PURPOSE: This rule sets out requirements for the provision of community psychiatric rehabilitation services.

1. (1) The community psychiatric rehabilitation

2. (CPR) provider shall have written policies and procedures defining client eligibility requirements, intake procedures, client assignment, and discharge, as set forth under 9 CSR 30-4.042.

   1. (A) The CPR provider shall implement policies and procedures that assure admission to treatment within ten (10) working days of the date of eligibility determination for eligible clients with serious mental illness. CPR services shall be prioritized to individuals who—

      1. 1. Have been discharged from inpatient

psychiatric hospitalization programs within the last ninety (90) days;

1. 2. Are residents of supervised or semi-

independent apartments, psychiatric group homes or residential care facilities;

1. 3. Have been determined to meet the

admission criteria as set forth in 9 CSR 30- 4.042;

1. 4. Have been committed by court order

under provisions of section 632.385, RSMo;

1. 5. Have been conditionally released

under section 552.040, RSMo;

1. 6. Are homeless, or considered home-

less, in accordance with the following criteria:

1. A. Persons who are sleeping in places

not meant for human habitation, such as cars, parks, sidewalks, and abandoned buildings;

1. B. Persons who are sleeping in emer-

gency shelters;

1. C. Persons who are from transitional

or supportive housing for homeless persons who originally came from streets or emergency shelters;

1. D. Persons who are being evicted

within the week from private dwelling units and no subsequent residences have been identified and they lack the resources and support networks needed to obtain access to housing; or

1. E. Persons who are being discharged

within the week from institutions in which they have been residents for more than thirty (30) consecutive days and no subsequent residences have been identified and they lack the resources and support networks needed to obtain access to housing;

1. 7. Persons at risk of out-of-home place-

ment due to psychiatric disorder;

1. 8. Persons having co-occurring disor-

ders;

1. 9. Persons moving from congregate to

independent living;

1. 10. Persons having a current episode of

acute crisis, or use of the crisis system;

1. 11. Persons who have used a hospital

emergency room two (2) or more times during the prior year;

1. 12. Persons attempting suicide one (1)

or more times requiring hospitalizations; or

1. 13. Persons unable to function for at

least a six- (6-) month period without mental health intervention.

1. (B) The CPR provider shall discharge from the community psychiatric rehabilitation program clients who have not received services for a twelve- (12-) month period.

2. (C) The CPR provider and its affiliates shall reserve the right to refuse admission to clients under the following conditions:

   1. 1. If the client poses an imminent threat

of harm to self or others;

1. 2. When, at any specific time, the client

is under the influence of alcohol or illegal drugs; and

1. 3. When the program is operating at full

capacity (a level previously determined). The CPR provider shall implement policies and procedures to monitor program capacity and advise designated department staff as necessary.

1. (D) The CPR provider and affiliates shall not have the right to refuse admission to clients on the basis of ineligibility for Medicaid or other sources of reimbursement.

1. (2) The CPR provider shall provide a community psychiatric rehabilitation program, either directly or through contractual agreement, to include, at a minimum, the following core services: intake/annual evaluation, as designated, crisis intervention and resolution, medication services, medication administration, community support and psychosocial rehabilitation.

   1. (A) The CPR provider shall provide a timely access to and reasonable level of services for those clients found to be eligible for treatment, according to the admission criteria set forth in 9 CSR 30-4.042.

      1. 1. Intake/annual evaluation—CPR pro-

vider staff shall complete, or arrange to have completed, all annual evaluations within thirty (30) days following the anniversary date of the client’s intake evaluation or last annual evaluation.

1. 2. Crisis intervention and resolution—

shall be available upon demand on a twentyfour- (24-) hour basis.

1. 3. Medication services—a physician,

psychiatrist or an advanced practice nurse shall see all clients requiring medication within ten (10) working days or sooner if clinically indicated of request for service.

1. 4. Community support—the CPR pro-

vider shall assign all clients requiring community support services to a community support worker’s caseload no later than ten (10) working days, or sooner if clinically indicated, of eligibility determination. The worker shall conduct an initial face-to-face contact as clinically appropriate but no later than five (5) working days of receiving the assignment.

1. 5. Psychosocial rehabilitation—the CPR

provider shall admit all clients requiring psychosocial rehabilitation services to a psychosocial rehabilitation program if adequate program capacity allows, within twenty (20) working days or sooner if clinically indicated of eligibility determination.

1. 6. Transportation—the CPR provider

shall provide or arrange for transportation for clients as deemed clinically and programmatically necessary to attend the psychosocial rehabilitation program and to receive medication services.

1. (3) The CPR program shall provide treatment which will assist in the support and rehabilitation of persons with serious mental illnesses.

   1. (A) The program shall provide equal opportunity to individuals with disabilities in accordance with the Americans with Disabilities Act.
   2. (B) The CPR program shall assure accessibility to its provided services. Access shall require no more than one and one-half (1 1/2) hours of travel by automobile.

   3. (C) The department shall designate the minimum geographic boundaries of service areas throughout the state. Exceptions shall only be granted by the director upon appeal from prospective providers.

      1. 1. The CPR provider shall designate an

identified service area(s) it will serve.

1. 2. The CPR program shall provide com-

munity psychiatric rehabilitation program services to the eligible residents of its designated service area to the extent that adequate program/facility capacity is available.

1. (4) The CPR provider shall have procedures approved by the department for emergency physician intervention linked to its crisis intervention and resolution service.
2. (5) The CPR provider shall have written policies and procedures which assure that an eligible client has access to needed services of the CPR provider beyond those services of a community psychiatric rehabilitation program.
3. (6) The CPR provider shall provide nonemergency community psychiatric rehabilitation services including, at a minimum, but not limited to, community support during evenings or weekends, or both to accommodate individual client needs.
4. (7) The CPR provider shall agree to provide community support and crisis intervention services to clients in their own home and in other locations off-site from its offices and facilities. The CPR provider shall have written policies and procedures to assure that a client shall not be required to visit a preselected site in order to receive needed treatments other than medication services, physician consultation and psychosocial rehabilitation. The CPR provider shall allow clients a choice in the service site to the extent that facility and program capacity and the treatment plan allow.

5. (8) The CPR program provides the following services and liaison activities to the criminal or juvenile justice system(s):

   1. (A) Promotion of effective relationships with local law enforcement systems, including courts, through training, education and consultation;
   2. (B) Information for law enforcement, court, juvenile officers, and probation/parole personnel about services offered by the CPR provider; and
   3. (C) Provision of community psychiatric rehabilitation services to persons with serious mental illness who are on parole, probation or in forensic aftercare, as appropriate, and working closely with the parole or probation officer, or juvenile officer and department forensic aftercare workers within the limits of confidentiality.

6. (9) The CPR provider shall provide the following services and liaison activities to state and local public assistance/housing agencies and employment/training agencies:

   1. (A) Promotion of effective relationships with state and local public assistance/housing agencies and employment/training agencies through training, education and consultation;
   2. (B) Information for personnel of state and local public assistance/housing agencies that provide public benefits about services offered by the CPR provider; and
   3. (C) Provision of assistance to persons with serious mental illness in seeking public benefits, and in working closely with the staff of state and local public assistance/housing and employment/training agencies within the limits of confidentiality to expedite the application process and continuation of the client’s eligibility.

7. (10) The CPR provider shall assure that clients receive the most appropriate care that is available. Transfer of a client from one (1) service to another, from community to hospital, hospital to community or to another CPR provider, as consistent with the client’s needs, may be considered to obtain that care and treatment.

   1. (A) The CPR provider shall have written procedures for referral from one (1) service element to another within the CPR program and to other CPR providers.

      1. 1. Procedures shall assure that pertinent

records, or portions of records, and other relevant information are readily transferable and are handled to comply with confidentiality regulations.

1. 2. Procedures shall assure that follow-up

is carried out on referrals to outside CPR programs or providers, as applicable.

1. (B) The policies and procedures shall stipulate the conditions under which referrals are made. These conditions may include:

   1. 1. Special services not provided by the

CPR provider; or

1. 2. Other ancillary services that will con-

tribute to the well-being of the client.

1. (C) The CPR provider shall implement policies and procedures that assure the continuity of care between or among referring providers including prior treatment programs, both inpatient and outpatient psychiatric and substance abuse programs.
2. (D) The CPR provider shall maintain a current resource directory of area community service agencies that may be used in the referral process. The CPR provider shall make its resource directory available to consumers upon request.

1. (11) Each program shall coordinate with inpatient psychiatric programs to assure continuity of care for eligible individuals returning to the community. This includes active participation of the community support team in the discharge planning.

   1. (A) CPR providers shall provide ongoing community support service to active community psychiatric rehabilitation CPR program clients who are admitted to inpatient psychiatric care.
   2. (B) The CPR provider shall have a procedure to assure that, within five (5) calendar 9 CSR 30-4

days of the discharge, active community psychiatric rehabilitation program clients who are discharged from an inpatient psychiatric program are seen face-to-face by the community support worker. The CPR provider shall document the contact in the client record.

1. (C) The procedure includes active followup within five (5) days of clients who failed to keep their appointment or a missed appointment.

1. (12) The program shall establish and implement procedures to contact community support clients who miss a scheduled appointment or whose absence is unanticipated. The procedures shall establish time frames for contacting the client which are consistent with clinical needs and the seriousness of the client’s disability.

2. (13) If the CPR provider employs a Certified Missouri Peer Specialist, the Certified Missouri Peer Specialist shall be considered a member of the treatment team and shall participate in staff meeting discussions regarding the individual care of persons served. Certified Missouri Peer Specialists shall not be assigned an independent client caseload.

   1. (A) The purpose of peer support services is to assist individuals served in their recovery from mental illness. The individualized treatment plan of the person served shall determine the focus of this service.
   2. (B) Peer support services are person-centered with a recovery focus. Services allow individuals the opportunity to direct their own recovery and advocacy processes. Peer support services promote skills for coping with and managing symptoms while facilitating the utilization of natural supports and the preservation and enhancement of community living skills.
   3. (C) Peer support services are defined as helping relationships between individuals and Certified Missouri Peer Specialists that promote respect, trust, and empower individuals to make changes and decisions to enhance their lives. Peer support services are directed toward achievement of specific goals that have been defined by the person serviced and specified in the individualized treatment plan. Activities provided by the Certified Missouri Peer Specialists emphasize the acquisition, developments, and expansion of the rehabilitation skills needed to move forward in recovery. Interventions are built on the unique therapeutic relationship between the Certified Missouri Peer Specialists, the individual served, and the individual’s family unit.
   4. (D) Certified Missouri Peer Specialists are trained to assist their peers in the process of recovery and the power of resilience and provide hope that recovery is possible.

3. (14) The CPR provider shall take appropriate precautions to assure the provision of confidentiality and safety of children and youth in all aspects of programming including but not limited to:

   1. (A) Outings;
   2. (B) Transportation; and
   3. (C) Day program activities.

AUTHORITY: sections 630.655 and 632.050, RSMo 2000, and section 630.050, RSMo Supp. 2011.* Original rule filed Jan. 19, 1989, effective April 15, 1989. Emergency amendment filed Aug. 27, 1993, effective Sept. 8, 1993, expired Nov. 7, 1993. Emergency amendment filed Oct. 28, 1993, effective Nov. 7, 1993, expired March 6, 1994. Emergency amendment filed Feb. 15, 1994, effective March 6, 1994, expired April 10, 1994. Amended: Filed Aug. 27, 1993, effective April 9, 1994. Amended: Filed Dec. 13, 1994, effective July 30, 1995. Emergency amendment filed Aug. 11, 1999, effective Aug. 22, 1999, expired Feb. 17, 2000. Amended: Filed Aug. 11, 1999, effective Feb. 29, 2000. Amended: Filed Feb. 28, 2001, effective Oct. 30, 2001. Emergency amendment filed Dec. 28, 2001, effective Jan. 13, 2002, expired July 11, 2002. Amended: Filed Dec. 28, 2001, effective July 12, 2002. Amended: Filed Dec. 1, 2011, effective June 30, 2012. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008; 630.655, RSMo 1980; and 632.050, RSMo 1980.