19 CSR 60-50.300 - Retail Licensees
PURPOSE: The committee is amending this rule to define the terms "Affiliate" and "Request to relicense," remove verbiage requiring replacement equipment to submit a full CON application and related organizations, add clarity for non-applicability 10/10% rule and service area requirements, and includes a CON form within the rule rather than incorporating it by reference.
(1)
Affiliate means an organization:
(A) That owns
five percent (5%) or more of the ownership interests in the operator;
or
(B) In which the operator owns
five percent (5%) or more of the ownership interests. Affiliates include,
without limitation, a parent organization, joint venture, partner, or general
partner.
(2) Applicant
means all owner(s) and operator(s) of any new institutional health
service.
(3) By or on behalf of a
health care facility includes any expenditures made by the facility itself as
well as capital expenditures made by other persons that assist the facility in
offering services to its patients/residents.
(4) Cost means-
(A)
Price paid or to be paid by the applicant for a new institutional health
service to acquire, purchase, or develop a health care facility or major
medical equipment; or
(B) Fair
market value of the health care facility or major medical equipment as
determined by the current selling price at the date of the application as
quoted by builders or architects for similar facilities, or normal suppliers of
the requested equipment; or
(C)
Fair market value of the existing land(s) and building(s) to be converted as
determined by the current selling price at the date of the application or a
current appraisal.
(5)
Construction of a new hospital means the establishment of a newly-licensed
facility at a specific location under the Hospital Licensing Law, section
197.020.2, RSMo, as the result of building, renovation, modernization, and/or
conversion of any structure not licensed as a hospital.
(6) Expedited application means a shorter
than full application and review period as defined in
19 CSR 60-50.420
and 19 CSR 6050.430 for any long-term care expansion or replacement as defined
in section 197.318.4.-6., RSMo, long-term care renovation and modernization, or
the replacement of any major medical equipment as defined in section (12) of
this rule.
(7) Full review means
the complete analytical period for applications as described in
19 CSR 60-50.420
and
19 CSR
60-50.430 for the development of health care
facilities and acquisition of major medical equipment.
(8) Generally accepted accounting principles
pertaining to capital expenditures include, but are not limited to-
(A) Expenditures related to acquisition or
construction of capital assets;
(B)
Capital assets are investments in property, plant and equipment used for the
production of other goods and services approved by the committee; and
(C) Land is not considered a capital asset
until actually converted for that purpose with commencement of aboveground
construction approved by the committee.
(9) Health care facility means those described in
section
197.366,
RSMo.
(10) Health care facility
expenditure includes the capital value of new construction or renovation costs,
architectural/engineering fees, equipment not in the construction contract,
land acquisition costs, consultants'/legal fees, interest during construction,
predevelopment costs as defined in section
197.305(12),
RSMo, in excess of one hundred fifty thousand dollars ($150,000), any existing
land and building converted to the applicant's medical use for the first time,
and any other capitalizable costs incurred over a twelve- (12-) month period as
listed on the "Proposed Project Budget" (Form MO 580-1863), included
herein.
(11) Health maintenance
organizations means entities as defined in section
354.400(10),
RSMo, except for activities directly related to the provision of insurance
only.
(12) Major medical equipment
means any piece of equipment and collection of functionally related devices
acquired to operate the equipment and additional related costs such as
software, shielding, and installation, acquired over a twelve- (12-) month
period with an aggregate cost of one (1) million dollars or more, when the
equipment is intended to provide the following diagnostic or treatment services
and related variations, including, but not limited to:
(A) Cardiac catheterization;
(B) Computed tomography;
(C) Gamma knife;
(D) Lithotripsy;
(E) Magnetic resonance imaging;
(F) Linear accelerator;
(G) Positron emission tomography/computed
tomography; or
(H) Evolving
technology.
(13)
Non-applicability review means a Letter of Intent process to document that a
CON is not needed for a proposal when the capital expenditure is less than the
expenditure minimum in section
197.305(6),
RSMo; the proposal is to increase the number of beds by ten (10) or ten percent
(10%) of total bed capacity, whichever is less, over a two- (2-) year period
since any long-term care beds were last licensed, the facility has had no
resident care class I deficiencies within the last eighteen (18) months and has
maintained at least an eighty-five percent (85%) average occupancy rate for the
previous six (6) quarters as shown by CON's most recent Six-Quarter Occupancy
of Intermediate Care and Skilled Nursing Facility (or Residential Care and
Assisted Living Facility) Licensed Beds report published on the CON website,
and the capital expenditure is less than the expenditure minimum in section
197.305(6),
RSMo; an exemption or exception is found in accordance with section
197.312,
RSMo; or the proposal meets the definition of a nonsubstantive
project.
(14) Nonsubstantive
project includes but is not limited to at least one (1) of the following
situations:
(A) An expenditure which is
required solely to meet federal or state requirements or involves
predevelopment costs or the development of a health maintenance
organization;
(B) The construction
or modification of nonpatient care services, including parking facilities,
sprinkler systems, heating or air-conditioning equipment, fire doors, food
service equipment, building maintenance, administrative equipment, telephone
systems, energy conservation measures, land acquisition, medical office
buildings, and other projects or functions of a similar nature; or
(C) Expenditures for construction, equipment,
or both, due to an act of God or a normal consequence of maintenance, but not
replacement, of health care facilities, beds, or equipment.
(15) "Request to relicense," a
health care facility licensed under Chapter 197 or Chapter 198 that ceases
offering health services may seek verification to relicense the facility within
twelve (12) months from the date of closure under the same general licensure
conditions at the time the facility ceased offering health services. Beds must
be relicensed in the same category of care at the time of closure and cannot
exceed the licensed bed capacity at the time of closure.
(16) Offer, when used in connection with health
services, means that the applicant asserts having the capability and the means
to provide and operate the specified health services.
(17) Predevelopment costs mean expenditures as defined
in section
197.305(12),
RSMo, including consulting, legal, architectural, engineering, financial, and
other activities directly related to the proposed project, but excluding the
application fee for submission of the application for the proposed
project.
(18) For new hospitals or
major medical equipment projects, service area means a geographic region made
up of an area such as a county or contiguous areas such as a set of contiguous
counties or zip codes, appropriate to the proposed service, documented by the
applicant and approved by the committee. For long-term care projects, the
fifteen- (15-) mile radius calculation must be used.
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Notes
*Original authority: 197.320, RSMo 1979, amended 1993, 1995, 1999.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
PURPOSE: The committee proposes to amend this rule for statute updates and to expand the cost definition.
(1) Applicant means all owner(s) and operator(s) of any new institutional health service.
(2) By or on behalf of a health care facility includes any expenditures made by the facility itself as well as capital expenditures made by other persons that assist the facility in offering services to its patients/residents.
(3) Cost means-
(A) Price paid or to be paid by the applicant for a new institutional health service to acquire, purchase or develop a health care facility or major medical equipment; or
(B) Fair market value of the health care facility or major medical equipment as determined by the current selling price at the date of the application as quoted by builders or architects for similar facilities, or normal suppliers of the requested equipment; or
(C) Fair market value of the existing land(s) and building(s) to be converted as determined by the current selling price at the date of the application or a current appraisal.
(4) Construction of a new hospital means the establishment of a newly-licensed facility at a specific location under the Hospital Licensing Law, section 197.020.2, RSMo, as the result of building, renovation, modernization, and/or conversion of any structure not licensed as a hospital.
(5) Expedited application means a shorter than full application and review period as defined in 19 CSR 60-50.420 and 19 CSR 60-50.430 for any long-term care expansion or replacement as defined in section 197.318.4.-6., RSMo, long-term care renovation and modernization, or the replacement of any major medical equipment as defined in section (11) of this rule which holds a Certificate of Need (CON) previously granted by the Missouri Health Facilities Review Committee (committee). An applicant for the replacement of major medical equipment not previously approved by the committee shall apply for a full review.
(6) Full review means the complete analytical period for applications as described in 19 CSR 60-50.420 and 19 CSR 60-50.430 for the development of health care facilities and acquisition of major medical equipment.
(7) Generally accepted accounting principles pertaining to capital expenditures include, but are not limited to-
(A) Expenditures related to acquisition or construction of capital assets;
(B) Capital assets are investments in property, plant and equipment used for the production of other goods and services approved by the committee; and
(C) Land is not considered a capital asset until actually converted for that purpose with commencement of aboveground construction approved by the committee.
(8) Health care facility means those described in section 197.366, RSMo.
(9) Health care facility expenditure includes the capital value of new construction or renovation costs, architectural/engineering fees, equipment not in the construction contract, land acquisition costs, consultants'/legal fees, interest during construction, predevelopment costs as defined in section 197.305(12), RSMo, in excess of one hundred fifty thousand dollars ($150,000), any existing land and building converted to the applicant's medical use for the first time, and any other capitalizable costs incurred over a twelve (12)-month period as listed on the "Proposed Project Budget" (Form MO 580-1863, ).
(10) Health maintenance organizations means entities as defined in section 354.400(10), RSMo, except for activities directly related to the provision of insurance only.
(11) Major medical equipment means any piece of equipment and collection of functionally related devices acquired to operate the equipment and additional related costs such as software, shielding, and installation, acquired over a twelve (12)-month period with an aggregate cost of one (1) million dollars or more, when the equipment is intended to provide the following diagnostic or treatment services and related variations, including, but not limited to:
(A) Cardiac catheterization;
(B) Computed tomography;
(C) Gamma knife;
(D) Lithotripsy;
(E) Magnetic resonance imaging;
(F) Linear accelerator;
(G) Positron emission tomography/computed tomography; or
(H) Evolving technology.
(12) Non-applicability review means a Letter of Intent process to document that a CON is not needed for a proposal when the capital expenditure is less than the expenditure minimum in section 197.305(6), RSMo; the proposal is to increase the number of beds by ten (10) or ten percent (10%) of total bed capacity, whichever is less, over a two- (2-) year period, the facility has had no patient care class I deficiencies within the last eighteen (18) months and has maintained at least an eighty-five percent (85%) average occupancy rate for the previous six (6) quarters as shown by CON's most recent Six-Quarter Occupancy of Intermediate Care and Skilled Nursing Facility (or Residential Care and Assisted Living Facility) Licensed Beds report published on the CON website, and the capital expenditure is less than the expenditure minimum in section 197.305(6), RSMo; an exemption or exception is found in accordance with section 197.312, RSMo; or the proposal meets the definition of a nonsubstantive project.
(13) Nonsubstantive project includes, but is not limited to, at least one (1) of the following situations:
(A) An expenditure which is required solely to meet federal or state requirements or involves predevelopment costs or the development of a health maintenance organization;
(B) The construction or modification of nonpatient care services, including parking facilities, sprinkler systems, heating or air-conditioning equipment, fire doors, food service equipment, building maintenance, administrative equipment, telephone systems, energy conservation measures, land acquisition, medical office buildings, and other projects or functions of a similar nature; or
(C) Expenditures for construction, equipment, or both, due to an act of God or a normal consequence of maintenance, but not replacement, of health care facilities, beds, or equipment.
(14) Offer, when used in connection with health services, means that the applicant asserts having the capability and the means to provide and operate the specified health services.
(15) Predevelopment costs mean expenditures as defined in section 197.305(12), RSMo, including consulting, legal, architectural, engineering, financial, and other activities directly related to the proposed project, but excluding the application fee for submission of the application for the proposed project.
(16) Related organization means an organization that is associated or affiliated with, has control over or is controlled by, or has any direct financial interest in, the organization applying for a project including, without limitation, an underwriter, guarantor, parent organization, joint venturer, partner, or general partner.
(17) Service area means a geographic region appropriate to the proposed service, documented by the applicant and approved by the committee. For long-term care projects, the fifteen (15)-mile radius calculation must be used.
(18) The following form cited in this rule is incorporated by reference and published by the Certificate of Need Program (CONP), February 1, 2013, and may be downloaded from obtained by mailing a written request with a self-addressed stamped envelope to CONP, PO Box 570, Jefferson City, MO 65102-0570 rms.php, obtained by emailing a written request to CONP@health.mo.gov, or acquired in person at the CONP Office, 3418 Knipp Drive, Suite F, Jefferson City, Missouri, 65102 (573) 751-6403. This rule does not include any later amendments or additions.
(A) Proposed Project Budget (Form MO 580-1863).
Notes
*Original authority: 197.320, RSMo 1979, amended 1993, 1995, 1999.