PURPOSE: This rule defines the terms used in the Certificate of Need (CON) review process.

1. (1) Affiliate means an organization—

   1. (A) That owns five percent (5%) or more of the ownership interests in the operator; or
   2. (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. (2) Applicant means all owner(s) and operator(s) of any new institutional health service.
3. (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. (4) Cost means—

   1. (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
   2. (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
   3. (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. (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. (6) 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 replacement as defined in section 197.318, RSMo, long-term care renovation and modernization, or the replacement of any major medical equipment as defined in section (13) of this rule.
7. (7) Full review means the complete analytical period for applications as described in 19 CSR 60-50.420 and 19 CSR FACILITIES REVIEW COMMITTEE

60-50.430 for the development of health care facilities and acquisition of major medical equipment.

1. (8) Generally accepted accounting principles pertaining to capital expenditures include, but are not limited to—

   1. (A) Expenditures related to acquisition or construction of capital assets;
   2. (B) Capital assets are investments in property, plant, and equipment used for the production of other goods and services approved by the committee; and
   3. (C) Land is not considered a capital asset until actually converted for that purpose with commencement of aboveground construction approved by the committee.
2. (9) Health care facility means those described in section 197.366, RSMo.
3. (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.
4. (11) LTC bed expansion review means a facility licensed pursuant to Chapter 198, RSMo, may increase its licensed bed capacity by submitting a Letter of Intent documenting the expansion, certification from the Department of Health and Senior Services and health facilities review committee that the requesting facility has had no patient care class I deficiencies within the last eighteen (18) months, and has maintained a ninety-percent (90%) 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 only report published on the CON website.
5. (12) Health maintenance organizations means entities as defined in section 354.400(10), RSMo, except for activities directly related to the provision of insurance only.

6. (13) 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—

   1. (A) Cardiac catheterization;
   2. (B) Computed tomography;
   3. (C) Gamma knife;
   4. (D) Lithotripsy;
   5. (E) Magnetic resonance imaging;
   6. (F) Linear accelerator;
   7. (G) Positron emission tomography/computed tomography; or
   8. (H) Evolving technology.
7. (14) Major medical equipment to be replaced shall mean a piece of existing and operational equipment, if applicable. If the existing equipment to be replaced has not operated in over SENIOR SERVICES

twelve (12) months, a CON application for new equipment must be made if the project cost is one (1) million dollars or more.

1. (15) 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
2. (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 non-substantive project.

3. (16) Nonsubstantive project includes but is not limited to at least one (1) of the following situations:

   1. (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;
   2. (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
   3. (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.
4. (17) 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.
5. (18) 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.
6. (19) “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
7. (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.
8. (20) 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. SENIOR SERVICES FACILITIES REVIEW COMMITTEE FACILITIES REVIEW COMMITTEE

AUTHORITY: section 197.320, RSMo 2016.* Original rule filed June 2, 1994, effective Nov. 30, 1994. Emergency rescission and rule filed Aug. 29, 1997, effective Sept. 8, 1997, expired March 6, 1998. Rescinded and readopted: Filed Aug. 29, 1997, effective March 30, 1998. Emergency amendment filed Oct. 20, 1998, effective Oct. 30, 1998, expired April 27, 1999. Amended: Filed Oct. 20, 1998, effective April 30, 1999. Amended: Filed Jan. 4, 2000, effective July 30, 2000. Emergency rescission and rule filed Dec. 14, 2001, effective Jan. 1, 2002, expired June 29, 2002. Emergency rescission and rule filed Dec. 16, 2002, effective Jan. 1, 2003, expired June 29, 2003. Rescinded and readopted: Filed Dec. 14, 2001, effective June 30, 2002. Amended: Filed April 12, 2004, effective Nov. 30, 2004. Emergency amendment filed Aug. 14, 2006, effective Aug. 28, 2006, expired Feb. 23, 2007. Amended: Filed Aug. 14, 2006, effective March 30, 2007. Amended: Filed Oct. 1, 2010, effective May 30, 2011. Amended: Filed Aug. 9, 2019, effective March 30, 2020. Amended: Filed June 29, 2022, effective Jan. 30, 2023. Amended: Filed Aug. 19, 2025, effective April 30, 2026.

*Original authority: 197.320, RSMo 1979, amended 1993, 1995, 1999.