EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
SENATE BILL NO. 337
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR MOON.
1081S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 197.305, 197.315, 197.320, 197.366, and 354.095, 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 197.305, 197.315, 197.320, 197.366, 1
and 354.095, RSMo, are repealed and four new sections enacted 2
in lieu thereof, t o be known as sections 197.305, 197.315, 3
197.320, and 354.095, to read as follows:4
197.305. As used in sections 197.300 to [197.366] 1
197.367, the following terms mean: 2
(1) "Affected persons", the person proposing the 3
development of a new ins titutional health service, the 4
public to be served, and health care facilities within the 5
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 8
Missouri department of h ealth and senior services; 9
(3) "Capital expenditure", an expenditure by or on 10
behalf of a health care facility which, under generally 11
accepted accounting principles, is not properly chargeable 12
as an expense of operation and maintenance; 13
(4) "Certificate of need", a written certificate 14
issued by the committee setting forth the committee's 15
affirmative finding that a proposed project sufficiently 16 SB 337 2
satisfies the criteria prescribed for such projects by 17
sections 197.300 to [197.366] 197.367; 18
(5) "Committee", the Missouri health facilities review 19
committee; 20
(6) "Department", the Missouri department of health 21
and senior services; 22
(7) "Develop", to undertake those activities which on 23
their completion will result in the offering of a new 24
institutional health service or the incurring of a financial 25
obligation in relation to the offering of such a service; 26
[(6)] (8) "Expenditure minimum" shall mean: 27
(a) For beds in existing or proposed health care 28
facilities licensed pursuant to chapter 198 and long -term 29
care beds in a hospital as described in subdivision (3) of 30
subsection 1 of section 198.012, six hundred thousand 31
dollars in the case of capital expenditures [, or four 32
hundred thousand dollars in the case of major medical 33
equipment,]; provided, [however,] that prior to January 1, 34
2003, the expenditure minimum for beds in such a facility 35
and long-term care beds in a hospital described in section 36
198.012 shall be zero, subject to the provisions of 37
subsection 7 of section 197.318; 38
(b) For beds [or equipment] in a long-term care 39
hospital meeting the requirements described in 42 CFR [, 40
Section] 412.23(e), the expenditure minimum shall be zero; 41
and 42
(c) For health care facilities, new institutional 43
health services or beds not described in paragraph (a) or 44
(b) of this subdivision one million dollars in the case of 45
capital expenditures [, excluding major medical equipment, 46
and one million dollars in the case of medical equipment ]; 47
(9) "Health care facilities": 48 SB 337 3
(a) Facilities licensed under chapter 198; 49
(b) Long-term care beds in a hospital, as described in 50
subdivision (3) of subsection 1 of section 198.012; and 51
(c) Long-term care hospitals or beds in a long -term 52
care hospital meeting the requirements described in 42 CFR 53
412.23(e); 54
[(7)] (10) "Health service area", a geographic region 55
appropriate for the effective planning and development of 56
health services, determined on the basis of factors 57
including population and the a vailability of resources, 58
consisting of a population of not less than five hundred 59
thousand or more than three million; 60
[(8) "Major medical equipment", medical equipment used 61
for the provision of medical and other health services; 62
(9)] (11) "New institutional health service": 63
(a) The development of a new health care facility 64
costing in excess of the applicable expenditure minimum; 65
(b) The acquisition, including acquisition by lease, 66
of any health care facility [, or major medical equipment] 67
costing in excess of the expenditure minimum; 68
(c) Any capital expenditure by or on behalf of a 69
health care facility in excess of the expenditure minimum; 70
(d) Predevelopment activities [as defined in 71
subdivision (12) hereof ] costing in excess of one hundred 72
fifty thousand dollars; 73
(e) Any change in licensed bed capacity of a health 74
care facility licensed under chapter 198 which increases the 75
total number of beds by more than ten or more than ten 76
percent of total bed capac ity, whichever is less, over a two - 77
year period, provided that any such health care facility 78
seeking a nonapplicability review for an increase in total 79
beds or total bed capacity in an amount less than described 80 SB 337 4
in this paragraph shall be eligible for s uch review only if 81
the facility has had no patient care class I deficiencies 82
within the last eighteen months and has maintained at least 83
an eighty-five percent average occupancy rate for the 84
previous six quarters; 85
(f) Health services, excluding h ome health services, 86
which are offered in a health care facility and which were 87
not offered on a regular basis in such health care facility 88
within the twelve-month period prior to the time such 89
services would be offered; 90
(g) A reallocation by an existing health care facility 91
of licensed beds among major types of service or 92
reallocation of licensed beds from one physical facility or 93
site to another by more than ten beds or more than ten 94
percent of total licensed bed capacity, whichever is less, 95
over a two-year period; 96
[(10)] (12) "Nonsubstantive projects", projects which 97
do not involve the addition, replacement, modernization or 98
conversion of beds or the provision of a new health service 99
but which include a capital expenditure which ex ceeds the 100
expenditure minimum and are due to an act of God or a normal 101
consequence of maintaining health care services, facility or 102
equipment; 103
[(11)] (13) "Person", any individual, trust, estate, 104
partnership, corporation, including associations a nd joint 105
stock companies, state or political subdivision or 106
instrumentality thereof, including a municipal corporation; 107
[(12)] (14) "Predevelopment activities", expenditures 108
for architectural designs, plans, working drawings and 109
specifications, and any arrangement or commitment made for 110
financing; but excluding submission of an application for a 111
certificate of need. 112 SB 337 5
197.315. 1. Any person who proposes to develop or 1
offer a new institutional health service within the state 2
[must] shall obtain a certificate of need from the committee 3
prior to the time such services are offered. 4
2. Only those new institutional health services which 5
are found by the committee to be needed shall be granted a 6
certificate of need. Only those new institutional health 7
services which are granted certificates of need shall be 8
offered or developed within the state. No expenditures for 9
new institutional health services in excess of the 10
applicable expenditure minimum shall be made by any pe rson 11
unless a certificate of need has been granted. 12
3. After October 1, 1980, no state agency charged by 13
statute to license or certify health care facilities shall 14
issue a license to or certify any such facility, or distinct 15
part of such facility , that is developed without obtaining a 16
certificate of need. 17
4. If any person proposes to develop any new 18
institutional health care service without a certificate of 19
need as required by sections 197.300 to [197.366] 197.367, 20
the committee shall no tify the attorney general, and he 21
shall apply for an injunction or other appropriate legal 22
action in any court of this state against that person. 23
5. After October 1, 1980, no agency of state 24
government may appropriate or grant funds to or make pay ment 25
of any funds to any person or health care facility which has 26
not first obtained every certificate of need required 27
pursuant to sections 197.300 to [197.366] 197.367. 28
6. A certificate of need shall be issued only for the 29
premises and persons named in the application and is not 30
transferable except by consent of the committee. 31 SB 337 6
7. Project cost increases, due to changes in the 32
project application as approved or due to project change 33
orders, exceeding the initial estimate by more than ten 34
percent shall not be incurred without consent of the 35
committee. 36
8. Periodic reports to the committee shall be required 37
of any applicant who has been granted a certificate of need 38
until the project has been completed. The committee may 39
order the forfeiture of the certificate of need upon failure 40
of the applicant to file any such report. 41
9. A certificate of need shall be subject to 42
forfeiture for failure to incur a capital expenditure on any 43
approved project within six months after the da te of the 44
order. The applicant may request an extension from the 45
committee of not more than six additional months based upon 46
substantial expenditure made. 47
10. Each application for a certificate of need must be 48
accompanied by an application fee. The time of filing 49
commences with the receipt of the application and the 50
application fee. The application fee is one thousand 51
dollars, or one-tenth of one percent of the total cost of 52
the proposed project, whichever is greater. All application 53
fees shall be deposited in the state treasury. Because of 54
the loss of federal funds, the general assembly will 55
appropriate funds to the Missouri health facilities review 56
committee. 57
11. In determining whether a certificate of need 58
should be granted, no consideration shall be given to the 59
facilities [or equipment] of any other health care facility 60
located more than a fifteen -mile radius from the applying 61
facility. 62 SB 337 7
12. When a [nursing] long-term care facility shifts 63
from a skilled to an interm ediate level of nursing care, it 64
may return to the higher level of care if it meets the 65
licensure requirements, without obtaining a certificate of 66
need. 67
13. In no event shall a certificate of need be denied 68
because the applicant refuses to provid e abortion services 69
or information. 70
14. A certificate of need shall not be required for 71
the transfer of ownership of an existing and operational 72
health facility in its entirety. 73
15. A certificate of need may be granted to a facility 74
for an expansion, an addition of services, or a new 75
institutional service [, or for a new hospital facility 76
which] that provides for something less than that which was 77
sought in the application. 78
16. The provisions of this section shall not apply to 79
facilities operated by the state, and appropriation of funds 80
to such facilities by the general assembly shall be deemed 81
in compliance with this section, and such facilities shall 82
be deemed to have received an appropriate certificate of 83
need without payment of any fee or charge. The provisions 84
of this subsection shall not apply to hospitals offering 85
long-term care services operated by the state and licensed 86
under this chapter, except for department of mental health 87
state-operated psychiatric hospitals. 88
17. Notwithstanding other provisions of this section, 89
a certificate of need may be issued after July 1, 1983, for 90
an intermediate care facility operated exclusively for the 91
intellectually disabled. 92
[18. To assure the safe, appropriate, and co st- 93
effective transfer of new medical technology throughout the 94 SB 337 8
state, a certificate of need shall not be required for the 95
purchase and operation of: 96
(1) Research equipment that is to be used in a 97
clinical trial that has received written approval from a 98
duly constituted institutional review board of an accredited 99
school of medicine or osteopathy located in Missouri to 100
establish its safety and efficacy and does not increase the 101
bed complement of the institution in which the equipment is 102
to be located. After the clinical trial has been completed, 103
a certificate of need must be obtained for continued use in 104
such facility; or 105
(2) Equipment that is to be used by an academic health 106
center operated by the state in furtherance of its research 107
or teaching missions. ] 108
197.320. The committee shall have the power to 1
promulgate reasonable rules, regulations, criteria and 2
standards in conformity with this section and chapter 536 to 3
meet the objectives of sections 197.300 to [197.366] 197.367 4
including the power to establish criteria and standards to 5
review new types of [equipment or service ] services. Any 6
rule or portion of a rule, as that term is defined in 7
section 536.010, that is created under the authority 8
delegated in sections 197.300 to [197.366] 197.367 shall 9
become effective only if it complies with and is subject to 10
all of the provisions of chapter 536 and, if applicable, 11
section 536.028. All rulemaking authority delegated prior to 12
August 28, 1999, is of no for ce and effect and repealed. 13
Nothing in this section shall be interpreted to repeal or 14
affect the validity of any rule filed or adopted prior to 15
August 28, 1999, if it fully complied with all applicable 16
provisions of law. This section and chapter 536 are 17
nonseverable and if any of the powers vested with the 18 SB 337 9
general assembly pursuant to chapter 536 to review, to delay 19
the effective date or to disapprove and annul a rule are 20
subsequently held unconstitutional, then the grant of 21
rulemaking authority and any rule proposed or adopted after 22
August 28, 1999, shall be invalid and void. 23
354.095. 1. A corporation subject to the provisions 1
of sections 354.010 to 354.380 may, in the discretion of its 2
board of directors, limit or define the classes of persons 3
who shall be eligible to become members or beneficiaries, 4
limit and define the benefits which it will furnish, and may 5
define such benefits as it undertakes to furnish into 6
classes or kinds. It may make available to its members or 7
beneficiaries such health services, or reimbursement 8
therefor, as the board of directors of any such corporation 9
may approve; if maternity benefits are provided to any 10
members of any plan, then maternity benefits shall be 11
provided to any member of such plan without discrimination 12
as to whether the member is married or unmarried, and if 13
maternity benefits are provided to a beneficiary of any 14
plan, then maternity benefits shall be provided to such 15
beneficiary of such plan without discrimination as to 16
whether the beneficiary is married or unmarried. 17
2. [If an ambulatory surgical facility as defined by 18
subdivision (2) of section 197.200, has received a 19
certificate of need as provided in chapter 197, ] A health 20
services corporation shall prov ide benefits to [the 21
facility] an ambulatory surgical center, as defined by 22
section 197.200, on the same basis as it does to all other 23
health care facilities, whether contracting members or 24
noncontracting members. A health services corporation shall 25
use the same standards that are applied to any other health 26
care facility within the same health services area in 27 SB 337 10
defining the benefits that the corporation will furnish to 28
the ambulatory surgical facility, the classes to which such 29
benefits will be furnished, and the amount of reimbursement. 30
[197.366. The term "health care 1
facilities" in sections 197.300 to 197.366 shall 2
mean: 3
(1) Facilities licensed under chapter 198; 4
(2) Long-term care beds in a hospital as 5
described in subdivision (3) of subsection 1 of 6
section 198.012; 7
(3) Long-term care hospitals or beds in a 8
long-term care hospital meeting the requirements 9
described in 42 CFR, section 412.23(e); and 10
(4) Construction of a new hospital as 11
defined in chapter 197.] 12