197.318. Certification ineligibility not to apply, when--department certification of no need final--ethnic and religious composition of residents may be considered--no expenditure minimum, expiration
Certification ineligibility not to apply, when--departmentcertification of no need final--ethnic and religious compositionof residents may be considered--no expenditure minimum,expiration date--licensed and available, defined--review ofletters of intent--application of law in pending courtcases--expansion procedures.
197.318. 1. The provisions of section 197.317 shall not apply to aresidential care facility, assisted living facility, intermediate carefacility or skilled nursing facility only where the department of socialservices has first determined that there presently exists a need foradditional beds of that classification because the average occupancy of alllicensed and available residential care facility, assisted living facility,intermediate care facility and skilled nursing facility beds exceeds ninetypercent for at least four consecutive calendar quarters, in a particularcounty, and within a fifteen-mile radius of the proposed facility, and thefacility otherwise appears to qualify for a certificate of need. Thedepartment's certification that there is no need for additional beds shallserve as the final determination and decision of the committee. Indetermining ninety percent occupancy, residential care facility and assistedliving facility shall be one separate classification and intermediate care andskilled nursing facilities are another separate classification.
2. The Missouri health facilities review committee may, for any facilitycertified to it by the department, consider the predominant ethnic orreligious composition of the residents to be served by that facility inconsidering whether to grant a certificate of need.
*3. There shall be no expenditure minimum for facilities, beds, orservices referred to in subdivisions (1), (2) and (3) of section 197.317. Theprovisions of this subsection shall expire January 1, 2003.
4. As used in this section, the term "licensed and available" means bedswhich are actually in place and for which a license has been issued.
5. The provisions of section 197.317 shall not apply to any facilitywhere at least ninety-five percent of the patients require diets meeting thedietary standards defined by section 196.165, RSMo.
6. The committee shall review all letters of intent and applications forlong-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 tolitigation pending in state court on or before April 1, 1996, in which theMissouri health facilities review committee is a defendant in an actionconcerning the application of sections 197.300 to 197.366 to long-term carehospital 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 itslicensed bed capacity by:
(a) Submitting a letter of intent to expand to the division of aging andthe 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 eighteenmonths; and
b. Has maintained a ninety-percent average occupancy rate for theprevious six quarters;
(c) Has made an effort to purchase beds for eighteen months followingthe 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 fromanother 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 forthe expansion of the purchaser facility upon surrender of the seller'slicense; 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 bedcapacity within the same licensure category by twenty-five percent or thirtybeds, whichever is greater, if that same licensure category in such facilityhas experienced an average occupancy of ninety-three percent or greater overthe previous six quarters;
b. A facility with fewer than forty beds may expand its licensed bedcapacity within the same licensure category by twenty-five percent or tenbeds, whichever is greater, if that same licensure category in such facilityhas experienced an average occupancy of ninety-two percent or greater over theprevious six quarters;
c. A facility adding beds pursuant to subparagraphs a. or b. of thisparagraph shall not expand by more than fifty percent of its then licensed bedcapacity in the qualifying licensure category;
(2) Any beds sold shall, for five years from the date of relicensure bythe purchaser, remain unlicensed and unused for any long-term care service inthe 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 beconsidered by the department of social services as licensed and available forpurposes 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 anyother facility to be licensed within the same licensure category if bothfacilities are under the same licensure ownership or control, and are locatedwithin six miles of each other;
(5) A facility licensed pursuant to chapter 198, RSMo, may transfer orsell individual long-term care licensed beds to facilities qualifying pursuantto paragraphs (a) and (b) of subdivision (1) of this subsection. Any facilitywhich transfers or sells licensed beds shall not expand its licensed bedcapacity in that licensure category for a period of five years from the datethe licensure is relinquished.
9. Any existing licensed and operating health care facility offeringlong-term care services may replace one-half of its licensed beds at the samesite or a site not more than thirty miles from its current location if, for atleast the most recent four consecutive calendar quarters, the facilityoperates only fifty percent of its then licensed capacity with every residentresiding in a private room. In such case:
(1) The facility shall report to the division of aging vacant beds asunavailable for occupancy for at least the most recent four consecutivecalendar quarters;
(2) The replacement beds shall be built to private room specificationsand only used for single occupancy; and
(3) The existing facility and proposed facility shall have the sameowner or owners, regardless of corporate or business structure, and such owneror owners shall stipulate in writing that the existing facility beds to bereplaced will not later be used to provide long-term care services. If thefacility is being operated under a lease, both the lessee and the owner of theexisting facility shall stipulate the same in writing.
10. Nothing in this section shall prohibit a health care facilitylicensed pursuant to chapter 198, RSMo, from being replaced in its entiretywithin fifteen miles of its existing site so long as the existing facility andproposed or replacement facility have the same owner or owners regardless ofcorporate or business structure and the health care facility being replacedremains unlicensed and unused for any long-term care services whether they door do not require a license from the date of licensure of the replacementfacility.
(L. 1986 S.B. 553 & 775 § 6, A.L. 1992 S.B. 573 & 634, A.L. 1994 H.B. 1408, A.L. 1996 S.B. 575, A.L. 1996 H.B. 1362, A.L. 1997 S.B. 373, A.L. 1999 S.B. 326)Effective 7-01-99
*Subsection 3 expires 1-01-03
**Revisor's note: The term "residential care facility" may include "assisted living facility", see section 198.005 regarding changes to name reference.