9 CSR 40-1.015 - Definitions
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) Unless the context clearly indicates
otherwise, the terms defined in sections
630.005,
632.005 and
633.005, RSMo and as used in 9
CSR 40 are incorporated by reference as if set out in this rule.
(2) The following additional words and terms,
as used in 9 CSR 40, mean:
(A) Administrative
agent, an organization and its approved designee(s) authorized by the
department as an entry and exit point into the state mental health service
delivery system for a geographic service area defined by the department.
Administrative agents provide statewide access crisis intervention services,
including a twenty-four (24) hour crisis mobile response by qualified mental
health professionals;
(B) Access
Crisis Intervention (ACI), as defined in
9 CSR
30-4.195 Access Crisis Intervention (ACI)
Programs;
(C) Affiliate, an
organization that is contracted with the department to provide specific
community psychiatric rehabilitation (CPR) services for adults in a specific
designated geographic region;
(D)
Applicant, an individual, partnership, association, corporation, or
governmental entity which has applied to the department for a license or
program license;
(E) Assisted
living facility (ALF), any residence, intermediate care facility, or skilled
nursing facility licensed under Chapter 198, RSMo, that provides twenty-four
(24) hour care and services and protective oversight to three (3) or more
adults who need assistance with activities of daily living and instrumental
activities of daily living; storage, distribution, or administration of
medications; and/or supervision of health care under the direction of a
licensed physician;
(F) Behavioral
health, the promotion of mental health, resilience, and well-being, the
treatment of mental health and substance use disorders, and the support of
individuals who experience and/or are in recovery from these conditions, along
with their families/natural supports and communities;
(G) Behavioral crisis/mental health crisis,
any situation in which a person's behavior puts him/her at risk of hurting
him/herself or others and/or prevents him/her from being able to care for
him/herself or function effectively in the community;
(H) Behavioral health services, mental health
services, substance use disorder treatment services, or a combination of both,
for youth, children, and adults. Services may be provided in a residential
program, on an outpatient basis, or in a home or community program;
(I) Care plan, document developed by staff of
a community residential program or day program in collaboration with the
individual served and family members/natural supports, as appropriate, which
includes measurable goals and objectives important to the individual to assist
him or her in achieving personally defined outcomes, ensures delivery of
services and supports in a manner that reflect personal preferences and
choices, and contributes to the assurance of health and wellness of the
individual served;
(J) Community
Psychiatric Rehabilitation (CPR), an array of community-based outpatient mental
health services for children, youth, and adults who have been diagnosed with a
severe, disabling mental illness or serious emotional disturbance.
Administrative agents or their affiliates are responsible for providing these
services to eligible individuals in designated service area(s);
(K) Community residential program, any
premises where services, structure, oversight, and supports are provided on a
residential basis for adults with mental illness who otherwise would not be
able to function outside of psychiatric inpatient care due to the severity and
chronicity of their mental illness. This includes, but is not limited to,
Intensive Residential Treatment Settings (IRTS), Psychiatric Individualized
Supported Living (PISL), Residential Care Facilities (RCF), Intermediate Care
Facilities (ICF), and Assisted Living Facilities (ALF);
(L) Competency-based training, the provision
of knowledge and skills sufficient to enable the trained staff person to meet
specified standards of performance consistent with generally accepted
professional standards or specified in law, regulation, or policy, as validated
by the person's demonstration that he/she can use such knowledge or skills
effectively;
(M) Compliance, a
program may be found in compliance with these licensing rules when deficiencies
do not involve-
1. Abuse or neglect-any
instance of abuse/neglect in which corrective action has not been
taken;
2. Life endangering
conditions-any single life-endangering event or combination of minor
deficiencies which collectively are life endangering or which become perilous
contingent upon an event such as the outbreak of fire;
3. Legal requirements-deficiencies related to
statutory requirements for programs licensed by the department, such as
individual rights and licensing procedures;
4. Repeated deficiencies-issues which may or
may not be serious in and of themselves, but which become significant when left
uncorrected according to agreed upon schedules over a period of time;
5. Numerous deficiencies-deficiencies which
may or may not be serious themselves, but become significant collectively
because they indicate an ineffective maintenance plan, deficient environmental
standards, inadequate orientation or training of staff, poor nursing care
practice, inadequate diet, lack of treatment or rehabilitation, ineffective
policies and procedures, inadequate staffing, improper recordkeeping, or other
issues which may affect the well being of individuals served; or
6. Minimum environmental
requirements-quantitative requirements under environment and fire
safety/emergency preparedness relating to minimum dimensions for hallways,
doors, ceiling heights, window space, floor space, number of bathrooms, and
individuals per bedroom;
(N) Consent agreement, an agreement with the
department that is entered into by the director of a community residential
program or day program to obtain a probationary license. Such a consent
agreement will include a provision that the director of the program will
voluntarily surrender the license if compliance with licensing requirements is
not reached in accordance with the terms and deadlines established under the
agreement. The agreement specifies the stages, actions, and time span to
achieve compliance;
(O) Continuing
care, the provision of a treatment plan and program structure that will ensure
an individual receives the type of care he/she needs at the time, particularly
at the point of discharge or transfer from the current program. Programs are
flexible and tailored to the changing needs of individuals served;
(P) Crisis, an event or time period for an
individual characterized by a substantial increase in symptoms, legal or
medical problems, and/or loss of housing, employment, or personal
supports;
(Q) Crisis prevention
plan, developed with individuals who have a mental illness when a potential
risk for suicide, violence, or other at-risk behavior is identified during the
assessment process or any time during the individual's engagement in services.
At a minimum, the crisis prevention plan includes factors that may precipitate
a crisis, a hierarchical list of skills/strengths identified by the individual
to regain a sense of control to return to his/her level of functioning before
the crisis or emergency, and a hierarchical list of staff interventions that
may be used when a critical situation occurs;
(R) Deemed license, acknowledges that an
organization/program is monitored and held accountable by a recognized national
accrediting body and the department accepts the organization's verification of
good standing with the accrediting body as sufficient to meet the department's
standards of care;
(S) Deficiency,
a condition, event, or omission that does not comply with a department
licensing rule;
(T) Discharge, the
point at which an individual's active involvement with a treatment or
rehabilitation program concludes in accordance with the goals in his or her
individual support plan (ISP), individual treatment plan (ITP), or care plan,
applicable utilization criteria, and/or program rules;
(U) Electronic health record (EHR), digital
version of individual records;
(V)
Family living arrangement (FLA) for adults, a program in the owned or leased
permanent residence of the licensee, serving no more than three (3) adults who
have a developmental disability who are integrated into the licensee's family
unit. The licensee of the home provides care and support as directed in the
individual support plan (ISP);
(W)
Family living arrangement (FLA) for children/youth, a program in the owned or
leased permanent residence of the licensee in which mental health interventions
are provided for children and youth placed in the home, allowing the child to
remain in his/her community until returning to his/her natural home or
alternative community placement to avoid being removed from a community
setting;
(X) Individual, a
person/consumer/client receiving services from a program licensed under 9 CSR
40;
(Y) Individualized education
plan (IEP), a plan developed by trained school staff for children who have a
disability and a need for specialized instruction;
(Z) Individual support plan (ISP), a document
resulting from a person-centered planning process with an individual with
intellectual or developmental disabilities, with assistance as needed by a
representative, in collaboration with an interdisciplinary team. The plan is
intended to identify the strengths, capacities, preferences, needs, and desired
outcomes of the person served. The process may include other people freely
chosen by the individual who are able to contribute to the process. The
person-centered planning process enables and assists the individual in
accessing a personalized mix of paid and non-paid services and supports that
will assist him/her in achieving personally defined outcomes and the training,
supports, therapies, treatments, and/or other services that become part of the
ISP;
(AA) Individual Treatment Plan
(ITP), written document developed in collaboration with the individual seeking
assistance for a behavioral health condition (or his or her parent/legal
guardian) that identifies the individual's strengths, goals, preferences,
abilities, physical and behavioral health needs, and desired outcomes for a
healthy lifestyle in the community. Treatment staff, treatment team members,
and family members/natural supports (if acceptable to the individual being
served) participate in the development of the plan and assist the individual in
identifying and accessing a mix of services and supports to meet his/her needs
and achieve desired goals for recovery and resiliency;
(BB) Intensive Residential Treatment Setting
(IRTS), living environment where medically necessary services/supports are
provided for five (5) to sixteen (16) adults with serious mental illness who
are transitioning from an inpatient psychiatric hospital to the community, or
are at risk of returning to inpatient care due to their clinical status or need
for increased support. This environment is most appropriate for individuals who
can tolerate regular interaction with their peers, but have significant
difficulties with activities of daily living and may require round-the-clock
observation and oversight and/or periodic redirection from staff to avoid
behaviors potentially harmful to themself or others;
(CC) Isolation, removing an individual from a
social setting to prevent spread of contagious disease;
(DD) License, written notification that a
community residential program or day program complies with department licensing
requirements to serve individuals with mental illness, intellectual
disabilities, and developmental disabilities;
(EE) Licensee, an individual, partnership,
association, corporation, or governmental entity which has received a license
or program license from the department to operate a community residential
program or day program to provide services and supports for individuals with
mental illness, intellectual disabilities, and developmental
disabilities;
(FF) Mechanical
supports, supportive devices used in normative situations to achieve proper
body position and balance; these are not restraints;
(GG) Medication administration, qualified
staff preparing and/or giving a legally prescribed individual dose of
medication to an individual served, including observation and monitoring the
individual's response to the medication;
(HH) Medication control, the process of
physically controlling, transporting, storing, and disposing of medications,
including medications self-administered by individuals served;
(II) Medication use, the practice of
handling, prescribing, and dispensing medication (including administering and
observing self-administration) to persons served in response to specific
symptoms, behaviors, and conditions for which the use of medication is
indicated and deemed effective. This includes prescribed and sample medications
and may, when required as part of the treatment regimen, include
over-the-counter or alternative medication provided to persons
served;
(JJ) Misuse of
funds/property, as defined in
9 CSR
10-5.200, Report of Complaints of Abuse, Neglect, and
Misuse of Funds/Prop-erty;
(KK)
Natural supports, provided by a person of the individual's choice to assist him
or her in achieving personal goals and facilitating integration into their
community. Natural supports are provided by persons who are not paid staff of
an agency but may be initiated, planned, and facilitated in partnership with an
agency;
(LL) Neglect, as defined in
9 CSR 105.200, Report of Complaints of Abuse, Neglect, and Misuse of
Funds/Property;
(MM) Outcome, a
specific measurable result of services/supports provided to an individual or
identified target population;
(NN)
Person-centered, services and supports developed in collaboration with the
individual served that are respectful of informed consent and the preferences
of the individual, resulting in a therapeutic alliance which contributes
significantly to treatment/rehabilitation outcomes;
(OO) Physical abuse, as defined in
9 CSR
10-5.200, Report of Complaints of Abuse, Neglect, and
Misuse of Funds/Property;
(PP)
Probationary license, written authorization to continue service delivery for a
specified period of time to enable a licensee to achieve compliance with the
department's licensing requirements as set forth in a consent agreement between
the department and the licensee;
(QQ) Program license, written notification
that a community residential program with a current license, temporary
operating permit, or probationary license from the Department of Health and
Senior Services (DHSS) under sections 198.006-198.096, RSMo, also meets the
department's licensing requirements relative to admission criteria, care,
treatment, and habilitation or rehabilitation needs of individuals
served;
(RR) Psychiatric crisis, an
individual is exhibiting a substantial increase in symptoms related to a severe
emotional disturbance or mental illness based upon his or her baseline
functioning. The reason(s) why the crisis occurred and how it is expressed
varies by individual and may include harm to self or others, disorientation,
being out of touch with reality, compromised ability to function, or other
expression of emotional distress not characteristic to the individual.
Immediate clinical assessment and intervention is necessary to ensure the
safety of the individual and others;
(SS) Psychiatric Individualized Supported
Living (PISL), living environment where medically necessary services/supports
are provided for one (1) to four (4) adults with serious mental illness who are
transitioning from an inpatient psychiatric hospital to the community, or are
at risk of returning to inpatient care due to their clinical status or need for
increased support. This environment is most appropriate for individuals who-
1. Have intermittent difficulty tolerating
other individuals in their immediate living area;
2. Require access to an individual bedroom to
avoid psychiatric relapse, aggression, or other behaviors associated with a
risk of re-hospitalization; and/or
3. Have substantial difficulties with
activities of daily living and require round-the-clock observation and
oversight; and/or
4. Require daily
redirection from staff to avoid behaviors potentially harmful to themselves or
others;
(TT) Qualified
mental health professional (QMHP), any of the following:
1. A physician licensed under Missouri law to
practice medicine or osteopathy and with training in mental health services or
one (1) year of experience, under supervision, in treating problems related to
mental illness or specialized training;
2. A psychiatrist licensed under Missouri law
as a physician and who has successfully completed a training program in
psychiatry approved by the American Medical Association, the American
Osteopathic Association, or other training program identified as equivalent by
DMH;
3. A psychologist licensed
under Missouri law to practice psychology with specialized training in mental
health services;
4. A professional
counselor licensed under Missouri law to practice counseling with specialized
training in mental health services;
5. A clinical social worker licensed under
Missouri law with a master's degree in social work from an accredited program
and with specialized training in mental health services;
6. A psychiatric nurse licensed under Chapter
335, RSMo, as a registered professional nurse with at least two (2) years of
experience in a psychiatric or substance use disorder treatment setting or a
master's degree in psychiatric nursing;
7. An individual possessing a master's or
doctorate degree in counseling and guidance, rehabilitation counseling and
guidance, vocational counseling, psychology, pastoral counseling, family
therapy, or related field who has successfully completed a practicum or has one
(1) year of experience under the supervision of a QMHP;
8. An occupational therapist certified by the
National Board for Certification in Occupational Therapy, registered in
Missouri, who has a bachelor's degree and has completed a practicum in a
psychiatric setting or has one (1) year of experience in a psychiatric setting,
or has a master's degree and has completed either a practicum in a psychiatric
setting or has one (1) year of experience in a psychiatric setting;
9. An advanced practice registered nurse
(APRN) under section 335.016, RSMo, who has had
education beyond the basic nursing education and is certified by a nationally
recognized professional organization as having a nursing specialty, or who
meets criteria for APRNs established by the board of nursing; or
10. A psychiatric pharmacist, registered
pharmacist in good standing with the Missouri Board of Pharmacy who is a
board-certified psychiatric pharmacist through the Board of Pharmaceutical
Specialties, or a registered pharmacist currently in a psy-chopharmacology
residency where the service has been supervised by a board-certified
psychiatric pharmacist;
(UU) Reciprocal license, issued by the
department to a residential program that has a current valid license as a
Residential Treatment Agency for Children and Youth from the Department of
Social Services under 13 CSR 35-71, if the applicant has applied for a license
from the department and paid the application fee;
(VV) Research, as defined in 9 CSR
601.010;
(WW) Residential care
facility (RCF), as defined in section
198.006, RSMo;
(XX) Residential program, program in the
community serving ten (10) or more individuals with intellectual or
developmental disabilities by providing social support, health supervision, and
habilitation training in skills of daily living;
(YY) Restraint, as defined in 9 CSR
107.140;
(ZZ) Safety crisis plan,
as defined in 9 CSR 45-3.090 Behavior
Supports;
(AAA) Scheduled
(controlled) medication, categories or schedules assigned to medication by the
Drug Enforcement Administration based on a drug's acceptable medical use and
the drug's abuse or dependency potential;
(BBB) Seclusion, involuntary confinement of
an individual alone in a room or an area from which he/she is physically
prevented from leaving or having contact with others;
(CCC) Self-administration of medication
(adults), the application of a medication, (whether by injection, inhalation,
oral ingestion, or any other means) by the individual served to his or her
body, and may include the program storing the medication and staff handing the
medication container to the individual at the time designated to take the
medication;
(DDD) Sexual abuse, as
defined in 9 CSR 10-5.200, Report of
Complaints of Abuse, Neglect, and Misuse of Funds/Property;
(EEE) Staff (staff member, employee,
personnel), paid employee or contractor providing services and/or supports on
behalf of a licensed or deemed licensed program, on a full- or part-time basis,
and has contact with individuals served by the program;
(FFF) Stock supply/stock pharmaceutical,
prescription and non-prescription medication stored on-site for the provision
of medication services by a program. Stock supplies are checked by qualified
staff on a routine basis for expiration dates and reviewed annually by a
pharmacy consultant and approved by the medical director or pharmacy
technician;
(GGG) Substance use
disorder, diagnostic term in the fifth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) referring to recurrent
use of alcohol or other drugs that causes clinically and functionally
significant impairment such as health problems, disability, and failure to meet
major responsibilities at work, school, or home. Depending on the level of
severity, this disorder is classified as mild, moderate, or severe. The
document incorporated by reference does not include any later revisions or
updates and is available from the American Psychiatric Association, 1000 Wilson
Boulevard, Suite 1825, Arlington, VA 22209-3901;
(HHH) Supports, array of activities,
resources, relationships, and services designed to assist an individual's
integration into the community, participation in ser-vices/supports, improve
functioning, and/or recovery and resiliency;
(III) Targeted case management, Medicaid
program that assists individuals served by the Division of Developmental
Disabilities (DD) to gain access to needed medical, social, educational, and
other services;
(JJJ) Temporary
operating permit, written authorization from the department permitting a
licensee seeking license renewal or a new owner applying for an initial license
to continue service delivery pending completion of the licensing survey process
and the applicant is not at fault for any delay in the process;
(KKK) Time-out, temporarily separating a
person from an environment where he or she has exhibited unacceptable
behavior;
(LLL) Trauma, experiences
that cause intense physical and psychological stress reactions. May refer to a
single event, multiple events, or a set of circumstances experienced by an
individual as physically and emotionally harmful or threatening and has lasting
adverse effects on the individual's physical, social, emotional, or spiritual
wellbeing;
(MMM) Treatment, a
professionally recognized approach that applies accepted theories, principles,
and techniques designed to achieve rehabilitative outcomes for individuals
served;
(NNN) Verbal abuse, as
defined in 9 CSR 10-5.200, Report of
Complaints of Abuse, Neglect, and Misuse of Funds/Property; and
(OOO) Volunteer, an unpaid person formally
recognized by a program to provide direct services or supports to individuals
it serves.
(3) Unless the
context clearly indicates otherwise, certain terms shall be used in 9 CSR 40 as
follows:
(A) Parent, the parent of a minor
child unless his/her parental rights have been terminated, or the parent of an
adult who consents to having the parent have access to or participate in the
record or activity subject of a particular rule. The term shall be disregarded
if the individual's parents are deceased or have had their parental rights
terminated; and
(B) Guardian, the
person appointed by a Missouri court of competent jurisdiction to have the
care, custody, and control of the individual. The term shall be disregarded if
the individual has not had a guardian appointed.
Notes
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