PURPOSE: This rule prescribes admissions criteria, the application process and placement procedures for Children’s Supported Community Living of the Division of Com - prehensive Psychiatric Services.

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) Terms defined in sections 630.005 and 632.005, RSMo are incorporated by reference in this rule. Unless the placement contract clearly requires otherwise, the following other terms, as used in this chapter, shall mean:

   1. (A) Applicant, a minor for whom placement services have been requested, in writing, including a person seeking readmission to Supported Community Living;
   2. (B) Client, a minor placed under section 630.620, RSMo in any residential facility licensed or certified solely by the department or in conjunction with the Department of Social Services under Chapter 630, RSMo;
   3. (C) DSM IV, Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) of the American Psychiatric Association;
   4. (D) Supported Community Living, an office which is responsible for the regional placement program and services and is the entry and exit for regional placement services and funding;
   5. (E) Minor, any person under the age of eighteen (18) years; and
   6. (F) Patient, an individual under observation, care, treatment or rehabilitation by any hospital or other mental health facility pursuant to the provisions of Chapter 632, RSMo.
2. (2) Application for placement shall be made by the applicant’s parents, the applicant’s guardian, a court of competent jurisdiction, or a state or private agency.

3. (3) An applicant shall meet all of the following admission criteria to be eligible for Children’s Supported Community Living services from the Division of Comprehensive Psy chiatric Services:

   1. (A) Be under the age of eighteen (18);
   2. (B) Have received a DSM IV Axis I primary diagnosis of mental disorder or mental illness; may have a secondary diagnosis of alcohol abuse, substance abuse or mental retardation; and

   3. (C) Have, based upon sufficient documentation, a mental disorder or mental illness which constitutes substantial impairment in social role functioning and daily living skills to the extent that the client cannot function successfully outside a mental health facility without services. This substantial impairment may include, but not be limited to, the following behavioral characteristics:

      1. 1. Substantial impairment in impulse

control and judgment in daily living skills;

1. 2. History of aggressive/assaultive

behaviors or self-abusive behaviors based on psychological disability;

1. 3. Dysfunctional in school, home, com-

munity or a combination of these as a result of a mental disorder or mental illness to the extent that family and available community resources are not able to meet needs; and

1. 4. Evidence of failure in less restrictive

treatment environments.

1. (4) Department placement staff shall consider an applicant ineligible for Supported Community Living services from the Division of Comprehensive Psychiatric Services if—

   1. (A) The primary diagnosis is alcohol or substance abuse, or mental retardation;
   2. (B) Medical needs supersede the psychiatric disability and require considerable supervision and ongoing medical treatment;
   3. (C) Impulses to harm self or others are not under control according to clinical judgment;
   4. (D) It has been established that appropriate services are otherwise available through alternative resources;
   5. (E) The application is submitted solely for the purpose of securing residential placement for a school-aged child as defined in Chapter 162, RSMo to receive an appropriate education; or
   6. (F) Child’s symptoms meet acute definition. 9 CSR 50-2
2. (5) Supported Community Living offices or designee shall screen applicants for placement services to determine appropriateness of the referral, eligibility for services and placement need, if any. The Supported Community Living office may request additional information as necessary.

3. (6) If the Supported Community Living office makes a preliminary decision to accept a referral, it shall obtain the following referral materials:

   1. (A) A comprehensive multidisciplinary evaluation including a psychosocial history, psychiatric evaluation/diagnosis, psychological evaluation/testing, performed within the past six (6) months; and information about the intellectual cognitive functioning of the youth;
   2. (B) The psychiatric assessment (an evaluation which includes diagnosis shall be done by a psychiatrist or licensed clinical psychologist designated by the department);
   3. (C) Current physical examination performed within the past ninety (90) days, laboratory tests and X-rays as ordered by physician;
   4. (D) Background information which includes the youth’s level of functioning including successes and failures in the school, home and community as well as in other placements;
   5. (E) Any special procedures done in the diagnosis process or any special needs of the client;
   6. (F) Information on medicines, allergies or other medical conditions;
   7. (G) Information on legal status, including copies of guardianship, circuit or civil detention orders, if applicable;
   8. (H) Completed and signed standard means test, 9 CSR 10-31.011;
   9. (I) Achenbach Child Behavior Checklist;
   10. (J) DMH Form 8311, Application for Supported Community Living Services for Minors; and
   11. (K) Other demographic and pertinent information.

4. (7) Within five (5) working days after receipt of the referral information, the Supported Community Living office shall mail the applicant a report or overview on the status of the application, including a list of the items missing. Within fourteen (14) working days after receipt of the complete referral information, the Supported Community Living office shall indicate the disposition of the referral, in writing, by registered/certified mail, return receipt requested. If the applicant does not meet criteria for acceptance, the department, in the registered/certified letter, shall notify the agency or person who made application for the applicant of—

   1. (A) The reasons for rejection;
   2. (B) The deadline for appealing the decision;
   3. (C) The name, address and telephone number of the person to whom the appeal should be directed; and
   4. (D) The name, address and telephone number of a Department of Mental Health staff person who is qualified to provide information about the services offered by the Division of Comprehensive Psychiatric Services.
5. (8) Appeals. If the agency or person making application for the applicant disagrees with the rejection, s/he may appeal, in writing, within thirty (30) days after receipt of the notice to the children’s area director. Within fifteen (15) days of receiving the appeal, the children’s area director shall review the applicant’s referral materials along with a copy of the rejection letter and shall notify the applicant and the agency or person who made application for the applicant, in writing, by registered/certified letter of his/her decision on the appeal. If the agency or person making application disagrees with the decision of the head of the department’s mental health facility, s/he may appeal, in writing, within fifteen (15) days of receipt of the decision to the director of Children and Youth Services. The children and youth director shall review the applicant’s referral materials along with a copy of the rejection letter and notify the applicant and the agency or per - son making application, in writing by certified/registered letter, of his/her decision on the appeal within fifteen (15) days of its receipt. The decision of the children and youth director shall be final.
6. (9) If the decision is to accept the applicant into the Supported Community Living Program, Supported Community Living office staff shall follow departmental procedures for client admission.

7. (10) Before placing any person in the Supported Community Living Program, the department shall consider each of the following:

   1. (A) Best interest of the patient or resident;
   2. (B) Least restrictive environment for care and treatment consistent with needs and conditions of the patient or resident;
   3. (C) Ability to provide necessary care and treatment for the patient or resident which is of comparable quality to existing care and treatment based upon investigation of the alternative facility and its program of care and treatment; and
   4. (D) Relationship of the patient or resident to family, guardian or friends so as to maintain relationships and encourage visits beneficial to the patient or resident.
8. (11) The Supported Community Living office staff shall notify the agency or person making application, in writing, to schedule a special staffing with applicant and other interested/responsible persons to determine all appropriate placement resources and to designate responsibility for procuring and making the placement.

9. (12) Supported Community Living/designee staff shall obtain appropriate releases of referral information signed by parent or guardian. The referral information shall include appropriate psychiatric, medical and social information. The referral information shall also include:

   1. (A) Treatment needs, including strengths and weaknesses; and
   2. (B) Legal status.
10. (13) The proposed Supported Community Living vendor shall indicate acceptance or rejection to the regional placement office, which shall document that response in the client file and inform the agency or person making application of the response.

11. (14) Consent for Placement.

    1. (A) If the applicant is a minor or has a legal guardian, the department shall obtain consent of the parent or guardian before placement.
    2. (B) If the applicant is an involuntary patient/client under Chapter 211 or 632, RSMo, the department shall notify the court of competent jurisdiction of the proposed placement and allow ten (10) working days for the court to object.
    3. (C) For patients committed under Chapter 552, RSMo, the department shall follow procedures set out in section 552.040, RSMo for obtaining conditional release and subsequent placement.
    4. (D) If a patient in a mental health facility, his/her parent, if s/he is a minor, or his/her legal guardian refuses to consent to the proposed placement, the department shall follow the procedure set out in section 630.635, RSMo.

12. (15) Funding will be approved by the area director, Children’s Services, or designee for an applicant based on the—

    1. (A) Applicant’s acceptance by a proposed Supported Community Living vendor; and
    2. (B) Availability of funds.
13. (16) Applicants for whom placement is being sought will have their names placed on a list of those eligible for funding. Their status will be reviewed weekly by Supported Com - munity Living office staff. Area directors will determine priorities for funding allocations within their regions.

AUTHORITY: sections 630.050 and 630.705, RSMo 1994.* Original rule filed Feb. 29, 1988, effective July 25, 1988. Amended: Filed March 30, 1992, effective Jan. 15, 1993. Amended: Filed July 17, 1995, effective March 30, 1996.

*Original authority: 630.050, RSMo 1980, amended 1993, 1995 and 630.705, RSMo 1980, amended 1982, 1984, 1985, 1990.