Title: Due Process Review Committee for Limitations and ... · PDF file3 At least one time per quarter Participate in DMH DD Contracted Provider Due Process Review Committee meetings

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Division Directive Number 4.200

Effective Date: 09.30.11

Revised date: 02.01.13

Revised Date 04.01.2017

R

___________________________

Valerie Huhn, Director

Title: Due Process Review Committee for Limitations and Restrictions of Individual Rights

Application: Department of Mental Health (DMH), Division of Developmental Disabilities (DD) , DMH DD

Contracted Providers of Service, Senate Bill 40 Boards (SB40) and Not-for-Profit TCM agencies

Purpose: To ensure through the use of a Due Process Review Committee that individuals receiving services

that are, licensed, certified, funded and/or operated by DMH Division of DD are provided with the opportunity

to exercise all rights explicitly provided without unnecessary restriction or limitation.

Due Process Review Committees

1) DMH DD Due Process Review Committees –.Committees operated by DD Regional Offices (RO) and DD

State Operated Programs (SOP).

2) DMH DD Contracted Provider Due Process Review Committees –Committees operated by a single DMH

DD contracted provider or several providers. Providers submit a Due Process Review Committee plan to the

appropriate regional office and are approved prior to establishment.

Regional Office Approval of a DMH DD Contracted Provider Due Process Review Committee:

The Regional Office may delegate responsibilities of the Due Process Review Committee to contracted

providers. The responsibilities are to ensure due process is occurring for any rights that have been restricted

(includes the appropriate signatures, documentation of notifications regarding the restrictions, and

documentation that persons are aware of appeal process and that they are assisted in accessing external advocacy

supports).

1. The Regional Office will assure that the provider has policies and procedures in place that are equivalent

to those required for DMH DD Due Process Committees before delegating the responsibilities:

2. Have a process in place for notifying the Regional Office of their Due Process Review Committee

meetings. (The provider should always notify the designated Regional Office staff of upcoming

meetings, agendas, and minutes from previous meetings.)

3. Agreement to participate in annual reviews by Regional Quality Enhancement staff. Reviews include,

but are not limited to, the Due Process Review Committee decisions, membership, documentation,

training, policies and meeting the established timelines on the operations and access to the committee.

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4. Provide Regional Office a quarterly summary of Due Process Committee Reviews (Attachment A). To

include, but not limited to:

o Number of reviews completed by the Due Process Committee.

o Names of agencies that will be implementing the restrictions.

o Distinct counts of individuals who were referred to the committee for review of restrictive

interventions.

o The types of restrictions/limitations being reviewed.

o Results and any follow-up completed by the committee.

o Committee member representation.

Approval by Regional Office Quality Enhancement team of provider’s Due Process Review training

to include, but not be limited to:

o Abuse/Neglect

o Individual Rights (Federal and State laws)

o Role of DMH Office of Constituent Services

o HIPAA Training/Disclosure of PHI/ Confidentiality - (Develop opening statement for

facilitators for the meeting)

o Medication Awareness

o Overview of Tools for Choice

o Ongoing training/education as determined by the division

o Due Process Guideline and Authorities

There is an expectation that the facilitator acquires training for committee members as needed, and there is

evidence that members are required to comply and have acknowledged their commitment to maintain

confidentiality.

Notification of Delegation

Within 30 days of all requirements being met the Contracted provider will be notified, in writing, by the

Regional Office if they have been delegated the Due Process Review Committee responsibility

Note: Regional Office Quality Enhancement team reviewer may approve committees comprised of more than

one provider.

Provider Due Process Review Committees Unable to Maintain Requirements:

Suspension of provider Due Process Review Committee shall occur if requirements are not being met, including

but not limited to the following; lack of follow-up regarding identified issues, the participating provider on the

committee is on a critical status plan. Providers who are suspended will be notified in writing by the Regional

Office.

Responsibilities of the Quality Enhancement(QE) Unit shall include:

Review of DMH DD Contracted Provider Due Process Review Committee’s policies and procedures.

Within 30 calendar days of receipt of request, the provider will be notified of acceptance or required

changes

Offer training and technical assistance for DMH DD Contracted Provider Due

Process Review Committees.

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At least one time per quarter Participate in DMH DD Contracted Provider Due

Process Review Committee meetings.

The Regional Quality Enhancement team will review information from the DMH DD Contracted Provider Due

Process Review Committees at least annually. Any time issues are discovered with a provider’s Due Process

Review Committee, the Regional Quality Enhancement staff will work with the provider to determine what

steps need to be taken to resolve the issues.

Notify Support Coordination agencies of available DMH DD Contracted Provider Due Process

Review Committees.

Identify patterns and trends of rights/limitations and restrictions annually and share with the

applicable Regional Office/State Operated Programs (SOP) Administration.

Due Process Review Committees shall:

Ensure that when an individual’s rights have been restricted:

o The individual has been notified and heard on the limitation.

o The individual has been given the opportunity to be assisted through external advocacy

if an individual disagrees with the limitation or restriction

o The individual has been informed of available options to restore individual rights.

Ensure individual rights are being promoted.

Ensure individuals are assisted in exercising their rights.

Ensure that the individual, support coordinator, and DMH DD contracted provider will receive the

results of the review within 30 calendar days of the acceptance of a referral.

Refer unresolved issues discovered from Due Process reviews to the appropriate DMH

personnel. Issues may include, but are not limited to, lack of follow-up on recommendations,

problems related to services being provided to an individual, etc.

Provide recommendations and resources regarding individual rights.

Provide an impartial review process of individual right restrictions.

Promote the basic assumptions that a restriction/limitation is:

o Temporary in nature.

o Defined with specific criteria (under what circumstances the rights restriction is to be used).

o Paired with learning/training components to assist the person in eventual removal of restriction.

o Removed upon reaching criteria for restoration.

o Reviewed by a DMH DD Due Process Review Committee at least annually upon referral.

Additional requirements for DMH DD Due Process Review Committees:

Review rights issues that were not resolved by a DMH DD Contracted Provider Due Process Review

Committee.

Due Process Review Committee Membership:

The Due Process Review Committee shall include representation by:

DMH DD Due Process Committee

Community member(s) with no financial affiliation with DMH

Quality Enhancement Unit Staff

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DMH DD Contract Provider Due Process Committee

Community member(s) with no financial affiliation with the provider approved to operate

committee.

Due Process Chairman/Facilitator

The Due Process Review Committee may include additional representation by:

Provider staff

Experts as needed (Behavior Analyst, Registered Nurse, Provider Relations, etc.)

A Self-Advocate receiving services from the Division (not employed by DMH)

DMH-DD Staff

A Family member or guardian of an individual receiving services from the Division

Note: A minimum of 3 members must participate to constitute a quorum, with one of those always being a

member with no financial affiliation with DMH.

Requirements of Non-Volunteer Due Process Review Committee Members training shall include:

Abuse/Neglect

Individual Rights (Federal and State laws)

Role of DMH - Office of Constituent Services

HIPAA Training/Disclosure of PHI/ Confidentiality –

Medication Awareness

Overview of Tools for Choice

Due Process Guideline and Authorities

Ongoing training/education as deemed necessary by the Division

Note: Facilitator has responsibility of ensuring members are trained as necessary. Note: All facilitators will be

trained on the use of the Due Process Review Division of DD Tracking System.

Requirements for Due Process Review Committee Volunteer Members:

Volunteer members include provider and community members not employed by DMH. All volunteer members

must meet all the requirements as outlined in the DOR 6.510 prior to serving on the committee.

http://dmh.mo.gov/docs/diroffice/dors/dor6-510-screeningemployeesandvolunteers.pdf

Note: The facilitator will ensure that all committee members have completed the background screening process

prior to participating on the Due Process Review Committee.

Participating in the Due Process Review Committee is bound by confidentiality and the Regional Office

Personnel Department must ensure that the members are required to sign a confidentiality form, annually,

acknowledging their commitment.

http://dmh.mo.gov/docs/diroffice/dors/dor6-510-screeningemployeesandvolunteers.pdf

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Due Process Review Committee Process:

Referral: A written or verbal request is submitted by any of the following:

individuals served

family member

guardian

committees

interdisciplinary teams

providers

DMH employees, and

general public

Where possible limitations or restrictions are being proposed or implemented.

State Operated Waiver Program Referral Process:

For individuals supported in State Operated Waiver Programs, referrals may be made to either the applicable

Regional Office Due Process Review Committee or to the applicable State Operated Program Due Process

Review Committee.

When the State Operated Program Due Process Review Committee is utilized, a Regional Office QE

Representative from the applicable regional office shall participate in the committee review of the person served

by the State Operated Waiver Program.

Referrals will be maintained electronically via the Division of DD Due Process Committee Share Point

Site

http://moteam.state.mo.us/dmh/DD/StateQualityEnhancementTeam/Human%20Rights/SitePages/Home

.aspx.

A copy of the findings from the review will be maintained by the provider and support coordinator

along with the individuals ISP.

Upon receipt of a referral a Due Process Review Committee representative will process the request to

review the use of restrictive interventions or rights limitations and request documentation to demonstrate the

need for the restrictive interventions or rights limitations and that due process has occurred.

Confidentiality and Impartial Review:

The Due Process Review Committee Facilitator is responsible for redacting any identifying information (which

shall include individual and agency names) prior to the committee reviews of a referral.

Time Frames for Completion of Reviews:

Referrals to the Due Process Review Committee will be reviewed within 30 calendar days from the date of

receipt of all necessary information to complete the referral tracker concerning the possible restriction or

limitation. If the committee review exceeds 30 calendar days, documentation on the referral tracker shall reflect

the justification for the extension.

When a referral is made by an individual that is not affiliated with the person’s planning team, the Due Process

Review Committee will review the information provided and request additional supporting documentation from

the planning team related to the possible restriction or limitation.

http://moteam.state.mo.us/dmh/DD/StateQualityEnhancementTeam/Human%20Rights/SitePages/Home.aspx

http://moteam.state.mo.us/dmh/DD/StateQualityEnhancementTeam/Human%20Rights/SitePages/Home.aspx

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Due Process Review Committee Meetings:

Will be scheduled by each Due Process Review Committee to ensure that referrals are reviewed

within the required timeframe as outlined in the directive.

Necessary information related to each review will be typed and/or attached to the Due Process

Review record in the Division’s Due Process Review Tracking System.

When the Due Process Review Committee convenes and reviews the information related to the restrictive

interventions/limitation(s), they will determine if the following items that apply have been identified for due

process and record this in the tracking system.

Due Process Components:

Justification - purpose & rationale:

Describe the restriction.

Document less intrusive methods of meeting the need that have been implemented and did not work.

Identify a specific and individualized assessed need.

Explain the reason the limitation or restriction is being put in place.

Explain if the restrictions or limitations are necessary to keep the person safe or others safe.

Describe any historical pattern or significant situation which has occurred that would justify a

limitation or restriction.

If the plan is being referred for annual review, there must be documentation noting the progress or

lack of progress from the past year of implementation (i.e. summary of monthly reviews, quarterly

reviews, behavioral data results, evaluations about the effectiveness of medications/interventions).

Conditions under which the restriction is applied:

Explain where the restriction or limitation will be imposed (i.e. only at home, in the community, day

program, in kitchen, etc.)

Include a clear description of the condition that is directly proportionate to the specific assessed

need.

Explain when the restriction will be imposed (i.e. at all times, in morning, after/before a specific

event or situation, if family present, only when…..)

Teaching Support Strategies:

Outcomes/strategies that are being taught to help an individual develop skills in order to overcome

the need for this restrictive intervention.

Document the positive interventions and supports used prior to any modifications to the

Individualized Support Plan(ISP)

Provide evidence that the requested type of intervention/teaching has worked in the past and

information on why this is the method by which the person learns best.

If there are restrictive interventions that are required to keep the person or others safe and teaching

strategies have not been identified, then the supports need to be identified, in the Individual Support

Plan, along with efforts that are being explored to support the person in the least restrictive way.

For teaching and support strategies, document who is responsible for the training of the strategies.

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Monitoring methods:

Include an assurance that interventions and supports will cause no harm to the individual.

Include a regular collection and review of data to measure the ongoing effectiveness of the

modification.

Information on data collection methods should include:

o Who is documenting?

o Where is data being kept (i.e., daily progress notes, outcome data sheets, MAR, etc)?

o What is the frequency of documentation (i.e. daily, weekly, monthly, etc)?

o How often is the data reviewed by team?

Criteria for restoration:

What will it take for the restriction to be lifted; how will the individual and team know when the

restrictive intervention is no longer needed or could be reduced in intensity/frequency?

The criterion needs to be in specific observable and measurable terms (i.e. if individual has three

consecutive months of no attempts to elope, chimes will be removed from the exterior door).

Review schedule:

Include established time limits for periodic reviews to determine if the modification is still necessary

or can be terminated.

State how often team will submit plan to Due Process Committee for review (minimum is annually).

Notice of right to due process:

Include informed consent of the individual.

Document that the individual and the guardian are aware of the restrictions, were part of the

planning process to develop interventions, know they have a right to due process, and have

information on what to do if they do not agree with the restrictions or interventions.

Individual was assisted through external advocacy if an they disagrees with the limitation or

restriction,

Signed authorization page (can either be signed by guardian only or can be signed by guardian and

individual).

If components are not present, the committee will send information to the support coordinator and provider on

all of the items that need additional information and the date that committee would like to receive them.

If the committee does not receive the information or if the additional information received does not ensure that

due process has occurred, the committee will document the actions taken on the electronic referral form.

Actions shall include but not limited to;

o Notification to the RO Director/ SOP Superintendent regarding the restriction or limitation

discovered that has not met due process.

o Onsite visit by Regional Office of State Operated Program representative with the individual

and take any appropriate measures to ensure protection of the individuals’ rights.

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The Due Process Review Committee shall provide the following documentation:

After the review the facilitator will document if all due process components were evident during the review,

any recommendations, or request for follow-up regarding missing components and send information to the

provider and the support coordinator. The support coordinator shall inform the individual, guardian, and/or

representative of the findings.

Dissatisfaction with Findings from Due Process Review Committee:

All committee findings documentation will include:

information on how to contact the DMH Office of Constituent Services to report if the individual

or the guardian is dissatisfied with the findings from the Due Process Review Committee .

information on how to contact the applicable Regional Office Director when a contracted

provider is dissatisfied with the findings of a Due Process Committee Review

Note: At least annually, the State Quality Enhancement Team will review information from all Due Process

Review Committees as part of an ongoing Quality Assurance Process. The State QE Team will provide

technical assistance as needed.

Authority and Other References

42 CFR 441.301(c)(2)(xiii) Subpart G—Home and Community-Based Services: Waiver Requirements

http://www.ecfr.gov/cgi-

bin/retrieveECFR?gp=&SID=045d6945dfd4f379c396ec073afe584f&mc=true&n=pt42.4.441&r=PART&ty=HTML#

se42.4.441_1301

Missouri Revised Statutes

Section 630.110 – Patient’s rights with limitations

Section 630.115 – Guaranteed Rights to all DMH consumers

Section 630.125 – Explanation of rights and entitlements

Section 630.120 –No presumptions regarding consumer rights, responsibilities, or competency

Missouri Code of State Regulations

9 CSR 45-3.030 Individual Rights

9 CSR 45-5.010 Certification of Medicaid Agencies Serving Persons with Developmental

Disabilities

Contract For Services Contract # ER019914XX Purchase of Services Program for the Division of DD 3.9 Consumer Rights http://dmh.mo.gov/docs/dd/POSContract.pdf

Resources: Due Process Components Guide: http://dmh.mo.gov/dd/directives/docs/dueprocesscomponentsguide.pdf

This guideline will be reviewed and updated annually, if needed.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=045d6945dfd4f379c396ec073afe584f&mc=true&n=pt42.4.441&r=PART&ty=HTML#se42.4.441_1301



http://dmh.mo.gov/docs/dd/POSContract.pdf

http://dmh.mo.gov/dd/directives/docs/dueprocesscomponentsguide.pdf

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Attachment (A)

Provider Due Process Committee Quarterly Report

Name of Agency

Date___________

Person Completing Form ______________________

Year Year Year Year Year Year Year Year Year Year Year Year

Region : Jan Feb March April May June July August Sept Oct Nov Dec

1.Total Number of Referrals

2. Number of distinct individuals who had restrictions/limitations that were referred to DPRC

3. Name of agencies and counts of referrals by agency sent to the Due Process

4. Number of meetings

5. Count of committee participants by type during the month.

Community Member Family/Guardian

Self- Advocate

Regional Office Staff

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Regional Office__________________________

Other

Jan Feb March April May June July Aug Sept Oct Nov Dec

4. Count by restriction types

Access to Community Access to media Access to personal possessions Access to sharps Communication Limitation Food Restriction Level of Supervision Limitation of Privacy Money Restriction Use of Medication Smoking Restrictions Agency Policy Restriction Relationship Restrictions Environmental Restrictions Transportation Restrictions Restriction of Movement (Restraint) Restriction Due to Roommate Due Process Committee Facilitator (s) Name

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Service Provider’s Guide to

Individual Rights of Persons Receiving Services from the Division of

Developmental Disabilities

The following is an explanation of rights for individuals receiving services from DMH - Division of Developmental

Disabilities (DD). It is important for every individual to know his or her rights and what the process is if their rights are

limited.

KEY POINTS: • DMH facilities and contracted provider must have rules to make sure an individual has the opportunity to learn and

understand their rights, and that no one takes their rights away before they have a chance to speak for themselves or have someone they choose speak for them. This is guaranteed through due process procedures. 9 CSR 45-3.030

• Individuals receiving services have the same legal rights and responsibilities as any other person unless a court has determined otherwise. Any proposed limitation of rights must be reviewed by a Due Process Committee to ensure that an individual’s rights are adequately protected. This includes court ordered and guardian placed limitations. This may include physician orders for with which the individual does not agree with but are being implemented, such as diet, medication, treatment, and non-medical related orders.

To contact a Due Process Committee representative please call or e-mail Phone (____ ______ _________) e-mail_____ ______________________

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Authority Rights Care

Section630.115, RSMo – Guaranteed Rights to all DMH Consumers

Guaranteed to all individual’s receiving service from the Department of Mental Health Includes the Divisions of Developmental Disabilities and Behavioral Health Services.

Right to Human Care and Treatment. Section 630.115.1(1), RSMo

9 CSR 45-3.030 – Individual Rights Guaranteed to all individuals who are eligible for services from the Division of Developmental Disabilities

To be treated with respect and dignity as a human being 9 CSR 45-3.030(1)(A)

To direct one’s own person-centered planning process and to choose others to be included in that process; 9 CSR 45-3.030(1)(H)

42 CFR 441.301 – Contents of Request for a Waiver

Guaranteed to all individuals receiving services from the Division of Developmental Disabilities funded through the Home and Community Based Medicaid Waiver Programs.

Ensure an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint.42 CFR 441.301(c)(4)(iii)

The personal plan will be understandable to the individual receiving services and supports, and the individuals important in supporting him or her. 42CFR 441.301(c)(2)(vii)

Standard of Practice



To the extent that the facilities, equipment and personnel are available, to medical care and treatment in accordance with the highest standards accepted in medical practice. Section 630.115.1(2), RSMo

Section 630.110, RSMo – Patient’s Rights and Limitations

Guaranteed to all individual’s receiving services from the Department of Mental Health, but may be limited if determined inconsistent with the person’s therapeutic care, treatment, habilitation, or rehabilitation and the safety of other facility or program clients and public safety. Includes the Divisions of Developmental Disabilities and Behavioral Health Services.

Persons have the right to receive information related to the highest standard for any needs they have. RSMo 630.110

42 CFR 441.301 – Contents of Request for a Waiver Guaranteed to all individuals receiving services from the Division of Developmental Disabilities funded through the Home and Community Based Medicaid Waiver Programs.

Individuals receive services in the community to the same degree of access as individuals not receiving Medicaid home and community-based services. 42 CFR 44.301(c)(2)(i)

Housing


Guaranteed to all individual’s receiving service from the Department of Mental Health

To Safe and Sanitary Housing Section 630.115.1(3), RSMo

9 CSR 45-3.030 – Individual Rights

Guaranteed to all individuals who are eligible for services from the Division of Developmental Disabilities

Within one’s financial means, to have a choice where to live and whether or not to share a home with other people; 9 CSR 45-3.030(1)(G) (If a person has the financial resources to

support where they want to live and the person is not given a choice of where to live because of

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therapeutic purposes then this would be considered a rights restriction) (If the person does not have the financial resources to live where they want, then their team will support them with options on where to live, and plans to help them develop resources for the future, this would not be considered restrictive

9 CSR 45-5.010 – Certification of Medicaid Agencies Serving Persons with Developmental Disabilities

Guaranteed to all individuals receiving the following services from the Division of Developmental Disabilities; residential habilitation, day habilitation, supported employment, or individualized supported living services under the Medicaid Home and Community Based or Nursing Home Reform Waiver program.

Individuals’ homes and other environments are clean, safe, and well maintained. 9 CSR 45-5.010(3)(D)(2)(B)

Individuals’ homes and other environments have modifications or adaptations to

ensure safety. 9 CSR 45-5.010(3)(D)(2)(C)

Individuals’ homes and other environments have passed externally conducted health, safety, and mechanical inspections. 9 CSR 45-5.010(3)(D)(2)(D)

Employment



To not participate in non-therapeutic labor. Section 630.115.1(4), RSMo



Individuals do not perform unpaid work for which others receive pay. 9CSR 45-5.010 (3)(C)(2)(M).



To seek employment and work in competitive integrated settings; 42 CFR 44.301(c)(2)(i) If the person is freely communicating that they do not want to seek employment in another setting this would not be considered a restriction. If the person is communicating they want to work in a community setting and they are being restricted from seeking that employment then this would be considered a restriction.

Religion



Right to attend or not attend religious services of their choice. Section 630.115.1(5), RSMo


Guaranteed to all individuals who are eligible for services from the Division of To choose where to go to church or place of worship, or to refuse to go to a church or

place of worship; 9 CSR 45-3.030(1)(O)

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Developmental Disabilities

Informed Care & Treatment



To receive prompt evaluation and care, treatment, habilitation or rehabilitation about which the individual is informed insofar that person is capable of understanding; Section 630.115.1(6), RSMo



To have rights, services, supports, and clinical records regarding services explained in a manner that is easily understood and in an accessible format; 9 CSR 45-3.030(1)(P)

To accept or decline supports and services; 9 CSR 45-3.030(1)(K)

To have freedom of choice among Division of DD approved providers; 9 CSR 45-

3.030(1)(L)

To be treated with respect and dignity as a human being; 9 CSR 45-3.030(1)(A) 42 CFR 441.301 – Contents of Request for a Waiver


The setting in which the individual resides is chosen by the individual. The State must ensure that the setting chosen by the individual is integrated in, and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree of access as individuals not receiving Medicaid HCBS.

Dignity & Respect Section630.115, RSMo – Guaranteed Rights to all DMH Consumers


To be treated with dignity as a human being; 630.115.1(7), RSMo



Ensure a person’s rights of privacy, dignity, respect, and freedom from coercion and restraint. 42 CFR 441.301 (c) (4) (iii) (remote monitoring and video surveillance may be

considered a restriction of a person’s rights.)

Research & Medical Experiment


Guaranteed to all individual’s receiving service from the Department of To not be the subject of experimental research without prior written and informed

consent or that of a parent, if the person is a minor, or guardian; except that no

https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=0e504496534ec33a1f9a4f95c7a8fa57&term_occur=4&term_src=Title:42:Chapter:IV:Subchapter:C:Part:441:Subpart:G:441.301

https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=0e504496534ec33a1f9a4f95c7a8fa57&term_occur=5&term_src=Title:42:Chapter:IV:Subchapter:C:Part:441:Subpart:G:441.301

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Mental Health Includes the Divisions of Developmental Disabilities and Behavioral Health Services.

involuntary committed person shall be subject to experimental research, except as provided by statute; Section630.115.1(8), RSMo



The person has input, is informed and agrees, prior to implementing treatment, medications, research, etc., RSMo 630.110



To participate or decline participation in any study or experiment; 9 CSR 45-3.030(1)(N)

Participation in Research



To decide not to participate or to withdraw from any research at any time for any reason; Section 630.115.1(9), RSMo

Access to services



To have access to consultation with a private physician at the individual’s expense; Section 630.115.1(10), RSMo



Persons have the right to access specialized medical, mental health, and assistive technology services. Individuals requiring specialized medical services have access to specialists 9CSR 45-5.010 (3) (D) (1)

Environment



To be evaluated, treated or habilitated in the least restrictive environment; Section 630.115.1(11), RSMo

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To receive services and supports to achieve the maximum level of independence 9 CSR 45-3.030(1)(E)

To participate fully in the community; 9 CSR 45-3.030(1)(I)

To accept or decline supports and services; 9 CSR 45-3.030(1)(K)

The right to a setting that optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4)(iv)

Individuals have a choice regarding services and supports, and who provides them. 42 CFR 441.301(c)(4)(v

Individuals have a choice of roommates. 42 CFR 441.303(c) (4) (B)(2) Individuals have the freedom and support to control their own schedules and

activities, and have access to food at any time. 42 CFR 441.301(c)(4)(vi)(C)

Individuals are able to have visitors of their choosing at any time. 42 CFR 441.301(c)(4)(vi)(D)

The setting is physically accessible to the individual. 42 CFR 441.301(c)(4)(vi)(E)

Potential Hazardous Treatment



To not be subjected to any hazardous treatment or surgical procedure unless the individual’s parent, if the person is a minor, or guardian consents; or unless such treatment or surgical procedure is ordered by a court of competent jurisdiction; Section 630.115.1(12), RSMo

in the case of hazardous treatment or irreversible surgical procedures, to have,

upon request, an impartial review prior to implementation, except in case of emergency procedures required for the preservation of life. Section630.115.1(13), RSMo

Any treatment that would be considered hazardous must have an impartial review.

(Section 630.115.1(13), RSMo) Add this information in and put in training. In the Division of DD this would be the Due Process Committee, or designated

committee appointed by the Division Director.

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Food



To a nourishing, well-balanced and varied diet; Section630.115.1(14)


Guaranteed to all individuals receiving the following services from the Division of Developmental Disabilities; residential habilitation, day habilitation, supported employment, or individualized supported living services under the Medicaid Home and Community Based or Nursing Home Reform Waiver

Individuals eat well balanced diets appropriate to nutritional needs. 9CSR 45-5.010 (3)(D)(1)(F)

Free from Abuse, Neglect, Financial Exploitation

(See 9CSR 45-10-5 200 reporting of abuse & neglect related to the process of reporting)



To be free from verbal and physical abuse. Section630.115.1(15), RSMo



To be free from physical, emotional, sexual, and verbal abuse, and financial exploitation; 9 CSR 45-3.030(1)(D)

To report any violation of one’s rights free from retaliation and without fear of retaliation; 9 CSR 45-3.030(1)®

To be informed on how to make an inquiry, file a complaint or report a violation of one’s rights, and to be assisted in these processes, if requested. 9 CSR 45-3.030(1)(S)

Personal Possessions



To wear one’s own clothes and to keep and use one’s personal possessions, Section 630.110.1(1), RSMo



A person has the rights to control their personal resources. 42 C.F.R. § 441.301(c)(4)

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Money



To keep and be allowed to spend a reasonable sum of one’s own money for canteen expenses and small purchases; Section 630.110.1(2), RSMo



A person has the rights to control their personal resources. 42 C.F.R. § 441.301(c)(4)

External Advocacy



To communicate by sealed mail or otherwise with persons, including agencies inside or outside the facility; Section 630.110.1(3), RSMo



Adults who do not have a legal guardian have the right to designate a representative to act on one’s behalf for purposes of receiving services from the Division of DD. 9 CSR 45-3.030(2)



Individuals are involved in any process to limit their rights and are assisted through external advocacy efforts. 9CSR 45-5.010 (3) (C) 2. B

Privacy



To receive visitors of one’s own choosing at reasonable times; RSMo 630.110

To have an absolute right to receive visits from his or her attorney, physician or clergyman, in private, at reasonable times. Section 630.110.3, RSMo.

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Individuals have the right to privacy in their home, such as locking their bathroom door or talking on the phone. 42 CFR Part 441.710 and 9CSR 45-5.010

Talk with friends/family privately. 42 CFR. § 441.301(c)(4)(iii) “Ensures an individual’s rights of privacy, dignity and respect, and freedom from

coercion and restraint.” 42 CFR 441.530 441.710 (a)(1)(iii)

Communication



To have reasonable access to a telephone booth to make and receive confidential calls; Section 630.110.1(5), RSMo

The right to communicate by sealed mail with the department, his legal counsel and with the court, if any, which has jurisdiction over the person. Section 630.110.4, RSMo.



To communicate in any form and to have privacy of communications; 9 CSR 45-3.030(1)(J)

Access to Personal Records



To have access to one’s own mental and medical records; Section 630.110.1(6), RSMo



Individuals have access to their records and staff is available to answer their questions. 9CSR 45-5.010 (3) (C) (2) (L)

To have all of an individual’s records maintained in a confidential manner; 9 CSR 45-3.030(1)(Q)

To have rights, services, supports, and clinical records regarding services explained in a manner that is easily understood and in an accessible format; 9 CSR 45-3.030(1)(P)

To have all of an individual’s records maintained in a confidential manner; 9 CSR 45-3.030(1)(Q)

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Freedom of Movement



To have opportunities for physical exercise and outdoor recreation; Section 630.110.1(7), RSMo



To have freedom of movement, free from environmental barriers such as alarms, locks, restraints, etc. 9CSR 45-5.010 (3) (C) (2) (E)

Individuals have freedom of movement. 9CSR 45-5.010 (3) (C) (2)(E)

Media



To have reasonable, prompt access to current newspapers, magazines, radio, and television programming. Section 630.110.1(8).. Note:(discuss in training that this includes

internet, dvds, social media, etc.)

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ADDITIONAL RESOURCES: If a person receiving services has complaints of abuse, neglect or violation or limitation of rights, the person, the person’s parents, guardian or

authorized representative may contact their service coordinator, state facility representative, or they may contact;

1. Mo Department of Mental Health’s Office of Constituent Services at

800-364-9687(Outside of Cole County) 8a-5p 573-751-8088 or TT 573-526-1201 for assistance. 8a-5p

2. Mo Department of Health and Senior Services 1-800-392-0210

3. Mo Children’s Services 1-800-392-3738

4. Mo Protection and Advocacy

The Division shall report abuse and neglect as mandated by law. Any violation of rights shall constitute, at a minimum, inadequate care and treatment.

People who work for state facilities must report any abuse or neglect that they see or that people report to them. The DMH complies with applicable State and Federal civil rights laws, and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Free language assistance available. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-364-9687. 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-364-9687。

* Quick Guide to Legal Sources Related to Individual Rights The Code of Federal Regulations (CFR ) - the codification of the rules published in the Federal Register by the departments and agencies of the Federal Government.

Missouri Revised Statutes - (RSMo)- state laws that serve as a basis for the Code of State Regulations.

Code of State Regulations – (CSR) - state rules that accompany the established laws set out in RSMo. In Missouri there are 22 Titles in the CSR and Department of Mental Health rules are found in Title 9. The CSR generally have more detail governing how the state laws are to be implemented and requirements that must be met by the department and providers.

http://www.moga.mo.gov/mostatutes/statutesAna.html

Documents

Title: Due Process Review Committee for Limitations and ... · PDF file3 At least one time per quarter Participate in DMH DD Contracted Provider Due Process Review Committee meetings