Mo. Code Regs. Ann. tit. 9, § 45-5.010
PURPOSE: This rule defines terms, establishes principles, and sets out the process by which agencies providing individualized supported living (ISL), group home, shared living, day habilitation, individualized skills development, community networking, outof-home respite, intensive therapeutic residential habilitation, and employment services to individuals with intellectual and developmental disabilities through the Medicaid Home and Community-Based Waiver (HCBS) attain certification.
PUBLISHER’S NOTE: The secretary of state has determined that publication of the entire text of the material that is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.
(1) The Division of Developmental Disabilities (division) establishes procedures under which a provider of Medicaid home and community-based waiver services to individuals with intellectual or developmental disabilities attains certification. In establishing those procedures, the division makes the following assumptions:
(D) The certification process is flexible and person-centered and serves three (3) critical purposes—
to individuals with intellectual or developmental disabilities;
that the provider will be more responsive to the individual’s needs; and
individuals with intellectual or developmental disabilities as valued members of their communities;
(2) Terms defined in sections 630.005 and 633.005, RSMo, are incorporated by reference for use in this rule. As used in this rule, unless the context clearly indicates otherwise, the following terms also mean—
(4) This section prescribes eight (8) sets of principles for providers serving participants of any HCBS waiver operated by DMH.
(A) Individuals are integrated in and have access to the greater community.
in the community.
regarding age-appropriate activities reflective of their interests, needs, and preferences.
disability-specific activities/functions that are not limited to individuals with disabilities.
and ethnic activities that reflect their interests and preferences.
ready access to public transportation, if available in their community.
and worshiping as they choose.
visiting family, friends, or other community members.
knowledgeable and respectful of their wants, needs, and preferences.
in accordance with their wants, needs, and preferences.
their education and skill development, in the area and manner of their choice.
(B) Individuals are provided with opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources.
integrated employment opportunities of their choice within the community.
setting that is non-disability-specific and fully integrated into the community.
a setting that is located among other private businesses and facilitates integration with the greater community.
setting which encourages interaction with the public.
employment settings have knowledge of or access to information regarding competitive work outside of the setting.
in settings physically accessible and which do not limit individuals’ mobility or freedom of movement in the workplace, including access to bathrooms and break rooms.
the workplace.
exercising autonomy to the greatest extent possible. Individual’s decisions are respected.
with wages and benefits, including but not limited to medical benefits, annual leave, sick leave, and retirement programs, to the same extent as individuals not receiving Medicaid-funded HCBS.
informed choice of available providers and setting options from which to choose.
setting that reflects the individual’s wants, assessed needs, and preferences, taking into account the individual’s skills, capabilities, and aptitudes.
maintaining relationships with coworkers.
knowledgeable about the individual’s capabilities, interests, preferences, and needs related to employment.
takes into account the individual’s financial goals.
related to working, earning, spending, and saving.
finances/resources.
independent.
(C) Individuals receive services in the community to the same degree of access as individuals not receiving Medicaidfunded HCBS.
them in a place or manner typical for all other community members.
participating in activities located in settings that are integrated into the community and consistent with their interests.
make informed choices of how and where they receive their services and their choices are honored.
that are non-disability-specific and fully integrated into the community, which they can afford with their own income.
skills and are transported safely.
physically accessible to the individual.
(D) The residence is selected by the individual from among setting options including non-disability-specific settings.
in selecting settings to receive Medicaid waiver services that are reflective of the individual’s wants, needs, and preferences.
reside in community settings with individuals not receiving Medicaid Home and Community-Based Services.
that limit individual mobility in the setting.
enforceable agreement, their own specific unit/dwelling. A copy of the lease, residency agreement, or other written agreement is maintained.
residences that facilitate integration with the greater community.
other residences; for example, the use of yard signs or other advertisement should not be used which distinguish the setting as disability specific.
interact with community members of their choice.
outside of their residence and are not restricted to or from any areas or rooms within their residence.
home such as a kitchen, dining area, laundry, bathroom, and living room.
to furnish and decorate their home.
(E) Individuals are assured the right of privacy, respect, and freedom from coercion and restraint.
respect is ensured and supported.
and promote the rights of each individual.
or living unit, as determined by the individual.
the following applies:
with only appropriate staff having keys to doors; and
in that setting.
in a manner that the individual understands, of their rights in accordance with sections 630.110 and 630.115, RSMo, and 9 CSR 45-3.030, and responsibilities and advocacy resources, documented in writing and signed by the individual or guardian, as applicable. Notification is made prior to or upon receiving services and annually thereafter. Receipt is acknowledged in writing.
and trained annually, with documentation of the training, on individual rights in accordance with sections 630.110 and 630.115, RSMo, and 9 CSR 45-3.030.
or communicated in a format understood by the individual on how to file a grievance with the provider or complaint with the department.
imposed on their rights without due process, as required by 9 CSR 45-3.030.
are free to communicate privately with whom they choose.
their needs and accessible at all times. Individuals are able to make and receive calls privately.
mail are supported by staff to whom they have given consent.
annually in identifying, preventing, detecting, and reporting abuse and neglect.
and procedures. Providers follow their policies and procedures and ensure action is taken to protect individuals who report abuse or neglect.
in discussions regarding their lives.
of the provider policies on confidentiality and the Privacy Rule of Health Insurance Portability and Accountability Act of 1996 (HIPAA) Health Information Protection. Staff shall maintain all information about individuals in confidence and shall not share information about individuals without consent.
supported in maintaining their records where they choose. Staff shall assist them as needed in reviewing records and answering questions.
their dignity. Signs shall not be posted in easily visible areas describing information about the individual that is private or confidential.
living in a manner that is dignified and respectful.
persuaded through the use of intimidation, force, or threats.
against for exercising his/her rights.
chemical restraints.
(F) Individual initiative, autonomy, and independence are optimized in making life choices.
Individuals’ right to choice and self-determination are respected.
individual’s expressed wants, needs, and preferences.
of the services and supports in meeting their needs.
members of the community.
the community both inside and outside their home.
consistent with personal preferences.
daily living, including dressing, eating, and grooming, in a manner that enhances their self-esteem and self-worth.
positive involvement in the community.
activities of their choice in the community.
their own schedules and activities and have access to food at any time.
needed, to furnish and decorate their sleeping and living units as they choose.
and sustaining friendships and family relationships.
relationships of their choice.
contact with the same people and have repeated opportunities for social contact with the same people or groups of people.
in activities at times which take into consideration their wants, needs, and preferences.
others their abilities and interests.
at any time.
assuming roles in community organizations.
assuming roles in religious organizations.
volunteering and helping in the community.
how they would like to make decisions about their health care, and whether or not they would like anyone else to be involved in those decisions.
supported by persons knowledgeable of how they communicate physical needs, how they communicate emotional and psychological needs.
individuals engage in positive, acceptable interactions.
competencies.
developing their self-advocacy skills.
(G) Individuals are supported in making choices regarding services and supports and who provides them.
and need.
informed choice in selecting who their provider of services will be and their choices are honored.
informed choice in selecting settings to receive Medicaid waiver services that are reflective of the individual’s wants, needs, and preferences, and their choices are honored.
care providers to meet their needs.
health care and their decisions are recognized and supported.
(H) Individuals are assured their basic needs will be met.
of, have access to, and who provide services in accordance with their current Individualized Support Plan (ISP).
and mental health care from the practitioner of their choice.
medical care at intervals typical for the individual’s gender, age, and condition.
and follow-up treatment as recommended by their practitioner.
access to specialists.
or medical care consistent with their wants, needs, and preferences.
individual choice and meets nutritional needs.
to meet identified healthcare needs of the individual, are informed of the reason for the diet and consent to the diet. Orders for specialized diets are reviewed at least annually by a registered dietician, the individual’s physician, physician assistant, or advanced practical nurse (APN). Direct care staff shall be trained by either a dietician or registered nurse in the preparation and implementation of the diet prior to providing independent direct care services. Individual choice shall be honored. Providers may elect to have management staff trained as a trainer for non-nurse delegated diets.
choosing to participate in wellness activities and fitness programs, both in their home and in their community.
typically taken to prevent communicable diseases for persons with similar health status. Individuals shall be supported by persons who are knowledgeable of infection control practices through annual training.
risks, and side effects of all prescribed medications and treatments, to assist them in making informed choices about their health care. Individuals are respected in their decision to refuse medication and treatment.
receiving treatments, and utilizing adaptive equipment as prescribed.
to safely manage and self-administer their medications as reflected in their ISP.
their physician to determine their continued effectiveness. The provider shall develop an effective system of medication administration, including monthly review of the medication system by a registered nurse.
administration shall be certified as a DD Medication Aide or be a licensed nurse or pharmacist. Individuals and staff shall be knowledgeable of the individuals’ medical conditions and possible side effects of medication.
and degree of supervision consistent with the personal abilities of the individual and in accordance with their ISP.
safe, and well maintained.
arrangements that are safe and take into account their physical abilities.
and/or adapted to meet identified needs as described in ISPs and are based upon assessments to ensure safety and mobility.
with federal, state, and local building and environmental codes.
maintenance of vehicles, equipment, and buildings.
maintaining their home.
by the individuals who live there. Homes shall have heating and air conditioning equipment capable of maintaining temperatures within a comfortable range for the individual.
ability to regulate water temperatures or have a physical or health condition that makes self-regulation unsafe, water temperatures are not to exceed 120 degrees Fahrenheit at the point of use.
in a safe manner.
emergency procedures, as included in the provider’s written procedures and any additional expectations as indicated in the individual’s ISP.
earthquake, intruder) occurring during daytime, evening, and sleep hours at least four (4) times annually. Individuals participate in fire drills at least four (4) times annually, including one (1) during sleep hours. Documentation of drills shall be maintained.
exits which are appropriate to their abilities and an unobstructed path of egress to safety.
extinguisher on each floor of the home. At least one (1) fire extinguisher shall be accessible in or near the kitchen area. All fire extinguishers shall have an expiration date or maintenance tag/documentation and indicator of charge. The fire extinguisher shall have directions for use on the equipment and shall be within the expiration date.
on each level of the home, including basements. Detectors shall be located in or near each bedroom and in proximity to the area where an individual or staff sleep. Smoke detectors shall be placed in the home according to manufacturer’s recommendations.
based upon need.
have an attached garage shall have operable carbon monoxide detectors on each level of the home, including basements.
cardiopulmonary resuscitation training and have access to basic first aid supplies.
cardiopulmonary resuscitation (CPR) certification for healthcare providers through training using curricula that is comparable to National Safety Council, American Red Cross, or American Heart Association. Training shall include hands-on practice and in-person skills assessment. Online-only certification is not acceptable. Individuals are provided first aid and cardiopulmonary resuscitation by knowledgeable staff, in accordance with their written advance directive.
approved by the department regarding medical emergencies. Such policies and procedures shall include—
respond to an incapacitated person; and
the emergency protocol are conducted at least every six (6) months for all staff.
event criteria shall have those events reported to the department, per 9 CSR 10-5.206.
to current contact information for family, guardians, or other interested parties identified by the individual.
maintenance should be stored according to safety standards for the item itself as well as according to supports specified in the ISP. If there are restrictions, the individual shall be given due process.
sanitary practices in food storage, preparation, and cleanup.
needed supports and adaptations, as identified in the ISP.
Individuals are supported by staff who are knowledgeable of use of the supports as addressed in the ISP.
of adaptive, corrective, mobility, orthotic, and prosthetic equipment, as addressed in the ISP. Individuals and staff are trained in purpose, use, and maintenance of the equipment.
AUTHORITY: section 630.655, RSMo 2016.* This rule originally filed as 9 CSR 30-5.050. Original rule filed July 25, 1994, effective March 30, 1995. Emergency amendment filed July 20, 1995, effective July 30, 1995, expired Nov. 26, 1995. Amended: Filed July 20, 1995, effective Nov. 30, 1995. Amended: Filed May 25, 1995, effective Dec. 30, 1995. Rescinded and readopted: Filed Aug. 2, 2023, effective Feb. 29, 2024. *Original authority: 630.655, RSMo 1980.