PURPOSE: This rule prescribes procedures on development of intermediate care facilities for persons with mental retardation.

1. (1) As used in this rule, a provider that owns, operates or has interest in only one (1) intermediate care facility for persons with mental retardation (ICF/MR) is—

   1. (A) A sole proprietor that owns no interest in another ICF/MR;
   2. (B) A partnership or a majority of the partnership that owns no interest in another ICF/MR; or
   3. (C) A corporation that has neither any officers nor a majority of board members in common with another corporation which has any interest in an ICF/MR.
2. (2) Any entity intending to operate a Medicaid-reimbursed ICF/MR in excess of those beds in existence on May 29, 1991, shall give written notice of that intent to the Department of Mental Health’s Division of Mental Retardation and Developmental Disabilities (Division of MRDD) between July 1 and October 1 of the fiscal year preceding the fiscal year in which the provider intends to operate the ICF/MR.
3. (3) No provider may be reimbursed under Medicaid to operate an ICF/MR without a provider agreement issued by the Department of Social Services’ Division of Medical Services (DMS). The DMS shall not issue a provider agreement without receiving either a certificate of authorization or an acknowledgment of exemption from the Division of MRDD.
4. (4) After May 29, 1991, the Division of MRDD shall issue an acknowledgment of exemption to permit the DMS to issue a 9 CSR 45-4

provider agreement to a certified ICF/MR if—

1. (A) The ICF/MR will have six (6) or fewer beds;
2. (B) The provider does not own, operate or have any interest in any other ICF/MR; and
3. (C) The provider has notified the Division of MRDD between July 1 and October 1 of its intent to operate the ICF/MR during the next fiscal year.

1. (5) Any provider that has received an exemption under section (4) and then either obtains, operates or acquires an interest in any other Medicaid-enrolled ICF/MR, or seeks to enroll an additional ICF/MR in the Medicaid program, shall forfeit the exemption granted under section (4). As soon as the ICF/MR for which exemption was originally granted can be accommodated in the Medicaid Home and Community-Based Waiver Program, the Division of MRDD shall notify the DMS to that effect, and DMS shall terminate the ICF/MR provider agreement within thirty
2. (30) days after receipt of the notification from the Division of MRDD.

3. (6) After May 29, 1991, the Division of MRDD may issue a certificate of authorization to permit the DMS to issue a provider agreement for a provider to operate an ICF/MR of seven (7) or more beds if—

   1. (A) The proposed ICF/MR is to be a freestanding facility and not attached to any other existing ICF/MR;
   2. (B) The provider has notified the Division of MRDD between July 1 and October 1 of its intent to operate the ICF/MR during the next fiscal year; and
   3. (C) The ICF/MR cannot be accommodated within the federal Home and Community- Based Waiver Program for persons with developmental disabilities as determined by the Division of MRDD.

AUTHORITY: sections 630.050 and 660.075, RSMo 1994.* This rule originally filed as 9 CSR 30-5.060. Original rule filed Sept. 1, 1993, effective April 9, 1994. Amended: Filed May 25, 1995, effective Dec. 30, 1995.

*Original authority: 630.050, RSMo 1980, amended 1993 and 660.075, RSMo 1991.