Missouri Code of State Regulations › Title 9 - DEPARTMENT OF MENTAL HEALTH › Division 45 - Division of Developmental Disabilities › Chapter 7 - Developmental Disabilities Health Home › Section 9 CSR 45-7.010 - Developmental Disabilities Health Home

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the requirements for
				  designation as a Developmental Disabilities (DD) Health Home by the Missouri
				  Department of Mental Health (DMH), Division of Developmental Disabilities
				  (Division of DD), for the Missouri Department of Social Services (DSS), MO
				  HealthNet Division (MHD), to support individuals with intellectual and
				  developmental disabilities who have chronic conditions and are served by the
				  Division of DD.
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.
EMERGENCY STATEMENT: This emergency rule is necessary
				  to preserve a compelling governmental interest as on June, 30, 2023, the
				  Governor signed the fiscal year 2024 state operating budget bills, which
				  included funds for the Division of Developmental Disabilities Health Home
				  program; a cost to continue has been requested for fiscal year 2025. The State
				  Plan Amendment was approved by Center for Medicare and Medicaid Services on
				  April 29, 2024, for program implementation to begin July 1, 2024. The Division
				  will be implementing the DD Health Home program July 1, 2024, at which time the
				  Division will start auto-enrolling individuals who meet eligibility criteria to
				  designated providers. Stakeholders were afforded the opportunity for informal
				  public comment and have the opportunity to provide formal comment through rule
				  promulgation. A proposed rule, which covers this same material, was published
				  in the April 1, 2024, issue of the Missouri Register. The Division believes
				  this emergency rule is fair to all interested persons and parties under the
				  circumstances. The scope of this emergency rule is limited to the circumstances
				  creating the emergency and complies with the protections extended the Missouri
				  and United States Constitutions. The consequence of this emergency rule not
				  being enacted is delay in services to qualifying individuals. This emergency
				  rule was filed May 29, 2024, became effective July 1, 2024, and expires August
				  30, 2024.
(1) Definitions.
(A) 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 family or other natural
				supports, and communities.
(B)
				Centers for Medicare & Medicaid Services (CMS)-CMS is a federal agency
				within the United States Department of Health and Human Services that
				administers Medicaid programs.
(C)
				Chronic or At-Risk Conditions-For the purpose of DD Health Home eligibility,
				chronic or at-risk conditions are as follows:
1. Intellectual and/or developmental
				disability;
2. Diabetes;
3. Asthma;
4. Cardiovascular disease (CVD) or
				hypertension;
5. Chronic
				obstructive pulmonary disease (COPD);
6. Overweight (body mass index
				(BMI)>25);
7.
				Dementia;
8. Dependent on a
				ventilator;
9. One (1) of the Fatal
				Five Plus conditions or one (1) or more chronic conditions that could lead to
				one (1) of the following Fatal Five Plus conditions:
A. Pulmonary aspiration;
B. Bowel obstruction;
C. Gastroesophageal reflux disease
				(GERD);
D. Seizures;
E. Sepsis;
F. Dehydration;
10. Tobacco use;
11. Diagnosis of Autism Spectrum Disorder;
				and
12. Healthcare level of 3 or
				greater as identified by the Health Risk Screening Tool.
(D) EMR-Electronic medical records, also
				referred to as electronic health records (EHR).
(E) Health Home-A Health Home provides
				coordination of health care to individuals with chronic physical and/or
				behavioral health conditions, using a partnership or team approach between the
				Health Home team and individuals in order to achieve improved health care, to
				avoid preventable hospitalizations and emergency department use.
(F) DD Health Home Enrollees-Individuals
				eligible for Division of DD services with one (1) or more chronic/at risk
				conditions as defined in enrollment/eligibility criteria section.
(G) DD Health Home Provider-DD Contracted
				Targeted Case Management (TCM) and/or DD Home and Community-Based Services
				(HCBS) certified or accredited waiver providers who meet criteria for DD health
				home provider eligibility.
(H) DD
				Health Home Team-DD Health Home core team shall consist of the following staff:
				Health Home Director, Nurse Care Manager, Physician Consultant (Advanced
				Practice Registered Nurse (APRN) as substitute and defined in the DD Health
				Home Provider Operations Manual), Specialized Healthcare Consultant, and DD
				Health Home Facilitator. Based on the unique needs of the individual,
				additional staff may be identified.
(I) Health Risk Screening Tool-The Health
				Risk Screening Tool (HRST) is a tool used to provide early detection of health
				risks and destabilization.
(J)
				Health Risk Support Plan (HRSP)-The HRSP are standardized electronic templates
				in the department's identified system which is a component of the individual's
				Individual Support Plan (ISP) and serves to identify implementation strategies
				to mitigate risk and improve health outcomes.
(K) Intellectual and/or Developmental
				Disability (IDD)- Adults and youth who meet the Missouri state statute
				definition of Developmental Disability, section 630.005(9), RSMo.
				"Developmental disability," a disability that is attributable to intellectual
				disability, cerebral palsy, epilepsy, head injury or autism, or a learning
				disability related to a brain dysfunction; or any other mental or physical
				impairment or combination of mental or physical impairments; and is manifested
				before the individual attains age twenty-two (22); and is likely to continue
				indefinitely; and results in substantial functional limitations in two (2) or
				more of the following areas of major life activities: self-care; receptive and
				expressive language development and use; learning; self-direction; capacity for
				independent living or economic self-sufficiency; mobility; and reflects the
				individual's need for a combination and sequence of special, interdisciplinary,
				or generic care, habilitation or other services which may be of lifelong or
				extended duration and are individually planned and coordinated.
(L) Missouri Department of Social Services
				(DSS), MO HealthNet Division (MHD)-Single State Medicaid authority.
(M) Social Determinants of Health (SDOH), the
				nonmedical factors that influence health outcomes. They are the conditions in
				which people are born, grow, work, live, and age, and the wider set of forces
				and systems shaping the conditions of daily life. These forces and systems
				include economic policies and systems, development agendas, social norms,
				social policies, racism, climate change, and political systems.