PURPOSE: This rule prescribes admissions criteria, the application process and placement procedures for the adult placement program of the Division of Comprehensive 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 residential services contract clearly requires otherwise, the following other terms, as used in this chapter, shall mean:

   1. (A) Applicant, a person for whom placement services have been requested in writing, including a person seeking readmission to the community placement program;
   2. (B) Client, a person 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) Forensic client, a person who is a client of the Division of Comprehensive Psychiatric Services pursuant to Chapter 552, RSMo; and
   5. (E) Regional Placement Program, an area Supported Community Living (SCL) office subject to supervision by the division director or any other entity designated by the division director with responsibility for the regional placement program and services.
2. (2) All forensic clients shall be eligible for adult placement services from the Division of Comprehensive Psychiatric Services.
3. (3) All adult persons who are inpatients of facilities operated by the Division of Comprehensive Psychiatric Services and are referred by facility staff receive priority in admission to the adult placement program of the Division of Comprehensive Psychiatric Services.

4. (4) An applicant who does not meet the criteria of section (2) or (3) shall meet all of the following admission criteria to be eligible for adult placement services from the Division of Comprehensive Psychiatric Services:

   1. (A) Be at least seventeen (17) years and nine (9) months of age;

   2. (B) Have a currently valid DSM-IV Axis I diagnosis limited to one (1) of the following list of mental disorders:

      1. 1. Schizophrenic disorder (295.10,

295.20, 295.30, 295.60 or 205.90);

1. 2. Delusional (paranoid) disorder

(297.1X);

1. 3. Schizoaffective disorder (295.70);
2. 4. Bipolar disorder (296.XX);
3. 5. Atypical psychosis (298.9X);
4. 6. Major depression, recurrent

(296.3X);

1. 7. Obsessive compulsive disorder

(300.30);

1. 8. Post-traumatic stress disorder

(309.81);

1. 9. Borderline personality disorder

(301.83);

1. 10. Dissociative identity disorder

(300.14);

1. 11. Generalized anxiety disorder

(300.02); or

1. 12. Panic disorder with agoraphobia,

agoraphobia without history of panic disorder and social phobia (300.21, 300.22 or 300.23); and

1. (C) Based upon sufficient documentation, have a mental disorder which constitutes substantial impairment in social role functioning and daily living skills to the extent that, based upon the department’s clinical judgment, the client cannot function successfully outside a mental health facility without placement services. Substantial impairment may include, but not be limited to, the following behavioral characteristics:

   1. 1. Substantial need for mental health

treatment and social services;

1. 2. History of inability or unwillingness

to comply with treatment plans, including taking medications;

1. 3. Inadequate living skills to provide for

basic necessities of food, clothing, shelter, safety, personal and health care without assistance;

1. 4. Poor social skills, which may be

exhibited in aggressive or withdrawn behavior;

1. 5. Frequent personal crises requiring

emergency treatment or support and assistance;

1. 6. Inability to effectively access com-

munity services;

1. 7. Lack of a personal support system

(for example, family or friends) to assist in accessing services; and

1. 8. Inability to sustain employment.

1. (5) Department placement staff shall consider an applicant ineligible for placement 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 judgement;
   4. (D) The diagnosis is dementia; or 9 CSR 50-2
   5. (E) Appropriate services have been established that are otherwise available through alternative resources.
2. (6) Regional placement programs shall screen applicants for placement services to determine the following: appropriateness of the referral, eligibility for services and placement need, if any. The referring agency or person shall provide a preliminary screening information summary on a form designated by the regional placement program. The regional placement program may request additional information as necessary. Regional placement programs shall conduct screenings in appropriate settings.

3. (7) If the regional placement program makes a preliminary decision to accept a referral, it shall obtain the following materials:

   1. (A) Psychiatric assessment (an evaluation which includes diagnosis);
   2. (B) Current physical examination, necessary laboratory tests and X-rays;
   3. (C) Background information and social history;
   4. (D) Any special procedures done in the diagnosis process or any special needs of the client, such as diet, information on medicines, allergies or other medical conditions; and
   5. (E) Copies of guardianship, circuit or civil detention orders, conditional release order, if applicable.
4. (8) Within fourteen (14) working days after receipt of the referral information, the regional placement program shall indicate the disposition of the referral in writing. If the applicant does not meet criteria for acceptance, the department shall notify the referring agency or applicant by registered mail, return receipt requested, of the reasons for rejection, including in the notice information on the deadline for appealing the decision and to whom the appeal is to be sent. If the applicant disagrees with the rejection, s/he may appeal in writing within thirty (30) days after receipt of the notice and may request to meet with the head of the mental health facility to present his/her case in person as well as in writing. If the referring agency disagrees with the rejection, it may appeal in writing within thirty (30) days after receipt of the notice. Appeals shall be addressed to the head of the department’s mental health facility. Within thirty (30) days of receiving the appeal, the head of the facility shall notify the applicant and the referring agency or person in writing of his/her decision on the appeal. If the referring agency or applicant 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 the Division of Comprehensive Psychiatric Services. The division director shall notify the applicant and the referring agency or person in writing of his/her decision on the appeal within thirty (30) days of its receipt. The decision of the division director shall be final. If the applicant meets criteria for placement services, the department shall notify the referring agency or applicant of tentative placement plans.
5. (9) If the decision is to accept the applicant into the placement program, placement staff shall follow department procedures for client admission.

6. (10) Before placing any person in a residential facility or program, the department shall consider each of the following:

   1. (A) The choices and requests 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 of the facility or program to provide necessary care and treatment for the patient or resident; 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.

7. (11) Regional placement program staff shall consider a variety of placement options consistent with an individual client’s clinical needs. When a proposed residential facility or program is determined appropriate, the regional placement program shall provide to the following persons written reasons that the proposed placement is appropriate under section 630.615, RSMo:

   1. (A) The patient or resident;
   2. (B) A parent, if the patient or resident is a minor;
   3. (C) The legal guardian;
   4. (D) The referring court, state, private agency or facility; and
   5. (E) The patient’s or resident’s next of kin.

8. (12) Regional placement program staff shall obtain appropriate releases of referral information signed by the patient or resident, his/her parent, if a minor, or guardian. The placement staff shall submit the referral information to the proposed residential facility or program. The referral information shall include appropriate psychiatric, medical and social information. The referral information shall also include:

   1. (A) Preliminary screening information summary;
   2. (B) Level of functioning;
   3. (C) Treatment needs, including strengths and weaknesses; and
   4. (D) Legal status.
9. (13) The proposed residential facility or program shall indicate acceptance or rejection to the regional placement office which shall document that response in the client file and inform the referring party of the response. If the patient or resident is competent to give informed consent, the department shall allow ten (10) working days to obtain his/her consent before making a placement. If the patient or resident is a minor or has a legal guardian, the department shall obtain consent of the parent or guardian before placement. If the patient or resident is an involuntary patient or resident 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. For patients or residents committed under Chapter 552, RSMo, the department shall follow procedures set out in section 552.040, RSMo for obtaining conditional release and subsequent placement. 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.

10. (14) At the time of placement, the department shall include the following information in the residential facility placement packet, which shall accompany the client:

    1. (A) Psychiatric evaluation;
    2. (B) Psychological evaluation, if applicable;
    3. (C) Social history and assessment;
    4. (D) Initial treatment plan;
    5. (E) A statement of financial resources;
    6. (F) Name of guardian, if applicable;
    7. (G) Commitment status;
    8. (H) Medical evaluation, including current physical examination, diet, medication and special problems or needs;
    9. (I) Burial plan information; and
    10. (J) Discharge plan, if from an inpatient setting.

11. (15) The department also shall provide the following items, which shall accompany the client at the time of placement:

    1. (A) Prescriptions for, or a fourteen (14)- day supply of, medication;
    2. (B) Initial personal spending monies, if available; and
    3. (C) Sufficient and appropriate clothing and personal items.

AUTHORITY: section 630.050, RSMo 1994.* Original rule filed July 3, 1986, effective Dec. 15, 1986. Amended: Filed July 17, 1995, effective March 30, 1996.

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