198.073. Persons eligible for care in residential care facility or assisted living facility--assisted living facility licenses granted, requirements--facility admission, requirements, disclosures--rul
Persons eligible for care in residential care facility or assistedliving facility--assisted living facility licenses granted,requirements--facility admission, requirements,disclosures--rulemaking authority.
198.073. 1. A residential care facility shall admit or retain onlythose persons who are capable mentally and physically of negotiating anormal path to safety using assistive devices or aids when necessary, andwho may need assisted personal care within the limitations of suchfacilities, and who do not require hospitalization or skilled nursing care.
2. Notwithstanding the provisions of subsection 1 of this section,those persons previously qualified for residence who may have a temporaryperiod of incapacity due to illness, surgery, or injury, which period doesnot exceed forty-five days, may be allowed to remain in a residential carefacility or assisted living facility if approved by a physician.
3. Any facility licensed as a residential care facility II on August27, 2006, shall be granted a license as an assisted living facility, asdefined in section 198.006, on August 28, 2006, regardless of the laws,rules, and regulations for licensure as an assisted living facility as longas such facility continues to meet all laws, rules, and regulations thatwere in place on August 27, 2006, for a residential care facility II. Atsuch time that the average total reimbursement, not including residents'cost-of-living increases in their benefits from the Social SecurityAdministration after August 28, 2006, for the care of persons eligible forMedicaid in an assisted living facility is equal to or exceeds forty-onedollars per day, all facilities with a license as an assisted livingfacility shall meet all laws, rules, and regulations for licensure as anassisted living facility. Nothing in this section shall be construed toallow any facility that has not met the requirements of subsections 4 and 6of this section to care for any individual with a physical, cognitive, orother impairment that prevents the individual from safely evacuating thefacility.
4. Any facility licensed as an assisted living facility, as definedin section 198.006, except for facilities licensed under subsection 3 ofthis section, may admit or retain an individual for residency in anassisted living facility only if the individual does not requirehospitalization or skilled nursing placement, and only if the facility:
(1) Provides for or coordinates oversight and services to meet theneeds of the resident as documented in a written contract signed by theresident, or legal representative of the resident;
(2) Has twenty-four-hour staff appropriate in numbers and withappropriate skills to provide such services;
(3) Has a written plan for the protection of all residents in theevent of a disaster, including keeping residents in place, evacuatingresidents to areas of refuge, evacuating residents from the building ifnecessary, or other methods of protection based on the disaster and theindividual building design;
(4) Completes a pre-move-in screening with participation of theprospective resident;
(5) Completes for each resident a community-based assessment, asdefined in subdivision (7) of section 198.006:
(a) Upon admission;
(b) At least semiannually; and
(c) Whenever a significant change has occurred in the resident'scondition which may require a change in services;
(6) Based on the assessment in subsection 7 of this section andsubdivision (5) of this subsection, develops an individualized service planin partnership with the resident, or legal representative of the resident,that outlines the needs and preferences of the resident. Theindividualized service plan will be reviewed with the resident, or legalrepresentative of the resident, at least annually, or when there is asignificant change in the resident's condition which may require a changein services. The signatures of an authorized representative of thefacility and the resident, or the resident's legal representative, shall becontained on the individualized service plan to acknowledge that theservice plan has been reviewed and understood by the resident or legalrepresentative;
(7) Makes available and implements self-care, productive and leisureactivity programs which maximize and encourage the resident's optimalfunctional ability;
(8) Ensures that the residence does not accept or retain a residentwho:
(a) Has exhibited behaviors that present a reasonable likelihood ofserious harm to himself or herself or others;
(b) Requires physical restraint;
(c) Requires chemical restraint. As used in this paragraph, thefollowing terms mean:
a. "Chemical restraint", a psychopharmacologic drug that is used fordiscipline or convenience and not required to treat medical symptoms;
b. "Convenience", any action taken by the facility to controlresident behavior or maintain residents with a lesser amount of effort bythe facility and not in the resident's best interest;
c. "Discipline", any action taken by the facility for the purpose ofpunishing or penalizing residents;
(d) Requires skilled nursing services as defined in subdivision (23)of section 198.006 for which the facility is not licensed or able toprovide;
(e) Requires more than one person to simultaneously physically assistthe resident with any activity of daily living, with the exception ofbathing and transferring;
(f) Is bed-bound or similarly immobilized due to a debilitating orchronic condition; and
(9) Develops and implements a plan to protect the rights, privacy,and safety of all residents and to protect against the financialexploitation of all residents;
(10) Complies with the training requirements of subsection 8 ofsection 660.050, RSMo.
5. Exceptions to paragraphs (d) to (f) of subdivision (8) ofsubsection 4 of this section shall be made for residents on hospice,provided the resident, designated representative, or both, and the assistedliving provider, physician, and licensed hospice provider all agree thatsuch program of care is appropriate for the resident.
6. If an assisted living facility accepts or retains any individualwith a physical, cognitive, or other impairment that prevents theindividual from safely evacuating the facility with minimal assistance, thefacility shall:
(1) Have sufficient staff present and awake twenty-four hours a dayto assist in the evacuation;
(2) Include an individualized evacuation plan in the service plan ofthe resident; and
(3) Take necessary measures to provide residents with the opportunityto explore the facility and, if appropriate, its grounds; and
(4) Use a personal electronic monitoring device for any residentwhose physician recommends the use of such device.
7. An individual admitted or readmitted to the facility shall have anadmission physical examination by a licensed physician. Documentationshould be obtained prior to admission but shall be on file not later thanten days after admission and shall contain information regarding theindividual's current medical status and any special orders or proceduresthat should be followed. If the individual is admitted directly from ahospital or another long-term care facility and is accompanied on admissionby a report that reflects his or her current medical status, an admissionphysical shall not be required.
8. Facilities licensed as an assisted living facility shall discloseto a prospective resident, or legal representative of the resident,information regarding the services the facility is able to provide orcoordinate, the costs of such services to the resident, and the residentconditions that will require discharge or transfer, including theprovisions of subdivision (8) of subsection 4 of this section.
9. After January 1, 2008, no entity shall hold itself out as anassisted living facility or advertise itself as an assisted living facilitywithout obtaining a license from the department to operate as an assistedliving facility. Any residential care facility II licensed under thischapter that does not use the term assisted living in the name of itslicensed facility on or before May 1, 2006, shall be prohibited from usingsuch term after August 28, 2006, unless such facility meets therequirements for an assisted living facility in subsection 4 of thissection. Any facility licensed as an intermediate care facility prior toAugust 28, 2006, that provides the services of an assisted living facility,as described in paragraphs (a), (b), and (c) of subdivision (6) of section198.006, utilizing the social model of care, may advertise itself as anassisted living facility without obtaining a license from the department tooperate as an assisted living facility.
10. The department of health and senior services shall promulgaterules to ensure compliance with this section. Any rule or portion of arule, as that term is defined in section 536.010, RSMo, that is createdunder the authority delegated in this section shall become effective onlyif it complies with and is subject to all of the provisions of chapter 536,RSMo, and, if applicable, section 536.028, RSMo. This section and chapter536, RSMo, are nonseverable and if any of the powers vested with thegeneral assembly pursuant to chapter 536, RSMo, to review, to delay theeffective date, or to disapprove and annul a rule are subsequently heldunconstitutional, then the grant of rulemaking authority and any ruleproposed or adopted after August 28, 2006, shall be invalid and void.
(L. 1979 S.B. 328, et al. § 24, A.L. 1984 S.B. 451, A.L. 1992 H.B. 899 merged with S.B. 573 & 634 merged with S.B. 721, A.L. 1999 S.B. 326, A.L. 2006 S.B. 616, A.L. 2007 H.B. 952 & 674)