PURPOSE: This rule outlines the criteria and standards against which a project involving a long-term care facility would be evaluated in a Certificate of Need (CON) review. FACILITIES REVIEW COMMITTEE

1. (1) The following population-based long-term care bed need methodology for the fifteen- (15-) mile radius shall be used to determine the need:

   1. (A) Approval of additional intermediate care facility/skilled nursing facility (ICF/SNF) beds will be based on—

      1. 1. A service area need determined to be fifty-three (53)

beds per one thousand (1,000) projected year population age sixty-five (65) and older minus the current supply of ICF/SNF beds shown in the most recent Six-Quarter Occupancy of Hospital and Nursing Home Licensed and Available Beds report as provided by the Certificate of Need Program (CONP), which includes licensed and Certificate of Need (CON)-approved beds;

1. (B) Approval of additional residential care facilities/assisted living facilities (RCF/ALF) beds will be based on—

   1. 1. A service area need determined to be twenty-five (25)

beds per one thousand (1,000) projected year population age sixty-five (65) and older minus the current supply of RCF/ ALF beds shown in the most recent Six-Quarter Occupancy of Residential Care and Assisted Living Facility Licensed and Available Beds as provided by the CONP which includes licensed and CON-approved beds;

1. (C) Approval for Long-Term Care Hospital (LTCH) beds, as described in 42 CFR, section 412.23(e), will be based on a service area need determined to be one-tenth (0.1) bed per one thousand (1,000) projected year population minus the current supply of LTCH beds shown in the most recent Six-Quarter Occupancy of Long-Term Care Hospital Facility Licensed and Available Beds as provided by the CONP, which includes licensed beds and CON-approved beds; and
2. (D) If the project is to add beds to an existing long-term care facility, the applicant shall state whether or not the facility received any resident care Class I deficiencies within the last eighteen (18) months as a result of a survey, inspection, or complaint investigation and the reason for and status of the deficiencies.

1. (2) Replacement Chapter 198 beds may qualify for an exception to the LTC bed minimum occupancy requirements (MOR) plus shortened information requirements and review time frames if an applicant proposes to—

   1. (A) Relocate RCF/ALF beds within a six- (6-) mile radius pursuant to section 197.318.4(4), RSMo;
   2. (B) Replace one-half (1/2) of its licensed beds within a thirty- (30-) mile radius pursuant to section 197.318.5, RSMo; or

   3. (C) Replace a facility in its entirety within a fifteen- (15-) mile radius pursuant to section 197.318.6, RSMo, under the following conditions:

      1. 1. The existing facility’s beds shall be replaced at only one

2. (1) site;

   1. 2. The existing facility and the proposed facility shall have

the same owner(s), regardless of corporate structure; and

1. 3. The owner(s) shall stipulate in writing that the existing

facility’s beds to be replaced will not be used later to provide long-term care services by any person or entity; or if the facility is operated under a lease, both the lessee and the owner of the existing facility shall stipulate the same in writing.

1. (3) An exception to the CON application filing fee will be recognized for any proposed facility which is designed and operated exclusively for persons with acquired human immunodeficiency syndrome (AIDS).

2. (4) For LTC renovation or modernization projects which do not include increasing the number of beds, the applicant shall document the following, if applicable: SENIOR SERVICES

   1. (A) The proposed project is needed to comply with current facility code local, state, or federal government requirements for licensure, certification, or accreditation;
   2. (B) Operational efficiencies will be attained through reconfiguration of space and functions;
   3. (C) The methodologies used for determining need and the reallocation of space and functions; and
   4. (D) The benefits to the facility because of its age or condition.

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. Emergency amendment filed Dec. 16, 2002, effective Jan. 1, 2003, expired June 29, 2003. Rescinded and readopted: Filed Dec. 14, 2001, effective June 30, 2002. 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 Aug. 9, 2019, effective March 30, 2020. Amended: Filed June 29, 2022, effective Jan. 30, 2023. Amended: Filed April 22, 2024, effective Nov. 30, 2024. Amended: Filed Aug. 19, 2025, effective April 30, 2026.

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