PURPOSE: This rule sets forth general licensure and application procedures and outlines the request for an exception procedure related to long-term care facility licensure.

PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.

1. (1) Persons wishing to operate a skilled nursing facility, intermediate care facility, assisted living facility, or residential care facility shall complete form MO 580-2631 (8-07), Application for License to Operate a Long-Term Care Facility, incorporated by reference in this rule and available through the Department of Health and Senior Services’ (department’s) website at www. dhss.mo.gov, or by mail at: Department of Health and Senior Services, Section for Long-Term Care Regulation, Licensure Unit, PO Box 570, Jefferson City, MO 65102-0570, telephone:

2. (573) 526-8524. This rule does not incorporate any subsequent amendments or additions. The application shall be signed by a person with the express authority to sign on behalf of the operator, who shall attest by signature that the information submitted is true and correct to the best of the applicant’s knowledge and belief and that all required documents are either included with the application or are currently on file with the department. The completed application form may be submitted by mail or electronically. If submitted electronically, send the completed application to LTCapplication@dhss. mo.gov. The application fee for application processing should be submitted by separate mail. If submitted by mail, send the application form and fee to Department of Health and Senior Services, Section for Long-Term Care Regulation, Fee Receipts, PO Box 570, 920 Wildwood, Jefferson City, MO 65102. One (1) application may be used to license multiple facilities if located on the same premises.

   1. (A) The applicant shall submit the following documents and information as listed in the application:

      1. 1. Financial information demonstrating that the applicant

has the financial capacity to operate the facility;

1. 2. A document disclosing the location, capacity, and type

of licensure and certification of any support buildings, wings, or floors housing residents on the same or adjoining premises or plots of ground;

1. 3. A document disclosing the name, address, and type of

license of all other long-term care facilities owned or operated by either the applicant or by the owner of the facility for which the application is being submitted;

1. 4. A copy of any executed management contracts between

the applicant and the manager of the facility;

1. 5. A copy of any executed contract conveying the legal

right to the facility premises, including, but not limited to, leases, subleases, rental agreements, contracts for deed, and any amendments to those contracts;

1. 6. A copy of any contract by which the facility’s land,

building, improvements, furnishings, fixtures, or accounts receivable are pledged in whole or in part as security, if the value of the asset pledged is greater than five hundred dollars ($500);

1. 7. A nursing home surety bond or noncancelable escrow

agreement, if the applicant holds or will hold facility residents’ personal funds in trust;

1. 8. A document disclosing the name, address, title, and per-

centage of ownership of each affiliate of any general partnership, limited partnership, general business corporation, nonprofit corporation, limited liability company, or governmental entity which owns or operates the facility or is an affiliate of an entity which owns or operates the facility. If an affiliate is a corporation, partnership, or LLC, a list of the affiliate’s affiliates must also be submitted. As used in this rule, the word “affiliate” means:

1. A. With respect to a partnership, each partner thereof;
2. B. With respect to a limited partnership, the general

partner and each limited partner with an interest of five percent (5%) or more in the limited partnership;

1. C. With respect to a corporation, each person who owns,

holds, or has the power to vote five percent (5%) or more of any class of securities issued by the corporation, and each officer and director;

1. D. With respect to an LLC, the LLC managers and

members with an interest of five percent (5%) or more;

1. 9. If applicable, a document stating the name and nature

of any additional businesses in operation on the facility premises and the document issued by the division giving its prior written approval for each business;

1. 10. A list of all principals in the operation of the facility

and their addresses and titles and, so that the department may verify the information disclosed pursuant to paragraphs (1)(A)11. and (1)(A)12. of this rule, the Social Security numbers or employer identification numbers of the operator and all principals in the operation of the facility. As used in this rule, “principal” means officer, director, owner, partner, key employee, or other person with primary management or supervisory responsibilities;

1. 11. Disclosure concerning whether the operator or any

principals in the operation of the facility are excluded from participation in the Title XVIII (Medicare) or Title XIX (Medicaid) program of any state or territory;

1. 12. Disclosure concerning whether the operator or any

principals in the operation of the facility have ever been convicted of a felony in any state or federal court concerning conduct involving either management of a long-term care facility or the provision or receipt of health care services;

1. 13. Emergency telephone, fax, and email contact

information for the facility administrator, director of nursing, and the operator’s corporate office; and

1. 14. Disclosure concerning whether the facility has a

Department of Mental Health (DMH) license.

1. (B) Every facility that provides specialized Alzheimer’s or dementia care services, as defined in sections 198.500 to 198.515, RSMo, by means of an Alzheimer’s special care unit or program shall submit to the department with the licensure application or renewal, the following:

   1. 1. Form MO 580-2637, Alzheimer’s Special Care Services

Disclosure (2-07), incorporated by reference in this rule and available through the department’s website: www.dhss.mo.gov, or by mail at: Department of Health and Senior Services, Section for Long-Term Care Regulation, Licensure Unit, PO Box 570, Jefferson City, MO 65102-0570, telephone: (573) 526-8524. This rule does not incorporate any subsequent amendments or additions. The form shall be completed showing how the care provided by the special care unit or program differs from care provided in the rest of the facility in the following areas:

1. A. The Alzheimer’s special care unit’s or program’s

written statement of its overall philosophy and mission which reflects the needs of residents afflicted with dementia;

1. B. The process and criteria for placement in, or transfer

or discharge from, the unit or program;

1. C. 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;

1. D. Staff training and continuing education practices;
2. E. The physical environment and design features

appropriate to support the functioning of cognitively impaired adult residents;

1. F. The frequency and types of resident activities;
2. G. The involvement of families and the availability of

family support programs;

1. H. The costs of care and any additional fees; and
2. I. Safety and security measures; and
3. 2. Form Guide to Selecting an Alzheimer’s Special Care Unit

(6/06) #455, incorporated by reference in this rule and available through the department’s website: at http://www.dhss.mo.gov/ Ombudsman, or by mail at: Department of Health and Senior Services, Section for Long-Term Care Regulation, Licensure Unit, PO Box 570, Jefferson City, MO 65102-0570, telephone: (573) 526-8524 or a document of choice which contains, but is not limited to, all information on selecting an Alzheimer’s special care unit or program that is contained in the Guide to Selecting an Alzheimer’s Special Care Unit (6/06) #455. This rule does not incorporate any subsequent amendments or additions.

1. (C) If, after filing an application, the operator identifies an error or if any information changes the issuance of the license, including but not limited to, a change in the administrator, board of directors, officers, level of care, number of beds, or change in the name of the operating entity, the operator shall—

   1. 1. Submit the correction or additional information to the

department’s Licensure and Certification Unit in a letter. The letter shall be signed by a person with express authority to sign on behalf of the operator attesting by signature that the information being submitted is true and correct to the best of the operator’s knowledge and belief; or

1. 2. Submit the correction or additional information to the

department’s Licensure and Certification Unit. The additional information may be submitted electronically or by mail. Information shall be submitted using form MO 580-2623 (8-07), Corrections For Long-Term Care Facility License Application, incorporated by reference in this rule and available through the Department of Health and Senior Services’ (department’s) website at www.dhss.mo.gov, or by mail at: Department of Health and Senior Services, Section for Long-Term Care Regulation, Licensure Unit, PO Box 570, Jefferson City, MO 65102-0570, telephone: (573) 526-8524. This rule does not incorporate any subsequent amendments or additions. The completed correction form shall be signed by a person with express authority to sign on behalf of the operator attesting by signature that the information submitted is true and correct to the best of the operator’s knowledge and belief and shall be submitted by electronic mail to LTCapplication@dhss.mo.gov, or by mail to: Department of Health and Senior Services, Section for Long-Term Care Regulation, Fee Receipts, PO Box 570, 920 Wildwood, Jefferson City, MO 65102.

1. (D) If, as a result of an application review, the department requests a correction or additional information, the operator, within ten (10) working days of receipt of the written request shall—

   1. 1. Submit the correction or additional information to

the department in a letter attesting by signature that the information being submitted is true and correct to the best of the operator’s knowledge and belief; or

1. 2. Submit the correction or additional information using

form MO 580-2623 (8-07), Corrections For Long-Term Care Facility License Application referenced in paragraph (1)(C)2. of this rule.

1. (E) A new facility shall submit an application for an original license not less than thirty (30) days before the anticipated opening date. The department must approve the application before a licensure inspection is scheduled. Sixty (60) days after its receipt, the department shall consider any application for an original license withdrawn if it is submitted without all the required information and documents. If intending to continue with licensure, the operator shall submit a new application and fee along with all necessary documents.
2. (F) An operator shall submit a relicensure application thirty

1. (30) to ninety (90) days prior to the existing license’s expiration date.

   1. (G) If, during the license’s effective period, an operator which is a partnership, limited partnership, or corporation undergoes any of the changes described in section 198.015.4, RSMo, or a new corporation, partnership, limited partnership, limited liability company, or other entity assumes facility operation, within ten (10) working days of the effective date of that change, the operator shall submit an application for a new license.
   2. (H) The department shall issue each license only for the premises and operator named in the application. This license shall cover the entire premises unless stipulated otherwise and shall not be transferable. If the licensed operator of a facility is replaced by another operator, the new operator shall apply for a new license before the effective date of the change. A change of operator shall include a change in form of business as well as a change of person. Upon receipt of the application and receipt of confirmation that the change of operator has taken place, the department shall grant the new operator a temporary operating permit of sufficient duration to allow the department time to evaluate the application, conduct any necessary inspection(s) to determine substantial compliance with the law and the rules, and to either issue or deny a license to the new operator. The new operator shall be subject to all the terms and conditions under which the previous operator’s license or temporary operating permit was issued. This includes any existing statement of deficiencies, plans of correction and compliance with any additional requirements imposed by the department as a result of any existing substantial noncompliance. The new operator, however, shall apply to the department for renewal in his/her/its name for any exception to the rules that had been granted the previous operator under the provisions of section (3) of this rule.
   3. (I) The operator shall accompany each application for a license to operate a long-term care facility (skilled nursing facility, intermediate care facility, assisted living facility or residential care facility) with a license fee of one hundred dollars ($100) for those facilities which have a resident capacity of at least three (3) but less than twenty-five (25), three hundred dollars ($300) for those facilities which have a resident capacity of twenty-five through one hundred (25–100), and six hundred dollars ($600) for those facilities with a capacity of over one hundred (100+). The operator shall submit a separate fee for each facility’s license application. This fee is nonrefundable unless the facility withdraws the application within ten (10) days of receipt by the department. The department will issue a license for a period of no more than two (2) years for the premises and operator named in the application. If the license is for less than two (2) years, the department will prorate the fees accordingly.

   4. (J) An operator may apply for licenses for two (2) or more different levels of care located on the same premises either by submitting one (1) application or by submitting a separate application for each level of care. If an operator elects to submit one (1) application for two (2) or more levels of care located on the same premises—

      1. 1. The application shall specify separately the number of

beds of each level of care being applied for;

1. 2. The application shall be accompanied by a license fee

for each level of care applied for, as required by subsection (1) (I) of this rule; and

1. 3. An application for two (2) or more levels of care on the

same premises shall indicate one (1) facility name only.

1. (K) The department shall issue a separate license for each level of care located on the same premises, whether applied for by one (1) application or more than one (1). If the operator uses one (1) application for two (2) or more levels of care on the same premises, the department shall issue licenses with one (1) expiration date. If two (2) or more levels of care have existing licenses with different expiration dates and the operator elects to apply for licenses for the levels of care by submitting one

1. (1) relicensure application, the expiration dates of the licenses issued shall be two (2) years subsequent to the expiration date of the license of the level of care expiring earliest following receipt of the application by the department. Fees for unused portions of licenses resulting from the submission of one (1) application for two (2) or more levels of care are nonrefundable.

   1. (L) After receiving a license application, 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—

      1. 1. The department has determined that the application is

complete, and that all necessary documents have been filed with the application including an approved nursing home bond or noncancelable escrow agreement if personal funds of residents are held in trust;

1. 2. The department has determined that the statements in

the application are true and correct;

1. 3. The department has determined that the facility and the

operator are in substantial compliance with the provisions of sections 198.003–198.096, RSMo, and the corresponding rules;

1. 4. The department has determined that the applicant has

the financial capacity to operate the facility;

1. 5. The department has verified that the administrator of a

residential care facility that was licensed as a residential care facility II on August 27, 2006 and chooses to continue to meet all laws, rules, and regulations that were in place on August 27, 2006 for a residential care facility II, assisted living facility, an intermediate care facility, or a skilled nursing facility is currently licensed by the Missouri Board of Nursing Home Administrators under the provisions of Chapter 344, RSMo;

1. 6. The department has received the fee required by

subsection (1)(I) of this rule;

1. 7. The applicant meets the definition of operator as

defined in 19 CSR 30-83.010;

1. 8. The applicant has received a Certificate of Need, if

required, or has received a determination from the Certificate of Need Program that no certificate is required, has completed construction, and is in substantial compliance with the licensure rules and laws;

1. 9. The department has determined that neither the

operator, owner, or any principals in the operation of the facility have ever been convicted of an offense concerning the operation of a long-term care facility or other health care facility or, while acting in a management capacity, ever knowingly acted or knowingly failed to perform any duty which materially and adversely affected the health, safety, welfare, or property of a resident;

1. 10. The department has determined that neither the

operator, owner, or any principals in the operation of the facility are excluded from participation in the Title XVIII (Medicare) or Title XIX (Medicaid) program of any state or territory;

1. 11. The department has determined that neither the

operator, owner, or any principals in the operation of the facility have ever been convicted of a felony in any state or federal court concerning conduct involving either management of a long-term care facility or the provision or receipt of health care services; and

1. 12. The department has determined that all fees due the

state have been paid.

1. (M) If, during the period in which a license is in effect, a change occurs which causes the statements in the application to no longer be correct, including change of administrator, or if any document is executed which replaces, succeeds or amends any of the documents filed with the application, within ten (10) working days of the effective date of the change, the operator shall—

   1. 1. Submit a letter to the department’s Licensure and

Certification Unit that contains a correction of the application with notification of the effective date of the change and a copy of any new documents. The operator must ensure the letter is signed by a person with the express authority to sign on behalf of the operator, who shall attest by signature that the information being submitted is true and correct to the best of the operator’s knowledge and belief; or

1. 2. Submit to the department a correction of the application

and a copy of any new documentation and information by submitting form Corrections for Long-Term Care Facility License Application referenced in paragraph (1)(C)2. of this rule.

1. (N) If from an analysis of financial information submitted with the application, or if from information obtained during the term of a license, the operator appears insolvent or shows a tendency toward insolvency, the department shall have the right to request additional financial information from the operator. Within ten (10) working days after receiving a written request from the department, the operator shall—

   1. 1. Submit to the department the additional information

requested in a letter accompanied by a statement attesting by signature that the information being submitted is true and correct to the best of the operator’s knowledge and belief; or

1. 2. Submit the financial information to the department

on form Corrections for Long-Term Care Facility License Application referenced in paragraph (1)(C)2. of this rule.

1. (O) A license applicant’s financial information, data, and records submitted to the department as required by this rule, including, but not limited to, copies of any Internal Revenue Service forms, shall be open for inspection and be released only—

   1. 1. To designated employees of the department;
   2. 2. To the applicant furnishing this information or to his/her

representative as designated in writing;

1. 3. To the director of the department or to his/her

representative as designated in writing;

1. 4. To the state auditor or his/her representative as

designated in writing;

1. 5. To appropriate committees of the General Assembly or

their representatives as designated in writing;

1. 6. In any judicial or administrative proceeding brought

under the Omnibus Nursing Home Act; or

1. 7. When so ordered by a court of competent jurisdiction.
2. (P) To obtain a license for an additional level of care on the premises, the licensed operator shall submit a written request by electronic mail to LTCapplication@dhss.mo.gov, or mail to the department for the issuance of a license for the desired level of care. The request shall indicate the level of care, the number of beds desired, the name and address of the facility, the name and address of the operator, and shall include the signature of the operator. The request shall be signed by a person with the express authority to sign on behalf of the operator, who shall attest by signature that the information submitted is true and correct to the best of the operator’s knowledge and belief. The licensure fee shall accompany this request. Requests are subject to department approval. The operator shall submit this request no less than sixty (60) days prior to the initiation date of the new level of care. The department shall coordinate this license’s expiration date with that of the original license and the department shall prorate the license fee accordingly.

3. (Q) To request issuance of an amended license or temporary operating permit currently in effect, the operator shall—

   1. 1. Submit a written request to the department containing

the request for amendment, the date the operator would like the amendment to be effective, and the number of the license or temporary operating permit to be amended; and

1. 2. Submit a fee for the issuance of the amended license or

temporary operating permit as required by subsection (1)(R) of this rule.

1. (R) If an operator initiates a request to amend a license or temporary operating permit currently in effect, the department requires the following fees:

   1. 1. If the request is for an increase in bed capacity, the

operator shall submit a fee with the request which is the greater of—

1. A. The amount that would have been required by

subsection (1)(I) of this rule if the increase in bed capacity has been included in the application, less any amount actually paid under that subsection; or

1. B. Fifty dollars ($50); and
2. 2. If the request is for a decrease in resident capacity or

any other change, the operator shall submit a fee of twenty-five dollars ($25) with the request.

1. (S) The department shall approve all requests for bed changes prior to issuance of an amended license or temporary operating permit. The effective date of the amended license or temporary operating permit shall be no earlier than the date the department approved the request for bed change.
2. (T) If the department issues a temporary operating permit, and then subsequently issues a regular license, the licensing period shall include the period of operation under the temporary operating permit. The licensing period shall also include any period during which the department was enjoined or stayed from revoking or denying a license or rendering the temporary operating permit null and void.
3. (U) Unless an operator indicates otherwise, all the rooms and space on the premises and all persons eighteen (18) years of age and over living on the premises shall be considered as part of the facility and its licensed capacity or staff and shall be subject to compliance with all rules governing the operation of a licensed facility. If an operator, when applying or reapplying for a license, wants to exclude some portion of the premises from being licensed or wants to exclude a relative as a resident, a statement to that effect shall be filed as a separate document indicating the use which will be made of that area of the premises and who or what occupies the area, and what the relationship is of the relative(s) being excluded. The statement shall be signed by a person with the express authority to sign on behalf of the operator, who shall attest by signature that the information submitted is true and correct to the best of the operator’s knowledge and belief.
4. (V) The operator shall not provide care in any area on the premises to any related person who requires protective oversight unless there has been a written request to the department to consider any portion of the facility for private use and that indicates facility staff shall not be used at any time to care for the relative(s). Prior to the area being used in that manner, the operator shall submit the request for the department’s approval. The department, after investigation, shall approve or disapprove the request in writing within thirty

1. (30) days and shall issue or reissue the license indicating clearly which portion of the premises is excluded from licensure or which specific relative(s) is/are not considered a resident(s).

2. (2) If a facility was licensed under Chapter 197 or 198, RSMo, and was in operation before September 28, 1979, or if an application was on file or construction plans were approved prior to September 28, 1979, the facility shall comply with construction, fire safety and physical plant rules applicable to an existing or existing licensed facility provided there has been continuous operation of the facility under a license or temporary operating permit issued by the division. If, however, there was an interruption in the operation of the facility due to license denial, license revocation, or voluntary closure, the facility may be relicensed utilizing the same fire safety, construction, and physical plant rules that were applicable prior to the license denial, license revocation, or voluntary closure provided that the facility reapplies for a license within one (1) year of the date of the denial, revocation, or voluntary closure. Regardless of licensure, application, or construction plan approval date, intermediate care facilities and skilled nursing facilities shall comply with the fire safety standards published in 19 CSR 30-85.022.

   1. (A) If a facility changes from a skilled nursing or intermediate care facility to any other level, or if the facility changes from a an assisted living facility to a residential care facility, the facility shall comply with construction, fire safety, and physical plant rules applicable to an existing or existing licensed facility as defined in 19 CSR 30-83.010.
   2. (B) If the facility changes from a residential care facility to any other level or if an assisted living facility changes to an intermediate care or skilled nursing facility, the facility shall comply with construction, fire safety, and physical plant rules applicable to a new or newly licensed facility as defined in 19 CSR 30-83.010.
   3. (C) The facility shall comply with the rules applicable to a new or newly licensed facility if an application for relicensure has not been filed with the department within one (1) year of the license denial, license revocation, or voluntary closure. All such facilities seeking licensure as an assisted living facility shall also comply with the requirements of 19 CSR 30-86.047 and, if applicable, 19 CSR 30-86.045.

3. (3) Licensed Facility Closures.

   1. (A) If a licensed facility discontinues operation as evidenced by the fact that no residents are in care or at any time the department is unable to freely gain entry into the facility to conduct an inspection, the facility shall be considered closed. The department shall notify the operator in writing requesting the voluntary surrender of the license. If the department does not receive the license within thirty (30) days, it shall be void. If the operator should choose to again license the facility, the operator shall submit a complete application. The provisions of section (1) shall apply.

   2. (B) If any licensed skilled nursing facility or intermediate care facility is required to temporarily close for two (2) years or less from the effective date of the temporary closure due to staffing shortages as a result of a COVID-19 vaccine mandate first issued in emergency regulation by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) on November 4, 2021, effective on November 5, 2021, or any amendment changes or amendments thereafter, then the skilled nursing and intermediate care facilities shall do the following:

      1. 1. The facility operator shall submit a closure plan to the

department which is in compliance with state and federal law, including 42 CFR part 483.15(c) (detailed in federal deficiency F623 in the State Operations Manual appendix PP), 42 CFR part 483.70(l) (detailed in federal deficiency F845 in the State Operations Manual appendix PP), and 42 CFR 483.70(m) (detailed in federal deficiency F846 in the State Operations Manual appendix PP). The State Operations Manual appendix PP revised November 22, 2017, is incorporated by reference in this rule, as published by the Centers for Medicare and Medicaid Services and is available at www.cms.gov/Regulations-and-Guidance/ Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf. pdf or the United States Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244. This rule does not incorporate any subsequent amendments or additions. After review of the temporary closure plan, the department shall either approve or disapprove the plan;

1. 2. Facilities with approved closure plans by the department

shall ensure that all residents residing at the facility are provided discharge notices in accordance with federal and state law and the facility shall assist all residents with discharge planning in accordance with federal and state law;

1. 3. Facilities with approved closure plans by the department

shall enter into a consent agreement with the department for a probationary license. These facilities shall agree to discharge all residents by the effective date of the temporary closure and to admit no residents while the facility is temporarily closed;

1. 4. Temporary closure of facilities shall not be allowed past

two (2) years from the effective date of the temporary closure. The effective date of the temporary closure is the date the last resident left the facility;

1. 5. Facilities shall be reopened within two (2) years of the

effective date of the temporary closure. Prior to reopening, the department shall conduct a full survey/inspection and the facility may be approved by the department to reopen after this survey or inspection. Facilities shall not reopen until approved by the department;

1. 6. Facilities shall be reopened by the facility operator which

initiated the temporary closure and a change of operator may not occur during this period of temporary closure;

1. 7. Facilities shall submit plans of corrections, applications,

licensure, and certification fees in accordance with state law regardless of temporary closure status;

1. 8. Facilities approved by the department to be temporarily

closed will be noted as temporarily closed on state directories. The department will communicate temporary closure status of these facilities approved for temporary closure to CMS; and

1. 9. Facilities not approved for temporary closure by the

department which have closed or those facilities which stayed closed longer than two (2) years from the effective date of the temporary closure shall be considered closed. The department shall notify the operator in writing requesting the voluntary surrender of the license. If the department does not receive the license within thirty (30) days, it shall be void. If the operator should choose to again license the facility, the operator shall submit a complete application. The provisions of section (1) shall apply.

1. (4) The department may grant exceptions for specified periods of time to any rule imposed by the department if the department has determined that the exception to the rule would not potentially jeopardize the health, safety, or welfare of any residents of a long-term care facility.

   1. (A) The owner or operator of the facility shall make requests for exceptions in writing to the director of the department. These requests shall contain—

      1. 1. A copy of the latest Statement of Deficiencies which

shows a violation of the rule being cited, if the exception request is being made as a result of a deficiency issued during an inspection of the facility;

1. 2. The section number and text of the rule being cited;
2. 3. If applicable, specific reasons why compliance with

the rule would impose an undue hardship on the operator, including an estimate of any additional cost that might be involved;

1. 4. An explanation of any extenuating factors that may be

relevant; and

1. 5. A complete description of the individual characteristics

of the facility or residents, or of any other factors that would safeguard the health, safety, and welfare of the residents if the exception were granted.

1. (B) With the advice of the division’s licensure inspection field staff, the department will consider any requests that contain all the information required in subsection (4)(A). The department shall notify the operator, in writing, of the decision on any request for an exception, stating the reason(s) for acceptance or denial, and, if granted, the length of time the exception is to be in effect and any additional corrective factors upon which acceptance may be conditioned.
2. (C) The department shall only grant exceptions to licensure requirements set out in rules imposed by the department and cannot grant exceptions to requirements established by state statute or federal regulations. Operators wishing to obtain waivers of regulations under Title XVIII or Title XIX of the Social Security Act shall follow procedures established by the Centers for Medicare and Medicaid (CMS).

1. (5) When the department issues a notice of noncompliance to a facility pursuant to the Omnibus Nursing Home Act (section 198.026, RSMo), the department, only after affording the facility operator a reasonable opportunity to remedy the situation, shall—

   1. (A) Make every reasonable effort to provide residents of the facility or their legally authorized representatives or designees, if any—

      1. 1. A written notice of the noncompliance;
      2. 2. A list of other licensed facilities appropriate to the

resident’s needs; and

1. 3. A list of agencies that will assist the resident if he/she

moves from the facility; and

1. (B) After providing the information required by subsection (5)

1. (A) and allowing a time period for the residents of the facility to relocate if they wish, notify the Social Security Administration in writing that a notice of noncompliance has been issued to the facility, and the effective date of the notice. If the facility achieves substantial compliance with standards and rules later, the department shall notify the Social Security Administration of the effective date of the facility’s substantial compliance.
2. (6) A licensed facility shall comply with the provisions of Title VI of the Civil Rights Act 1964, as amended; Section 504 of the Rehabilitation Act of 1973; Title IX of the Education Amendment of 1972; the Age Discrimination Act of 1975; the Omnibus Budget and Reconciliation Act of 1982; the Americans with Disabilities Act of 1990; and the Keyes Amendment to the Social Security Act. No person shall be denied admission to, be denied benefits of, or be subjected to discrimination under any program, activity, or service provided by the facility based on his/her race, color, national origin, sex, religion, age, or disability, including Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS). Every licensed facility shall complete and sign form MO 580-2622 (9-05), Assurance of Compliance, incorporated by reference in this rule and available through the department’s website at www. dhss.mo.gov or by telephone at (573) 526-8505 and file the form with the application for licensure or relicensure. This rule does not incorporate any subsequent amendments or additions.

3. (7) The department shall make available by Internet at www. dhss.mo.gov to interested individuals or without charge a single copy of—

   1. (A) A complete set of the standards promulgated for each type of facility;
   2. (B) An explanation of the procedures used in the state to ensure the enforcement of standards;
   3. (C) A list of any facilities granted exception from a standard, including the justification for the exception; and
   4. (D) A list of any facilities issued notices of noncompliance, including the details of the noncompliance.
4. (8) Every skilled nursing facility, intermediate care facility, residential care facility, and assisted living facility issued a license or temporary operating permit by the department shall submit the required certificate of need quarterly surveys to the department on or before the fifteenth day of the first month following the previous Social Security quarter. (For example, for the Social Security quarter ending December 31, the due date is by January 15; for the Social Security quarter ending March 31, the due date is by April 15; for the Social Security quarter ending June 30, the due date is by July 15; and for the Social Security quarter ending September 30, the due date is by October 15). The information shall be submitted on the ICF/ SNF Certificate of Need Quarterly Survey form or the RCF/ALF Certificate of Need Quarterly Survey form obtained from the Missouri Certificate of Need Program, PO Box 570, Jefferson City, MO 65102.

AUTHORITY: sections 198.018, 198.073, 198.076, and 198.079, RSMo 2016.* This rule was originally filed as 13 CSR 15-10.010. Emergency rule filed Sept. 7, 1979, effective Sept. 28, 1979, expired Jan. 24, 1980. Original rule filed Sept. 7, 1979, effective Jan. 12, 1980. Emergency amendment filed Jan. 15, 1980, effective Jan. 25, 1980, expired May 1, 1980. Amended: Filed Jan. 15, 1980, effective May 11, 1980. Amended: Filed Dec. 10, 1980, effective May 11, 1981. Amended: Filed Dec. 7, 1981, effective May 11, 1982. Rescinded and readopted: Filed July 13, 1983, effective Oct. 13, 1983. Emergency amendment filed Aug. 1, 1984, effective Aug. 13, 1984, expired Dec. 10, 1984. Amended: Filed Sept. 12, 1984, effective Dec. 13, 1984. Amended: Filed June 17, 1986, effective Oct. 24, 1986. Amended: Filed Aug. 1, 1988, effective Nov. 10, 1988. Emergency amendment filed Aug. 14, 1992, effective Aug. 28, 1992, expired Dec. 25, 1992. Rescinded and readopted: Filed April 14, 1993, effective Oct. 10, 1993. Amended: Filed Feb. 13, 1998, effective Sept. 30, 1998. Moved to 19 CSR 30-82.010, effective Aug. 28, 2001. Amended: Filed Aug. 23, 2006, effective April 30, 2007. Amended: Filed March 13, 2008, effective Oct. 30, 2008. ** Emergency amendment filed Nov. 10, 2021, effective Nov. 29, 2021, expired May 27, 2022. Amended: Filed Nov. 10, 2021, effective May 30, 2022. *Original authority: 198.018, RSMo 1979, amended 1984, 1987, 1988, 1994, 2007, 2014; 198.073, RSMo 1979, amended 1984, 1992, 1999, 2006, 2007; 198.076, RSMo 1979, amended 1984, 2007; and 198.079, RSMo 1979, amended 2007. **Pursuant to Executive Order 21-07, 19 CSR 30-82.010, paragraphs (4)(A)1.-3. and subsection (4)(B) was suspended from April 22, 2020 through August 31, 2021.