PURPOSE: This rule provides the information requirements and the details for how to complete the Letter of Intent package to begin the Certificate of Need (CON) review process.

1. (1) The Letter of Intent (LOI) (Form MO 580-1860), included herein, shall be completed as follows:

   1. (A) Project Information: sufficient information to identify the intended service, such as the name of the existing or proposed facility, whichever is applicable, and address or if address is unknown or not yet established, a specific description or the latitude and longitude identifying a specific site rather than a general area (county designation alone is not sufficient);
   2. (B) Applicant Identification: the full legal name of all owner(s) and operator(s) which compose the applicant who, singly or jointly, propose to develop, offer, lease, or operate a new institutional health service within Missouri; provide the corporate entity, not individual names, of the corporate board of directors or the facility administrator;
   3. (C) Type of Review: the applicant shall indicate if the review is for a full review, expedited review, non-applicability review, or a long-term care (LTC) bed expansion review pursuant to section 197.318, RSMo;
   4. (D) Project Description: information which provides details of the number and type of beds to be added, removed, or replaced, square footage of new construction and/or renovation, services affected, and equipment to be acquired. If a replacement project, information which provides details of the facilities or equipment to be replaced, including name, location, distance from the current site, and its final disposition. If replacing equipment previously approved, provide the CON project number of existing equipment;
   5. (E) Estimated Project Cost: total proposed expenditures necessary to achieve the application’s objectives—not required for LTC bed expansions pursuant to section 197.318, RSMo;
   6. (F) Authorized Contact Person Identification: the full name, SENIOR SERVICES

title, address (including association), telephone number, email, fax number, signature, and date of signature; and

1. (G) Applicability: page 2 of the LOI must be filled out by applicants requesting a non-applicability review or LTC bed expansion pursuant to section 197.318, RSMo, to provide the reason and rationale for the non-applicability or LTC bed expansion review request.

1. (2) If a non-applicability review is sought, the applicant shall submit the following additional information:

   1. (A) Proposed Expenditures (Form MO 580-2375), included herein;
   2. (B) Information which details all methods and assumptions used to estimate project costs. Documentation of costs may be requested;
   3. (C) Schematic drawings and evidence of site control, with appropriate documentation;
   4. (D) Evidence of submission of architectural plans to the Division of Regulation and Licensure Engineering Consultation Unit, Department of Health and Senior Services, for long-term care projects and other facilities; and
   5. (E) In addition to the above information, for exceptions or exemptions, documentation of other provisions in compliance with the Certificate of Need (CON) statute, as described in sections (7) through (8) below of this rule.

2. (3) If a LTC bed expansion review is sought pursuant to section 197.318, RSMo, the applicant shall submit the following additional information:

   1. (A) Purchase Agreement (Form MO 580-2352 included herein); and
   2. (B) Schematic drawings and evidence of site control, with appropriate documentation.
3. (4) When an LOI for a LTC bed expansion review pursuant to section 197.318, RSMo, is filed, the Certificate of Need Program (CONP) staff shall immediately review that facility’s average licensed bed occupancy for the most recent six (6) consecutive calendar quarters, and request certification that the requesting facility had no patient care Class I deficiencies within the last eighteen (18) months from the Division of Regulation and Licensure (DRL), Department of Health and Senior Services, through a LTC Facility Expansion Certification (Form MO 580- 2351, included herein), to verify compliance with occupancy and deficiency requirements pursuant to section 197.318.4(1), RSMo. Occupancy data shall be taken from the 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.
4. (5) For a LTC bed expansion review pursuant to section 197.318, RSMo, the sellers and purchasers shall be defined as the owner(s) and operator(s) of the respective facilities, which includes building, land, and license. On the Purchase Agreement (Form MO 580-2352 included herein), both the owner(s) and operator(s) of the purchasing and selling facilities shall sign.

5. (6) Upon staff verification that the statutory requirements described in sections (3) through (5) above in this rule are satisfied, staff will notify the applicant and request the applicant to submit either—

   1. (A) If an agreement is reached by the selling and purchasing entities, a copy of the selling facility’s reissued license verifying SENIOR SERVICES FACILITIES REVIEW COMMITTEE

surrender of beds sold; or

1. (B) If no agreement is reached by the selling and purchasing entities and effort(s) to purchase have been unsuccessful, Purchase Agreement Form(s) (MO 580-2352 included herein), and additional documentation verifying unsuccessful effort(s) to purchase.

1. (7) If an exemption is sought for a residential care or assisted living facility (RCF/ALF) pursuant to section 197.312, RSMo, the applicant shall submit documentation that this facility had previously been owned or operated for or on behalf of St. Louis City.

2. (8) The LOI must have an original signature for the contact person, which can be an electronic signature. FACILITIES REVIEW COMMITTEE

   Certificate of Need Program

   LETTER OF INTENT

Full Review: New Hospital New/Add LTC Beds* New/Add LTCH Beds/Eqpt. New/ Additional Equipment Expedited Review: 6-mile RCF/ALF Replacement 15-mile LTC Replacement 30-mile LTC Replacement LTC Renov./Modernization Equipment Replacement previously approved Non-Applicability Review: (See 7. Applicability next page) LTC Bed Expansion Review (See 8. LTC Bed Expansion next page)

MO 580-1860 (03/2026) SENIOR SERVICES

Include the number and type of long-term care beds to be added (RCF/ALF/ICF/SNF/LTCH), replaced, removed, or purchased, square footage of new construction and/or renovation, services affected, and major medical equipment to be acquired or replaced. If replacing equipment previously approved, provide the CON project number of the existing equipment. If replacing or purchasing long-term care beds, include the facility name the beds are being replaced or purchased from. If requesting a non-applicability or LTC bed expansion CON letter, also complete the next page of this form.

SENIOR SERVICES FACILITIES REVIEW COMMITTEE

Certificate of Need Program

LETTER OF INTENT

(Check the box below to indicate the rationale for the exemption or waiver being sought.)

1. 7. Applicability

   A Proposed Expenditure form (MO 580-2375) is required even if the project cost is “$0”. If proposed expenditures are less than the minimums in §197.305(6), attach supporting documentation to illustrate how each of those amounts were determined, such as schematic drawings, equipment quotes, and contractor estimates.

   §197.305(9)(e) for additional long term care beds in the same category (certified as RCF/ALF, ICF or SNF) in a RCF/ALF, nursing home, or acute care hospital costing less than $600,000, and are 10 beds or 10% of that facility’s existing capacity, whichever is less. The facility must have had no patient care class I deficiencies within the last 18 months and has maintained at least an 85% average occupancy rate for the previous 6 quarters.

If the proposal meets one of the exemptions or exceptions below, then check the appropriate box, and attach detailed documentation substantiating compliance with the statutory provisions as set out in Rule 19 CSR 60-50.410: §197.312 for an RCF/ALF previously owned and operated by the city of St. Louis; or

If the proposal meets the definition of “nonsubstantive projects” in §197.305(10) and 19 CSR 60-50.300(13) for a waiver from review, complete both pages of this form as the first step in the process, and provide the rationale as to why the proposal should be deemed to be “nonsubstantive” in the space below.

If the proposal meets the definition of “purchase” or “replacement” in §197.318(4) and 19 CSR 60-50.450(4) for an exception from review, complete both pages of this form, and provide the rationale in the space below, including attached schematics and other documentation as to why the proposal should be deemed to be “nonapplicable”.

1. 8. LTC Bed Expansion (Provide the items outlined below.)

   If a LTC bed expansion review is sought pursuant to section §197.318, RSMo, the applicant shall submit the following additional information: (A) Purchase Agreement (Form MO 580-2352); (B) Schematic drawings and evidence of site control, with appropriate documentation. (C) A Proposed Expenditure form (MO 580-2375) is required even if the project cost is “$0”.

   Upon CON staff verification that the statutory requirements are met described in section 197.318, RSMo, CON staff will notify the applicant and request the applicant to submit either: (A) If an agreement is reached by the selling and purchasing entities, provide a copy of the selling facility’s reissued license verifying surrender of beds sold; or (B) If no agreement is reached by the selling and purchasing entities and effort(s) to purchase have been unsuccessful, provide Purchase Agreement Form(s) (MO 580-2352), and additional documentation verifying unsuccessful effort(s) to purchase.

MO 580-1860 (03/2026) FACILITIES REVIEW COMMITTEE

LTC Facility Expansion CERTIFICATION by the Division of Regulation and Licensure (DRL)

Part I: Facility Information

Project Number:

Part II: Quarterly RCF/ALF/ICF/SNF Bed Occupancy Rate Occupancy statistics for this facility for the most recent six consecutive calendar quarters prior to the LOI date shown above:

Qtr 1 2 3 4 CY_____: _____%

Qtr 1 2 3 4 CY_____: _____%

Six-quarter average: _______ %

Yes No

Yes No

Part III: Deficiencies

Yes No

Part IV: Certification of Information

Statement: The above information is an accurate representation of the findings

Signature: Title/Date:

MO 580-2351 (07/09) (circle appropriate quarter, insert the Calendar Year (CY), and complete information below)

For expansion through the purchase of beds, based on the DRL Quarterly Survey Data, the 90% bed occupancy requirement has been met.

For expansion through the addition of beds, based on the DRL’s Quarterly Survey Data, the 92% bed occupancy requirement has been met for under 40 LTC beds, or 93% for 40 bed or more LTC beds (see above).

For expansion through the purchase or addition of beds, based on the DRL’s annual facility survey, the above-named facility has not had any final Class I patient care deficiencies during the past 18 months.

by the DRL in accordance with appropriate CON rules. SENIOR SERVICES

Qtr 1 2 3 4 CY_____: _____% Qtr 1 2 3 4 CY_____: _____%

Qtr 1 2 3 4 CY_____: _____% Qtr 1 2 3 4 CY_____: _____%

SENIOR SERVICES

Certificate of Need Program

PURCHASE AGREEMENT

Part 1: Purchasing Facility Information

Part II: Selling Facility Information

Part III: Value of Consideration

Monetary Value of Purchase: $

Terms of Purchase:

Part IV: Certification of Information ∆ Yes No The above Purchaser and Seller have agreed to these purchase terms.

Purchaser Signature:

Seller(s) Signature(s):

MO 580‐2352 (05/12) FACILITIES REVIEW COMMITTEE

No./Type Beds:

(Add more pages as necessary to describe the sale.)

Title/Date:

Owner(s): Operator(s): Title/Date:

FACILITIES REVIEW COMMITTEE SENIOR SERVICES SENIOR SERVICES

AUTHORITY: section 197.320, RSMo 2016.* Emergency rule filed Aug. 29, 1997, effective Sept. 8, 1997, expired March 6, 1998. Original rule filed Aug. 29, 1997, effective March 30, 1998. Emergency rescission and rule filed June 29, 1999, effective July 9, 1999, expired Jan. 5, 2000. Rescinded and readopted: Filed June 29, 1999, effective Jan. 30, 2000. Emergency rescission and rule filed Dec. 14, 2001, effective Jan. 1, 2002, expired June 29, 2002. Rescinded and readopted: Filed Dec. 14, 2001, effective June 30, 2002. Emergency rescission and rule filed Dec. 16, 2002, effective Jan. 1, 2003, expired June 29, 2003. Amended: Filed June 9, 2003, effective Nov. 30, 2003. 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 March 10, 2014, effective Oct. 30, 2014. 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.