Missouri 2025 Regular Session

Missouri Senate Bill SB337 Compare Versions

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Old	New	Differences
1	1
2	2	EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
3	3	and is intended to be omitted in the law.
4	4	FIRST REGULAR SESSION
5	5	SENATE BILL NO. 337
6	6	103RD GENERAL ASSEMBLY
7	7	INTRODUCED BY SENATOR MOON.
8	8	1081S.01I KRISTINA MARTIN, Secretary
9	9	AN ACT
10	10	To repeal sections 197.305, 197.315, 197.320, 197.366, and 354.095, RSMo, and to enact in lieu
11	11	thereof four new sections relating to certificates of need.
12	12
13	13	Be it enacted by the General Assembly of the State of Missouri, as follows:
14	14	Section A. Sections 197.305, 197.315, 197.320, 197.366, 1
15	15	and 354.095, RSMo, are repealed and four new sections enacted 2
16	16	in lieu thereof, t o be known as sections 197.305, 197.315, 3
17	17	197.320, and 354.095, to read as follows:4
18	18	197.305. As used in sections 197.300 to [197.366] 1
19	19	197.367, the following terms mean: 2
20	20	(1) "Affected persons", the person proposing the 3
21	21	development of a new ins titutional health service, the 4
22	22	public to be served, and health care facilities within the 5
23	23	service area in which the proposed new health care service 6
24	24	is to be developed; 7
25	25	(2) "Agency", the certificate of need program of the 8
26	26	Missouri department of h ealth and senior services; 9
27	27	(3) "Capital expenditure", an expenditure by or on 10
28	28	behalf of a health care facility which, under generally 11
29	29	accepted accounting principles, is not properly chargeable 12
30	30	as an expense of operation and maintenance; 13
31	31	(4) "Certificate of need", a written certificate 14
32	32	issued by the committee setting forth the committee's 15
33	33	affirmative finding that a proposed project sufficiently 16 SB 337 2
34	34	satisfies the criteria prescribed for such projects by 17
35	35	sections 197.300 to [197.366] 197.367; 18
36	36	(5) "Committee", the Missouri health facilities review 19
37	37	committee; 20
38	38	(6) "Department", the Missouri department of health 21
39	39	and senior services; 22
40	40	(7) "Develop", to undertake those activities which on 23
41	41	their completion will result in the offering of a new 24
42	42	institutional health service or the incurring of a financial 25
43	43	obligation in relation to the offering of such a service; 26
44	44	[(6)] (8) "Expenditure minimum" shall mean: 27
45	45	(a) For beds in existing or proposed health care 28
46	46	facilities licensed pursuant to chapter 198 and long -term 29
47	47	care beds in a hospital as described in subdivision (3) of 30
48	48	subsection 1 of section 198.012, six hundred thousand 31
49	49	dollars in the case of capital expenditures [, or four 32
50	50	hundred thousand dollars in the case of major medical 33
51	51	equipment,]; provided, [however,] that prior to January 1, 34
52	52	2003, the expenditure minimum for beds in such a facility 35
53	53	and long-term care beds in a hospital described in section 36
54	54	198.012 shall be zero, subject to the provisions of 37
55	55	subsection 7 of section 197.318; 38
56	56	(b) For beds [or equipment] in a long-term care 39
57	57	hospital meeting the requirements described in 42 CFR [, 40
58	58	Section] 412.23(e), the expenditure minimum shall be zero; 41
59	59	and 42
60	60	(c) For health care facilities, new institutional 43
61	61	health services or beds not described in paragraph (a) or 44
62	62	(b) of this subdivision one million dollars in the case of 45
63	63	capital expenditures [, excluding major medical equipment, 46
64	64	and one million dollars in the case of medical equipment ]; 47
65	65	(9) "Health care facilities": 48 SB 337 3
66	66	(a) Facilities licensed under chapter 198; 49
67	67	(b) Long-term care beds in a hospital, as described in 50
68	68	subdivision (3) of subsection 1 of section 198.012; and 51
69	69	(c) Long-term care hospitals or beds in a long -term 52
70	70	care hospital meeting the requirements described in 42 CFR 53
71	71	412.23(e); 54
72	72	[(7)] (10) "Health service area", a geographic region 55
73	73	appropriate for the effective planning and development of 56
74	74	health services, determined on the basis of factors 57
75	75	including population and the a vailability of resources, 58
76	76	consisting of a population of not less than five hundred 59
77	77	thousand or more than three million; 60
78	78	[(8) "Major medical equipment", medical equipment used 61
79	79	for the provision of medical and other health services; 62
80	80	(9)] (11) "New institutional health service": 63
81	81	(a) The development of a new health care facility 64
82	82	costing in excess of the applicable expenditure minimum; 65
83	83	(b) The acquisition, including acquisition by lease, 66
84	84	of any health care facility [, or major medical equipment] 67
85	85	costing in excess of the expenditure minimum; 68
86	86	(c) Any capital expenditure by or on behalf of a 69
87	87	health care facility in excess of the expenditure minimum; 70
88	88	(d) Predevelopment activities [as defined in 71
89	89	subdivision (12) hereof ] costing in excess of one hundred 72
90	90	fifty thousand dollars; 73
91	91	(e) Any change in licensed bed capacity of a health 74
92	92	care facility licensed under chapter 198 which increases the 75
93	93	total number of beds by more than ten or more than ten 76
94	94	percent of total bed capac ity, whichever is less, over a two - 77
95	95	year period, provided that any such health care facility 78
96	96	seeking a nonapplicability review for an increase in total 79
97	97	beds or total bed capacity in an amount less than described 80 SB 337 4
98	98	in this paragraph shall be eligible for s uch review only if 81
99	99	the facility has had no patient care class I deficiencies 82
100	100	within the last eighteen months and has maintained at least 83
101	101	an eighty-five percent average occupancy rate for the 84
102	102	previous six quarters; 85
103	103	(f) Health services, excluding h ome health services, 86
104	104	which are offered in a health care facility and which were 87
105	105	not offered on a regular basis in such health care facility 88
106	106	within the twelve-month period prior to the time such 89
107	107	services would be offered; 90
108	108	(g) A reallocation by an existing health care facility 91
109	109	of licensed beds among major types of service or 92
110	110	reallocation of licensed beds from one physical facility or 93
111	111	site to another by more than ten beds or more than ten 94
112	112	percent of total licensed bed capacity, whichever is less, 95
113	113	over a two-year period; 96
114	114	[(10)] (12) "Nonsubstantive projects", projects which 97
115	115	do not involve the addition, replacement, modernization or 98
116	116	conversion of beds or the provision of a new health service 99
117	117	but which include a capital expenditure which ex ceeds the 100
118	118	expenditure minimum and are due to an act of God or a normal 101
119	119	consequence of maintaining health care services, facility or 102
120	120	equipment; 103
121	121	[(11)] (13) "Person", any individual, trust, estate, 104
122	122	partnership, corporation, including associations a nd joint 105
123	123	stock companies, state or political subdivision or 106
124	124	instrumentality thereof, including a municipal corporation; 107
125	125	[(12)] (14) "Predevelopment activities", expenditures 108
126	126	for architectural designs, plans, working drawings and 109
127	127	specifications, and any arrangement or commitment made for 110
128	128	financing; but excluding submission of an application for a 111
129	129	certificate of need. 112 SB 337 5
130	130	197.315. 1. Any person who proposes to develop or 1
131	131	offer a new institutional health service within the state 2
132	132	[must] shall obtain a certificate of need from the committee 3
133	133	prior to the time such services are offered. 4
134	134	2. Only those new institutional health services which 5
135	135	are found by the committee to be needed shall be granted a 6
136	136	certificate of need. Only those new institutional health 7
137	137	services which are granted certificates of need shall be 8
138	138	offered or developed within the state. No expenditures for 9
139	139	new institutional health services in excess of the 10
140	140	applicable expenditure minimum shall be made by any pe rson 11
141	141	unless a certificate of need has been granted. 12
142	142	3. After October 1, 1980, no state agency charged by 13
143	143	statute to license or certify health care facilities shall 14
144	144	issue a license to or certify any such facility, or distinct 15
145	145	part of such facility , that is developed without obtaining a 16
146	146	certificate of need. 17
147	147	4. If any person proposes to develop any new 18
148	148	institutional health care service without a certificate of 19
149	149	need as required by sections 197.300 to [197.366] 197.367, 20
150	150	the committee shall no tify the attorney general, and he 21
151	151	shall apply for an injunction or other appropriate legal 22
152	152	action in any court of this state against that person. 23
153	153	5. After October 1, 1980, no agency of state 24
154	154	government may appropriate or grant funds to or make pay ment 25
155	155	of any funds to any person or health care facility which has 26
156	156	not first obtained every certificate of need required 27
157	157	pursuant to sections 197.300 to [197.366] 197.367. 28
158	158	6. A certificate of need shall be issued only for the 29
159	159	premises and persons named in the application and is not 30
160	160	transferable except by consent of the committee. 31 SB 337 6
161	161	7. Project cost increases, due to changes in the 32
162	162	project application as approved or due to project change 33
163	163	orders, exceeding the initial estimate by more than ten 34
164	164	percent shall not be incurred without consent of the 35
165	165	committee. 36
166	166	8. Periodic reports to the committee shall be required 37
167	167	of any applicant who has been granted a certificate of need 38
168	168	until the project has been completed. The committee may 39
169	169	order the forfeiture of the certificate of need upon failure 40
170	170	of the applicant to file any such report. 41
171	171	9. A certificate of need shall be subject to 42
172	172	forfeiture for failure to incur a capital expenditure on any 43
173	173	approved project within six months after the da te of the 44
174	174	order. The applicant may request an extension from the 45
175	175	committee of not more than six additional months based upon 46
176	176	substantial expenditure made. 47
177	177	10. Each application for a certificate of need must be 48
178	178	accompanied by an application fee. The time of filing 49
179	179	commences with the receipt of the application and the 50
180	180	application fee. The application fee is one thousand 51
181	181	dollars, or one-tenth of one percent of the total cost of 52
182	182	the proposed project, whichever is greater. All application 53
183	183	fees shall be deposited in the state treasury. Because of 54
184	184	the loss of federal funds, the general assembly will 55
185	185	appropriate funds to the Missouri health facilities review 56
186	186	committee. 57
187	187	11. In determining whether a certificate of need 58
188	188	should be granted, no consideration shall be given to the 59
189	189	facilities [or equipment] of any other health care facility 60
190	190	located more than a fifteen -mile radius from the applying 61
191	191	facility. 62 SB 337 7
192	192	12. When a [nursing] long-term care facility shifts 63
193	193	from a skilled to an interm ediate level of nursing care, it 64
194	194	may return to the higher level of care if it meets the 65
195	195	licensure requirements, without obtaining a certificate of 66
196	196	need. 67
197	197	13. In no event shall a certificate of need be denied 68
198	198	because the applicant refuses to provid e abortion services 69
199	199	or information. 70
200	200	14. A certificate of need shall not be required for 71
201	201	the transfer of ownership of an existing and operational 72
202	202	health facility in its entirety. 73
203	203	15. A certificate of need may be granted to a facility 74
204	204	for an expansion, an addition of services, or a new 75
205	205	institutional service [, or for a new hospital facility 76
206	206	which] that provides for something less than that which was 77
207	207	sought in the application. 78
208	208	16. The provisions of this section shall not apply to 79
209	209	facilities operated by the state, and appropriation of funds 80
210	210	to such facilities by the general assembly shall be deemed 81
211	211	in compliance with this section, and such facilities shall 82
212	212	be deemed to have received an appropriate certificate of 83
213	213	need without payment of any fee or charge. The provisions 84
214	214	of this subsection shall not apply to hospitals offering 85
215	215	long-term care services operated by the state and licensed 86
216	216	under this chapter, except for department of mental health 87
217	217	state-operated psychiatric hospitals. 88
218	218	17. Notwithstanding other provisions of this section, 89
219	219	a certificate of need may be issued after July 1, 1983, for 90
220	220	an intermediate care facility operated exclusively for the 91
221	221	intellectually disabled. 92
222	222	[18. To assure the safe, appropriate, and co st- 93
223	223	effective transfer of new medical technology throughout the 94 SB 337 8
224	224	state, a certificate of need shall not be required for the 95
225	225	purchase and operation of: 96
226	226	(1) Research equipment that is to be used in a 97
227	227	clinical trial that has received written approval from a 98
228	228	duly constituted institutional review board of an accredited 99
229	229	school of medicine or osteopathy located in Missouri to 100
230	230	establish its safety and efficacy and does not increase the 101
231	231	bed complement of the institution in which the equipment is 102
232	232	to be located. After the clinical trial has been completed, 103
233	233	a certificate of need must be obtained for continued use in 104
234	234	such facility; or 105
235	235	(2) Equipment that is to be used by an academic health 106
236	236	center operated by the state in furtherance of its research 107
237	237	or teaching missions. ] 108
238	238	197.320. The committee shall have the power to 1
239	239	promulgate reasonable rules, regulations, criteria and 2
240	240	standards in conformity with this section and chapter 536 to 3
241	241	meet the objectives of sections 197.300 to [197.366] 197.367 4
242	242	including the power to establish criteria and standards to 5
243	243	review new types of [equipment or service ] services. Any 6
244	244	rule or portion of a rule, as that term is defined in 7
245	245	section 536.010, that is created under the authority 8
246	246	delegated in sections 197.300 to [197.366] 197.367 shall 9
247	247	become effective only if it complies with and is subject to 10
248	248	all of the provisions of chapter 536 and, if applicable, 11
249	249	section 536.028. All rulemaking authority delegated prior to 12
250	250	August 28, 1999, is of no for ce and effect and repealed. 13
251	251	Nothing in this section shall be interpreted to repeal or 14
252	252	affect the validity of any rule filed or adopted prior to 15
253	253	August 28, 1999, if it fully complied with all applicable 16
254	254	provisions of law. This section and chapter 536 are 17
255	255	nonseverable and if any of the powers vested with the 18 SB 337 9
256	256	general assembly pursuant to chapter 536 to review, to delay 19
257	257	the effective date or to disapprove and annul a rule are 20
258	258	subsequently held unconstitutional, then the grant of 21
259	259	rulemaking authority and any rule proposed or adopted after 22
260	260	August 28, 1999, shall be invalid and void. 23
261	261	354.095. 1. A corporation subject to the provisions 1
262	262	of sections 354.010 to 354.380 may, in the discretion of its 2
263	263	board of directors, limit or define the classes of persons 3
264	264	who shall be eligible to become members or beneficiaries, 4
265	265	limit and define the benefits which it will furnish, and may 5
266	266	define such benefits as it undertakes to furnish into 6
267	267	classes or kinds. It may make available to its members or 7
268	268	beneficiaries such health services, or reimbursement 8
269	269	therefor, as the board of directors of any such corporation 9
270	270	may approve; if maternity benefits are provided to any 10
271	271	members of any plan, then maternity benefits shall be 11
272	272	provided to any member of such plan without discrimination 12
273	273	as to whether the member is married or unmarried, and if 13
274	274	maternity benefits are provided to a beneficiary of any 14
275	275	plan, then maternity benefits shall be provided to such 15
276	276	beneficiary of such plan without discrimination as to 16
277	277	whether the beneficiary is married or unmarried. 17
278	278	2. [If an ambulatory surgical facility as defined by 18
279	279	subdivision (2) of section 197.200, has received a 19
280	280	certificate of need as provided in chapter 197, ] A health 20
281	281	services corporation shall prov ide benefits to [the 21
282	282	facility] an ambulatory surgical center, as defined by 22
283	283	section 197.200, on the same basis as it does to all other 23
284	284	health care facilities, whether contracting members or 24
285	285	noncontracting members. A health services corporation shall 25
286	286	use the same standards that are applied to any other health 26
287	287	care facility within the same health services area in 27 SB 337 10
288	288	defining the benefits that the corporation will furnish to 28
289	289	the ambulatory surgical facility, the classes to which such 29
290	290	benefits will be furnished, and the amount of reimbursement. 30
291	291	[197.366. The term "health care 1
292	292	facilities" in sections 197.300 to 197.366 shall 2
293	293	mean: 3
294	294	(1) Facilities licensed under chapter 198; 4
295	295	(2) Long-term care beds in a hospital as 5
296	296	described in subdivision (3) of subsection 1 of 6
297	297	section 198.012; 7
298	298	(3) Long-term care hospitals or beds in a 8
299	299	long-term care hospital meeting the requirements 9
300	300	described in 42 CFR, section 412.23(e); and 10
301	301	(4) Construction of a new hospital as 11
302	302	defined in chapter 197.] 12
303	303	