Missouri Statute | Act | Code |Public Health And Welfare| US Code - US Statute | Chapter 198 Convalescent, Nursing And Boarding Homes

Sections 198.003 to 198.186 shall be known and may be cited as
the "Omnibus Nursing Home Act". (L. 1979 S.B. 328, et al. § 2)

As used in sections 198.003 to 198.186, unless the context
clearly indicates otherwise, the following terms mean:

(1) "Abuse", the infliction of physical, sexual, or emotional injury or
harm;

(2) "Administrator", the person who is in general administrative charge
of a facility;

(3) "Affiliate":

(a) With respect to a partnership, each partner thereof;

(b) With respect to a limited partnership, the general partner and each
limited partner with an interest of five percent or more in the limited
partnership;

(c) With respect to a corporation, each person who owns, holds or has the
power to vote five percent or more of any class of securities issued by
the corporation, and each officer and director;

(d) With respect to a natural person, any parent, child, sibling, or
spouse of that person;

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

(5) "Emergency", a situation, physical condition or one or more
practices, methods or operations which presents imminent danger of death
or serious physical or mental harm to residents of a facility;

(6) "Facility", any residential care facility I, residential care
facility II, immediate care facility, or skilled nursing facility;

(7) "Health care provider", any person providing health care services or
goods to residents and who receives funds in payment for such goods or
services under Medicaid;

(8) "Intermediate care facility", any premises, other than a residential
care facility I, residential care facility II, or skilled nursing
facility, which is utilized by its owner, operator, or manager to provide
twenty-four hour accommodation, board, personal care, and basic health
and nursing care services under the daily supervision of a licensed nurse
and under the direction of a licensed physician to three or more
residents dependent for care and supervision and who are not related
within the fourth degree of consanguinity or affinity to the owner,
operator or manager of the facility;

(9) "Manager", any person other than the administrator of a facility who
contracts or otherwise agrees with an owner or operator to supervise the
general operation of a facility, providing such services as hiring and
training personnel, purchasing supplies, keeping financial records, and
making reports;

(10) "Medicaid", medical assistance under section 208.151, RSMo, et seq.,
in compliance with Title XIX, Public Law 89-97, 1965 amendments to the
Social Security Act (42 U.S.C. 301 et seq.), as amended;

(11) "Neglect", the failure to provide, by those responsible for the
care, custody, and control of a resident in a facility, the services
which are reasonable and necessary to maintain the physical and mental
health of the resident, when such failure presents either an imminent
danger to the health, safety or welfare of the resident or a substantial
probability that death or serious physical harm would result;

(12) "Operator", any person licensed or required to be licensed under the
provisions of sections 198.003 to 198.096 in order to establish, conduct
or maintain a facility;

(13) "Owner", any person who owns an interest of five percent or more in:

(a) The land on which any facility is located;

(b) The structure or structures in which any facility is located;

(c) Any mortgage, contract for deed, or other obligation secured in whole
or in part by the land or structure in or on which a facility is located;
or

(d) Any lease or sublease of the land or structure in or on which a
facility is located.

"Owner" does not include a holder of a debenture or bond purchased at
public issue nor does it include any regulated lender unless the entity
or person directly or through a subsidiary operates a facility;

(14) "Protective oversight", an awareness twenty-four hours a day of the
location of a resident, the ability to intervene on behalf of the
resident, the supervision of nutrition, medication, or actual provisions
of care, and the responsibility for the welfare of the resident, except
where the resident is on voluntary leave;

(15) "Resident", a person who by reason of aging, illness, disease, or
physical or mental infirmity receives or requires care and services
furnished by a facility and who resides or boards in or is otherwise
kept, cared for, treated or accommodated in such facility for a period
exceeding twenty-four consecutive hours;

(16) "Residential care facility I", any premises, other than a
residential care facility II, intermediate care facility, or skilled
nursing facility, which is utilized by its owner, operator or manager to
provide twenty-four hour care to three or more residents, who are not
related within the fourth degree of consanguinity or affinity to the
owner, operator, or manager of the facility and who need or are provided
with shelter, board, and with protective oversight, which may include
storage and distribution or administration of medications and care during
short-term illness or recuperation;

(17) "Residential care facility II", any premises, other than a
residential care facility I, an intermediate care facility, or a skilled
nursing facility, which is utilized by its owner, operator or manager to
provide twenty-four hour accommodation, board, and care to three or more
residents who are not related within the fourth degree of consanguinity
or affinity to the owner, operator, or manager of the facility, and who
need or are provided with supervision of diets, assistance in personal
care, storage and distribution or administration of medications,
supervision of health care under the direction of a licensed physician,
and protective oversight, including care during short-term illness or
recuperation;

(18) "Skilled nursing facility", any premises, other than a residential
care facility I, a residential care facility II, or an intermediate care
facility, which is utilized by its owner, operator or manager to provide
for twenty-four hour accommodation, board and skilled nursing care and
treatment services to at least three residents who are not related within
the fourth degree of consanguinity or affinity to the owner, operator or
manager of the facility. Skilled nursing care and treatment services are
those services commonly performed by or under the supervision of a
registered professional nurse for individuals requiring twenty-four hours
a day care by licensed nursing personnel including acts of observation,
care and counsel of the aged, ill, injured or infirm, the administration
of medications and treatments as prescribed by a licensed physician or
dentist, and other nursing functions requiring substantial specialized
judgment and skill;

(19) "Vendor", any person selling goods or services to a health care
provider;

(20) "Voluntary leave", an off-premise leave initiated by:

(a) A resident that has not been declared mentally incompetent or
incapacitated by a court; or

(b) A legal guardian of a resident that has been declared mentally
incompetent or incapacitated by a court. (L. 1979 S.B. 328, et al. § 3,
A.L. 1984 S.B. 451, A.L. 1987 S.B. 277, A.L. 2003 S.B. 534 merged with
S.B. 556 & 311)

1. The provisions of sections 198.003 to 198.186 shall be
administered by the department. The department shall have authority to
promulgate rules and regulations for the purposes of administering
sections 198.003 to 198.186. All such rules and regulations shall be
promulgated in accordance with this section and chapter 536, RSMo. No
rule or portion of a rule promulgated under the authority of this chapter
shall become effective unless it has been promulgated pursuant to the
provisions of section 536.024, RSMo.

2. All agencies of the state or any of its political subdivisions shall
assist and cooperate with the department whenever necessary to carry out
the department's responsibility under sections 198.003 to 198.186. (L.
1979 S.B. 328, et al. § 4, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3)

1. The provisions of sections 198.003 to 198.136 shall not apply
to any of the following entities:

(1) Any hospital, facility or other entity operated by the state or the
United States;

(2) Any facility or other entity otherwise licensed by the state and
operating exclusively under such license and within the limits of such
license, unless the activities and services are or are held out as being
activities or services normally provided by a licensed facility under
sections 198.003 to 198.186, 198.200, 208.030, and 208.159, RSMo, except
hospitals licensed under the provisions of chapter 197, RSMo;

(3) Any hospital licensed under the provisions of chapter 197, RSMo,
provided that the residential care facility II, intermediate care
facility or skilled nursing facility are physically attached to the acute
care hospital; and provided further that the department of health and
senior services in promulgating rules, regulations and standards pursuant
to section 197.080, RSMo, with respect to such facilities, shall
establish requirements and standards for such hospitals consistent with
the intent of this chapter, and sections 198.067, 198.070, 198.090,
198.093 and 198.139 to 198.180 shall apply to every residential care
facility II, intermediate care facility or skilled nursing facility
regardless of physical proximity to any other health care facility;

(4) Any facility licensed pursuant to sections 630.705 to 630.760, RSMo,
which provides care, treatment, habilitation and rehabilitation
exclusively to persons who have a primary diagnosis of mental disorder,
mental illness, mental retardation or developmental disabilities, as
defined in section 630.005, RSMo;

(5) Any provider of care under a life care contract, except to any
portion of the provider's premises on which the provider offers services
provided by an intermediate care facility or skilled nursing facility as
defined in section 198.006. For the purposes of this section, "provider
of care under a life care contract" means any person contracting with any
individual to furnish specified care and treatment to the individual for
the life of the individual, with significant prepayment for such care and
treatment.

2. Nothing in this section shall prohibit any of these entities from
applying for a license under sections 198.003 to 198.136. (L. 1979 S.B.
328, et al. § 5, A.L. 1980 H.B. 1724, A.L. 1982 S.B. 698, A.L. 1984 S.B.
451, A.L. 1988 S.B. 602, A.L. 1989 H.B. 210)

CROSS REFERENCE: Missouri veterans homes, nursing home license not
required, RSMo 42.130

The department of health and senior services, with the full
cooperation of and in conjunction with the department of social services,
shall evaluate the implementation and compliance of the provisions of
subdivision (3) of subsection 1 of section 198.012 in which rules,
requirements, regulations and standards pursuant to section 197.080,
RSMo, for residential care facilities II, intermediate care facilities
and skilled nursing facilities attached to an acute care hospital are
consistent with the intent of chapter 198. A report of the differences
found in the evaluation conducted pursuant to this section shall be made
jointly by the departments of health and senior services and social
services to the governor and members of the general assembly by January
1, 2000. (L. 1999 S.B. 8 & 173 § 2)

1. No person shall establish, conduct or maintain a residential
care facility I, residential care facility II, intermediate care
facility, or skilled nursing facility in this state without a valid
license issued by the department. Any person violating this subsection is
guilty of a class A misdemeanor. Any person violating this subsection
wherein abuse or neglect of a resident of the facility has occurred is
guilty of a class D felony. The department of health and senior services
shall investigate any complaint concerning operating unlicensed
facilities. For complaints alleging abuse or neglect, the department
shall initiate an investigation within twenty-four hours. All other
complaints regarding unlicensed facilities shall be investigated within
forty-five days.

2. If the department determines the unlicensed facility is in violation
of sections 198.006 to 198.186, the department shall immediately notify
the local prosecuting attorney or attorney general's office.

3. Each license shall be issued only for the premises and persons named
in the application. A license, unless sooner revoked, shall be issued for
a period of up to two years, in order to coordinate licensure with
certification in accordance with section 198.045.

4. If during the period in which a license is in effect, a licensed
operator which is a partnership, limited partnership, or corporation
undergoes any of the following changes, or a new corporation,
partnership, limited partnership or other entity assumes operation of a
facility whether by one or by more than one action, the current operator
shall notify the department of the intent to change operators and the
succeeding operator shall within ten working days of such change apply
for a new license:

(1) With respect to a partnership, a change in the majority interest of
general partners;

(2) With respect to a limited partnership, a change in the general
partner or in the majority interest of limited partners;

(3) With respect to a corporation, a change in the persons who own, hold
or have the power to vote the majority of any class of securities issued
by the corporation.

5. Licenses shall be posted in a conspicuous place on the licensed
premises.

6. Any license granted shall state the maximum resident capacity for
which granted, the person or persons to whom granted, the date, the
expiration date, and such additional information and special limitations
as the department by rule may require.

7. The department shall notify the operator at least sixty days prior to
the expiration of an existing license of the date that the license
application is due. Application for a license shall be made to the
department at least thirty days prior to the expiration of any existing
license.

8. The department shall grant an operator a temporary operating permit in
order to allow for state review of the application and inspection for the
purposes of relicensure if the application review and inspection process
has not been completed prior to the expiration of a license and the
operator is not at fault for the failure to complete the application
review and inspection process.

9. The department shall grant an operator a temporary operating permit of
sufficient duration to allow the department to evaluate any application
for a license submitted as a result of any change of operator. (L. 1979
S.B. 328, et al. § 6, A.L. 1984 S.B. 451, A.L. 1987 S.B. 277, A.L. 1988
S.B. 602, A.L. 1994 H.B. 1335 & 1381, A.L. 1999 S.B. 326, A.L. 2003 S.B.
556 & 311)

CROSS REFERENCES: License for administrator of residential care
facilities II required, limitations, RSMo 344.020 Skilled nursing care
facilities, a license for residential care facilities II insufficient,
RSMo 344.020

1. Applications for a license shall be made to the department by
the operator upon such forms and including such information and documents
as the department may reasonably require by rule or regulation for the
purposes of administering sections 198.003 to 198.186, section 198.200,
and sections 208.030 and 208.159, RSMo.

2. The applicant shall submit an affidavit under oath that all documents
required by the department to be filed pursuant to this section are true
and correct to the best of his knowledge and belief, that the statements
contained in the application are true and correct to the best of his
knowledge and belief, and that all required documents are either included
with the application or are currently on file with the department.

3. The application shall be accompanied by a license fee in an amount
established by the department. The fee established by the department
shall not exceed six hundred dollars, and shall be a graduated fee based
on the licensed capacity of the applicant and the duration of the
license. A fee of not more than fifty dollars shall be charged for any
amendments to a license initiated by an applicant. In addition,
facilities certified to participate in the Medicaid or Medicare programs
shall pay a certification fee of up to one thousand dollars annually,
payable on or before October first of each year. The amount remitted for
the license fee, fee for amendments to a license, or certification fee
shall be deposited in the state treasury to the credit of the "Nursing
Facility Quality of Care Fund", which is hereby created. All investment
earnings of the nursing facility quality of care fund shall be credited
to such fund. All moneys in the nursing facility quality of care fund
shall, upon appropriation, be used by the division of aging for
conducting inspections and surveys, and providing training and technical
assistance to facilities licensed under the provisions of this chapter.
The unexpended balance in the nursing facility quality of care fund at
the end of the biennium is exempt from the provisions of sections 33.080,
RSMo. The unexpended balance in the nursing facility quality of care fund
shall not revert to the general revenue fund, but shall accumulate in the
nursing facility quality of care fund from year to year.

4. Within ten working days of the effective date of any document that
replaces, succeeds, or amends any of the documents required by the
department to be filed pursuant to this section, an operator shall file
with the department a certified copy of such document. If the operator
knowingly fails to file a required document or provide any information
amending any document within the time provided for in this section, a
circuit court may, upon application of the department or the attorney
general, assess a penalty of up to fifty dollars per document for each
day past the required date of filing.

5. If an operator fails to file documents or amendments to documents as
required pursuant to this section and such failure is part of a pattern
or practice of concealment, such failure shall be sufficient grounds for
revocation of a license or disapproval of an application for a license.

6. Any facility defined in subdivision (8), (15), (16) or (17) of section
198.006 that is licensed by the state of Missouri pursuant to the
provisions of section 198.015 may not be licensed, certified or
registered by any other political subdivision of the state of Missouri
whether or not it has taxing power, provided, however, that nothing in
this subsection shall prohibit a county or city, otherwise empowered
under law, to inspect such facility for compliance with local ordinances
of food service or fire safety. (L. 1979 S.B. 328, et al. § 7, A.L. 1984
S.B. 451, A.L. 1987 S.B. 277, A.L. 1988 S.B. 602, A.L. 1994 H.B. 1335 &
1381)

1. Upon receipt of an application for a license to operate a
facility, the department shall review the application, investigate the
applicant and the statements sworn to in the application for license and
conduct any necessary inspections. A license shall be issued if the
following requirements are met:

(1) The statements in the application are true and correct;

(2) The facility and the operator are in substantial compliance with the
provisions of sections 198.003 to 198.096 and the standards established
thereunder;

(3) The applicant has the financial capacity to operate the facility;

(4) The administrator of a residential care facility II, a skilled
nursing facility, or an intermediate care facility is currently licensed
under the provisions of chapter 344, RSMo;

(5) Neither the operator nor any principals in the operation of the
facility have ever been convicted of a felony offense concerning the
operation of a long-term health care facility or other health care
facility or ever knowingly acted or knowingly failed to perform any duty
which materially and adversely affected the health, safety, welfare or
property of a resident, while acting in a management capacity. The
operator of the facility or any principal in the operation of the
facility shall not be under exclusion from participation in the Title
XVIII (Medicare) or Title XIX (Medicaid) program of any state or
territory;

(6) Neither the operator nor any principals involved in the operation of
the facility have ever been convicted of a felony in any state or federal
court arising out of conduct involving either management of a long-term
care facility or the provision or receipt of health care;

(7) All fees due to the state have been paid.

2. Upon denial of any application for a license, the department shall so
notify the applicant in writing, setting forth therein the reasons and
grounds for denial.

3. The department may inspect any facility and any records and may make
copies of records, at the facility, at the department's own expense,
required to be maintained by sections 198.003 to 198.096 or by the rules
and regulations promulgated thereunder at any time if a license has been
issued to or an application for a license has been filed by the operator
of such facility. Copies of any records requested by the department shall
be prepared by the staff of such facility within two business days or as
determined by the department. The department shall not remove or
disassemble any medical record during any inspection of the facility, but
may observe the photocopying or may make its own copies if the facility
does not have the technology to make the copies. In accordance with the
provisions of section 198.525, the department shall make at least two
inspections per year, at least one of which shall be unannounced to the
operator. The department may make such other inspections, announced or
unannounced, as it deems necessary to carry out the provisions of
sections 198.003 to 198.136.

4. Whenever the department has reasonable grounds to believe that a
facility required to be licensed under sections 198.003 to 198.096 is
operating without a license, and the department is not permitted access
to inspect the facility, or when a licensed operator refuses to permit
access to the department to inspect the facility, the department shall
apply to the circuit court of the county in which the premises is located
for an order authorizing entry for such inspection, and the court shall
issue the order if it finds reasonable grounds for inspection or if it
finds that a licensed operator has refused to permit the department
access to inspect the facility.

5. Whenever the department is inspecting a facility in response to an
application from an operator 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 facilities owned by the
applicant located outside of this state. (L. 1979 S.B. 328, et al. § 8,
A.L. 1984 S.B. 451, A.L. 1988 S.B. 602, A.L. 1994 H.B. 1335 & 1381, A.L.
2003 S.B. 556 & 311)

1. Whenever a duly authorized representative of the department
finds upon an inspection of a facility that it is not in compliance with
the provisions of sections 198.003 to 198.096 and the standards
established thereunder, the operator or administrator shall be informed
of the deficiencies in an exit interview conducted with the operator or
administrator or his designee. The department shall inform the operator
or administrator, in writing, of any violation of a class I standard at
the time the determination is made. A written report shall be prepared of
any deficiency for which there has not been prompt remedial action, and a
copy of such report and a written correction order shall be sent to the
operator or administrator by certified mail or other delivery service
that provides a dated receipt of delivery at the facility address within
ten working days after the inspection, stating separately each deficiency
and the specific statute or regulation violated.

2. The operator or administrator shall have five working days following
receipt of a written report and correction order regarding a violation of
a class I standard and ten working days following receipt of the report
and correction order regarding violations of class II or class III
standards to request any conference and to submit a plan of correction
for the department's approval which contains specific dates for achieving
compliance. Within five working days after receiving a plan of correction
regarding a violation of a class I standard and within ten working days
after receiving a plan of correction regarding a violation of a class II
or III standard, the department shall give its written approval or
rejection of the plan. If there was a violation of any class I standard,
immediate corrective action shall be taken by the operator or
administrator and a written plan of correction shall be submitted to the
department. The department shall give its written approval or rejection
of the plan and if the plan is acceptable, a reinspection shall be
conducted within twenty calendar days of the exit interview to determine
if deficiencies have been corrected. If there was a violation of any
class II standard and the plan of correction is acceptable, an
unannounced reinspection shall be conducted between forty and ninety
calendar days from the date of the exit conference to determine the
status of all previously cited deficiencies. If there was a violation of
class III standards sufficient to establish that the facility was not in
substantial compliance, an unannounced reinspection shall be conducted
within one hundred twenty days of the exit interview to determine the
status of previously identified deficiencies.

3. If, following the reinspection, the facility is found not in
substantial compliance with sections 198.003 to 198.096 and the standards
established thereunder or the operator is not correcting the
noncompliance in accordance with the approved plan of correction, the
department shall issue a notice of noncompliance, which shall be sent by
certified mail or other delivery service that provides a dated receipt of
delivery to each person disclosed to be an owner or operator of the
facility, according to the most recent information or documents on file
with the department.

4. The notice of noncompliance shall inform the operator or administrator
that the department may seek the imposition of any of the sanctions and
remedies provided for in section 198.067, or any other action authorized
by law.

5. At any time after an inspection is conducted, the operator may choose
to enter into a consent agreement with the department to obtain a
probationary license. The consent agreement shall include a provision
that the operator will voluntarily surrender the license if substantial
compliance is not reached in accordance with the terms and deadlines
established under the agreement. The agreement shall specify the stages,
actions and time span to achieve substantial compliance.

6. Whenever a notice of noncompliance has been issued, the operator shall
post a copy of the notice of noncompliance and a copy of the most recent
inspection report in a conspicuous location in the facility, and the
department shall send a copy of the notice of noncompliance to the
division of family services of the department of social services, the
department of mental health, and any other concerned federal, state or
local governmental agencies. (L. 1979 S.B. 328, et al. § 9, A.L. 1984
S.B. 451, A.L. 1988 S.B. 602, A.L. 1994 H.B. 1335 & 1381)

If a facility submits satisfactory documentation that
establishes correction of any deficiency contained within the written
report of deficiency required by section 198.026, an on-site revisit of
such deficiency may not be required. (L. 2003 S.B. 556 & 311)

The provisions of section 198.026 notwithstanding, whenever a
duly authorized representative of the department finds upon inspection of
a licensed facility, and the director of the department finds upon
review, that the facility or the operator is not in substantial
compliance with a standard or standards the violations of which would
present either an imminent danger to the health, safety or welfare of any
resident or a substantial probability that death or serious physical harm
would result and which is not immediately corrected, the department shall:

(1) Give immediate written notice of the noncompliance to the operator,
administrator or person managing or supervising the conduct of the
facility at the time the noncompliance is found;

(2) Make public the fact that a notice of noncompliance has been issued
to the facility. Copies of the notice shall be sent to appropriate
hospitals and social service agencies;

(3) Send a copy of the notice of noncompliance to the division of family
services of the department of social services, the department of mental
health, and any other concerned federal, state or local government
agencies. The facility shall post in a conspicuous location in the
facility a copy of the notice of noncompliance and a copy of the most
recent inspection report. (L. 1979 S.B. 328, et al. § 10)

Every residential care facility I, residential care facility II,
intermediate care facility, and skilled nursing facility shall post the
most recent inspection report of the facility in a conspicuous place. If
the operator determines that the inspection report of the facility
contains individually identifiable health information, the operator may
redact such information prior to posting the inspection report. (L. 2003
S.B. 556 & 311)

1. Nothing contained in sections 198.003 to 198.186 shall permit
the public disclosure by the department of confidential medical, social,
personal or financial records of any resident in any facility, except
when disclosed in a manner which does not identify any resident, or when
ordered to do so by a court of competent jurisdiction. Such records shall
be accessible without court order for examination and copying only to the
following persons or offices, or to their designees:

(1) The department or any person or agency designated by the department;

(2) The attorney general;

(3) The department of mental health for residents placed through that
department;

(4) Any appropriate law enforcement agency;

(5) The resident, the resident's guardian, or any other person designated
by the resident; and

(6) Appropriate committees of the general assembly and the state auditor,
but only to the extent of financial records which the operator is
required to maintain pursuant to sections 198.088 and 198.090.

2. Inspection reports and written reports of investigations of
complaints, of substantiated reports of abuse and neglect received in
accordance with section 198.070, and complaints received by the
department relating to the quality of care of facility residents, shall
be accessible to the public for examination and copying, provided that
such reports are disclosed in a manner which does not identify the
complainant or any particular resident. Records and reports shall clearly
show what steps the department and the institution are taking to resolve
problems indicated in said inspections, reports and complaints.

3. The department shall maintain a central registry capable of receiving
and maintaining reports received in a manner that facilitates rapid
access and recall of the information reported, and of subsequent
investigations and other relevant information. The department shall
electronically record and maintain a hotline caller log for the reporting
of suspected abuse and neglect in long-term care facilities. Any
telephone report of suspected abuse and neglect received by the
department and such recorded reports shall be retained by the department
for a period of one year after recording. The department shall in all
cases attempt to obtain the name of any person making a report after
obtaining relevant information regarding the alleged abuse or neglect.
The department shall also attempt to obtain the address of any person
making a report. The identity of the person making the report shall
remain confidential. (L. 1979 S.B. 328, et al. § 11, A.L. 1987 S.B. 277,
A.L. 2003 S.B. 556 & 311)

1. The department may revoke a license in any case in which it
finds that:

(1) The operator failed or refused to comply with class I or II
standards, as established by the department pursuant to section 198.085;
or failed or refused to comply with class III standards as established by
the department pursuant to section 198.085, where the aggregate effect of
such noncompliances presents either an imminent danger to the health,
safety or welfare of any resident or a substantial probability that death
or serious physical harm would result;

(2) The operator refused to allow representatives of the department to
inspect the facility for compliance with standards or denied
representatives of the department access to residents and employees
necessary to carry out the duties set forth in this chapter and rules
promulgated thereunder, except where employees of the facility are in the
process of rendering immediate care to a resident of such facility;

(3) The operator knowingly acted or knowingly omitted any duty in a
manner which would materially and adversely affect the health, safety,
welfare or property of a resident;

(4) The operator demonstrated financial incapacity to operate and conduct
the facility in accordance with the provisions of sections 198.003 to
198.096;

(5) The operator or any principals in the operation of the facility have
ever been convicted of, or pled guilty or nolo contendere to a felony
offense concerning the operation of a long-term health care facility or
other health care facility, or ever knowingly acted or knowingly failed
to perform any duty which materially and adversely affected the health,
safety, welfare, or property of a resident while acting in a management
capacity. The operator of the facility or any principal in the operation
of the facility shall not be under exclusion from participation in the
Title XVIII (Medicare) or Title XIX (Medicaid) program of any state or
territory; or

(6) The operator or any principals involved in the operation of the
facility have ever been convicted of or pled guilty or nolo contendere to
a felony in any state or federal court arising out of conduct involving
either management of a long-term care facility or the provision or
receipt of health care.

2. Nothing in subdivision (2) of subsection 1 of this section shall be
construed as allowing the department access to information not necessary
to carry out the duties set forth in sections 198.006 to 198.186.

3. Upon revocation of a license, the director of the department shall so
notify the operator in writing, setting forth the reason and grounds for
the revocation. Notice of such revocation shall be sent either by
certified mail, return receipt requested, to the operator at the address
of the facility, or served personally upon the operator. The department
shall provide the operator notice of such revocation at least ten days
prior to its effective date. (L. 1979 S.B. 328, et al. § 12, A.L. 2003
S.B. 556 & 311)

(1987) It has been held that the legislature did not intend that a single
non-life-threatening incident would be sufficient to justify a license
revocation under this section. Villines v. Division of Aging, 722 S.W.2d
939 (Mo. banc).

1. Any person aggrieved by an official action of the department
either refusing to issue a license or revoking a license may seek a
determination thereon by the administrative hearing commission pursuant
to the provisions of section 621.045, RSMo, et seq., except that the
petition must be filed with the administrative hearing commission within
fifteen days after the mailing or delivery of notice to the operator. 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.

2. The administrative hearing commission may stay the revocation of such
license, pending the commission's findings and determination in the
cause, upon such conditions as the commission deems necessary and
appropriate including the posting of bond or other security except that
the commission shall not grant a stay or if a stay has already been
entered shall set aside its stay, if upon application of the department
the commission finds reason to believe that continued operation of a
facility pending the commission's final determination would present an
imminent danger to the health, safety or welfare of any resident or a
substantial probability that death or serious physical harm would result.
In any case in which the department has refused to issue a license, the
commission shall have no authority to stay or to require the issuance of
a license pending final determination by the commission.

3. The administrative hearing commission shall make the final decision as
to the issuance or revocation of a license. Any person aggrieved by a
final decision of the administrative hearing commission, including the
department, may seek judicial review of such decision by filing a
petition for review in the court of appeals for the district in which the
facility is located. Review shall be had, except as modified herein, in
accordance with the provisions of sections 621.189 and 621.193, RSMo. (L.
1979 S.B. 328, et al. § 13)

Nothing in sections 198.003 to 198.096, or the rules and
regulations adopted pursuant thereto, shall be construed as authorizing
the medical supervision, regulation or control of the remedial care or
treatment of those residents who rely solely upon treatment by prayer or
spiritual means in accordance with creed or tenets of any well-recognized
church or religious denomination. All remaining rules and regulations and
minimum standards not in conflict with this section shall apply. (L. 1979
S.B. 328, et al. § 14)

Participation in reimbursement programs under either Medicare or
Medicaid, Title XVIII and Title XIX of the Social Security Act, (Title
42, United States Code, Sec. 1395x or 1396d), or other federal laws,
shall be at the option of the individual facility. A skilled nursing
facility or an intermediate care facility which chooses to participate in
such programs shall be surveyed for certification for reimbursement and
inspected for state licensure at the same time. (L. 1979 S.B. 328, et al.
§ 15)

A skilled nursing, intermediate care, residential care facility
II, or residential care facility I may exist on the same premises under
the following circumstances:

(1) The skilled nursing, intermediate care, residential care facility II
or residential care facility I is an identifiable unit thereof, such as
an entire ward or contiguous wards, wing or floor of a building or a
separate contiguous building and such identifiable unit is approved in
writing by the department;

(2) The identifiable unit meets all the reasonable standards for such
facility;

(3) Central services and facilities such as management services, nursing
and other patient-care services, building maintenance and laundry which
are shared with other units are determined to be sufficient to meet the
reasonable standards for such a facility. (L. 1979 S.B. 328, et al. § 16,
A.L. 1984 S.B. 451)

1. The state auditor, at the request of the department or on his
own initiative, may examine and audit any records relating to the
operation of any facility.

2. The director of the department may examine and audit, or cause to be
examined and audited, any records relating to the operation of any
facility.

3. Each facility shall retain all financial information, data and records
relating to the operation and reimbursement of the facility for a period
of not less than seven years.

4. Notwithstanding anything to the contrary in sections 198.003 to
198.186, 198.200, 202.905, 208.030, or 208.159, RSMo, the state auditor
shall have the right to examine the records of any facility which he
deems necessary in connection with any examination conducted pursuant to
his statutory authority, and to disclose the results of any such
examination including the identity of any facility examined, provided
that the identity of any resident of any such facility shall not be
divulged or made known by the state auditor.

5. All financial information, data and records of facilities under the
provisions of sections 198.003 to 198.186, 198.200, 202.905, 208.030, or
208.159, RSMo, shall be open upon request for inspection, examination and
audit by the director of the department, the state auditor, appropriate
committees of the general assembly, and their designees, at all
reasonable times.

6. Each facility shall retain medical records of each resident for five
years after he leaves the facility. In the event the resident is less
than twenty-one years of age, the records shall be retained for five
years after the age of twenty-one years is reached. The time limitations
of this subsection shall not apply when longer time limitations are
specified in standards for facilities certified under Medicare or
Medicaid, Title XVIII and Title XIX of the Social Security Act, (Title
42, United States Code, Sec. 1395x or 1396d).

7. In the event a new operator takes over a facility's operation, the
original medical records of the residents of such facility shall be
retained in the facility by the new operator.

8. In the event a resident is transferred from the facility, the resident
shall be accompanied by a copy of his medical records. (L. 1979 S.B. 328,
et al. § 17)

A facility may provide accommodations, board, health care or
treatment, or personal services for residents placed through the
department of mental health. Inspections made pursuant to provisions of
sections 198.003 to 198.096 shall also serve as the inspections required
under the provisions of chapter 630, RSMo, except for inspections and
visits to determine appropriateness of resident placement, to develop and
review treatment plans, and to monitor the conditions and status of
residents. (L. 1979 S.B. 328, et al. § 18, A.L. 1984 S.B. 451)

Any facility licensed under chapter 197, RSMo, or chapter 198,
which is in operation before September 28, 1979, or whose application is
on file, or whose construction plans have been approved by the department
before September 28, 1979, shall be exempt from construction standards
developed by the department subsequent to the date such facility became
first licensed and including those construction standards developed after
September 28, 1979, for buildings or other physical units which were in
existence or under construction on September 28, 1979. Such facilities
shall be licensed in accordance with all other standards and regulations
promulgated under sections 198.003 to 198.096. The department shall
survey all such facilities and shall prepare a report for submission to
the general assembly on actions and standards necessary to bring such
facilities into full compliance. The report shall be filed with the
speaker of the house and the president pro tem of the senate by January
1, 1982. (L. 1979 S.B. 328, et al. § 19)

1. No person shall, jointly or severally, offer, advertise or
hold out to the public, services subject to section 198.015 without a
currently valid appropriate license issued by the department to render
the particular services.

2. No person, jointly or severally, shall interfere with or prevent any
duly authorized representative of the department or the attorney general
from lawful enforcement of sections 198.003 to 198.186, 198.200, 202.905,
208.030, or 208.159, RSMo.

3. Any person violating any provision of this section shall be guilty of
a class C misdemeanor. (L. 1979 S.B. 328, et al. § 20)

1. No operator shall retain any duplicate payment for the care
of a resident received from any state agency or agencies. For the
purposes of this section a duplicate payment is one which results in a
total payment to the operator in excess of the per diem or monthly rate
authorized by the agency or agencies. The operator shall report all such
duplicate payments to the paying agency or agencies within five business
days after such duplicate payment is discovered or reasonably should have
been discovered.

2. The operator shall repay the excess amount in accordance with such
procedures as the paying agency or agencies shall reasonably require,
together with interest at the rate of one and five-tenths percent per
month from the date the duplicate payment was discovered or reasonably
should have been discovered. (L. 1979 S.B. 328, et al. § 21)

To encourage compliance with the provisions of this chapter and
any rules promulgated thereto, the department of health and senior
services shall impose sanctions commensurate with the seriousness of the
violation which occurred. For class I, II, or III violations, the
following remedies may be imposed:

(1) A plan of correction;

(2) Additional directed staff training;

(3) State monitoring;

(4) A directed plan of correction;

(5) Denial of payment for new Medicaid admissions;

(6) A probationary license and consent agreement as described in section
198.026;

(7) Recovery of civil monetary penalties pursuant to section 198.067;

(8) Denial of payment for all new admissions;

(9) Receivership pursuant to section 198.105; or

(10) License revocation. (L. 2003 S.B. 556 & 311)

1. An action may be brought by the department, or by the
attorney general on his or her own volition or at the request of the
department or any other appropriate state agency, to temporarily or
permanently enjoin or restrain any violation of sections 198.003 to
198.096, to enjoin the acceptance of new residents until substantial
compliance with sections 198.003 to 198.096 is achieved, or to enjoin any
specific action or practice of the facility. Any action brought pursuant
to the provisions of this section shall be placed at the head of the
docket by the court, and the court shall hold a hearing on any action
brought pursuant to the provisions of this section no less than fifteen
days after the filing of the action.

2. The department may bring an action in circuit court to recover a civil
penalty against the licensed operator of the facility as provided by this
section. Such action shall be brought in the circuit court for the county
in which the facility is located. The circuit court shall determine the
amount of penalty to be assessed within the limits set out in this
section. Appeals may be taken from the judgment of the circuit court as
in other civil cases.

3. The operator of any facility which has been cited with a violation of
sections 198.003 to 198.096 or the regulations established pursuant
thereto, or of subsection (b), (c), or (d) of Section 1396r of Title 42
of the United States Code or the regulations established pursuant
thereto, is liable to the state for civil penalties of up to twenty-five
thousand dollars for each day that the violations existed or continue to
exist. Violations shall be presumed to continue to exist from the time
they are found until the time the department of health and senior
services finds them to have been corrected. When applicable, the amount
of the penalty shall be determined as follows:

(1) For each violation of a class I standard when applicable pursuant to
subdivision (6) of this subsection, not less than one thousand dollars
nor more than ten thousand dollars;

(2) For each violation of a class II standard, not less than two hundred
fifty dollars nor more than one thousand dollars;

(3) For each violation of a class III standard, not less than fifty
dollars nor more than two hundred fifty dollars;

(4) For each violation of a federal standard which does not also
constitute a violation of a state law or regulation, not less than two
hundred fifty dollars nor more than five hundred dollars;

(5) For each specific class I violation by the same operator at a
particular facility which has been previously cited within the past
twenty-four months and for each specific class II or III violation by the
same operator at a particular facility which has been previously cited
within the past twelve months, double the amount last imposed;

(6) In accordance with the provisions of this section, if the department
imposes a civil monetary penalty for a class I violation, the liability
for such penalty shall be incurred immediately upon the imposition of the
penalty for the violation regardless of any subsequent correction of the
violation by the facility. For class II or III violations, if the
department imposes a civil monetary penalty, the liability for such
penalty shall be incurred if a breach of a specific state or federal
standard or statute remains uncorrected and not in accord with the
accepted plan of correction at the time of the reinspection conducted
pursuant to subsection 3 of section 198.026 or the regulations
established pursuant to Title 42 of the United States Code.

A judgment rendered against the operator of a facility pursuant to this
subsection shall bear interest as provided in subsection 1 of section
408.040, RSMo.

4. Any individual who willfully and knowingly certifies pursuant to
subsection (b)(3)(B)(i) of Section 1396r of Title 42 of the United States
Code a material and false statement in a resident assessment is subject
to a civil penalty of not more than one thousand dollars with respect to
each assessment. Any individual who willfully and knowingly causes
another individual to certify pursuant to subsection (b)(3)(B)(i) of
Section 1396r of Title 42 of the United States Code a material and false
statement in a resident assessment is subject to a civil penalty of not
more than five thousand dollars with respect to each assessment.

5. The imposition of any remedy provided for in sections 198.003 to
198.186 shall not bar the imposition of any other remedy.

6. Twenty-five percent of the penalties collected pursuant to this
section shall be deposited in the elderly home-delivered meals trust fund
as established in section 143.1002, RSMo. Twenty-five percent of the
penalties collected pursuant to this section shall be deposited in the
nursing facility quality of care fund established in section 198.418 to
be used for the sole purpose of supporting quality care improvement
projects within the office of state ombudsman for long-term care facility
residents, established pursuant to section 660.603, RSMo. The remaining
fifty percent of the penalties collected pursuant to this section shall
be deposited into the nursing facility quality of care fund to be used by
the department for the sole purpose of developing a program to assist
qualified nursing facilities to improve the quality of service to their
residents. The director of the department shall, by rule, develop a
definition of qualified facilities and shall establish procedures for the
selection of qualified facilities. 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, 2003, shall be invalid and void.
Such penalties shall not be considered a charitable contribution for tax
purposes.

7. To recover any civil penalty, the moving party shall prove by clear
and convincing evidence that the violation occurred.

8. The licensed operator of a facility against whom an action to recover
a civil penalty is brought pursuant to this section may confess judgment
as provided in section 511.070, RSMo, at any time prior to hearing. If
such licensed operator agrees to confess judgment, the amount of the
civil penalty recommended by the moving party in its petition shall be
reduced by twenty-five percent and the confessed judgment shall be
entered by the circuit court at the reduced amount.

9. The amount of any civil penalty assessed by the circuit court pursuant
to this section shall be reduced by the amount of any civil monetary
penalty which the licensed operator of the facility may establish it has
paid pursuant to the laws of the United States for the breach of the same
federal standards for which the state action is brought.

10. In addition to the civil penalties specified in subdivision (1) of
subsection 3 of this section, any facility which is cited with a
violation of a class I standard pursuant to subsection 1 of section
198.085, when such violation results in serious physical injury or abuse
of a sexual nature pursuant to subdivision (1) of section 198.006, to any
resident of that facility shall be liable to the state for a civil
penalty of one hundred dollars multiplied by the number of beds licensed
to the facility, up to a maximum of ten thousand dollars pursuant to
subsections 1 and 2 of this section. The liability of the facility for
civil penalties pursuant to this section shall be incurred immediately
upon the citation of the violation and shall not be affected by any
subsequent correction of the violation. For the purposes of this section,
"serious physical injury" means physical injury that creates a
substantial risk of death or that causes serious disfigurement or
protracted loss or impairment of the function of any part of the body.

11. The department shall not impose a fine for self-reporting class II
and class III violations so long as each violation is corrected within a
specified period of time as determined by the department and there is no
reoccurrence of the particular violation for twelve months following the
date of the first self-reporting.

12. If a facility is sold or changes its operator, any civil penalty
assessed shall not be sold, transferred, or otherwise assigned to the
successor operator but shall remain the sole liability of the operator at
the time of the violation. (L. 1979 S.B. 328, et al. § 22, A.L. 1989 S.B.
203 & 270, A.L. 1996 H.B. 781, A.L. 1999 H.B. 316, et al. merged with
S.B. 326, A.L. 2003 S.B. 556 & 311)

*Word "an" appears in original rolls.

1. When any adult day care worker; chiropractor; Christian
Science practitioner; coroner; dentist; embalmer; employee of the
departments of social services, mental health, or health and senior
services; employee of a local area agency on aging or an organized area
agency on aging program; funeral director; home health agency or home
health agency employee; hospital and clinic personnel engaged in
examination, care, or treatment of persons; in-home services owner,
provider, operator, or employee; law enforcement officer; long-term care
facility administrator or employee; medical examiner; medical resident or
intern; mental health professional; minister; nurse; nurse practitioner;
optometrist; other health practitioner; peace officer; pharmacist;
physical therapist; physician; physician's assistant; podiatrist;
probation or parole officer; psychologist; social worker; or other person
with the care of a person sixty years of age or older or an eligible
adult has reasonable cause to believe that a resident of a facility has
been abused or neglected, he or she shall immediately report or cause a
report to be made to the department.

2. The report shall contain the name and address of the facility, the
name of the resident, information regarding the nature of the abuse or
neglect, the name of the complainant, and any other information which
might be helpful in an investigation.

3. Any person required in subsection 1 of this section to report or cause
a report to be made to the department who knowingly fails to make a
report within a reasonable time after the act of abuse or neglect as
required in this subsection is guilty of a class A misdemeanor.

4. In addition to the penalties imposed by this section, any
administrator who knowingly conceals any act of abuse or neglect
resulting in death or serious physical injury, as defined in section
565.002, RSMo, is guilty of a class D felony.

5. In addition to those persons required to report pursuant to subsection
1 of this section, any other person having reasonable cause to believe
that a resident has been abused or neglected may report such information
to the department.

6. Upon receipt of a report, the department shall initiate an
investigation within twenty-four hours and, as soon as possible during
the course of the investigation, shall notify the resident's next of kin
or responsible party of the report and the investigation and further
notify them whether the report was substantiated or unsubstantiated
unless such person is the alleged perpetrator of the abuse or neglect. As
provided in section 565.186, RSMo, substantiated reports of elder abuse
shall be promptly reported by the department to the appropriate law
enforcement agency and prosecutor.

7. If the investigation indicates possible abuse or neglect of a
resident, the investigator shall refer the complaint together with the
investigator's report to the department director or the director's
designee for appropriate action. If, during the investigation or at its
completion, the department has reasonable cause to believe that immediate
removal is necessary to protect the resident from abuse or neglect, the
department or the local prosecuting attorney may, or the attorney general
upon request of the department shall, file a petition for temporary care
and protection of the resident in a circuit court of competent
jurisdiction. The circuit court in which the petition is filed shall have
equitable jurisdiction to issue an ex parte order granting the department
authority for the temporary care and protection of the resident, for a
period not to exceed thirty days.

8. Reports shall be confidential, as provided pursuant to section
660.320, RSMo.

9. Anyone, except any person who has abused or neglected a resident in a
facility, who makes a report pursuant to this section or who testifies in
any administrative or judicial proceeding arising from the report shall
be immune from any civil or criminal liability for making such a report
or for testifying except for liability for perjury, unless such person
acted negligently, recklessly, in bad faith or with malicious purpose. It
is a crime pursuant to section 565.186 and 565.188, RSMo, for any person
to purposely file a false report of elder abuse or neglect.

10. Within five working days after a report required to be made pursuant
to this section is received, the person making the report shall be
notified in writing of its receipt and of the initiation of the
investigation.

11. No person who directs or exercises any authority in a facility shall
evict, harass, dismiss or retaliate against a resident or employee
because such resident or employee or any member of such resident's or
employee's family has made a report of any violation or suspected
violation of laws, ordinances or regulations applying to the facility
which the resident, the resident's family or an employee has reasonable
cause to believe has been committed or has occurred. Through the existing
department information and referral telephone contact line, residents,
their families and employees of a facility shall be able to obtain
information about their rights, protections and options in cases of
eviction, harassment, dismissal or retaliation due to a report being made
pursuant to this section.

12. Any person who abuses or neglects a resident of a facility is subject
to criminal prosecution under section 565.180, 565.182, or 565.184, RSMo.

13. The department shall maintain the employee disqualification list and
place on the employee disqualification list the names of any persons who
are or have been employed in any facility and who have been finally
determined by the department pursuant to section 660.315, RSMo, to have
knowingly or recklessly abused or neglected a resident. 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.

14. The timely self-reporting of incidents to the central registry by a
facility shall continue to be investigated in accordance with department
policy, and shall not be counted or reported by the department as a
hot-line call but rather a self-reported incident. If the self-reported
incident results in a regulatory violation, such incident shall be
reported as a substantiated report. (L. 1979 S.B. 328, et al. § 23, A.L.
1984 S.B. 451, A.L. 1987 S.B. 277, A.L. 1988 S.B. 602, A.L. 1990 H.B.
1370, et al., A.L. 1992 S.B. 573 & 634, A.L. 1994 H.B. 1335 & 1381, A.L.
1999 H.B. 316, et al. merged with S.B. 326, A.L. 2003 S.B. 556 & 311)

(1989) Owners and operators of nursing home were convicted of knowing
neglect where they had knowledge of neglect in administration of required
care; but persons may not be convicted of knowing neglect simply because
of ownership or supervisory authority over a facility. (Mo. banc) State
v. Dale, 775 S.W.2d 126.

(1989) Statute making it a Class D felony to knowingly abuse or neglect
resident of nursing care facility, held not unconstitutionally vague.
Owners or managers responsible for known abuse or neglect. State v. Dale
775 S.W.2d 126 (Mo. banc).

(1989) Where statute requires a finding of knowing neglect and "neglect"
is specifically defined in § 198.006, RSMo, statutes are not
unconstitutionally vague. (Mo. banc) State v. Dale, 775 S.W.2d 126.

(2003) Subsection 10 of section implicitly creates a private cause of
action for nursing home district employees terminated in violation of the
statute. Bachtel v. Miller County Nursing Home District, 110 S.W.3d 799
(Mo.banc).

The staff of a residential care facility I, a residential care
facility II, an intermediate care facility, or a skilled nursing facility
shall attempt to contact the resident's immediate family or a resident's
responsible party, and shall contact the attending physician and notify
the local coroner or medical examiner immediately upon the death of any
resident of the facility prior to transferring the deceased resident to a
funeral home. (L. 2003 S.B. 556 & 311)

1. Except as provided in subsection 3 of this section, a
residential care facility II or residential care facility I shall admit
or retain only those persons who are capable mentally and physically of
negotiating a normal path to safety using assistive devices or aids when
necessary, and who may need assisted personal care within the limitations
of such facilities, and who do not require hospitalization or skilled
nursing care.

2. Notwithstanding the provisions of subsection 3 of this section, those
persons previously qualified for residence who may have a temporary
period of incapacity due to illness, surgery, or injury, which period
does not exceed forty-five days, may be allowed to remain in a
residential care facility II or residential care facility I if approved
by a physician.

3. A residential care facility II may admit or continue to care for those
persons who are physically capable of negotiating a normal path to safety
using assistive devices or aids when necessary but are mentally incapable
of negotiating such a path to safety that have been diagnosed with
Alzheimer's disease or Alzheimer's related dementia, if the following
requirements are met:

(1) A family member or legal representative of the resident, in
consultation with the resident's primary physician and the facility,
determines that the facility can meet the needs of the resident. The
facility shall document the decision regarding continued placement in the
facility through written verification by the family member, physician and
the facility representative;

(2) The facility is equipped with an automatic sprinkler system, in
compliance with National Fire Protection Association Code 13 or National
Fire Protection Association Code 13R, and an automated fire door system
and smoke alarms in compliance with 13-3.4 of the 1997 Life Safety Codes
for Existing Health Care Occupancy;

(3) In a multilevel facility, residents who are mentally incapable of
negotiating a pathway to safety are housed only on the ground floor;

(4) The facility shall take necessary measures to provide residents with
the opportunity to explore the facility and, if appropriate, its grounds;

(5) The facility shall be staffed twenty-four hours a day by the
appropriate number and type of personnel necessary for the proper care of
residents and upkeep of the facility. In meeting such staffing
requirements, every resident who is mentally incapable of negotiating a
pathway to safety shall count as three residents. All on-duty staff of
the facility shall, at all times, be awake, dressed and prepared to
assist residents in case of emergency;

(6) Every resident mentally incapable of negotiating a pathway to safety
in the facility shall be assessed by a licensed professional, as defined
in sections 334.010 to 334.265, RSMo, chapter 335, RSMo, or chapter 337,
RSMo, with an assessment instrument utilized by the division of aging
known as the minimum data set used for assessing residents of skilled
nursing facilities:

(a) Upon admission;

(b) At least semiannually; and

(c) When a significant change has occurred in the resident's condition
which may require additional services;

(7) Based on the assessment in subdivision (6) of this subsection, a
licensed professional, as defined in sections 334.010 to 334.265, RSMo,
chapter 335, RSMo, or chapter 337, RSMo, shall develop an individualized
service plan for every resident who is mentally incapable of negotiating
a pathway to safety. Such individualized service plan shall be
implemented by the facility's staff to meet the specific needs of the
resident;

(8) Every facility shall use a personal electronic monitoring device for
any resident whose physician recommends the use of such device;

(9) All facility personnel who will provide direct care to residents who
are mentally incapable of negotiating a pathway to safety shall receive
at least twenty-four hours of training within the first thirty days of
employment. At least twelve hours of such training shall be classroom
instruction, with six classroom instruction hours and two on-the-job
training hours related to the special needs, care and safety of residents
with dementia;

(10) All personnel of the facility, regardless of whether such personnel
provides direct care to residents who cannot negotiate a pathway to
safety, shall receive on a quarterly basis at least four hours of in-
service training, with at least two such hours relating to the care and
safety of residents who are mentally incapable of negotiating a pathway
to safety;

(11) Every facility shall make available and implement self-care,
productive and leisure activity programs for persons with dementia which
maximize and encourage the resident's optimal functional ability;

(12) Every facility shall develop and implement a plan to protect the
rights, privacy and safety of all residents and to prevent the financial
exploitation of all residents; and

(13) A licensee of any licensed residential care facility or any
residential care facility shall ensure that its facility does not accept
or retain a resident who is mentally incapable of negotiating a normal
pathway to safety using assistive devices and aids that:

(a) Has exhibited behaviors which indicate such resident is a danger to
self or others;

(b) Is at constant risk of elopement;

(c) Requires physical restraint;

(d) Requires chemical restraint. As used in this subdivision, the
following terms mean:

a. "Chemical restraint", a psychopharmacologic drug that is used for
discipline or convenience and not required to treat medical symptoms;

b. "Convenience", any action taken by the facility to control resident
behavior or maintain residents with a lesser amount of effort by the
facility and not in the resident's best interests;

c. "Discipline", any action taken by the facility for the purpose of
punishing or penalizing residents;

(e) Requires skilled nursing services as defined in subdivision (17) of
section 198.003 for which the facility is not licensed or able to provide;

(f) Requires more than one person to simultaneously physically assist the
resident with any activity of daily living, with the exception of bathing;

(g) Is bed-bound or chair-bound due to a debilitating or chronic
condition.

4. The facility shall not care for any person unless such facility is
able to provide appropriate services for and meet the needs of such
person.

5. Nothing in this chapter shall prevent a facility from discharging a
resident who is a danger to himself or herself, or to others.

6. The training requirements established in subdivisions (9) and (10) of
subsection 3 of this section shall fully satisfy the training
requirements for the program described in subdivision (18) of subsection
1 of section 208.152, RSMo.

7. The division of aging shall promulgate rules to ensure compliance with
this section and to sanction facilities that fail to comply with this
section. 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, 1999, shall be invalid and void. (L.
1979 S.B. 328, et al. § 24, A.L. 1984 S.B. 451, A.L. 1992 H.B. 899 merged
with S.B. 573 & 634 merged with S.B. 721, A.L. 1999 S.B. 326)

The department shall promulgate reasonable standards and
regulations for all residential care facilities I and all residential
care facilities II. The standards and regulations shall take into account
the level of care provided and the number and type of residents served by
the facility to insure maximum flexibility. These standards and
regulations shall relate to:

(1) The number and qualifications of employed and contract personnel
having responsibility for any of the services provided for residents;

(2) The equipment, facilities, services and supplies essential to the
health and welfare of the residents;

(3) Fire safety and sanitation in the facility;

(4) Diet, which shall be based on good nutritional practice;

(5) Personal funds and property of residents;

(6) Resident rights and resident grievance procedures appropriate to the
levels of care, size and type of facility;

(7) Record keeping appropriate to the levels of care, size and type of
facility;

(8) Construction of the facility;

(9) Care of residents. (L. 1979 S.B. 328, et al. § 25, A.L. 1984 S.B. 451)

For any residential care facility I, residential care facility
II, intermediate care facility or skilled nursing facility, if the
department of social services maintains records of site inspections and
violations of statutes, rules, or the terms or conditions of any license
issued to such facility, the department shall also maintain records of
compliance with such statutes, rules, or terms or conditions of any
license, and shall specifically record in such records any actions taken
by the facility that are above and beyond what is minimally required for
compliance. (L. 1999 H.B. 316, et al. § 4 merged with S.B. 326 § 15)

The department shall promulgate reasonable standards and
regulations for all intermediate care facilities and all skilled nursing
facilities. The standards and regulations shall take into account the
level of care provided and the type of residents served by the facility.
These standards and regulations shall relate to:

(1) The number and qualifications of employed and contract personnel
having responsibility for any of the services provided for residents;

(2) The equipment, facilities, services and supplies essential to the
health and welfare of the residents;

(3) Fire safety and sanitation in the facility;

(4) Diet, which shall be related to the needs of each resident and based
on good nutritional practice and on recommendations which may be made by
the physician attending the resident;

(5) Personal funds and property of residents;

(6) Resident rights and resident grievance procedures;

(7) Record keeping, including clinical and personnel records;

(8) The construction of the facility, including plumbing, heating,
ventilation and other housing conditions which shall insure the health,
safety and comfort of residents and protection from fire hazards;

(9) Care of residents;

(10) Social and rehabilitative service;

(11) Staff training and continuing education. (L. 1979 S.B. 328, et al. §
26)

The division of aging shall develop flexible assessment
procedures for individuals in long-term care and those considering long-
term care services which follow* the individual through the continuum of
care, including periodic reassessment. By January 1, 2002, the division
of aging shall promulgate rules and regulations to implement the new
assessment system and shall make a report to the appropriate house and
senate committees of the general assembly regarding the new assessment
system. 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,
1999, shall be invalid and void. (L. 1999 S.B. 326 § 3)

*Word "follows" appears in original rolls.

CROSS REFERENCE: Rulemaking authority, RSMo 198.534

1. Each nursing assistant hired to work in a skilled nursing or
intermediate care facility after January 1, 1980, shall have successfully
completed a nursing assistant training program approved by the department
or shall enroll in and begin the first available approved training
program which is scheduled to commence within ninety days of the date of
the nursing assistant's employment and which shall be completed within
four months of employment. Training programs shall be offered at any
facility licensed or approved by the department of health and senior
services which is most reasonably accessible to the enrollees in each
class. The program may be established by the skilled nursing or
intermediate care facility, by a professional organization, or by the
department, and training shall be given by the personnel of the facility,
by a professional organization, by the department, by any junior college
or by the vocational education department of any high school.

2. As used in this section the term "nursing assistant" means an
employee, including a nurse's aide or an orderly, who is assigned by a
skilled nursing or intermediate care facility to provide or assist in the
provision of direct resident health care services under the supervision
of a nurse licensed under the nursing practice law, chapter 335, RSMo.
This section shall not apply to any person otherwise licensed to perform
health care services under the laws of this state. It shall not apply to
volunteers or to members of religious or fraternal orders which operate
and administer the facility, if such volunteers or members work without
compensation.

3. The training program after January 1, 1989, shall consist of at least
the following:

(1) A training program consisting of at least seventy-five classroom
hours of training on basic nursing skills, clinical practice, resident
safety and rights, the social and psychological problems of residents,
and the methods of handling and caring for mentally confused residents
such as those with Alzheimer's disease and related disorders, and one
hundred hours supervised and on-the-job training. The one hundred hours
shall be completed within four months of employment and may consist of
normal employment as nurse assistants under the supervision of a licensed
nurse; and

(2) Continuing in-service training to assure continuing competency in
existing and new nursing skills. All nursing assistants trained prior to
January 1, 1989, shall attend, by August 31, 1989, an entire special
retraining program established by rule or regulation of the department
which shall contain information on methods of handling mentally confused
residents and which may be offered on premises by the employing facility.

4. Nursing assistants who have not successfully completed the nursing
assistant training program prior to employment may begin duties as a
nursing assistant only after completing an initial twelve hours of basic
orientation approved by the department and may provide direct resident
care only if under the general supervision of a licensed nurse prior to
completion of the seventy-five classroom hours of the training program.
(L. 1979 S.B. 328, et al. § 27, A.L. 1988 S.B. 602, A.L. 2003 S.B. 556 &
311)

In establishing standards for each type of facility, the
department shall classify the standards into three categories for each
type of licensed facility as follows:

(1) Class I standards are standards the violation of which would present
either an imminent danger to the health, safety or welfare of any
resident or a substantial probability that death or serious physical harm
would result;

(2) Class II standards are standards which have a direct or immediate
relationship to the health, safety or welfare of any resident, but which
do not create imminent danger;

(3) Class III standards are standards which have an indirect or a
potential impact on the health, safety or welfare of any resident. (L.
1979 S.B. 328, et al. § 28, A.L. 1984 S.B. 451, A.L. 1995 H.B. 574)

1. The department of health and senior services shall develop
and implement a demonstration project designed to establish a licensure
category for health care facilities that wish to provide treatment to
persons with Alzheimer's disease or Alzheimer's-related dementia. The
division shall also:

(1) Inform potential providers of the demonstration project and seek
letters of intent;

(2) Review letters of intent and select provider organizations to
participate in the demonstration project. Ten such organizations may
develop such projects using an existing license and additional
organizations shall be newly licensed facilities with no more than thirty
beds per project. One demonstration project shall be at a stand-alone
facility of no more than one hundred twenty beds designed and operated
exclusively for the care of residents with Alzheimer's disease or
dementia within a county of the first classification with a charter form
of government with a population over nine hundred thousand. A total of
not more than three hundred beds may be newly licensed through the
demonstration projects. All projects shall maintain their pilot status
until a complete evaluation is completed by the division of aging, in
conjunction with a qualified Missouri school or university, and a written
determination is made from such evaluation that the pilot project is
successful;

(3) Monitor the participants' compliance with the criteria established in
this section;

(4) Recommend legislation regarding the licensure of dementia-specific
residential care based on the results of the demonstration project; and

(5) Submit a report regarding the division's activities and
recommendations for administrative or legislative action on or before
November fifteenth of each year to the governor, the president pro tem of
the senate and the speaker of the house of representatives.

2. The director of the division of aging shall:

(1) Develop a reimbursement methodology to reasonably and adequately
compensate the pilot projects for the costs of operation of the project,
and require the filing of annual cost reports by each participating
facility which shall include, but not be limited to, the cost equivalent
of unpaid volunteer or donated labor;

(2) Process the license applications of project participants;

(3) Monitor each participant to assure its compliance with the
requirements and that the life, health and safety of residents are
assured;

(4) Require each participating facility to complete a minimum data set
form for each resident occupying a pilot bed;

(5) Require the division of aging to assign a single team of the same
surveyors to inspect and survey all participating facilities at least
twice a year for the entire period of the project; and

(6) Submit to the president pro tem of the senate and speaker of the
house of representatives copies of any statements of deficiencies, plans
of correction and complaint investigation reports applying to project
participants.

3. Project participants shall:

(1) Be licensed by the division of aging;

(2) Provide care only to persons who have been diagnosed with Alzheimer's
disease or Alzheimer's-related dementia;

(3) Have buildings and furnishings that are designed to provide for the
resident's safety. Facilities shall have indoor and outdoor activity
areas, and electronically controlled exits from the buildings and grounds
to allow residents the ability to explore while preventing them from
exiting the facility's grounds unattended;

(4) Be staffed twenty-four hours a day by the appropriate number and type
of personnel necessary for the proper care of residents and upkeep of the
facility;

(5) Conduct special staff training relating to the needs, care and safety
of persons with Alzheimer's disease or Alzheimer's-related dementia
within the first thirty days of employment;

(6) Utilize personal electronic monitoring devices for any resident whose
physician recommends use of such device;

(7) Permit the resident's physician, in consultation with the family
members or health care advocates of the resident, to determine whether
the facility meets the needs of the resident;

(8) Be equipped with an automatic sprinkler system, in compliance with
the National Fire Protection Association Code 13 or National Fire
Protection Association Code 13R, and an automated fire alarm system and
smoke barriers in compliance with the 1997 Life Safety Codes for Existing
Health Care Occupancy; and

(9) Implement a social model for the residential environment rather than
an institutional medical model.

4. For purposes of this section, "health care facilities for persons with
Alzheimer's disease or Alzheimer's-related dementia" means facilities
that are specifically designed and operated to provide elderly
individuals who have chronic confusion or dementia illness, or both, with
a safe, structured but flexible environment that encourages physical
activity through a well-developed recreational and aging-in-place and
activity program. Such program shall continually strive to promote the
highest practicable physical and mental abilities and functioning of each
resident.

5. Nothing in this section shall be construed to prohibit project
participants from accommodating a family member or other caregiver from
residing with the resident in accordance with all life, health, and
safety standards of the facility. (L. 1999 S.B. 326 § 5, A.L. 2003 S.B.
556 & 311)

CROSS REFERENCE: Rulemaking authority, RSMo 198.534

To ensure uniformity of application of regulation standards in
long-term care facilities throughout the state, the department of social
services shall:

(1) Evaluate the requirements for inspectors or surveyors of facilities,
including the eligibility, training and testing requirements for the
position. Based on the evaluation, the department shall develop and
implement additional training and knowledge standards for inspectors and
surveyors;

(2) Periodically evaluate the performance of the inspectors or surveyors
regionally and statewide to identify any deviations or inconsistencies in
regulation application. At a minimum, the Missouri on- site surveyor
evaluation process, and the number and type of actions overturned by the
informal dispute resolution process and formal appeal shall be used in
the evaluation. Based on such evaluation, the department shall develop
standards and a retraining process for the region, state, or individual
inspector or surveyor, as needed;

(3) In addition to the provisions of subdivisions (1) and (2) of this
section, the department shall develop a single uniform comprehensive and
mandatory course of instruction for inspectors/surveyors on the practical
application of enforcement of statutes, rules and regulations. Such
course shall also be open to attendance by administrators and staff of
facilities licensed pursuant to this chapter;

(4) With the full cooperation of and in conjunction with the department
of health and senior services, evaluate the implementation and compliance
of the provisions of subdivision (3) of subsection 1 of section 198.012
in which rules, requirements, regulations and standards pursuant to
section 197.080, RSMo, for residential care facilities II, intermediate
care facilities and skilled nursing facilities attached to an acute care
hospital are consistent with the intent of this chapter. A report of the
differences found in the evaluation conducted pursuant to this
subdivision shall be made jointly by the departments of social services
and health to the governor and members of the general assembly by January
1, 2000; and

(5) With the full cooperation and in conjunction with the department of
health and senior services, develop rules and regulations requiring the
exchange of information, including regulatory violations, between the
departments to ensure the protection of individuals who are served by
health care providers regulated by either the department of health and
senior services or the department of social services. (L. 1999 S.B. 326 §
11)

1. Every facility, in accordance with the rules applying to each
particular type of facility, shall ensure that:

(1) There are written policies and procedures available to staff,
residents, their families or legal representative and the public which
govern all areas of service provided by the facility. The facility shall
also retain and make available for public inspection at the facility to
staff, residents, their families or legal representative and the public a
complete copy of each official notification from the department of
violations, deficiencies, licensure approvals, disapprovals, and
responses, a description of services, basic rate and charges for any
services not covered by the basic rate, if any, and a list of names,
addresses and occupation of all individuals who have a proprietary
interest in the facility;

(2) Policies relating to admission, transfer, and discharge of residents
shall assure that:

(a) Only those persons are accepted whose needs can be met by the
facility directly or in cooperation with community resources or other
providers of care with which it is affiliated or has contracts;

(b) As changes occur in their physical or mental condition, necessitating
service or care which cannot be adequately provided by the facility,
residents are transferred promptly to hospitals, skilled nursing
facilities, or other appropriate facilities; and

(c) Except in the case of an emergency, the resident, his next of kin,
attending physician, and the responsible agency, if any, are consulted at
least thirty days in advance of the transfer or discharge of any
resident, and casework services or other means are utilized to assure
that adequate arrangements exist for meeting his needs through other
resources;

(3) Policies define the uses of chemical and physical restraints,
identify the professional personnel who may authorize the application of
restraints in emergencies and describe the mechanism for monitoring and
controlling their use;

(4) Policies define procedures for submittal of complaints and
recommendations by residents and for assuring response and disposition;

(5) There are written policies governing access to, duplication of, and
dissemination of information from the resident's records;

(6) Each resident admitted to the facility:

(a) Is fully informed of his rights and responsibilities as a resident.
Prior to or at the time of admission, a list of resident rights shall be
provided to each resident, or his designee, next of kin, or legal
guardian. A list of resident rights shall be posted in a conspicuous
location in the facility and copies shall be available to anyone upon
request;

(b) Is fully informed in writing, prior to or at the time of admission
and during stay, of services available in the facility, and of related
charges including any charges for services not covered under the federal
or state programs or not covered by the facility's basic per diem rate;

(c) Is fully informed by a physician of his health and medical condition
unless medically contraindicated, as documented by a physician in his
resident record, and is afforded the opportunity to participate in the
planning of his total care and medical treatment and to refuse treatment,
and participates in experimental research only upon his informed written
consent;

(d) Is transferred or discharged only for medical reasons or for his
welfare or that of other residents, or for nonpayment for his stay. No
resident may be discharged without notice of his right to a hearing and
an opportunity to be heard on the issue of whether his immediate
discharge is necessary. Such notice shall be given in writing no less
than thirty days in advance of the discharge except in the case of an
emergency discharge. In emergency discharges a written notice of
discharge and right to a hearing shall be given as soon as practicable
and an expedited hearing shall be held upon request of the resident, next
of kin, legal guardian, or nursing facility;

(e) Is encouraged and assisted, throughout his period of stay, to
exercise his rights as a resident and as a citizen, and to this end may
voice grievances and recommend changes in policies and services to
facility staff or to outside representatives of his choice, free from
restraint, interference, coercion, discrimination, or reprisal;

(f) May manage his personal financial affairs, and, to the extent that
the facility assists in such management, has his personal financial
affairs managed in accordance with section 198.090;

(g) Is free from mental and physical abuse, and free from chemical and
physical restraints except as follows:

a. When used as a part of a total program of care to assist the resident
to attain or maintain the highest practicable level of physical, mental
or psychosocial well-being;

b. When authorized in writing by a physician for a specified period of
time; and

c. When necessary in an emergency to protect the resident from injury to
himself or to others, in which case restraints may be authorized by
designated professional personnel who promptly report the action taken to
the physician. When restraints are indicated, devices that are least
restrictive, consistent with the resident's total treatment program,
shall be used;

(h) Is ensured confidential treatment of all information contained in his
records, including information contained in an automatic data bank, and
his written consent shall be required for the release of information to
persons not otherwise authorized under law to receive it;

(i) Is treated with consideration, respect, and full recognition of his
dignity and individuality, including privacy in treatment and in care for
his personal needs;

(j) Is not required to perform services for the facility;

(k) May communicate, associate and meet privately with persons of his
choice, unless to do so would infringe upon the rights of other
residents, and send and receive his personal mail unopened;

(l) May participate in activities of social, religious and community
groups at his discretion, unless contraindicated for reasons documented
by a physician in the resident's medical record;

(m) May retain and use his personal clothing and possessions as space
permits;

(n) If married, is ensured privacy for visits by his or her spouse; if
both are residents in the facility, they are permitted to share a room;
and

(o) Is allowed the option of purchasing or renting goods or services not
included in the per diem or monthly rate from a supplier of his own
choice;

(7) The resident or his designee, next of kin or legal guardian receives
an itemized bill for all goods and services actually rendered;

(8) A written account, available to residents and their families, is
maintained on a current basis for each resident with written receipts for
all personal possessions and funds received by or deposited with the
facility and for all disbursements made to or on behalf of the resident.

2. Each facility and the department shall encourage and assist residents
in the free exercise of the resident's rights to civil and religious
liberties, including knowledge of available choices and the right to
independent personal decision. Each resident shall be given a copy of a
statement of his rights and responsibilities, including a copy of the
facility's rules and regulations. Each facility shall prepare a written
plan to ensure the respect of each resident's rights and privacy and
shall provide appropriate staff training to implement the plan.

3. (1) Each facility shall establish written procedures approved by the
department by which complaints and grievances of residents may be heard
and considered. The procedures shall provide for referral to the
department of any complaints or grievances not resolved by the facility's
grievance procedure.

(2) Each facility shall designate one staff member, employed full time,
referred to in this subsection as the "designee", to receive all
grievances when they are first made.

(3) If anyone wishes to complain about treatment, conditions, or
violations of rights, he shall write or cause to be written his grievance
or shall state it orally to the designee no later than fourteen days
after the occurrence giving rise to the grievance. When the department
receives a complaint that does not contain allegations of abuse or
neglect or allegations which would, if substantiated, constitute
violation of a class I or class II standard as defined in section
198.085, and the complainant indicates that the complaint was not filed
with the facility prior to the reporting of it to the department, the
department may in such instances refer the complaint to the staff person
who is designated by the facility to receive all grievances when they are
first made. In such instances the department shall assure appropriate
response from the facility, assure resolution at a subsequent on-site
visit and provide a report to the complainant. The designee shall confer
with persons involved in the occurrence and with any other witnesses and,
no later than three days after the grievance, give a written explanation
of findings and proposed remedies, if any, to the complainant and to the
aggrieved party, if someone other than the complainant. Where appropriate
because of the mental or physical condition of the complainant or the
aggrieved party, the written explanation shall be accompanied by an oral
explanation.

(4) The department shall establish and implement procedures for the
making and transmission of complaints to the department by any person
alleging violation of the provisions of sections 198.003 to 198.186,
198.200, 208.030, and 208.159, RSMo, and the standards established
thereunder. The department shall promptly review each complaint. In the
case of a refusal to investigate, the department shall promptly notify
the complainant of its refusal and the reasons therefor; and in every
other case, the department shall, following investigation, notify the
complainant of its investigation and any proposed action.

4. Whenever the department finds upon investigation that there have been
violations of the provisions of sections 198.003 to 198.186, 198.200,
208.030, and 208.159, RSMo, or the standards established thereunder by
any person licensed under the provisions of chapter 330, 331, 332, 334,
335, 336, 337, 338, or 344, RSMo, the department shall forward a report
of its findings to the appropriate licensing or examining board for
further investigation.

5. Each facility shall maintain a complete record of complaints and
grievances made against such facility and a record of the final
disposition of the complaints and grievances. Such record shall be open
to inspection by representatives of the department during normal business
hours.

6. Nothing in this section shall be construed as requiring a resident to
exhaust grievance procedures established by the facility or by the
department prior to filing a complaint pursuant to section 198.090. (L.
1979 S.B. 328, et al. § 29, A.L. 1988 S.B. 602, A.L. 1989 S.B. 203 & 270,
A.L. 1994 H.B. 1335 & 1381)

1. An operator may make available to any resident the service of
holding in trust personal possessions and funds of the resident and
shall, as authorized by the resident, expend the funds to meet the
resident's personal needs. In providing this service the operator shall:

(1) At the time of admission, provide each resident or his next of kin or
legal guardian with a written statement explaining the resident's rights
regarding personal funds;

(2) Accept funds and personal possessions from or for a resident for
safekeeping and management, only upon written authorization by the
resident or by his designee, or guardian in the case of an adjudged
incompetent;

(3) Deposit any personal funds received from or on behalf of a resident
in an account separate from the facility's funds, except that an amount
to be established by rule of the division of aging may be kept in a petty
cash fund for the resident's personal needs;

(4) Keep a written account, available to a resident and his designee or
guardian, maintained on a current basis for each resident, with written
receipts, for all personal possessions and funds received by or deposited
with the facility and for all disbursements made to or on behalf of the
resident;

(5) Provide each resident or his designee or guardian with a quarterly
accounting of all financial transactions made on behalf of the resident;

(6) Within five days of the discharge of a resident, provide the
resident, or his designee or guardian, with an up-to-date accounting of
the resident's personal funds and return to the resident the balance of
his funds and all his personal possessions;

(7) Upon the death of a resident who has been a recipient of aid,
assistance, care, services, or who has had moneys expended on his behalf
by the department of social services, provide the department a complete
account of all the resident's personal funds within sixty days from the
date of death. The total amount paid to the decedent or expended upon his
behalf by the department shall be a debt due the state and recovered from
the available funds upon the department's claim on such funds. The
department shall make a claim on the funds within sixty days from the
date of the accounting of the funds by the facility. The nursing facility
shall pay the claim made by the department of social services from the
resident's personal funds within sixty days. Where the name and address
are reasonably ascertainable, the department of social services shall
give notice of the debt due the state to the person whom the recipient
had designated to receive the quarterly accounting of all financial
transactions made under this section, or the resident's guardian or
conservator or the person or persons listed in nursing home records as a
responsible party or the fiduciary of the resident's estate. If any funds
are available after the department's claim, the remaining provisions of
this section shall apply to the balance, unless the funds belonged to a
person other than the resident, in which case the funds shall be paid to
that person;

(8) Upon the death of a resident who has not been a recipient of aid,
assistance, care, services, or who has not had moneys expended on his
behalf by the department of social services or the department has not
made a claim on the funds, provide the fiduciary of resident's estate, at
the fiduciary's request, a complete account of all the resident's
personal funds and possessions and deliver to the fiduciary all
possessions of the resident and the balance of the resident's funds. If,
after one year from the date of death, no fiduciary makes claim upon such
funds or possessions, the operator shall notify the department that the
funds remain unclaimed. Such unclaimed funds or possessions shall be
disposed of as follows:

(a) If the unclaimed funds or possessions have a value totaling one
hundred and fifty dollars or less, the funds or the proceeds of the sale
of the possessions may be deposited in a fund to be used for the benefit
of all residents of the facility by providing the residents social or
educational activities. The facility shall keep an accounting of the
acquisitions and expenditure of these funds; or

(b) If the unclaimed funds or possessions have a value greater than one
hundred and fifty dollars, the funds or possessions shall be immediately
presumed to be abandoned property under sections 447.500 to 447.585,
RSMo, and the procedures provided for in those sections shall apply
notwithstanding any other provisions of those sections which require a
period greater than two years for a presumption of abandonment;

(9) Upon ceasing to be the operator of a facility, all funds and property
held in trust pursuant to this section shall be transferred to the new
operator in accordance with sound accounting principles, and a closeout
report signed by both the outgoing operator and the successor operator
shall be prepared. The closeout report shall include a list of current
balances of all funds held for residents respectively and an inventory of
all property held for residents respectively. If the outgoing operator
refuses to sign the closeout report, he shall state in writing the
specific reasons for his failure to so sign, and the successor operator
shall complete the report and attach an affidavit stating that the
information contained therein is true to the best of his knowledge and
belief. Such report shall be retained with all other records and accounts
required to be maintained under this section;

(10) Not be required to invest any funds received from or on behalf of a
resident, nor to increase the principal of any such funds.

2. Any owner, operator, manager, employee, or affiliate of an owner or
operator who receives any personal property or anything else of value
from a resident, shall, if the thing received has a value of ten dollars
or more, make a written statement giving the date it was received, from
whom it was received, and its estimated value. Statements required to be
made pursuant to this subsection shall be retained by the operator and
shall be made available for inspection by the department, or by the
department of mental health when the resident has been placed by that
department, and by the resident, and his designee or legal guardian. Any
person who fails to make a statement required by this subsection is
guilty of a class C misdemeanor.

3. No owner, operator, manager, employee, or affiliate of an owner or
operator shall in one calendar year receive any personal property or
anything else of value from the residents of any facility which have a
total estimated value in excess of one hundred dollars.

4. Subsections 2 and 3 of this section shall not apply if the property or
other thing of value is held in trust in accordance with subsection 1 of
this section, is received in payment for services rendered or pursuant to
the terms of a lawful contract, or is received from a resident who is
related to the recipient within the fourth degree of consanguinity or
affinity.

5. Any operator who fails to maintain records or who fails to maintain
any resident's personal funds in an account separate from the facility's
funds as required by this section shall be guilty of a class C
misdemeanor.

6. Any operator, or any affiliate or employee of an operator, who puts to
his own use or the use of the facility or otherwise diverts from the
resident's use any personal funds of the resident shall be guilty of a
class A misdemeanor.

7. Any person having reasonable cause to believe that a misappropriation
of a resident's funds or property has occurred may report such
information to the department.

8. For each report the division shall attempt to obtain the name and
address of the facility, the name of the facility employee, the name of
the resident, information regarding the nature of the misappropriation,
the name of the complainant, and any other information which might be
helpful in an investigation.

9. Upon receipt of a report, the department shall initiate an
investigation.

10. If the investigation indicates probable misappropriation of property
or funds of a resident, the investigator shall refer the complaint
together with his report to the department director or his designee for
appropriate action.

11. Reports shall be confidential, as provided under section 660.320,
RSMo.

12. Anyone, except any person participating in or benefiting from the
misappropriation of funds, who makes a report pursuant to this section or
who testifies in any administrative or judicial proceeding arising from
the report shall be immune from any civil or criminal liability for
making such a report or for testifying except for liability for perjury,
unless such person acted negligently, recklessly, in bad faith, or with
malicious purpose.

13. Within five working days after a report required to be made under
this section is received, the person making the report shall be notified
in writing of its receipt and of the initiation of the investigation.

14. No person who directs or exercises any authority in a facility shall
evict, harass, dismiss or retaliate against a resident or employee
because he or any member of his family has made a report of any violation
or suspected violation of laws, ordinances or regulations applying to the
facility which he has reasonable cause to believe has been committed or
has occurred.

15. The department shall maintain the employee disqualification list and
place on the employee disqualification list the names of any persons who
have been finally determined by the department, pursuant to section
660.315, RSMo, to have misappropriated any property or funds of a
resident while employed in any facility. (L. 1979 S.B. 328, et al. § 30,
A.L. 1982 H.B. 1086, A.L. 1989 S.B. 203 & 270, A.L. 1992 S.B. 573 & 634,
A.L. 1993 H.B. 564)

(2003) Violation of written report provision of subsection 2 of section
does not automatically constitute misappropriation of resident's funds
under subsection 15 of section. Wells v. Dunn, 104 S.W.3d 792 (Mo.App.
W.D.).

1. Any resident or former resident who is deprived of any right
created by sections 198.088 and 198.090, or the estate of a former
resident so deprived, may file a written complaint within one hundred
eighty days of the alleged deprivation or injury with the office of the
attorney general describing the facts surrounding the alleged
deprivation. A copy of the complaint shall be sent to the department by
the attorney general.

2. The attorney general shall review each complaint and may initiate
legal action as provided under sections 198.003 to 198.186.

3. If the attorney general fails to initiate a legal action within sixty
days of receipt of the complaint, the complainant may, within two hundred
forty days of filing the complaint with the attorney general, bring a
civil action in an appropriate court against any owner, operator or the
agent of any owner or operator to recover actual damages. The court may,
in its discretion, award punitive damages which shall be limited to the
larger of five hundred dollars or five times the amount of special
damages, unless the deprivation complained of is the result of an
intentional act or omission causing physical or emotional injury to the
resident, and may award to the prevailing party attorney's fees based on
the amount of time reasonably expended, and may provide such equitable
relief as it deems necessary and proper; except that, an attorney who is
paid in whole or part from public funds for his representation in any
cause arising under this section shall not be awarded any attorney fees.

4. No owner or operator who pleads and proves as an affirmative defense
that he exercised all care reasonably necessary to prevent the
deprivation and injury for which liability is asserted shall be liable
under this section.

5. Persons bringing suit to recover against a bond for personal funds
pursuant to section 198.096 shall not be required to first file a
complaint with the attorney general pursuant to subsection 1 of this
section, nor shall subsection 1 be construed to limit in any way the
right to recover on such bond.

6. Nothing contained in sections 198.003 to 198.186 shall be construed as
abrogating, abridging or otherwise limiting the right of any person to
bring appropriate legal actions in any court of competent jurisdiction to
insure or enforce any legal right or to seek damages, nor shall any
provision of the above-named sections be construed as preventing or
discouraging any person from filing a complaint with the department or
notifying the department of any alleged deficiency or noncompliance on
the part of any facility. (L. 1979 S.B. 328, et al. § 31)

(2003) Failure by relatives of deceased nursing home resident to file
written complaint with Attorney General precluded filing wrongful death
claim against nursing home. Dickerson v. Deaconess Long Term Care of
Missouri, Inc., 279 F.Supp.2d 1068 (E.D. Mo.).

1. The operator of any facility who holds in trust personal
funds of residents as provided in section 198.090 shall obtain and file
with the department a bond in a form approved by the department in an
amount equal to one and one-half times the average monthly balance or
average total of the monthly balances, rounded to the nearest one
thousand dollars, in the residents' personal funds account or accounts
kept pursuant to subdivision (3) of subsection 1 of section 198.090 for
the preceding calendar year. In the case of a new facility or of an
operator not previously holding in trust the personal funds of residents,
the department shall determine the amount of bond to be required, taking
into consideration the size and type of facility, the number of
residents, and the experience of comparable facilities.

2. The required bond shall be conditioned to secure to every resident or
former resident, or the estate of a former resident, the return of any
moneys held in trust of which the resident has been wrongfully deprived
by acts of the operator or any affiliates or employees of the operator.
The liability of the surety to any and all persons shall not exceed the
stated amount of the bond regardless of the period of time the bond has
been in effect.

3. Whenever the director determines that the amount of any bond which is
filed pursuant to this subsection is insufficient to adequately protect
the money of residents which is being handled, or whenever the amount of
any such bond is impaired by any recovery against the bond, the director
may require the operator to file an additional bond in such amount as
necessary to adequately protect the money of residents being handled.

4. In the event that any such bond includes a provision allowing the
surety to cancel after notice, the bond shall provide for a minimum of
sixty days' notice to the department.

5. The operator may, in lieu of a bond, place a cash deposit equal to the
amount of the bond required in this section with an insured lending
institution pursuant to a noncancelable escrow agreement with the lending
institution if the written agreement is submitted to and approved by the
department. No escrow agreement shall be approved without verification of
cash deposit. (L. 1979 S.B. 328, et al. § 32, A.L. 1988 S.B. 602)

Any person who assumes the responsibility of managing the
financial affairs of an elderly person who is a resident of a nursing
home shall be guilty of a class D felony if such person misappropriates
the funds and fails to pay for the nursing home care of the elderly
person. (L. 1987 S.B. 277 § 1)

The attorney general, either on his own initiative or upon the
request of the department or of any other state governmental agency
having an interest in the matter, a resident or residents or the guardian
of a resident of a facility or the owner or operator of a facility may
petition for appointment of a receiver for a facility when any of the
following conditions exist:

(1) The operator is operating without a license;

(2) The department has revoked the license of an operator or refused to
grant an application for a license to the operator;

(3) The department has initiated revocation procedures and has determined
that the lives, health, safety, or welfare of the residents cannot be
adequately assured pending a full hearing on license revocation;

(4) The facility is closing or intends to close and adequate arrangements
for relocation of residents have not been made at least thirty days prior
to closure;

(5) An emergency exists in the facility;

(6) The operator is insolvent; or

(7) An owner of the land or structure is insolvent and such insolvency
substantially affects the operation of the facility. (L. 1979 S.B. 328,
et al. § 33)

Effective 7-1-79

In any situation described in section 198.099, the department
may place a person to act as a monitor in the facility. The monitor shall
observe operation of the facility and shall advise it on how to comply
with state laws and regulations, and shall submit a written report
periodically to the department on the operation of the facility. (L. 1979
S.B. 328, et al. § 34)

Effective 7-1-79

1. Any petition for appointment of a receiver shall be verified
and shall be accompanied by an affidavit or affidavits setting forth
material facts showing there exists one or more of the conditions
specified in section 198.099. The petition shall be filed in the circuit
court of Cole County or in the county where the facility is located. If
the petition is not filed by the attorney general, a copy of the petition
shall be served upon the department and upon the attorney general. The
court shall hold a hearing on the petition within five days of the filing
of the petition and determine the matter within fifteen days of the
initial hearing. The petition and notice of the hearing shall be served
on the operator or administrator of the facility or, if personal service
is impossible, shall be posted in a conspicuous place in the facility not
later than three days before the time specified for the hearing, unless a
different period is fixed by order of the court.

2. The court shall appoint a person, selected in accordance with the
provisions of this subsection and the rules promulgated pursuant to this
section, to act as receiver if it finds that any ground exists which
would authorize the appointment of a receiver under section 198.099 and
that appointment of a receiver will contribute to the continuity of care
or the orderly and safe transfer of residents in the facility. The
department shall, within six months of August 28, 2003, promulgate rules
to establish guidelines for the determination of qualified receivers,
procedures for maintaining the list of qualified receivers that requested
in writing to act as a receiver, and the selection or removal of such
receivers. 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, 2003, shall be invalid and void.

3. The director of the department shall maintain a list of persons who
have submitted a written request in accordance with the provisions of
this subsection and the rules promulgated by the department to act as
receiver pursuant to section 198.099. When a petition is filed seeking
the appointment of a receiver, the director of the department shall
select the first name on the list. The director of the department shall
inform such person of his or her selection, the name of the facility, and
the grounds for seeking receivership of such facility. Such person may
elect not to be appointed, in which case the director of the department
shall choose the next consecutive name on the list, continuing until a
person has agreed to serve as the receiver. The director shall provide
the name of the person selected and agreeing to serve as the receiver to
the judge of the court wherein the petition for receivership is filed.
For each additional petition filed seeking the appointment of a receiver,
names shall be chosen from the list in consecutive order beginning with
the next name that follows the last name chosen. If none of the persons
on the list agree to serve as the receiver, the court shall appoint a
person determined by the court to be qualified to act as receiver. (L.
1979 S.B. 328, et al. § 35, A.L. 1984 S.B. 451, A.L. 2003 S.B. 556 & 311)

If it appears from the petition filed under section 198.105, or
from an affidavit or affidavits filed with the petition, or from
testimony of witnesses under oath when the court determines that this is
necessary, that there is probable cause to believe that an emergency
exists in the facility, the court shall immediately issue the requested
order for appointment of a receiver, ex parte and without further
hearing. Notice of the petition and order shall be served on the operator
or administrator of the facility or, if personal service is impossible,
shall be posted in a conspicuous place in the facility within twenty-four
hours after issuance of the order. If the petition is not filed by the
attorney general, a copy of the petition shall be served on the
department and upon the attorney general. A hearing on the petition shall
be held within three days after notice is served or posted unless the
operator consents to a later date. After the hearing, the court may
terminate, continue or modify the temporary order. (L. 1979 S.B. 328, et
al. § 36)

Effective 7-1-79

A receiver appointed under this section:

(1) May exercise those powers and shall perform those duties set out by
the court;

(2) May, in his discretion, either:

(a) Assume the role of administrator or manager and take control of all
day-to-day operations; or

(b) Name an administrator or manager to conduct the day-to-day operations
of the facility subject to the supervision and direction of the receiver;

(3) May upgrade deficient homes by any methods, procedures, or actions he
deems necessary; provided, however, that expenditures in excess of three
thousand dollars, or in excess of any amount set by the court, be first
approved by the court;

(4) Shall have the same rights to possession of the building in which the
facility is located and of all goods and fixtures in the building at the
time the petition for receivership is filed as the operator would have
had if the receiver had not been appointed. The receiver shall take such
action as is reasonably necessary to protect and conserve the assets or
property of which the receiver takes possession, or the proceeds of any
transfer thereof, and may use them only in the performance of the powers
and duties set forth in this section and by order of the court;

(5) May use the building, fixtures, furnishings and any accompanying
consumable goods in the provision of care and services to residents and
to any other persons receiving services from the facility at the time the
petition for receivership was filed. The receiver shall collect payments
for all goods and services provided to residents or others during the
period of receivership, at the same rate of payment as was charged by the
operators at the time the petition for receivership was filed, unless a
different rate is set by the court;

(6) May let contracts and hire agents and employees, including legal
counsel, to carry out the powers and duties created under this section or
by the court;

(7) May hire or discharge any employees, including the administrator;

(8) Shall receive and expend in a reasonable manner the revenues of the
facility due on the date of the order of appointment as receiver, and to
become due during the receivership;

(9) Shall do all acts necessary or appropriate to conserve the property
and promote the health, safety or care of the residents of the facility;

(10) Except as hereinafter specified in section 198.115, shall honor all
leases, mortgages, secured transactions or other wholly or partially
executory contracts entered into by the facility's operator or
administrator while acting in that capacity, but only to the extent of
payments which become due or are for the use of the property during the
period of the receivership;

(11) Shall be responsible, to the same extent as the operator would have
been, for taxes which accrue during the period of the receivership;

(12) Shall be entitled to and shall take possession of all property or
assets of residents which are in possession of an operator or
administrator of the facility. The receiver shall preserve all property,
assets and records of residents of which the receiver takes possession
and shall provide for the prompt transfer of the property, assets and
records to the alternative placement of any transferred or discharged
resident;

(13) Shall provide, if upgrading of the facility or correction of the
deficiencies is not possible, for the orderly transfer of all residents
in the facility to other suitable facilities, or make other provisions
for their continued health, safety and welfare;

(14) Shall, if any resident is transferred or discharged, provide for:

(a) Transportation of the resident and the resident's belongings and
medical records to the place to which the resident is being transferred
or discharged;

(b) Aid in locating an alternative placement and in discharge planning;

(c) If the resident is being transferred, preparation for transfer to
mitigate transfer trauma;

(15) Shall, if any resident is to be transferred, permit participation by
the resident or the resident's guardian in the selection of the
resident's alternative placement;

(16) Shall, unless emergency transfer is necessary, prepare a resident
under subdivisions (14)(c) and (15) by explaining alternative placements,
and by providing orientation to the placement chosen by the resident or
the resident's guardian. (L. 1979 S.B. 328, et al. § 37)

Effective 7-1-79

1. A receiver may not be required to honor any lease, mortgage,
secured transaction or other wholly or partially executory contract
entered into by the facility's operator or administrator while acting in
that capacity, if the agreement is unconscionable. Factors which shall be
considered in determining the unconscionability include, but are not
limited to, the following:

(1) The person seeking payment under the agreement was an affiliate of
the operator or owner at the time the agreement was made;

(2) The rental, price, or rate of interest required to be paid under the
agreement was substantially in excess of a reasonable rental, price or
rate of interest at the time the agreement was entered into.

2. If the receiver is in possession of real estate or goods subject to a
lease, mortgage or security interest which the receiver is permitted to
avoid under subsection 1 of this section, and if the real estate or goods
are necessary for the continued operation of the facility, the receiver
may apply to the court to set a reasonable rental, price or rate of
interest to be paid by the receiver during the duration of the
receivership. The court shall hold a hearing on the application within
fifteen days. The receiver shall send notice of the application to any
known owners of the property involved at least ten working days prior to
the hearing. Payment by the receiver of the amount determined by the
court to be reasonable is a defense to any action against the receiver
for payment or for possession of the goods or real estate subject to the
lease or mortgage involved by any person who received such notice, but
the payment does not relieve the owner or operator of the facility of any
liability for the difference between the amount paid by the receiver and
the amount due under the original lease or mortgage involved. (L. 1979
S.B. 328, et al. § 38)

Effective 7-1-79

The court shall set the compensation of the receiver, which
shall be considered a necessary expense of a receivership. (L. 1979 S.B.
328, et al. § 39)

Effective 7-1-79

A receiver may be required by the court to post a bond, which
shall be considered a necessary expense of the receivership. (L. 1979
S.B. 328, et al. § 40)

Effective 7-1-79

Other provisions of sections 198.003 to 198.096 notwithstanding,
the department may issue a license to a facility being operated by a
receiver under sections 198.099 to 198.136. The duration of a license
issued under this subsection is limited to the duration of the
receivership. (L. 1979 S.B. 328, et al. § 41)

Effective 7-1-79

The court may terminate a receivership:

(1) Upon a motion by any party to the petition, by the department, or by
the receiver, and a finding by the court that the deficiencies and
violations in the facility have been substantially eliminated or
remedied; or

(2) If all residents in the facility have been provided alternative modes
of health care, either in another facility or otherwise. The court may
immediately terminate the receivership, or may terminate the receivership
subject to such terms as the court deems necessary or appropriate to
prevent the conditions complained of from recurring. (L. 1979 S.B. 328,
et al. § 42)

Effective 7-1-79

1. Within thirty days after termination or such other time as
the court may set, the receiver shall give the court a complete
accounting of all property of which the receiver has taken possession, of
all funds collected under section 198.108 and of the expenses of the
receivership.

2. If the operating funds collected by the receiver under section 198.112
exceed the reasonable expenses of the receivership, the court shall order
the payment of the surplus to the operator. If the operating funds are
insufficient to cover reasonable expenses of the receivership, the
operator shall be liable for the deficiency. The operator may apply to
the court to determine the reasonableness of any expense of the
receivership. The operator shall not be responsible for expenses in
excess of what the court finds to be reasonable.

3. If a deficiency exists under subsection 2 of this section, the
receiver may apply to the court for such a determination. If after notice
to all interested parties and a hearing the court finds that in fact a
deficiency does exist, then the court shall enter judgment in favor of
the receiver and against the appropriate party or parties as set forth in
subsection 2 of this section for the amount of such deficiency. Any
judgment obtained under this subsection shall be treated as any other
judgment and may be enforced according to law.

4. Any judgment for a deficiency obtained in accordance with this section
by the receiver or any portion thereof may be assigned wholly or in part
upon approval of the court.

5. The judgment shall have priority over any other judgment or lien or
other interest which originates subsequent to the filing of a petition
for receivership under the provisions of sections 198.099 to 198.136
except for a construction or mechanic's lien arising out of work
performed with the express consent of the receiver. (L. 1979 S.B. 328, et
al. § 43)

Effective 7-1-79

No operator or affiliate may be held liable for acts or
omissions of the receiver or the receiver's employees during the term of
the receivership. Nothing in sections 198.099 to 198.136 shall be deemed
to relieve any operator or any affiliate of an operator of a facility
placed in receivership of any civil or criminal liability incurred, or
any duty imposed by law, by reason of acts or omissions of the operator
or affiliates of the operator prior to the appointment of a receiver
under section 198.105 or 198.108, nor shall anything contained in
sections 198.099 to 198.136 be construed to suspend during the
receivership any obligation of the operator or any affiliate of an
operator for payment of taxes or other operating and maintenance expenses
of the facility, nor of the operator or affiliates of the operator for
the payment of mortgages or liens. (L. 1979 S.B. 328, et al. § 44)

Effective 7-1-79

A health care provider or vendor shall not knowingly use any
moneys paid to him under Medicaid for services provided to any resident
for any purpose other than that permitted by the provisions of chapter
208, RSMo, or state regulations or federal regulations or statutes
governing Medicaid reimbursement. (L. 1979 S.B. 328, et al. § 45)

Effective 7-1-79

A health care provider or vendor shall not knowingly:

(1) Make or cause to be made any false statement or representation of a
material fact in any application for any benefit or payment under
Medicaid for services provided to any resident;

(2) Make or cause to be made any false statement or representation of any
material fact for use in determining the person's eligibility for any
benefit or payment under Medicaid for services provided to any resident;

(3) Conceal or fail to disclose any material fact that affects his
eligibility for any benefit or payment under Medicaid for services
provided to any resident or affects the eligibility of another for whom
he applies or for whom he receives such benefit or payment, with the
intent to secure the benefit or payment in a greater quantity than is due
or to secure the benefit or payment when none is permitted;

(4) Convert a benefit or payment he receives under Medicaid for services
provided to a resident for a use or benefit other than that for which it
was specifically intended. (L. 1979 S.B. 328, et al. § 46)

Effective 7-1-79

A person shall not purposely solicit or receive any payment,
including, without limitation, any kickback, bribe or rebate, directly or
indirectly, overtly or covertly, in cash or in kind, from any vendor or
health care provider:

(1) In return for referring an individual to a person for the furnishing
or arranging for the furnishing of any item or service for which payment
may be made in whole or in part under Medicaid; or

(2) In return for purchasing, leasing, ordering or arranging for or
recommending purchasing, leasing or ordering any good, facility, service
or item for which payment may be made in whole or in part under Medicaid.
(L. 1979 S.B. 328, et al. § 47)

Effective 7-1-79

A health care provider or vendor shall not purposely offer or
make any payment, including without limitation, any kickback, bribe or
rebate, directly or indirectly, overtly or covertly, in cash or in kind,
to any person to induce the person:

(1) To refer an individual to a person for the furnishing or arranging
for the furnishing of any item or service for which payment may be made
in whole or in part under Medicaid; or

(2) To purchase, lease, order or arrange for or recommend purchasing,
leasing or ordering any good, facility, service or item for which payment
may be made in whole or in part under Medicaid. (L. 1979 S.B. 328, et al.
§ 48)

Effective 7-1-79

Sections 198.145 and 198.148 do not apply to:

(1) Any usual trade discount which is dependent solely upon time of
payment or quantity buying to wholesalers which is obtained by a health
care provider regardless of whether reflected in the cost claimed or
charges made by the health care provider under Medicaid; and

(2) Any amount paid by an employer to an employee, who has a bona fide
employment relationship with the employer, for employment in the
provision of covered services or items. (L. 1979 S.B. 328, et al. § 49)

Effective 7-1-79

1. A health care provider shall not knowingly make or cause to
be made any false statement or representation of material fact in order
to qualify either upon initial certification or upon recertification to
receive funds under Medicaid.

2. A health care provider shall not knowingly induce or seek to induce
any such false statement or representation of material fact for
consideration, whether the consideration is direct or indirect. (L. 1979
S.B. 328, et al. § 50)

Effective 7-1-79

1. A person committing any act in violation of any provision of
sections 198.139 to 198.155 is guilty of a class D felony.

2. A vendor or health care provider convicted of a criminal violation of
sections 198.139 to 198.155 shall be prohibited from receiving future
moneys under Medicaid or from providing services under Medicaid for or on
behalf of any other health care provider. However, the director of the
department or his designee shall review this prohibition upon the
petition of a vendor or health care provider so convicted and, for good
cause shown, may reinstate the vendor or health care provider as being
eligible to receive funds under Medicaid. The decision of the director or
his designee shall be made in writing after the director of the fraud
investigation division is allowed the opportunity to state his position
concerning such petition.

3. A vendor or health care provider committing any act or omission in
violation of sections 198.139 to 198.155 shall be civilly liable to the
state for any moneys obtained under Medicaid as a result of such act or
omission. (L. 1979 S.B. 328, et al. § 51)

Effective 7-1-79

1. There is hereby created within the department of social
services a "Fraud Investigation Division". The fraud investigation
division shall be headed by a division director appointed by the director
of the department of social services. The director of the fraud
investigation division shall be an attorney at law licensed to practice
in this state and shall have substantial experience in criminal
prosecution or defense. The director of the fraud investigation division
shall receive such compensation as the director of the department of
social services may designate subject to appropriation by the general
assembly. The director of the fraud investigation division may employ
such attorneys, accountants, investigators and such other personnel as
are necessary to conduct the activities of the division. A team approach
to the operations of the division shall be utilized wherever practicable.

2. The director of the fraud investigation division, with such assistance
as he may require from the appropriate county prosecuting attorney, shall
investigate suspected violations of sections 198.139 to 198.155 and any
civil liabilities due the state as a result of any such violation.
Evidence of actions which may constitute criminal violations under
sections 198.139 to 198.155 shall be referred to the appropriate county
prosecuting attorney. If the prosecuting attorney fails or refuses to
initiate prosecution on a cause referred to him by the director of the
fraud investigation division within sixty days after he is made aware by
complaint of an alleged violation, the prosecuting attorney shall so
notify the attorney general, who may take full charge of the prosecution
and may initiate prosecution by information or indictment for the
violation. (L. 1979 S.B. 328, et al. § 52)

Effective 7-1-79

1. When the director of the investigation division has probable
cause to believe that a health care provider is committing any act or
omission in violation of any provision of sections 198.139 to 198.186, he
may petition an appropriate court for an order to stop payments under
Medicaid to the health care provider pending completion of the
investigation and litigation under sections 198.139 to 198.186.

2. The court shall allow the health care provider the opportunity to be
heard on the request of the director of the fraud investigation division
and shall decide, in writing, whether to stop payments to the health care
provider. (L. 1979 S.B. 328, et al. § 53)

Effective 7-1-79

If the director of the fraud investigation division has probable
cause to believe that any acts or omissions in violation of sections
198.139 to 198.155 have been committed by a person who is in control of
assets purchased, in whole or in part, directly or indirectly, with funds
from Medicaid and is likely to convert, destroy or remove those assets,
the director of the fraud investigation division can petition the circuit
court of the county in which those assets may be found to appoint a
receiver to manage those assets until the investigation and any
litigation are completed. The circuit court immediately upon receipt of
the petition of the director of the fraud investigation division shall
enjoin the person in control of the assets from converting, destroying or
removing those assets. A hearing for the appointment of a receiver shall
be held within ten days of the filing of the petition. If the court finds
that there is probable cause to believe the person has committed any acts
or omissions in violation of any provisions of sections 198.139 to
198.155 and that the assets are likely to be converted, destroyed or
removed, the circuit court shall appoint a receiver to manage the assets
until the investigation and any litigation are completed. The court shall
maintain continuing jurisdiction over the assets and may modify its
orders as circumstances require. The order appointing a receiver shall be
a final order for purposes of appeal. (L. 1979 S.B. 328, et al. § 54)

Effective 7-1-79

The director of the fraud investigation division may seek civil
restitution of any moneys dispensed under Medicaid for services provided
to any resident or under section 208.030, RSMo, which have been
misappropriated, fraudulently obtained, or constitute overpayments. The
authority of the director of the fraud investigation division under
sections 198.139 to 198.186 to seek civil restitution does not diminish
the authority of the department to seek restitution. (L. 1979 S.B. 328,
et al. § 55)

Effective 7-1-79

1. For the purpose of any investigation or proceeding under
sections 198.158 to 198.171, the director of fraud investigation or any
officer designated by him may administer oaths and affirmations, subpoena
witnesses, compel their attendance, take testimony, require answers to
written interrogatories and require production of any books, papers,
correspondence, memoranda, agreements or other documents or records which
the director of fraud investigation deems relevant and material to the
inquiry.

2. In the case of contumacy by, or refusal to obey a subpoena issued to,
any person, the circuit court of any county of the state or the city of
St. Louis, upon application by the division director may issue to the
person an order requiring him to appear before the division director, or
the officer designated by him, there to produce documentary evidence if
so ordered or to give testimony or answer interrogatories touching the
matter under investigation or in question in accordance with the forms
and procedures otherwise authorized by the Rules of Civil Procedure. The
court may make any order which justice requires to protect any person
from undue annoyance, embarrassment, expense or oppression. Failure to
obey the order of the court may be punished by the court as a contempt of
court.

3. Notwithstanding the provisions of section 326.151, RSMo, the
accountant-client privilege recognized therein shall not, upon a knowing
and intelligent waiver by any person subject to sections 198.003 to
198.186, constitute a defense and shall not apply to a subpoena under
this section and shall not apply in court proceedings instituted pursuant
to sections 198.139 to 198.186.

4. Information or documents obtained under this section by the director
of the fraud investigation division shall not be disclosed except in the
course of civil or criminal litigation or to another prosecutorial or
investigative agency, or to the divisions of the department.

5. Anyone improperly disclosing information obtained under this section
is guilty of a class A misdemeanor.

6. The provisions of this section do not repeal existing provisions of
law and shall be construed as supplementary thereto. (L. 1979 S.B. 328,
et al. § 56)

Effective 7-1-79

1. In any investigation or proceeding under sections 198.139 to
198.186 in which any person has been or may be called to testify, produce
evidence or provide other information by means of a subpoena or before a
court or grand jury, if the person refuses to answer any question or
produce evidence or material of any kind on the ground that he may be
incriminated thereby, the director of the fraud investigation division
may, in writing, request the circuit court of the county in which the
proceeding is held to order the person to answer the question or produce
the evidence. Upon receipt of the request, the court shall hold a hearing
on said written request after written notice to the person specifying the
nature of the request and the time and place of the hearing, and advising
the person of his right to be present and his right to counsel at such
hearing. At the hearing the director of the fraud investigation division
and the person may participate. The burden of proof is on the director of
the division to demonstrate to the court (1) the necessity for and (2)
the reasonableness of the request to order the person to answer the
question or produce the evidence or both. If the court is satisfied that
such burden has been met, it may issue an order requiring the person to
answer the questions or produce the evidence, or both, which he refuses
to give or produce on the basis of his privilege against
self-incrimination. If the court believes such burden has not been met,
it shall dismiss the request. When the order is communicated to the
person, the person may not refuse to comply with the order on the basis
of his privilege against self-incrimination. After complying with the
order and giving the testimony or producing the evidence, no testimony or
other evidence or information obtained or any information directly or
indirectly derived from the testimony or evidence may be used against the
person in any proceeding or prosecution for any offense concerning which
he gave answer or produced evidence under court order, except a
prosecution for perjury, false swearing or contempt committed in
answering or failing to answer, or in the producing or failing to produce
evidence in accordance with the order.

2. If any person refuses to testify after being granted immunity from
prosecution under sections 198.139 to 198.186 and after being ordered to
testify or produce evidence, the court may find the person in contempt.
(L. 1979 S.B. 328, et al. § 57)

Effective 7-1-79

During any investigation under sections 198.139 to 198.186, the
director of the fraud investigation division shall have the right to
audit and to inspect the records of any health care provider or vendor.
If the health care provider or vendor refuses to allow such audit or
inspection or if there is reason to believe that the records are in
danger of being destroyed, altered or secreted, the director of the fraud
investigation division may make written application under oath to any
court in the county where the records in question are being kept, or in
Cole County, and if the judge shall be satisfied that there is reasonable
cause for the audit or inspection or reasonable cause to believe that the
records are in danger of being destroyed, altered or secreted, he shall
issue a warrant to search for and seize such records. (L. 1979 S.B. 328,
et al. § 58)

Effective 7-1-79

1. All state agencies shall cooperate with the director of the
fraud investigation division in his efforts to enforce the provisions of
sections 198.139 to 198.186. All officers of the state of Missouri
charged with the enforcement of criminal law shall also render and
furnish to the director of the fraud investigation division, when
requested, all information and assistance in their possession or within
their power relating to sections 198.139 to 198.186.

2. The department and all of its other divisions shall promptly notify
the director of the fraud investigation division of any substantial
complaint or allegation of possible fraudulent activity on the part of a
health care provider or vendor under Medicaid and shall refer to the
director of the fraud investigation division all suspected cases of fraud
in Medicaid services provided to any resident.

3. The director of the fraud investigation division shall be allowed
access to all information in the possession of the department which
relates to Medicaid services provided to any resident. The department
shall make available to the director of the fraud investigation division
electronic data processing services pertaining to such Medicaid
information. (L. 1979 S.B. 328, et al. § 59)

Effective 7-1-79

The powers of the director of the fraud investigation division
under sections 198.139 to 198.186 shall not diminish the powers of local
authorities to investigate criminal conduct within their jurisdiction.
(L. 1979 S.B. 328, et al. § 60)

Effective 7-1-79

1. A nursing home district may be created, incorporated and
managed as provided in sections 198.200 to 198.350 and may exercise the
powers herein granted or necessarily implied. A nursing home district may
include municipalities or territory not in municipalities or both or
territory in one or more counties; except, that the provisions of
sections 198.200 to 198.350 are not effective in counties having a
population of more than four hundred thousand inhabitants. The territory
contained within the corporate limits of an existing nursing home
district shall not be incorporated in another nursing home district.

2. When a nursing home district is organized it shall be a body corporate
and political subdivision of the state and shall be known as "........
Nursing Home District", and in that name may sue and be sued, levy and
collect taxes within the limitations of sections 198.200 to 198.350 and
the constitution and issue bonds as herein provided.

3. For the purposes of sections 198.200 to 198.360, "nursing home" shall
mean a residential care facility I, a residential care facility II, an
intermediate care facility, or a skilled nursing facility as defined in
section 198.006. (L. 1963 p. 368 § 2, A.L. 1979 S.B. 328, et al., A.L.
1984 S.B. 451)

Whenever the creation of a nursing home district is desired, a
number of voters residing in the proposed district equal to ten percent
of the vote cast for governor in the proposed district in the next
preceding gubernatorial election, may file with the county clerk in which
the territory or the greater part thereof is situated, a petition
requesting the creation thereof. In case the proposed district which
shall be contiguous is situated in two or more counties, the petition
shall be filed in the office of the county clerk of the county in which
the greater part of the area is situated, and the commissioners of the
county commission of the county shall set the petition for public
hearing. The petition shall set forth:

(1) A description of the territory to be embraced in the proposed
district;

(2) The names of the municipalities located within the area;

(3) The name of the proposed district;

(4) The population of the district, which shall not be less than two
thousand inhabitants;

(5) The assessed valuation of the area, which shall not be less than two
million five hundred thousand dollars; and

(6) A request that the question be submitted to the voters residing
within the limits of the proposed nursing home district whether they will
establish a nursing home district under sections 198.200 to 198.350, to
be known as "......... Nursing Home District" for the purpose of
constructing and maintaining a public nursing home. (L. 1963 p. 368 § 3,
A.L. 1978 H.B. 971)

1. Upon the filing of the petition with the county clerk, he
shall present it to the commissioners of the county commission who shall
thereupon set the petition for hearing within not less than thirty nor
more than forty days after the filing.

2. Notice shall be given by the commissioner of the county commission of
the time and place where the hearing will be held, by publication on
three separate days in one or more newspapers having a general
circulation within the territory proposed to be incorporated as a nursing
home district, the first of which publications shall be not less than
twenty days prior to the date set for the hearing and if there is no such
newspaper, then notice shall be posted in ten of the most public places
in the territory, not less than twenty days prior to the date set for the
hearing. This notice shall include a description of the territory as set
out in the petition, names of municipalities located therein and the name
of the proposed district and the question of creating a nursing home
district.

3. The costs of printing and publication or posting of notices of public
hearing thereon shall be paid in advance by the petitioners, and, if a
district is organized under sections 198.200 to 198.350, they shall be
reimbursed out of the funds received by the district from taxation or
other sources. (L. 1963 p. 368 § 4)

If two or more petitions covering in part the same territory are
filed prior to the public hearing upon the petition which is first filed,
the petitions shall be consolidated for public hearing, and hearing
thereon may be continued to permit the giving of notice of any subsequent
petitions. At the public hearing upon the petitions, the petitioners in
the petition first filed may move to amend the petition to include any
part of the territory described in the subsequent petitions, either as
originally filed or as amended. Any such motion shall be allowed by the
commissioners of the county commission. The public hearing shall proceed
upon the first petition as originally filed or as so amended, and further
proceedings upon any other petitions subsequently filed shall be stayed
and held in abeyance until the termination of all proceedings upon the
first petition, or any petition may be dismissed or withdrawn upon motion
of the petitioners therein by their representatives. (L. 1963 p. 368 § 5)

If the territory, petition and proceedings meet the requirements
of sections 198.200 to 198.350, the commissioners of the county
commission shall in and by the order finding and determining the
sufficiency of the petition and that the territory meets the requirements
of sections 198.200 to 198.350 * order the question to be submitted to
the voters of the proposed district. (L. 1963 p. 368 § 6, A.L. 1978 H.B.
971)

*Words "and shall" appear in original rolls.

Each notice shall state briefly the purpose of the election,
setting forth the proposition to be voted upon and a description of the
territory. The notice shall further state that any district upon its
establishment shall have the powers, objects and purposes provided by
sections 198.200 to 198.350, and shall have the power to levy a property
tax not to exceed thirty-five cents on the one hundred dollars valuation.
(L. 1963 p. 368 § 7, A.L. 1978 H.B. 971, A.L. 1985 S.B. 100)

The question of whether or not a nursing home shall be organized
shall be submitted in substantially the following form:

Shall there be organized in the counties of ........., state of Missouri,
a nursing home district for the establishment and operation of a nursing
home to be located within the boundaries of the proposed district and
having the power to impose a property tax not to exceed the annual rate
of thirty-five cents on the hundred dollars assessed valuation without
voter approval, and such additional tax as may be approved hereafter by
vote thereon, to be known as "......... Nursing Home District" as prayed
for by petition filed with the county clerk of ......... County,
Missouri, on the .... day of ......, 20.....? (L. 1963 p. 368 § 8, A.L.
1978 H.B. 971, A.L. 1985 S.B. 100)

Any district which has a lower tax levy than the maximum levy
authorized by section 198.250 may increase its levy up to, but not in
excess of, such maximum levy if a majority of the voters of the district
who vote on the increase approve the increase. The ballot of submission
for a tax increase under this section shall be in substantially the
following form:

Shall the ................. Nursing Home District be authorized to
increase the annual rate of property tax from ........ cents to ........
cents on the hundred dollars assessed valuation?

Yes

No (Place an "X" in the square opposite the answer for which you wish to
vote.) If a majority of the qualified voters casting votes thereon are in
favor of the increase, the board of directors of the district shall levy
the annual rate of tax approved; but if a majority of the voters casting
votes thereon are opposed to the increase, any annual tax rate in effect
at the time of the election shall remain in effect; provided, however,
that if the voters of the district have previously approved a levy and
the levy has not been imposed, the board of directors may impose such
previously approved levy or portion thereof, subject to other provisions
of the law with respect to limitation on tax revenues. (L. 1985 S.B. 100)

The order determining and declaring results of the election
shall be entered upon the records of the commission and a certified copy
thereof shall be filed with the county clerk of each other county in
which the proposed district lies who shall cause the same to be spread
upon the records of the county commission. If the order shows that the
question to organize the district received a majority of the votes cast,
the order shall declare the district organized. (L. 1963 p. 368 § 9, A.L.
1978 H.B. 971)

1. After the nursing home district has been declared organized,
the declaring county commission shall either:

(1) Divide the district into six election districts as equal in
population as possible, and shall by lot number the districts from one to
six, inclusive. The county commission shall cause an election to be held
in the nursing home district within ninety days after the order
establishing the nursing home district to elect nursing home district
directors. The election shall be called, held and conducted and notice
shall be given as provided in sections 198.240 to 198.270, and each voter
shall vote for the director from his or her district; or

(2) Cause an election to be held in the nursing home district within
ninety days after the order establishing the nursing home district to
elect six at-large nursing home district directors. The election shall be
called, held and conducted and notice shall be given as provided in
sections 198.240 to 198.270. After August 28, 1994, directors shall be
elected for a term of three years. The first director whose term expires
after August 28, 1994, shall continue to hold office until the expiration
of the term of the second director whose term expires after August 28,
1994, at which time both such directors shall be elected for a term of
three years. The third director whose term expires after August 28, 1994,
shall continue to hold office until the expiration of the term of the
fourth director whose term expires after August 28, 1994, at which time
both such directors shall be elected for a term of three years. The fifth
director whose term expires after August 28, 1994, shall continue to hold
office until the expiration of the term of the sixth director whose term
expires after August 28, 1994, at which time both such directors shall be
elected for a term of three years. All directors shall serve until their
successors are elected and qualified. If a vacancy occurs, the board
shall select a successor who shall serve until the next regular election
of a director is to be held in that nursing home or election district. If
no candidate files a declaration of candidacy for a nursing home or
election district, a majority of the board of directors may, after the
election in that nursing home or election district would have regularly
been held, appoint any resident of the nursing home district who
otherwise qualifies pursuant to subsection 3 of this section to fill that
vacancy.

2. Following the initial election establishing the nursing home district
board of directors pursuant to subsection 1 of this section, the circuit
court may choose to elect the board of directors at large.

3. Candidates for director of the nursing home district shall be citizens
of the United States, resident taxpayers of the nursing home district who
have resided within the state for one year next preceding the election
and who are at least twenty-four years of age. All candidates shall file
their declarations of candidacy with the county commission calling the
election at least twenty days prior to the special election.

4. Notwithstanding any other provisions of law to the contrary, if the
number of candidates for the office of director is equal to the number of
directors to be elected, no election shall be held, and the candidates
shall assume the responsibility of their offices at the same time and in
the same manner as if they have been elected; however, if any vacancies
are created after local certification and prior to the deadline provided
in subdivision (4) of section 115.453, RSMo, which cause the number of
filed candidates to be less than the number of vacancies to be filled, an
election shall be held, and write-in candidates for such positions shall
be eligible as otherwise provided by law. (L. 1963 p. 368 § 10, A.L. 1978
H.B. 971, H.B. 1208, A.L. 1982 S.B. 526, A.L. 1986 S.B. 527, A.L. 1994
H.B. 1221, A.L. 2001 H.B. 881)

1. The board of directors of a district shall possess and
exercise all of its legislative and executive powers. Within thirty days
after the election of the initial directors, the board shall meet. The
time and place of the first meeting of the board shall be designated by
the county commission. At its first meeting the board shall elect a
chairman from its members and select a secretary, treasurer and such
officers or employees as it deems expedient or necessary for the
accomplishment of its corporate objects. The secretary and treasurer need
not be members of the board. At the meeting the board, by ordinance,
shall define the first and subsequent fiscal years of the district, and
shall adopt a corporate seal and bylaws, which shall determine the times
for the annual election of officers and of other regular and special
meetings of the board and shall contain the rules for the transaction of
other business of the district and for amending the bylaws.

2. Each director of any district shall devote such time to the duties of
the office as the faithful discharge thereof may require and shall serve
without compensation. (L. 1963 p. 368 § 11)

1. A nursing home district shall have and exercise the following
governmental powers, and all other powers incidental, necessary,
convenient or desirable to carry out and effectuate the express powers:

(1) To establish and maintain a nursing home within its corporate limits,
and to construct, acquire, develop, expand, extend and improve the
nursing home;

(2) To acquire or convey land or structures in fee simple, rights in land
and easements upon, over or across land and leasehold interests in land
and tangible and intangible personal property used or useful for the
location, establishment, maintenance, development, expansion, extension
or improvement of any nursing home. The acquisition may be by dedication,
purchase, gift, agreement, lease, use or adverse possession or by
condemnation. The conveyance may be by deed or lease;

(3) To operate, maintain and manage the nursing home, and to make and
enter into contracts for the use, operation or management of and to
provide rules and regulations for the operation, management or use of the
nursing home;

(4) To fix, charge and collect reasonable fees and compensation for the
use or occupancy of the nursing home or any part thereof, and for nursing
care, medicine, attendance, or other services furnished by the nursing
home, according to the rules and regulations prescribed by the board from
time to time;

(5) To borrow money and to issue bonds, notes, certificates, or other
evidences of indebtedness for the purpose of accomplishing any of its
corporate purposes, subject to compliance with any condition or
limitation set forth in sections 198.200 to 198.350 or otherwise provided
by the Constitution of the state of Missouri;

(6) To employ or enter into contracts for the employment of any person,
firm, or corporation, and for professional services, necessary or
desirable for the accomplishment of the corporate objects of the district
or the proper administration, management, protection or control of its
property;

(7) To maintain the nursing home for the benefit of the inhabitants of
the area comprising the district regardless of race, creed or color, and
to adopt such reasonable rules and regulations as may be necessary to
render the use of the nursing home of the greatest benefit to the
greatest number; to exclude from the use of the nursing home all persons
who willfully disregard any of the rules and regulations so established;
to extend the privileges and use of the nursing home to persons residing
outside the area of the district upon such terms and conditions as the
board of directors prescribes by its rules and regulations;

(8) To police its property and to exercise police powers in respect
thereto or in respect to the enforcement of any rule or regulation
provided by the ordinances of the district and to employ and commission
police officers and other qualified persons to enforce the same.

2. The use of any nursing home of a district shall be subject to the
reasonable regulation and control of the district and upon such
reasonable terms and conditions as shall be established by its board of
directors.

3. A regulatory ordinance of a district adopted under any provision of
this section may provide for a suspension or revocation of any rights or
privileges within the control of the district for a violation of any
regulatory ordinance.

4. Nothing in this section or in other provisions of sections 198.200 to
198.350 shall be construed to authorize the district or board to
establish or enforce any regulation or rule in respect to the operation
or maintenance of the nursing home within its jurisdiction which is in
conflict with any federal or state law or regulation applicable to the
same subject matter. (L. 1963 p. 368 § 12, A.L. 1991 H.B. 450)

No employee of a nursing home district who directs or exercises
any authority in a facility shall evict, harass, dismiss, or retaliate
against a resident or employee because such resident or employee or any
member of such resident's or employee's family has made a report of any
violation or suspected violation of laws, ordinances, or regulations
applying to the facility which the resident, the resident's family, or an
employee has reasonable cause to believe has been committed or has
occurred. Through the existing department information and referral
telephone contact line, residents, their families, and employees of a
facility shall be able to obtain information about their rights,
protections, and options in cases of eviction, harassment, dismissal, or
retaliation due to a report being made pursuant to this section. (L. 2003
S.B. 556 & 311)

1. If, after acquiring a site for a nursing home or a nursing
home, the board of the district by resolution determines that the site or
nursing home acquired is unsuitable or unnecessary for the purpose, or it
is in the best interest of the district, that the property should be
sold, the board may sell and convey the property in the manner provided
in subsection 2 of this section, provided that all outstanding bonds of
the district constituting a lien on the property to be sold have been
paid in full; or a sum sufficient to pay all such bonds, together with
interest accrued or to accrue thereon, together with any other items of
expense provided in such bonds, is deposited with the fiscal agent named
in the bonds for the purpose of full payment; or consent in writing is
obtained from all of the holders of the bonds.

2. Upon filing with the county clerk of the county in which the original
petition to organize the district was filed of a certified copy of the
resolution adopted by the board of directors of the district setting
forth the reasons for selling the property and the manner in which the
conditions of the provisions in subsection 1 of this section have been
satisfied, the clerk shall present the resolution to the county
commission. If the commission is satisfied that the statements in the
resolution are true and valid, it shall by order entered of record
approve the resolution. The board of directors of the district may then
proceed to sell and convey the property. The deed shall be executed by
the secretary of the board for and on behalf of the district, and shall
convey to the purchaser all the right, title, interest, and estate which
the nursing home district has in the property.

3. Any proceeds from the sale of the property remaining after the
expenses of the sale of the property and the purchase price and costs of
purchase of any new site or structure have been paid shall be placed in
the treasury of the district and used to carry out the purposes for which
the district was organized. (L. 1975 H.B. 382, A.L. 1991 H.B. 450)

1. For the purpose of purchasing nursing home district sites,
erecting nursing homes and related facilities and furnishing the same,
building additions to and repairing old buildings, the board of directors
may borrow money and issue bonds for the payment thereof in the manner
provided herein. The question of the loan shall be submitted by an order
of the board of directors of the district. Notice of the submission of
the question, the amount and the purpose of the loan shall be given as
provided in section 198.250.

2. The question shall be submitted in substantially the following form:

Shall the ......... Nursing Home District borrow money in the amount of
......... dollars for the purpose of ....... and issue bonds in payment
thereof?

3. If two-thirds of the votes cast are for the loan, the board shall,
subject to the restrictions of subsection 4, be vested with the power to
borrow money in the name of the district, to the amount and for the
purposes specified on the ballot, and issue the bonds of the district for
the payment thereof.

4. The loans authorized by this section shall not be contracted for a
period longer than twenty years, and the entire amount of the loan shall
at no time exceed, including the existing indebtedness of the district,
in the aggregate, ten percent of the value of taxable tangible property
therein, as shown by the last completed assessment for state and county
purposes, the rate of interest to be agreed upon by the parties, but in
no case to exceed the highest legal rate allowed by contract; when
effected, it shall be the duty of the directors to provide for the
collection of an annual tax sufficient to pay the interest on the
indebtedness as it falls due, and also to constitute a sinking fund for
the payment of the principal thereof within the time the principal
becomes due. (L. 1963 p. 368 § 13, A.L. 1978 H.B. 971)

As an alternative to the authorization for an indebtedness
provided by section 198.310, for the purpose of providing funds for the
acquisition, construction, erection, equipment and furnishing of nursing
homes and related facilities, and for providing a site therefor,
including offstreet parking space, and making from time to time
enlargements or extensions thereof, the board of directors may issue and
sell revenue bonds. The revenue bonds are payable, both as to principal
and interest, solely and only out of the net income and revenues arising
from the operation of the facility, after providing for the costs of
operation and maintenance thereof, or from other funds made available to
the facility from sources other than from proceeds of taxation. (L. 1978
H.B. 1769)

Any bonds issued under and pursuant to sections 198.312 to
198.318 shall not be deemed to be an indebtedness of the state of
Missouri, or of any city, or of the board of directors, or of the
individual members of the board of directors, and shall not be deemed to
be an indebtedness within the meaning of any constitutional or statutory
limitation upon the incurring of indebtedness. (L. 1978 H.B. 1769)

1. Revenue bonds issued pursuant to the provisions of section
198.312 shall be of such denomination, shall bear such rate of interest
not to exceed the highest rate permitted by law, and shall mature at such
times as determined by the board of directors. The bonds may be either
serial bonds or term bonds and may be issued with or without reservation
of the right to call them for payment or redemption in advance of their
maturity, upon the giving of notice and with or without the covenant
requiring the payment of a premium in the event of the call and
redemption prior to maturity as the board determines.

2. The bonds when issued and sold shall be negotiable instruments within
the meaning of the law merchant and the negotiable instruments law and
the interest thereon is exempt from income taxes under the laws of the
state of Missouri. (L. 1978 H.B. 1769)

1. The board of directors, issuing bonds under the provisions of
section 198.312, shall prescribe the form, details and incidents of the
bonds, and the board of directors shall make such covenants as in their
judgment are advisable or necessary properly to secure the payment
thereof; but the form, details, incidents and covenants shall not be
inconsistent with any of the provisions of sections 198.312 to 198.318.

2. The holder of any bonds issued hereunder or of any coupons
representing interest accrued thereon may, by civil action either at law
or in equity, compel the board of directors issuing such bonds to perform
all duties imposed upon them by the provisions of sections 198.312 to
198.318, and also to enforce the performance of any and all other
covenants made by such board of directors in the issuance of the bonds.

3. The provisions of sections 198.312 to 198.318 shall not be exclusive
of other legal methods of financing the facilities therein described, but
shall furnish an alternative method of finance. (L. 1978 H.B. 1769)

1. A petition for annexation of land to a nursing home district
shall be signed by not less than ten percent or fifty voters, whichever
is fewer, residing within the territory therein described proposed for
annexation and shall be filed with the county clerk of the county in
which the district or the greater portion thereof is situated, and shall
be addressed to the commissioners of the county commission. A hearing
shall be held thereon as nearly as possible as in the case of a formation
petition. If, upon hearing, the commissioners of the county commission
find that the petition is in compliance with sections 198.200 to 198.350,
they shall order the submission of the question to the voters to decide
whether or not the proposed annexation shall take place. The question
shall be submitted within the territory by the county commission as is
provided in section 198.250.

2. The question shall be submitted in substantially the following form:

Shall (description of territory) be annexed to the .... Nursing Home
District?

3. If a majority of the votes cast on the question in the district and in
the territory described in the petition, respectively, are in favor of
the annexation, the commissioners of the county commission shall by order
declare the territory annexed and shall describe the altered boundaries
of the district. (L. 1963 p. 368 § 14, A.L. 1978 H.B. 971)

The board shall provide for the proper and safe keeping of its
permanent records and for the recording of the corporate action of the
district. It shall keep a true and accurate account of its receipts and
an annual audit shall be made of its books, records and accounts. All
officers and employees authorized to receive or retain the custody of
money or to sign vouchers, checks, warrants or evidences of indebtedness
binding upon the district shall furnish surety bond for the faithful
performance of their duties and the faithful accounting for all moneys
that may come into their hands in an amount to be fixed and in a form to
be approved by the board. (L. 1963 p. 368 § 15)

Any person desiring to donate property for the benefit of a
nursing home, constructed or to be constructed under sections 198.200 to
198.350, may vest title to the property so donated in the board of
directors created under sections 198.200 to 198.350, and the board of
directors shall hold and control the property so received and accepted
according to the terms of the deed, gift, devise or bequest of the
property, and shall be a trustee of the property, and shall take title to
all property it may acquire in the name of the district and shall control
the property for the purposes provided in sections 198.200 to 198.350.
(L. 1963 p. 368 § 16)

Nothing in sections 198.200 to 198.350 shall prohibit a nursing
home district from establishing and maintaining apartments for seniors
that provide at a minimum housing, food services, and emergency call
buttons to the apartment residents in any county of the third
classification without a township form of government and with more than
twenty-eight thousand two hundred but fewer than twenty-eight thousand
three hundred inhabitants or any county of the third classification
without a township form of government and with more than nine thousand
five hundred fifty but fewer than nine thousand six hundred fifty
inhabitants. Such nursing home districts shall not lease such apartments
for less than fair market rent as reported by the United States
Department of Housing and Urban Development. (L. 2005 H.B. 58 merged with
S.B. 210)

Sections 198.200 to 198.350 shall be known and may be referred
to as "The Nursing Home District Law". (L. 1963 p. 368 § 1)

In any nursing home district created under the provisions of
sections 198.200 to 198.350 which is not operating a nursing home, and in
which the voters of the district have on three separate occasions refused
to approve a bond issue for the construction of a nursing home, or in
which the voters of the district have not approved a bond issue for the
construction of a nursing home within three years after the establishment
of the district, the board of that district shall submit to the voters
the proposition of the dissolution of the district. If a majority of the
voters approve the dissolution, the district shall be dissolved and any
tax money in the treasury shall be paid into the general revenue fund of
the county or counties in which the district is located, in the same
proportion as the proportion of the valuation of the district in each
county is to the total valuation of the district. (L. 1969 p. 304 § 1,
A.L. 1971 S.B. 158, A.L. 1973 H.B. 364, A.L. 1978 H.B. 1208)

1. Each nursing facility, except for state-owned and -operated
facilities, shall, in addition to all other fees and taxes now required
or paid, pay a nursing facility reimbursement allowance for the privilege
of engaging in the business of providing nursing facility services, other
than services in an institution for mental diseases, in this state.

2. For the purpose of this section, the phrase "engaging in the business
of providing nursing facility services, other than services in an
institution for mental diseases, in this state" means accepting payment
for such services.

3. For the purpose of this section, the term "nursing facility" shall be
defined using the definition in section 1396r, Title 42 United States
Code, as amended, and as such qualifies as a class of health care
providers recognized in federal Public Law 102-234 Medicaid Voluntary
Contribution and Provider Specific Tax Amendment of 1991. (L. 1994 H.B.
1362 § 1)

Expires 9-30-06

Each nursing facility's reimbursement allowance shall be based
on a formula set forth in rules and regulations promulgated by the
department of social services as provided in section 198.436. (L. 1994
H.B. 1362 § 2)

Expires 9-30-06

1. Each nursing facility shall keep such records as may be
necessary to determine the amount of its reimbursement allowance. On or
before the first day of October of each year, every nursing facility
shall submit to the department of social services a statement that
accurately reflects such information as is necessary to determine that
nursing facility's reimbursement allowance.

2. If a nursing facility does not have a third prior year desk-reviewed
cost report, elements of the reimbursement allowance shall be based on
determinations by the department of social services in accordance with
rules and regulations established under section 198.436. (L. 1994 H.B.
1362 § 3)

Expires 9-30-06

1. The director of the department of social services shall make
a determination as to the amount of nursing facility reimbursement
allowance due from each nursing facility.

2. The director of the department of social services shall notify each
nursing facility of the annual amount of its reimbursement allowance on
or before the first day of October each year. Such amount may be paid in
monthly* increments over the balance of the reimbursement allowance
period.

3. The department of social services may offset the nursing facility
reimbursement allowance owed by the nursing facility against any payment
due that nursing facility only if the nursing facility requests such an
offset. The amounts to be offset shall result, so far as practicable, in
withholding from the nursing facility an amount substantially equivalent
to the reimbursement allowance owed by the nursing facility. The office
of administration and state treasurer may make any fund transfers
necessary to execute the offset. (L. 1994 H.B. 1362 § 4)

Expires 9-30-06

*Word "month" appears in original rolls.

1. Each nursing facility reimbursement allowance determination
shall be final after receipt of written notice from the department of
social services, unless the nursing facility files a protest with the
director of the department of social services setting forth the grounds
on which the protest is based, within thirty days from the date of
receipt of written notice from the department of social services to the
nursing facility.

2. If a timely protest is filed, the director of the department of social
services shall reconsider the determination and, if the nursing facility
has so requested, the director or the director's designee shall grant the
nursing facility a hearing to be held within forty-five days after the
protest is filed, unless extended by agreement between the nursing
facility and the director. The director shall issue a final decision
within forty-five days of the completion of the hearing. After
reconsideration of the reimbursement allowance determination and a final
decision by the director of the department of social services, a nursing
home's appeal of the director's final decision shall be to the
administrative hearing commission in accordance with sections 208.156 and
621.055, RSMo. (L. 1994 H.B. 1362 § 5)

Expires 9-30-06

The director of the department of social services shall
prescribe by rule the form and content of any document required to be
filed pursuant to the provisions of sections 198.401 to 198.436. (L. 1994
H.B. 1362 § 6)

Expires 9-30-06

1. The nursing facility reimbursement allowance owed or, if an
offset has been requested, the balance, if any, after such offset, shall
be remitted by the nursing facility to the department of social services.
The remittance shall be made payable to the director of the department of
revenue. The amount remitted shall be deposited in the state treasury to
the credit of the "Nursing Facility Reimbursement Allowance Fund", which
is hereby created for the sole purposes of providing payment to nursing
facilities and disbursing up to five percent of the federal funds
deposited to the nursing facility reimbursement allowance fund each year,
not to exceed one million five hundred thousand dollars, to the credit of
the nursing facility quality of care fund, subject to appropriation. The
"Nursing Facility Quality of Care Fund" is hereby created in the state
treasury. All investment earnings of the nursing facility quality of care
fund shall be credited to the nursing facility quality of care fund. The
unexpended balance in the nursing facility quality of care fund at the
end of the biennium is exempt from the provisions of section 33.080,
RSMo. The unexpended balance shall not revert to the general revenue
fund, but shall accumulate in the nursing facility quality of care fund
from year to year. All investment earnings of the nursing facility
reimbursement allowance fund shall be credited to the nursing facility
reimbursement allowance fund.

2. An offset as authorized by this section or a payment to the nursing
facility reimbursement allowance fund shall be accepted as payment of the
nursing facility's obligation imposed by section 198.401.

3. The state treasurer shall maintain records that show the amount of
money in the nursing facility reimbursement allowance fund at any time
and the amount of any investment earnings on that amount. The department
of social services shall disclose such information to any interested
party upon written request.

4. The unexpended balance in the nursing facility reimbursement allowance
fund at the end of the biennium is exempt from the provisions of section
33.080, RSMo. The unexpended balance shall not revert to the general
revenue fund, but shall accumulate in the nursing facility reimbursement
allowance fund from year to year. (L. 1994 H.B. 1362 § 7)

Expires 9-30-06

1. A nursing facility reimbursement allowance period as provided
in sections 198.401 to 198.436 shall be from the first day of October to
the thirtieth day of September. The department shall notify each nursing
facility with a balance due on the thirtieth day of September of each
year the amount of such balance due. If any nursing home fails to pay its
nursing facility reimbursement allowance within thirty days of such
notice, the reimbursement allowance shall be delinquent. The
reimbursement allowance may remain unpaid during an appeal or as allowed
in section 198.412.

2. Except as otherwise provided in this section, if any reimbursement
allowance imposed under the provision of section 198.401 for a previous
reimbursement allowance period is unpaid and delinquent, the department
of social services may proceed to enforce the state's lien against the
property of the nursing facility and to compel the payment of such
reimbursement allowance in the circuit court having jurisdiction in the
county where the nursing facility is located. In addition, the director
of the department of social services or the director's designee may
cancel or refuse to issue, extend or reinstate a Medicaid provider
agreement to any nursing facility which fails to pay such delinquent
reimbursement allowance required by section 198.401 unless under appeal
as allowed in section 198.412.

3. Except as otherwise provided in this section, failure to pay a
delinquent reimbursement allowance imposed under section 198.401 shall be
grounds for denial, suspension or revocation of a license granted under
this chapter. The director of the department of social services may deny,
suspend or revoke the license of any nursing facility which fails to pay
a delinquent reimbursement allowance unless under appeal as allowed in
section 198.412. (L. 1994 H.B. 1362 § 8)

Expires 9-30-06

Nothing in sections 198.401 to 198.436 shall be deemed to affect
or in any way limit the tax-exempt or nonprofit status of any nursing
facility granted by state law. (L. 1994 H.B. 1362 § 9)

Expires 9-30-06

The department of social services shall make payments to those
nursing facilities that have a valid Medicaid provider agreement with the
department. Any per diem rate, or its equivalent, used to compute such
payments shall be equal to or greater than the nursing facility's per
diem rate in effect on January 1, 1994, for those facilities with a
permanent rate established in accordance with regulations promulgated by
the department of social services. Those nursing facilities without a
permanent rate or with an interim rate as of January 1, 1994, will be
subject to having their permanent rate established in accordance with
regulations promulgated by the department of social services in effect on
January 1, 1994. Once the permanent rate is established, any per diem
rate, or its equivalent, used to compute such payments shall be equal to
or greater than the permanent rate established according to regulations
in effect on January 1, 1994. The nursing facility reimbursement
allowance shall not be used to supplant, and shall be in addition to,
general revenue payments to nursing facilities. (L. 1994 H.B. 1362 § 10)

Expires 9-30-06

If the division of family services is unable to make a
determination regarding Medicaid eligibility for a resident within sixty
days of the submission of a completed application for medical assistance
for nursing facility services, the patient shall be Medicaid eligible
until the application is approved or denied. However, in no event shall
benefits be construed to commence prior to the date of application. (L.
2003 S.B. 556 & 311)

Expires 9-30-06

The requirements of sections 198.401 to 198.433 shall apply only
as long as the revenues generated under section 198.401 are eligible for
federal financial participation as provided in sections 198.401 to
198.433 and payments are made pursuant to the provisions of section
198.401. For the purpose of this section, "federal financial
participation" is the federal government's share of Missouri's
expenditures under the Medicaid program. Notwithstanding anything in this
section to the contrary, in the event federal financial participation is
either denied, discontinued, reduced in excess of five percent per year
or no longer available for the revenues generated under section 198.401,
the director of the department of social services shall cause
disbursement of all funds held in the nursing facility reimbursement
allowance fund to be made to all nursing facilities in accordance with
regulations promulgated by the department of social services, along with
a full accounting of such disbursements, within forty-five days of
receipt of notice thereof by the department of social services. (L. 1994
H.B. 1362 § 11)

Expires 9-30-06

The nursing home reimbursement allowance provided in section
198.401 shall not be imposed prior to the effective date of rules and
regulations promulgated by the department of social services, but in no
event prior to October 1, 1994. (L. 1994 H.B. 1362 § 12)

Expires 9-30-06

No regulations implementing sections 198.401 to 198.436 may be
filed with the secretary of state without first being provided to
interested parties registered on a list of such parties to be maintained
by the director of the department of social services. Regulations must be
provided to all interested parties seventy-two hours prior to being filed
with the secretary of state. No rule or portion of a rule promulgated
under the authority of sections 198.401 to 198.436 shall become effective
unless it has been promulgated pursuant to the provisions of section
536.024, RSMo. (L. 1994 H.B. 1362 § 13, A.L. 1995 S.B. 3)

Expires 9-30-06

Sections 198.401 to 198.436 shall expire on September 30, 2006.
(L. 1994 H.B. 1362 § 14, A.L. 1996 S.B. 952, A.L. 1999 S.B. 326, A.L.
2002 H.B. 1781 merged with S.B. 1094, A.L. 2005 S.B. 189)

Effective 5-13-05

Sections 198.500 to 198.515 shall be known and may be cited as
the "Alzheimer's Special Care Disclosure Act". (L. 1996 H.B. 781 § 1)

For the purposes of sections 198.500 to 198.515, "Alzheimer's
special care unit" or "Alzheimer's special care program" means any
facility as defined in section 198.006, or any home health agency, adult
day care center, hospice or adult foster home that locks, secures,
segregates or provides a special program or special unit for residents
with a diagnosis of probable Alzheimer's disease or a related disorder,
to prevent or limit access by a resident outside the designated or
separated area; and that advertises, markets or otherwise promotes the
facility as providing specialized Alzheimer's or dementia care services.
(L. 1996 H.B. 781 § 2)

1. Any facility which offers to provide or provides care for
persons with Alzheimer's disease by means of an Alzheimer's special care
unit or Alzheimer's special care program shall be required to disclose
the form of care or treatment provided that distinguishes that unit or
program as being especially applicable, or suitable for persons with
Alzheimer's or dementia. The disclosure shall be made to the department
which licenses the facility, agency or center giving the special care. At
the time of admission of a patient requiring treatment rendered by the
Alzheimer's special care program, a copy of the disclosure made to the
department shall be delivered by the facility to the patient and the
patient's next of kin, designee, or guardian. The licensing department
shall examine all such disclosures in the department's records and verify
the information on the disclosure for accuracy as part of the facility's
regular license renewal procedure.

2. The department of social services and the department of health and
senior services shall develop a single disclosure form to be completed by
the facility, agency or center giving the special care. The information
required to be disclosed by subsection 1 of this section on this form
shall include, if applicable, an explanation of how the care is different
from the rest of the facility in the following areas:

(1) The Alzheimer's special care unit's or program's written statement of
its overall philosophy and mission which reflects the need of residents
afflicted with dementia;

(2) The process and criteria for placement in, transfer or discharge
from, the unit or program;

(3) The process used for assessment and establishment of the plan of care
and its implementation, including the method by which the plan of care
evolves and is responsive to changes in condition;

(4) Staff training and continuing education practices;

(5) The physical environment and design features appropriate to support
the functioning of cognitively impaired adult residents;

(6) The frequency and types of resident activities;

(7) The involvement of families and the availability of family support
programs;

(8) The costs of care and any additional fees; and

(9) Safety and security measures. (L. 1996 H.B. 781 § 3)

Any facility which offers to provide or provides care for
persons with Alzheimer's disease by means of an Alzheimer's special care
unit or Alzheimer's special care program shall be required to provide an
informational document developed by or approved by the division of aging.
The document shall include but is not limited to updated information on
selecting an Alzheimer's special care unit or Alzheimer's special care
program. The document shall be given to any person seeking information
about or placement in an Alzheimer's special care unit or Alzheimer's
special care program. The distribution of this document shall be verified
by the licensing department as part of the facility's regular license
renewal procedure. (L. 1996 H.B. 781 § 4)

Except as otherwise provided pursuant to section 198.526, in
order to comply with sections 198.012 and 198.022, the department of
health and senior services shall inspect residential care facilities I,
residential care facilities II, intermediate care facilities, and skilled
nursing, including those facilities attached to acute care hospitals at
least twice a year. (L. 1999 S.B. 8 & 173 § 4, A.L. 2003 S.B. 556 & 311)

1. Except as provided in subsection 3 of this section, the
department of health and senior services shall inspect all facilities
licensed by the department at least twice each year. Such inspections
shall be conducted:

(1) Without the prior notification of the facility; and

(2) At times of the day, on dates and at intervals which do not permit
facilities to anticipate such inspections.

2. The department shall annually reevaluate the inspection process to
ensure the requirements of subsection 1 of this section are met.

3. The department may reduce the frequency of inspections to once a year
if a facility is found to be in substantial compliance. The basis for
such determination shall include, but not be limited to, the following:

(1) Previous inspection reports;

(2) The facility's history of compliance with rules promulgated pursuant
to this chapter;

(3) The number and severity of complaints received about the facility; and

(4) In the year subsequent to a finding of no class I violations or class
II violations, the facility does not have a change in ownership,
operator, or, if the department finds it significant, a change in
director of nursing.

4. Information regarding unannounced inspections shall be disclosed to
employees of the department on a need-to-know basis only. Any employee of
the department who knowingly discloses the time of an unannounced
inspection in violation of this section is guilty of a class A
misdemeanor and shall have his or her employment immediately terminated.
(L. 1999 S.B. 326 § 4, A.L. 2003 S.B. 556 & 311)

CROSS REFERENCE: Rulemaking authority, RSMo 198.534

To ensure uniformity of application of regulation standards in
long-term care facilities throughout the state, the department of social
services shall:

(1) Evaluate the requirements for inspectors or surveyors of facilities,
including the eligibility, training and testing requirements for the
position. Based on the evaluation, the department shall develop and
implement additional training and knowledge standards for inspectors and
surveyors;

(2) Periodically evaluate the performance of the inspectors or surveyors
regionally and statewide to identify any deviations or inconsistencies in
regulation application. At a minimum, the Missouri on- site surveyor
evaluation process, and the number and type of actions overturned by the
informal dispute resolution process and formal appeal shall be used in
the evaluation. Based on such evaluation, the department shall develop
standards and a retraining process for the region, state, or individual
inspector or surveyor, as needed;

(3) In addition to the provisions of subdivisions (1) and (2) of this
section, the department shall develop a single uniform comprehensive and
mandatory course of instruction for inspectors/surveyors on the practical
application of enforcement of statutes, rules and regulations. Such
course shall also be open to attendance by administrators and staff of
facilities licensed pursuant to this chapter. (L. 1999 H.B. 316, et al. §
2)

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

(1) The most recent survey of every long-term care facility licensed in
this state and any such findings of deficiencies and the effect the
deficiency would have on such facility. If such survey is in dispute, the
survey shall not be posted on the web site until the facility's informal
dispute resolution process resolves the dispute and the department shall,
upon request of the facility, post the facility's response;

(2) The facility's proposed plan of correction;

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

(4) Information on how to obtain a copy of a complete facility 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)

1. If an enrollee in a managed care organization is also a
resident in a long-term care facility licensed pursuant to chapter 198,
or a continuing care retirement community, as defined in section 197.305,
RSMo, such enrollee's managed care organization shall provide the
enrollee with the option of receiving the covered service in the
long-term care facility which serves as the enrollee's primary residence.
For purposes of this section, "managed care organization" means any
organization that offers any health plan certified by the department of
health and senior services designed to provide incentives to medical care
providers to manage the cost and use of care associated with claims,
including, but not limited to, a health maintenance organization and
preferred provider organization. The resident enrollee's managed care
organization shall reimburse the resident facility for those services
which would otherwise be covered by the managed care organization if the
following conditions apply:

(1) The facility is willing and able to provide the services to the
resident; and

(2) The facility and those health care professionals delivering services
to residents pursuant to this section meet the licensing and training
standards as prescribed by law; and

(3) The facility is certified through Medicare; and

(4) The facility and those health care professionals delivering services
to residents pursuant to this section agree to abide by the terms and
conditions of the health carrier's contracts with similar providers,
abide by patient protection standards and requirements imposed by state
or federal law for plan enrollees and meet the quality standards
established by the health carrier for similar providers.

2. The managed care organization shall reimburse the resident facility at
a rate of reimbursement not less than the Medicare allowable rate
pursuant to Medicare rules and regulations.

3. The services in subsection 1 of this section shall include, but are
not limited to, skilled nursing care, rehabilitative and other therapy
services, and postacute care, as needed. Nothing in this section shall
limit the managed care organization from utilizing contracted providers
to deliver the services in the enrollee's resident facility.

4. A resident facility shall not prohibit a health carrier's
participating providers from providing covered benefits to an enrollee in
the resident facility. A resident facility or health care professional
shall not impose any charges on an enrollee for any service that is
ancillary to, a component of, or in support of the services provided
under this section when the services are provided by a health carrier's
participating provider, or otherwise create a disincentive for the use of
the health carrier's participating providers. Any violation of the
requirements of this subsection by the resident facility shall be
considered abuse or neglect of the resident enrollee. (L. 1999 H.B. 316,
et al. § 3)

1. The division of aging, in collaboration with qualified
Missouri schools and universities, shall establish an aging-in-place
pilot program at a maximum of four selected sites throughout the state
which will provide a continuum of care for elders who need long-term
care. For purposes of this section, "qualified Missouri schools and
universities" means any Missouri school or university which has a school
of nursing, a graduate nursing program, or any other similar program or
specialized expertise in the areas of aging, long-term care or health
services for the elderly.

2. The pilot program shall:

(1) Deliver a full range of physical and mental health services to
residents in the least restrictive environment of choice to reduce the
necessity of relocating such residents to other locations as their health
care needs change;

(2) Base licensure on services provided rather than on facility type; and

(3) Be established in selected urban, rural and regional sites throughout
the state.

3. The directors of the division of aging and division of medical
services shall apply for all federal waivers necessary to provide
Medicaid reimbursement for health care services received through the
aging-in-place pilot program.

4. The division of aging shall monitor the pilot program and report to
the general assembly on the effectiveness of such program, including
quality of care, resident satisfaction and cost-effectiveness to include
the cost equivalent of unpaid or volunteer labor.

5. Developments authorized by this section shall be exempt from the
provisions of sections 197.300 to 197.367, RSMo, and shall be licensed by
the division of aging. (L. 1999 S.B. 326 § 9, A.L. 2001 S.B. 266)

1. Complaints filed with the department of health and senior
services against a long-term care facility which allege that harm has
occurred or is likely to occur to a resident or residents of the facility
due to actions or the lack of actions taken by the facility shall be
investigated within thirty days of receipt of such complaints. The
purpose of such investigation shall be to ensure the safety, protection
and care of all residents of the facility likely to be affected by the
alleged action or inaction. Such investigation shall be in addition to
the investigation requirements for abuse and neglect reports pursuant to
section 198.070.

2. The department shall provide the results of all investigations in
accordance with section 660.320, RSMo. The department shall provide the
results of such investigation in writing to all parties to the complaint,
and if requested, to any of the facility's residents, or their family
members or guardians. Complaints and written results will be readily
available for public access and review at the department of health and
senior services and at the long-term care facility. Personal information
identifying the resident will be blanked out, except in regard to
immediate family, the attorney-in-fact or the legal guardian of the
resident in question. This information will remain readily available for
a period of time determined by the department of health and senior
services. (L. 1999 S.B. 326 § 1, A.L. 2003 S.B. 556 & 311)

The division shall ensure that any monitor selected to perform
state investigations of long-term care facilities has no conflict of
interest, and has no direct or indirect connection to the facility or its
parent corporation. (L. 1999 S.B. 326 § 2)

In consultation with consumers, providers and others, the
division shall promulgate rules and regulations to implement the
provisions of this section and sections 198.080, 198.086, 198.526,
198.532 and 198.533. 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 and sections 198.080, 198.086, 198.526, 198.532
and 198.533 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, 1999, shall be invalid and void. (L.
1999 S.B. 326 § 6)

By January 1, 2000, the division of aging shall establish an
informal dispute resolution pilot project in one area of the state to be
designated by the division. Such pilot project shall require that, if
requested, a division representative provide at least one face-to-face
conference in a timely fashion with a facility resident or such
resident's family members or guardians when a resident is the subject of
a complaint investigation, or cited in a facility inspection or survey
completed by the division pursuant to this chapter. The primary purpose
of such face-to- face conference shall be to obtain information and
facilitate a satisfactory resolution of any concerns communicated by a
resident, a resident's family members or guardians. By December 31, 2001,
the division shall report to the general assembly on the effectiveness of
the pilot project, and include recommendations for continuing, expanding
or modifying the project. (L. 1999 S.B. 326 § 7)

1. The department of health and senior services shall establish
a "Uniform Data Management Pilot Program" at a minimum of fifty selected
facilities of varying licensure or classification throughout the state to
improve patient care and retention of nursing facility staff. The
department shall determine the nature and extent of the pilot program and
provide all necessary resources.

2. The pilot program shall be implemented no later than six months after
funding for the pilot program is made available.

3. The pilot program shall:

(1) Encourage the utilization of existing or the purchase of new software
in an effort to modernize the procedures for compiling and disseminating
data for long-term care facilities;

(2) Enable physicians, licensed nurses, and facility personnel to devote
more quality time to patient care; and

(3) Be established in selected urban, rural, and regional sites
throughout the state.

4. The department of health and senior services shall monitor the pilot
program and report to the general assembly by January first next
following the implementation of the pilot program pursuant to this
section on the effectiveness of such program, including quality of care,
employee satisfaction, and cost-effectiveness. (L. 2003 S.B. 556 & 311)

Usa-missouri Law Firm / Lawyers Services Provided in Usa-missouri :

Usa-missouri Divorce Laws, custody, Usa-missouri Corporate Lawyers, Agreement, provident fund, Registered marriage, Court marriage Lawyers, Special/ Foreign marriage, Incorporation of company, Rent, eviction, tenancy, Lease Lawyers, Usa-missouri Labour laws, Appeals, Supreme Court Lawyers, High Court Lawyers, Bail, medical, negligence, Insurance claims/ accidents Lawyer, Usa-missouri Citizenship/ immigration Lawyers, Copyright Laws, Consumer, district Laywer, State, national, Dowry, Wills & Probate, Trust & Estates Lawyers, Intellectual Property Lawyer, Bankrupt Lawyers, Banking & Finance, Corporate, Private Business Law, Recovery, Joint Venture & Mergers, Consumer, Civil Right Law Usa-missouri, Medical Negligence, Medical Malpractice, legal notice, summons, Income Tax Lawyers, sales, Custom Law, Excise Law, octroi, cess Civil, Criminal Solicitor Usa-missouri, Registration of property, Title search, mutation relationship, Conveyance, Transfer of Property Law, Usa-missouri Property lawyer, deeds, drafts, power of attorney, Recovery, Taxation Laws in Usa-missouri

This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship. Persons accessing this site are encouraged to seek independent counsel for advice in India abroad regarding their individual legal, civil criminal issues or consult one of the experts online.