The Initial Findings Shall Be Summarized and Forwarded to the Central Registry Unit (CRU) s1

Home & Community Services Protective Service Manual

History 1701.20

January, 1979 FORMATION OF THE DIVISION OF AGING The Missouri Division of Aging was created within the Department of Social Services by Executive Order of Governor Joseph P. Teasdale, January 31, 1979, to provide a comprehensive range of services to the elderly population in the State of Missouri. The Executive Order established the position of the Director of the Division of Aging, transferred staff from other Departments and specified the Division of Aging as the unit of state government charged with the fulfilling:

1. all the powers, duties and functions of the Board of Nursing Home Administrators (chapter 344, RSMo); 2. the powers, duties and functions relating to regulation and licensing of all long-term care facilities (chapter 198, RSMo); 3. the State's responsibility under the Older Americans Act (OAA) of 1965, as amended pertaining to the Office of Aging and administered by the Area Agencies on Aging (AAA) (section 251.070, RSMo); 4. all the powers, duties and functions relating to certification and review of nursing home services for the aged residing in skilled nursing facilities, intermediate care facilities or intermediate care facilities for the mentally retarded which are authorized under Title XIX of the Federal Social Security Act; 5. all the powers, duties and functions relating to vendor payments for aged and handicapped 18 years of age and over under the (then named Title XX) Social Services Block Grant (SSBG) of the Federal Social Security Act (42 USC 1397); 6. all the powers, duties and functions relating to direct adult services for the aged and handicapped 18 years of age and over under the (then named Title XX) Social Services Block Grant of the Federal Social Security Act (42 USC 1397). (and later included) 7. pre-admission screening and case management for Title XIX (Medicaid) long-term care services; 8. licensing of adult day care facilities; 9. services and responsibilities regarding adult protective services authorized under sections 192.2400 through 192.2470, RSMo.

The Division's broad responsibilities were divided into three areas:

Management Services; in charge of fiscal operations of the division, staff, training, program and advocacy planning, legal services, research and analysis, administration of the employment program for older adults (Title V), development of the state plan for administration of Title III funds and preparing grants to the Area Agencies on Aging Page 1 of 3 Effective: 08/93 (Statutory references updated 01/15) Home & Community Services Protective Service Manual

History 1701.20

(AAA) for Older American Act (OAA) moneys, the USDA commodity programs and the SSBG funds for nutrition and transportation, under the supervision of its deputy director. The unit also monitors and provides technical assistance to the AAA regarding fiscal matters.

Currently, Management Services continues to be in charge of the Central Registry Unit, fiscal operations, data processing and the monitoring and technical assistance to the AAA regarding fiscal matters. Other responsibilities have since been reassigned.

Institutional Services; functions as the regulatory agent to license long-term care facilities (chapter 198, RSMo); certify and review facilities participating in the Title XIX (Medicaid) and Title XVIII (Medicare) programs; monitor through medical review for appropriate level of care of individuals receiving federal or state inpatient financial assistance; and investigate complaints regarding care in long-term care facilities.

Alternative Services; responsible for planning and administering programs which serve elderly and handicapped adults throughout the state of Missouri who are not in an institutional environment; advocates on behalf of the elderly, assists in integrating services available to assist them to remain in their homes and communities through SSBG, Title III, Title V, Title XIX and Title XIX waiver services.

Social Services Block Grant (SSBG), (earlier known as Title XX) services are limited to persons who are sixty (60) years and older or handicapped adults eighteen (18) years or older who require services available under the various programs and who are in the greatest social or economic need.

Title III (OAA) services are limited to persons sixty (60) years or over, and are directed toward those in the greatest social or economic need.

Title V (OAA) services are limited to persons fifty-five (55) years or over and meet the federally stipulated guidelines for participation.

Title XIX (Medicaid) services are administered through the Division of Family Services (DFS). Coverage ranges from in-home services to payment for long-term care in certain facilities. Eligibility for in-home services is limited to persons who are considered to be medically eligible for long-term care in a facility.

Title XIX (Medicaid) Waivered Services under the Omnibus Reconciliation Act of 1981 and matching General Revenue funds are limited to persons 65 years of age or older.

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Later the same year, the Omnibus Nursing Home Bill, signed in June of 1979, contained major nursing home reform provisions under Chapter 198 RSMo. Licensure and regulation activities for residents of long-term care facilities were transferred from the Department of Health to the Department of Social Services, Division of Aging effective September 28, 1979. Actual operation by the Division began October 1, 1979. During this period of state reform, an amendment to the Older American's Act (1980) required the Ombudsman to establish records regarding complaints of care for adults residing in facilities. June of 1980, S.B. 576 established mandated reporting by persons who have reasonable cause to suspect that an eligible adult is in need of protective service to the Department of Social Services (DSS), through a toll-free phone number. DSS designated the responsibility of receipt of reports and investigation to the Division of Aging. The Central Registry Unit (CRU) was established in October, 1980 to screen and refer reports through the statewide hotline regarding abuse and neglect of older adults. In-home services were included in the State Plan for Medicaid reimbursement in 1982. An amendment was approved by the Health Care Financing Administration to establish homemaker/chore (H/C) and respite services to persons who wish to remain in their own home, and would require Nursing Facility placement, were it not for these Elderly Waiver services. Statutory authority for the Division of Aging was granted by the 82nd Session of the Missouri General Assembly through the passage of House Bill 1131. Chapter 192.2000 RSMo, effective August 13, 1984 further defined the duties and responsibilities of the Division, including the creation of the Employee Disqualification List (EDL). Senate Bill 277, enacted in 1987, standardized the term "handicap" to include mentally impaired individuals, expanding the population considered eligible for protective services offered by the Division of Aging. 1992 Legislation 565.180 - 565.190 RSMo provided for the crime of elder abuse as an offense against the person. Senate Bills 573 and 634 passed which included an amendment to the Employee Disqualification List to include in-home services employees, and mandated certain professionals to report suspected abuse and/or neglect of Division of Aging eligible adults. August, 1993 the Division of Aging released its first Protective Services manual. Alternative Services Field Operations Central Office identified a need to have a more comprehensive protective service manual, and formed a task force in the fall of 1991 to identify needs, gather and review information regarding the delivery of protective services. Hours of diligent effort were combined to develop the manual in an effort to improve the effectiveness of the services provided to the adults the Missouri the Division of Aging has been charged to serve. August, 1994, the 87th General Assembly passed HB 1335 & 1381 extending the EDL provisions to agencies licensed by the Department of Health as provided in sections 197.400 to 197.470, RSMo.

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