PURPOSE: This rule establishes procedures for applying for and obtaining a license. (1) As set out in section 630.705, RSMo, each community residential facility or day program serving the mentally retarded, developmentally disabled, mentally ill or mentally disordered shall have a license or program license from the department unless specifically exempted under section 630.705.3., RSMo.

1. (2) As set out in section 630.715.1., RSMo, the department shall accept a license, a temporary operating permit or a probationary license issued by the Department of Social Services under sections 198.006—198.096, RSMo except that a facility shall meet the department’s requirements which are appropriate to admission criteria and care, treatment habilitation and rehabilitation needs, including adequate staffing.
2. (3) Applicants may only apply for licenses or program licenses on application forms provided by the department. Persons applying for the first time for a given premises shall submit with the application a drawing of the interior of the facility, in approximate scale, and a narrative indicating how each area in the facility will be used.
3. (4) The department does not require fees from community residential facilities or day programs which have three (3) or fewer residents or clients or from community residential facilities or day programs which are owned and operated by governmental entities. Applicants shall submit fees of ten dollars ($10) for establishments having at least four (4), but less than ten (10), residents or clients and fifty dollars ($50) for establishments having ten (10) or more residents or clients. The license fee is not refundable. The applicant shall pay the fee based on the total bed or day program capacity of its facility or premises and not the number of residents or clients in the facility or program.
4. (5) An application shall be active for no more than one (1) year. If the department does not issue a license or program license within one
5. (1) year from the date of application, the applicant must submit a new application with fee, if necessary, to be considered for licensure.
6. (6) A license or program license is effective for one (1) year unless sooner revoked. At least one hundred twenty (120) days before the expiration of a license or program license, the department shall notify the licensee that an application is necessary for licensing for the next year after expiration of its license.
7. (7) The licensee shall submit the application for a license for a succeeding year to the department at least ninety (90) days before the expiration date of its current license.
8. (8) If the licensee does not apply for a new license or program license within at least ninety (90) days before its expiration date, the department shall notify the facility or program that the community residential facility or day program would not be authorized under Missouri law to serve residents or clients without a license.
9. (9) If the department has not completed its survey before the expiration date of a current license or program license and if the applicant is not at fault for the failure to complete the survey process, the department shall grant a temporary operating permit for a specified period of time not to exceed ninety

10. (90) days to complete the survey.

    1. (A) The department shall consider a licensee seeking a license for a succeeding period to be at fault for reasons including, but not limited to, the following examples:

       1. 1. The licensee did not apply for a new

license or program license at least ninety (90) days before the expiration date of either license;

1. 2. The department found the licensee to

be substantially out of compliance with its licensing requirements for community residential facilities or day programs and the head of the facility failed to achieve substantial compliance in accordance with section (12) of this rule; and

1. 3. The licensee refused to allow survey

or otherwise to cooperate with the licensing survey team.

1. (B) The department shall grant a temporary operating permit to authorize continuity of service to allow the department to evaluate any application for a license or program license submitted as a result of any change of community residential facility or day program ownership.

2. (C) A change in ownership shall be considered to have occurred under the following circumstances:

   1. 1. An individual licensee incorporates

or forms a partnership and the individual does not retain a majority interest in the corporation or partnership formed;

1. 2. With respect to a licensee which is a

general partnership, a change occurs in the majority interest of the partners;

1. 3. With respect to a licensee which is a

limited partnership, a change occurs in the majority interest of the general partners or in the majority interest of limited partners; and

1. 4. With respect to a licensee which is a

corporation, a change occurs in the persons who own, hold or have the power to vote the majority of any class of stock issued by the corporation.

1. (10) The head of the facility shall cooperate with and assist authorized departmental representatives in making announced and unannounced surveys by allowing access to the facility or program premises and records.

2. (11) After receiving an application for either an initial or succeeding license or program license, a departmental licensing team shall inspect the community residential facility or day program by making one (1) or more site visits to the facility to assess compliance with the licensing requirements through interviews with facility employees and residents or clients, reviewing facility records and observing activities and physical conditions.

   1. (A) At the end of each site visit, one (1) or more members of the licensing team shall conduct an exit interview with the head of the facility or program regarding deficiencies noted during the survey.
   2. (B) If the licensing team finds the facility or program to be in substantial compliance with the departmental requirements, the team shall recommend, within twenty (20) working days of completion of the survey, that the department issue a license or program license.
   3. (C) After reviewing the recommendation of the licensing team, the director shall either issue a license or program license to the applicant or licensee or return the recommendation of the licensure team for further survey or other appropriate action.

3. (12) If the department finds an applicant or licensee at the survey to be out of substantial compliance with its requirements, the department shall take the following steps:

   1. (A) The licensing team shall inform the head of the facility or program of the deficiencies in an exit interview;
   2. (B) Within twenty (20) working days after the survey, the licensing team shall prepare a written report of any deficiency for which there has not been prompt remedial action and shall send a copy of the report to the head of the facility or program by certified mail, return receipt requested, stating separately each deficiency and the specific statute or rule violated;
   3. (C) The licensing report shall be accompanied by a request for a plan of correction;

   4. (D) Following receipt of the request for a plan of correction, the head of the facility or program shall submit, within twenty (20)

      (2/29/96)* MATT BLUNT

working days, a plan of correction to the department survey team;

1. (E) In the plan of correction, the head of the facility or program shall address each of the deficiencies noted on the report of deficiencies by indicating action steps and time frames for achieving compliance;
2. (F) Following receipt of a plan of correction, the department has ten (10) working days to give its written approval or disapproval of the plan;

3. (G) Within fifty-five (55) working days of the survey(s) which gave rise to a request for a plan of correction, the department shall reinspect the facility or program to determine whether or not the facility or program has achieved substantial compliance with departmental standards within the time frames specified in the plan of correction.

   1. 1. If the licensing team finds the facility

or program in substantial compliance, the department shall issue a license under section (11) of this rule.

1. 2. If the licensing team does not find

that the facility or program has achieved substantial compliance or that the head of the facility or program is correcting the noted deficiencies, in accordance with the approved plan of correction, the licensing team shall submit its finding and recommendations to the director, Bureau of Quality Improvement for a decision regarding license issuance, revocation or denial.

1. (H) The department shall deny the application for license as set out in section (17), invite the head of the facility or program to enter into a consent agreement for a probationary license as set forth in section (20), issue the license or request additional information or review;
2. (I) The department shall issue a notice of noncompliance as set out in section 630.745, RSMo if the licensee or applicant is out of compliance with departmental requirements and the licensee or applicant is not found to be implementing its approved plan of correction; and
3. (J) If new applicants who are not licensed by the department and do not currently serve persons for whom licensure is required fail to correct deficiencies, submit a plan of correction, or cooperate with the licensure process, a license will not be formally denied. The application will be allowed to expire and considered withdrawn.

1. (13) The department shall issue a license or program license to an applicant or licensee the department finds to be in compliance with the provisions of sections 630.705—630.760, RSMo and the department’s rules.

   MATT BLUNT (2/29/96)*

2. (14) The department shall issue a license or program license only for the premises and the individual, partnership, association, corporation or governmental entity named on the application. The license shall be valid for a single community residential facility or day program and shall not be valid for two (2) or more facilities or programs, located on different premises even though they are operated by a single agency.
3. (15) The head of the facility shall post the facility or program license in a conspicuous place on the premises.
4. (16) The department may conduct reinspections during a licensure year to determine compliance with its requirements. If the reinspections find a residential facility or program to be out of substantial compliance with departmental requirements, the department may revoke the license or program license if the facility or program does not achieve compliance under the process set out in section (12).

5. (17) The department shall deny an application for license or program license to a facility or program already licensed, revoke an existing license or program license or deny a license or program license to a new applicant if the department finds substantial failure to comply with sections 630.705—630.760, RSMo and corresponding rule, and if applicant or licensee has failed to submit, implement, or both, an approved plan of correction as described in section (12).

   1. (A) Prior to the formal notice of license denial or revocation, the director, Bureau of Quality Improvement, will give notice of the intent to deny and the reasons for denial to the head of the facility or program and that the head of the facility or program, within ten
6. (10) days of the receipt of the notice, may request a review by the department’s hearing officer. The review shall occur within fifteen

7. (15) days of the request for the review by the head of the facility or program.

   1. (B) The review by the department under subsection (17)(A) of this rule shall not be available in cases in which a license was denied or revoked due to substantiated abuse or neglect pursuant to 9 CSR 40-2.035.
   2. (C) A notice of license revocation or denial shall become effective not less than thirty

8. (30) days from the date of mailing by certified or registered mail (return receipt requested) or of personal service of the notice upon the licensee. The department shall state the effective date in the notice.

   1. (D) The notice of revocation or denial shall inform the applicant or licensee of the right to 9 CSR 40-1

seek a determination of the revocation or denial by the Administrative Hearing Commission as set out in section 161.272, RSMo and also of the right to stay the department’s action pending the determination under rules promulgated by the Administrative Hearing Commission unless, upon application of the department, the commission finds that continued operation before final determination by the commission would present an imminent danger to the health, safety or welfare of any resident or client or substantial probability that death or serious injury would result.

1. (18) Any person aggrieved by the action of the department to deny or revoke a license or program license may seek a determination of the department director’s decision by the Administrative Hearing Commission as set out in section 161.272, RSMo and the rules of the commission.
2. (19) The head of the facility or program at any time during the inspection process may withdraw, either orally or in writing, an application for a license or program license.
3. (20) At any time after an inspection is conducted, the head of the facility or program may choose to enter into a consent agreement with the department to obtain a probationary license. The consent agreement shall include a provision that the head of the facility or program shall voluntarily surrender the license if substantial compliance is not reached in accordance with the terms and deadlines established under the agreement. The agreement shall specify the stages, actions and time schedule to achieve substantial compliance.
4. (21) As set out in section 630.750, RSMo, if the departmental licensing survey team finds upon survey of a licensed residential facility or day program that the facility or program is not in compliance with any standard, the continuation of which noncompliance presents an imminent danger to the health, safety or welfare of a resident or client or a substantial probability that death or serious physical harm would result and the noncompliance is not immediately corrected, the department director shall issue the facility or program a notice of noncompliance and initiate the procedures set out in subsections (12)(C)—(G) of this rule to deny or revoke the facility’s or program’s license.
5. (22) If compliance with any standard is medically contraindicated for any resident or client, the head of the facility or program shall submit a written statement to the licensing office indicating why and for how long compliance with the standard will not be possible. The request shall be signed by a physician and by the members of the resident’s or client’s multidisciplinary team.
6. (23) The director, Bureau of Quality Improvement, at his/her discretion, may waive a licensing rule for a specified period of time, or make an exception to a rule, if the head of the facility or program provides evidence that a waiver or exception is in the best interests of residents or clients. Each request for waiver or exemption shall be addressed to Director, Bureau of Quality Improvement, P.O. Box 687, Jefferson City, MO 65102.

AUTHORITY: sections 630.050, 630.135 and 630.705, RSMo 1994.* Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed March 14, 1984, effective Aug. 15, 1984. Amended: Filed July 15, 1985, effective Feb. 1, 1986. Amended: Filed March 18, 1987, effective Aug. 15, 1987. Amended: Filed Jan. 2, 1990, effective June 11, 1990. Emergency amendment filed Sept. 15, 1992, effective Oct. 1, 1992, expired Jan. 28, 1993. Amended: Filed Sept. 15, 1992, effective April 8, 1993. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, effective March 30, 1996. *Original authority: 630.050, RSMo 1980, amended 1993, 1995; 630.135, RSMo 1980; and 630.705, RSMo 1980, amended 1982, 1984, 1985, 1990. (2/29/96)* MATT BLUNT MATT BLUNT (2/29/96)* (2/29/96)* MATT BLUNT