Section 4, Chapter 2 (Placements), Subsection 6 – Qualified Residential Treatment Program (QRTP) Designation

Section 4, Chapter 2 (Placements), Subsection 6 – Qualified Residential Treatment Program (QRTP) Designation

Effective Date: 7-1-2021

As part of the Children’s Division’s efforts to implement the Family First Prevention Services Act (FFPSA) (Public Law 1115-123), licensed residential treatment agencies may qualify for the Qualified Residential Treatment Program (QRTP) designation.

A QRTP means a program that has met all program requirements for designation as a QRTP, as determined herein. To qualify for designation as a QRTP, the agency shall meet the requirements set forth below. The designation shall not be considered a license issued by the Department of Social Services, Children’s Division.

Designation Requirements

The designation requirements shall include:

  1. The agency shall have and maintain a residential treatment license at the specialized standards for residential treatment or intensive residential treatment level in accordance with 13 CSR 35-71.130 and 13 CSR 35-71.140.
  2. The agency shall have and maintain accreditation by any of the following independent, not-for-profit organizations:
    1. The Commission on Accreditation of Rehabilitation Facilities (CARF);
    2. The Joint Commission (JCO); or
    3. The Council on Accreditation (COA).
  3. The agency shall have a trauma-informed treatment model designed to address the needs of children in the program. The Trauma-Informed definitions, processes, and indicators established in The Missouri Model shall be used to assess compliance with the principles of a trauma-informed treatment model.
  4. The agency shall be equipped to meet the clinical needs, as appropriate, of children with serious emotional or behavioral disorders or disturbances, as appropriate for the agency’s residential treatment license.
  5. The agency shall be equipped to implement the treatment identified as necessary for the children in the program.
  6. The agency shall acquire the services of a registered or licensed nursing staff who-
    1. Provide care within the scope of their practice as defined by law;
    2. Are available twenty-four (24) hours a day and seven (7) days a week; and
    3. Are on-site according to the minimum standards set forth in 13 CSR 35-71.
  7.  The agency shall acquire the services of licensed clinical staff to fulfill the clinical needs of children in the program.
  8. The agency shall designate lead personnel involved in the implementation of the trauma-informed practices.
  9. The agency shall create a family engagement plan to explain how the requirements below will be met for each child. To the extent appropriate, and in accordance with the child’s treatment plan, agencies shall facilitate the participation of family members in the child’s treatment program by:
    1. Facilitating outreach to the family members of the child, including siblings. The agency shall maintain documentation demonstrating how the outreach is made (including contact information), and shall maintain contact information for any known biological family and fictive kin of the child;
    2. Documenting how family members are integrated into the treatment process for the child, including post-discharge, and how sibling connections are maintained; and
    3. Providing discharge planning and family-based aftercare support for at least six (6) months post-discharge.
  10. The agency shall create and follow a family engagement plan, as described in this policy, for each child.

Designation Application

The agency shall submit written documentation to the Division or the Division’s designee to demonstrate the minimum qualifications identified in the Designation Requirements section of this policy utilizing the Application for Qualified Residential Treatment Provider Designation form.

The Division or designee may conduct site visits, a review of records, and interviews with staff and residents in assessing the application materials and qualifications of the agency in meeting the requirements herein.

Upon receipt of all documents and information set forth herein, the Division shall review and determine if all QRTP designation requirements are met. The Division may request further supporting documentation or information to demonstrate the minimum qualifications herein.

The Division shall issue a written finding to either approve or deny the agency’s application for QRTP designation within forty-five (45) days of receipt of the agency’s application. In the event that the Division denies the agency’s complete application for QRTP designation, the agency shall have the right to administrative review as stated in this policy. The denial shall be in writing and shall provide the factual basis for the decision.

 Designation

The QRTP designation shall be valid for a period not to exceed six (6) years and shall be subject to periodic, including unannounced, monitoring as determined by the Division.

The agency shall participate in all requests by the Division to review records or documents, or contact agency personnel, related to the trauma-informed model and QRTP designation.

The agency shall provide written notice to the Division within five (5) calendar days identifying a personnel change of the lead personnel of the trauma-informed practices and shall name a new individual to lead trauma-informed practices within thirty (30) calendar days of the change.

The Division shall have the authority to suspend, revoke, or deny the QRTP designation in the event the Division determines the agency does not meet the requirements pursuant to this policy and any subsequent state regulation.

In the event of non-compliance with the requirements of this policy, the Division may suspend or revoke the QRTP designation. In the Notice of Suspension or Revocation, the Division shall-

  1. Include the factual basis for the suspension or revocation;
  2. In the event of a suspension, issue an immediate corrective action plan to mitigate the conditions related to the suspension; and
  3. Notify the agency of the right to administrative review pursuant to this policy.

The agency may rescind the suspension on its own decision in the event that the Division determines-

  1. The agency has successfully implemented the corrective action plan issued by the Division to remedy the concerns that resulted in the suspension of the designation; and
  2. The agency meets all criteria set forth in this policy.

The failure to correct the non-compliance which led to the suspension of the designation shall be grounds for designation revocation.

In the event that an agency’s QRTP designation has been suspended, the agency shall have three (3) months to correct the areas of non-compliance which lead to the suspension action by the Division. If the areas of non-compliance have not been corrected after the three (3) months, as determined by the Division, the Division shall have the right to commence the revocation of the designation.

In the event that an agency’s QRTP designation has been revoked, the agency shall wait a period of not less than six (6) months prior to submitting the designation application again.

Administrative Review

To request an administrative review the agency shall submit a written request for administrative review within thirty (30) calendar days of notice of the decision of the Division. The request for administrative review shall set forth the basis of the agency’s objection to the Division’s decision.

If the agency requests a hearing, the Division shall hold an administrative hearing. The hearing shall be held by the Children’s Division’s Director or the Director’s designee. The determination of the Director or the Director’s designee shall be the final agency decision.

 Use of QRTP Placements and Additional Resources

When considering placement options, the Children’s Service Worker, in consultation with the Independent Assessor (IA), as applicable, should consider the use of QRTP designated placements, when available and clinically and/or developmentally appropriate for children in the legal custody of the Children’s Division.

To learn more about the FFPSA, see https://dss.mo.gov/cd/family-first-prevention-services-act.htm. To learn more about The Missouri Model, see https://dmh.mo.gov/trauma.