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

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) 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. 19 CSR 60-50
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., 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). Applications for replacement of major medical equipment not previously approved by the committee shall apply for a full review.
6. (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. (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.
8. (8) Health care facility means those described in section 197.366, RSMo, which replaces section 197.305.7, RSMo.
9. (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, incorporated by reference). SENIOR SERVICES
10. (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. (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:

    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.
12. (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 minimums in section 197.305(6), RSMo; the proposal is to increase the number of beds by ten (10) or more than ten percent (10%) of total bed capacity, whichever is less, over a two (2)- year period; an exemption or exception is found in accordance with section 197.312, RSMo, or section 197.314(1), RSMo; or the proposal meets the definition of a non-substantive project.

13. (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.
14. (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. (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.
16. (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. (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. (18) The following form cited in this rule is incorporated by reference and published by the Certificate of Need Program (CONP), October 1, 2009, and may be downloaded from http://www.dhss.mo.gov/CON/Forms.html, obtained by mailing a written request with a self-addressed stamped envelope to CONP, PO Box 570, Jefferson City, MO 65102-0570, or acquired in person at the CONP Office, 3418 Knipp Drive, Jefferson City, Missouri,

19. (573) 751-6403. This rule does not include any later amendments or additions.

    1. (A) Proposed Project Budget (MO 580- 1863)

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. Amended: Filed Oct. 1, 2010, effective May 30, 2011.

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