Repeals provisions relating to certificates of need

SECOND REGULAR SESSION
HOUSE BILL NO. 1637
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE OVERCAST .
4268H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o repeal sections 197.300, 197.305, 197.310, 197.31 1, 197.312, 197.315, 197.316, 197.318,
197.320, 197.325, 197.326, 197.327, 197.330, 197.335, 197.340, 197.345, 197.355,
197.357, 197.366, 197.367, 197.705, 198.530, 208.169, and 208.225, RSMo, and to
enact in lieu thereof four new sections relating to certificates of need.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 197.300, 197.305, 197.310, 197.31 1, 197.312, 197.315, 197.316,
2 197.318, 197.320, 197.325, 197.326, 197.327, 197.330, 197.335, 197.340, 197.345, 197.355,
3 197.357, 197.366, 197.367, 197.705, 198.530, 208.169, and 208.225, RSMo, are repealed and
4 four new sections enacted in lieu thereof, to be known as sections 197.705, 198.530, 208.169,
5 and 208.225, to read as follows:
197.705. 1. For purposes of this section, the term "health car e facilities" means:
2 (1) Facilities licensed under chapter 198;
3 (2) Long-term car e beds in a hospital as described in subdivision (3) of
4 subsection 1 of section 198.012; and
5 (3) Long-term car e hospitals or beds in a long-term car e hospital meeting the
6 r equir ements described in 42 CFR 412.23(e).
7 2. All hospitals , as defined in section 197.020, and health care facilities[ , defined in
8 sections 197.020 and 197.305, ] shall require all personnel providing services in such facilities
9 to wear identification badges while acting within the scope of their employment. The
10 identification badges of all personnel shall prominently display the licensure status of such
11 personnel.
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
198.530. 1. For purposes of this section, the term "continuing care ret ire ment
2 community" means a community that pr ovides at the same site or location independent
3 housing, long-term health care, and other services to older persons not r elated by blood
4 or marriage to the owner or operator of the community under an agre ement effective
5 for the life of the person or a specified period of time in excess of one year that
6 guarantees or pro vides priority access to on-site health-relat ed long-term care services
7 when needed.
8 2. If an enrollee in a managed care org anization is also a resident in a long-term care
9 facility licensed pursuant to chapter 198, or a continuing care retirement community[ , as
10 defined in section 197.305 ], such enrollee's managed care or ganization shall provide the
11 enrollee with the option of receiving the covered service in the long-term care facility which
12 serves as the enrollee's primary residence. For purposes of this section, "managed care
13 or ganization" means any org anization that of fers any health plan certified by the department
14 of health and senior services designed to provide incentives to medical care providers to
15 manage the cost and use of care associated with claims, including, but not limited to, a health
16 maintenance or ganization and preferred provider or ganization. The resident enrollee's
17 managed care or ganization shall reimburse the resident facility for those services which
18 would otherwise be covered by the managed care or ganization if the following conditions
19 apply:
20 (1) The facility is willing and able to provide the services to the resident; and
21 (2) The facility and those health care professionals delivering services to residents
22 pursuant to this section meet the licensing and training standards as prescribed by law; and
23 (3) The facility is certified through Medicare; and
24 (4) The facility and those health care professionals delivering services to residents
25 pursuant to this section agree to abide by the terms and conditions of the health carrier's
26 contracts with similar providers, abide by patient protection standards and requirements
27 imposed by state or federal law for plan enrollees and meet the quality standards established
28 by the health carrier for similar providers.
29 [ 2. ] 3. The managed care or ganization shall reimburse the resident facility at a rate of
30 reimbursement not less than the Medicare allowable rate pursuant to Medicare rules and
31 regulations.
32 [ 3. ] 4. The services in subsection [ 1 ] 2 of this section shall include, but are not limited
33 to, skilled nursing care, rehabilitative and other therapy services, and postacute care, as
34 needed. Nothing in this section shall limit the managed care or ganization from utilizing
35 contracted providers to deliver the services in the enrollee's resident facility .
36 [ 4. ] 5. A resident facility shall not prohibit a health carrier's participating providers
37 from providing covered benefits to an enrollee in the resident facility . A resident facility or
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38 health care professional shall not impose any char ges on an enrollee for any service that is
39 ancillary to, a component of, or in support of the services provided under this section when
40 the services are provided by a health carrier's participating provider , or otherwise create a
41 disincentive for the use of the health carrier's participating providers. Any violation of the
42 requirements of this subsection by the resident facility shall be considered abuse or neglect of
43 the resident enrollee.
208.169. [ 1. ] Notwithstanding other provisions of this chapter , including but not
2 limited to sections 208.152, 208.153, 208.159 and 208.162[ :
3 (1) There shall be no revisions to a facility's reimbursement rate for providing nursing
4 care services under this chapter upon a change in ownership, management control, operation,
5 stock, leasehold interests by whatever form for any facility previously licensed or certified for
6 participation in the Medicaid program. Increased costs for the successor owner , management
7 or leaseholder that result from such a change shall not be recognized for purposes of
8 reimbursement;
9 (2) In the case of a newly built facility or part thereof which is less than two years of
10 age and enters the T itle XIX program under this chapter after July 1, 1983, a reimbursement
11 rate shall be assigned based on the lesser of projected estimated operating costs or one
12 hundred ten percent of the median rate for the facility's class to include urban and rural
13 categories for each level of care including ICF only and SNF/ICF . The rates set under this
14 provision shall be ef fective for a period of twelve months from the ef fective date of the
15 provider agreement at which time the rate for the future year shall be set in accordance with
16 reported costs of the facility recognized under the reimbursement plan and as provided in
17 subdivisions (3) and (4) of this subsection. Rates set under this section may in no case exceed
18 the maximum ceiling amounts in ef fect under the reimbursement regulation;
19 (3) Reimbursement for capital related expenses for newly built facilities entering the
20 T itle XIX program after March 18, 1983, shall be calculated as the building and building
21 equipment rate, movable equipment rate, land rate, and working capital rate.
22 (a) The building and building equipment rate will be the lower of:
23 a. Actual acquisition costs, which is the original cost to construct or acquire the
24 building, not to exceed the costs as determined in section 197.357; or
25 b. Reasonable construction or acquisition cost computed by applying the regional
26 Dodge Construction Index for 1981 with a trend factor , if necessary , or another current
27 construction cost measure multiplied by one hundred eight percent as an allowance for fees
28 authorized as architectural or legal not included in the Dodge Index V alue, multiplied by the
29 square footage of the facility not to exceed three hundred twenty-five square feet per bed,
30 multiplied by the ratio of forty minus the actual years of the age of the facility divided by
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31 forty; and multiplied by a return rate of twelve percent; and divided by ninety-three percent of
32 the facility's total available beds times three hundred sixty-five days.
33 (b) The maximum movable equipment rate will be fifty-three cents per bed day .
34 (c) The maximum allowable land area is defined as five acres for a facility with one
35 hundred or less beds and one additional acre for each additional one hundred beds or fraction
36 thereof for a facility with one hundred one or more beds.
37 (d) The land rate will be calculated as:
38 a. For facilities with land areas at or below the maximum allowable land area,
39 multiply the acquisition cost of the land by the return rate of twelve percent, divide by ninety-
40 three percent of the facility's total available beds times three hundred sixty-five days.
41 b. For facilities with land areas greater than the maximum allowable land area, divide
42 the acquisition cost of the land by the total acres, multiply by the maximum allowable land
43 area, multiply by the return rate of twelve percent, divide by ninety-three percent of the
44 facility's total available beds times three hundred sixty-five days.
45 (e) The maximum working capital rate will be twenty cents per day;
46 (4) If a provider does not provide the actual acquisition cost to determine a
47 reimbursement rate under subparagraph a. of paragraph (a) of subdivision (3) of subsection 1
48 of this section, the sum of the building and building equipment rate, movable equipment rate,
49 land rate, and working capital rate shall be set at a reimbursement rate of six dollars;
50 (5) ] , for each state fiscal year a negotiated trend factor shall be applied to each
51 facility's T itle XIX per diem reimbursement rate. The trend factor shall be determined
52 through negotiations between the department and the af fected providers and is intended to
53 hold the providers harmless against increase in cost. In no circumstances shall the negotiated
54 trend factor to be applied to state funds exceed the health care finance administration market
55 basket price index for that year . The provisions of this subdivision shall apply to fiscal year
56 1996 and thereafter .
57 [2. The provisions of subdivisions (1), (2), (3), and (4) of subsection 1 of this section
58 shall remain in ef fect until July 1, 1989, unless otherwise provided by law . ]
208.225. 1. T o implement fully the provisions of section 208.152, the MO HealthNet
2 division shall calculate the Medicaid per diem reimbursement rates of each nursing home
3 participating in the Medicaid program as a provider of nursing home services based on its
4 costs reported in the T itle XIX cost report filed with the MO HealthNet division for its fiscal
5 year as provided in subsection 2 of this section.
6 2. The recalculation of Medicaid rates to all Missouri facilities will be performed as
7 follows: ef fective July 1, 2004, the department of social services shall use the Medicaid cost
8 report containing adjusted costs for the facility fiscal year ending in 2001 and redetermine the
9 allowable per -patient day costs for each facility . The department shall recalculate the class
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10 ceilings in the patient care, one hundred twenty percent of the median; ancillary , one hundred
11 twenty percent of the median; and administration, one hundred ten percent of the median cost
12 centers. Each facility shall receive as a rate increase one-third of the amount that is unpaid
13 based on the recalculated cost determination.
14 3. (1) For purposes of this subsection, the term "capital expenditur es" means
15 expenditur es by or on behalf of a facility that, under generally accepted accounting
16 principles, ar e not prop erly chargeable as an expense of operation and maintenance.
17 (2) Any intermediate care facility or skilled nursing facility , as such terms are defined
18 in section 198.006, participating in MO HealthNet that incurs total capital expenditures[ , as
19 such term is defined in section 197.305, ] in excess of two thousand dollars per bed shall be
20 entitled to obtain from the MO HealthNet division a recalculation of its Medicaid per diem
21 reimbursement rate based on its additional capital costs or all costs incurred during the facility
22 fiscal year during which such capital expenditures were made. Such recalculated
23 reimbursement rate shall become ef fective and payable when granted by the MO
24 HealthNet division as of the date of application for a rate adjustment.
[ 197.300. Sections 197.300 to 197.366 shall be known as the
2 "Missouri Certificate of Need Law". ]
[ 197.305. As used in sections 197.300 to 197.366, the following terms
2 mean:
3 (1) "Aff ected persons", the person proposing the development of a
4 new institutional health service, the public to be served, and health care
5 facilities within the service area in which the proposed new health care service
6 is to be developed;
7 (2) "Agency", the certificate of need program of the Missouri
8 department of health and senior services;
9 (3) "Capital expenditure", an expenditure by or on behalf of a health
10 care facility which, under generally accepted accounting principles, is not
11 properly char geable as an expense of operation and maintenance;
12 (4) "Certificate of need", a written certificate issued by the committee
13 setting forth the committee's affir mative finding that a proposed project
14 suf ficiently satisfies the criteria prescribed for such projects by sections
15 197.300 to 197.366;
16 (5) "Develop", to undertake those activities which on their completion
17 will result in the of fering of a new institutional health service or the incurring
18 of a financial obligation in relation to the of fering of such a service;
19 (6) "Expenditure minimum" shall mean:
20 (a) For beds in existing or proposed health care facilities licensed
21 pursuant to chapter 198 and long-term care beds in a hospital as described in
22 subdivision (3) of subsection 1 of section 198.012, six hundred thousand
23 dollars in the case of capital expenditures, or four hundred thousand dollars in
24 the case of major medical equipment, provided, however , that prior to January
25 1, 2003, the expenditure minimum for beds in such a facility and long-term
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26 care beds in a hospital described in section 198.012 shall be zero, subject to the
27 provisions of subsection 7 of section 197.318;
28 (b) For beds or equipment in a long-term care hospital meeting the
29 requirements described in 42 CFR, Section 412.23(e), the expenditure
30 minimum shall be zero; and
31 (c) For health care facilities, new institutional health services or beds
32 not described in paragraph (a) or (b) of this subdivision one million dollars in
33 the case of capital expenditures, excluding major medical equipment, and one
34 million dollars in the case of medical equipment;
35 (7) "Health service area", a geographic region appropriate for the
36 ef fective planning and development of health services, determined on the basis
37 of factors including population and the availability of resources, consisting of
38 a population of not less than five hundred thousand or more than three million;
39 (8) "Major medical equipment", medical equipment used for the
40 provision of medical and other health services;
41 (9) "New institutional health service":
42 (a) The development of a new health care facility costing in excess of
43 the applicable expenditure minimum;
44 (b) The acquisition, including acquisition by lease, of any health care
45 facility , or major medical equipment costing in excess of the expenditure
46 minimum;
47 (c) Any capital expenditure by or on behalf of a health care facility in
48 excess of the expenditure minimum;
49 (d) Predevelopment activities as defined in subdivision (12) hereof
50 costing in excess of one hundred fifty thousand dollars;
51 (e) Any change in licensed bed capacity of a health care facility
52 licensed under chapter 198 which increases the total number of beds by more
53 than ten or more than ten percent of total bed capacity , whichever is less, over
54 a two-year period, provided that any such health care facility seeking a
55 nonapplicability review for an increase in total beds or total bed capacity in an
56 amount less than described in this paragraph shall be eligible for such review
57 only if the facility has had no patient care class I deficiencies within the last
58 eighteen months and has maintained at least an eighty-five percent average
59 occupancy rate for the previous six quarters;
60 (f) Health services, excluding home health services, which are of fered
61 in a health care facility and which were not of fered on a regular basis in such
62 health care facility within the twelve-month period prior to the time such
63 services would be of fered;
64 (g) A reallocation by an existing health care facility of licensed beds
65 among major types of service or reallocation of licensed beds from one
66 physical facility or site to another by more than ten beds or more than ten
67 percent of total licensed bed capacity , whichever is less, over a two-year
68 period;
69 (10) "Nonsubstantive projects", projects which do not involve the
70 addition, replacement, modernization or conversion of beds or the provision of
71 a new health service but which include a capital expenditure which exceeds
72 the expenditure minimum and are due to an act of God or a normal
73 consequence of maintaining health care services, facility or equipment;
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74 (1 1) "Person", any individual, trust, estate, partnership, corporation,
75 including associations and joint stock companies, state or political subdivision
76 or instrumentality thereof, including a municipal corporation;
77 (12) "Predevelopment activities", expenditures for architectural
78 designs, plans, working drawings and specifications, and any arrangement
79 or commitment made for financing; but excluding submission of an
8 0 application for a certificate of need. ]
[ 197.310. 1. The "Missouri Health Facilities Review Committee" is
2 hereby established. The agency shall provide clerical and administrative
3 support to the committee. The committee may employ additional staf f as it
4 deems necessary .
5 2. The committee shall be composed of:
6 (1) T wo members of the senate appointed by the president pro tem,
7 who shall be from dif ferent political parties; and
8 (2) T wo members of the house of representatives appointed by the
9 speaker , who shall be from dif ferent political parties; and
10 (3) Five members appointed by the governor with the advice and
11 consent of the senate, not more than three of whom shall be from the same
12 political party .
13 3. No business of this committee shall be performed without a
14 majority of the full body .
15 4. The members shall be appointed as soon as possible after September
16 28, 1979. One of the senate members, one of the house members and three of
17 the members appointed by the governor shall serve until January 1, 1981, and
18 the remaining members shall serve until January 1, 1982. All subsequent
19 members shall be appointed in the manner provided in subsection 2 of this
20 section and shall serve terms of two years.
21 5. The committee shall elect a chairman at its first meeting which shall
22 be called by the governor . The committee shall meet upon the call of the
23 chairman or the governor .
24 6. The committee shall review and approve or disapprove all
25 applications for a certificate of need made under sections 197.300 to 197.366.
26 It shall issue reasonable rules and regulations governing the submission,
27 review and disposition of applications.
28 7. Members of the committee shall serve without compensation but
29 shall be reimbursed for necessary expenses incurred in the performance of
30 their duties.
31 8. Notwithstanding the provisions of subsection 4 of section 610.025,
32 the proceedings and records of the facilities review committee shall be subject
33 to the provisions of chapter 610. ]
[ 197.31 1. No member of the Missouri health facilities review
2 committee may accept a political donation from any applicant for a license. ]
[ 197.312. A certificate of need shall not be required for any institution
2 previously owned and operated for or in behalf of a city not within a county
3 which chooses to be licensed as a facility defined under subdivision (22) or
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4 (23) of section 198.006 for a facility of ninety beds or less that is owned or
5 operated by a not-for- profit corporation which is exempt from federal income
6 tax as an or ganization described in section 501(c)(3) of the Internal Revenue
7 Code of 1986, which is controlled directly by a religious or ganization and
8 which has received approval by the department of health and senior services of
9 plans for construction of such facility by August 1, 1995, and is licensed by the
10 department of health and senior services by July 1, 1996, as a facility defined
11 under subdivision (22) or (23) of section 198.006 or for a facility , serving
12 exclusively mentally ill, homeless persons, of sixteen beds or less that is
13 owned or operated by a not-for- profit corporation which is exempt from
14 federal income tax which is described in section 501(c)(3) of the Internal
15 Revenue Code of 1986, which is controlled directly by a religious or ganization
16 and which has received approval by the department of health and senior
17 services of plans for construction of such facility by May 1, 1996, and is
18 licensed by the department of health and senior services by July 1, 1996, as a
19 facility defined under subdivision (22) or (23) of section 198.006 or an assisted
20 living facility located in a city not within a county operated by a not for profit
21 corporation which is exempt from federal income tax which is described in
22 section 501(c)(3) of the Internal Revenue Code of 1986, which is controlled
23 directly by a religious org anization and which is licensed for one hundred beds
24 or less on or before August 28, 1997. ]
[ 197.315. 1. Any person who proposes to develop or offer a new
2 institutional health service within the state must obtain a certificate of need
3 from the committee prior to the time such services are of fered.
4 2. Only those new institutional health services which are found by the
5 committee to be needed shall be granted a certificate of need. Only those new
6 institutional health services which are granted certificates of need shall be
7 of fered or developed within the state. No expenditures for new institutional
8 health services in excess of the applicable expenditure minimum shall be made
9 by any person unless a certificate of need has been granted.
10 3. After October 1, 1980, no state agency char ged by statute to license
11 or certify health care facilities shall issue a license to or certify any such
12 facility , or distinct part of such facility , that is developed without obtaining a
13 certificate of need.
14 4. If any person proposes to develop any new institutional health care
15 service without a certificate of need as required by sections 197.300 to
16 197.366, the committee shall notify the attorney general, and he shall apply for
17 an injunction or other appropriate legal action in any court of this state against
18 that person.
19 5. After October 1, 1980, no agency of state government may
20 appropriate or grant funds to or make payment of any funds to any person or
21 health care facility which has not first obtained every certificate of need
22 required pursuant to sections 197.300 to 197.366.
23 6. A certificate of need shall be issued only for the premises and
24 persons named in the application and is not transferable except by consent of
25 the committee.
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26 7. Project cost increases, due to changes in the project application as
27 approved or due to project change orders, exceeding the initial estimate by
28 more than ten percent shall not be incurred without consent of the committee.
29 8. Periodic reports to the committee shall be required of any applicant
30 who has been granted a certificate of need until the project has been
31 completed. The committee may order the forfeiture of the certificate of need
32 upon failure of the applicant to file any such report.
33 9. A certificate of need shall be subject to forfeiture for failure to incur
34 a capital expenditure on any approved project within six months after the date
35 of the order . The applicant may request an extension from the committee of
36 not more than six additional months based upon substantial expenditure made.
37 10. Each application for a certificate of need must be accompanied by
38 an application fee. The time of filing commences with the receipt of the
39 application and the application fee. The application fee is one thousand
40 dollars, or one-tenth of one percent of the total cost of the proposed project,
41 whichever is greater . All application fees shall be deposited in the state
42 treasury . Because of the loss of federal funds, the general assembly will
43 appropriate funds to the Missouri health facilities review committee.
44 1 1. In determining whether a certificate of need should be granted, no
45 consideration shall be given to the facilities or equipment of any other health
46 care facility located more than a fifteen-mile radius from the applying facility .
47 12. When a nursing facility shifts from a skilled to an intermediate
48 level of nursing care, it may return to the higher level of care if it meets the
49 licensure requirements, without obtaining a certificate of need.
50 13. In no event shall a certificate of need be denied because the
51 applicant refuses to provide abortion services or information.
52 14. A certificate of need shall not be required for the transfer of
53 ownership of an existing and operational health facility in its entirety .
54 15. A certificate of need may be granted to a facility for an expansion,
55 an addition of services, a new institutional service, or for a new hospital
56 facility which provides for something less than that which was sought in the
57 application.
58 16. The provisions of this section shall not apply to facilities operated
59 by the state, and appropriation of funds to such facilities by the general
60 assembly shall be deemed in compliance with this section, and such facilities
61 shall be deemed to have received an appropriate certificate of need without
62 payment of any fee or char ge. The provisions of this subsection shall not
63 apply to hospitals operated by the state and licensed under this chapter , except
64 for department of mental health state-operated psychiatric hospitals.
65 17. Notwithstanding other provisions of this section, a certificate of
66 need may be issued after July 1, 1983, for an intermediate care facility
67 operated exclusively for the intellectually disabled.
68 18. T o assure the safe, appropriate, and cost-ef fective transfer of new
69 medical technology throughout the state, a certificate of need shall not be
70 required for the purchase and operation of:
71 (1) Research equipment that is to be used in a clinical trial that has
72 received written approval from a duly constituted institutional review board of
73 an accredited school of medicine or osteopathy located in Missouri to establish
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74 its safety and ef ficacy and does not increase the bed complement of the
75 institution in which the equipment is to be located. After the clinical trial has
76 been completed, a certificate of need must be obtained for continued use in
77 such facility; or
78 (2) Equipment that is to be used by an academic health center operated
79 by the state in furtherance of its research or teaching missions. ]
[ 197.316. 1. The provisions of subsection 10 of section 197.315 and
2 sections 197.317 and 197.318 shall not apply to facilities which are licensed
3 pursuant to the provisions of chapter 198, which are designed and operated
4 exclusively for the care and treatment of persons with acquired human
5 immunodeficiency syndrome, AIDS.
6 2. If a facility is granted a certificate of need and is found to be exempt
7 from the provisions of subsection 10 of section 197.315 and sections 197.317
8 and 197.318 pursuant to the provisions of subsection 1 of this section, then
9 only AIDS patients shall be residents of such facility and no others.
10 3. Any facility that violates the provisions of subsection 2 of this
11 section shall be liable for a fine of one hundred dollars per resident per day for
12 each such violation.
13 4. The attorney general shall, upon request of the department of health
14 and senior services, bring an action in a circuit court of competent jurisdiction
15 for violation of this section. ]
[ 197.318. 1. As used in this section, the term "licensed and available"
2 means beds which are actually in place and for which a license has been
3 issued.
4 2. The committee shall review all letters of intent and applications for
5 long-term care hospital beds meeting the requirements described in 42 CFR,
6 Section 412.23(e) under its criteria and standards for long-term care beds.
7 3. Sections 197.300 to 197.366 shall not be construed to apply to
8 litigation pending in state court on or before April 1, 1996, in which the
9 Missouri health facilities review committee is a defendant in an action
10 concerning the application of sections 197.300 to 197.366 to long-term care
11 hospital beds meeting the requirements described in 42 CFR, Section 412.23
12 (e).
13 4. Notwithstanding any other provision of this chapter to the contrary:
14 (1) A facility licensed pursuant to chapter 198 may increase its
15 licensed bed capacity by:
16 (a) Submitting a letter of intent to expand to the department of health
17 and senior services and the health facilities review committee;
18 (b) Certification from the department of health and senior services that
19 the facility:
20 a. Has no patient care class I deficiencies within the last eighteen
21 months; and
22 b. Has maintained a ninety-percent average occupancy rate for the
23 previous six quarters;
24 (c) Has made an ef fort to purchase beds for eighteen months following
25 the date the letter of intent to expand is submitted pursuant to paragraph (a) of
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26 this subdivision. For purposes of this paragraph, an "eff ort to purchase" means
27 a copy certified by the of feror as an of fer to purchase beds from another
28 licensed facility in the same licensure category; and
29 (d) If an agreement is reached by the selling and purchasing entities,
30 the health facilities review committee shall issue a certificate of need for the
31 expansion of the purchaser facility upon surrender of the seller's license; or
32 (e) If no agreement is reached by the selling and purchasing entities,
33 the health facilities review committee shall permit an expansion for:
34 a. A facility with more than forty beds may expand its licensed bed
35 capacity within the same licensure category by twenty-five percent or thirty
36 beds, whichever is greater , if that same licensure category in such facility has
37 experienced an average occupancy of ninety-three percent or greater over the
38 previous six quarters;
39 b. A facility with fewer than forty beds may expand its licensed bed
40 capacity within the same licensure category by twenty-five percent or ten beds,
41 whichever is greater , if that same licensure category in such facility has
42 experienced an average occupancy of ninety-two percent or greater over the
43 previous six quarters;
44 c. A facility adding beds pursuant to subparagraphs a. or b. of this
45 paragraph shall not expand by more than fifty percent of its then licensed bed
46 capacity in the qualifying licensure category;
47 (2) Any beds sold shall, for five years from the date of relicensure by
48 the purchaser , remain unlicensed and unused for any long-term care service in
49 the selling facility , whether they do or do not require a license;
50 (3) The beds purchased shall, for two years from the date of purchase,
51 remain in the bed inventory attributed to the selling facility and be considered
52 by the department of social services as licensed and available for purposes of
53 this section;
54 (4) Any residential care facility licensed pursuant to chapter 198 may
55 relocate any portion of such facility's current licensed beds to any other facility
56 to be licensed within the same licensure category if both facilities are under the
57 same licensure ownership or control, and are located within six miles of each
58 other;
59 (5) A facility licensed pursuant to chapter 198 may transfer or sell
60 individual long-term care licensed beds to facilities qualifying pursuant to
61 paragraphs (a) and (b) of subdivision (1) of this subsection. Any facility which
62 transfers or sells licensed beds shall not expand its licensed bed capacity in
63 that licensure category for a period of five years from the date the licensure is
64 relinquished.
65 5. Any existing licensed and operating health care facility offer ing
66 long-term care services may replace one-half of its licensed beds at the same
67 site or a site not more than thirty miles from its current location if, for at least
68 the most recent four consecutive calendar quarters, the facility operates only
69 fifty percent of its then licensed capacity with every resident residing in a
70 private room. In such case:
71 (1) The facility shall report to the health and senior services vacant
72 beds as unavailable for occupancy for at least the most recent four consecutive
73 calendar quarters;
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74 (2) The replacement beds shall be built to private room specifications
75 and only used for single occupancy; and
76 (3) The existing facility and proposed facility shall have the same
77 owner or owners, regardless of corporate or business structure, and such owner
78 or owners shall stipulate in writing that the existing facility beds to be replaced
79 will not later be used to provide long-term care services. If the facility is being
80 operated under a lease, both the lessee and the owner of the existing facility
81 shall stipulate the same in writing.
82 6. Nothing in this section shall prohibit a health care facility licensed
83 pursuant to chapter 198 from being replaced in its entirety within fifteen miles
84 of its existing site so long as the existing facility and proposed or replacement
85 facility have the same owner or owners regardless of corporate or business
86 structure and the health care facility being replaced remains unlicensed and
87 unused for any long-term care services whether they do or do not require a
88 license from the date of licensure of the replacement facility . ]
[ 197.320. The committee shall have the power to promulgate
2 reasonable rules, regulations, criteria and standards in conformity with this
3 section and chapter 536 to meet the objectives of sections 197.300 to 197.366
4 including the power to establish criteria and standards to review new types of
5 equipment or service. Any rule or portion of a rule, as that term is defined in
6 section 536.010, that is created under the authority delegated in sections
7 197.300 to 197.366 shall become ef fective only if it complies with and is
8 subject to all of the provisions of chapter 536 and, if applicable, section
9 536.028. All rulemaking authority delegated prior to August 28, 1999, is of no
10 force and ef fect and repealed. Nothing in this section shall be interpreted to
11 repeal or af fect the validity of any rule filed or adopted prior to August 28,
12 1999, if it fully complied with all applicable provisions of law . This section
13 and chapter 536 are nonseverable and if any of the powers vested with the
14 general assembly pursuant to chapter 536 to review , to delay the ef fective date
15 or to disapprove and annul a rule are subsequently held unconstitutional, then
16 the grant of rulemaking authority and any rule proposed or adopted after
17 August 28, 1999, shall be invalid and void. ]
[ 197.325. Any person who proposes to develop or offer a new
2 institutional health service shall submit a letter of intent to the committee at
3 least thirty days prior to the filing of the application. ]
[ 197.326. 1. Any person who is paid either as part of his or her normal
2 employment or as a lobbyist to support or oppose any project before the health
3 facilities review committee shall register as a lobbyist pursuant to chapter 105
4 and shall also register with the staff of the health facilities review committee
5 for every project in which such person has an interest and indicate whether
6 such person supports or opposes the named project. The registration shall also
7 include the names and addresses of any person, firm, corporation or
8 association that the person registering represents in relation to the named
9 project. Any person violating the provisions of this subsection shall be subject
10 to the penalties specified in section 105.478.
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11 2. A member of the general assembly who also serves as a member of
12 the health facilities review committee is prohibited from soliciting or accepting
13 campaign contributions from any applicant or person speaking for an applicant
14 or any opponent to any application or persons speaking for any opponent while
15 such application is pending before the health facilities review committee.
16 3. Any person regulated by chapter 197 or 198 and any of ficer ,
17 attorney , agent and employee thereof, shall not of fer to any committee member
18 or to any person employed as staf f to the committee, any of fice, appointment
19 or position, or any present, gift, entertainment or gratuity of any kind or any
20 campaign contribution while such application is pending before the health
21 facilities review committee. Any person guilty of knowingly violating the
22 provisions of this section shall be punished as follows: For the first offense,
23 such person is guilty of a class B misdemeanor; and for the second and
24 subsequent of fenses, such person is guilty of a class E felony . ]
[ 197.327. 1. If a facility is granted a certificate of need pursuant to
2 sections 197.300 to 197.365 based on an application stating a need for
3 additional Medicaid beds, such beds shall be used for Medicaid patients and no
4 other .
5 2. Any person who violates the provisions of subsection 1 of this
6 section shall be liable to the state for civil penalties of one hundred dollars for
7 every day of such violation. Each nonMedicaid patient placed in a Medicaid
8 bed shall constitute a separate violation.
9 3. The attorney general shall, upon the request of the department, bring
10 an action in a circuit court of competent jurisdiction to recover the civil
11 penalty . The department may bring such an action itself. The civil action may
12 be brought in the circuit court of Cole County or , at the option of the director ,
13 in another county which has venue of an action against the person under other
14 provisions of law . ]
[ 197.330. 1. The committee shall:
2 (1) Notify the applicant within fifteen days of the date of filing of an
3 application as to the completeness of such application;
4 (2) Provide written notification to af fected persons located within this
5 state at the beginning of a review . This notification may be given through
6 publication of the review schedule in all newspapers of general circulation in
7 the area to be served;
8 (3) Hold public hearings on all applications when a request in writing
9 is filed by any af fected person within thirty days from the date of publication
10 of the notification of review;
11 (4) W ithin one hundred days of the filing of any application for a
12 certificate of need, issue in writing its findings of fact, conclusions of law , and
13 its approval or denial of the certificate of need; provided, that the committee
14 may grant an extension of not more than thirty days on its own initiative or
15 upon the written request of any affected person;
16 (5) Cause to be served upon the applicant, the respective health system
17 agency , and any af fected person who has filed his prior request in writing, a
18 copy of the aforesaid findings, conclusions and decisions;
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19 (6) Consider the needs and circumstances of institutions providing
20 training programs for health personnel;
21 (7) Provide for the availability , based on demonstrated need, of both
22 medical and osteopathic facilities and services to protect the freedom of patient
23 choice; and
24 (8) Establish by regulation procedures to review , or grant a waiver
25 from review , nonsubstantive projects.
26
27 The term "filed" or "filing" as used in this section shall mean delivery to the
28 staf f of the health facilities review committee the document or documents the
29 applicant believes constitute an application.
30 2. Failure by the committee to issue a written decision on an
31 application for a certificate of need within the time required by this section
32 shall constitute approval of and final administrative action on the application,
33 and is subject to appeal pursuant to section 197.335 only on the question of
34 approval by operation of law . ]
[ 197.335. W ithin thirty days of the decision of the committee, the
2 applicant may file an appeal to be heard de novo by the administrative hearing
3 commissioner , the circuit court of Cole County or the circuit court in the
4 county within which such health care service or facility is proposed to be
5 developed. ]
[ 197.340. Any health facility providing a health service must notify
2 the committee of any discontinuance of any previously provided health care
3 service, a decrease in the number of licensed beds by ten percent or more, or
4 the change in licensure category for any such facility . ]
[ 197.345. Any health facility with a project for facilities or services for
2 which a binding construction or purchase contract has been executed prior to
3 October 1, 1980, or health care facility which has commenced operations prior
4 to October 1, 1980, shall be deemed to have received a certificate of need,
5 except that such certificate of need shall be subject to forfeiture under the
6 provisions of subsections 8 and 9 of section 197.315. ]
[ 197.355. The legislature may not appropriate any money for capital
2 expenditures for health care facilities until a certificate of need has been issued
3 for such expenditures. ]
[ 197.357. For the purposes of reimbursement under section 208.152,
2 project costs for new institutional health services in excess of ten percent of
3 the initial project estimate whether or not approval was obtained under
4 subsection 7 of section 197.315 shall not be eligible for reimbursement for the
5 first three years that a facility receives payment for services provided under
6 section 208.152. The initial estimate shall be that amount for which the
7 original certificate of need was obtained or , in the case of facilities for which a
8 binding construction or purchase contract was executed prior to October 1,
9 1980, the amount of that contract. Reimbursement for these excess costs after
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10 the first three years shall not be made until a certificate of need has been
11 granted for the excess project costs. The provisions of this section shall apply
12 only to facilities which file an application for a certificate of need or make
13 application for cost-overrun review of their original application or waiver after
14 August 13, 1982. ]
[ 197.366. The term "health care facilities" in sections 197.300 to
2 197.366 shall mean:
3 (1) Facilities licensed under chapter 198;
4 (2) Long-term care beds in a hospital as described in subdivision (3) of
5 subsection 1 of section 198.012;
6 (3) Long-term care hospitals or beds in a long-term care hospital
7 meeting the requirements described in 42 CFR, section 412.23(e); and
8 (4) Construction of a new hospital as defined in chapter 197. ]
[ 197.367. Upon application for renewal by any residential care facility
2 or assisted living facility which on the ef fective date of this act has been
3 licensed for more than five years, is licensed for more than fifty beds and fails
4 to maintain for any calendar year its occupancy level above thirty percent of its
5 then licensed beds, the department of health and senior services shall license
6 only fifty beds for such facility . ]
✔
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