PURPOSE: This rule establishes the Missouri Alliance for Individuals with Developmental Disabilities (MOAIDD) and its governing board, and describes its activities. The functions of MOAIDD were previously promulgated under 9 CSR 45-5.010. This new rule separates the MOAIDD functions from the certification process. MOAIDD is an organization of volunteers with developmental disabilities or immediate family members of persons with developmental disabilities which shall conduct visits with individuals receiving services from the Division of Mental Retardation and Developmental Disabilities. This rule defines terms, establishes principles and sets out the process by which MOAIDD will conduct visits.

1. (1) The Missouri Alliance for Individuals with Developmental Disabilities (MOAIDD) Board shall be established by the Department of Mental Health, Division of Mental Retardation/Developmental Disabilities. The board shall be appointed by the division director.

   1. (A) The MOAIDD Board shall be responsible for the development, modification, evaluation and continuing oversight of the process of volunteer visiting. The MOAIDD Board, in cooperation with the Department of Mental Health, Division of Mental Retardation/Developmental Disabilities, shall determine necessary administrative, staffing and procedural functions of the volunteer visiting and shall advise the division on policy matters. The board is advisory and shall focus on the individuals receiving services. The board shall not review the agency or facility for compliance with local, state, or federal standards.
   2. (B) Membership of the MOAIDD Board shall consist of fifteen (15) individuals with developmental disabilities and/or their family members who reside in the state of Missouri and share involvement in the life of their family member with developmental disabilities. At no time shall less than two (2) members of the board be individuals with developmental disabilities. One individual shall be selected to serve from each of the eleven (11) regions of the state. Four (4) additional individuals shall be selected from the state to serve as atlarge members.
   3. (C) Board members shall not serve more than two (2) consecutive three (3)-year terms. Following a one-year period off the board, an individual may be eligible to serve again.
   4. (D) The board shall establish a Constitution and Bylaws, approved by the division, that sets forth its responsibilities, operating procedures and membership guidelines.

2. (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:

   1. (A) ACD—Accreditation Council on Services for People with Disabilities, also known as The Council on Quality and Leadership in Supports for People with Disabilities.
   2. (B) Agency quality assurance/enhancement—a written document prepared by the regional center and provider agency to address quality assurance issues.
   3. (C) CARF—The Commission for Accreditation of Rehabilitation Facilities, also known as The Rehabilitation Accreditation Commission.
   4. (D) Certification unit—the unit within the Department of Mental Health that administers the certification process described in 9 CSR 45-5.010 for community-based programs funded under the Medicaid HCB waiver program.
   5. (E) Department—the Missouri Department of Mental Health.
   6. (F) Division—the Division of Mental Retardation and Developmental Disabilities within the Missouri Department of Mental Health.
   7. (G) HCB waiver program—the Missouri Medicaid Homeand Community-Based Waiver for Persons with Mental Retardation and Developmental Disabilities.
   8. (H) MOAIDD is a self-governing organization of volunteers with developmental disabilities and immediate family members of individuals with developmental disabilities, established by the division, to assess the quality of life for individuals receiving services through the division.
   9. (I) MOAIDD team—a volunteer team consisting of a team leader and at least one team member.
   10. (J) MOAIDD team leader—an experienced team member who has received MOAIDD volunteer training and team leader training.
   11. (K) MOAIDD team member—a person with a developmental disability or such person’s immediate family member who has participated in volunteer training, has passed a background screening according to 9 CSR 10-5.190 and has signed a confidentiality statement.
   12. (L) MOAIDD visit—a visit by a MOAIDD team with an individual receiving services 9 CSR 45-5

through the division to ensure the individual is living as full a life as possible.

1. (M) Observations—comments in the MOAIDD team report reflecting positive outcomes present in the individual’s life.
2. (N) Overriding concern—a significant concern in the individual’s life identified by the MOAIDD team that, while not a Red or Yellow Flag, needs to be addressed.
3. (O) Recommendation—an action step suggested by the MOAIDD team intended to address a Yellow Flag issue or overriding concern, or otherwise to enhance the individual’s quality of life.
4. (P) Red Flag—an immediate threat to the individual’s health/safety.
5. (Q) Yellow Flag—a significant, but not immediate, threat to an individual’s health, safety or rights.

1. (3) MOAIDD Visits.

   1. (A) The purpose of the MOAIDD visit is to determine if an individual is living as full a life as possible, not to review local, state or federal standards. This determination is based, in part, on the division’s philosophy and guidelines regarding self-determination, community membership, rights, health and safety. Of more significance, the determination is based on the volunteer’s own perspective as a person with a developmental disability or the family member of a person with such a disability. Visits are conducted independently from other quality assurance reviews including those by the certification unit.

   2. (B) Who Gets Visited.

      1. 1. Routine visits: MOAIDD shall visit

individuals served in residential setting by residential providers reimbursed under the HCB Waiver. Not-for-profit providers accredited by CARF or ACD and in good standing with the accrediting agency are exempt from routine visits. If an individual resident in a CARF or ACD accredited agency or that person’s guardian requests a MOAIDD visit, the visit can occur with the provider’s permission.

1. 2. Requested visits: MOAIDD visits

may be requested at any time by an individual, family member or guardian, regional center, or provider to assist with planning and resource development to enhance the individual’s life. The permission of the individual or his or her guardian must be obtained. Requested visits shall not be made to individuals receiving residential services from agencies exempted from routine visits in paragraph 1., without the provider’s permission.

1. (C) Schedule of MOAIDD visits. MOAIDD will conduct routine visits alternately with certification, with at least nine (9) months intervening between routine certification surveys and routine MOAIDD visits. MOAIDD visits are subject to the availability of volunteers. Requested visits will occur as quickly as possible following the request.

2. (D) Outcome of Visits.

   1. 1. MOAIDD visits shall result in obser-

vations and recommendations regarding the individual visited. These observations and recommendations shall be reported to the regional center director or designee and to the provider. The regional center shall consider the recommendations, and as appropriate, and with agreement of the individual or guardian, incorporate them in the individual’s plan. These recommendations are intended to enhance the life of the individual visited, but may also contain information pertinent to the lives of other individuals served. The regional center and provider shall determine the generalized applicability of the recommendations and shall incorporate those that are pertinent, in the agency’s quality assurance/enhancement plan.

1. 2. In addition, section (4) of this rule

specifies how the MOAIDD team will react to observing conditions that, in its opinion, require prompt action on behalf of the individual to preserve or protect health, safety or rights.

1. (4) This section prescribes two (2) sets of indicators referred to as Red and Yellow Flags.

   1. (A) The following conditions shall be considered Red Flags.

      1. 1. The team members suspect, for what-

ever reason, that the individual’s health or safety is at immediate risk. This could include situations in which agency staff appear not sufficiently trained/knowledgeable, or otherwise unable, to address threatening health, dietary, medicinal needs or operate prescribed equipment to an extent that it constitutes an imminent or immediate threat.

1. 2. The team members suspect, for what-

ever reason, that the individual(s):

1. A. Is being verbally, physically or

sexually abused;

1. B. Is being neglected;
2. C. Is the victim of verbal manipula-

tion or other type of psychological mistreatment; or

1. D. Has been mechanically, physically

and/or chemically restrained and the restraint is not appropriately addressed in the individual’s plan.

1. (B) The following conditions shall be considered Yellow Flags if the team members believe they constitute a significant but not immediate threat to an individual’s health, safety or rights.

   1. 1. The individual does not have a physi-

cian or dentist and/or does not see them at least annually.

1. 2. The individual has experienced emo-

tional or physical trauma and his/her needs have not been addressed.

1. 3. Safety devices (smoke detectors, fire

extinguishers, locks, railings, etc.) are missing or in need of repair.

1. 4. There are no procedures or practice

for emergency situations.

1. 5. Residence appears to be an unhealthy

environment (e.g. dirty, strong odors, mildew, wiring is exposed, electrical fixtures and/or plumbing fixtures are broken, broken furniture, unhealthy clutter, heating or air conditioning is inadequate or nonfunctioning, etc.).

1. 6. The individual’s ordinary living

activities are unreasonably limited or restricted.

1. 7. The individual is not provided with

needed information or training that would allow him/her greater independence.

1. 8. Community access rarely occurs or is

limited by insufficient staff and/or available transportation.

1. 9. Staff lacks adequate training on

health/medical issues, (cardiopulmonary resuscitation, first aid, physical management, nutritional management, drug side effects, seizures and allergies).

1. 10. Staff lacks a means of communica-

tion with the individual they serve.

1. 11. There is insufficient staff or staff is

unfamiliar with the individual, resulting in staff not meeting the needs of the individual.

1. 12. There is evidence that the individu-

al is, or has been, restricted from activities.

1. 13. Staff is unfamiliar or untrained

regarding the specific needs of the individual they support (e.g. behavior, verbal, physical, psychological or recognition of abuse and neglect).

1. 14. Medication is not stored or managed

in a safe manner.

1. 15. The individual is restricted from

seeing family, friends or guardian.

1. 16. The individual is not treated in a

respectful manner by staff/administration.

1. 17. Adaptive equipment is unavailable,

broken or restricted from use.

1. 18. Other items, which may not be sig-

nificant individually but cumulatively, represent a threat to the safety, health or rights of the individual.

1. (5) MOAIDD visits shall proceed according to the requirements set forth in this section. and Developmental Disabilities

   1. (A) The MOAIDD coordinator shall randomly select at least one individual from each residence where an agency provides residential service and shall notify the agency and regional center of the intent to visit.
   2. (B) With the individual’s/guardian’s permission, pre-visit surveys returnable within thirty (30) days, shall be sent to the individual’s family/guardian, residential provider, service coordinator and, when appropriate, daily activities provider.

   3. (C) The MOAIDD team shall—

      1. 1. Gather information through observa-

tion, review of relevant records and conversation with the individual and staff; and

1. 2. Issue a written report within seventy-

two (72) hours to the MOAIDD coordinator for further processing.

1. (D) The MOAIDD coordinator shall distribute the written report within thirty (30) days of the visit to the individual visited, guardian, residential provider agency appropriate division staff, certification unit, members of the MOAIDD team that conducted the visit and other persons designated by the individual visited or the individual’s guardian.

2. (E) If the MOAIDD team identifies Red Flags, the team shall proceed as follows:

   1. 1. The team leader shall remain on-site

and immediately notify the MOAIDD coordinator who shall contact the regional center director or designee and request that he/she go to the location where the Red Flag was reported.

1. 2. After the regional center director or

designee arrives and the team leader provides any necessary information, the MOAIDD visit ceases and standard division procedures shall be followed. The team leader may then leave the site and contact the MOAIDD coordinator to complete any further documentation.

1. 3. Should the Red Flag result in an

abuse/neglect investigation, the findings shall be recorded in the department’s Incident and Investigation Tracking System. The regional center director shall incorporate in the agency’s quality assurance/enhancement plan the action steps that result from the findings and notify the MOAIDD coordinator of the actions taken. If there are enforcement issues the regional center shall notify the certification unit.

1. 4. If the initial inquiry into the Red Flag

does not warrant an abuse/neglect investigation, the regional center shall submit a written report of findings within two (2) working days of the inquiry to the MOAIDD coordinator.

1. (F) If the MOAIDD team identifies Yellow Flags, the team shall proceed as follows:

   1. 1. The team leader shall inform the

MOAIDD coordinator of the Yellow Flags within twenty-four (24) hours of the visit.

1. 2. The MOAIDD coordinator shall

immediately notify the regional center director or designee of the Yellow Flag issues. The coordinator shall follow up with written notification within two (2) working days following contact with the regional center.

1. 3. The regional center director shall

incorporate in the agency’s quality assurance/enhancement plan the action steps that result from the findings and notify the MOAIDD coordinator of the actions taken. If there are enforcement issues the regional center shall notify the certification unit.

1. 4. After receiving consent from the indi-

vidual/guardian, all action steps which pertain specifically to the individual will be documented in his/her personal plan and forwarded to the MOAIDD coordinator.

1. (G) The regional center director shall review all overriding concerns and recommendations reported by the MOAIDD team. Action steps to address these overriding concerns and recommendations shall be incorporated, as appropriate, in the agency’s quality assurance/enhancement plan. They shall also be incorporated in the individual’s personal plan, with the consent of the individual/guardian. The regional center director shall provide a written report to the MOAIDD coordinator indicating action taken.

AUTHORITY: section 633.010, RSMo 1994.* Original rule filed Feb. 15, 2000, effective Aug. 30, 2000. *Original authority: 633.010, RSMo 1980.