Missouri Statute | Act | Code |Public Health And Welfare| US Code - US Statute | Chapter 197 Medical Treatment Facility Licenses

This law may be cited and referred to as the "Hospital Licensing
Law". (L. 1953 p. 631 § 1)

1. "Governmental unit" means any county, municipality or other
political subdivision or any department, division, board or other agency
of any of the foregoing.

2. "Hospital" means a place devoted primarily to the maintenance and
operation of facilities for the diagnosis, treatment or care for not less
than twenty-four consecutive hours in any week of three or more
nonrelated individuals suffering from illness, disease, injury, deformity
or other abnormal physical conditions; or a place devoted primarily to
provide for not less than twenty-four consecutive hours in any week
medical or nursing care for three or more nonrelated individuals. The
term "hospital" does not include convalescent, nursing, shelter or
boarding homes as defined in chapter 198, RSMo.

3. "Person" means any individual, firm, partnership, corporation, company
or association and the legal successors thereof. (L. 1953 p. 631 § 2,
A.L. 1959 S.B. 19, A.L. 1994 H.B. 1408 merged with H.B. 1427)

Effective 6-3-94 (H.B. 1408) 8-28-94 (H.B. 1427)

(1995) Outpatient radiation therapy services operated by hospital in
commercial building was not open twenty-four hours in any day and is not
a hospital, therefore is not subject to certificate of need law. SSM
Health Care v. Missouri Health Facilities Review Committee, 894 S.W.2d
674 (Mo. en banc).

The purpose of this law is to provide for the development,
establishment and enforcement of standards for the care and treatment of
individuals in hospitals and for the construction, maintenance and
operation of hospitals, which, in the light of advancing knowledge, will
promote safe and adequate treatment of such individuals in hospitals. (L.
1953 p. 631 § 3)

1. No physician or surgeon, registered nurse, practical nurse,
midwife or hospital, public or private, shall be required to treat or
admit for treatment any woman for the purpose of abortion if such
treatment or admission for treatment is contrary to the established
policy of, or the moral, ethical or religious beliefs of, such physician,
surgeon, registered nurse, midwife, practical nurse or hospital. No cause
of action shall accrue against any such physician, surgeon, registered
nurse, midwife, practical nurse or hospital on account of such refusal to
treat or admit for treatment any woman for abortion purposes.

2. No person or institution shall be denied or discriminated against in
the reception of any public benefit, assistance or privilege whatsoever
or in any employment, public or private, on the grounds that they refuse
to undergo an abortion, to advise, consent to, assist in or perform an
abortion.

3. Any person who shall deny or discriminate against another for refusal
to perform or participate in an abortion shall be liable to the party
injured in an action at law, suit in equity or other redress. (L. 1973
H.B. 731 & 793 §§ 1, 2, 3)

After ninety days from the date this law becomes effective, no
person or governmental unit, acting severally or jointly with any other
person or governmental unit, shall establish, conduct or maintain a
hospital in this state without a license under this law issued by the
department of health and senior services. (L. 1953 p. 631 § 4)

Application for a license shall be made to the department of
health and senior services upon forms provided by it and shall contain
such information as the department of health and senior services
requires, which may include affirmative evidence of ability to comply
with such reasonable standards, rules and regulations as are lawfully
prescribed hereunder. Until June 30, 1989, each application for a
license, except applications from governmental units, shall be
accompanied by an annual license fee of two hundred dollars plus two
dollars per bed for the first one hundred beds and one dollar per bed for
each additional bed. Beginning July 1, 1989, each application for a
license, except applications from governmental units, shall be
accompanied by an annual license fee of two hundred fifty dollars plus
three dollars per bed for the first four hundred beds and two dollars per
bed for each additional bed. All license fees shall be paid to the
director of revenue and deposited in the state treasury to the credit of
the general revenue fund. (L. 1953 p. 631 § 5, A.L. 1961 p. 517, A.L.
1982 S.B. 575, A.L. 1988 H.B. 1134)

Effective 5-4-88

1. Upon receipt of an application for a license, the department
of health and senior services shall issue a license if the applicant and
hospital facilities meet the requirements established under this law. A
license, unless sooner suspended or revoked, shall be renewable annually
upon receipt of an application for a license and the license fee from the
licensee and approval by the department of health and senior services.

2. Each license shall be issued only for the premises and persons or
governmental units named in the application, and shall not be
transferable or assignable except with the written approval of the
department of health and senior services. Licenses shall be posted in a
conspicuous place on the licensed premises. (L. 1953 p. 631 § 6)

The department of health and senior services may deny, suspend
or revoke a license in any case in which it finds that there has been a
substantial failure to comply with the requirements established under
this law. (L. 1953 p. 631 § 7, A.L. 1978 S.B. 661)

Any person aggrieved by an official action of the department of
health and senior services affecting the licensed status of a person
under the provisions of sections 197.010 to 197.120, including the
refusal to grant, the grant, the revocation, the suspension, or the
failure to renew a license, may seek a determination thereon by the
administrative hearing commission pursuant to the provisions of section
621.045, RSMo, and it shall not be a condition to such determination that
the person aggrieved seek a reconsideration, a rehearing, or exhaust any
other procedure within the department of health and senior services. (L.
1978 S.B. 661)

The department of health and senior services, with the advice of
the state advisory council and pursuant to the provisions of this section
and chapter 536, RSMo, shall adopt, amend, promulgate and enforce such
rules, regulations and standards with respect to all hospitals or
different types of hospitals to be licensed hereunder as may be designed
to further the accomplishment of the purposes of this law in promoting
safe and adequate treatment of individuals in hospitals in the interest
of public health, safety and welfare. No rule or portion of a rule
promulgated under the authority of sections 197.010 to 197.280 shall
become effective unless it has been promulgated pursuant to the
provisions of section 536.024, RSMo. (L. 1953 p. 631 § 8, A.L. 1993 S.B.
52, A.L. 1995 S.B. 3)

Any hospital which is in operation at the time of the
promulgation of any applicable rule or regulation or minimum standard
under this law shall be given a reasonable time under the particular
circumstances not to exceed two years from the date of such promulgation
within which to comply with such rules and regulations and minimum
standards. (L. 1953 p. 631 § 9)

1. Any provision of chapter 198, RSMo, and chapter 338, RSMo, to
the contrary notwithstanding, the department of health and senior
services shall have sole authority, and responsibility for inspection and
licensure of hospitals in this state including, but not limited to all
parts, services, functions, support functions and activities which
contribute directly or indirectly to patient care of any kind whatsoever.
The department of health and senior services shall annually inspect each
licensed hospital and shall make any other inspections and investigations
as it deems necessary for good cause shown. The department of health
shall accept reports of hospital inspections from governmental agencies
and recognized accrediting organizations in whole or in part for
licensure purposes if:

(1) The inspection is comparable to an inspection performed by the
department of health and senior services;

(2) The hospital meets minimum licensure standards; and

(3) The inspection was conducted within one year of the date of license
renewal.

The department of health and senior services shall attempt to schedule
inspections and evaluations required by this section so as not to cause a
hospital to be subject to more than one inspection in any twelve-month
period from the department of health and senior services or any agency or
accreditation organization the reports of which are accepted for
licensure purposes pursuant to this section, except for good cause shown.

2. Other provisions of law to the contrary notwithstanding, the
department of health and senior services shall be the only state agency
to determine life safety and building codes for hospitals defined or
licensed pursuant to the provisions of this chapter, including but not
limited to sprinkler systems, smoke detection devices and other fire
safety related matters so long as any new standards shall apply only to
new construction. (L. 1953 p. 631 § 10, A.L. 1988 H.B. 1134)

Effective 5-4-88

1. Any person establishing, conducting, managing or operating
any hospital without a license under this law shall be guilty of a
misdemeanor.

2. The attorney general shall represent the department of health and
senior services, who may institute an action in the name of the state for
injunction or other process against any person or governmental unit to
restrain or prevent the establishment, conduct, management or operation
of a hospital without a license under this law. (L. 1953 p. 631 § 12)

The department of health and senior services shall not license
any entity as a hospital, as the term "hospital" is defined in section
197.020, that is devoted primarily or exclusively to surgical procedures,
patients with a cardiac condition, patients with an orthopedic condition,
or any other specialized category of patients or cases as may be
determined by the director of the department. Nothing in this section
shall prohibit licensure or certification of any entity as a hospital
that is devoted primarily to care and treatment of children under the age
of eighteen years, psychiatric patients, or patients undergoing
rehabilitation care or to long-term care hospitals meeting the
requirements described in 42 CFR Sec. 412.23(e). The provisions of this
section shall expire, and be of no effect, on and after August 28, 2005.
(L. 2004 H.B. 1195 § 1)

Expires 8-28-05

The department shall require that each hospital, ambulatory
surgical center, and other facility have in place procedures for
monitoring and enforcing compliance with infection control regulations
and standards. Such procedures shall be coordinated with administrative
staff, personnel staff, and the quality improvement program. Such
procedures shall include, at a minimum, requirements for the facility's
infection control program to conduct surveillance of personnel with a
portion of the surveillance to be done in such manner that employees and
medical staff are observed without their knowledge of such observation,
provided that this unobserved surveillance requirement shall not be
considered to be grounds for licensure enforcement action by the
department until the department establishes clear and verifiable criteria
for determining compliance. Such surveillance also may include monitoring
of the rate of use of hand hygiene products. (L. 2004 S.B. 1279)

1. Infection control officers as defined in federal regulation
and other hospital and ambulatory surgical center employees shall be
protected against retaliation by the hospital or ambulatory surgical
center for reporting infection control concerns pursuant to section
197.285 and shall be entitled to the full benefits of that section. Such
infection control officers shall report any interference in the
performance of their duties by their supervisors to the hospital or
ambulatory surgical center compliance officer established by and
empowered to act pursuant to section 197.285.

2. Infection control officers as defined in federal regulation shall also
have the authority to order the cessation of a practice that falls
outside accepted practices as defined by appropriate state and federal
regulatory agencies, accreditation organizations, or the standards
adopted by the Centers for Disease Control and Prevention or the
Association of Professionals in Infection Control and Epidemiology. The
hospital or ambulatory surgical center may require that such a cessation
order of an infection control officer be endorsed by the hospital or
ambulatory surgical center chief executive officer or his or her designee
before taking effect. The hospital or ambulatory surgical center
infection control committee shall convene as soon as possible to review
such cessation order and may overrule or sustain the directive of the
infection control officer. The department shall promulgate rules
governing documentation of such events.

3. Members of the medical staff who report in good faith infection
control concerns to the hospital or ambulatory surgical center
administration or medical staff leadership shall not be subject to
retaliation or discrimination for doing so. Nothing in this section shall
prevent or shield medical staff members from being subject to
professional review actions for substandard care or breach of standards
established in hospital policy, rules, or medical staff bylaws. (L. 2004
S.B. 1279)

No later than July 1, 2005, the department shall review and
update its current regulations governing hospital and ambulatory surgical
center infection control programs. Such standards shall be based upon
nationally recognized standards and shall include, but not be limited to,
standards for:

(1) Maintaining databases to be used for infection tracking;

(2) Developing hospital protocols related to aseptic technique and
infection control practices including but not limited to hand washing,
isolation, and other infection control policies;

(3) Developing appropriate corrective action plans and follow-ups for any
deficiencies identified in hospital infection control practices;

(4) Conducting root cause analysis and follow-up of sentinel events, as
defined by the Joint Commission on Accreditation of Health Organizations,
attributable to nosocomial infections; and

(5) Ensuring that hospital and ambulatory surgical center policies and
medical staff bylaws are in place to promote and enforce compliance with
infection control policies. (L. 2004 S.B. 1279)

For purposes of reporting nosocomial infection outbreaks as
required by department rule, the term "nosocomial infection outbreaks"
shall mean infections as defined by the national Centers for Disease
Control and Prevention within a defined time period. The time period
shall be defined by the department based upon the number of infected
patients in a facility. (L. 2004 S.B. 1279)

Every hospital and ambulatory surgery center shall, beginning
June 1, 2006, provide each patient an opportunity to submit to the
hospital or ambulatory surgical center administration complaints,
comments, and suggestions related to the care they received or their
personal observations related to the quality of care provided. The
department shall promulgate rules to implement this section. (L. 2004
S.B. 1279)

The department of health and senior services shall have access
to all data and information held by hospitals, ambulatory surgical
centers, and other facilities related to their infection control
practices, rates, or treatments of infections. Failure to provide such
access shall be grounds for full or partial licensure suspension or
revocation pursuant to section 197.293, sections 197.010 to 197.100, or
sections 197.200 to 197.240. If the department determines that the
hospital, ambulatory surgical center, or other facility is willfully
impeding access to such information, the department shall be authorized
to direct all state agencies to suspend all or a portion of state
payments to such hospital until such time as the desired information is
obtained by the department. (L. 2004 S.B. 1279)

The department shall in its licensure of hospitals and
ambulatory surgical centers give special attention to infection control
practices and shall direct hospitals and ambulatory surgical centers to
set quantifiable measures of performance for reducing the incidence of
nosocomial infections in Missouri. The department shall prepare an annual
report on infection control standards and compliance, which shall be
shared with the governor and the general assembly. (L. 2004 S.B. 1279)

1. The department shall appoint an "Infection Control Advisory
Panel" for the purposes of implementing sections 192.131 and 192.667,
RSMo.

2. Members of the infection control advisory panel shall include:

(1) Two public members;

(2) Three board-certified or board-eligible physicians licensed pursuant
to chapter 334, RSMo, who are affiliated with a Missouri hospital or
medical school, active members of the Society for Health Care
Epidemiology of America, and have demonstrated interest and expertise in
health facility infection control;

(3) One physician licensed pursuant to chapter 334, RSMo, who is active
in the practice of medicine in Missouri and who holds medical staff
privileges at a Missouri hospital;

(4) Four infection control practitioners certified by the certification
board of infection control and epidemiology, at least two of whom shall
be practicing in a rural hospital or setting and at least two of whom
shall be registered professional nurses licensed under chapter 335, RSMo;

(5) A medical statistician with an advanced degree in such specialty; *

(6) A clinical microbiologist with an advanced degree in such specialty;

(7) Three employees of the department, representing the functions of
hospital and ambulatory surgical center licensure, epidemiology and
health data analysis, who shall serve as ex officio nonvoting members of
the panel.

3. Reasonable expenses of the panel shall be paid from private donations
made specifically for that purpose to the "Infection Control Advisory
Panel Fund", which is hereby created in the state treasury. If such
donations are not received from private sources, then the provisions of
this act** shall be implemented without the advisory panel. (L. 2004 S.B.
1279)

*Word "and" appears in original rolls.

**"This act" (S.B. 1279, 2004) contained numerous sections. Consult
Disposition of Sections table for a definitive listing.

As used in sections 197.200 to 197.240, unless the context
clearly indicates otherwise, the following terms mean:

(1) "Ambulatory surgical center", any public or private establishment
operated primarily for the purpose of performing surgical procedures or
primarily for the purpose of performing childbirths, and which does not
provide services or other accommodations for patients to stay more than
twenty-three hours within the establishment, provided, however, that
nothing in this definition shall be construed to include the offices of
dentists currently licensed pursuant to chapter 332, RSMo;

(2) "Dentist", any person currently licensed to practice dentistry
pursuant to chapter 332, RSMo;

(3) "Department", the department of health and senior services;

(4) "Governmental unit", any city, county or other political subdivision
of this state, or any department, division, board or other agency of any
political subdivision of this state;

(5) "Person", any individual, firm, partnership, corporation, company, or
association and the legal successors thereof;

(6) "Physician", any person currently licensed to practice medicine
pursuant to chapter 334, RSMo;

(7) "Podiatrist", any person currently licensed to practice podiatry
pursuant to chapter 330, RSMo. (L. 1975 S.B. 1 § 1, A.L. 1986 H.B. 1162,
A.L. 1991 H.B. 444)

1. No person or governmental unit acting severally or jointly
with any other person or governmental unit shall establish, conduct or
maintain an ambulatory surgical center in this state without a license
under sections 197.200 to 197.240 issued by the department of health and
senior services.

2. Nothing in sections 197.200 to 197.240 shall be construed to impair or
abridge the authority of a governmental unit to license ambulatory
surgical centers, provided that any ordinance of a governmental unit
shall require compliance with all rules, regulations, and standards
adopted by the department to implement the provisions of sections 197.200
to 197.240. (L. 1975 S.B. 1 § 2, A.L. 1986 H.B. 1162)

1. Application for a license shall be made to the department
upon forms provided by the department and shall contain such information
as the department may require. The department of health and senior
services may require affirmative evidence of ability to comply with such
reasonable standards, rules and regulations as are lawfully prescribed
under the provisions of sections 197.200 to 197.240.

2. Each application for a license, except applications from governmental
units, shall be accompanied by an annual license fee of two hundred
dollars. All license fees shall be deposited in the state treasury to the
credit of general revenue. (L. 1975 S.B. 1 § 3, A.L. 1982 S.B. 575)

1. Upon receipt of an application for a license, the department
of health and senior services shall issue a license if the applicant and
ambulatory surgical center facilities meet the requirements established
under sections 197.200 to 197.240, and have provided affirmative evidence
that:

(1) Each member of the surgical staff is a physician, dentist or
podiatrist currently licensed to practice in Missouri;

(2) Surgical procedures shall be performed only by physicians, dentists
or podiatrists, who at the time are privileged to perform surgical
procedures in at least one licensed hospital in the community in which
the ambulatory surgical center is located, thus providing assurance to
the public that patients treated in the center shall receive continuity
of care should the services of a hospital be required; alternatively,
applicant shall submit a copy of a current working agreement with at
least one licensed hospital in the community in which the ambulatory
surgical center is located, guaranteeing the transfer and admittance of
patients for emergency treatment whenever necessary;

(3) Continuous physician services or registered professional nursing
services are provided whenever a patient is in the facility;

(4) Adequate medical records for each patient are to be maintained.

2. Upon receipt of an application for a license, or the renewal thereof,
the department shall issue or renew the license if the applicant and
program meet the requirements established under sections 197.200 to
197.240. Each license shall be issued only for the persons and premises
named in the application. A license, unless sooner suspended or revoked,
shall be issued for a period of one year.

3. Each license shall be issued only for the premises and persons or
governmental units named in the application, and shall not be
transferable or assignable except with the written consent of the
department. Licenses shall be posted in a conspicuous place on the
licensed premises.

4. If, during the period in which an ambulatory surgical center license
is in effect, the license holder or operator legally transfers
operational responsibilities by any process to another person as defined
in section 197.200, an application shall be made for the issuance of a
new license to become effective on the transfer date. (L. 1975 S.B. 1 §
4, A.L. 1986 H.B. 1162)

The department of health and senior services may deny, suspend
or revoke a license in any case in which the department finds that there
has been a substantial failure to comply with the requirements of
sections 197.200 to 197.240, or in any case in which the director of the
department makes a finding that:

(1) The applicant, or if the applicant is a firm, partnership or
association, any of its members, or if a corporation, any of its officers
or directors, or the person designated to manage or supervise the
facility, has been finally adjudicated and found guilty, or entered a
plea of guilty or nolo contendere, in a criminal prosecution under the
laws of any state or of the United States, for any offense reasonably
related to the qualifications, functions, or duties of an ambulatory
surgical center, or for any offense an essential element of which is
fraud, dishonesty, or an act of violence, or for any offense involving
moral turpitude, whether or not sentence is imposed;

(2) The licensure status or record of the applicant, or if the applicant
is a firm, partnership or association, of any of its members, or if a
corporation, of any of its officers or directors, or of the person
designated to manage or supervise the facility, from any other state,
federal district or land, territory or commonwealth of the United States,
or of any foreign country where the applicant has done business in a
similar capacity indicates that granting a license to the applicant would
be detrimental to the interests of the public. (L. 1975 S.B. 1 § 5, A.L.
1978 S.B. 661, A.L. 1986 H.B. 1162)

Any person aggrieved by an official action of the department of
health and senior services affecting the licensed status of a person
under the provisions of sections 197.200 to 197.240, including the
refusal to grant, the grant, the revocation, the suspension, or the
failure to renew a license, may seek a determination thereon by the
administrative hearing commission pursuant to the provisions of section
621.045, RSMo, and it shall not be a condition to such determination that
the person aggrieved seek a reconsideration, a rehearing, or exhaust any
other procedure within the department of health and senior services. (L.
1978 S.B. 661, A.L. 1986 H.B. 1162, A.L. 1993 S.B. 52)

The department of health and senior services may adopt such
reasonable rules, regulations, and standards for the types of services
provided as are necessary to carry out the provisions of sections 197.200
to 197.240, and to assure quality patient care and patient safety, which
shall include, but not be limited to:

(1) Construction of the facility including, but not limited to, plumbing,
heating, lighting, and ventilation which should insure the health,
safety, comfort, and privacy of patients and protection from fire hazard;

(2) Number, qualifications, and organization of all personnel, having
responsibility for any part of the care provided to the patients;

(3) Equipment essential to the health, welfare, and safety of the
patients;

(4) Facilities, programs, and services to be provided in connection with
the care of patients in ambulatory surgical centers; and

(5) Procedures for peer review and for receiving and investigating
complaints regarding any ambulatory surgical center or any physician,
dentist, podiatrist, nurse, assistant, manager, supervisor, or employee
practicing or working in any such facility. (L. 1975 S.B. 1 § 6, A.L.
1986 H.B. 1162)

The department of health and senior services shall make, or
cause to be made, such inspections and investigations as it deems
necessary. The department may delegate its powers and duties to
investigate and inspect ambulatory surgical centers to an official of a
political subdivision having a population of at least four hundred fifty
thousand if such political subdivision is deemed qualified by the
department to inspect and investigate ambulatory surgical centers. The
official so designated shall submit a written report of his findings to
the department and the department may accept the recommendations of such
official if it determines that the facility inspected meets minimum
standards established pursuant to sections 197.200 to 197.240. (L. 1975
S.B. 1 § 7)

1. Any person operating, conducting, managing, or establishing
an ambulatory surgical center without a license required by sections
197.200 to 197.240 is guilty of a class A misdemeanor and, upon
conviction, shall be subject to a fine of not more than five hundred
dollars. Each day of continuing violation shall constitute a separate
offense.

2. The attorney general shall represent the department of health and
senior services and shall institute an action in the name of the state
for injunctive or other relief against any person or governmental unit to
restrain or prevent the establishment, conduct, management, or operation
of an ambulatory surgical center without a license issued pursuant to the
provisions of sections 197.200 to 197.240.

3. Any person operating, conducting, managing, or establishing an
ambulatory surgical center who, in the course of advertising, promoting,
or otherwise publicizing the activities, business, location, or any other
matter concerning the operations of said ambulatory surgical center, uses
or employs in any manner the words "State, Missouri, State of Missouri,
Department of Health and Senior Services, the initials 'Mo.'," or any
emblem of the state of Missouri or the department of health and senior
services, for the purpose of conveying or in any manner reasonably
calculated to convey the false impression that the state of Missouri or
any department, agency, bureau, or instrumentality thereof is involved in
the business of said ambulatory surgical center, or took part in said
advertisement, promotion, publicity, or other statement, shall be subject
to a fine of one hundred dollars per day for each day during the period
beginning with the day said advertisement, promotion, publication, or
statement first appears and ending on the day on which it is withdrawn.
(L. 1975 S.B. 1 § 8, A.L. 1986 H.B. 1162)

After September 28, 1975, no individual or group health
insurance policy of insurance providing coverage on an expense incurred
basis, nor individual or group service or indemnity type contract issued
by a nonprofit corporation, nor any self-insured group health benefit
plan or trust, of any kind or description, shall be issued or payment
accepted therefor in renewal or continuation thereof unless coverage for
any service performed in an ambulatory surgical center is provided for
therein if such service would have been covered under the terms of the
policy or contract as an eligible inpatient service, except as provided
in section 376.805, RSMo. Nothing in this section shall apply to a group
contract, plan or trust which provides health care and surgical care
directly to its members and their dependents. Nothing in this section
shall be construed to mandate coverage under an individual or group
health insurance policy of insurance providing coverage on an expense
incurred basis, or an individual or group service or indemnity type
contract issued by a nonprofit corporation, or any self-insured group
health benefit plan or trust, of any kind or description, to provide
health insurance for services which are usually performed in a
physician's office. (L. 1975 S.B. 1 § 9, A.L. 1986 H.B. 1162)

As used in sections 197.250 to 197.280, the following terms mean:

(1) "Abuse", any physical, emotional, or sexual maltreatment;

(2) "Branch office", a location or site from which a hospice provides
services within a portion of the total geographic area served by the
parent agency where the area served is contiguous to or part of the area
served by the whole agency;

(3) "Council", the state hospice advisory council created in section
197.272;

(4) "Department", the department of health and senior services;

(5) "Hospice", a coordinated program of palliative and supportive
services provided in both home and inpatient settings which provides for
physical, psychological, social and spiritual care for dying persons and
their families where services are provided by a medically directed
interdisciplinary team of professionals and volunteers and bereavement
care is available to the family following the death of the person;

(6) "Neglect", the failure to provide, or arrange for the provisions of,
the services which are reasonable and necessary to maintain the physical
and mental health of a client when such failure presents either an
imminent danger to the health, safety or welfare of the client or a
substantial probability that death or serious physical harm would result.
Such failure shall not constitute neglect if the failure results from
circumstances which:

(a) Are beyond the control of the person or entity failing to provide
such services; and

(b) Render it impossible for the person or entity to provide such
services and to arrange for the provision of such services;

(7) "Parent agency", the agency that develops and maintains
administrative control of subunits and branch offices, and also maintains
supervisory control of branch offices;

(8) "Physician", a person licensed by the state board of registration for
the healing arts under the provisions of chapter 334, RSMo, to practice
in this state as a physician and surgeon;

(9) "Residence", the client's actual dwelling place, including
institutional dwelling places. (L. 1992 H.B. 899 § 1)

1. No person or other entity shall provide hospice care, or hold
himself out as a hospice, unless such person has a certificate pursuant
to sections 197.250 to 197.280.

2. All skilled care provided by a hospice shall be provided in accordance
with professionally accepted standards. (L. 1992 H.B. 899 § 2)

1. Any person or other entity desiring to provide hospice care
shall file, with the department of health and senior services, a written
application for a certificate on a form to be prescribed by the director
of the department. Such application shall be accompanied by a fee to be
determined by the department of health and senior services with input
from the hospice advisory council. The fee will be based on a sliding
scale with a minimum of two hundred fifty dollars, maximum seven hundred
fifty dollars. Any person or entity which exacts no charge shall be
exempt from the provisions of sections 197.250 to 197.280.

2. The department may issue a temporary operating permit to any hospice
which has filed an application, pending the approval of such application.
Any temporary operating permit or certificate issued pursuant to sections
197.250 to 197.280 shall be issued only for the person or entity listed
on the application.

3. Upon the receipt of the application and the fee, if one is required,
the department shall conduct a survey to evaluate the quality of services
rendered by an applicant for certification. The department shall approve
the application of and issue a certificate to any applicant which is in
compliance with all the provisions of sections 197.250 to 197.280 and the
rules made pursuant thereto, and which passes the department's survey.

4. The hospice shall post the temporary operating permit or certificate
under which it is operating in a conspicuous place in its main office.

5. Any certificate issued pursuant to this section shall be subject to
renewal as provided in section 197.256.

6. Any pharmacy operated by a licensed hospice shall be licensed and
inspected by the board of pharmacy as provided in chapter 338, RSMo.

7. Branch offices shall be located sufficiently close to share
administration and supervision and services in a manner that renders it
unnecessary for it to be separately certificated, except as otherwise
provided in sections 197.250 to 197.280. (L. 1992 H.B. 899 § 3, A.L. 1996
S.B. 916)

1. A hospice shall apply for renewal of its certificate not less
than once every twelve months. In addition, such hospice shall apply for
renewal not less than thirty days before any change in ownership or
management of the hospice. Such application shall be accompanied by the
appropriate fee as set forth in subsection 1 of section 197.254.
Application shall be made upon a form prescribed by the department.

2. Upon receipt of the application and fee, if a fee is required, the
department shall conduct a survey to evaluate the quality of services
rendered by an applicant for renewal. The department shall approve the
application and renew the certificate of any applicant which is in
compliance with sections 197.250 to 197.280 and the rules made pursuant
thereto and which passes the department's survey.

3. The certificate of any hospice which has not been renewed as required
by this section shall be void.

4. The department shall require all certificated hospices to submit
statistical reports. The content, format, and frequency of such reports
shall be prescribed by the department. (L. 1992 H.B. 899 § 4)

1. In addition to any survey pursuant to sections 197.250 to
197.280, the department may make such surveys as it deems necessary
during normal business hours. The department shall survey every hospice
not less than once annually. The hospice shall permit the department's
representatives to enter upon any of its business premises during normal
business hours for the purpose of a survey.

2. As a part of its survey of a hospice, the department may visit the
home of any client of such hospice with such client's consent.

3. In lieu of any survey required by sections 197.250 to 197.280, the
department may accept in whole or in part the survey of any state or
federal agency, or of any professional accrediting agency, if such survey:

(1) Is comparable in scope and method to the department's surveys; and

(2) Is conducted within one year of initial application for or renewal of
the hospice's certificate.

4. The department shall not be required to survey any hospice providing
service to Missouri residents through an office located in a state
bordering Missouri if such bordering state has a reciprocal agreement
with Missouri on hospice certification and the area served in Missouri by
the agency is contiguous to the area served in the bordering state.

5. Any hospice which has its parent office in a state which does not have
a reciprocal agreement with Missouri on hospice certification shall
maintain a branch office in Missouri. Such branch office shall maintain
all records required by the department for survey and shall be
certificated as a hospice. (L. 1992 H.B. 899 § 5)

1. Upon the completion of a survey, the department shall prepare
a report of the department's findings with respect to whether the hospice
is in compliance or out of compliance with the provisions of sections
197.250 to 197.280 and the rules made pursuant thereto. The report shall
contain a list of deficiencies found and cite each statute or rule with
which the hospice is found to be out of compliance. A copy of the report
shall be served upon the hospice not later than fifteen working days
after the survey is completed. The hospice shall inform the department of
the time necessary for compliance and shall file a plan of correction
with the department within ten days of the receipt of the deficiency
list. As used in this subsection, "days" shall exclude weekends and state
holidays.

2. The department of health and senior services may disclose to the
public final reports of the inspections or surveys showing the standards
by which inspections or surveys were conducted, whether such standards
were met, and, if such standards were not met, in what manner they were
not met and how the facility proposed to correct or did correct the
deficiencies. All other information whatsoever, including information and
reports submitted to the department of health and senior services by
governmental agencies and recognized accrediting organizations in whole
or in part for certification purposes pursuant to sections 197.250 to
197.280, collected during such inspections or surveys or information
which is derived as a result of such inspections or surveys shall be
confidential and shall be disclosed only to the person or organization
which is the subject of the inspection or survey or a representative
thereof. (L. 1992 H.B. 899 § 6)

1. The department may deny any hospice application for
certification or renewal or may suspend or revoke such agency's
certificate or invoke intermediate sanctions, if the hospice:

(1) Is out of compliance with any of the provisions of sections 197.250
to 197.280 and the rules made pursuant thereto; or

(2) Obtained its certificate through misrepresentation of, or concealment
of, any fact.

2. Any hospice may seek a review of any denial, suspension, or revocation
of its certification or renewal before the administrative hearing
commission, as provided in chapter 621, RSMo. (L. 1992 H.B. 899 § 7)

1. The hospice shall submit to the department for approval a
bill of rights that shall be equally applicable to all clients. This bill
of rights shall at least include the client's right to be fully informed
about his care alternatives, including choice of service providers,
charges and payment resources, the right to be a full participant in the
development of his plan of care and the right to be treated with dignity
and respect. The hospice shall provide each client with a copy of its
bill of rights. The hospice shall ensure that each of its clients can
fully receive each provision of its approved bill of rights.

2. Discharge planning shall be an ongoing responsibility of the agency.
Appropriate discharge activity shall include reasonable notice of
discharge to the client or responsible party or both. (L. 1992 H.B. 899 §
8)

Any hospice or employee of a hospice who knowingly abuses or
neglects any client, or misappropriates the property of any client, shall
be guilty of a class D felony. (L. 1992 H.B. 899 § 9)

The department shall receive, process, and dispose of complaints
against a hospice. Any person may complain of any suspected abuse,
neglect, or misappropriation by a hospice or employee of a hospice. The
department shall make rules providing for the processing of such
complaints. (L. 1992 H.B. 899 § 10)

The department shall promulgate rules as provided in section
197.080 and chapter 536, RSMo, to effectuate the provisions of sections
197.250 to 197.280. (L. 1992 H.B. 899 § 11, A.L. 1993 S.B. 52)

1. There is hereby established a "State Hospice Advisory
Council" which shall guide, advise and make recommendations to the
department of health and senior services.

2. Members of the council shall be United States citizens and residents
of the state for a period of not less than one year. The council shall
consist of five members who have experience with hospices. Of the members
appointed to the council at least one shall be employed by or associated
with each of the following:

(1) A home health agency-based hospice;

(2) A hospital-based hospice; and

(3) A hospice based in a rural area.

3. All members of the council shall be appointed by the director of the
department. The term of office of each member shall be for five years.
Before a member's term expires, the director of the department shall
appoint a successor to assume the member's duties on the expiration of
his or her predecessor's term. A vacancy in the office of a member shall
be filled by appointment for the unexpired term. The members of the
council shall annually designate one member to serve as chairperson and
another to serve as secretary.

4. No member of the council who has served two full terms may be
reappointed to the council until at least one year after the expiration
of the member's most recent full term of office.

5. Members of the council shall receive no compensation for their
service, but shall, subject to appropriations, be reimbursed for their
actual and necessary expenses incurred in the performance of their duties.

6. The council shall advise and consult with the department of health and
senior services in carrying out the administration of sections 197.250 to
197.280, and shall:

(1) Consult and advise with the department in matters of policy affecting
administration of sections 197.250 to 197.280, and in the development of
rules, regulations and standards provided for under sections 197.250 to
197.280;

(2) Review and make recommendations with respect to rules, regulations
and standards authorized under sections 197.250 to 197.280 prior to their
promulgation by the department of health and senior services. (L. 1992
H.B. 899 § 12, A.L. 2002 H.B. 1953)

The department may file an action to enjoin any violation of
sections 197.250 to 197.280, or of the rules made pursuant thereto, or
both. Such action shall be filed in the circuit court of the county in
which such hospice has its parent office, or in which such violation is
alleged to have occurred. (L. 1992 H.B. 899 § 13)

Any person who violates any provision of sections 197.250 to
197.280 shall be guilty of a class A misdemeanor, except as otherwise
provided in section 197.266. (L. 1992 H.B. 899 § 14)

Any provision of chapter 198, RSMo, to the contrary
notwithstanding, the department shall have sole authority and
responsibility for inspection and certification of hospices in this
state, including, but not limited to, the physical facilities. (L. 1992
H.B. 899 § 15)

Whenever the department has reasonable grounds to believe that a
hospice required to be certificated under sections 197.250 to 197.280 is
operating without a certificate, and the department is not permitted
access to survey the hospice, or when a certificated hospice refuses to
permit access to the department to survey the hospice, the department
shall apply to the circuit court of the county in which the premises are
located for an order authorizing entry for such survey. The court shall
issue the order if it finds reasonable grounds for the survey or if it
finds that a certificated hospice has refused to permit the department
access to survey the hospice. (L. 1992 H.B. 899 § 16)

1. Hospitals and ambulatory surgical centers shall establish and
implement a written policy adopted by each hospital and ambulatory
surgical center relating to the protections for employees who disclose
information pursuant to subsection 2 of this section. This policy shall
include a time frame for completion of investigations related to
complaints, not to exceed thirty days, and a method for notifying the
complainant of the disposition of the investigation. This policy shall be
submitted to the department of health and senior services to verify
implementation. At a minimum, such policy shall include the following
provisions:

(1) No supervisor or individual with authority to hire or fire in a
hospital or ambulatory surgical center shall prohibit employees from
disclosing information pursuant to subsection 2 of this section;

(2) No supervisor or individual with authority to hire or fire in a
hospital or ambulatory surgical center shall use or threaten to use his
or her supervisory authority to knowingly discriminate against, dismiss,
penalize or in any way retaliate against or harass an employee because
the employee in good faith reported or disclosed any information pursuant
to subsection 2 of this section, or in any way attempt to dissuade,
prevent or interfere with an employee who wishes to report or disclose
such information;

(3) Establish a program to identify a compliance officer who is a
designated person responsible for administering the reporting and
investigation process and an alternate person should the primary designee
be implicated in the report.

2. This section shall apply to information disclosed or reported in good
faith by an employee concerning:

(1) Alleged facility mismanagement or fraudulent activity;

(2) Alleged violations of applicable federal or state laws or
administrative rules concerning patient care, patient safety or facility
safety; or

(3) The ability of employees to successfully perform their assigned
duties.

All information disclosed, collected and maintained pursuant to this
subsection and pursuant to the written policy requirements of this
section shall be accessible to the department of health and senior
services at all times and shall be reviewed by the department of health
and senior services at least annually. Complainants shall be notified of
the department of health and senior services' access to such information
and of the complainant's right to notify the department of health and
senior services of any information concerning alleged violations of
applicable federal or state laws or administrative rules concerning
patient care, patient safety or facility safety.

3. Prior to any disclosure to individuals or agencies other than the
department of health and senior services, employees wishing to make a
disclosure pursuant to the provisions of this section shall first report
to the individual or individuals designated by the hospital or ambulatory
surgical center pursuant to subsection 1 of this section.

4. If the compliance officer, compliance committee or management official
discovers credible evidence of misconduct from any source and, after a
reasonable inquiry, has reason to believe that the misconduct may violate
criminal, civil or administrative law, then the hospital or ambulatory
surgical center shall report the existence of misconduct to the
appropriate governmental authority within a reasonable period, but not
more than seven days after determining that there is credible evidence of
a violation.

5. Reports made to the department of health and senior services shall be
subject to the provisions of section 197.477, provided that the
restrictions of section 197.477 shall not be construed to limit the
employee's ability to subpoena from the original source the information
reported to the department pursuant to this section.

6. Each written policy shall allow employees making a report who wish to
remain anonymous to do so, and shall include safeguards to protect the
confidentiality of the employee making the report, the confidentiality of
patients and the integrity of data, information and medical records.

7. Each hospital and ambulatory surgical center shall, within forty-eight
hours of the receipt of a report, notify the employee that his or her
report has been received and is being reviewed. (L. 2000 S.B. 788 §§
197.285, B, A.L. 2001 H.B. 328 & 88 merged with H.B. 762)

By July 1, 2001, all hospitals and ambulatory surgical centers
shall provide training programs, with measurable minimal training
outcomes relating to quality of patient care and patient safety, to all
unlicensed staff providing patient care in their facility within ninety
days of the beginning date of employment. Standards for such training
shall be established by the department of health and senior services by
rule. It shall be a requirement of hospital and ambulatory surgical
center licensure pursuant to this chapter that all hospitals and
ambulatory surgical centers submit documentation to the department of
health and senior services on the training program used. (L. 2000 S.B.
788 § 1)

1. All hospitals and ambulatory surgical centers shall develop
and implement a methodology which ensures adequate nurse staffing that
will meet the needs of patients. At a minimum, there shall be on duty at
all times a sufficient number of licensed registered nurses to provide
patient care requiring the judgment and skills of a licensed registered
nurse and to oversee the activities of all nursing personnel.

2. There shall be sufficient licensed and ancillary nursing personnel on
duty on each nursing unit to meet the needs of each patient in accordance
with accepted standards of quality patient care. (L. 2000 S.B. 788 § 2)

1. There is hereby established a "Technical Advisory Committee
on the Quality of Patient Care and Nursing Practices" within the
department of health and senior services. The committee shall be
comprised of nine members appointed by the director of the department of
health and senior services on or before December 1, 2000, one of whom
shall be a representative of the department of health and senior services
and one of whom shall be a representative of the general public. In
addition, the director shall appoint three members representing licensed
registered nurses from a list of recommended appointees provided by the
Missouri Nurses Association, one member representing licensed practical
nurses from a list of recommended appointees provided by the Missouri
Licensed Practical Nurses Association, two members from a list of
recommended appointees provided by the Missouri Hospital Association, and
one member representing licensed physicians from a list of recommended
appointees provided by the Missouri State Medical Association.

2. The committee shall work with hospitals, nurses, physicians, state
agencies, community groups and academic researchers to develop specific
recommendations related to staffing, improving the quality of patient
care, and insuring the safe and appropriate employment of licensed nurses
within hospitals and ambulatory surgical centers. The committee shall
develop recommendations and submit an annual report based on such
recommendations to the governor, chairpersons of standing health and
appropriations committees of the general assembly and the department of
health and senior services no later than December thirty-first of each
year, beginning in 2001.

3. The department of health and senior services shall provide such
support as the committee members require to aid it in the performance of
its duties.

4. Committee members shall not be compensated for their services but
shall be reimbursed for their actual and necessary expenses incurred in
the performance of their duties.

5. The provisions of this section shall expire on December 31, 2006. (L.
2000 S.B. 788 § 3)

Expires 12-31-06

1. In addition to the powers established in sections 197.070 and
197.220, the department of health and senior services shall use the
following standards for enforcing hospital and ambulatory surgical center
licensure regulations promulgated to enforce the provisions of sections
197.010 to 197.120, sections 197.150 to 197.165, and sections 197.200 to
197.240:

(1) Upon notification of a deficiency in meeting regulatory standards,
the hospital or ambulatory surgical center shall develop and implement a
plan of correction approved by the department which includes, but is not
limited to, the specific type of corrective action to be taken and an
estimated time to complete such action;

(2) If the plan as implemented does not correct the deficiency, the
department may either:

(a) Direct the hospital or ambulatory surgical center to develop and
implement a plan of correction pursuant to subdivision (1) of this
subsection; or

(b) Require the hospital or ambulatory surgical center to implement a
plan of correction developed by the department;

(3) If there is a continuing deficiency after implementation of the plan
of correction pursuant to subdivision (2) of this subsection and the
hospital or ambulatory surgical center has had an opportunity to correct
such deficiency, the department may restrict new inpatient admissions or
outpatient entrants to the service or services affected by such
deficiency;

(4) If there is a continuing deficiency after the department restricts
new inpatient admissions or outpatient entrants to the service or
services pursuant to subdivision (3) of this subsection and the hospital
or ambulatory surgical center has had an opportunity to correct such
deficiency, the department may suspend operations in all or part of the
service or services affected by such deficiency;

(5) If there is a continuing deficiency after suspension of operations
pursuant to subdivision (4) of this subsection, the department may deny,
suspend or revoke the hospital's or ambulatory surgical center's license
pursuant to section 197.070 or section 197.220.

2. Notwithstanding the provisions of subsection 1 of this section to the
contrary, if a deficiency in meeting licensure standards presents an
immediate and serious threat to the patients' health and safety, the
department may, based on the scope and severity of the deficiency,
restrict access to the service or services affected by the deficiency
until the hospital or ambulatory surgical center has developed and
implemented an approved plan of correction. Decisions as to whether a
deficiency constitutes an immediate and serious threat to the patients'
health and safety shall be made in accordance with guidelines established
pursuant to regulation of the department of health and senior services
and such decisions shall be approved by the bureau of health facility
licensing in the department of health and senior services, or its
successor agency, or by a person authorized by the regulations to approve
such decisions in the absence of the director. (L. 2000 S.B. 788 § 4,
A.L. 2004 S.B. 1279)

No information disclosed by the department to the public
pursuant to sections 192.019, 192.020, 192.067, 192.131, 192.138,
192.665, and 192.667, RSMo, and sections 197.150, 197.152, 197.154,
197.156, 197.158, 197.160, 197.162, 197.165, and 197.293 shall be used to
establish a standard of care in a private civil action. (L. 2004 S.B.
1279)

1. A hospital or ambulatory surgical center aggrieved by a
decision of the department pursuant to the provisions of paragraph (b) of
subdivision (2) and subdivisions (3), (4) and (5) of subsection 1 of
section 197.293 may appeal such decision to the administrative hearing
commission pursuant to section 197.071 or section 197.221, and seek
judicial review pursuant to section 621.145, RSMo. An appeal of an action
to restrict new inpatient admissions or outpatient entrants, suspend
operations or revoke a license shall be heard on an expedited basis by
the administrative hearing commission. The hospital or ambulatory
surgical center may apply to the administrative hearing commission for an
order to stay or suspend any such departmental action pending the
commission's findings and ruling as authorized by section 621.035, RSMo.

2. If both the department and the hospital or ambulatory surgical center
agree to do so, prior to an appeal to the administrative hearing
commission pursuant to section 197.071 or section 197.221, an official
action of the department made pursuant to sections 197.010 to 197.120 or
sections 197.200 to 197.240 may be appealed to a departmental hearing
officer. The department of health and senior services shall promulgate
rules specifying the qualifications of such a hearing officer, establish
procedures to ensure impartial decisions and provide for comparable
appeal remedies when a departmental hearing officer is unavailable. (L.
2000 S.B. 788 § 5)

1. The department of health and senior services may adopt rules
necessary to implement the provisions of sections 197.287 to 197.297.

2. No rule or portion of a rule promulgated pursuant to the authority of
sections 197.287 to 197.297 shall become effective unless it has been
promulgated pursuant to the provisions of chapter 536, RSMo. Any rule or
portion of a rule, as that term is defined in section 536.010, RSMo, that
is created under the authority delegated in this section shall become
effective only if it complies with and is subject to all of the
provisions of chapter 536, RSMo, and, if applicable, section 536.028,
RSMo. This section and chapter 536, RSMo, are nonseverable and if any of
the powers vested with the general assembly pursuant to chapter 536,
RSMo, to review, to delay the effective date or to disapprove and annul a
rule are subsequently held unconstitutional, then the grant of rulemaking
authority and any rule proposed or adopted after August 28, 2000, shall
be invalid and void. (L. 2000 S.B. 788 § 6)

Sections 197.300 to 197.366 shall be known as the "Missouri
Certificate of Need Law". (L. 1979 H.B. 222 § 1, A.L. 1996 H.B. 1362)

Effective 7-12-96

As used in sections 197.300 to 197.366, the following terms mean:

(1) "Affected persons", the person proposing the development of a new
institutional health service, the public to be served, and health care
facilities within the service area in which the proposed new health care
service is to be developed;

(2) "Agency", the certificate of need program of the Missouri department
of health and senior services;

(3) "Capital expenditure", an expenditure by or on behalf of a health
care facility which, under generally accepted accounting principles, is
not properly chargeable as an expense of operation and maintenance;

(4) "Certificate of need", a written certificate issued by the committee
setting forth the committee's affirmative finding that a proposed project
sufficiently satisfies the criteria prescribed for such projects by
sections 197.300 to 197.366;

(5) "Develop", to undertake those activities which on their completion
will result in the offering of a new institutional health service or the
incurring of a financial obligation in relation to the offering of such a
service;

(6) "Expenditure minimum" shall mean:

(a) For beds in existing or proposed health care facilities licensed
pursuant to chapter 198, RSMo, and long-term care beds in a hospital as
described in subdivision (3) of subsection 1 of section 198.012, RSMo,
six hundred thousand dollars in the case of capital expenditures, or four
hundred thousand dollars in the case of major medical equipment,
provided, however, that prior to January 1, 2003, the expenditure minimum
for beds in such a facility and long-term care beds in a hospital
described in section 198.012, RSMo, shall be zero, subject to the
provisions of subsection 7 of section 197.318;

(b) For beds or equipment in a long-term care hospital meeting the
requirements described in 42 CFR, Section 412.23(e), the expenditure
minimum shall be zero; and

(c) For health care facilities, new institutional health services or beds
not described in paragraph (a) or (b) of this subdivision one million
dollars in the case of capital expenditures, excluding major medical
equipment, and one million dollars in the case of medical equipment;

(7) "Health care facilities", hospitals, health maintenance
organizations, tuberculosis hospitals, psychiatric hospitals,
intermediate care facilities, skilled nursing facilities, residential
care facilities I and II, kidney disease treatment centers, including
freestanding hemodialysis units, diagnostic imaging centers, radiation
therapy centers and ambulatory surgical facilities, but excluding the
private offices of physicians, dentists and other practitioners of the
healing arts, and Christian Science sanatoriums, also known as Christian
Science Nursing facilities listed and certified by the Commission for
Accreditation of Christian Science Nursing Organization/Facilities, Inc.,
and facilities of not-for-profit corporations in existence on October 1,
1980, subject either to the provisions and regulations of Section 302 of
the Labor-Management Relations Act, 29 U.S.C. 186 or the Labor-Management
Reporting and Disclosure Act, 29 U.S.C. 401-538, and any residential care
facility I or residential care facility II operated by a religious
organization qualified pursuant to Section 501(c)(3) of the federal
Internal Revenue Code, as amended, which does not require the expenditure
of public funds for purchase or operation, with a total licensed bed
capacity of one hundred beds or fewer;

(8) "Health service area", a geographic region appropriate for the
effective planning and development of health services, determined on the
basis of factors including population and the availability of resources,
consisting of a population of not less than five hundred thousand or more
than three million;

(9) "Major medical equipment", medical equipment used for the provision
of medical and other health services;

(10) "New institutional health service":

(a) The development of a new health care facility costing in excess of
the applicable expenditure minimum;

(b) The acquisition, including acquisition by lease, of any health care
facility, or major medical equipment costing in excess of the expenditure
minimum;

(c) Any capital expenditure by or on behalf of a health care facility in
excess of the expenditure minimum;

(d) Predevelopment activities as defined in subdivision (13) hereof
costing in excess of one hundred fifty thousand dollars;

(e) Any change in licensed bed capacity of a health care facility which
increases the total number of beds by more than ten or more than ten
percent of total bed capacity, whichever is less, over a two-year period;

(f) Health services, excluding home health services, which are offered in
a health care facility and which were not offered on a regular basis in
such health care facility within the twelve-month period prior to the
time such services would be offered;

(g) A reallocation by an existing health care facility of licensed beds
among major types of service or reallocation of licensed beds from one
physical facility or site to another by more than ten beds or more than
ten percent of total licensed bed capacity, whichever is less, over a
two-year period;

(11) "Nonsubstantive projects", projects which do not involve the
addition, replacement, modernization or conversion of beds or the
provision of a new health service but which include a capital expenditure
which exceeds the expenditure minimum and are due to an act of God or a
normal consequence of maintaining health care services, facility or
equipment;

(12) "Person", any individual, trust, estate, partnership, corporation,
including associations and joint stock companies, state or political
subdivision or instrumentality thereof, including a municipal corporation;

(13) "Predevelopment activities", expenditures for architectural designs,
plans, working drawings and specifications, and any arrangement or
commitment made for financing; but excluding submission of an application
for a certificate of need. (L. 1979 H.B. 222 § 2, A.L. 1982 S.B. 481,
A.L. 1983 H.B. 825, A.L. 1994 H.B. 1408, A.L. 1996 H.B. 905 merged with
H.B. 1362, A.L. 1997 S.B. 373, A.L. 1998 S.B. 963, A.L. 1999 S.B. 326)

Effective 7-1-99

CROSS REFERENCE: Health care facilities, definition, effective after
December 31, 2001, RSMo 197.366

(1995) Acquisition cost for major medical equipment for purposes of
minimum expenditure necessary to subject expenditure to certificate of
need law, refers to cost to hospital and not original purchase price.
Cost of land and construction costs for building were attributable to
separate commercial enterprise and not made by, or on behalf of, health
care facility where hospital leased space for outpatient radiation
therapy services. SSM Health Care v. Missouri Health Facilities Review
Committee, 894 S.W.2d 674 (Mo. en banc).

(2004) Nursing facility's proposal to add twelve beds constituted a new
institutional health service requiring certificate of need, even though
the proposed capital expenditure was below the expenditure minimum.
McKnight Place v. Missouri Health Facilities Review Committee, 142 S.W.3d
228 (Mo.App. W.D.).

1. The "Missouri Health Facilities Review Committee" is hereby
established. The agency shall provide clerical and administrative support
to the committee. The committee may employ additional staff as it deems
necessary.

2. The committee shall be composed of:

(1) Two members of the senate appointed by the president pro tem, who
shall be from different political parties; and

(2) Two members of the house of representatives appointed by the speaker,
who shall be from different political parties; and

(3) Five members appointed by the governor with the advice and consent of
the senate, not more than three of whom shall be from the same political
party.

3. No business of this committee shall be performed without a majority of
the full body.

4. The members shall be appointed as soon as possible after September 28,
1979. One of the senate members, one of the house members and three of
the members appointed by the governor shall serve until January 1, 1981,
and the remaining members shall serve until January 1, 1982. All
subsequent members shall be appointed in the manner provided in
subsection 2 of this section and shall serve terms of two years.

5. The committee shall elect a chairman at its first meeting which shall
be called by the governor. The committee shall meet upon the call of the
chairman or the governor.

6. The committee shall review and approve or disapprove all applications
for a certificate of need made under sections 197.300 to 197.366. It
shall issue reasonable rules and regulations governing the submission,
review and disposition of applications.

7. Members of the committee shall serve without compensation but shall be
reimbursed for necessary expenses incurred in the performance of their
duties.

8. Notwithstanding the provisions of subsection 4 of section 610.025*,
RSMo, the proceedings and records of the facilities review committee
shall be subject to the provisions of chapter 610, RSMo. (L. 1979 H.B.
222 § 3, A.L. 1999 S.B. 326)

Effective 7-1-99

*Section 610.025 was repealed by S.B. 2, 1987.

No member of the Missouri health facilities review committee may
accept a political donation from any applicant for a license. (L. 1994
H.B. 1408 § 1)

Effective 6-3-94

A certificate of need shall not be required for any institution
previously owned and operated for or in behalf of a city not within a
county which chooses to be licensed as a facility defined under
subdivision (15) or (16) of section 198.006, RSMo, for a facility of
ninety beds or less that is owned or operated by a not-for-profit
corporation which is exempt from federal income tax as an organization
described in section 501(c)(3) of the Internal Revenue Code of 1986,
which is controlled directly by a religious organization and which has
received approval by the division of aging of plans for construction of
such facility by August 1, 1995, and is licensed by the division of aging
by July 1, 1996, as a facility defined under subdivision (15) or (16) of
section 198.006, RSMo, or for a facility, serving exclusively mentally
ill, homeless persons, of sixteen beds or less that is owned or operated
by a not-for-profit corporation which is exempt from federal income tax
which is described in section 501(c)(3) of the Internal Revenue Code of
1986, which is controlled directly by a religious organization and which
has received approval by the division of aging of plans for construction
of such facility by May 1, 1996, and is licensed by the division of aging
by July 1, 1996, as a facility defined under subdivision (15) or (16) of
section 198.006, RSMo, or a residential care facility II located in a
city not within a county operated by a not for profit corporation which
is exempt from federal income tax which is described in section 501(c)(3)
of the Internal Revenue Code of 1986, which is controlled directly by a
religious organization and which is licensed for one hundred beds or less
on or before August 28, 1997. (L. 1995 S.B. 108 § 1 subsec. 5, A.L. 1996
H.B. 1362)

Effective 7-12-96

1. The provisions of sections 197.300 to 197.366 shall not apply
to any sixty-bed stand-alone facility designed and operated exclusively
for the care of residents with Alzheimer's disease or dementia and
located in a tax increment financing district established prior to 1990
within any county of the first classification with a charter form of
government containing a city with a population of over three hundred
fifty thousand and which district also has within its boundaries a
skilled nursing facility.

2. The provisions of sections 197.300 to 197.366 shall not apply, as
hereinafter stated, to a skilled nursing facility that is owned or
operated by a not-for-profit corporation which was created by a special
act of the Missouri general assembly, is exempt from federal income tax
as an organization described in Section 501(c)(3) of the Internal Revenue
Code of 1986, is owned by a religious organization and is to be operated
as part of a continuing care retirement community offering independent
living, residential care and skilled care. This exemption shall authorize
no more than twenty additional skilled nursing beds at each of two
facilities which do not have any skilled nursing beds as of January 1,
1999. (L. 1999 S.B. 326 §§ 12, 13)

1. Any person who proposes to develop or offer a new
institutional health service within the state must obtain a certificate
of need from the committee prior to the time such services are offered.

2. Only those new institutional health services which are found by the
committee to be needed shall be granted a certificate of need. Only those
new institutional health services which are granted certificates of need
shall be offered or developed within the state. No expenditures for new
institutional health services in excess of the applicable expenditure
minimum shall be made by any person unless a certificate of need has been
granted.

3. After October 1, 1980, no state agency charged by statute to license
or certify health care facilities shall issue a license to or certify any
such facility, or distinct part of such facility, that is developed
without obtaining a certificate of need.

4. If any person proposes to develop any new institutional health care
service without a certificate of need as required by sections 197.300 to
197.366, the committee shall notify the attorney general, and he shall
apply for an injunction or other appropriate legal action in any court of
this state against that person.

5. After October 1, 1980, no agency of state government may appropriate
or grant funds to or make payment of any funds to any person or health
care facility which has not first obtained every certificate of need
required pursuant to sections 197.300 to 197.366.

6. A certificate of need shall be issued only for the premises and
persons named in the application and is not transferable except by
consent of the committee.

7. Project cost increases, due to changes in the project application as
approved or due to project change orders, exceeding the initial estimate
by more than ten percent shall not be incurred without consent of the
committee.

8. Periodic reports to the committee shall be required of any applicant
who has been granted a certificate of need until the project has been
completed. The committee may order the forfeiture of the certificate of
need upon failure of the applicant to file any such report.

9. A certificate of need shall be subject to forfeiture for failure to
incur a capital expenditure on any approved project within six months
after the date of the order. The applicant may request an extension from
the committee of not more than six additional months based upon
substantial expenditure made.

10. Each application for a certificate of need must be accompanied by an
application fee. The time of filing commences with the receipt of the
application and the application fee. The application fee is one thousand
dollars, or one-tenth of one percent of the total cost of the proposed
project, whichever is greater. All application fees shall be deposited in
the state treasury. Because of the loss of federal funds, the general
assembly will appropriate funds to the Missouri health facilities review
committee.

11. In determining whether a certificate of need should be granted, no
consideration shall be given to the facilities or equipment of any other
health care facility located more than a fifteen-mile radius from the
applying facility.

12. When a nursing facility shifts from a skilled to an* intermediate
level of nursing care, it may return to the higher level of care if it
meets the licensure requirements, without obtaining a certificate of need.

13. In no event shall a certificate of need be denied because the
applicant refuses to provide abortion services or information.

14. A certificate of need shall not be required for the transfer of
ownership of an existing and operational health facility in its entirety.

15. A certificate of need may be granted to a facility for an expansion,
an addition of services, a new institutional service, or for a new
hospital facility which provides for something less than that which was
sought in the application.

16. The provisions of this section shall not apply to facilities operated
by the state, and appropriation of funds to such facilities by the
general assembly shall be deemed in compliance with this section, and
such facilities shall be deemed to have received an appropriate
certificate of need without payment of any fee or charge.

17. Notwithstanding other provisions of this section, a certificate of
need may be issued after July 1, 1983, for an intermediate care facility
operated exclusively for the mentally retarded.

18. To assure the safe, appropriate, and cost-effective transfer of new
medical technology throughout the state, a certificate of need shall not
be required for the purchase and operation of research equipment that is
to be used in a clinical trial that has received written approval from a
duly constituted institutional review board of an accredited school of
medicine or osteopathy located in Missouri to establish its safety and
efficacy and does not increase the bed complement of the institution in
which the equipment is to be located. After the clinical trial has been
completed, a certificate of need must be obtained for continued use in
such facility. (L. 1979 H.B. 222 § 4, A.L. 1982 S.B. 481, A.L. 1983 H.B.
825, A.L. 1987 S.B. 1, A.L. 1999 S.B. 326)

Effective 7-1-99

*Word "a" appears in original rolls.

1. The provisions of subsection 10 of section 197.315 and
sections 197.317 and 197.318 shall not apply to facilities which are
licensed pursuant to the provisions of chapter 198, RSMo, which are
designed and operated exclusively for the care and treatment of persons
with acquired human immunodeficiency syndrome, AIDS.

2. If a facility is granted a certificate of need and is found to be
exempt from the provisions of subsection 10 of section 197.315 and
sections 197.317 and 197.318 pursuant to the provisions of subsection 1
of this section, then only AIDS patients shall be residents of such
facility and no others.

3. Any facility that violates the provisions of subsection 2 of this
section shall be liable for a fine of one hundred dollars per resident
per day for each such violation.

4. The attorney general shall, upon request of the department of health
and senior services, bring an action in a circuit court of competent
jurisdiction for violation of this section. (L. 1995 S.B. 108 § 1
subsecs. 1 to 4, A.L. 1999 S.B. 326)

Effective 7-1-99

1. After July 1, 1983, no certificate of need shall be issued
for the following:

(1) Additional residential care facility I, residential care facility II,
intermediate care facility or skilled nursing facility beds above the
number then licensed by this state;

(2) Beds in a licensed hospital to be reallocated on a temporary or
permanent basis to nursing care or beds in a long-term care hospital
meeting the requirements described in 42 CFR, Section 412.23(e),
excepting those which are not subject to a certificate of need pursuant
to paragraphs (e) and (g) of subdivision (10) of section 197.305; nor

(3) The reallocation of intermediate care facility or skilled nursing
facility beds of existing licensed beds by transfer or sale of licensed
beds between a hospital licensed pursuant to this chapter or a nursing
care facility licensed pursuant to chapter 198, RSMo; except for beds in
counties in which there is no existing nursing care facility. No
certificate of need shall be issued for the reallocation of existing
residential care facility I or II, or intermediate care facilities
operated exclusively for the mentally retarded to intermediate care or
skilled nursing facilities or beds. However, after January 1, 2003,
nothing in this section shall prohibit the Missouri health facilities
review committee from issuing a certificate of need for additional beds
in existing health care facilities or for new beds in new health care
facilities or for the reallocation of licensed beds, provided that no
construction shall begin prior to January 1, 2004. The provisions of
subsections 16 and 17 of section 197.315 shall apply to the provisions of
this section.

2. The health facilities review committee shall utilize demographic data
from the office of social and economic data analysis, or its successor
organization, at the University of Missouri as their source of
information in considering applications for new institutional long-term
care facilities. (L. 1986 S.B. 553 & 775 § 5, A.L. 1987 S.B. 1, A.L. 1990
H.B. 1725, A.L. 1994 H.B. 1408, A.L. 1996 H.B. 1362, A.L. 1999 S.B. 326)

Effective 7-1-99

1. The provisions of section 197.317 shall not apply to a
residential care facility I, residential care facility II, intermediate
care facility or skilled nursing facility only where the department of
social services has first determined that there presently exists a need
for additional beds of that classification because the average occupancy
of all licensed and available residential care facility I, residential
care facility II, intermediate care facility and skilled nursing facility
beds exceeds ninety percent for at least four consecutive calendar
quarters, in a particular county, and within a fifteen-mile radius of the
proposed facility, and the facility otherwise appears to qualify for a
certificate of need. The department's certification that there is no need
for additional beds shall serve as the final determination and decision
of the committee. In determining ninety percent occupancy, residential
care facility I and II shall be one separate classification and
intermediate care and skilled nursing facilities are another separate
classification.

2. The Missouri health facilities review committee may, for any facility
certified to it by the department, consider the predominant ethnic or
religious composition of the residents to be served by that facility in
considering whether to grant a certificate of need.

*3. There shall be no expenditure minimum for facilities, beds, or
services referred to in subdivisions (1), (2) and (3) of section 197.317.
The provisions of this subsection shall expire January 1, 2003.

4. As used in this section, the term "licensed and available" means beds
which are actually in place and for which a license has been issued.

5. The provisions of section 197.317 shall not apply to any facility
where at least ninety-five percent of the patients require diets meeting
the dietary standards defined by section 196.165, RSMo.

6. The committee shall review all letters of intent and applications for
long-term care hospital beds meeting the requirements described in 42
CFR, Section 412.23(e) under its criteria and standards for long-term
care beds.

7. Sections 197.300 to 197.366 shall not be construed to apply to
litigation pending in state court on or before April 1, 1996, in which
the Missouri health facilities review committee is a defendant in an
action concerning the application of sections 197.300 to 197.366 to
long-term care hospital beds meeting the requirements described in 42
CFR, Section 412.23(e).

8. Notwithstanding any other provision of this chapter to the contrary:

(1) A facility licensed pursuant to chapter 198, RSMo, may increase its
licensed bed capacity by:

(a) Submitting a letter of intent to expand to the division of aging and
the health facilities review committee;

(b) Certification from the division of aging that the facility:

a. Has no patient care class I deficiencies within the last eighteen
months; and

b. Has maintained a ninety-percent average occupancy rate for the
previous six quarters;

(c) Has made an effort to purchase beds for eighteen months following the
date the letter of intent to expand is submitted pursuant to paragraph
(a) of this subdivision. For purposes of this paragraph, an "effort to
purchase" means a copy certified by the offeror as an offer to purchase
beds from another licensed facility in the same licensure category; and

(d) If an agreement is reached by the selling and purchasing entities,
the health facilities review committee shall issue a certificate of need
for the expansion of the purchaser facility upon surrender of the
seller's license; or

(e) If no agreement is reached by the selling and purchasing entities,
the health facilities review committee shall permit an expansion for:

a. A facility with more than forty beds may expand its licensed bed
capacity within the same licensure category by twenty-five percent or
thirty beds, whichever is greater, if that same licensure category in
such facility has experienced an average occupancy of ninety-three
percent or greater over the previous six quarters;

b. A facility with fewer than forty beds may expand its licensed bed
capacity within the same licensure category by twenty-five percent or ten
beds, whichever is greater, if that same licensure category in such
facility has experienced an average occupancy of ninety-two percent or
greater over the previous six quarters;

c. A facility adding beds pursuant to subparagraphs a. or b. of this
paragraph shall not expand by more than fifty percent of its then
licensed bed capacity in the qualifying licensure category;

(2) Any beds sold shall, for five years from the date of relicensure by
the purchaser, remain unlicensed and unused for any long-term care
service in the selling facility, whether they do or do not require a
license;

(3) The beds purchased shall, for two years from the date of purchase,
remain in the bed inventory attributed to the selling facility and be
considered by the department of social services as licensed and available
for purposes of this section;

(4) Any residential care facility licensed pursuant to chapter 198, RSMo,
may relocate any portion of such facility's current licensed beds to any
other facility to be licensed within the same licensure category if both
facilities are under the same licensure ownership or control, and are
located within six miles of each other;

(5) A facility licensed pursuant to chapter 198, RSMo, may transfer or
sell individual long-term care licensed beds to facilities qualifying
pursuant to paragraphs (a) and (b) of subdivision (1) of this subsection.
Any facility which transfers or sells licensed beds shall not expand its
licensed bed capacity in that licensure category for a period of five
years from the date the licensure is relinquished.

9. Any existing licensed and operating health care facility offering
long-term care services may replace one-half of its licensed beds at the
same site or a site not more than thirty miles from its current location
if, for at least the most recent four consecutive calendar quarters, the
facility operates only fifty percent of its then licensed capacity with
every resident residing in a private room. In such case:

(1) The facility shall report to the division of aging vacant beds as
unavailable for occupancy for at least the most recent four consecutive
calendar quarters;

(2) The replacement beds shall be built to private room specifications
and only used for single occupancy; and

(3) The existing facility and proposed facility shall have the same owner
or owners, regardless of corporate or business structure, and such owner
or owners shall stipulate in writing that the existing facility beds to
be replaced will not later be used to provide long-term care services. If
the facility is being operated under a lease, both the lessee and the
owner of the existing facility shall stipulate the same in writing.

10. Nothing in this section shall prohibit a health care facility
licensed pursuant to chapter 198, RSMo, from being replaced in its
entirety within fifteen miles of its existing site so long as the
existing facility and proposed or replacement facility have the same
owner or owners regardless of corporate or business structure and the
health care facility being replaced remains unlicensed and unused for any
long-term care services whether they do or do not require a license from
the date of licensure of the replacement facility. (L. 1986 S.B. 553 &
775 § 6, A.L. 1992 S.B. 573 & 634, A.L. 1994 H.B. 1408, A.L. 1996 S.B.
575, A.L. 1996 H.B. 1362, A.L. 1997 S.B. 373, A.L. 1999 S.B. 326)

Effective 7-1-99

*Subsection 3 expires 1-1-03

The committee shall have the power to promulgate reasonable
rules, regulations, criteria and standards in conformity with this
section and chapter 536, RSMo, to meet the objectives of sections 197.300
to 197.366 including the power to establish criteria and standards to
review new types of equipment or service. Any rule or portion of a rule,
as that term is defined in section 536.010, RSMo, that is created under
the authority delegated in sections 197.300 to 197.366 shall become
effective only if it complies with and is subject to all of the
provisions of chapter 536, RSMo, and, if applicable, section 536.028,
RSMo. All rulemaking authority delegated prior to August 28, 1999, is of
no force and effect and repealed. Nothing in this section shall be
interpreted to repeal or affect the validity of any rule filed or adopted
prior to August 28, 1999, if it fully complied with all applicable
provisions of law. This section and chapter 536, RSMo, are nonseverable
and if any of the powers vested with the general assembly pursuant to
chapter 536, RSMo, to review, to delay the effective date or to
disapprove and annul a rule are subsequently held unconstitutional, then
the grant of rulemaking authority and any rule proposed or adopted after
August 28, 1999, shall be invalid and void. (L. 1979 H.B. 222 § 5, A.L.
1993 S.B. 52, A.L. 1995 S.B. 3, A.L. 1999 S.B. 326)

Effective 7-1-99

Any person who proposes to develop or offer a new institutional
health service shall submit a letter of intent to the committee at least
thirty days prior to the filing of the application. (L. 1979 H.B. 222 §
6, A.L. 1999 S.B. 326)

Effective 7-1-99

1. Any person who is paid either as part of his normal
employment or as a lobbyist to support or oppose any project before the
health facilities review committee shall register as a lobbyist pursuant
to chapter 105, RSMo, and shall also register with the staff of the
health facilities review committee for every project in which such person
has an interest and indicate whether such person supports or opposes the
named project. The registration shall also include the names and
addresses of any person, firm, corporation or association that the person
registering represents in relation to the named project. Any person
violating the provisions of this subsection shall be subject to the
penalties specified in section 105.478, RSMo.

2. A member of the general assembly who also serves as a member of the
health facilities review committee is prohibited from soliciting or
accepting campaign contributions from any applicant or person speaking
for an applicant or any opponent to any application or persons speaking
for any opponent while such application is pending before the health
facilities review committee.

3. Any person regulated by chapter 197 or 198, RSMo, and any officer,
attorney, agent and employee thereof, shall not offer to any committee
member or to any person employed as staff to the committee, any office,
appointment or position, or any present, gift, entertainment or gratuity
of any kind or any campaign contribution while such application is
pending before the health facilities review committee. Any person guilty
of knowingly violating the provisions of this section shall be punished
as follows: For the first offense, such person is guilty of a class B
misdemeanor; and for the second and subsequent offenses, such person is
guilty of a class D felony. (L. 1992 S.B. 573 & 634)

1. If a facility is granted a certificate of need pursuant to
sections 197.300 to 197.365 based on an application stating a need for
additional Medicaid beds, such beds shall be used for Medicaid patients
and no other.

2. Any person who violates the provisions of subsection 1 of this section
shall be liable to the state for civil penalties of one hundred dollars
for every day of such violation. Each nonMedicaid patient placed in a
Medicaid bed shall constitute a separate violation.

3. The attorney general shall, upon the request of the department, bring
an action in a circuit court of competent jurisdiction to recover the
civil penalty. The department may bring such an action itself. The civil
action may be brought in the circuit court of Cole County or, at the
option of the director, in another county which has venue of an action
against the person under other provisions of law. (L. 1988 H.B. 1368)

1. The committee shall:

(1) Notify the applicant within fifteen days of the date of filing of an
application as to the completeness of such application;

(2) Provide written notification to affected persons located within this
state at the beginning of a review. This notification may be given
through publication of the review schedule in all newspapers of general
circulation in the area to be served;

(3) Hold public hearings on all applications when a request in writing is
filed by any affected person within thirty days from the date of
publication of the notification of review;

(4) Within one hundred days of the filing of any application for a
certificate of need, issue in writing its findings of fact, conclusions
of law, and its approval or denial of the certificate of need; provided,
that the committee may grant an extension of not more than thirty days on
its own initiative or upon the written request of any affected person;

(5) Cause to be served upon the applicant, the respective health system
agency, and any affected person who has filed his prior request in
writing, a copy of the aforesaid findings, conclusions and decisions;

(6) Consider the needs and circumstances of institutions providing
training programs for health personnel;

(7) Provide for the availability, based on demonstrated need, of both
medical and osteopathic facilities and services to protect the freedom of
patient choice; and

(8) Establish by regulation procedures to review, or grant a waiver from
review, nonsubstantive projects.

The term "filed" or "filing" as used in this section shall mean delivery
to the staff of the health facilities review committee the document or
documents the applicant believes constitute an application.

2. Failure by the committee to issue a written decision on an application
for a certificate of need within the time required by this section shall
constitute approval of and final administrative action on the
application, and is subject to appeal pursuant to section 197.335 only on
the question of approval by operation of law. (L. 1979 H.B. 222 § 7, A.L.
1986 S.B. 553 & 775, A.L. 1987 H.B. 384 Revision, A.L. 1999 S.B. 326)

Effective 7-1-99

(1987) Failure of Health Facilities Review Committee to issue decision on
application within the time allotted by this section constitutes approval
of application and pendency of prior application by same applicant for
larger hospital at same location is irrelevant. Platte County Medical
Center, Inc. v. Mo. Health F. Review, 734 S.W.2d 608 (Mo. App.).

Within thirty days of the decision of the committee, the
applicant may file an appeal to be heard de novo by the administrative
hearing commissioner, the circuit court of Cole County or the circuit
court in the county within which such health care service or facility is
proposed to be developed. (L. 1979 H.B. 222 § 8, A.L. 1986 S.B. 553 &
775, A.L. 1987 H.B. 384 Revision, A.L. 1999 S.B. 326)

Effective 7-1-99

(1984) While a competing facility may be an "affected person" under
sections 197.300 to 197.365, it has no right to appeal a decision of the
Health Facilities Review Committee. St. Joseph's Hill Infirmary, Inc. v.
Mandl (Mo. App.) 682 S.W.2d 821.

(1987) Competitor of applicant for certificate of need to construct
nursing home lacked standing to appeal administrative decision to grant
certificate since this section expressly limits participants in an appeal
to applicant and the health service agency within the affected area.
Comm. Care Ctrs. v. Health Fac. Rev. Com., 735 S.W.2d 13 (Mo. App.).

Any health facility providing a health service must notify the
committee of any discontinuance of any previously provided health care
service, a decrease in the number of licensed beds by ten percent or
more, or the change in licensure category for any such facility. (L. 1979
H.B. 222 § 9)

Effective 10-1-80

Any health facility with a project for facilities or services
for which a binding construction or purchase contract has been executed
prior to October 1, 1980, or health care facility which has commenced
operations prior to October 1, 1980, shall be deemed to have received a
certificate of need, except that such certificate of need shall be
subject to forfeiture under the provisions of subsections 8 and 9 of
section 197.315. (L. 1979 H.B. 222 § 10)

The legislature may not appropriate any money for capital
expenditures for health care facilities until a certificate of need has
been issued for such expenditures. (L. 1979 H.B. 222 § 12)

Effective 10-1-80

For the purposes of reimbursement under section 208.152, RSMo,
project costs for new institutional health services in excess of ten
percent of the initial project estimate whether or not approval was
obtained under subsection 7 of section 197.315 shall not be eligible for
reimbursement for the first three years that a facility receives payment
for services provided under section 208.152, RSMo. The initial estimate
shall be that amount for which the original certificate of need was
obtained or, in the case of facilities for which a binding construction
or purchase contract was executed prior to October 1, 1980, the amount of
that contract. Reimbursement for these excess costs after the first three
years shall not be made until a certificate of need has been granted for
the excess project costs. The provisions of this section shall apply only
to facilities which file an application for a certificate of need or make
application for cost-overrun review of their original application or
waiver after August 13, 1982. (L. 1982 H.B. 1086)

The provisions of subdivision (8) of section 197.305 to the
contrary notwithstanding, after December 31, 2001, the term "health care
facilities" in sections 197.300 to 197.366 shall mean:

(1) Facilities licensed under chapter 198, RSMo;

(2) Long-term care beds in a hospital as described in subdivision (3) of
subsection 1 of section 198.012, RSMo;

(3) Long-term care hospitals or beds in a long-term care hospital meeting
the requirements described in 42 CFR, section 412.23(e); and

(4) Construction of a new hospital as defined in chapter 197. (L. 1996
H.B. 1362)

Effective 7-12-96

CROSS REFERENCE: Health care facilities defined until December 31, 2001,
RSMo 197.305

Upon application for renewal by any residential care facility I
or II which on the effective date of this act* has been licensed for more
than five years, is licensed for more than fifty beds and fails to
maintain for any calendar year its occupancy level above thirty percent
of its then licensed beds, the division of aging shall license only fifty
beds for such facility. (L. 1999 S.B. 326 § 8)

*"This act" (S.B. 326, 1999) contained more than one effective date.

As used in sections 197.400 to 197.475, unless the context
otherwise requires, the following terms mean:

(1) "Council", the home health services advisory council created by
sections 197.400 to 197.475;

(2) "Department", the department of health and senior services;

(3) "Home health agency", a public agency or private organization or a
subdivision or subunit of an agency or organization that provides two or
more home health services at the residence of a patient according to a
physician's written and signed plan of treatment;

(4) "Home health services", any of the following items and services
provided at the residence of the patient on a part-time or intermittent
basis: nursing, physical therapy, speech therapy, occupational therapy,
home health aid, or medical social service;

(5) "Part-time or intermittent basis", the providing of home health
services in an interrupted interval sequence on the average of not to
exceed three hours in any twenty-four-hour period;

(6) "Patient's residence", the actual place of residence of the person
receiving home health services, including institutional residences as
well as individual dwelling units;

(7) "Physician", a person licensed by the state board of registration for
the healing arts pursuant to the provisions of chapter 334, RSMo, to
practice in this state as a physician and surgeon;

(8) "Plan of treatment", a plan reviewed and signed as often as medically
necessary by a physician or podiatrist, not to exceed sixty days in
duration, prescribing items and services for an individual patient's
condition;

(9) "Podiatrist", a person licensed by the state board of podiatry
pursuant to the provisions of chapter 330, RSMo, to practice in this
state as a podiatrist;

(10) "Subunit" or "subdivision", any organizational unit of a larger
organization which can be clearly defined as a separate entity within the
larger structure, which can meet all of the requirements of sections
197.400 to 197.475 independent of the larger organization, which can be
held accountable for the care of patients it is serving, and which
provides to all patients care and services meeting the standards and
requirements of sections 197.400 to 197.475. (L. 1983 H.B. 51 § 1, A.L.
1997 H.B. 642)

No home health agency, including Medicare and Medicaid
providers, shall provide two or more of the home health services covered
by subdivision (4) of section 197.400 or shall hold itself out as
providing such home health services or as a home health agency unless it
is licensed and registered in accordance with the provisions of sections
197.400 to 197.475. (L. 1983 H.B. 51 § 2)

1. Persons desiring to receive a license to operate a home
health agency in the state of Missouri shall file a written application
with the department of health and senior services on a form prescribed by
the director of the department.

2. The application shall be accompanied by a six hundred- dollar license
fee. (L. 1983 H.B. 51 § 3)

1. The department shall review the applications and shall issue
a license to applicants who have complied with the requirements of
sections 197.400 to 197.475 and have received approval of the department.

2. A license shall be renewed annually upon approval of the department
when the following conditions have been met:

(1) The application for renewal is accompanied by a six-hundred-dollar
license fee;

(2) The home health agency is in compliance with the requirements
established pursuant to the provisions of sections 197.400 to 197.475 as
evidenced by a survey inspection by the department which shall occur at
least every thirty-six months for agencies that have been in operation
thirty-six consecutive months from initial inspection. The frequency of
inspections for agencies in operation at least thirty-six consecutive
months from the initial inspection shall be determined by such factors as
number of complaints received and changes in management, supervision or
ownership. The frequency of each survey inspection for any agency in
operation less than thirty-six consecutive months from the initial
inspection shall occur and be conducted at least every twelve months;

(3) The application is accompanied by a statement of any changes in the
information previously filed with the department pursuant to section
197.410.

3. Each license shall be issued only for the home health agency listed in
the application. Licenses shall be posted in a conspicuous place in the
main offices of the licensed home health agency.

4. In lieu of any survey required by sections 197.400 to 197.475, the
department may accept in whole or in part written reports of the survey
of any state or federal agency, or of any professional accrediting
agency, if such survey:

(1) Is comparable in scope and method to the department's surveys; and

(2) Is conducted within one year of initial application or within
thirty-six months for the renewal of the home health license as required
by subdivision (2) of subsection 2 of this section. (L. 1983 H.B. 51 § 4,
subsecs. 1, 2, 3, A.L. 1997 H.B. 643 merged with S.B. 373)

Whenever the department is inspecting a home health agency in
response to an application from an applicant located outside of Missouri
not previously licensed by the department, the department may request
from the applicant the past five years compliance history of all home
health agencies owned by the applicant located outside of this state. (L.
2003 S.B. 556 & 311)

A license shall not be transferable or assignable. When a home
health agency is sold or ownership or management is transferred, or the
corporate legal organization status is substantially changed, the license
of the agency shall be voided and a new license obtained. Application for
a new license shall be made to the department in writing, at least ninety
days prior to the effective date of the sale, transfer, or change in
corporate status. The application for a new license shall be on the same
form, containing the same information required for an original license,
and shall be accompanied by a license fee of six hundred dollars. The
department may issue a temporary operating permit for the continuation of
the operation of the home health agency for a period of not more than
ninety days pending the survey inspection and the final disposition of
the application. The department shall require all licensed home health
agencies to submit statistical reports. The content, format, and
frequency of such reports shall be determined by the department with
council approval. (L. 1983 H.B. 51 § 4, subsec. 4)

In addition to the survey inspection required for licensing or
license renewal, the department may make other survey inspections during
normal business hours. Each home health agency shall allow the department
or its authorized representatives to enter upon its premises during
normal business hours for the purpose of conducting the survey
inspection. (L. 1983 H.B. 51 § 5)

After completion of each department survey, a written report of
the findings with respect to compliance or noncompliance with the
provisions of sections 197.400 to 197.475 and the standards established
hereunder as well as a list of deficiencies found shall be prepared. A
copy of the report and the list of deficiencies found shall be served
upon the home health agency within fifteen business days following the
survey inspection. The list of deficiencies shall specifically state the
statute or rule which the home health agency is alleged to have violated.
If the home health agency acknowledges the deficiencies found by the
survey inspection, the home health agency shall inform the department of
the time necessary for compliance and shall file a plan of correction
with the department. If the home health agency does not acknowledge the
deficiencies, it may request a resurvey by the department. If, after the
resurvey, the home health agency still does not agree with the findings
of the department, it may seek a review of the findings of the department
by the administrative hearing commission. (L. 1983 H.B. 51 § 6)

Any person wishing to make a complaint against a home health
agency licensed under the provisions of sections 197.400 to 197.475 may
file the complaint in writing with the department setting forth the
details and facts supporting the complaint. If the department determines
the charges are sufficient to warrant a hearing to determine whether the
license of the home health agency should be suspended or revoked, the
department shall fix a time and place for a hearing and require the home
health agency to appear and defend against the complaint. A copy of the
complaint shall be given to the home health agency at the time it is
notified of the hearing. The notice of the hearing shall be given at
least twenty days prior to the date of the hearing. The hearing shall be
conducted by the administrative hearing commission in accordance with the
provisions of chapter 621, RSMo. (L. 1983 H.B. 51 § 7)

1. The department shall refuse to issue or shall suspend or
shall revoke the license of any home health agency for failure to comply
with any provision of sections 197.400 to 197.475 or with any rule or
standard of the department adopted under the provisions of sections
197.400 to 197.475 or for obtaining the license by means of fraud,
misrepresentation, or concealment of material facts.

2. Any home health agency which has been refused a license or which has
had its license revoked or suspended by the department may seek a review
of the department's action by the administrative hearing commission. (L.
1983 H.B. 51 § 8)

1. The department may adopt reasonable rules and standards
necessary to carry out the provisions of sections 197.400 to 197.477. The
rules and standards adopted shall not be less than the standards
established by the federal government for home health agencies under
Title XVIII of the Federal Social Security Act. The reasonable rules and
standards shall be initially promulgated within one year of September 28,
1983.

2. The rules and standards adopted by the department pursuant to the
provisions of sections 197.400 to 197.477 shall apply to all health
services covered by sections 197.400 to 197.477 rendered to any patient
being served by a home health agency regardless of source of payment for
the service, patient's condition, or place of residence, at which the
home health services are ordered by the physician or podiatrist. No rule
or portion of a rule promulgated pursuant to the authority of sections
197.400 to 197.477 shall become effective unless it has been promulgated
pursuant to the provisions of section 536.024, RSMo. (L. 1983 H.B. 51 §
9, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3, A.L. 1997 H.B. 642)

1. There is hereby created the "Home Health Services Advisory
Council", which shall guide, advise and make recommendations to the
department relating to the rules and standards adopted and the
implementation and administration of sections 197.400 to 197.475.

2. Members of the council shall be residents of this state. The council
shall consist of members who shall serve for a term of three years. No
member may serve more than two successive full terms. One member of the
council shall be a representative of the department, and such member
shall serve as chairman of the council. Three members shall be citizens
selected from the state at large and shall have no connection with any
home health agency. Five members shall be representatives of home health
agencies and one of these five members shall be selected from each of the
following types of home health agencies:

(1) Public sponsored home health agencies;

(2) Institutional sponsored home health agencies;

(3) Voluntary nonprofit home health agencies;

(4) Private nonprofit home health agencies; and

(5) For-profit home health agencies.

3. All members of the council shall be appointed by the director of the
department. The term of office of each member shall be for three years or
until his successor is appointed; except that, of the members first
appointed, three shall be selected for one year, three shall be selected
for two years, and three shall be selected for three years. Before a
member's term expires, the director of the department shall appoint a
successor to assume his duties on the expiration of his predecessor's
term. A vacancy in the office of a member shall be filled by appointment
for the unexpired term.

4. The council shall meet not less than quarterly each year at a place,
day and hour determined by the council. The council may also meet at such
other times and places as may be designated by the chairman, or upon the
request of the majority of the other members of the council.

5. Members of the council shall receive no compensation for their
services, but shall be reimbursed, subject to appropriations, for their
actual and necessary expenses incurred in the performance of their
duties. (L. 1983 H.B. 51 § 10, A.L. 2002 H.B. 1953)

The department may file an action in the circuit court for the
county in which any home health agency alleged to be violating the
provisions of sections 197.400 to 197.475 resides or may be found for an
injunction to restrain the home health agency from continuing the
violation. (L. 1983 H.B. 51 § 11)

1. The provisions of sections 197.400 to 197.475 shall not apply
to individuals who personally provide one or more home health services if
such persons are not under the direct control and doing work for and
employed by a home health agency.

2. The provisions of sections 197.400 to 197.475 shall not apply to any
person or organization conducting a home health agency by and for the
adherents of any recognized church or religious denomination or sect for
the purpose of providing services for the care or treatment of the sick
or infirm who depend upon prayer or spiritual means for healing in the
practice of the religion of such church or religious denomination or sect.

3. The provisions of sections 197.400 to 197.475 shall not apply to any
person or other entity which provides services pursuant to subdivision
(18) of subsection 1 of section 208.152, RSMo, or provides in-home
services pursuant to subdivision (21) of subsection 2 of section 660.050,
RSMo. (L. 1983 H.B. 51 § 12, A.L. 1990 S.B. 524)

Effective 1-1-91

All funds received by the department under the provisions of
sections 197.400 to 197.475 shall be deposited in the state treasury to
the credit of general revenue. (L. 1983 H.B. 51 § 13)

All reports or documents collected by the department, or
findings and decisions made by the department, under the provisions of
sections 197.400 to 197.475, unless declared to be a confidential record
under any other provision of law, shall be available to public inspection
upon written request. The material requested shall be made available
within thirty days after receipt of the request. The department may
charge a reasonable fee for the copying of any material. (L. 1983 H.B. 51
§ 14)

Any person who violates any of the provisions of sections
197.400 to 197.475 is guilty of a class A misdemeanor and, upon
conviction, shall be punished as provided by law. (L. 1983 H.B. 51 § 15)

Upon the completion of the final report of an inspection or
evaluation of a health facility or agency or any part thereof pursuant to
sections 190.235 to 190.249, RSMo, sections 197.010 to 197.120, sections
197.200 to 197.240, or sections 197.400 to 197.475, including any
amendments thereto which may hereinafter be enacted by the general
assembly or rule or regulation promulgated pursuant thereto, the
department of health and senior services may disclose to the public
reports of the inspections or evaluations showing the standards by which
the inspections or evaluations were conducted, whether such standards
were met, and, if such standards were not met, in what manner they were
not met and how the facility proposed to correct or did correct the
deficiencies. All other information whatsoever, including information and
reports submitted to the department of health and senior services by
governmental agencies and recognized accrediting organizations in whole
or in part for licensure purposes pursuant to sections 190.235 to
190.249, RSMo, sections 197.010 to 197.120, sections 197.200 to 197.240,
or sections 197.400 to 197.475, collected during such inspections or
evaluations or information which is derived as a result of such
inspections or evaluations shall be confidential and shall be disclosed
only to the person or organization which is the subject of the inspection
or evaluation or a representative thereof. (L. 1988 H.B. 1134 § 2)

Effective 5-4-88

1. The department of health and senior services shall provide
through their Internet web site:

(1) The most recent survey of all home health agencies and any such
findings of deficiencies and the effect the deficiency would have on such
agencies. If such survey is in dispute, the survey shall not be posted on
the web site until the agency's dispute has been resolved and the
department shall, upon request of the home health agency, post the
agency's response;

(2) The home health agency's proposed plan of correction;

(3) A link to the federal web site that provides a summary of home health
agency surveys conducted over the last three years; and

(4) Information on how to obtain a copy of a complete home health agency
survey conducted over the last three years.

2. Nothing in this section shall be construed as requiring the department
to post any information on its Internet web site that is prohibited from
disclosure pursuant to the federal Health Insurance Portability and
Accountability Act, as amended. (L. 2003 S.B. 556 & 311)

There shall be a rebuttable presumption of undue influence for
any transfer of assets or bequest or devise to the benefit of any in-
home health care provider who is not related to the grantor within the
third degree of consanguinity. Such presumption shall not apply to
reasonable payments for services rendered nor to transfers of less than
five percent of the assets of the grantor. (L. 2004 H.B. 1511 § 1)

1. The department shall maintain an employee disqualification
list and place on the employee disqualification list the names of any
persons who are or who have been employed by any entity licensed pursuant
to this chapter and who have been finally determined by the department
pursuant to section 660.315, RSMo, to have knowingly or recklessly abused
or neglected a patient. For the purpose of this section, "abuse" and
"neglect" shall have the same meanings as such terms are defined in
section 198.006, RSMo. For purposes of this section only, "knowingly" and
"recklessly" shall have the meanings that are ascribed to them in this
section. A person acts "knowingly" with respect to the person's conduct
when a reasonable person should be aware of the result caused by his or
her conduct. A person acts "recklessly" when the person consciously
disregards a substantial and unjustifiable risk that the person's conduct
will result in serious physical injury and such disregard constitutes a
gross deviation from the standard of care that a reasonable person would
exercise in the situation.

2. The department shall compile and maintain an employee disqualification
list in the same manner as the employee disqualification list compiled
and maintained by the department pursuant to section 660.315, RSMo. (L.
2003 S.B. 556 & 311)

In the selection of medical staff members licensed under chapter
334, RSMo, no medical staff bylaws, departmental bylaws or hospital
licensed under this chapter shall discriminate against any practitioner
of the healing arts who holds a license to practice medicine and surgery
in this state for reasons based solely upon the practitioner's branch of
the healing arts or the school or health care facility in which the
practitioner received medical schooling, postgraduate training or
certification if such medical schooling or postgraduate training was
accredited by the American Osteopathic Association or the American
Medical Association. Each applicant for medical staff membership shall be
considered on an individual basis pursuant to objective criteria applied
equally to each applicant. (L. 1993 S.B. 54 § 1)

All hospitals and health care facilities, defined in sections
197.020 and 197.305, shall require all personnel providing services in
such facilities to wear identification badges while acting within the
scope of their employment. The identification badges of all personnel
shall prominently display the licensure status of such personnel. (L.
1997 H.B. 762 § 1)

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