PURPOSE: This rule describes requirements in the delivery and documentation of services for those programs certified under 9 CSR 30- 3.120 through 9 CSR 30-3.199.

1. (1) Other Requirements. In addition to the requirements of this rule, a program must also comply with 9 CSR 10-7.030 Service Delivery Process and Documentation that is applicable to both substance abuse and psychiatric programs.
2. (2) Available Services. Assessment, individual counseling, group education and counseling, community support and family therapy shall be available to each person participating in substance abuse treatment and rehabilitation in accordance with the individual’s clinical needs. Day treatment shall be provided if indicated by the person’s level of care.

3. (3) Services to Family Members. Services shall be available to family members of those persons participating in substance abuse treatment and rehabilitation.

   1. (A) Available services shall include family therapy and individual and group codependency counseling. Groups may include both family members and primary clients when indicated by the goals, content and methods of the group.
   2. (B) Family members shall be routinely informed of available services, and the program shall demonstrate the ability to effectively engage family members in a recovery process.
   3. (C) The program shall not be required to establish a client record for a family member, if group education is the only service provided to the family member and if this service is funded by the department or provided through a service network authorized by the department. However, the program shall be required to maintain documentation of group education services and the participating family members.

4. (4) Services to Women. A program that lacks certification as a specialized program for women and children must meet the following requirements in order to provide services to women:

   1. (A) Offer gender specific groups which address therapeutic issues relevant to women; and
   2. (B) Have staff with experience and training in the treatment of women.

5. (5) Services to Adolescents. A program that lacks certification as a specialized program for adolescents must meet the following requirements in order to provide services to adolescents—

   1. (A) Offer groups specifically for adolescents;
   2. (B) Have staff with experience and training in the treatment of adolescents;
   3. (C) Maintain an affiliation agreement and demonstrate an effective working relationship with a certified adolescent program; and
   4. (D) Obtain clinical utilization review authorization that the adolescent may participate in services. Services are limited to the supported recovery level, unless otherwise authorized by clinical utilization review.

6. (6) Assessment. Each person with a substance abuse problem shall have an assessment by a qualified substance abuse professional in order to ensure an appropriate level of care and an individualized plan.

   1. (A) The assessment shall be completed within seventy-two (72) hours for residential clients or the first three (3) outpatient visits.

      1. 1. The seventy-two (72)-hour period for

residential clients does not include weekends and holidays observed by the state of Missouri.

1. 2. The initial treatment plan for the indi-

vidual must also be completed within this designated time period.

1. (B) If there is a history of prior services in a substance abuse treatment program or a psychiatric facility, a request for prior treatment records shall be made upon written consent of the client or legal guardian to access the department’s client tracking registration admissions and commitments system.

1. (7) Diagnosis. Eligibility for services shall include a diagnosis of substance abuse or dependency including all five (5) axis as defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.

   1. (A) A face-to-face diagnostic interview shall be conducted as part of the assessment by a licensed physician, licensed psychologist, licensed clinical social worker, or licensed professional counselor.
   2. (B) A diagnostician must also have at least one (1) year experience in treating persons with substance disorders.
2. (8) Transportation and Supports. Transportation shall be provided or arranged by the program to promote participation in treatment and rehabilitation services and to access other resources and supports in the community. Supports that are funded by the department (such as housing or child care) shall meet contractual and other applicable regulatory requirements.

3. (9) Program Schedule. A current schedule of groups and other structured program activities shall be maintained.

   1. (A) Each person shall actively participate in the program schedule, with individualized scheduling and services based on the person’s treatment goals, level of care, and physical, mental, and emotional status.
   2. (B) Group sessions shall address therapeutic issues relevant to the needs of persons served. Some of these scheduled group sessions may not be applicable to or appropriate for all persons and should be attended by each individual on a designated or selective basis. Examples of designated or selective groups may include parenting, budgeting, anger management, domestic violence, cooccurring disorders, relapse intervention track, etc.

4. (10) Therapeutic Setting. Services shall be provided in a therapeutic, alcohol and drugfree setting.

   1. (A) Productive, meaningful, age-appropriate alternatives to substance use shall be encouraged for each individual.
   2. (B) Any incident of client use of alcohol or drugs shall be documented in the client’s record.
   3. (C) An incident of possession or use of alcohol or drugs may result in termination from the program, particularly in residential settings.
   4. (D) Repeated incidents of possession or use shall result in termination from the program.
   5. (E) The program shall not allow gambling or wagering on its premises or as part of its activities.

5. (11) Drug Testing. The program should conduct tests to determine and detect a client’s use of alcohol and drugs. The program shall identify its goals, policies and procedures regarding drug testing.

   1. (A) The program shall implement written policies and procedures regarding the collection and handling of specimens. Urine or other specimens shall be collected in a manner that communicates respect for persons served while taking reasonable steps to prevent falsification of samples.
   2. (B) A laboratory which analyzes specimens shall meet all applicable state and federal laws and regulations.
   3. (C) The program shall implement written policies and procedures outlining the interpretation of results and actions to be taken when the presence of alcohol and/or drugs has been determined.
   4. (D) Test results shall be addressed with persons served once the results are available, in order to intervene with substance use behavior. Test results and actions taken shall be documented in the client’s record.
6. (12) A qualified diagnostician as defined under section (7) of this rule shall approve the treatment plan.
7. (13) Reviewing Treatment Goals and Outcomes. The individual treatment plan shall be reviewed on a periodic basis and shall accurately reflect the person’s needs and goals. Persons who receive services funded by the department or through a service network authorized by the department shall participate in continuing reviews of their progress and 9 CSR 30-3

outcomes and updates of their plans within the following time frames:

1. (A) Ten (10) days for residential treatment and community-based primary treatment;
2. (B) Thirty (30) days for intensive outpatient rehabilitation;
3. (C) Ninety (90) days for other levels of care.

1. (14) Clinical Utilization Review. Services are subject to clinical utilization review when funded by the department or provided through a service network authorized by the department. Clinical utilization review shall promote the delivery of services that are necessary, appropriate, likely to benefit the client, and provided in accordance with admission criteria and service definitions.

   1. (A) The department shall have authority in all matters subject to clinical utilization review including client eligibility and service definition, authorization, and limitations.
   2. (B) Any service matrix or package that is developed by the department or its authorized representative shall include input from service providers.

   3. (C) Clinical utilization review shall include, but is not limited to, the following situations regarding an individual client:

      1. 1. Length of stay beyond any specified

maximum time period;

1. 2. Service authorization beyond any

specified maximum amount or cost;

1. 3. Admission of adolescents into adult

programs; and

1. 4. Unusual patterns of service or utiliza-

tion, based on periodic data analysis and norms compiled by the division.

1. (D) Clinical utilization review may be required of any client’s situation and needs prior to initial or continued service authorization.
2. (E) The need for clinical utilization review may be identified and initiated by a provider, an individual client, or by the department.

3. (F) Clinical utilization review may include, but is not limited to, the following situations regarding a program:

   1. 1. Unusual patterns of service or utiliza-

tion, based on periodic data analysis and norms compiled by the division regarding the utilization of particular services and total service costs; and

1. 2. Compliance issues related to certifi-

cation standards or contract requirements that can reasonably be monitored through clinical review.

1. (15) Credentialed Staff. Clinical utilization review shall be conducted by credentialed staff with relevant professional experience.

2. (16) Procedures for Clinical Utilization Review. Procedures shall be made available to all affected programs and services.

   1. (A) Reviews shall be completed in a timely manner not to exceed three (3) working days from the time a request is received.

   2. (B) To the extent feasible, a review request from a provider shall be made prior to the delivery of services.

      1. 1. No request made more than ninety

3. (90) days after service provision shall be accepted or authorized by the department.

   1. 2. The provider is fully responsible for

sending all pertinent information and documentation related to a clinical utilization review request.

1. (C) It is the responsibility of the provider to request a review regarding the appropriateness of admission and treatment services, if a provider considers a client to meet some but not all admission criteria or if any reasonable question may exist or be raised about client eligibility for services.
2. (D) The department may require or initiate clinical utilization review of any situation related to client eligibility.
3. (E) Service authorization for a client may be continued, increased, reduced, or discontinued in accordance with a clinical utilization review decision.
4. (F) When a review determines that services have been inappropriate, unnecessary, or delivered to a client who does not meet eligibility and admission criteria, all service authorization for the client may be discontinued and any other necessary action may be taken.

5. (G) The department shall establish procedures for the review and appeal of an adverse clinical utilization review action. The provider may deliver services to the client during a review or appeal period, with the understanding that such services may not be authorized or funded. A provider or client may—

   1. 1. Request further review of an adverse

action. The request must be in writing, identify the clinical factors warranting further review, and be received or postmarked within fifteen (15) days of the initial clinical utilization review action; and

1. 2. Appeal any clinical utilization review

decision to discontinue all service authorization for the client.

1. A. The appeal must be in writing,

identify the reason for the appeal, and be received or postmarked within thirty (30) days of receiving notice that service authorization has been discontinued.

1. B. The department shall designate an

Appeal Panel to make a final determination in the matter. The panel shall include one (1) or more representatives who are not staff members of the department and shall include at least one (1) member who is a substance abuse treatment provider.

1. C. Unless otherwise determined by

the panel, its final decision shall be based on information available at the time of the initial clinical utilization review action.

AUTHORITY: sections 630.050, 630.655 and 631.010, RSMo 2000.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001. ** *Original authority: 630.050, RSMo 1980, amended 1993, 1995; 630.655, RSMo 1980; and 631.010, RSMo 1980. **Pursuant to Executive Orders 20-04 and 20-10, 9 CSR 30-3.100, paragraph (6)(A)2. was suspended from April 23, 2020 through June 15, 2020.