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. 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) Terms defined in sections 630.005 and 632.005, RSMo shall be used in the interpretation and enforcement of this rule. Unless the residential services contract clearly requires otherwise, the following other terms, as used in this chapter, shall mean:

1. (A) Administrative agents, contracted mental health provider of adult and children’s services by the Division of Comprehensive Psychiatric Services as defined in 9 CSR 25- 2.005(2)(F).
2. (B) Affiliate, an organization linked to the department through operation of a certified community psychiatric rehabilitation center (CPRC) and/or a contract with one (1) or more administrative agents.
3. (C) Applicant, a person for whom placement services have been requested in writing, including a person seeking readmission to the community placement program.
4. (D) 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.
5. (E) DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, (2000), by the American Psychiatric Association, 1400 K Street NW, Washington, DC 20005, which is incorporated herein by reference. This rule does not incorporate any subsequent amendment or additions.
6. (F) Forensic client, a person who is a client of the Division of Comprehensive Psychiatric Services pursuant to Chapter 552, RSMo.
7. (G) Supported Community Living (SCL), offices 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.

1. (2) All forensic clients shall be eligible for adult placement services from the Division of Comprehensive Psychiatric Services.
2. (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.

3. (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 current diagnosis that qualifies for the Comprehensive Psychiatric Rehabilitation Program under the DSM-IV- TR.

   3. (C) Based upon sufficient documentation, have a mental disorder that constitutes substantial impairment in social role functioning and daily living skills to the extent that, based upon the administrative agent/affiliate’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) Administrative agent/affiliates 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
   5. (E) Appropriate services have been established that are otherwise available through alternative resources.
2. (6) Administrative agents/affiliates 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 9 CSR 50-2

additional information as necessary. Administrative agents/affiliates shall conduct screenings in appropriate settings.

1. (7) If the administrative agent/affiliate makes a preliminary decision to accept a referral, it shall obtain the following materials:

   1. (A) Current physical examination, if available, necessary laboratory tests and X-rays as indicated; and
   2. (B) Additional information at necessary to verity eligibility.

2. (8) Within fourteen (14) working days after receipt of the referral information, the administrative agent/affiliate shall indicate the disposition of the referral in writing.

   1. (A) If the applicant does not meet criteria for acceptance, the administrative agent/affiliate shall notify the referring agency or applicant by certified 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.

      1. 1. 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.

1. 2. If the referring agency disagrees with

the rejection, it may appeal in writing within thirty (30) days after receipt of the notice.

1. 3. Appeals shall be addressed to the

head of the department’s mental health facility.

1. 4. 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.

1. 5. 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.

1. 6. 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.

1. (B) If the applicant meets criteria for placement services, based upon the clinical judgement of the administrative agent/affiliate, the administrative agent/affiliate shall notify the referring agency or applicant of tentative placement plans.

1. (9) If the decision is to accept the applicant into the placement program, administrative agent/affiliate staff shall follow department procedures for client admission.

2. (10) Before placing any person in a residential facility or program, the administrative agent/affiliate shall consider each of the following:

   1. (A) The choices and requests of the client;
   2. (B) Least restrictive environment for care and treatment consistent with needs and conditions of the client;
   3. (C) Ability of the facility or program to provide necessary care and treatment for the client; and
   4. (D) Relationship of the client to family, guardian or friends so as to maintain relationships and encourage visits beneficial to the client.

3. (11) The administrative agent/affiliate 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 administrative agent/affiliate shall provide to the following persons written reasons that the proposed placement is appropriate under section 630.615, RSMo:

   1. (A) The client;
   2. (B) A parent, if the client is a minor;
   3. (C) The legal guardian; and
   4. (D) The client’s next of kin if applicable and with appropriate release of information.

4. (12) The administrative agent/affiliate staff shall obtain appropriate releases of referral information signed by the client, his/her parent, if a minor, or guardian. The administrative agent/affiliate 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.
5. (13) The proposed residential facility or program shall indicate acceptance or rejection to the administrative agent/affiliate which shall document that response in the client file and inform the referring party of the response. If the client is competent to give informed consent, the administrative agent/affiliate shall allow ten (10) working days to obtain his/her consent before making a placement. If the client is a minor or has a legal guardian, the administrative agent/affiliate shall obtain consent of the parent or guardian before placement. If the client is an involuntary client under Chapter 211 or 632, RSMo, the administrative agent/affiliate shall notify the court of competent jurisdiction of the proposed placement and allow ten (10) working days for the court to object. For clients 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 client 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 administrative agent/affiliate shall follow the procedure set out in section 630.635, RSMo.

6. (14) At the time of placement, the administrative agent/affiliate shall include the following information in the residential facility placement packet, which shall accompany the client:

   1. (A) Social history and assessment, if available; and
   2. (B) Medical evaluation, if available, including current physical examination, diet, medication and special problems or needs.
7. (15) At the time of placement the administrative agent/affiliate shall provide a fourteen (14)-day supply of the client’s prescription medication, unless less is requested by the placement facility, or the written prescription(s).
8. (16) The administrative agent/affiliate shall notify the supported community living office of the placement date.

AUTHORITY: section 630.050, RSMo 2000.* Original rule filed July 3, 1986, effective Dec. 15, 1986. Amended: Filed July 17, 1995, effective March 30, 1996. Amended: Filed Jan. 31, 2006, effective Aug. 30, 2006. *Original authority: 630.050, RSMo 1980, amended 1993, 1995.