PURPOSE: This rule sets forth standards and regulations for the provision of intensive community psychiatric rehabilitation service. (1) Intensive Community Psychiatric Rehabilitation (CPR). A level of support designed to help consumers who are experiencing an acute psychiatric condition, alleviating or eliminating the need to admit them into a psychiatric inpatient or residential setting. It is a comprehensive, time-limited, communitybased service delivered to consumers who are exhibiting symptoms that interfere with individual/family life in a highly disabling manner.

1. (A) The intensive community psychiatric rehabilitation is intended for the following consumers:

   1. 1. Persons who would be hospitalized

without the provision of intensive community-based intervention; or

1. 2. Persons who have extended or repeat-

ed hospitalizations; or

1. 3. Persons who have crisis episodes; or
2. 4. Persons who are at risk of being

removed from their home or school to a more restrictive environment; or

1. 5. Persons who require assistance in

transitioning from a highly restrictive setting to a community-based alternative, including specifically persons being discharged from inpatient psychiatric settings who require assertive outreach and engagement.

1. (B) Intensive community psychiatric rehabilitation is provided by treatment teams delivering services that will maintain the consumer within the family and significant support systems and assist consumers in meeting basic living needs and age appropriate developmental needs.
2. (C) A treatment team comprised of individuals required to provide the specific services identified on the Individualized Treatment Plan (ITP), delivers this level of service to consumers who meet the Community Psychiatric Rehabilitation (CPR) eligibility criteria.

1. (2) Admission Criteria. Persons meeting criteria for this level of service must meet admission criteria as defined in 9 CSR 30- 4.042, will be in need of intensive clinical intervention or support to alleviate or eliminate the need for admission into a psychiatric inpatient or a restrictive living setting and must meet at least one (1) of the following descriptions:

   1. (A) A person who is being discharged from a Department of Mental Health facility or Department of Mental Health purchased bed;
   2. (B) A person who has had extended or repeated psychiatric inpatient hospitalizations or crisis episodes within the past six (6) months;
   3. (C) A person who has had multiple out-ofhome placements due to their mental disorder; or
   4. (D) A person who is at imminent risk of being removed from his/her home, school or current living situation.

2. (3) Personnel and Staff Development. Intensive CPR shall be delivered by a treatment team responsible for coordinating a comprehensive array of services available to the individual through CPR with the amount of frequency of service commensurate with the individual’s assessed acuity and need.

   1. (A) The treatment team shall be supervised by a qualified mental health professional as defined in 9 CSR 30-4.030(2)(HH) and shall include the following:

      1. 1. Individuals required to provide spe-

cific services identified on the Individualized Treatment Plan; and

1. 2. The consumer, and family if develop-

mentally appropriate.

1. (B) Treatment team models shall follow one (1) of two (2) options:

   1. 1. The treatment team may serve exclu-

sively individuals enrolled in the intensive CPR level; or

1. 2. The treatment team may serve indi-

viduals enrolled in intensive CPR and individuals enrolled in the rehabilitation levels.

1. (4) Treatment.

   1. (A) Intensive CPR shall include—

      1. 1. Multiple face-to-face contacts on a

weekly basis and may require contact on a daily basis;

1. 2. Services that are available twenty-

four (24) hours per day and seven (7) days per week;

1. 3. Crisis response services that may be

coordinated with an existing crisis system.

1. (B) A full array of CPR services as defined in 9 CSR 30-4.043 shall be available to each individual based upon identified needs. In addition, the following services are also available, including but not limited to:

   1. 1. Outreach and engagement;
   2. 2. Behavioral aide/family assistance

worker;

1. 3. Targeted case management;
2. 4. Clinical interventions for the purpose

of stabilizing the individual offered twentyfour (24) hours per day and seven (7) days per week;

1. 5. Increased services to assist the indi-

vidual with medication stabilization;

1. 6. Utilization of natural services and

supports needed to maintain the individual in the community;

1. 7. Day treatment.
2. (C) The frequency of service delivery shall be based upon the individual’s assessed acuity and need.

3. (D) Individuals can be moved out of the intensive level when:

   1. 1. There is a reduction of acute symp-

toms; and

1. 2. The individual is able to function in

the rehabilitation level of CPR; or

1. 3. The individual chooses to move from

the intensive level.

1. (5) Client Records.

   1. (A) For consumers currently enrolled in the CPR Program, documentation must be present in the client record indicating the individual’s acuity level and supporting admission into the intensive level of care. Upon admission to the intensive level of care, the following is required—

      1. 1. A progress note must be written that

documents the individual’s acuity level and compliance with admission criteria;

1. 2. The treatment plan must be updated

to reflect the higher level of service the individual will receive while participating in the intensive level of care;

1. 3. The appropriate outcomes packet

shall be completed and forwarded to the department; and

1. 4. Service system reporting shall be

updated to reflect participation with the appropriate program code.

1. (B) For new consumers who have been admitted directly from the community into the intensive level of care, a brief evaluation to substantiate acuity and criteria for admission will initially be accepted which may be in the form of a separate report or progress note that includes the following elements: presenting problem, recent psychiatric history, current medications, current housing status, current legal status, family and/or guardian, and mental status examination.

   1. 1. Each individual shall have a psychi-

atric evaluation at admission. For individuals who have been discharged from an inpatient bed into the intensive level of care, a psychiatric evaluation completed at the facility will initially be accepted.

1. 2. A comprehensive evaluation shall be

completed within thirty (30) days of admission except for individuals admitted provisionally.

1. 3. Treatment plans shall be developed

upon admission to the intensive level of care.

1. 4. The appropriate outcomes packet

shall be completed and forwarded to the department.

1. 5. Service system reporting shall be

updated to reflect participation with the appropriate program code.

1. (C) Treatment plans shall be reviewed on a weekly basis and the review documented in the case record with a summary progress note including updates to the treatment plan as appropriate.
2. (D) Each individual shall have a critical intervention plan.

3. (E) All services provided must have accompanying progress notes that include:

   1. 1. Specific type of service rendered as

defined in the CPR menu of services or the Purchase of Service Catalogue;

1. 2. Date and actual time the service was

rendered;

1. 3. Who rendered the service;
2. 4. The setting in which the service was

rendered;

1. 5. The amount of time it took to deliver

the service;

1. 6. The relationship of services to the

treatment regimen described in the treatment plan;

1. 7. Updates describing the client’s

response to prescribed care and treatment; and

1. 8. Signature and position of staff mem-

ber delivering the service.

1. (F) Upon change from the intensive level of care, a transition plan for follow-up services must be documented in a level of care transition summary and reflected in an updated treatment plan.
2. (G) Upon change from the intensive level of care, the provider must complete the appropriate outcomes packet and forward to the department.

1. (6) Quality Assurance.

   1. (A) The department will track the following indicators:

      1. 1. Hospitalizations that occur while the

individual is participating in the intensive level of care; and

1. 2. Consumer movement to a more

restrictive level of care while the individual is participating in the intensive level of care.

1. (B) The department will monitor specific services provided to an individual while they are enrolled in intensive CPR. The providers shall maintain and have available for review, the detail regarding service delivery. This information must be in the same format as if the services had been billed separately. The review may consist of documents sent to the department for review or a face-to-face review on-site at an agency.

AUTHORITY: sections 630.050, 630.655 and 632.050, RSMo 2000.* Emergency rule filed Dec. 28, 2001, effective Jan. 13, 2002, expired July 11, 2002. Original rule filed Dec. 28, 2001, effective July 12, 2002.

*Original authority: 630.050, RSMo 1980, amended 1993, 1995; 630.655, RSMo 1980; and 632.050, RSMo 1980.