Missouri Code of State Regulations › Title 9 - DEPARTMENT OF MENTAL HEALTH › Division 45 - Division of Developmental Disabilities › Chapter 2 - Eligibility for Services › Section 9 CSR 45-2.017 - Utilization Review Process

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment establishes the Missouri
				  Adaptive Ability Scale (MAAS) for use in the prioritization of need and removes
				  the requirement for a committee in the utilization review
				  process
(1) Definitions.
(A) Authorization-Approval notice to a
				provider that a specific amount of service at a specific rate may be provided
				to an individual.
(B) Budget-The
				total cost of services and supports funded through the division recommended or
				approved to meet an individual's needs identified in an Individualized Support
				Plan. Services and supports paid for outside of the department billing system
				are excluded from the budget.
(C)
				Department-Department of Mental Health.
(D) Division-Division of Developmental
				Disabilities.
(E) Emergency
				criteria consist of one (1) or more of the following:
1. The individual is in immediate need of
				life-sustaining services (food and shelter, or protection from harm) and there
				is no alternative to division funding or provision of those services;
2. The individual needs immediate services in
				order to protect self or another person from imminent physical harm;
3. The individual is residing in an
				intermediate care facility for persons who have developmental disabilities
				(ICF/DD) or a skilled nursing facility (SNF) and has been assessed as able to
				live in a less restrictive arrangement in the community, the individual wants
				to live in the community, and appropriate services and supports can be arranged
				through the waiver;
4. The
				individual had been receiving significant services through division
				waiver-funded programs and services, is evaluated to still need the significant
				level of services, but is no longer eligible for the program or services due to
				age; or
5. The individual is in the
				care and custody of the Department of Social Services, Children's Division,
				which has a formal agreement in place with the division to fund the costs of
				waiver services for the specific individual or for individuals who are in a
				Voluntary Placement Agreement (VPA).
6. The individual is under age eighteen (18)
				and requires coordinated services through several agencies to avoid court
				action; or
7. The individual is
				subject to ongoing or pending legal action that requires immediate delivery of
				services.
(F) Missouri
				Adaptive Ability Scale (MAAS)-A norm-referenced, standardized assessment of
				functional ability. The MAAS shall be used to determine number and severity of
				functional limitations for eligibility, prioritization of need score, and rate
				setting.
(G) Person-centered
				planning process-A process directed by the individual, with assistance as
				needed from a guardian, public administrator, the responsible party, or other
				person as freely chosen by the individual. The process may include other
				individuals freely chosen by the participant who are able to serve as important
				contributors to the process. The person-centered planning process enables and
				assists the individual to access a personalized mix of paid and nonpaid
				services and supports that will assist him/her to achieve personally defined
				outcomes and the training, supports, therapies, treatments, and/or other
				services become part of the ISP.
(H) Prioritization of need (PON) score- A
				component of the MAAS that quantifies the level of impairment of an individual
				and is used to determine priority of access to services. The PON score is
				expressed on a one (1) to five (5) scale with five (5) being the highest
				possible score.
(I) Responsible
				party-The parent(s) of a minor child, spouse, court appointed guardian, public
				administrator, or any other person who has legal authority to make decisions
				for a person served by the division.
(J) Senate Bill 40 County Developmental
				Disability Boards (SB40 Board)-County boards established pursuant to section
				205.970, RSMo, to provide
				services with voter approved tax levies to residents of that county who are
				handicapped persons as defined in sections
				178.900 and
				205.968, RSMo.
(K) Individualized Support Plan (ISP)-A
				document directed by the individual, with assistance as needed from a
				representative, in collaboration with a planning team. The ISP identifies
				strengths, capacities, preferences, needs, and desired outcomes of the
				individual. The ISP shall encompass personalized mix of paid and non-paid
				services and supports that will assist him/her to achieve personally defined
				outcomes. Training, supports, therapies, treatments, and/or other services to
				be provided for the individual become part of the ISP.
(L) Service/Support-Informal and formal means
				of meeting needs identified in the ISP.
(M) Utilization Review (UR)- A formal process
				at the regional office to review PON, proposed ISPs, and budgets and make
				recommendations for approval, modification, or denial of the requested
				services. The regional director or assistant regional director has the
				authority to review and approve recommended services and may designate
				individuals to review and approve recommended services. The authority to deny
				or modify requested services lies solely with the regional director or
				assistant regional director.