PURPOSE: Individuals who administer medications or supervise self-administration of medications in any residential setting or day program funded, licensed or certified by the Department of Mental Health to provide services to persons who are mentally retarded or developmentally disabled, are required to be either a physician, a licensed nurse, a certified medication technician, a certified medication employee, a level I medication aide or Department of Mental Health medication aide. The provisions of the rule do not apply to family-living arrangements unless they are receiving reimbursement through the Medicaid Home and Community-Based Waiver for persons with developmental disabilities. This rule sets forth the requirements for approval of a Medication Aide Training Program designating the required course curriculum content, outlining the qualifications required of students and instructors, designating approved training facilities and outlining the testing and certification requirements.

PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. Therefore, the material which is so incorporated is on file with the agency who filed this rule, and with the Office of the Secretary of State. Any interested person may view this material at either agency’s headquarters or the same will be made available at the Office of the Secretary of State at a cost not to exceed actual cost of copy reproduction. The entire text of the rule is printed here. This note refers only to the incorporated by reference material.

1. (1) The purpose of the Medication Aide Training Program shall be to prepare individuals for employment as medication aides in any residential setting or day program fundand Developmental Disabilities

ed, licensed or certified by the Department of Mental Health to provide services to persons with mental retardation or developmental disabilities. The training program does not prepare individuals for the parenteral administration of medications such as insulin or the administration of medications or other fluids via enteral feeding tubes.

1. (2) All aspects of the Medication Aide Training Program included in this rule shall be met in order for a program to be considered approved.

2. (3) The objectives of the Medication Aide Training Program shall be to ensure that the medication aide will be able to—

   1. (A) Define the role of a medication aide;
   2. (B) Prepare, administer and chart medications by nonparenteral routes;
   3. (C) Observe, report and record unusual responses to medications;
   4. (D) Identify responsibilities associated with control and storage of medications; and
   5. (E) Utilize appropriate drug reference materials.
3. (4) The course shall be a minimum of sixteen
4. (16) hours of integrated formal instruction and practice sessions supervised by an approved instructor.
5. (5) The curriculum content shall include procedures and instructions in the following areas: basic human needs and relationships; drug classifications and their implications; assessing drug reactions; techniques of drug administration; documentation; medication storage and control; drug reference resources; and infection control.
6. (6) The approved course curriculum shall be the manual entitled Level I Medication Aide (IE 64-1), developed by the Department of Elementary and Secondary Education, Department of Mental Health and the Division of Aging and produced by the Instructional Materials Laboratory, University of Missouri-Columbia. This manual is incorporated by reference in this rule. Students and instructors each shall have a copy of this manual.
7. (7) A student shall not administer medications without the instructor present until s/he successfully completes the course and obtains a certificate.

8. (8) Student Qualifications.

   1. (A) Any individual employable in a residential setting or day program funded, licensed or certified by the Department of Mental Health to provide services to persons who are mentally retarded or developmentally disabled, and who meet the requirements of 9 CSR 10-5.190, shall be eligible to enroll as a student in this course or to challenge the final examination.
   2. (B) An individual may qualify as a medication aide by successfully challenging the final examination if that individual has successfully completed a medication administration course and is currently employed to perform medication administration tasks in a residential setting or day program operated, funded, licensed or certified by the Department of Mental Health to provide services to persons who are mentally retarded or developmentally disabled.
   3. (C) Certain persons may be deemed certified under paragraph (13)(B)4. of this rule.
9. (9) Those persons wanting to challenge the final examination shall submit a request in writing to the Missouri Division of Mental Retardation and Developmental Disabilities enclosing applicable documentation. If approved to challenge the examination, the Division of Mental Retardation and Developmental Disabilities will send the applicant a letter to present to an approved instructor so arrangements can be made for testing.

10. (10) Instructor Qualifications.

    1. (A) An instructor shall be currently licensed to practice as either a registered nurse or practical nurse in Missouri or shall hold a current temporary permit from the Missouri State Board of Nursing. The licensee shall not be subject to current disciplinary action such as censure probation, suspension or revocation. If the individual is a licensed practical nurse, the following additional requirements shall be met:

       1. 1. Shall not be waived: the instructor

has a valid Missouri license or a temporary permit from the Missouri State Board of Nursing; and

1. 2. Shall be a graduate of an accredited

program, which has pharmacology in the curriculum.

1. (B) In order to be qualified as an instructor, the individual shall—

   1. 1. Have attended a “Train the Trainer”

workshop to implement the Level I Medication Aide Training Program conducted by a Missouri registered nurse presenter approved by the Missouri Division of Aging.

1. 2. Meet at least one (1) of the following

criteria:

1. A. Have had one (1) year’s experience

working in a long-term care (LTC) facility licensed by the Division of Aging or in a residential facility or day program operated, funded, licensed or certified by the Department of Mental Health within the past five (5) years; or

1. B. Be currently employed in a LTC

facility licensed by the Department of Mental Health and shall have been employed by that facility for at least six (6) months; or

1. C. Shall be an instructor in a Health

Occupations Education Program.

1. (11) Sponsoring Agencies.

   1. (A) The Medication Aide Training Program may be sponsored by providers of residential or day programs operated, funded, licensed or certified by the Department of Mental Health, Division of Mental Retardation and Developmental Disabilities.
   2. (B) The sponsoring agency is responsible for obtaining an approved instructor, determining the number of manuals needed for a given program, ordering the manuals for the students and presenting a class schedule for approval by the local regional center. The sponsoring agency shall maintain the following documentation: the name of the approved instructor; the instructor’s Social Security number, current address and telephone number; the number of students enrolled; the name, address, telephone number, Social Security number and age of each student; the name and address of the facility that employs the student, if applicable; the date and location of each class to be held; and the date and location of the final examination. If there is a change in the date and location of the training, the sponsoring agency shall notify the local regional center.
   3. (C) Classrooms used for training shall contain sufficient space, equipment and teaching aids to meet the course objectives as determined by the Division of Mental Retardation and Developmental Disabilities.
   4. (D) If the instructor is not directly employed by the agency, there shall be a signed written agreement between the sponsoring agency and the instructor which shall specify the role, responsibilities and liabilities of each party.

2. (12) Testing.

   1. (A) The final examination shall consist of a written and a practicum examination administered by the instructor.

      1. 1. The written examination shall include

questions based on the course objectives developed by the Division of Mental Retardation and Developmental Disabilities.

1. 2. The practicum examination shall be

conducted in a residential setting or day program operated, funded, licensed or certified by the Department of Mental Health, Division of Mental Retardation and Development- 9 CSR 45-3

al Disabilities or an LTC facility which shall include the preparation and administration by nonparenteral routes and recording of medications administered to consumers under the direct supervision of the instructor and the person responsible for medication administration in the facility. When it is not feasible and/or possible to conduct the practicum examination in an approved residential or day program, the instructor may request a waiver from the local regional center to conduct the practicum examination in an approved simulated classroom situation.

1. (B) A score of eighty percent (80%) is required for passing the final written examination and one hundred percent (100%) accuracy in the performance of the steps of procedure in the practicum examination.
2. (C) The final examination, if not successfully passed, may be retaken within ninety

1. (90) days one (1) time without repeating the course, however, those challenging the final examination must complete the course if the examination is not passed in the challenge process.

   1. (D) The instructor shall complete final records and shall submit these and all test booklets to the sponsoring agency.

2. (13) Records and Certification.

   1. (A) Records.

      1. 1. The sponsoring agency shall maintain

records of all individuals who have been enrolled in the Medication Aide Training Program and shall submit to the local regional center all test booklets, a copy of the score sheets and a complete class roster.

1. 2. A copy of the final record shall be

provided to any individual enrolled in the course.

1. 3. A final record may be released only

with written permission from the student in accordance with the provisions of the Privacy Act—PL 900-247.

1. (B) Certification.

   1. 1. The regional center shall issue a

Department of Mental Health, Division of Mental Retardation and Developmental Disabilities, Medication Aide Certificate to employable individuals successfully completing the course upon receiving the required final records and test booklets from the sponsoring agency.

1. 2. The regional center shall enter the

names of all individuals receiving a Medication Aide Certificate in the Division of Mental Retardation and Developmental Disabilities Medication Aide Registry.

1. 3. Medication aides who do not current-

ly meet certification requirements must successfully pass the Level I Medication Aide course or challenge the final examination, if eligible, and obtain a Division of Mental Retardation and Developmental Disabilities Medication Aide Certificate within eighteen (18) months from the effective date of this regulation. Individuals who fail to comply shall not be allowed to administer medications.

1. 4. Individuals who hold a Medication

Aide Certificate issued by a regional center or a Division of Aging Level I Medication Aide Certificate, and have completed biannual training as required in section (14), will meet the requirements of this rule.

1. (14) Bi-Annual Training Program.

   1. (A) Level I medication aides shall participate in a minimum of four (4) hours of medication administration training every two (2) years in order to administer medications in a residential setting or day program funded, certified or licensed by the Department of Mental Health to provide services to persons who are mentally retarded or developmentally disabled. The training shall be taken in two

2. (2) two (2)-hour blocks or a four (4)-hour block and must be completed by the anniversary date of the medication aide’s initial level I medication aide certificate. The training shall be—

   1. 1. Offered by a qualified instructor as

outlined in section (10) of this rule; and

1. 2. Documented on the Level I

Medication Aide Bi-Annual Training form MO 650-8730 and kept in the employee’s personnel file. This form is incorporated by reference in this rule.

1. (B) The training shall address at the least the following:

   1. 1. Medication ordering and storage;

   2. 2. Medication administration;

      1. A. Use of generic drugs;
      2. B. How to pour, chart, administer and

document;

1. C. Information and techniques specif-

ic to the following: inhalers, eye drops, topical medications and suppositories;

1. D. Infection control;
2. E. Side effects and adverse reactions;
3. F. New medications and/or new pro-

cedures;

1. G. Medication errors;
2. 3. Individual rights, and refusal of med-

ications and treatments;

1. 4. Issues specific to the facility/program

as indicated by the needs of the consumers, and the medications and treatments currently being administered; and

1. 5. Corrective actions based on problems

identified by the staff, the trainees or issues identified by regulatory and accrediting bodies, professional consultants or by any other authoritative source. and Developmental Disabilities

1. (C) The Department of Mental Health regional centers will routinely monitor the quality of medication administration. When quality assurance monitoring documents that a medication aide is not administering medications within training guidelines, the regional center may require the aide to take additional training in order to continue passing medications in the residential setting or day program.

1. (15) Revocation of Certification.

   1. (A) If the Department of Mental Health upon completion of an investigation, finds that a medication aide has stolen or diverted drugs from a consumer or facility or has had his/her name added to the Department of Mental Health Employee Disqualification Registry or Division of Aging Employee Disqualification Registry, the Department of Mental Health shall render the medication aide’s certificate invalid. and Developmental Disabilities

AUTHORITY: sections 630.050 and 633.190, RSMo 2000.* Original rule filed Jan. 10, 2001, effective Aug. 30, 2001.

*Original authority: 630.050, RSMo 1980, amended 1993, 1995; 633.190, RSMo 1993, amended 1995.