State Assisted Living Policy: 1998. Missouri



Residential care facilities. Missouri revised statutes § 198.003 et. seq.; Missouri. code of regulations, title 13 § 15-10.010 et seq.

General Approach

State agencies started to explore developing new regulations for assisted living in 1997. No formal work group or plan has been established. The state Division of Aging licenses two levels of residential care facilities. RCFs must obtain a certificate of need.


Type I RCFs means any premises, other than a residential care facility II, intermediate care facility or skilled nursing facility, which is utilized by its owner, operator or manager to provide twenty-four hour care to three or more residents, who are not related within the fourth degree of consanguinity or affinity to the owner, operator or manager of the facility and who need or are provided with shelter, board and with protective oversight, which may include storage and distribution or administration of medications and care during short term illness or recuperation.

The definition of Type II RCFs adds supervision of diets, assistance in personal care, and supervision of health care under the direction of a licensed physician to the definition of Type I RCFs. Facilities can be licensed to provide both levels of care within the same facility.

Tenant Policy

RCFs may admit or retain only residents who are capable mentally and physically of negotiating a normal path to safety using assistance devices or aides when necessary. The rules allow RCFs to admit any resident who can be cared for by the facility directly or in cooperation with community resources or other providers of care with whom it is affiliated or has contracts. Residents must be able to evacuate without physical assistance.

Unit Requirements

Homes licensed after 1987 must provide 70 square feet of space per resident in both private and multiple occupancy rooms. A maximum of four residents may share a room. Homes licensed prior to 1987 could provide 60 square feet per resident. One tub/shower must be provided for every 20 residents and one toilet and lavatory for every six residents.


Personal care services are reimbursed through Medicaid for residents who have chronic, stable conditions. Tasks include bathing, hair care, oral hygiene, nail care, dressing, assistance with toileting, walking or transfers, meal preparation, and light housework. Advanced personal care services include assistance for persons with altered body functions who have a catheter or ostomy, require bowel and bladder routines, range of motion exercises, applying prescription lotions or ointments and other tasks requiring a highly trained aide.


Personal care and advanced personal care services are reimbursed as a Medicaid state plan service in residential care facilities. The payment varies by resident based on an assessment and a plan of care completed by a case manager from the Division of Aging. Facilities are reimbursed at an hourly rate of $11.37, for the number of hours authorized in the plan of care. The actual number of hours authorized ranges from 5-6 hours to 70 or 80 hours a month. The average number of hours authorized is 25-30 hours a month. The payment rate is $11.37 an hour for personal care aides, $13.41 for advanced personal care aide services and $26.30 an hour for nursing visits. The maximum payment is $1962 a month for people receiving advanced personal care services. No more than one nursing visit a week can be authorized. Very few residents receive advanced personal care and nursing visits.

The room and board rate is paid through the federal SSI payment and a state "cash grant" or SSI supplement payment. Type I facilities receive a combined room and board payment of $645 a month and Type II facilities receive a combined payment of $776 a month. With an average personal care payment of $302.10, the total payment would equal $947 in Type I facilities and $1078 in Type II facilities. The maximum payments are $2607 and $2738 respectively for room and board and services.

The state is interested in developing a per diem rate with seven tiers based on an assessment by the facility and monitoring by the Division of Aging.


Administrators of RCF II facilities must be licensed nursing home administrators or attend at least one continuing education workshop each calendar year given or approved by the Division on Aging. They must also successfully complete a state approved Level I Medication Aide course unless a full time licensed nurse is available. Licenses are not required for administrators of RCF I facilities although annual attendance at in-service training sessions is required.

Staff Prior to or on the first day that a new employee works in the facility, s/he shall receive orientation of at least one hour appropriate to his/her job function. This shall include, at a minimum, job responsibilities, how to handle emergency situations, the importance of infection control and hand washing, confidentiality of resident information, preservation of resident dignity, how to report abuse/neglect to the Division on Aging, information regarding the employee Disqualification List and instruction regarding the rights of residents and protection of property.

A statement must be included in the personnel record of each employee that the employee was instructed on resident's rights, facility's policies, job duties and other orientation received.

Staff administering medications receive a certificate after completing a designated course developed by the University of Missouri-Columbia.

Background Check

Administrators must not have been convicted of an offense involving the operation of a long term facility or similar facility.

Staff No person on listed on the employee disqualification list maintained by the Division shall work or volunteer in the facility in any capacity.


Licensing fees are $100 for facilities of 3-25 beds; $300 for 25-100 beds; and $600 for 100+ beds.

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