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.

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 construction, renovation, new or replacement equipment, and address or plat map 19 CSR 60-50

identifying a specific site rather than a general area (county designation alone is not sufficient);

1. (B) Applicant Identification: the full legal name of all owner(s) and operator(s) which compose the applicant(s) 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;
2. (C) Type of Review: the applicant shall indicate if the review is for a full review, expedited review or a non-applicability review;
3. (D) Project Description: information which provides details of the number of beds to be added, deleted, 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;
4. (E) Estimated Project Cost: total proposed expenditures necessary to achieve application’s objectives—not required for long-term care (LTC) bed expansions pursuant to section 197.318.8(1), RSMo;
5. (F) Authorized Contact Person Identification: the full name, title, address (including association), telephone number, e-mail, and fax number; and
6. (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 exemption or exception being sought.

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

   1. (A) Proposed Expenditures (Form MO 580-2375) including information which details all methods and assumptions used to estimate project costs;
   2. (B) Schematic drawings; and
   3. (C) 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.
2. (3) If an exemption is sought for a residential care facility (RCF) I or II of one hundred

3. (100) beds or less operated by a religious organization pursuant to section 197.305(7), RSMo, applicants shall submit the following additional information: SENIOR SERVICES

   1. (A) A letter from the Internal Revenue Service documenting the religious organization’s 501(c)(3) tax-exempt status;
   2. (B) Copies of the religious organization’s By-Laws and Articles of Incorporation stating the organization’s religious mission;
   3. (C) A letter from the religious organization stipulating that it will be the licensed operator and public funds would not be used for the purchase or operation of the proposed facility; and
   4. (D) Any other documents necessary to establish compliance with section 197.305(7), RSMo.
4. (4) If an exemption is sought for an RCF I or II pursuant to section 197.312, RSMo, applicants shall submit documentation that this facility had previously been owned or operated for or, on behalf of St. Louis City.
5. (5) 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.
6. (6) If an exemption is sought pursuant to section 197.314(2), RSMo, for either of two (2) SNFs of up to twenty (20) beds each, by a Chapter 198 facility that is owned or operated by a not-for-profit corporation which was created by a special act of the Missouri General Assembly, is exempt from federal income tax as an organization described in section 501(c)(3) of the Internal Revenue Code of 1986, is owned by a religious organization and is to be operated as part of a continuing care retirement community offering independent living, residential care and skilled care which had no skilled nursing beds as of January 1, 1999, documentation that the health care facility would meet all of these provisions.
7. (7) The LOI must have an original signature for the contact person until the Certificate of Need Program (CONP), when technically ready, shall allow for submission of electronic signatures.
8. (8) The most current version of Forms MO 580-1860 and MO 580-2375 may be obtained by mailing a written request to the CONP, 915G Leslie Boulevard, Jefferson City, MO 65101, or in person at the CONP office, or, if technically feasible, by downloading a copy of the forms from the CONP website at www.dhss.state.mo.us/con.

AUTHORITY: section 197.320, RSMo 2000.* 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.

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