197.305. Definitions.
Definitions.
197.305. As used in sections 197.300 to 197.366, the following termsmean:
(1) "Affected persons", the person proposing the development of a newinstitutional health service, the public to be served, and health carefacilities within the service area in which the proposed new health careservice is to be developed;
(2) "Agency", the certificate of need program of the Missouri departmentof health and senior services;
(3) "Capital expenditure", an expenditure by or on behalf of a healthcare facility which, under generally accepted accounting principles, is notproperly chargeable as an expense of operation and maintenance;
(4) "Certificate of need", a written certificate issued by the committeesetting forth the committee's affirmative finding that a proposed projectsufficiently satisfies the criteria prescribed for such projects by sections197.300 to 197.366;
(5) "Develop", to undertake those activities which on their completionwill result in the offering of a new institutional health service or theincurring of a financial obligation in relation to the offering of such aservice;
(6) "Expenditure minimum" shall mean:
(a) For beds in existing or proposed health care facilities licensedpursuant to chapter 198, RSMo, and long-term care beds in a hospital asdescribed in subdivision (3) of subsection 1 of section 198.012, RSMo, sixhundred thousand dollars in the case of capital expenditures, or four hundredthousand dollars in the case of major medical equipment, provided, however,that prior to January 1, 2003, the expenditure minimum for beds in such afacility and long-term care beds in a hospital described in section 198.012,RSMo, shall be zero, subject to the provisions of subsection 7 of section197.318;
(b) For beds or equipment in a long-term care hospital meeting therequirements described in 42 CFR, Section 412.23(e), the expenditure minimumshall be zero; and
(c) For health care facilities, new institutional health services orbeds not described in paragraph (a) or (b) of this subdivision one milliondollars in the case of capital expenditures, excluding major medicalequipment, and one million dollars in the case of medical equipment;
(7) "Health care facilities", hospitals, health maintenanceorganizations, tuberculosis hospitals, psychiatric hospitals, intermediatecare facilities, skilled nursing facilities, residential care facilities andassisted living facilities, kidney disease treatment centers, includingfreestanding hemodialysis units, diagnostic imaging centers, radiation therapycenters and ambulatory surgical facilities, but excluding the private officesof physicians, dentists and other practitioners of the healing arts, andChristian Science sanatoriums, also known as Christian Science Nursingfacilities listed and certified by the Commission for Accreditation ofChristian Science Nursing Organization/Facilities, Inc., and facilities ofnot-for-profit corporations in existence on October 1, 1980, subject either tothe provisions and regulations of Section 302 of the Labor-ManagementRelations Act, 29 U.S.C. 186 or the Labor-Management Reporting and DisclosureAct, 29 U.S.C. 401-538, and any residential care facility or assisted livingfacility operated by a religious organization qualified pursuant to Section501(c)(3) of the federal Internal Revenue Code, as amended, which does notrequire the expenditure of public funds for purchase or operation, with atotal licensed bed capacity of one hundred beds or fewer;
(8) "Health service area", a geographic region appropriate for theeffective planning and development of health services, determined on the basisof factors including population and the availability of resources, consistingof a population of not less than five hundred thousand or more than threemillion;
(9) "Major medical equipment", medical equipment used for the provisionof medical and other health services;
(10) "New institutional health service":
(a) The development of a new health care facility costing in excess ofthe applicable expenditure minimum;
(b) The acquisition, including acquisition by lease, of any health carefacility, or major medical equipment costing in excess of the expenditureminimum;
(c) Any capital expenditure by or on behalf of a health care facility inexcess of the expenditure minimum;
(d) Predevelopment activities as defined in subdivision (13) hereofcosting in excess of one hundred fifty thousand dollars;
(e) Any change in licensed bed capacity of a health care facility whichincreases the total number of beds by more than ten or more than ten percentof total bed capacity, whichever is less, over a two-year period;
(f) Health services, excluding home health services, which are offeredin a health care facility and which were not offered on a regular basis insuch health care facility within the twelve-month period prior to the timesuch services would be offered;
(g) A reallocation by an existing health care facility of licensed bedsamong major types of service or reallocation of licensed beds from onephysical facility or site to another by more than ten beds or more than tenpercent of total licensed bed capacity, whichever is less, over a two-yearperiod;
(11) "Nonsubstantive projects", projects which do not involve theaddition, replacement, modernization or conversion of beds or the provision ofa new health service but which include a capital expenditure which exceeds theexpenditure minimum and are due to an act of God or a normal consequence ofmaintaining health care services, facility or equipment;
(12) "Person", any individual, trust, estate, partnership, corporation,including associations and joint stock companies, state or politicalsubdivision or instrumentality thereof, including a municipal corporation;
(13) "Predevelopment activities", expenditures for architecturaldesigns, plans, working drawings and specifications, and any arrangement orcommitment made for financing; but excluding submission of an application fora certificate of need.
(L. 1979 H.B. 222 § 2, A.L. 1982 S.B. 481, A.L. 1983 H.B. 825, A.L. 1994 H.B. 1408, A.L. 1996 H.B. 905 merged with H.B. 1362, A.L. 1997 S.B. 373, A.L. 1998 S.B. 963, A.L. 1999 S.B. 326)Effective 7-01-99
*Reprinted due to editorial change required by § 198.005.
CROSS REFERENCE:
Health care facilities, definition, effective after December 31, 2001, RSMo 197.366
(1995) Acquisition cost for major medical equipment for purposes of minimum expenditure necessary to subject expenditure to certificate of need law, refers to cost to hospital and not original purchase price. Cost of land and construction costs for building were attributable to separate commercial enterprise and not made by, or on behalf of, health care facility where hospital leased space for outpatient radiation therapy services. SSM Health Care v. Missouri Health Facilities Review Committee, 894 S.W.2d 674 (Mo. en banc).
(2004) Nursing facility's proposal to add twelve beds constituted a new institutional health service requiring certificate of need, even though the proposed capital expenditure was below the expenditure minimum. McKnight Place v. Missouri Health Facilities Review Committee, 142 S.W.3d 228 (Mo.App.W.D.).