This Missouri Department of Mental Health chapter establishes licensing standards for day programs serving individuals with mental illness, intellectual disabilities, and developmental disabilities (IDD). The sole active rule (9 CSR 40-9.075) sets program, activity, and staffing requirements, including director qualifications and staff-to-client ratios differentiated by population (adults with mental illness, children/youth with serious emotional disturbances, and individuals with IDD). Operators must follow structured individual support or treatment plans, provide community-inclusion activities, and ensure adequate supervision during transportation. Most other sections in the chapter were rescinded effective December 30, 2020.
View official sourceCODE OF STATE REGULATIONS 1JOHN R. ASHCROFT (11/30/20) Secretary of State Rules of Department of Mental Health Division 40—Licensing Rules Chapter 9—Day Programs Serving Individuals with Mental Illness and Intellectual or Developmental Disabilities Title Page 9 CSR 40-9.015 Physical Plant Requirements (Rescinded December 30, 2020) .........................3 9 CSR 40-9.035 General Medical and Health Care (Rescinded December 30, 2020) ..................3 9 CSR 40-9.055 Food Services (Rescinded December 30, 2020)...........................................3 9 CSR 40-9.075 Program and Staffing Requirements.........................................................3 9 CSR 40-9.095 Recordkeeping (Rescinded December 30, 2020)..........................................3 9 CSR 40-9.115 Admission Criteria (Rescinded December 30, 2020).....................................4 9 CSR 40-9.135 Care, Treatment, Habilitation and Rehabilitation (Rescinded December 30, 2020)............................................................4 9 CSR 40-9.145 Maintenance, Housekeeping and Laundry (Rescinded December 30, 2020).........4 9 CSR 40-9.155 Fire Safety (Rescinded December 30, 2020) ..............................................4 CODE OF STATE REGULATIONS 3JOHN R. ASHCROFT (11/30/20) Secretary of State Chapter 9—Day Programs Serving Individuals with Mental Illness and Intellectual or Developmental Disabilities 9 CSR 40-9 Title 9—DEPARTMENT OF MENTAL HEALTH Division 40—Licensing Rules Chapter 9—Day Programs Serving Individuals with Mental Illness and Intellectual or Developmental Disabilities 9 CSR 40-9.015 Physical Plant Require- ments (Rescinded December 30, 2020) AUTHORITY: sections 630.050 and 630.705, RSMo (1994). Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. Amended: Filed Jan. 2, 1990, effective June 1 1, 1990. Amended: Filed July 17, 1995, effective March 30, 1996. Rescinded: Filed May 14, 2020, effective Dec. 30, 2020. 9 CSR 40-9.035 General Medical and Health Care (Rescinded December 30, 2020) AUTHORITY: sections 630.050 and 630.705, RSMo (1994). Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. Amended: Filed Aug. 4, 1987, effective Nov. 15, 1987. Amended: Filed Jan. 2, 1990, effective June 1 1, 1990. Amended: Filed July 17, 1995, effective March 30, 1996. Rescind- ed: Filed May 14, 2020, effective Dec. 30, 2020. 9 CSR 40-9.055 Food Services (Rescinded December 30, 2020) AUTHORITY: sections 630.050 and 630.705, RSMo (1994). Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. Amended: Filed Jan. 2, 1990, effective June 1 1, 1990. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, effective March 30, 1996. Rescind- ed: Filed May 14, 2020, effective Dec. 30, 2020. 9 CSR 40-9.075 Program and Staffing Requirements PURPOSE: This rule specifies the program and staffing requirements for day programs serving individuals with mental illness, intel- lectual disabilities, and developmental dis- abilities (IDD) that are subject to licensure by the department. (1) Licensed day programs shall comply with 9 CSR 40-1 unless specified otherwise in this rule. (2) Day programs shall provide structured activities, services, and supports to assist individuals in developing personal support systems, social skills, community living skills, basic self-care skills, and pre-vocation- al skills that promote community inclusion, integration, and independence. (A) Activities and services/supports shall be based on the individual support plan (ISP), individual treatment plan (ITP), or care plan of each individual being served as specified in 9 CSR 40-1.075(1). (B) Activities and services/supports may take place during the day, evening, weekend, or a combination of these, to effectively address the needs of individuals served. Activities and services/supports are not limit- ed to the program site to provide individuals with opportunities for off-site training and rehabilitation in realistic community settings. (C) Transportation to/from the program site to various locations in the community shall be provided for individuals served to promote participation and involvement in out- side activities and services/supports. Permis- sion forms for off-site activities, signed by the individual served or their parent/guardian, as applicable, shall be main- tained on-site. 1. Program staff are responsible for the care, safety, and supervision of individuals served when they are transported from the operating site to other locations in the com- munity, and staff ratios shall be maintained at the operating site. (3) All direct care staff must be eighteen (18) years of age or older and have a high school diploma or equivalent certificate. (A) Staffing requirements for day pro- grams serving adults with mental illness— 1. The director must be a Qualified Mental Health Professional (QMHP) with two (2) years of relevant work experience; 2. At a minimum, a daily direct care staff ratio of one (1) staff person for each six- teen (16) individuals served (1:16) shall be maintained, unless program needs or the needs of individuals being served require oth- erwise; and 3. At least one (1) staff person must be on duty at all times when individuals served are present at the program. (B) Staffing requirements for day programs serving children and youth with serious emo- tional disturbances— 1. The director must be a QMHP with two (2) years of experience working with children and youth; 2. One (1) full-time mental health pro- fessional must be available during the provi- sion of services; 3. Direct care staffing ratios shall be based on the ages and needs of the children/youth being served. A. At a minimum, a daily staffing ratio of one (1) staff to four (4) individuals (1:4) shall be maintained for children/youth between the ages of three (3) and eleven (11). A daily staffing ratio of one (1) staff to six (6) individuals (1:6) shall be maintained for chil- dren/youth between the ages of twelve (12) and seventeen (17); 4. Based on the needs of children/youth being served, other staff shall include: A. Registered nurse; B. Occupational therapist; C. Recreational therapist; D. Rehabilitation therapist; E. Community support specialist; F . Family assistance worker; and 5. At least one (1) staff person must be on duty at all times when individuals served are present at the program. (C) Staffing requirements for day programs serving individuals with IDD shall be as fol- lows, unless program needs or the needs of individuals being served require otherwise: 1. For children and youth between the ages of three (3) and eleven (11), the daily staffing ratio shall be one (1) staff to four (4) individuals (1:4); 2. For children/youth between the ages of twelve (12) and seventeen (17), the daily staffing ratio shall be one (1) staff to six (6) individuals (1:6); and 3. For adults, the daily staffing ratio shall be a minimum of one (1) staff for each sixteen (16) individuals (1:16) served. AUTHORITY: sections 630.050 and 630.705, RSMo 2016.* Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. Amended: Filed Jan. 2, 1990, effective June 1 1, 1990. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, effective March 30, 1996. Amend- ed: Filed May 14, 2020, effective Dec. 30, 2020. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008 and 630.705, RSMo 1980, amended 1982, 1984, 1985, 1990, 2000, 201 1, 2014. 9 CSR 40-9.095 Recordkeeping (Rescinded December 30, 2020) AUTHORITY: sections 630.050 and 630.705, RSMo (1994). Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. Amended: Filed Jan. 2, 1990, effective June 1 1, 1990. Amended: Filed July 17, 1995, effective March 30, 1996. Rescinded: Filed May 14, 2020, effective Dec. 30, 2020. 9 CSR 40-9.115 Admission Criteria (Rescinded December 30, 2020) AUTHORITY: sections 630.050 and 630.705, RSMo (1994). Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. Amended: Filed Jan. 2, 1990, effective June 1 1, 1990. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, effective March 30, 1996. Rescind- ed: Filed May 14, 2020, effective Dec. 30, 2020. 9 CSR 40-9.135 Care, Treatment, Habilita- tion and Rehabilitation (Rescinded December 30, 2020) AUTHORITY: sections 630.050 and 630.705, RSMo (1994). Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. Amended: Filed Jan. 2, 1990, effective June 1 1, 1990. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, effective March 30, 1996. Rescind- ed: Filed May 14, 2020, effective Dec. 30, 2020. 9 CSR 40-9.145 Maintenance, Housekeep- ing and Laundry (Rescinded December 30, 2020) AUTHORITY: sections 630.050 and 630.705, RSMo (1994). Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. Amended: Filed July 17, 1995, effective March 30, 1996. Rescinded: Filed May 14, 2020, effective Dec. 30, 2020. 9 CSR 40-9.155 Fire Safety (Rescinded December 30, 2020) AUTHORITY: sections 630.050 and 630.705, RSMo (1994). Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed Feb. 4, 1986, effective July 1, 1986. Amended: Filed Jan. 2, 1990, effective June 1 1, 1990. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, effective March 30, 1996. Rescind- ed: Filed May 14, 2020, effective Dec. 30, 2020. 4 CODE OF STATE REGULATIONS (11/30/20) JOHN R. ASHCROFT Secretary of State 9 CSR 40-9—DEPARTMENT OF MENTAL HEALTH Division 40—Licensing Rules