FIRSTREGULARSESSION
HOUSEBILLNO.1240
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEOVERCAST.
2787H.01I JOSEPHENGLER,ChiefClerk
ANACT
Torepealsections197.300,197.305,197.310,197.311,197.312,197.315,197.316,197.318,
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,and208.225,RSMo,andto
enactinlieuthereoffournewsectionsrelatingtocertificatesofneed.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections197.300,197.305,197.310,197.311,197.312,197.315,197.316,
2197.318,197.320,197.325,197.326,197.327,197.330,197.335,197.340,197.345,197.355,
3197.357,197.366,197.367,197.705,198.530,208.169,and208.225,RSMo,arerepealedand
4fournewsectionsenactedinlieuthereof,tobeknownassections197.705,198.530,208.169,
5and208.225,toreadasfollows:
197.705.1.Forpurposesofthissection,theterm"healthcarefacilities"means:
2 (1)Facilitieslicensedunderchapter198;
3 (2)Long-termcarebedsinahospitalasdescribedinsubdivision(3)of
4subsection1ofsection198.012;and
5 (3)Long-termcarehospitalsorbedsinalong-termcarehospitalmeetingthe
6requirementsdescribedin42CFR412.23(e).
7 2.Allhospitals, asdefinedinsection197.020,andhealthcarefacilities[, definedin
8sections197.020and197.305,] shallrequireallpersonnelprovidingservicesinsuchfacilities
9towearidentificationbadgeswhileactingwithinthescopeoftheiremployment.The
10identificationbadgesofallpersonnelshallprominentlydisplaythelicensurestatusofsuch
11personnel.
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 198.530.1.Forpurposesofthissection,theterm"continuingcareretirement
2community"meansacommunitythatprovidesatthesamesiteorlocationindependent
3housing,long-termhealthcare,andotherservicestoolderpersonsnotrelatedbyblood
4ormarriagetotheowneroroperatorofthecommunityunderanagreementeffective
5forthelifeofthepersonoraspecifiedperiodoftimeinexcessofoneyearthat
6guaranteesorprovidespriorityaccesstoon-sitehealth-relatedlong-termcareservices
7whenneeded.
8 2.Ifanenrolleeinamanagedcareorganizationisalsoaresidentinalong-termcare
9facilitylicensedpursuanttochapter198,oracontinuingcareretirementcommunity[, as
10definedinsection197.305], suchenrollee'smanagedcareorganizationshallprovidethe
11enrolleewiththeoptionofreceivingthecoveredserviceinthelong-termcarefacilitywhich
12servesastheenrollee'sprimaryresidence.Forpurposesofthissection,"managedcare
13organization"meansanyorganizationthatoffersanyhealthplancertifiedbythedepartment
14ofhealthandseniorservicesdesignedtoprovideincentivestomedicalcareprovidersto
15managethecostanduseofcareassociatedwithclaims,including,butnotlimitedto,ahealth
16maintenanceorganizationandpreferredproviderorganization.Theresidentenrollee's
17managedcareorganizationshallreimbursetheresidentfacilityforthoseserviceswhich
18wouldotherwisebecoveredbythemanagedcareorganizationifthefollowingconditions
19apply:
20 (1)Thefacilityiswillingandabletoprovidetheservicestotheresident;and
21 (2)Thefacilityandthosehealthcareprofessionalsdeliveringservicestoresidents
22pursuanttothissectionmeetthelicensingandtrainingstandardsasprescribedbylaw;and
23 (3)ThefacilityiscertifiedthroughMedicare;and
24 (4)Thefacilityandthosehealthcareprofessionalsdeliveringservicestoresidents
25pursuanttothissectionagreetoabidebythetermsandconditionsofthehealthcarrier's
26contractswithsimilarproviders,abidebypatientprotectionstandardsandrequirements
27imposedbystateorfederallawforplanenrolleesandmeetthequalitystandardsestablished
28bythehealthcarrierforsimilarproviders.
29 [2.]3.Themanagedcareorganizationshallreimbursetheresidentfacilityatarateof
30reimbursementnotlessthantheMedicareallowableratepursuanttoMedicarerulesand
31regulations.
32 [3.]4.Theservicesinsubsection[1]2ofthissectionshallinclude,butarenotlimited
33to,skillednursingcare,rehabilitativeandothertherapyservices,andpostacutecare,as
34needed.Nothinginthissectionshalllimitthemanagedcareorganizationfromutilizing
35contractedproviderstodelivertheservicesintheenrollee'sresidentfacility.
36 [4.]5.Aresidentfacilityshallnotprohibitahealthcarrier'sparticipatingproviders
37fromprovidingcoveredbenefitstoanenrolleeintheresidentfacility.Aresidentfacilityor
HB1240 2 38healthcareprofessionalshallnotimposeanychargesonanenrolleeforanyservicethatis
39ancillaryto,acomponentof,orinsupportoftheservicesprovidedunderthissectionwhen
40theservicesareprovidedbyahealthcarrier'sparticipatingprovider,orotherwisecreatea
41disincentivefortheuseofthehealthcarrier'sparticipatingproviders.Anyviolationofthe
42requirementsofthissubsectionbytheresidentfacilityshallbeconsideredabuseorneglectof
43theresidentenrollee.
208.169.[1.]Notwithstandingotherprovisionsofthischapter,includingbutnot
2limitedtosections208.152,208.153,208.159and208.162[:
3 (1)Thereshallbenorevisionstoafacility'sreimbursementrateforprovidingnursing
4careservicesunderthischapteruponachangeinownership,managementcontrol,operation,
5stock,leaseholdinterestsbywhateverformforanyfacilitypreviouslylicensedorcertifiedfor
6participationintheMedicaidprogram.Increasedcostsforthesuccessorowner,management
7orleaseholderthatresultfromsuchachangeshallnotberecognizedforpurposesof
8reimbursement;
9 (2)Inthecaseofanewlybuiltfacilityorpartthereofwhichislessthantwoyearsof
10ageandenterstheTitleXIXprogramunderthischapterafterJuly1,1983,areimbursement
11rateshallbeassignedbasedonthelesserofprojectedestimatedoperatingcostsorone
12hundredtenpercentofthemedianrateforthefacility'sclasstoincludeurbanandrural
13categoriesforeachlevelofcareincludingICFonlyandSNF/ICF.Theratessetunderthis
14provisionshallbeeffectiveforaperiodoftwelvemonthsfromtheeffectivedateofthe
15provideragreementatwhichtimetherateforthefutureyearshallbesetinaccordancewith
16reportedcostsofthefacilityrecognizedunderthereimbursementplanandasprovidedin
17subdivisions(3)and(4)ofthissubsection.Ratessetunderthissectionmayinnocaseexceed
18themaximumceilingamountsineffectunderthereimbursementregulation;
19 (3)Reimbursementforcapitalrelatedexpensesfornewlybuiltfacilitiesenteringthe
20TitleXIXprogramafterMarch18,1983,shallbecalculatedasthebuildingandbuilding
21equipmentrate,movableequipmentrate,landrate,andworkingcapitalrate.
22 (a)Thebuildingandbuildingequipmentratewillbethelowerof:
23 a.Actualacquisitioncosts,whichistheoriginalcosttoconstructoracquirethe
24building,nottoexceedthecostsasdeterminedinsection197.357;or
25 b.Reasonableconstructionoracquisitioncostcomputedbyapplyingtheregional
26DodgeConstructionIndexfor1981withatrendfactor,ifnecessary,oranothercurrent
27constructioncostmeasuremultipliedbyonehundredeightpercentasanallowanceforfees
28authorizedasarchitecturalorlegalnotincludedintheDodgeIndexValue,multipliedbythe
29squarefootageofthefacilitynottoexceedthreehundredtwenty-fivesquarefeetperbed,
30multipliedbytheratiooffortyminustheactualyearsoftheageofthefacilitydividedby
HB1240 3 31forty;andmultipliedbyareturnrateoftwelvepercent;anddividedbyninety-threepercentof
32thefacility'stotalavailablebedstimesthreehundredsixty-fivedays.
33 (b)Themaximummovableequipmentratewillbefifty-threecentsperbedday.
34 (c)Themaximumallowablelandareaisdefinedasfiveacresforafacilitywithone
35hundredorlessbedsandoneadditionalacreforeachadditionalonehundredbedsorfraction
36thereofforafacilitywithonehundredoneormorebeds.
37 (d)Thelandratewillbecalculatedas:
38 a.Forfacilitieswithlandareasatorbelowthemaximumallowablelandarea,
39multiplytheacquisitioncostofthelandbythereturnrateoftwelvepercent,dividebyninety-
40threepercentofthefacility'stotalavailablebedstimesthreehundredsixty-fivedays.
41 b.Forfacilitieswithlandareasgreaterthanthemaximumallowablelandarea,divide
42theacquisitioncostofthelandbythetotalacres,multiplybythemaximumallowableland
43area,multiplybythereturnrateoftwelvepercent,dividebyninety-threepercentofthe
44facility'stotalavailablebedstimesthreehundredsixty-fivedays.
45 (e)Themaximumworkingcapitalratewillbetwentycentsperday;
46 (4)Ifaproviderdoesnotprovidetheactualacquisitioncosttodeterminea
47reimbursementrateundersubparagrapha.ofparagraph(a)ofsubdivision(3)ofsubsection1
48ofthissection,thesumofthebuildingandbuildingequipmentrate,movableequipmentrate,
49landrate,andworkingcapitalrateshallbesetatareimbursementrateofsixdollars;
50 (5)],foreachstatefiscalyearanegotiatedtrendfactorshallbeappliedtoeach
51facility'sTitleXIXperdiemreimbursementrate.Thetrendfactorshallbedetermined
52throughnegotiationsbetweenthedepartmentandtheaffectedprovidersandisintendedto
53holdtheprovidersharmlessagainstincreaseincost.Innocircumstancesshallthenegotiated
54trendfactortobeappliedtostatefundsexceedthehealthcarefinanceadministrationmarket
55basketpriceindexforthatyear.Theprovisionsofthissubdivisionshallapplytofiscalyear
561996andthereafter.
57 [2.Theprovisionsofsubdivisions(1),(2),(3),and(4)ofsubsection1ofthissection
58shallremainineffectuntilJuly1,1989,unlessotherwiseprovidedbylaw.]
208.225.1.Toimplementfullytheprovisionsofsection208.152,theMOHealthNet
2divisionshallcalculatetheMedicaidperdiemreimbursementratesofeachnursinghome
3participatingintheMedicaidprogramasaproviderofnursinghomeservicesbasedonits
4costsreportedintheTitleXIXcostreportfiledwiththeMOHealthNetdivisionforitsfiscal
5yearasprovidedinsubsection2ofthissection.
6 2.TherecalculationofMedicaidratestoallMissourifacilitieswillbeperformedas
7follows:effectiveJuly1,2004,thedepartmentofsocialservicesshallusetheMedicaidcost
8reportcontainingadjustedcostsforthefacilityfiscalyearendingin2001andredeterminethe
9allowableper-patientdaycostsforeachfacility.Thedepartmentshallrecalculatetheclass
HB1240 4 10ceilingsinthepatientcare,onehundredtwentypercentofthemedian;ancillary,onehundred
11twentypercentofthemedian;andadministration,onehundredtenpercentofthemediancost
12centers.Eachfacilityshallreceiveasarateincreaseone-thirdoftheamountthatisunpaid
13basedontherecalculatedcostdetermination.
14 3.(1)Forpurposesofthissubsection,theterm"capitalexpenditures"means
15expendituresbyoronbehalfofafacilitythat,undergenerallyacceptedaccounting
16principles,arenotproperlychargeableasanexpenseofoperationandmaintenance.
17 (2)Anyintermediatecarefacilityorskillednursingfacility,assuchtermsaredefined
18insection198.006,participatinginMOHealthNetthatincurstotalcapitalexpenditures[, as
19suchtermisdefinedinsection197.305,] inexcessoftwothousanddollarsperbedshallbe
20entitledtoobtainfromtheMOHealthNetdivisionarecalculationofitsMedicaidperdiem
21reimbursementratebasedonitsadditionalcapitalcostsorallcostsincurredduringthefacility
22fiscalyearduringwhichsuchcapitalexpendituresweremade.Suchrecalculated
23reimbursementrateshallbecomeeffectiveandpayablewhengrantedbytheMO
24HealthNetdivisionasofthedateofapplicationforarateadjustment.
[197.300.Sections197.300to197.366shallbeknownasthe
2 "MissouriCertificateofNeedLaw".]
[197.305.Asusedinsections197.300to197.366,thefollowingterms
2 mean:
3 (1)"Affectedpersons",thepersonproposingthedevelopmentofa
4 newinstitutionalhealthservice,thepublictobeserved,andhealthcare
5 facilitieswithintheserviceareainwhichtheproposednewhealthcareservice
6 istobedeveloped;
7 (2)"Agency",thecertificateofneedprogramoftheMissouri
8 departmentofhealthandseniorservices;
9 (3)"Capitalexpenditure",anexpenditurebyoronbehalfofahealth
10 carefacilitywhich,undergenerallyacceptedaccountingprinciples,isnot
11 properlychargeableasanexpenseofoperationandmaintenance;
12 (4)"Certificateofneed",awrittencertificateissuedbythecommittee
13 settingforththecommittee'saffirmativefindingthataproposedproject
14 sufficientlysatisfiesthecriteriaprescribedforsuchprojectsbysections
15 197.300to197.366;
16 (5)"Develop",toundertakethoseactivitieswhichontheircompletion
17 willresultintheofferingofanewinstitutionalhealthserviceortheincurring
18 ofafinancialobligationinrelationtotheofferingofsuchaservice;
19 (6)"Expenditureminimum"shallmean:
20 (a)Forbedsinexistingorproposedhealthcarefacilitieslicensed
21 pursuanttochapter198andlong-termcarebedsinahospitalasdescribedin
22 subdivision(3)ofsubsection1ofsection198.012,sixhundredthousand
23 dollarsinthecaseofcapitalexpenditures,orfourhundredthousanddollarsin
24 thecaseofmajormedicalequipment,provided,however,thatpriortoJanuary
25 1,2003,theexpenditureminimumforbedsinsuchafacilityandlong-term
HB1240 5 26 carebedsinahospitaldescribedinsection198.012shallbezero,subjecttothe
27 provisionsofsubsection7ofsection197.318;
28 (b)Forbedsorequipmentinalong-termcarehospitalmeetingthe
29 requirementsdescribedin42CFR,Section412.23(e),theexpenditure
30 minimumshallbezero;and
31 (c)Forhealthcarefacilities,newinstitutionalhealthservicesorbeds
32 notdescribedinparagraph(a)or(b)ofthissubdivisiononemilliondollarsin
33 thecaseofcapitalexpenditures,excludingmajormedicalequipment,andone
34 milliondollarsinthecaseofmedicalequipment;
35 (7)"Healthservicearea",ageographicregionappropriateforthe
36 effectiveplanninganddevelopmentofhealthservices,determinedonthebasis
37 offactorsincludingpopulationandtheavailabilityofresources,consistingof
38 apopulationofnotlessthanfivehundredthousandormorethanthreemillion;
39 (8)"Majormedicalequipment",medicalequipmentusedforthe
40 provisionofmedicalandotherhealthservices;
41 (9)"Newinstitutionalhealthservice":
42 (a)Thedevelopmentofanewhealthcarefacilitycostinginexcessof
43 theapplicableexpenditureminimum;
44 (b)Theacquisition,includingacquisitionbylease,ofanyhealthcare
45 facility,ormajormedicalequipmentcostinginexcessoftheexpenditure
46 minimum;
47 (c)Anycapitalexpenditurebyoronbehalfofahealthcarefacilityin
48 excessoftheexpenditureminimum;
49 (d)Predevelopmentactivitiesasdefinedinsubdivision(12)hereof
50 costinginexcessofonehundredfiftythousanddollars;
51 (e)Anychangeinlicensedbedcapacityofahealthcarefacility
52 licensedunderchapter198whichincreasesthetotalnumberofbedsbymore
53 thantenormorethantenpercentoftotalbedcapacity,whicheverisless,over
54 atwo-yearperiod,providedthatanysuchhealthcarefacilityseekinga
55 nonapplicabilityreviewforanincreaseintotalbedsortotalbedcapacityinan
56 amountlessthandescribedinthisparagraphshallbeeligibleforsuchreview
57 onlyifthefacilityhashadnopatientcareclassIdeficiencieswithinthelast
58 eighteenmonthsandhasmaintainedatleastaneighty-fivepercentaverage
59 occupancyratefortheprevioussixquarters;
60 (f)Healthservices,excludinghomehealthservices,whichareoffered
61 inahealthcarefacilityandwhichwerenotofferedonaregularbasisinsuch
62 healthcarefacilitywithinthetwelve-monthperiodpriortothetimesuch
63 serviceswouldbeoffered;
64 (g)Areallocationbyanexistinghealthcarefacilityoflicensedbeds
65 amongmajortypesofserviceorreallocationoflicensedbedsfromone
66 physicalfacilityorsitetoanotherbymorethantenbedsormorethanten
67 percentoftotallicensedbedcapacity,whicheverisless,overatwo-year
68 period;
69 (10)"Nonsubstantiveprojects",projectswhichdonotinvolvethe
70 addition,replacement,modernizationorconversionofbedsortheprovisionof
71 anewhealthservicebutwhichincludeacapitalexpenditurewhichexceeds
72 theexpenditureminimumandareduetoanactofGodoranormal
73 consequenceofmaintaininghealthcareservices,facilityorequipment;
HB1240 6 74 (11)"Person",anyindividual,trust,estate,partnership,corporation,
75 includingassociationsandjointstockcompanies,stateorpoliticalsubdivision
76 orinstrumentalitythereof,includingamunicipalcorporation;
77 (12)"Predevelopmentactivities",expendituresforarchitectural
78 designs,plans,workingdrawingsandspecifications,andanyarrangement
79 orcommitmentmadeforfinancing;butexcludingsubmissionofan
80 applicationforacertificateofneed.]
[197.310.1.The"MissouriHealthFacilitiesReviewCommittee"is
2 herebyestablished.Theagencyshallprovideclericalandadministrative
3 supporttothecommittee.Thecommitteemayemployadditionalstaffasit
4 deemsnecessary.
5 2.Thecommitteeshallbecomposedof:
6 (1)Twomembersofthesenateappointedbythepresidentprotem,
7 whoshallbefromdifferentpoliticalparties;and
8 (2)Twomembersofthehouseofrepresentativesappointedbythe
9 speaker,whoshallbefromdifferentpoliticalparties;and
10 (3)Fivemembersappointedbythegovernorwiththeadviceand
11 consentofthesenate,notmorethanthreeofwhomshallbefromthesame
12 politicalparty.
13 3.Nobusinessofthiscommitteeshallbeperformedwithouta
14 majorityofthefullbody.
15 4.ThemembersshallbeappointedassoonaspossibleafterSeptember
16 28,1979.Oneofthesenatemembers,oneofthehousemembersandthreeof
17 themembersappointedbythegovernorshallserveuntilJanuary1,1981,and
18 theremainingmembersshallserveuntilJanuary1,1982.Allsubsequent
19 membersshallbeappointedinthemannerprovidedinsubsection2ofthis
20 sectionandshallservetermsoftwoyears.
21 5.Thecommitteeshallelectachairmanatitsfirstmeetingwhichshall
22 becalledbythegovernor.Thecommitteeshallmeetuponthecallofthe
23 chairmanorthegovernor.
24 6.Thecommitteeshallreviewandapproveordisapproveall
25 applicationsforacertificateofneedmadeundersections197.300to197.366.
26 Itshallissuereasonablerulesandregulationsgoverningthesubmission,
27 reviewanddispositionofapplications.
28 7.Membersofthecommitteeshallservewithoutcompensationbut
29 shallbereimbursedfornecessaryexpensesincurredintheperformanceof
30 theirduties.
31 8.Notwithstandingtheprovisionsofsubsection4ofsection610.025,
32 theproceedingsandrecordsofthefacilitiesreviewcommitteeshallbesubject
33 totheprovisionsofchapter610.]
[197.311.NomemberoftheMissourihealthfacilitiesreview
2 committeemayacceptapoliticaldonationfromanyapplicantforalicense.]
[197.312.Acertificateofneedshallnotberequiredforanyinstitution
2 previouslyownedandoperatedfororinbehalfofacitynotwithinacounty
3 whichchoosestobelicensedasafacilitydefinedundersubdivision(22)or
HB1240 7 4 (23)ofsection198.006forafacilityofninetybedsorlessthatisownedor
5 operatedbyanot-for-profitcorporationwhichisexemptfromfederalincome
6 taxasanorganizationdescribedinsection501(c)(3)oftheInternalRevenue
7 Codeof1986,whichiscontrolleddirectlybyareligiousorganizationand
8 whichhasreceivedapprovalbythedepartmentofhealthandseniorservicesof
9 plansforconstructionofsuchfacilitybyAugust1,1995,andislicensedbythe
10 departmentofhealthandseniorservicesbyJuly1,1996,asafacilitydefined
11 undersubdivision(22)or(23)ofsection198.006orforafacility,serving
12 exclusivelymentallyill,homelesspersons,ofsixteenbedsorlessthatis
13 ownedoroperatedbyanot-for-profitcorporationwhichisexemptfrom
14 federalincometaxwhichisdescribedinsection501(c)(3)oftheInternal
15 RevenueCodeof1986,whichiscontrolleddirectlybyareligiousorganization
16 andwhichhasreceivedapprovalbythedepartmentofhealthandsenior
17 servicesofplansforconstructionofsuchfacilitybyMay1,1996,andis
18 licensedbythedepartmentofhealthandseniorservicesbyJuly1,1996,asa
19 facilitydefinedundersubdivision(22)or(23)ofsection198.006oranassisted
20 livingfacilitylocatedinacitynotwithinacountyoperatedbyanotforprofit
21 corporationwhichisexemptfromfederalincometaxwhichisdescribedin
22 section501(c)(3)oftheInternalRevenueCodeof1986,whichiscontrolled
23 directlybyareligiousorganizationandwhichislicensedforonehundredbeds
24 orlessonorbeforeAugust28,1997.]
[197.315.1.Anypersonwhoproposestodeveloporofferanew
2 institutionalhealthservicewithinthestatemustobtainacertificateofneed
3 fromthecommitteepriortothetimesuchservicesareoffered.
4 2.Onlythosenewinstitutionalhealthserviceswhicharefoundbythe
5 committeetobeneededshallbegrantedacertificateofneed.Onlythosenew
6 institutionalhealthserviceswhicharegrantedcertificatesofneedshallbe
7 offeredordevelopedwithinthestate.Noexpendituresfornewinstitutional
8 healthservicesinexcessoftheapplicableexpenditureminimumshallbemade
9 byanypersonunlessacertificateofneedhasbeengranted.
10 3.AfterOctober1,1980,nostateagencychargedbystatutetolicense
11 orcertifyhealthcarefacilitiesshallissuealicensetoorcertifyanysuch
12 facility,ordistinctpartofsuchfacility,thatisdevelopedwithoutobtaininga
13 certificateofneed.
14 4.Ifanypersonproposestodevelopanynewinstitutionalhealthcare
15 servicewithoutacertificateofneedasrequiredbysections197.300to
16 197.366,thecommitteeshallnotifytheattorneygeneral,andheshallapplyfor
17 aninjunctionorotherappropriatelegalactioninanycourtofthisstateagainst
18 thatperson.
19 5.AfterOctober1,1980,noagencyofstategovernmentmay
20 appropriateorgrantfundstoormakepaymentofanyfundstoanypersonor
21 healthcarefacilitywhichhasnotfirstobtainedeverycertificateofneed
22 requiredpursuanttosections197.300to197.366.
23 6.Acertificateofneedshallbeissuedonlyforthepremisesand
24 personsnamedintheapplicationandisnottransferableexceptbyconsentof
25 thecommittee.
HB1240 8 26 7.Projectcostincreases,duetochangesintheprojectapplicationas
27 approvedorduetoprojectchangeorders,exceedingtheinitialestimateby
28 morethantenpercentshallnotbeincurredwithoutconsentofthecommittee.
29 8.Periodicreportstothecommitteeshallberequiredofanyapplicant
30 whohasbeengrantedacertificateofneeduntiltheprojecthasbeen
31 completed.Thecommitteemayordertheforfeitureofthecertificateofneed
32 uponfailureoftheapplicanttofileanysuchreport.
33 9.Acertificateofneedshallbesubjecttoforfeitureforfailuretoincur
34 acapitalexpenditureonanyapprovedprojectwithinsixmonthsafterthedate
35 oftheorder.Theapplicantmayrequestanextensionfromthecommitteeof
36 notmorethansixadditionalmonthsbaseduponsubstantialexpendituremade.
37 10.Eachapplicationforacertificateofneedmustbeaccompaniedby
38 anapplicationfee.Thetimeoffilingcommenceswiththereceiptofthe
39 applicationandtheapplicationfee.Theapplicationfeeisonethousand
40 dollars,orone-tenthofonepercentofthetotalcostoftheproposedproject,
41 whicheverisgreater.Allapplicationfeesshallbedepositedinthestate
42 treasury.Becauseofthelossoffederalfunds,thegeneralassemblywill
43 appropriatefundstotheMissourihealthfacilitiesreviewcommittee.
44 11.Indeterminingwhetheracertificateofneedshouldbegranted,no
45 considerationshallbegiventothefacilitiesorequipmentofanyotherhealth
46 carefacilitylocatedmorethanafifteen-mileradiusfromtheapplyingfacility.
47 12.Whenanursingfacilityshiftsfromaskilledtoanintermediate
48 levelofnursingcare,itmayreturntothehigherlevelofcareifitmeetsthe
49 licensurerequirements,withoutobtainingacertificateofneed.
50 13.Innoeventshallacertificateofneedbedeniedbecausethe
51 applicantrefusestoprovideabortionservicesorinformation.
52 14.Acertificateofneedshallnotberequiredforthetransferof
53 ownershipofanexistingandoperationalhealthfacilityinitsentirety.
54 15.Acertificateofneedmaybegrantedtoafacilityforanexpansion,
55 anadditionofservices,anewinstitutionalservice,orforanewhospital
56 facilitywhichprovidesforsomethinglessthanthatwhichwassoughtinthe
57 application.
58 16.Theprovisionsofthissectionshallnotapplytofacilitiesoperated
59 bythestate,andappropriationoffundstosuchfacilitiesbythegeneral
60 assemblyshallbedeemedincompliancewiththissection,andsuchfacilities
61 shallbedeemedtohavereceivedanappropriatecertificateofneedwithout
62 paymentofanyfeeorcharge.Theprovisionsofthissubsectionshallnot
63 applytohospitalsoperatedbythestateandlicensedunderthischapter,except
64 fordepartmentofmentalhealthstate-operatedpsychiatrichospitals.
65 17.Notwithstandingotherprovisionsofthissection,acertificateof
66 needmaybeissuedafterJuly1,1983,foranintermediatecarefacility
67 operatedexclusivelyfortheintellectuallydisabled.
68 18.Toassurethesafe,appropriate,andcost-effectivetransferofnew
69 medicaltechnologythroughoutthestate,acertificateofneedshallnotbe
70 requiredforthepurchaseandoperationof:
71 (1)Researchequipmentthatistobeusedinaclinicaltrialthathas
72 receivedwrittenapprovalfromadulyconstitutedinstitutionalreviewboardof
73 anaccreditedschoolofmedicineorosteopathylocatedinMissouritoestablish
HB1240 9 74 itssafetyandefficacyanddoesnotincreasethebedcomplementofthe
75 institutioninwhichtheequipmentistobelocated.Aftertheclinicaltrialhas
76 beencompleted,acertificateofneedmustbeobtainedforcontinuedusein
77 suchfacility;or
78 (2)Equipmentthatistobeusedbyanacademichealthcenteroperated
79 bythestateinfurtheranceofitsresearchorteachingmissions.]
[197.316.1.Theprovisionsofsubsection10ofsection197.315and
2 sections197.317and197.318shallnotapplytofacilitieswhicharelicensed
3 pursuanttotheprovisionsofchapter198,whicharedesignedandoperated
4 exclusivelyforthecareandtreatmentofpersonswithacquiredhuman
5 immunodeficiencysyndrome,AIDS.
6 2.Ifafacilityisgrantedacertificateofneedandisfoundtobeexempt
7 fromtheprovisionsofsubsection10ofsection197.315andsections197.317
8 and197.318pursuanttotheprovisionsofsubsection1ofthissection,then
9 onlyAIDSpatientsshallberesidentsofsuchfacilityandnoothers.
10 3.Anyfacilitythatviolatestheprovisionsofsubsection2ofthis
11 sectionshallbeliableforafineofonehundreddollarsperresidentperdayfor
12 eachsuchviolation.
13 4.Theattorneygeneralshall,uponrequestofthedepartmentofhealth
14 andseniorservices,bringanactioninacircuitcourtofcompetentjurisdiction
15 forviolationofthissection.]
[197.318.1.Asusedinthissection,theterm"licensedandavailable"
2 meansbedswhichareactuallyinplaceandforwhichalicensehasbeen
3 issued.
4 2.Thecommitteeshallreviewalllettersofintentandapplicationsfor
5 long-termcarehospitalbedsmeetingtherequirementsdescribedin42CFR,
6 Section412.23(e)underitscriteriaandstandardsforlong-termcarebeds.
7 3.Sections197.300to197.366shallnotbeconstruedtoapplyto
8 litigationpendinginstatecourtonorbeforeApril1,1996,inwhichthe
9 Missourihealthfacilitiesreviewcommitteeisadefendantinanaction
10 concerningtheapplicationofsections197.300to197.366tolong-termcare
11 hospitalbedsmeetingtherequirementsdescribedin42CFR,Section412.23
12 (e).
13 4.Notwithstandinganyotherprovisionofthischaptertothecontrary:
14 (1)Afacilitylicensedpursuanttochapter198mayincreaseits
15 licensedbedcapacityby:
16 (a)Submittingaletterofintenttoexpandtothedepartmentofhealth
17 andseniorservicesandthehealthfacilitiesreviewcommittee;
18 (b)Certificationfromthedepartmentofhealthandseniorservicesthat
19 thefacility:
20 a.HasnopatientcareclassIdeficiencieswithinthelasteighteen
21 months;and
22 b.Hasmaintainedaninety-percentaverageoccupancyrateforthe
23 previoussixquarters;
24 (c)Hasmadeanefforttopurchasebedsforeighteenmonthsfollowing
25 thedatetheletterofintenttoexpandissubmittedpursuanttoparagraph(a)of
HB1240 10 26 thissubdivision.Forpurposesofthisparagraph,an"efforttopurchase"means
27 acopycertifiedbytheofferorasanoffertopurchasebedsfromanother
28 licensedfacilityinthesamelicensurecategory;and
29 (d)Ifanagreementisreachedbythesellingandpurchasingentities,
30 thehealthfacilitiesreviewcommitteeshallissueacertificateofneedforthe
31 expansionofthepurchaserfacilityuponsurrenderoftheseller'slicense;or
32 (e)Ifnoagreementisreachedbythesellingandpurchasingentities,
33 thehealthfacilitiesreviewcommitteeshallpermitanexpansionfor:
34 a.Afacilitywithmorethanfortybedsmayexpanditslicensedbed
35 capacitywithinthesamelicensurecategorybytwenty-fivepercentorthirty
36 beds,whicheverisgreater,ifthatsamelicensurecategoryinsuchfacilityhas
37 experiencedanaverageoccupancyofninety-threepercentorgreateroverthe
38 previoussixquarters;
39 b.Afacilitywithfewerthanfortybedsmayexpanditslicensedbed
40 capacitywithinthesamelicensurecategorybytwenty-fivepercentortenbeds,
41 whicheverisgreater,ifthatsamelicensurecategoryinsuchfacilityhas
42 experiencedanaverageoccupancyofninety-twopercentorgreateroverthe
43 previoussixquarters;
44 c.Afacilityaddingbedspursuanttosubparagraphsa.orb.ofthis
45 paragraphshallnotexpandbymorethanfiftypercentofitsthenlicensedbed
46 capacityinthequalifyinglicensurecategory;
47 (2)Anybedssoldshall,forfiveyearsfromthedateofrelicensureby
48 thepurchaser,remainunlicensedandunusedforanylong-termcareservicein
49 thesellingfacility,whethertheydoordonotrequirealicense;
50 (3)Thebedspurchasedshall,fortwoyearsfromthedateofpurchase,
51 remaininthebedinventoryattributedtothesellingfacilityandbeconsidered
52 bythedepartmentofsocialservicesaslicensedandavailableforpurposesof
53 thissection;
54 (4)Anyresidentialcarefacilitylicensedpursuanttochapter198may
55 relocateanyportionofsuchfacility'scurrentlicensedbedstoanyotherfacility
56 tobelicensedwithinthesamelicensurecategoryifbothfacilitiesareunderthe
57 samelicensureownershiporcontrol,andarelocatedwithinsixmilesofeach
58 other;
59 (5)Afacilitylicensedpursuanttochapter198maytransferorsell
60 individuallong-termcarelicensedbedstofacilitiesqualifyingpursuantto
61 paragraphs(a)and(b)ofsubdivision(1)ofthissubsection.Anyfacilitywhich
62 transfersorsellslicensedbedsshallnotexpanditslicensedbedcapacityin
63 thatlicensurecategoryforaperiodoffiveyearsfromthedatethelicensureis
64 relinquished.
65 5.Anyexistinglicensedandoperatinghealthcarefacilityoffering
66 long-termcareservicesmayreplaceone-halfofitslicensedbedsatthesame
67 siteorasitenotmorethanthirtymilesfromitscurrentlocationif,foratleast
68 themostrecentfourconsecutivecalendarquarters,thefacilityoperatesonly
69 fiftypercentofitsthenlicensedcapacitywitheveryresidentresidingina
70 privateroom.Insuchcase:
71 (1)Thefacilityshallreporttothehealthandseniorservicesvacant
72 bedsasunavailableforoccupancyforatleastthemostrecentfourconsecutive
73 calendarquarters;
HB1240 11 74 (2)Thereplacementbedsshallbebuilttoprivateroomspecifications
75 andonlyusedforsingleoccupancy;and
76 (3)Theexistingfacilityandproposedfacilityshallhavethesame
77 ownerorowners,regardlessofcorporateorbusinessstructure,andsuchowner
78 orownersshallstipulateinwritingthattheexistingfacilitybedstobereplaced
79 willnotlaterbeusedtoprovidelong-termcareservices.Ifthefacilityisbeing
80 operatedunderalease,boththelesseeandtheowneroftheexistingfacility
81 shallstipulatethesameinwriting.
82 6.Nothinginthissectionshallprohibitahealthcarefacilitylicensed
83 pursuanttochapter198frombeingreplacedinitsentiretywithinfifteenmiles
84 ofitsexistingsitesolongastheexistingfacilityandproposedorreplacement
85 facilityhavethesameownerorownersregardlessofcorporateorbusiness
86 structureandthehealthcarefacilitybeingreplacedremainsunlicensedand
87 unusedforanylong-termcareserviceswhethertheydoordonotrequirea
88 licensefromthedateoflicensureofthereplacementfacility.]
[197.320.Thecommitteeshallhavethepowertopromulgate
2 reasonablerules,regulations,criteriaandstandardsinconformitywiththis
3 sectionandchapter536tomeettheobjectivesofsections197.300to197.366
4 includingthepowertoestablishcriteriaandstandardstoreviewnewtypesof
5 equipmentorservice.Anyruleorportionofarule,asthattermisdefinedin
6 section536.010,thatiscreatedundertheauthoritydelegatedinsections
7 197.300to197.366shallbecomeeffectiveonlyifitcomplieswithandis
8 subjecttoalloftheprovisionsofchapter536and,ifapplicable,section
9 536.028.AllrulemakingauthoritydelegatedpriortoAugust28,1999,isofno
10 forceandeffectandrepealed.Nothinginthissectionshallbeinterpretedto
11 repealoraffectthevalidityofanyrulefiledoradoptedpriortoAugust28,
12 1999,ifitfullycompliedwithallapplicableprovisionsoflaw.Thissection
13 andchapter536arenonseverableandifanyofthepowersvestedwiththe
14 generalassemblypursuanttochapter536toreview,todelaytheeffectivedate
15 ortodisapproveandannularulearesubsequentlyheldunconstitutional,then
16 thegrantofrulemakingauthorityandanyruleproposedoradoptedafter
17 August28,1999,shallbeinvalidandvoid.]
[197.325.Anypersonwhoproposestodeveloporofferanew
2 institutionalhealthserviceshallsubmitaletterofintenttothecommitteeat
3 leastthirtydayspriortothefilingoftheapplication.]
[197.326.1.Anypersonwhoispaideitheraspartofhisorhernormal
2 employmentorasalobbyisttosupportoropposeanyprojectbeforethehealth
3 facilitiesreviewcommitteeshallregisterasalobbyistpursuanttochapter105
4 andshallalsoregisterwiththestaffofthehealthfacilitiesreviewcommittee
5 foreveryprojectinwhichsuchpersonhasaninterestandindicatewhether
6 suchpersonsupportsoropposesthenamedproject.Theregistrationshallalso
7 includethenamesandaddressesofanyperson,firm,corporationor
8 associationthatthepersonregisteringrepresentsinrelationtothenamed
9 project.Anypersonviolatingtheprovisionsofthissubsectionshallbesubject
10 tothepenaltiesspecifiedinsection105.478.
HB1240 12 11 2.Amemberofthegeneralassemblywhoalsoservesasamemberof
12 thehealthfacilitiesreviewcommitteeisprohibitedfromsolicitingoraccepting
13 campaigncontributionsfromanyapplicantorpersonspeakingforanapplicant
14 oranyopponenttoanyapplicationorpersonsspeakingforanyopponentwhile
15 suchapplicationispendingbeforethehealthfacilitiesreviewcommittee.
16 3.Anypersonregulatedbychapter197or198andanyofficer,
17 attorney,agentandemployeethereof,shallnotoffertoanycommitteemember
18 ortoanypersonemployedasstafftothecommittee,anyoffice,appointment
19 orposition,oranypresent,gift,entertainmentorgratuityofanykindorany
20 campaigncontributionwhilesuchapplicationispendingbeforethehealth
21 facilitiesreviewcommittee.Anypersonguiltyofknowinglyviolatingthe
22 provisionsofthissectionshallbepunishedasfollows:Forthefirstoffense,
23 suchpersonisguiltyofaclassBmisdemeanor;andforthesecondand
24 subsequentoffenses,suchpersonisguiltyofaclassEfelony.]
[197.327.1.Ifafacilityisgrantedacertificateofneedpursuantto
2 sections197.300to197.365basedonanapplicationstatinganeedfor
3 additionalMedicaidbeds,suchbedsshallbeusedforMedicaidpatientsandno
4 other.
5 2.Anypersonwhoviolatestheprovisionsofsubsection1ofthis
6 sectionshallbeliabletothestateforcivilpenaltiesofonehundreddollarsfor
7 everydayofsuchviolation.EachnonMedicaidpatientplacedinaMedicaid
8 bedshallconstituteaseparateviolation.
9 3.Theattorneygeneralshall,upontherequestofthedepartment,bring
10 anactioninacircuitcourtofcompetentjurisdictiontorecoverthecivil
11 penalty.Thedepartmentmaybringsuchanactionitself.Thecivilactionmay
12 bebroughtinthecircuitcourtofColeCountyor,attheoptionofthedirector,
13 inanothercountywhichhasvenueofanactionagainstthepersonunderother
14 provisionsoflaw.]
[197.330.1.Thecommitteeshall:
2 (1)Notifytheapplicantwithinfifteendaysofthedateoffilingofan
3 applicationastothecompletenessofsuchapplication;
4 (2)Providewrittennotificationtoaffectedpersonslocatedwithinthis
5 stateatthebeginningofareview.Thisnotificationmaybegiventhrough
6 publicationofthereviewscheduleinallnewspapersofgeneralcirculationin
7 theareatobeserved;
8 (3)Holdpublichearingsonallapplicationswhenarequestinwriting
9 isfiledbyanyaffectedpersonwithinthirtydaysfromthedateofpublication
10 ofthenotificationofreview;
11 (4)Withinonehundreddaysofthefilingofanyapplicationfora
12 certificateofneed,issueinwritingitsfindingsoffact,conclusionsoflaw,and
13 itsapprovalordenialofthecertificateofneed;provided,thatthecommittee
14 maygrantanextensionofnotmorethanthirtydaysonitsowninitiativeor
15 uponthewrittenrequestofanyaffectedperson;
16 (5)Causetobeservedupontheapplicant,therespectivehealthsystem
17 agency,andanyaffectedpersonwhohasfiledhispriorrequestinwriting,a
18 copyoftheaforesaidfindings,conclusionsanddecisions;
HB1240 13 19 (6)Considertheneedsandcircumstancesofinstitutionsproviding
20 trainingprogramsforhealthpersonnel;
21 (7)Providefortheavailability,basedondemonstratedneed,ofboth
22 medicalandosteopathicfacilitiesandservicestoprotectthefreedomofpatient
23 choice;and
24 (8)Establishbyregulationprocedurestoreview,orgrantawaiver
25 fromreview,nonsubstantiveprojects.
26
27 Theterm"filed"or"filing"asusedinthissectionshallmeandeliverytothe
28 staffofthehealthfacilitiesreviewcommitteethedocumentordocumentsthe
29 applicantbelievesconstituteanapplication.
30 2.Failurebythecommitteetoissueawrittendecisiononan
31 applicationforacertificateofneedwithinthetimerequiredbythissection
32 shallconstituteapprovalofandfinaladministrativeactionontheapplication,
33 andissubjecttoappealpursuanttosection197.335onlyonthequestionof
34 approvalbyoperationoflaw.]
[197.335.Withinthirtydaysofthedecisionofthecommittee,the
2 applicantmayfileanappealtobehearddenovobytheadministrativehearing
3 commissioner,thecircuitcourtofColeCountyorthecircuitcourtinthe
4 countywithinwhichsuchhealthcareserviceorfacilityisproposedtobe
5 developed.]
[197.340.Anyhealthfacilityprovidingahealthservicemustnotify
2 thecommitteeofanydiscontinuanceofanypreviouslyprovidedhealthcare
3 service,adecreaseinthenumberoflicensedbedsbytenpercentormore,or
4 thechangeinlicensurecategoryforanysuchfacility.]
[197.345.Anyhealthfacilitywithaprojectforfacilitiesorservicesfor
2 whichabindingconstructionorpurchasecontracthasbeenexecutedpriorto
3 October1,1980,orhealthcarefacilitywhichhascommencedoperationsprior
4 toOctober1,1980,shallbedeemedtohavereceivedacertificateofneed,
5 exceptthatsuchcertificateofneedshallbesubjecttoforfeitureunderthe
6 provisionsofsubsections8and9ofsection197.315.]
[197.355.Thelegislaturemaynotappropriateanymoneyforcapital
2 expendituresforhealthcarefacilitiesuntilacertificateofneedhasbeenissued
3 forsuchexpenditures.]
[197.357.Forthepurposesofreimbursementundersection208.152,
2 projectcostsfornewinstitutionalhealthservicesinexcessoftenpercentof
3 theinitialprojectestimatewhetherornotapprovalwasobtainedunder
4 subsection7ofsection197.315shallnotbeeligibleforreimbursementforthe
5 firstthreeyearsthatafacilityreceivespaymentforservicesprovidedunder
6 section208.152.Theinitialestimateshallbethatamountforwhichthe
7 originalcertificateofneedwasobtainedor,inthecaseoffacilitiesforwhicha
8 bindingconstructionorpurchasecontractwasexecutedpriortoOctober1,
9 1980,theamountofthatcontract.Reimbursementfortheseexcesscostsafter
HB1240 14 10 thefirstthreeyearsshallnotbemadeuntilacertificateofneedhasbeen
11 grantedfortheexcessprojectcosts.Theprovisionsofthissectionshallapply
12 onlytofacilitieswhichfileanapplicationforacertificateofneedormake
13 applicationforcost-overrunreviewoftheiroriginalapplicationorwaiverafter
14 August13,1982.]
[197.366.Theterm"healthcarefacilities"insections197.300to
2 197.366shallmean:
3 (1)Facilitieslicensedunderchapter198;
4 (2)Long-termcarebedsinahospitalasdescribedinsubdivision(3)of
5 subsection1ofsection198.012;
6 (3)Long-termcarehospitalsorbedsinalong-termcarehospital
7 meetingtherequirementsdescribedin42CFR,section412.23(e);and
8 (4)Constructionofanewhospitalasdefinedinchapter197.]
[197.367.Uponapplicationforrenewalbyanyresidentialcarefacility
2 orassistedlivingfacilitywhichontheeffectivedateofthisacthasbeen
3 licensedformorethanfiveyears,islicensedformorethanfiftybedsandfails
4 tomaintainforanycalendaryearitsoccupancylevelabovethirtypercentofits
5 thenlicensedbeds,thedepartmentofhealthandseniorservicesshalllicense
6 onlyfiftybedsforsuchfacility.]
âś”
HB1240 15