legal Rights. All individuals have the same legal rights and responsibilities as any other citizen, unless otherwise limited by law.

   1. (A) In accordance with section 208.009, RSMo, individuals presenting for services who are not legal residents of the United States cannot receive any Missouri state benefit unless his/her lawful presence in the United States is verified by the federal government.
   2. (B) Organizations shall not knowingly provide nonemergency services to individuals who are eighteen (18) years of age or older and whose presence in the United States is unlawful.

   3. (C) Individuals seeking nonemergency state or local public benefits shall provide affirmative proof they are a citizen or permanent resident of Missouri and the United States or are lawfully present in the United States. Affirmative proof is considered to be at least one of the following:

      1. 1. Documentary evidence recognized by the Missouri

Department of Revenue when processing an application for a driver’s license;

1. 2. A Missouri driver’s license;
2. 3. MO HealthNet identification card; or
3. 4. Any document issued by the federal government that

confirms an alien’s lawful presence in the United States.

1. (6) Access to Services. The organization shall have written policies and procedures regarding the provision of services for individuals who fall under the protection of the Americans with Disabilities Act of 1990.

   1. (A) An individual shall not be denied admission or services solely on the grounds of prior treatment, withdrawal from treatment against advice, or continuation or return of symptoms after prior treatment.

2. (7) Grievances. The organization shall establish policies, procedures, and practices to ensure all individuals receive a prompt, responsive, impartial review of any grievance or alleged violation of rights.

   1. (A) Reasonable assistance from staff shall be provided to an individual wishing to file a grievance.
   2. (B) The review shall be consistent with principles of due process.
   3. (C) The organization shall cooperate with the department in any review or investigation conducted by the department or its authorized representative.
3. (8) Records of Events and Reporting Requirements. All organizations must maintain records of events and comply with reporting requirements as specified in 9 CSR 10-5.200 and 9 CSR 10-5.206.

AUTHORITY: sections 630.050 and 630.055, RSMo 2016.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001. Amended: Filed Dec. 12, 2001, effective June 30, 2002. Amended: Filed July 29, 2002, effective March 30, 2003. Amended: Filed Nov. 5, 2018, effective June 30, 2019. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008 and 630.055, RSMo 1980.