EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
[TRULY AGREED TO AND FINALLY PASSED ]
SENATE SUBSTITUTE FOR
SENATE BILL NO. 1111
102ND GENERAL ASSEMBLY
2024
4268S.03T
AN ACT
To repeal sections 210.201, 210.211, 210.252, and 210.275, RSMo, and to enact in lieu thereof ten
new sections relating to the regulation of child care.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 210.201, 210.211, 210.252, and 1
210.275, RSMo, are repealed and ten new sections enacted in 2
lieu thereof, to be known as sections 192.2550, 192.2552, 3
192.2554, 192.2556, 192.2558, 192.2560, 210.201, 210.211, 4
210.252, and 210.275, to read as follows:5
192.2550. As used in sections 192.2550 to 192.2560, 1
the following terms mean: 2
(1) "Child", an individual who is under the age of 3
seventeen; 4
(2) "Department", the department of health and senior 5
services; 6
(3) "Eligible child", an individual who is under the 7
age of six years and has complex medical needs requiring 8
continuous skilled nursi ng intervention of at least four 9
hours per day, as ordered by a physician; 10
(4) "Person", any individual, firm, corporation, 11
partnership, association, agency, incorporated or 12
unincorporated organization, or other legal entity, 13
regardless of the na me used; 14 SS SB 1111 2
(5) "Prescribed pediatric extended care facility", a 15
facility providing medically necessary multidisciplinary 16
services to eligible children in a child care facility 17
licensed by the department of elementary and secondary 18
education under chapter 210. Multidisciplinary services 19
include skilled nursing, personal care, nutritional 20
assessment, developmental assessment, and speech, physical, 21
and occupational therapy services, as ordered by a physician; 22
(6) "Prescribed pediatric extende d care provider" or 23
"provider", the person or persons licensed or required to be 24
licensed under sections 192.2550 to 192.2560 to establish, 25
conduct, or maintain, a prescribed pediatric extended care 26
facility. 27
192.2552. 1. Beginning on August 28, 2025, it shall 1
be unlawful for any person to establish, maintain, or 2
operate a prescribed pediatric extended care facility, or to 3
advertise or hold himself or herself out as being able to 4
perform any of the services of a prescribed pedia tric 5
extended care facility, without having in effect a written 6
license granted by the department. 7
2. Nothing in sections 192.2550 to 192.2560 shall be 8
construed to apply to: 9
(1) Any child care facility that provides care to 10
eligible children with a caregiver staffing ratio of not 11
fewer than one licensed nurse present for every one eligible 12
child present, unless said facility voluntarily applies for 13
licensure as a prescribed pediatric extended care facility; 14
(2) Any hospital, sanita rium, or home that is 15
conducted in good faith primarily to provide medical 16
treatment or nursing or convalescent care for children; or 17
(3) Any program licensed by the department of mental 18
health under sections 630.705 to 630.760 that provides care, 19 SS SB 1111 3
treatment, and habilitation exclusively to children who have 20
a primary diagnosis of mental disorder, mental illness, 21
intellectual disability, or developmental disability, as 22
those terms are defined in section 630.005. 23
192.2554. 1. The department shall have the following 1
powers and duties: 2
(1) After inspection, to grant licenses to persons to 3
operate prescribed pediatric extended care facilities if 4
satisfied as to the good character and intent of the 5
applicant and that suc h applicant is qualified and equipped 6
to render care or service conducive to the welfare of 7
children; 8
(2) To inspect the conditions of the places in which 9
the applicant operates a prescribed pediatric extended care 10
facility; inspect their books a nd records, premises, and 11
numbers of children to be served, provided that the 12
department shall not interview a child without the consent 13
of the child's parents or guardian; examine their officers 14
and agents; and deny, immediately suspend, place on 15
probation, or revoke the license of such persons as fail to 16
obey the provisions of sections 192.2550 to 192.2560. The 17
director may revoke or suspend a license when the licensee 18
surrenders the license; and 19
(3) To promulgate rules and regulations the department 20
deems necessary or proper in order to establish standards of 21
service and care to be rendered by such licensees to 22
children. Such rules and regulations shall include, at a 23
minimum, requirements related to the following: 24
(a) Staffing; 25
(b) Fire safety; 26
(c) Sanitation, including infection control; 27
(d) Equipment; and 28 SS SB 1111 4
(e) Record keeping. 29
2. (1) The department shall have the right to enter 30
the premises of any prescribed pediatric extended care 31
facility or potential facility pursuant to an announced 32
inspection at any time during the hours of operation of a 33
facility to determine compliance with sections 192.2550 to 34
192.2560 and applicable rules promulgated pursuant thereto. 35
Entry shall also be granted for in vestigative purposes 36
involving complaints regarding the operations of a 37
prescribed pediatric extended care facility. The department 38
may make inspections, announced to the applicant for or 39
holder of a license twenty -four hours in advance of the 40
inspection, as it deems necessary to carry out the 41
provisions of sections 192.2550 to 192.2560. 42
(2) Notwithstanding the provisions of subdivision (1) 43
of this subsection, the department may make unannounced 44
inspections as necessary to investigate allegat ions of abuse 45
or neglect of a child served by the facility. 46
3. The applicant for or holder of a license shall 47
cooperate with the investigation and inspection. 48
4. Failure to comply with any lawful request of the 49
department in connection with the investigation and 50
inspection is a ground for refusal to issue a license or for 51
the revocation of a license. 52
5. Any prescribed pediatric extended care facility may 53
request a variance from a rule or regulation promulgated 54
pursuant to sections 1 92.2550 to 192.2560. The request for 55
a variance shall be made in writing to the department and 56
shall include the reasons the facility is requesting the 57
variance. The department shall not approve any variance 58
request that endangers the health or safet y of the children 59
served by the facility. 60 SS SB 1111 5
6. Any rule or portion of a rule, as that term is 61
defined in section 536.010, that is created under the 62
authority delegated in sections 192.2550 to 192.2560 shall 63
become effective only if it complies with and is subject to 64
all of the provisions of chapter 536 and, if applicable, 65
section 536.028. This section and chapter 536 are 66
nonseverable and if any of the powers vested with the 67
general assembly pursuant to chapter 536 to review, to delay 68
the effective date, or to disapprove and annul a rule are 69
subsequently held unconstitutional, then the grant of 70
rulemaking authority and any rule proposed or adopted after 71
August 28, 2024, shall be invalid and void. 72
192.2556. 1. All applicants for or holders of a 1
license to operate a prescribed pediatric extended care 2
facility shall have an active, nonsuspended license to 3
operate a child care facility issued by the department of 4
elementary and secondary education. 5
2. All persons employed by the prescribed pediatric 6
extended care facility for compensation, including contract 7
employees or self-employed individuals, and individuals or 8
volunteers whose activities involve the care or supervision 9
of children for a prescribed pediatric extended care 10
provider or unsupervised access to children who are cared 11
for or supervised by a prescribed pediatric extended care 12
provider shall be considered a child care staff member, as 13
that term is defined in section 210.1080, and shall comply 14
with all requirements under that section and regulations 15
promulgated pursuant thereto. 16
192.2558. 1. If the department proposes to deny, 1
place on probation, or revoke a license, the department 2
shall serve upon the applicant or licensee written notice of 3
the proposed action to be taken. The notice shall contain a 4 SS SB 1111 6
statement of the type of action proposed, the basis for it, 5
the date the action will become effective, and a statement 6
that the applicant or licensee shall have thirty days to 7
request in writing a hearing before the administrative 8
hearing commission and that such request shall be made to 9
the department. If no written request for a hearing is 10
received by the department within thirty days of the 11
delivery or mailing by cer tified mail of the notice to the 12
applicant or licensee, then the proposed discipline shall 13
take effect on the thirty -first day after such delivery or 14
mailing of the notice to the applicant or licensee. If the 15
applicant or licensee makes a written requ est for a hearing, 16
the department shall file a complaint with the 17
administrative hearing commission within thirty days of 18
receipt of the request for a hearing. 19
2. The department shall immediately suspend and 20
propose to revoke any prescribed pedia tric extended care 21
facility license if the department of elementary and 22
secondary education immediately suspends the licensee's 23
license to operate a child care facility. The immediate 24
suspension of the license to operate a child care facility 25
shall be sufficient grounds for the department of health and 26
senior services to immediately suspend and revoke the 27
prescribed pediatric extended care license. 28
3. The department shall immediately suspend and 29
propose to revoke any prescribed pediatric exte nded care 30
license if the department of elementary and secondary 31
education revokes the licensee's license to operate a child 32
care facility. The revocation of the license to operate a 33
child care facility shall be sufficient grounds for the 34
department of health and senior services to immediately 35 SS SB 1111 7
suspend and revoke the prescribed pediatric extended care 36
license. 37
4. The department may immediately suspend any license 38
simultaneously with the notice of the proposed action to be 39
taken in subsection 1 of this section if the department 40
finds that there is a threat of imminent bodily harm to the 41
children in the care of the prescribed pediatric extended 42
care facility. 43
5. The notice of immediate suspension shall include 44
the basis of the immediate suspension and the appeal rights 45
of the licensee pursuant to this section. The licensee may 46
appeal the decision to immediately suspend the license to 47
the department. The appeal shall be filed within ten days 48
from the delivery or mailing by certified mail of the notice 49
of appeal. A hearing shall be conducted by the department 50
within fifteen days from the date the appeal is filed. The 51
immediate suspension shall continue in effect until the 52
conclusion of the proceedings, including review thereof, 53
unless sooner withdrawn by the department or stayed by a 54
court of competent jurisdiction. 55
6. Any person aggrieved by a final decision of the 56
department made in the administration of sections 192.2550 57
to 192.2560 shall be entitled to judicial revi ew thereof as 58
provided in chapter 536. 59
7. In cases of imminent bodily harm to children in the 60
care of a prescribed pediatric extended care facility, 61
including an unlicensed facility not exempt under section 62
192.2552, the department may file suit in the circuit court 63
of the county in which the prescribed pediatric extended 64
care facility is located for injunctive relief, which may 65
include removing children from the facility, overseeing the 66
operation of the facility, or closing the facility. The 67 SS SB 1111 8
department may request that the attorney general bring the 68
action in place of the department. Failure by the 69
department to file suit under the provisions of this 70
subsection shall not be construed as creating any civil 71
liability or incurring other ob ligations or duties, except 72
as otherwise specified. 73
192.2560. 1. Nothing contained in sections 192.2550 1
to 192.2560 shall permit the public disclosure by the 2
department of confidential medical, social, personal, or 3
financial records of any child in the care of any prescribed 4
pediatric extended care facility, except when disclosed in a 5
manner which does not identify any child or when ordered to 6
do so by a court of competent jurisdiction. Such records 7
shall be accessible without court order for examination and 8
copying only to the following persons or offices, or to 9
their designees: 10
(1) The department or any person or agency designated 11
by the department; 12
(2) The department of elementary and secondary 13
education or any person or agency designated by the 14
department of elementary and secondary education; 15
(3) The department of social services or any person or 16
agency designated by the department of social services; 17
(4) The attorney general; 18
(5) Any appropriate law enforcement agency; 19
(6) Any appropriate prosecutor's office; and 20
(7) The child's parent or guardian, or any other 21
person designated by the child's parent or guardian. 22
2. Inspection reports and written reports of 23
investigations of complaints and complaints received by the 24
department relating to the quality of care of children in 25
the care of a prescribed pediatric extended care provider 26 SS SB 1111 9
shall be accessible to the public for examination and 27
copying, provided that such report s are disclosed in a 28
manner which does not identify the complainant or any 29
particular child. 30
210.201. As used in sections 210.201 to 210.257, the 1
following terms mean: 2
(1) "Child", an individual who is under the age of 3
seventeen; 4
(2) "Child care", care of a child away from his or her 5
home for any part of the twenty -four-hour day for 6
compensation or otherwise. Child care is a voluntary 7
supplement to parental responsibility for the child's 8
protection, development, and s upervision; 9
(3) "Child-care facility" or "child care facility", a 10
house or other place conducted or maintained by any person 11
who advertises or holds himself or herself out as providing 12
child care for any part of the twenty -four-hour day for 13
compensation or otherwise if providing child care to more 14
than: 15
(a) Six children; or 16
(b) Three children under two years of age; 17
(4) "Child care provider" or "provider", the person or 18
persons licensed or required to be licensed under section 19
210.221 to establish, conduct, or maintain a child care 20
facility; 21
(5) "Day camp", a program operated by a person or 22
organization between the hours of 6:00 a.m. and 7:00 p.m., 23
when a local school system is not in session requiring 24
actual pupil attendance, and with the primary function of 25
providing a recreational program for children five years of 26
age or older who are enrolled in kindergarten or any grade 27
above kindergarten, but providing no child care for children 28 SS SB 1111 10
under five years of age who a re not yet enrolled in 29
kindergarten in the same space or in the same outdoor play 30
area simultaneously; 31
(6) "Montessori school", a child care program that is 32
either accredited by, actively seeking accreditation by, or 33
maintains an active school me mbership with the American 34
Montessori Society, the Association Montessori 35
Internationale, the International Montessori Counsel, or the 36
Montessori Educational Programs International; 37
(7) "Neighborhood youth development program", as 38
described in section 210.278; 39
(8) "Nursery school", a program operated by a person 40
or an organization with the primary function of providing an 41
educational program for preschool -age children for no more 42
than four hours per day per child; 43
(9) "Person", any individual, firm, corporation, 44
partnership, association, agency, or an incorporated or 45
unincorporated organization regardless of the name used; 46
(10) "Religious organization", a church, synagogue or 47
mosque; an entity that has or would qualify for f ederal tax- 48
exempt status as a nonprofit religious organization under 49
Section 501(c) of the Internal Revenue Code; or an entity 50
whose real estate on which the child -care facility is 51
located is exempt from taxation because it is used for 52
religious purposes; 53
(11) "School-age child", any child five years of age 54
or older who is in kindergarten or above; 55
(12) "School system", a program established primarily 56
for education and that meets the following criteria: 57
(a) Provides education in at least the first to the 58
sixth grade; and 59 SS SB 1111 11
(b) Provides evidence that the school system's records 60
will be accepted by a public or private school for the 61
transfer of any student; 62
[(12)] (13) "Summer camp", a program operated from May 63
to September by a person or organization with the primary 64
function of providing a summer recreational program for 65
children five years of age or older and providing no child 66
care for children under five years of age in the same space 67
or in the same outdoor play a rea simultaneously. 68
210.211. 1. It shall be unlawful for any person to 1
establish, maintain or operate a child -care facility for 2
children, or to advertise or hold himself or herself out as 3
being able to perform any of the services as defined in 4
section 210.201, without having in effect a written license 5
granted by the department of elementary and secondary 6
education; except that nothing in sections 210.203 to 7
210.245 shall apply to: 8
(1) Any person who is caring for six or few er 9
children, including a maximum of three children under the 10
age of two, at the same physical address. For purposes of 11
this subdivision, children who live in the caregiver's home 12
and who are eligible for enrollment in a public 13
kindergarten, elementar y, or high school shall not be 14
considered in the total number of children being cared for; 15
(2) Any person who receives free of charge, and not as 16
a business, for periods not exceeding ninety consecutive 17
days, as bona fide, occasional and personal guests the child 18
or children of personal friends of such person, and who 19
receives custody of no other unrelated child or children; 20
(3) Any graded boarding school that is conducted in 21
good faith primarily to provide education; 22 SS SB 1111 12
(4) Any summer or day camp that is conducted in good 23
faith primarily to provide recreation; 24
(5) Any hospital, sanitarium, or home that is 25
conducted in good faith primarily to provide medical 26
treatment or nursing or convalescent care for children; 27
(6) Any residential facility or day program licensed 28
by the department of mental health under sections 630.705 to 29
630.760 that provides care, treatment, and habilitation 30
exclusively to children who have a primary diagnosis of 31
mental disorder, mental illness, in tellectual disability, or 32
developmental disability, as those terms are defined in 33
section 630.005; 34
(7) Any school system as defined in section 210.201; 35
(8) Any Montessori school as defined in section 36
210.201; 37
(9) Any business that oper ates a child care program 38
for the convenience of its customers or its employees if the 39
following conditions are met: 40
(a) The business provides child care for customers' or 41
employees' children for no more than four hours per day; and 42
(b) Customers or employees remain on site while their 43
children are being cared for by the business establishment; 44
(10) Any home school as defined in section 167.031; 45
(11) Any religious organization academic preschool or 46
kindergarten for four - and five-year-old children; 47
(12) Any weekly Sunday or Sabbath school, a vacation 48
bible school, or child care made available while the parents 49
or guardians are attending worship services or other 50
meetings and activities conducted or sponsored by a 51
religious organization; 52
(13) Any neighborhood youth development program under 53
section 210.278; 54 SS SB 1111 13
(14) Any program serving only children enrolled in 55
grade six or above; 56
(15) Any religious organization elementary or 57
secondary school; 58
[(15)] (16) Any private organization elementary or 59
secondary school system providing child care to children 60
younger than school age. If a facility or program is exempt 61
from licensure based upon this exception, such facility or 62
program shall submit document ation annually to the 63
department to verify its licensure -exempt status; 64
[(16)] (17) Any nursery school as defined in section 65
210.201; and 66
[(17)] (18) Any child care facility maintained or 67
operated under the exclusive control of a religious 68
organization. If a nonreligious organization having as its 69
principal purpose the provision of child care services 70
enters into an arrangement with a religious organization for 71
the maintenance or operation of a child care facility, the 72
facility is not under the exclusive control of the religious 73
organization. 74
2. Notwithstanding the provisions of subsection 1 of 75
this section, no child -care facility shall be exempt from 76
licensure if such facility receives any state or federal 77
funds for providing care for children, except for federal 78
funds for those programs which meet the requirements for 79
participation in the Child and Adult Care Food Program 80
pursuant to 42 U.S.C. Section 1766. Grants to parents for 81
child care pursuant to sections 210.201 to 210.257 shall not 82
be construed to be funds received by a person or facility 83
listed in subdivisions (1) and [(17)] (18) of subsection 1 84
of this section. 85 SS SB 1111 14
3. Every child care facility shall disclose the 86
licensure status of the facility to the parent s or guardians 87
of children for which the facility provides care. No child 88
care facility exempt from licensure shall represent to any 89
parent or guardian of children for which the facility 90
provides care that the facility is licensed when such 91
facility is in fact not licensed. A parent or guardian 92
utilizing an unlicensed child care facility shall sign a 93
written notice indicating he or she is aware of the 94
unlicensed status of the facility. The facility shall keep 95
a copy of this signed written notice on file. All child 96
care facilities shall provide the parent or guardian 97
enrolling a child in the facility with a written explanation 98
of the disciplinary philosophy and policies of the child 99
care facility. 100
4. Up to two children who are five year s of age or 101
older and who are related within the third degree of 102
consanguinity or affinity to, adopted by, or under court 103
appointed guardianship or legal custody of a child care 104
provider who is responsible for the daily operation of a 105
licensed family child care home that is organized as a 106
corporation, association, firm, partnership, limited 107
liability company, sole proprietorship, or any other type of 108
business entity in this state shall not be included in the 109
number of children counted toward the ma ximum number of 110
children for which the family child care home is licensed 111
under section 210.221. If more than one member of the 112
corporation, association, firm, partnership, limited 113
liability company, or other business entity is responsible 114
for the daily operation of the licensed family child care 115
home, then the related children of only one such member 116
shall be excluded. A family child care home caring for 117 SS SB 1111 15
children not counted in the maximum number of children, as 118
permitted under this subsection, shall disclose this to 119
parents or guardians on the written notice required under 120
subsection 3 of this section. If a family child care home 121
begins caring for children not counted in the maximum number 122
of children after a parent or guardian has signed t he 123
written notice required under subsection 3 of this section, 124
the family child care home shall provide a separate notice 125
to the parent or guardian that the family child care home is 126
caring for children not counted in the maximum number of 127
children for which the family child care home is licensed 128
and shall keep a copy of the signed notice on file. 129
5. Nothing in this section shall prevent the 130
department from enforcing licensing regulations promulgated 131
under this chapter, including, but not limi ted to, 132
supervision requirements and capacity limitations based on 133
the amount of child care space available. 134
210.252. 1. All buildings and premises used by a 1
child-care facility to care for more than six children 2
except those exempted from the licensing provisions of the 3
department of elementary and secondary education pursuant to 4
subdivisions (1) to [(15)] (16) of subsection 1 of section 5
210.211, shall be inspected annually for fire and safety by 6
the state fire marshal, the mar shal's designee or officials 7
of a local fire district and for health and sanitation by 8
the department of elementary and secondary education or the 9
department's designee, including officials of the department 10
of health and senior services, or officials of the local 11
health department. Evidence of compliance with the 12
inspections required by this section shall be kept on file 13
and available to parents of children enrolling in the child - 14
care facility. 15 SS SB 1111 16
2. Local inspection of child -care facilities may be 16
accomplished if the standards employed by local personnel 17
are substantially equivalent to state standards and local 18
personnel are available for enforcement of such standards. 19
3. Any child-care facility may request a variance from 20
a rule or regulation promulgated pursuant to this section. 21
The request for a variance shall be made in writing to the 22
department of elementary and secondary education and shall 23
include the reasons the facility is requesting the variance. 24
The department shall ap prove any variance request that does 25
not endanger the health or safety of the children served by 26
the facility. The burden of proof at any appeal of a 27
disapproval of a variance application shall be with the 28
department of elementary and secondary educat ion. Local 29
inspectors may grant a variance, subject to approval by the 30
department of elementary and secondary education. 31
4. The department of elementary and secondary 32
education shall administer the provisions of sections 33
210.252 to 210.256, with the cooperation of the state fire 34
marshal, the department of health and senior services, local 35
fire departments and local health agencies. 36
5. The department of elementary and secondary 37
education shall promulgate rules and regulations to 38
implement and administer the provisions of sections 210.252 39
to 210.256. Such rules and regulations shall provide for 40
the protection of children in all child -care facilities 41
whether or not such facility is subject to the licensing 42
provisions of sections 210.20 1 to 210.245. 43
6. The department of health and senior services, after 44
consultation with the department of elementary and secondary 45
education, may promulgate rules and regulations to implement 46
and administer the provisions of this section related to 47 SS SB 1111 17
sanitation requirements. Such rules and regulations shall 48
provide for the protection of children in all child -care 49
facilities whether or not such facility is subject to the 50
licensing provisions of sections 210.201 to 210.245. 51
7. Any rule or portion of a rule, as that term is 52
defined in section 536.010, that is created under the 53
authority delegated in sections 210.252 to 210.256 shall 54
become effective only if it complies with and is subject to 55
all of the provisions of chapter 536 and, if appl icable, 56
section 536.028. All rulemaking authority delegated prior 57
to August 28, 1999, is of no force and effect and repealed. 58
Nothing in this section shall be interpreted to repeal or 59
affect the validity of any rule filed or adopted prior to 60
August 28, 1999, if it fully complied with all applicable 61
provisions of law. This section and chapter 536 are 62
nonseverable and if any of the powers vested with the 63
general assembly pursuant to chapter 536 to review, to delay 64
the effective date or to disappro ve and annul a rule are 65
subsequently held unconstitutional, then the grant of 66
rulemaking authority and any rule proposed or adopted after 67
August 28, 1999, shall be invalid and void. 68
210.275. Any program licensed by the department of 1
elementary and secondary education pursuant to this chapter 2
providing child care to only school-age children [that is 3
located and operated on elementary or secondary school 4
property] shall comply with the child -care licensure 5
provisions in this chapte r; except that, for safety, health 6
and fire purposes, all buildings and premises for any such 7
programs shall be deemed to be in compliance with the child - 8
care licensure provisions in this chapter. 9