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

1. (1) Applicant means all owner(s) and operator(s) of any new institutional health service.
2. (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. (3) 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.
4. (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. (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 197.318.8–10, long-term care renovation and modernization, or the replacement of any major medical equipment as defined in sec- 19 CSR 60-50

tion (11) of this rule which holds a Certificate of Need (CON) previously granted by the Missouri Health Facilities Review Committee (committee). Applications for replacement of major medical equipment not previously approved by the committee should apply for a full review.

1. (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.

2. (7) 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.
3. (8) Health care facility means those described in section 197.366, RSMo, which replaces section 197.305.7, RSMo.
4. (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(13), RSMo, in excess of one hundred fifty thousand dollars ($150,000), any existing land and building converted to 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.
5. (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.
6. (11) Interested party means any licensed health care provider or other affected person who has expressed an interest in the Certificate of Need (CON) process or a CON application.
7. (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, SENIOR SERVICES

acquired over a twelve (12)-month period with an aggregate cost of one million dollars ($1,000,000) or more, when the equipment is intended to provide the following services:

1. (A) Cardiac Catheterization;
2. (B) CT (Computed Tomography);
3. (C) Gamma Knife;
4. (D) Hemodialysis;
5. (E) Lithotripsy;
6. (F) MRI (Magnetic Resonance Imaging);
7. (G) PET (Positron Emission Tomography);
8. (H) Linear Accelerator;
9. (I) Open Heart Surgery;
10. (J) EBCT (Electron Beam Computed Tomography);
11. (K) PET/CT (Positron Emission Tomography/Computed Tomography); or
12. (L) Evolving Technology.

1. (13) 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 airconditioning 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.
2. (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.
3. (15) Predevelopment costs mean expenditures as defined in section 197.305(13), 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.
4. (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.
5. (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.
6. (18) The most current version of Form MO 580-1863 may be obtained by mailing a written request to the Certificate of Need Program (CONP), PO Box 570, Jefferson City, MO 65102, or in person at the CONP Office, or, if technically feasible, by downloading a copy of the form from the CONP website at www.dhss.mo.gov/con. AUTHORITY: section 197.320, RSMo 2000.* 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. *Original authority: 197.320, RSMo 1979, amended 1993, 1995, 1999.