reglab/statecodes huggingface dataset:
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.180 - Use of Pneumatic Counter Pressure Device by EMTs

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded February 28, 1999)
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.190 - Exceptions to the Requirement for Maintenance of Voice Con-act or Telemetry in Regard to Mobile Emergency Medical Technician Advanced Life-Support Procedures

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded February 28, 1999)
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.195 - Emergency Medical Service (EMS) Personnel Within the Hospital Emergency Department

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded February 28, 1999)
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.200 - Definitions Relating to Air Ambulance Services

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded February 28, 1999)
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.210 - Air Ambulance Regulations for Helicopter

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded February 28, 1999)
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.220 - Air Ambulance Regulations for Fixed-Wing Aircraft

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded February 28, 1999)
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.302 - Emergency Medical Services Regions and Committees

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule identifies the counties that are
				  included in each of the six (6) emergency medical services regions and
				  establishes the requirements for the appointment of members to each of the six
				  (6) regional committees.
(1)
				The following identifies the counties that shall be included in each of the six
				(6) emergency medical services (EMS) regions.
(A) The Central EMS region shall include the
				counties of Adair, Audrain, Benton, Boone, Callaway, Camden, Chariton, Clark,
				Cole, Cooper, Dent, Gasconade, Howard, Knox, Lewis, Linn, Macon, Maries,
				Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Phelps,
				Pulaski, Putnam, Ralls, Randolph, Saline, Schuyler, Scotland, Shelby, and
				Sullivan.
(B) The Kansas City EMS
				region shall include the counties of Bates, Caldwell, Carroll, Cass, Clay,
				Clinton, Henry, Jackson, Johnson, Lafayette, Platte, and Ray.
(C) The Northwest EMS region shall include
				the counties of Andrew, Atchison, Buchanan, Davies, DeKalb, Gentry, Grundy,
				Harrison, Holt, Livingston, Mercer, Nodaway, and Worth.
(D) The St. Louis EMS region shall include
				the counties of Franklin, Jefferson, Lincoln, Pike, St. Charles, St. Louis,
				Warren, and St. Louis City.
(E) The
				Southeast EMS region shall include the counties of Bollinger, Butler, Cape
				Girardeau, Carter, Crawford, Dunklin, Iron, Madison, Mississippi, New Madrid,
				Pemiscot, Perry, Reynolds, Ripley, Saint Francois, Sainte Genevieve, Scott,
				Stoddard, Washington, and Wayne.
(F) The Southwest EMS region shall include
				the counties of Barry, Barton, Cedar, Christian, Dade, Dallas, Douglas, Greene,
				Hickory, Howell, Jasper, Laclede, Lawrence, McDonald, Newton, Oregon, Ozark,
				Polk, St. Clair, Shannon, Stone, Taney, Texas, Vernon, Webster, and
				Wright.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.303 - Medical Director Required for All: Ambulance Services and Emergency Medical Response Agencies That Provide Advanced Life Support Services, Basic Life Support Services Utilizing Medications or Providing Assistance With Patients' Medications, or Basic Life Support Services Performing Invasive Procedures Including Invasive Airway Procedures; Dispatch Agencies Providing Pre-arrival Medical Instructions; and Training Entities

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule describes the qualifications and
				  requirements related to medical directors of ambulance services, emergency
				  medical response agencies, dispatch agencies, and training
				  entities.
(1) As used in this
				rule, the following terms shall have the meanings specified:
(A) ACLS-advanced cardiac life
				support;
(B) ALS-advanced life
				support;
(C) ATLS-advanced trauma
				life support;
(D) BCLS-basic
				cardiac life support;
(E) BLS-basic
				life support;
(F) Board
				eligibility-a physician who has applied to a specialty board and has received a
				ruling that s/he has fulfilled the requirements to take the board examination
				and the board certification must be obtained within five (5) years of the first
				appointment;
(G) EMS-emergency
				medical services;
(H)
				EMT-Basic-emergency medical technician-basic;
(I) EMT-Paramedic-emergency medical
				technician-paramedic;
(J)
				PALS-pediatric advanced life support; and
(K) Primary care specialty-family/general
				practice, internal medicine, or pediatrics.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.333 - Application and Licensure Requirements for the Licensure and Relicensure of Emergency Medical Response Agencies That Provide Advanced Life Support

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule provides the requirement and
				  standards related to the licensure and relicensure of emergency medical
				  response agencies.
(1)
				Application Requirements for Emergency Medical Response Agency Licensure.
(A) Each applicant for an emergency medical
				response agency license or relicense shall submit an application for licensure
				to the Bureau of Emergency Medical Services (EMS) no less than thirty (30) days
				or no more than one hundred twenty (120) days prior to their desired date of
				licensure or relicensure.
(B) An
				application shall include the following information: trade name of the
				emergency medical response agency; location of vehicles; name, address,
				telephone numbers and e-mail address (if applicable) of operator of the
				emergency medical response agency; name of manager; name, address, whether a
				medical doctor or doctor of osteopathy, telephone numbers, e-mail address (if
				applicable), and signature of medical director and date signed; certification
				by the medical director that they are aware of the qualification requirements
				and the responsibilities of an emergency medical response agency medical
				director and agree to serve as medical director; name, address, telephone
				numbers and e-mail address (if applicable) of proposed licensee of the
				emergency medical response agency; name of licensee's chief executive officer;
				all emergency medical response agency licensure and related administrative
				licensure actions taken against the emergency medical response agency or owner
				by any state agency in any state; and certification by the applicant that the
				application contains no misrepresentations or falsifications and that the
				information given by them is true and complete to the best of their knowledge,
				and that the emergency medical response agency has both the intention and the
				ability to comply with the regulations promulgated under the Comprehensive
				Emergency Medical Service Systems Act, Chapter 190, RSMo Supp. 1998.
(C) Each emergency medical response agency
				that meets the requirements and standards of the statute and regulations shall
				be licensed and relicensed for a period of five (5) years.
(D) A political subdivision or corporation
				that is licensed as an ambulance service cannot be licensed as an emergency
				medical response agency.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.340 - Initial Emergency Medical Technician Licensure of Mobile Emergency Medical Technicians, Ambulance Attendants and Ambulance Attendant-Drivers Who Have a License with an Expiration Date of August 28, 1998 or Later

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule provides the requirements related
				  to the initial emergency medical technician licensure of mobile emergency
				  medical technicians, ambulance attendants and ambulance attendant-drivers who
				  have a license with an expiration date of August 28, 1998 or
				  later.
(1) Any person who has
				a valid mobile emergency medical technician, ambulance attendant or ambulance
				attendant-driver license with an expiration date of August 28, 1998, or later
				shall be considered as holding a valid initial license as an emergency medical
				technician in accordance with section
				190.142,
				RSMo Supp. 1998, after August 28, 1998.
(2) Mobile emergency technicians shall be
				considered as Emergency Medical Technician-Paramedics and ambulance attendants
				and ambulance attendant-drivers shall be considered as Emergency Medical
				Technician-Basics in accordance with section
				190.142,
				RSMo Supp. 1998 after August 28, 1998.
(3) A licensee who has a valid mobile
				emergency medical technician, ambulance attendant or ambulance attendant-driver
				license with an expiration date of August 28, 1998 or later shall be issued
				upon application a replacement license with an expiration date two (2) years
				from the date of expiration shown on that license.
(4) Each application for an emergency medical
				technician (EMT) replacement license and two (2)-year extension shall include
				the following: current Missouri Emergency Medical Services (EMS) license number
				and expiration date; applicant's name, address, date of birth, sex, daytime
				telephone number, e-mail address (if applicable), and Social Security number;
				applicant's signature; and a photocopy of the applicant's current
				license.
*Original authority: 190.142, RSMo 1998 and 190.185, RSMo
					 1973, amended 1989, 1993, 1995, 1998.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.375 - Uniform Data Collection System and Ambulance Reporting Requirements for Ambulance Services

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule provides the requirements for an
				  ambulance service to report certain information on each ambulance run and to
				  submit certain data to the department.
(1) An ambulance report or an electronic
				ambulance reporting system shall be used by an ambulance service to record
				information on each ambulance run and shall be subject to approval by the
				department.
(2) A copy of all
				emergency life threatening runs as described in section (4) shall be sent to
				the department at least quarterly no later than thirty (30) days after the end
				of each quarter.
(3) Each ambulance
				service shall report to the department the total number of emergency life
				threatening runs, emergency urgent runs, emergency dry runs, non-emergency life
				threatening runs, non-emergency urgent, and non-emergency dry runs no later
				than thirty (30) days after the end of each calendar year.
(4) Each ambulance report shall include, but
				not be limited to, the following information: run report number; date of run;
				ambulance service number, vehicle identification number; state of pickup;
				county of pickup; type of run to scene; type of run from scene; times
				dispatched, enroute, arrive scene, depart scene, and arrive destination; place
				of incident; patient destination; personnel license numbers; systolic blood
				pressure; respiratory rate; glasgow coma score; protective equipment used;
				factors affecting emergency medical services (EMS); treatment authorization;
				trauma assessments; cause of injury; illness assessment; destination
				determination; patient name, address, date of birth, race, and sex; and
				treatment administered. The ambulance service shall keep a copy of this
				information for at least five (5) years.
*Original authority: 190.175, RSMo 1973; amended 1998 and
					 190.185, RSMo 1973, amended 1989, 1993, 1995,
					 1998.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.528 - Application and Licensure Requirements; Standards for the Licensure and Relicensure of Stretcher Va n Services

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule provides the requirements and
				  standards related to the licensure and relicensure of stretcher van
				  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
				  and 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) Application requirements for stretcher
				van service licensure-
(A) Each applicant for
				a stretcher van service license shall submit an application for licensure to
				the Emergency Medical Services (EMS) Bureau no less than thirty (30) days or no
				more than one hundred twenty (120) days prior to their desired date of
				licensure or relicensure.
(B) An
				application shall include, but is not limited to, the following information:
				trade name of the stretcher van service; location of vehicles; number of
				vehicles to be operated by the stretcher van service; name, address, telephone
				numbers, and email address (if applicable) of manager; name, address, telephone
				numbers, and email address (if applicable) of proposed licensee of the
				stretcher van service; name, address, telephone numbers, and email address (if
				applicable) of licensee's chief executive officer; all stretcher van service
				licensure and related administrative licensure actions taken against the
				stretcher van service or owner by any state agency in any state; and
				certification by the applicant that the application contains no
				misrepresentation or falsifications and that the information given by them is
				true and complete to the best of their knowledge and that the stretcher van
				service has both the intention and the ability to comply with the regulations
				promulgated under Chapter 190, RSMo. The stretcher van application form,
				included herein, is available at the EMS Bureau office or by mailing a written
				request to the Missouri Department of Health and Senior Services, EMS Bureau,
				PO Box 570, Jefferson City, MO 65102-0570.
(C) Each stretcher van service that meets the
				requirements and standards of the statutes and regulations shall be licensed
				for a period of five (5) years.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.600 - Outside the Hospital Do-Not-Resuscitate (OHDNR)

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes a procedure to be
				  followed by personnel to comply with the outside the hospital
				  do-not-resuscitate protocol when presented with an outside the hospital
				  do-not-resuscitate identification or an outside the hospital do-not-resuscitate
				  order.
(1) As used in this
				rule, the following terms shall mean:
(A)
				"Attending physician"-
1. A physician licensed
				under Chapter 334, RSMo, selected by or assigned to a patient who has primary
				responsibility for treatment and care of the patient; or
2. If more than one (1) physician shares
				responsibility for the treatment and care of a patient, one (1) such physician
				who has been designated the attending physician by the patient or the patient's
				representative shall serve as the attending physician;
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.770 - Community-based or Regional Plan for Emergency Medical Services for Trauma, ST-Segment Elevation Myocardial Infarction (STEMI), or Stroke

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the procedures for the
				  submission of a community-based or regional plan for the transportation of
				  patients to stroke, STEMI, or trauma centers.
(1) A community or region developing its own
				transportation plan for stroke, STEMI, and trauma patients may submit a plan at
				any time and shall ensure that it complies with section 190.200.3, RSMo. Such a
				plan shall also-
(A) Identify the geographic
				boundaries of the area covered by the plan;
(B) Designate, and provide contact
				information for, an individual, plan's designee who will serve as the plan's
				point of contact throughout the plan's approval and administration process;
				and
(C) Identify individuals
				involved in the drafting, planning, and/or consultation of the plan, who shall
				collectively be known as the "planning committee."
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.790 - Transport Protocol for Stroke and ST-Segment Elevation Myocardial Infarction (STEMI) Patients

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes protocols for
				  transporting suspected STEMI patients by severity and time of onset to the
				  STEMI center where resources exist to provide appropriate care and suspected
				  stroke patients by severity and time of onset to the stroke center where
				  resources exist to provide appropriate care.
(1) All ground and air ambulances shall use
				the following state transport protocol for suspected stroke patients except in
				those circumstances listed in sections (3), (4), and (5) of this rule:
(A) Step 1-Assess for life threatening
				conditions (serious airway or respiratory compromise or immediate life
				threatening conditions that cannot be managed in the field).
1. If there are life threatening conditions,
				transport the patient to the nearest appropriate facility for stabilization
				prior to transport to a stroke center. Consider air/ground/facility options for
				timely and medically appropriate care (particularly in non-urban
				areas).
2. If there are no life
				threatening conditions, go to step 2 below in subsection (1)(B); and
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.810 - Ground Ambulance Transport of Patients to Locations That Are Not Hospitals

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes training and transport
				  requirements for ground ambulances to transport patients to Missouri Department
				  of Mental Health designated Behavioral Health Crisis Centers and other
				  locations for those patients who do not require transport to a hospital and
				  whose health needs can be met by Behavioral Health Crisis Centers or these
				  other locations where patients are transported.
(1) As used in this rule, the following terms
				and phrases shall mean-
(A) Advanced emergency
				medical technician (also known as Emergency Medical Technician-Intermediate)
				shall mean the mid-level of licensure of licensed emergency medical services
				personnel who meet the requirements of
				19 CSR
				30-40.342(5);
(B) Advanced life support shall mean an
				advanced level of care as provided to the adult and pediatric patient when a
				patient is in a more critical condition and a paramedic is required to assist
				in the treatment of the patient during transport by an ambulance;
(C) Basic life support shall mean a basic
				level of care, as provided to the adult and pediatric patient where only
				emergency medical technicians are on ambulances during transport;
(D) BHCC shall mean Behavioral Health Crisis
				Centers designated by the Missouri Department of Mental Health;
(E) Department shall mean the Missouri
				Department of Health and Senior Services;
(F) Emergency Medical Technician means the
				lowest level of licensure of licensed emergency medical services personnel who
				meet the requirements in
				19 CSR
				30-40.342(2);
(G) Ground ambulance services shall mean
				ambulance services licensed under
				19 CSR
				30-40.309;
(H) Hospital shall mean the definition of
				hospital in section 197.020, RSMo, or a hospital
				operated by the state of Missouri;
(I) Medical director shall mean the medical
				director of an ambulance service as required by
				19 CSR
				30-40.303; and
(J) Paramedic shall mean the highest level of
				licensure of licensed emergency medical services' personnel who meet the
				requirements in 19 CSR
				30-40.342(4).
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 41 - Head and Spinal Cord Injuries › Section 19 CSR 30-41.010 - Head and Spinal Cord Injury Reporting Requirements

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: The Department of Health is mandated by
				  section
				  192.737,
				  RSMo 1986 to establish and maintain an information registry and reporting
				  system for the purpose of data collection and needs assessment of head and
				  spinal cord injured persons in this state.
(1) Based on information provided by the
				reporting physician or his/her designee, all Missouri hospitals shall report on
				forms supplied by the Department of Health registry information on the
				following patients:
(A) Any head- or spinal
				cord-injured patient who is dead on arrival or dies after arriving in the
				emergency department;
(B) Any head-
				or spinal cord-injured patient who is transferred to another hospital from the
				emergency department; and
(C) Any
				inpatient admitted to a hospital for the purpose of treating a head or spinal
				cord injury.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 45 - Trauma Centers › Section 19 CSR 30-45.010 - Definitions and Abbreviations Relating to Trauma Centers

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded February 28, 1999)
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 45 - Trauma Centers › Section 19 CSR 30-45.030 - Standards for Trauma Center Designation

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded February 28, 1999)
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 45 - Trauma Centers › Section 19 CSR 30-45.040 - Standards for Pediatric Trauma Center Designation

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded February 28, 1999)
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 45 - Trauma Centers › Section 19 CSR 30-45.050 - Triage, Transportation and Treatment of Trauma Patients

Current through Register Vol. 49, No. 14, July 15, 2024
(Rescinded February 25, 1999)
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.010 - Definitions Relating to Child Care Facilities

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule defines the terms used throughout
				  this chapter.
(1) The
				following definitions shall be used in interpreting the rules of this chapter:
(A) Adult is an individual eighteen (18)
				years of age or older;
(B) Bureau
				is the Bureau of Child Care Safety and Licensure of the Department of Health
				responsible for enforcement of child care rules and laws;
(C) Caregiver is the facility director or
				other child care staff whether they are paid or volunteering;
(D) Child care is care of a child away from
				his/her own home for any part of the day or night;
(E) Department is the Missouri Department of
				Health;
(F) Infant is a child less
				than twelve (12) months of age;
(G)
				Kindergarten is a children's educational program offered to prepare children
				for the first grade;
(H)
				License-exempt facility or facility is a nursery school not operated by a
				religious organization or a child care operation run by a religious
				organization;
(I) Local health
				department is an entity that enforces local public health codes and ordinances
				and provides other services related to public health;
(J) Nursery school is a program for preschool
				children that is operated for no more than four (4) hours per child per
				day;
(K) Premises is a house(s),
				dwelling(s) or building(s) and the adjoining land of a license-exempt
				facility;
(L) Preschool child is a
				child between two and five (2-5) years of age not enrolled in
				kindergarten;
(M) Registered
				professional nurse or registered nurse is one licensed under the provisions of
				sections 335.011-335.096, RSMo to engage in the practice of professional
				nursing;
(N) Religious organization
				academic preschool is a child care program provided exclusively for four (4)-
				and five (5)-year-old children that is operated by a religious
				organization;
(O) Sanitarian is a
				person employed by a state or local health department that conducts sanitation
				inspections for license-exempt child care facilities;
(P) School-age child is a child four (4)
				years of age or older who is enrolled in kindergarten or elementary
				school;
(Q) Staff/child ratio is
				the number of care-givers required for the number of children in
				care;
(R) Toddler is a child
				between twelve (12) and twenty-four (24) months of age; and
(S) Variance is approval by the department
				for a provider not to be required to meet a specific requirement of the rules
				of this chapter.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.030 - Local Inspections

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes criteria for local
				  health departments to conduct health and safety inspections and for local fire
				  districts to conduct fire safety inspections of license-exempt child care
				  facilities.
(1) Sanitation
				inspections of license-exempt facilities may be delegated to local health
				departments if the standards employed for inspections are substantially
				equivalent to 19 CSR 40-60.090 Sanitation Requirements. Fees, as provided for
				in section
				192.300,
				RSMo, may be charged at the option of the local health department.
(2) Fire safety inspections of license-exempt
				facilities may be delegated to local fire districts if the standards employed
				for inspections are equivalent to 19 CSR 40-60.080 Fire Safety
				Requirements.
*Original authority: 210.221, RSMo 1949, amended 1955,
					 1987, 1993, 1995, 1999; 210.252, RSMo 1993, amended
					 1999.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.040 - Variance Requests

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the procedure for a
				  facility director to request a variance from any portion of the rules of this
				  chapter.
(1) Any facility
				director may request a variance from any portion of the rules of this chapter.
				The request for a variance shall be made in writing to the department and shall
				include the reasons for requesting the variance. The department shall approve
				any variance request that does not endanger the health or safety of the
				children served by the facility. Local inspectors may grant a variance, subject
				to approval by the department.
(2)
				If a variance request is not recommended by the bureau, the facility owner or
				director shall be advised in writing of the basis for the recommendation. If
				the owner or facility director does not agree with the recommendation to deny
				the variance, s/he may request the department to make a final decision
				regarding the denial.
*Original authority: 210.221, RSMo 1949, amended 1955,
					 1987, 1993, 1995, 1999; 210.252, RSMo 1993, amended
					 1999.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.050 - Staffing Requirements

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment removes rule language that
				  the Department of Health and Senior Services has no statutory authority to
				  enforce and adds background screening language requirements to comply with
				  210.1080, RSMo.
(1)
				Supervision and basic care shall be provided at all license-exempt
				facilities.
(2) All caregivers
				shall review the rules of this chapter.
(3) Nursery schools shall have on file
				qualifying background screening results for child care staff members in
				accordance with 19 CSR 30-63.020 General Requirements.
(4) Facilities operated by a religious
				organization and that receive federal funds for providing care for children
				shall have on file qualifying background screening results for child care staff
				members in accordance with 19 CSR 30-63.020 General Requirements.
(5) Child care staff members of nursery
				schools or facilities operated by a religious organization and that receive
				federal funds for providing care for children with disqualifying background
				screening results are prohibited from being on the premises during child care
				hours in accordance with 19 CSR 30-63.020 General Requirements.
(6) Criminal background checks shall be
				completed every five (5) years for child care staff members of nursery schools
				and facilities operated by a religious organization and that receive federal
				funds for providing care for children in accordance with 19 CSR 30-63.020
				General Requirements.
(7) A check
				of the Family Care Safety Registry shall be conducted for all child care staff
				members of nursery schools every two (2) years.
(8) Background screening information received
				by the provider shall be retained in the individual's file in a confidential
				manner and made available for review when requested by the
				department.
*Original authority: 210.221, RSMo 1949, amended 1955,
					 1987, 1993, 1995, 1999; 210.252, RSMo 1993, amended
					 1999.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.060 - Health Requirements

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes health requirements
				  for child care providers and children in license-exempt child care
				  facilities.
(1) Facility
				staff shall meet the following health requirements:
(A) The director or other caregiver shall
				report to the local health department when any child in a facility is suspected
				of having a reportable communicable disease listed in 19 CSR 20-20.020(1)-(5).
				In the event of an unusual outbreak of a reportable communicable disease,
				caregivers shall implement control measures recommended by the department or
				local health department;
(B)
				Caregivers shall use proper handwashing techniques with soap and warm, running
				water after toileting, after assisting a child with toileting, after diapering
				a child, and at other times as needed. Good hygiene practices shall be followed
				during food preparation. These practices include, but are not limited to,
				washing hands properly after smoking, eating, drinking, using the restroom,
				after touching raw food products and before preparing and serving food. Hands
				shall be dried with single-service towels. Caregivers shall teach and see that
				children wash their hands at appropriate times: before eating, after toileting
				and as needed when hands are soiled;
(C) Caregivers shall not work when ill and
				likely to transmit an illness that might endanger the health or well-being of
				children. This may include symptoms such as fever, coughing, upper respiratory
				infection, vomiting or diarrhea;
(D) All caregivers working in a facility
				during child care hours shall be in good health. They shall have a physical
				assessment, including a tuberculosis status assessment by a licensed physician
				or registered professional nurse. A physical assessment report, signed by a
				licensed physician or registered professional nurse, shall be on file at the
				time of employment or within thirty (30) days following employment.
1. Physical assessment reports shall be
				completed not more than twelve (12) months before beginning work in the
				facility. The reports may be transferred to another facility for future
				employment.
2. The facility may use
				the department's physical assessment form, MO 580-1879 (6-94), or the facility
				may use its own form if it contains all the information on the department's
				form.
3. After the initial physical
				assessment, all caregivers working in a facility during child care hours shall
				be tested for tuberculosis at least every two (2) years. Caregivers with
				previously positive tuberculin tests shall be under the management of a
				physician; and
(E) No
				person shall smoke or use tobacco products in any area of a child care facility
				while children are in care.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.070 - Responsibilities of Caregivers

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the responsibilities
				  of caregivers in license-exempt facilities.
(1) The responsibilities of caregivers are-
(A) Children shall not be left without adult
				supervision.
1. A caregiver shall personally
				admit each child upon arrival and personally dismiss each child upon departure.
				Children shall be dismissed only to a parent, guardian, legal custodian, or to
				individuals approved by a parent, guardian or legal custodian.
2. A caregiver shall remain in the room with
				infants, preschool and school-age children while the children are napping and
				shall be able to see and hear the children if they have difficulty during
				napping or when they awaken.
3.
				Caregivers shall be alert to various needs of each child such as thirst,
				hunger, diaper change, aggression by other children and need for
				attention;
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.080 - Fire Safety Requirements

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the fire safety
				  requirements for all license-exempt child care facilities.
(1) These general fire safety requirements
				shall be followed at all facilities:
(A) At
				least one (1) portable, operable flashlight shall be accessible to
				staff;
(B) All flammable materials
				shall be stored properly and accessible only to authorized persons;
(C) House numbers shall be plainly visible
				from the street, or the location of the facility shall be made known to the
				local fire department;
(D) If child
				care is provided after dark, emergency lighting with a battery back-up shall be
				required;
(E) Facilities beginning
				operation after the effective date of these rules shall have a minimum ceiling
				height of seven feet (7') in all areas used for child care; and
(F) Providers shall notify the nearest fire
				department when the facility begins operation.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.090 - Sanitation Requirements

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the requirements for
				  maintaining proper sanitation in license-exempt child care
				  facilities.
(1) The premises
				of facilities shall be clean and free of unsanitary conditions and observable
				insects, spiders and rodents.
(A) Floors in
				bathrooms and kitchens shall be clean. Carpet shall not be used in
				bathrooms.
(B) Infant and toddler
				toys shall be kept clean and shall be sanitized after any contact with body
				fluids.
(C) Sanitizers shall be
				used in appropriate concentrations.
(D) If toothbrushes, combs, hairbrushes or
				other personal care items are used, they shall be individually air-dried and
				labeled with each child's name.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.100 - Physical Plant, Space, Supplies and Equipment

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth the requirements for
				  the physical plant, indoor and outdoor space, supplies and equipment for
				  license-exempt child care facilities.
(1) The premises of all facilities shall be
				safe and suitable for the care of children.
(A) Children shall have no access to areas
				not approved for child care.
(B)
				Porches, decks, stairwells or other areas in approved child care space shall
				have protective handrails and guardrails if there is a drop-off of more than
				twenty-four inches (24") from which children might fall and be injured.
				Guardrails shall be at least thirty-six inches (36") high, and shall have bars
				placed at intervals of no more than three and one-half inches (3 1/2"), or have
				protective material to prevent a three and one-half inch (3 1/2") sphere from
				passing through the bars.
(C)
				Approved safety gates at stairways and doors shall be provided as
				needed.
(D) Hazardous materials
				such as cleaning supplies, poisonous materials, medicines, alcoholic beverages
				or hazardous personal care items shall be inaccessible to children and stored
				to prevent cross-contamination of food and food-related materials.
(E) Ammunition, guns, hunting knives, bows
				and arrows, or other weapons shall not be on the premises unless stored in a
				locked cabinet or closet.
(F)
				Walls, ceilings, floors and equipment shall be finished with materials that can
				be cleaned easily and shall be free of splinters, cracks and chipped paint.
				Floor covering shall be in good condition. The facility shall be free of all
				lead hazards and asbestos that is friable or dangerous.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.110 - Transportation and Field Trip Requirements

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule identifies the requirements the
				  provider in a license-exempt child care facility is responsible for when
				  transporting children and taking field trips.
(1) The caregiver shall ensure the care,
				safety and supervision of children when children are transported away from the
				premises.
(A) Written parental consent shall
				be on file for field trips and transportation, and the facility director shall
				have a procedure on file for handling emergencies.
(B) Parents shall be informed when field
				trips are planned.
(C) Short,
				unscheduled walks may be taken without parent notification. Unscheduled outings
				shall be discussed with a parent at the time of enrollment.
(D) All children shall be seated in a
				stationary seat in the vehicle and restrained by seat belts or child restraint
				devices as required by Missouri law.
(E) Identifying information, including the
				name and address of the facility, the names of the children and the name,
				addresses and telephone number of each child's parent(s) shall be carried in
				the vehicle and available to staff members responsible for the
				children.
(F) Children shall remain
				seated while the vehicle is in motion and doors shall be locked when the
				vehicle is moving.
(G) Children
				shall be assisted when necessary while entering or leaving the vehicle and
				shall enter and leave the vehicle from the curbside unless the vehicle is in a
				protected area or driveway. Children shall not be left unattended in a vehicle
				at any time.
(H) Caregivers shall
				have a procedure for taking head counts before leaving the facility, during
				field trips and when back at the facility.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 60 - License-Exempt Child Care Facilities › Section 19 CSR 30-60.120 - Admission Procedures and Required Reports and Records

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes admission procedures,
				  records and reports facility directors are required to keep for children and
				  caregivers.
(1) The facility
				director shall have an admitting procedure for each child in care that includes
				a plan for caring for the child if s/he becomes ill or needs emergency medical
				treatment. The director shall maintain an individual file on each child in
				order to communicate with the parent(s), guardian or legal custodian. The
				director shall have a plan for any child with special health needs, identified
				through a physical assessment by a licensed physician or an advance practice
				nurse, to ensure that those needs are met during care.
(2) The facility director shall obtain and
				file the following written information on each child:
(A) The child's full name, address,
				birth-date and the date care begins and ends;
(B) The full name of the parent(s), guardian
				or legal custodian, home address, work schedule, home and work telephone
				numbers, and employer's name and address;
(C) Full name, address and phone number of a
				friend or relative who might be reached in an emergency when a parent, guardian
				or legal custodian can not be reached;
(D) Name and phone number of a physician and
				preferred hospital to be used in an emergency;
(E) The name of the individual(s) authorized
				to take the child from the premises; and
(F) Information concerning any accident or
				injury to a child while in care or any emergency medical care given.
Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 61 - Licensing Rules for Family Child Care Homes › Section 19 CSR 30-61.010 - Definitions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates the existing
				  definitions and terms used in the licensing rules for family child care homes
				  and adds new definitions for child care facility, child care staff member,
				  group size, homeless children and youths, hourly care facility, legal entity,
				  licensee, and Montessori school. This amendment also deletes the terms "review
				  board" and "related," places the definitions in correct alphabetical order, and
				  updates the term "day care" to "child care" in the chapter name and across
				  several definitions.
(1)
				Adult is any individual eighteen (18) years of age or older.
(2) The assistant is an adult who is employed
				or volunteers in the home to care for children in case of an emergency, to meet
				staff/child ratios, to substitute for the provider during absences or to assist
				the provider with the care of children.
(3) Caregiver is the child care provider,
				other child care staff member, or an assistant.
(4) A child care center or center, whether
				owned by a sole proprietor or other legal entity, is a child care program
				conducted in a location other than the provider's permanent residence, or
				separate from the provider's living quarters, where care is provided for
				children for any part of the twenty-four- (24-) hour day.
(5) A child care facility or facility is a
				family child care home, group child care home, or child care center.
(6) Child care provider, group child care
				home provider, or provider is the person(s) licensed or required to be licensed
				under section
				210.211,
				RSMo in order to establish, conduct, or maintain a child care facility. This
				person(s) shall have the following rights and responsibilities as determined by
				the division:
(A) Ultimate responsibility for
				making and implementing decisions regarding the operation of the facility;
				and
(B) Ultimate financial control
				of the operation of the facility.