PURPOSE: This rule provides the information requirements and the details of how to complete the Letter of Intent package to begin 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) The Letter of Intent (LOI) (Form MO 580-1860), 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, or a non-applicability review;
   4. (D) Project Description: information which provides details of the number and type of beds to be added, deleted, or replaced, square footage of new construction and/or renovation, services affected, and equipment to be acquired. If an application for new or additional long-term care beds, confirm that the bed need standard has been met or that special exceptions exist. 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 longterm care (LTC) bed expansions pursuant to section 197.318.4(1), RSMo;
   6. (F) Authorized Contact Person Identification: the full name, title, address (including association), telephone number, email, fax number, signature, and date of signature;
   7. (G) Applicability: page 2 of the LOI must be filled out by applicants requesting a nonapplicability review to provide the reason and rationale for the non-applicability review request; and
   8. (H) Special Exceptions: if the LOI indicates that special exceptions apply, applicant shall attach a separate sheet with a complete explanation of all reasons for such special exceptions.

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

   1. (A) Proposed Expenditures (Form MO 580-2375);
   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; and
   4. (D) 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 (3) through (6) below of this rule.
3. (3) 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.
4. (4) If an exemption is sought pursuant to section 197.314(1), RSMo, for a sixty- (60-) bed stand-alone facility designed and operated exclusively for the care of residents with Alzheimer’s disease or dementia and located in a tax increment financing district established prior to 1990 within any county of the first classification with a charter form of government containing a city with a population of over three hundred fifty thousand (350,000) and which district also has within its boundaries a skilled nursing facility (SNF), applicants shall submit documentation that the health care facility would meet all of these provisions.
5. (5) If the LOI relates to new or additional long-term care beds, applicant shall submit documentation of the need for such beds and the average occupancy of all licensed beds in the appropriate category within the fifteen- (15-) mile radius of the project site.
6. (6) The LOI must have an original signature for the contact person which can be an electronic signature.

7. (7) The following forms cited in this rule are incorporated by reference and published by the Certificate of Need Program (CONP), December 13, 2019 and may be downloaded from http://health.mo.gov/information/boards/certificateofneed/forms.php, obtained by emailing a written request to CONP@health.mo.gov, or acquired in person at the CONP Office, 3418 Knipp Drive, Suite F, Jefferson City, Missouri, 65102 (573) 751-6403. This rule does not include any later amendments or additions.

   1. (A) Letter of Intent (Form MO 580-1860).
   2. (B) Proposed Expenditures (Form MO 580-2375).

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.

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