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Section: 197.0318 Licensed and available, defined--review of letters of intent--application of law in pending court cases--expansion procedures. RSMO 197.318


Published: 2015

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Missouri Revised Statutes













Chapter 197

Medical Treatment Facility Licenses

←197.317

Section 197.318.1

197.320→

August 28, 2015

Licensed and available, defined--review of letters of intent--application of law in pending court cases--expansion procedures.

197.318. 1. As used in this section, the term "licensed and

available" means beds which are actually in place and for which a license

has been issued.



2. The committee shall review all letters of intent and applications

for long-term care hospital beds meeting the requirements described in 42

CFR, Section 412.23(e) under its criteria and standards for long-term care

beds.



3. Sections 197.300 to 197.366 shall not be construed to apply to

litigation pending in state court on or before April 1, 1996, in which the

Missouri health facilities review committee is a defendant in an action

concerning the application of sections 197.300 to 197.366 to long-term care

hospital beds meeting the requirements described in 42 CFR, Section

412.23(e).



4. Notwithstanding any other provision of this chapter to the

contrary:



(1) A facility licensed pursuant to chapter 198 may increase its

licensed bed capacity by:



(a) Submitting a letter of intent to expand to the department of

health and senior services and the health facilities review committee;



(b) Certification from the department of health and senior services

that the facility:



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

months; and



b. Has maintained a ninety-percent average occupancy rate for the

previous six quarters;



(c) Has made an effort to purchase beds for eighteen months following

the date the letter of intent to expand is submitted pursuant to paragraph

(a) of this subdivision. For purposes of this paragraph, an "effort to

purchase" means a copy certified by the offeror as an offer to purchase

beds from another licensed facility in the same licensure category; and



(d) If an agreement is reached by the selling and purchasing

entities, the health facilities review committee shall issue a certificate

of need for the expansion of the purchaser facility upon surrender of the

seller's license; or



(e) If no agreement is reached by the selling and purchasing

entities, the health facilities review committee shall permit an expansion

for:



a. A facility with more than forty beds may expand its licensed bed

capacity within the same licensure category by twenty-five percent or

thirty beds, whichever is greater, if that same licensure category in such

facility has experienced an average occupancy of ninety-three percent or

greater over the previous six quarters;



b. A facility with fewer than forty beds may expand its licensed bed

capacity within the same licensure category by twenty-five percent or ten

beds, whichever is greater, if that same licensure category in such

facility has experienced an average occupancy of ninety-two percent or

greater over the previous six quarters;



c. A facility adding beds pursuant to subparagraphs a. or b. of this

paragraph shall not expand by more than fifty percent of its then licensed

bed capacity in the qualifying licensure category;



(2) Any beds sold shall, for five years from the date of relicensure

by the purchaser, remain unlicensed and unused for any long-term care

service in the selling facility, whether they do or do not require a

license;



(3) The beds purchased shall, for two years from the date of

purchase, remain in the bed inventory attributed to the selling facility

and be considered by the department of social services as licensed and

available for purposes of this section;



(4) Any residential care facility licensed pursuant to chapter 198

may relocate any portion of such facility's current licensed beds to any

other facility to be licensed within the same licensure category if both

facilities are under the same licensure ownership or control, and are

located within six miles of each other;



(5) A facility licensed pursuant to chapter 198 may transfer or sell

individual long-term care licensed beds to facilities qualifying pursuant

to paragraphs (a) and (b) of subdivision (1) of this subsection. Any

facility which transfers or sells licensed beds shall not expand its

licensed bed capacity in that licensure category for a period of five years

from the date the licensure is relinquished.



5. Any existing licensed and operating health care facility offering

long-term care services may replace one-half of its licensed beds at the

same site or a site not more than thirty miles from its current location

if, for at least the most recent four consecutive calendar quarters, the

facility operates only fifty percent of its then licensed capacity with

every resident residing in a private room. In such case:



(1) The facility shall report to the health and senior services

vacant beds as unavailable for occupancy for at least the most recent four

consecutive calendar quarters;



(2) The replacement beds shall be built to private room

specifications and only used for single occupancy; and



(3) The existing facility and proposed facility shall have the same

owner or owners, regardless of corporate or business structure, and such

owner or owners shall stipulate in writing that the existing facility beds

to be replaced will not later be used to provide long-term care services.

If the facility is being operated under a lease, both the lessee and the

owner of the existing facility shall stipulate the same in writing.



6. Nothing in this section shall prohibit a health care facility

licensed pursuant to chapter 198 from being replaced in its entirety within

fifteen miles of its existing site so long as the existing facility and

proposed or replacement facility have the same owner or owners regardless

of corporate or business structure and the health care facility being

replaced remains unlicensed and unused for any long-term care services

whether they do or do not require a license from the date of licensure of

the replacement facility.



(L. 1986 S.B. 553 & 775 § 6, A.L. 1992 S.B. 573 & 634, A.L. 1994 H.B.

1408, A.L. 1996 S.B. 575, A.L. 1996 H.B. 1362, A.L. 1997 S.B.

373, A.L. 1999 S.B. 326, A.L. 2010 H.B. 1516 Revision merged with

H.B. 1965, A.L. 2014 H.B. 1299 Revision)





2010

1999



2010



197.318. 1. As used in this section, the term "licensed and

available" means beds which are actually in place and for which a license

has been issued.



2. The committee shall review all letters of intent and applications

for long-term care hospital beds meeting the requirements described in 42

CFR, Section 412.23(e) under its criteria and standards for long-term care

beds.



3. Sections 197.300 to 197.366 shall not be construed to apply to

litigation pending in state court on or before April 1, 1996, in which the

Missouri health facilities review committee is a defendant in an action

concerning the application of sections 197.300 to 197.366 to long-term care

hospital beds meeting the requirements described in 42 CFR, Section

412.23(e).



4. Notwithstanding any other provision of this chapter to the

contrary:



(1) A facility licensed pursuant to chapter 198 may increase its

licensed bed capacity by:



(a) Submitting a letter of intent to expand to the division of aging

and the health facilities review committee;



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



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

months; and



b. Has maintained a ninety-percent average occupancy rate for the

previous six quarters;



(c) Has made an effort to purchase beds for eighteen months following

the date the letter of intent to expand is submitted pursuant to paragraph

(a) of this subdivision. For purposes of this paragraph, an "effort to

purchase" means a copy certified by the offeror as an offer to purchase

beds from another licensed facility in the same licensure category; and



(d) If an agreement is reached by the selling and purchasing

entities, the health facilities review committee shall issue a certificate

of need for the expansion of the purchaser facility upon surrender of the

seller's license; or



(e) If no agreement is reached by the selling and purchasing

entities, the health facilities review committee shall permit an expansion

for:



a. A facility with more than forty beds may expand its licensed bed

capacity within the same licensure category by twenty-five percent or

thirty beds, whichever is greater, if that same licensure category in such

facility has experienced an average occupancy of ninety-three percent or

greater over the previous six quarters;



b. A facility with fewer than forty beds may expand its licensed bed

capacity within the same licensure category by twenty-five percent or ten

beds, whichever is greater, if that same licensure category in such

facility has experienced an average occupancy of ninety-two percent or

greater over the previous six quarters;



c. A facility adding beds pursuant to subparagraphs a. or b. of this

paragraph shall not expand by more than fifty percent of its then licensed

bed capacity in the qualifying licensure category;



(2) Any beds sold shall, for five years from the date of relicensure

by the purchaser, remain unlicensed and unused for any long-term care

service in the selling facility, whether they do or do not require a

license;



(3) The beds purchased shall, for two years from the date of

purchase, remain in the bed inventory attributed to the selling facility

and be considered by the department of social services as licensed and

available for purposes of this section;



(4) Any residential care facility licensed pursuant to chapter 198

may relocate any portion of such facility's current licensed beds to any

other facility to be licensed within the same licensure category if both

facilities are under the same licensure ownership or control, and are

located within six miles of each other;



(5) A facility licensed pursuant to chapter 198 may transfer or sell

individual long-term care licensed beds to facilities qualifying pursuant

to paragraphs (a) and (b) of subdivision (1) of this subsection. Any

facility which transfers or sells licensed beds shall not expand its

licensed bed capacity in that licensure category for a period of five years

from the date the licensure is relinquished.



5. Any existing licensed and operating health care facility offering

long-term care services may replace one-half of its licensed beds at the

same site or a site not more than thirty miles from its current location

if, for at least the most recent four consecutive calendar quarters, the

facility operates only fifty percent of its then licensed capacity with

every resident residing in a private room. In such case:



(1) The facility shall report to the division of aging vacant beds as

unavailable for occupancy for at least the most recent four consecutive

calendar quarters;



(2) The replacement beds shall be built to private room

specifications and only used for single occupancy; and



(3) The existing facility and proposed facility shall have the same

owner or owners, regardless of corporate or business structure, and such

owner or owners shall stipulate in writing that the existing facility beds

to be replaced will not later be used to provide long-term care services.

If the facility is being operated under a lease, both the lessee and the

owner of the existing facility shall stipulate the same in writing.



6. Nothing in this section shall prohibit a health care facility

licensed pursuant to chapter 198 from being replaced in its entirety within

fifteen miles of its existing site so long as the existing facility and

proposed or replacement facility have the same owner or owners regardless

of corporate or business structure and the health care facility being

replaced remains unlicensed and unused for any long-term care services

whether they do or do not require a license from the date of licensure of

the replacement facility.



1999



197.318. 1. The provisions of section 197.317 shall not apply to a

residential care facility, assisted living facility, intermediate care

facility or skilled nursing facility only where the department of social

services has first determined that there presently exists a need for

additional beds of that classification because the average occupancy of all

licensed and available residential care facility, assisted living facility,

intermediate care facility and skilled nursing facility beds exceeds ninety

percent for at least four consecutive calendar quarters, in a particular

county, and within a fifteen-mile radius of the proposed facility, and the

facility otherwise appears to qualify for a certificate of need. The

department's certification that there is no need for additional beds shall

serve as the final determination and decision of the committee. In

determining ninety percent occupancy, residential care facility and assisted

living facility shall be one separate classification and intermediate care and

skilled nursing facilities are another separate classification.



2. The Missouri health facilities review committee may, for any facility

certified to it by the department, consider the predominant ethnic or

religious composition of the residents to be served by that facility in

considering whether to grant a certificate of need.



*3. There shall be no expenditure minimum for facilities, beds, or

services referred to in subdivisions (1), (2) and (3) of section 197.317. The

provisions of this subsection shall expire January 1, 2003.



4. As used in this section, the term "licensed and available" means beds

which are actually in place and for which a license has been issued.



5. The provisions of section 197.317 shall not apply to any facility

where at least ninety-five percent of the patients require diets meeting the

dietary standards defined by section 196.165, RSMo.



6. The committee shall review all letters of intent and applications for

long-term care hospital beds meeting the requirements described in 42 CFR,

Section 412.23(e) under its criteria and standards for long-term care beds.



7. Sections 197.300 to 197.366 shall not be construed to apply to

litigation pending in state court on or before April 1, 1996, in which the

Missouri health facilities review committee is a defendant in an action

concerning the application of sections 197.300 to 197.366 to long-term care

hospital beds meeting the requirements described in 42 CFR, Section 412.23(e).



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



(1) A facility licensed pursuant to chapter 198, RSMo, may increase its

licensed bed capacity by:



(a) Submitting a letter of intent to expand to the division of aging and

the health facilities review committee;



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



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

months; and



b. Has maintained a ninety-percent average occupancy rate for the

previous six quarters;



(c) Has made an effort to purchase beds for eighteen months following

the date the letter of intent to expand is submitted pursuant to paragraph (a)

of this subdivision. For purposes of this paragraph, an "effort to purchase"

means a copy certified by the offeror as an offer to purchase beds from

another licensed facility in the same licensure category; and



(d) If an agreement is reached by the selling and purchasing entities,

the health facilities review committee shall issue a certificate of need for

the expansion of the purchaser facility upon surrender of the seller's

license; or



(e) If no agreement is reached by the selling and purchasing entities,

the health facilities review committee shall permit an expansion for:



a. A facility with more than forty beds may expand its licensed bed

capacity within the same licensure category by twenty-five percent or thirty

beds, whichever is greater, if that same licensure category in such facility

has experienced an average occupancy of ninety-three percent or greater over

the previous six quarters;



b. A facility with fewer than forty beds may expand its licensed bed

capacity within the same licensure category by twenty-five percent or ten

beds, whichever is greater, if that same licensure category in such facility

has experienced an average occupancy of ninety-two percent or greater over the

previous six quarters;



c. A facility adding beds pursuant to subparagraphs a. or b. of this

paragraph shall not expand by more than fifty percent of its then licensed bed

capacity in the qualifying licensure category;



(2) Any beds sold shall, for five years from the date of relicensure by

the purchaser, remain unlicensed and unused for any long-term care service in

the selling facility, whether they do or do not require a license;



(3) The beds purchased shall, for two years from the date of purchase,

remain in the bed inventory attributed to the selling facility and be

considered by the department of social services as licensed and available for

purposes of this section;



(4) Any residential care facility** licensed pursuant to chapter 198,

RSMo, may relocate any portion of such facility's current licensed beds to any

other facility to be licensed within the same licensure category if both

facilities are under the same licensure ownership or control, and are located

within six miles of each other;



(5) A facility licensed pursuant to chapter 198, RSMo, may transfer or

sell individual long-term care licensed beds to facilities qualifying pursuant

to paragraphs (a) and (b) of subdivision (1) of this subsection. Any facility

which transfers or sells licensed beds shall not expand its licensed bed

capacity in that licensure category for a period of five years from the date

the licensure is relinquished.



9. Any existing licensed and operating health care facility offering

long-term care services may replace one-half of its licensed beds at the same

site or a site not more than thirty miles from its current location if, for at

least the most recent four consecutive calendar quarters, the facility

operates only fifty percent of its then licensed capacity with every resident

residing in a private room. In such case:



(1) The facility shall report to the division of aging vacant beds as

unavailable for occupancy for at least the most recent four consecutive

calendar quarters;



(2) The replacement beds shall be built to private room specifications

and only used for single occupancy; and



(3) The existing facility and proposed facility shall have the same

owner or owners, regardless of corporate or business structure, and such owner

or owners shall stipulate in writing that the existing facility beds to be

replaced will not later be used to provide long-term care services. If the

facility is being operated under a lease, both the lessee and the owner of the

existing facility shall stipulate the same in writing.



10. Nothing in this section shall prohibit a health care facility

licensed pursuant to chapter 198, RSMo, from being replaced in its entirety

within fifteen miles of its existing site so long as the existing facility and

proposed or replacement facility have the same owner or owners regardless of

corporate or business structure and the health care facility being replaced

remains unlicensed and unused for any long-term care services whether they do

or do not require a license from the date of licensure of the replacement

facility.



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