Missouri Code of State Regulations
Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES
Division 30 - Division of Regulation and Licensure
Chapter 82 - General Licensure Requirements
Section 19 CSR 30-82.010 - General Licensure Requirements
Universal Citation: 19 MO Code of State Regs 30-82.010
Current through Register Vol. 49, No. 18, September 16, 2024
This amendment creates a temporary closure procedure for those Medicare and Medicaid federally certified facilities (skilled nursing facilities and intermediate care facilities) licensed in Missouri which experience staffing shortages from the COVID-19 vaccine mandate issued by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services emergency regulation 42 CFR part 483 for long term care facilities and intermediate care facilities on November 4, 2021, with an effective date of November 5, 2021.
(1) Persons wishing to operate a skilled nursing facility, intermediate care facility, assisted living facility or residential care facility shall complete form MO 580-2631 (8-07), Application for License to Operate a Long-Term Care Facility, incorporated by reference in this rule and available through the Department of Health and Senior Services' (department's) website at www.dhss.mo.gov, or by mail at: Department of Health and Senior Services, Section for Long-Term Care Regulation, Licensure Unit, PO Box 570, Jefferson City, MO 65102-0570, telephone: (573) 526-8524. This rule does not incorporate any subsequent amendments or additions. The application shall be signed by a person with the express authority to sign on behalf of the operator, who shall attest by signature that the information submitted is true and correct to the best of the applicant's knowledge and belief and that all required documents are either included with the application or are currently on file with the department. The completed application form may be submitted by mail or electronically. If submitted electronically, send the completed application to LTCapplication@dhss.mo.gov. The application fee for application processing should be submitted by separate mail. If submitted by mail, send the application form and fee to Department of Health and Senior Services, Section for Long-Term Care Regulation, Fee Receipts, PO Box 570, 920 Wildwood, Jefferson City, MO 65102. One (1) application may be used to license multiple facilities if located on the same premises.
(A) The applicant shall submit the following
documents and information as listed in the application:
1. Financial information demonstrating that
the applicant has the financial capacity to operate the facility;
2. A document disclosing the location,
capacity, and type of licensure and certification of any support buildings,
wings, or floors housing residents on the same or adjoining premises or plots
of ground;
3. A document disclosing
the name, address, and type of license of all other long-term care facilities
owned or operated by either the applicant or by the owner of the facility for
which the application is being submitted;
4. A copy of any executed management
contracts between the applicant and the manager of the facility;
5. A copy of any executed contract conveying
the legal right to the facility premises, including, but not limited to,
leases, subleases, rental agreements, contracts for deed, and any amendments to
those contracts;
6. A copy of any
contract by which the facility's land, building, improvements, furnishings,
fixtures, or accounts receivable are pledged in whole or in part as security,
if the value of the asset pledged is greater than five hundred dollars
($500);
7. A nursing home surety
bond or non-cancelable escrow agreement, if the applicant holds or will hold
facility residents' personal funds in trust;
8. A document disclosing the name, address,
title, and percentage of ownership of each affiliate of any general
partnership, limited partnership, general business corporation, nonprofit
corporation, limited liability company, or governmental entity which owns or
operates the facility or is an affiliate of an entity which owns or operates
the facility. If an affiliate is a corporation, partnership, or LLC, a list of
the affiliate's affiliates must also be submitted. As used in this rule, the
word "affiliate" means:
A. With respect to a
partnership, each partner thereof;
B. With respect to a limited partnership, the
general partner and each limited partner with an interest of five percent (5%)
or more in the limited partnership;
C. With respect to a corporation, each person
who owns, holds, or has the power to vote five percent (5%) or more of any
class of securities issued by the corporation, and each officer and
director;
D. With respect to an
LLC, the LLC managers and members with an interest of five percent (5%) or
more;
9. If applicable,
a document stating the name and nature of any additional businesses in
operation on the facility premises and the document issued by the division
giving its prior written approval for each business;
10. A list of all principals in the operation
of the facility and their addresses and titles and, so that the department may
verify the information disclosed pursuant to paragraphs (1)(A)11. and (1)(A)12.
of this rule, the Social Security numbers or employer identification numbers of
the operator and all principals in the operation of the facility. As used in
this rule, "principal" means officer, director, owner, partner, key employee,
or other person with primary management or supervisory
responsibilities;
11. Disclosure
concerning whether the operator or any principals in the operation of the
facility are excluded from participation in the Title XVIII (Medicare) or Title
XIX (Medicaid) program of any state or territory;
12. Disclosure concerning whether the
operator or any principals in the operation of the facility have ever been
convicted of a felony in any state or federal court concerning conduct
involving either management of a long-term care facility or the provision or
receipt of health care services;
13. Emergency telephone, fax, and email
contact information for the facility administrator, director of nursing, and
the operator's corporate office; and
14. Disclosure concerning whether the
facility has a Department of Mental Health (DMH) license.
(B) Every facility that provides specialized
Alzheimer's or dementia care services, as defined in sections
198.500 to
198.515,
RSMo, by means of an Alzheimer's special care unit or program shall submit to
the department with the licensure application or renewal, the following:
1. Form MO 580-2637, Alzheimer's Special Care
Services Disclosure (2-07), incorporated by reference in this rule and
available through the department's website: www.dhss.mo.gov, or by mail at: Department
of Health and Senior Services, Section for Long-Term Care
Regulation, Licensure Unit, PO Box 570, Jefferson City, MO 65102-0570,
telephone: (573) 526-8524. This rule does not incorporate any subsequent
amendments or additions. The form shall be completed showing how the care
provided by the special care unit or program differs from care provided in the
rest of the facility in the following areas:
A. The Alzheimer's special care unit's or
program's written statement of its overall philosophy and mission which
reflects the needs of residents afflicted with dementia;
B. The process and criteria for placement in,
or transfer or discharge from, the unit or program;
C. The process used for assessment and
establishment of the plan of care and its implementation, including the method
by which the plan of care evolves and is responsive to changes in
condition;
D. Staff training and
continuing education practices;
E.
The physical environment and design features appropriate to support the
functioning of cognitively impaired adult residents;
F. The frequency and types of resident
activities;
G. The involvement of
families and the availability of family support programs;
H. The costs of care and any additional fees;
and
I. Safety and security
measures; and
2. Form
Guide to Selecting an Alzheimer's Special Care Unit (6/06)
#455, incorporated by reference in this rule and available through the
department's website: at http://www.dhss.mo.gov/Ombudsman,
or by mail at: Department of Health and Senior Services,
Section for Long-Term Care Regulation, Licensure Unit, PO Box 570, Jefferson
City, MO 65102-0570, telephone: (573) 526-8524 or a document of choice which
contains, but is not limited to, all information on selecting an Alzheimer's
special care unit or program that is contained in the Guide to
Selecting an Alzheimer's Special Care Unit (6/06) #455. This rule does
not incorporate any subsequent amendments or additions.
(C) If, after filing an application, the
operator identifies an error or if any information changes the issuance of the
license, including but not limited to, a change in the administrator, board of
directors, officers, level of care, number of beds, or change in the name of
the operating entity, the operator shall-
1.
Submit the correction or additional information to the department's Licensure
and Certification Unit in a letter. The letter shall be signed by a person with
express authority to sign on behalf of the operator attesting by signature that
the information being submitted is true and correct to the best of the
operator's knowledge and belief; or
2. Submit the correction or additional
information to the department's Licensure and Certification Unit. The
additional information may be submitted electronically or by mail. Information
shall be submitted using form MO 580-2623 (8-07), Corrections For Long-Term
Care Facility License Application, incorporated by reference in this rule and
available through the Department of Health and Senior Services' (department's)
website at www.dhss.mo.gov, or by
mail at: Department of Health and Senior Services, Section for Long-Term Care
Regulation, Licensure Unit, PO Box 570, Jefferson City, MO 65102-0570,
telephone: (573) 526-8524. This rule does not incorporate any subsequent
amendments or additions. The completed correction form shall be signed by a
person with express authority to sign on behalf of the operator attesting by
signature that the information submitted is true and correct to the best of the
operator's knowledge and belief and shall be submitted by electronic mail to
LTCapplica-tion@dhss.mo.gov, or by mail to: Department of Health and Senior
Services, Section for Long-Term Care Regulation, Fee Receipts, PO Box 570, 920
Wildwood, Jefferson City, MO 65102.
(D) If, as a result of an application review,
the department requests a correction or additional information, the operator,
within ten (10) working days of receipt of the written request shall-
1. Submit the correction or additional
information to the department in a letter attesting by signature that the
information being submitted is true and correct to the best of the operator's
knowledge and belief; or
2. Submit
the correction or additional information using form MO 580-2623 (8-07),
Corrections For Long-Term Care Facility License Application referenced in
paragraph (1)(C)2. of this rule.
(E) A new facility shall submit an
application for an original license not less than thirty (30) days before the
anticipated opening date. The department must approve the application before a
licensure inspection is scheduled. Sixty (60) days after its receipt, the
department shall consider any application for an original license withdrawn if
it is submitted without all the required information and documents. If
intending to continue with licensure, the operator shall submit a new
application and fee along with all necessary documents.
(F) An operator shall submit a relicensure
application thirty (30) to ninety (90) days prior to the existing license's
expiration date.
(G) If, during the
license's effective period, an operator which is a partnership, limited
partnership or corporation undergoes any of the changes described in section
198.015.4, RSMo, or a new corporation, partnership, limited partnership,
limited liability company or other entity assumes facility operation, within
ten (10) working days of the effective date of that change, the operator shall
submit an application for a new license.
(H) The department shall issue each license
only for the premises and operator named in the application. This license shall
cover the entire premises unless stipulated otherwise and shall not be
transferable. If the licensed operator of a facility is replaced by another
operator, the new operator shall apply for a new license before the effective
date of the change. A change of operator shall include a change in form of
business as well as a change of person. Upon receipt of the application and
receipt of confirmation that the change of operator has taken place, the
department shall grant the new operator a temporary operating permit of
sufficient duration to allow the department time to evaluate the application,
conduct any necessary inspection(s) to determine substantial compliance with
the law and the rules, and to either issue or deny a license to the new
operator. The new operator shall be subject to all the terms and conditions
under which the previous operator's license or temporary operating permit was
issued. This includes any existing statement of deficiencies, plans of
correction and compliance with any additional requirements imposed by the
department as a result of any existing substantial noncompliance. The new
operator, however, shall apply to the department for renewal in his/her/its
name for any exception to the rules that had been granted the previous operator
under the provisions of section (3) of this rule.
(I) The operator shall accompany each
application for a license to operate a long-term care facility (skilled nursing
facility, intermediate care facility, assisted living facility or residential
care facility with a license fee of one hundred dollars ($100) for those
facilities which have a resident capacity of at least three (3) but less than
twenty-five (25), three hundred dollars ($300) for those facilities which have
a resident capacity of twenty-five through one hundred (25-100), and six
hundred dollars ($600) for those facilities with a capacity of over one hundred
(100+). The operator shall submit a separate fee for each facility's license
application. This fee is nonrefundable unless the facility withdraws the
application within ten (10) days of receipt by the department. The department
will issue a license for a period of no more than two (2) years for the
premises and operator named in the application. If the license is for less than
two (2) years, the department will prorate the fees accordingly.
(J) An operator may apply for licenses for
two (2) or more different levels of care located on the same premises either by
submitting one (1) application or by submitting a separate application for each
level of care. If an operator elects to submit one (1) application for two (2)
or more levels of care located on the same premises-
1. The application shall specify separately
the number of beds of each level of care being applied for;
2. The application shall be accompanied by a
license fee for each level of care applied for, as required by subsection
(1)(I) of this rule; and
3. An
application for two (2) or more levels of care on the same premises shall
indicate one (1) facility name only.
(K) The department shall issue a separate
license for each level of care located on the same premises, whether applied
for by one (1) application or more than one (1). If the operator uses one (1)
application for two (2) or more levels of care on the same premises, the
department shall issue licenses with one (1) expiration date. If two (2) or
more levels of care have existing licenses with different expiration dates and
the operator elects to apply for licenses for the levels of care by submitting
one (1) relicensure application, the expiration dates of the licenses issued
shall be two (2) years subsequent to the expiration date of the license of the
level of care expiring earliest following receipt of the application by the
department. Fees for unused portions of licenses resulting from the submission
of one (1) application for two (2) or more levels of care are
nonrefundable.
(L) After receiving
a license application, the department shall review the application, investigate
the applicant and the statements sworn to in the application for license and
conduct any necessary inspections. A license shall be issued if-
1. The department has determined that the
application is complete, and that all necessary documents have been filed with
the application including an approved nursing home bond or noncancelable escrow
agreement if personal funds of residents are held in trust;
2. The department has determined that the
statements in the application are true and correct;
3. The department has determined that the
facility and the operator are in substantial compliance with the provisions of
sections 198.003-198.096, RSMo and the corresponding rules;
4. The department has determined that the
applicant has the financial capacity to operate the facility;
5. The department has verified that the
administrator of a residential care facility that was licensed as a residential
care facility II on August 27, 2006 and chooses to continue to meet all laws,
rules and regulations that were in place on August 27, 2006 for a residential
care facility II, assisted living facility, an intermediate care facility or a
skilled nursing facility is currently licensed by the Missouri Board of Nursing
Home Administrators under the provisions of Chapter 344, RSMo;
6. The department has received the fee
required by subsection (1)(I) of this rule;
7. The applicant meets the definition of
operator as defined in
19 CSR
30-83.010;
8. The applicant has received a Certificate
of Need, if required, or has received a determination from the Certificate of
Need Program that no certificate is required, has completed construction, and
is in substantial compliance with the licensure rules and laws;
9. The department has determined that neither
the operator, owner or any principals in the operation of the facility have
ever been convicted of an offense concerning the operation of a long-term care
facility or other health care facility or, while acting in a management
capacity, ever knowingly acted or knowingly failed to perform any duty which
materially and adversely affected the health, safety, welfare or property of a
resident;
10. The department has
determined that neither the operator, owner or any principals in the operation
of the facility are excluded from participation in the Title XVIII (Medicare)
or Title XIX (Medicaid) program of any state or territory;
11. The department has determined that
neither the operator, owner or any principals in the operation of the facility
have ever been convicted of a felony in any state or federal court concerning
conduct involving either management of a long-term care facility or the
provision or receipt of health care services; and
12. The department has determined that all
fees due the state have been paid.
(M) If, during the period in which a license
is in effect, a change occurs which causes the statements in the application to
no longer be correct, including change of administrator, or if any document is
executed which replaces, succeeds or amends any of the documents filed with the
application, within ten (10) working days of the effective date of the change,
the operator shall-
1. Submit a letter to the
department's Licensure and Certification Unit that contains a correction of the
application with notification of the effective date of the change and a copy of
any new documents. The operator must ensure the letter is signed by a person
with the express authority to sign on behalf of the operator, who shall attest
by signature that the information being submitted is true and correct to the
best of the operator's knowledge and belief; or
2. Submit to the department a correction of
the application and a copy of any new documentation and information by
submitting form Corrections for Long-Term Care Facility License Application
referenced in paragraph (1)(C) 2. of this rule.
(N) If from an analysis of financial
information submitted with the application, or if from information obtained
during the term of a license, the operator appears insolvent or shows a
tendency toward insolvency, the department shall have the right to request
additional financial information from the operator. Within ten (10) working
days after receiving a written request from the department, the operator shall-
1. Submit to the department the additional
information requested in a letter accompanied by a statement attesting by
signature that the information being submitted is true and correct to the best
of the operator's knowledge and belief; or
2. Submit the financial information to the
department on form Corrections for Long-Term Care Facility License Application
referenced in paragraph (1)(C)2. of this rule.
(O) A license applicant's financial
information, data and records submitted to the department as required by this
rule, including, but not limited to, copies of any Internal Revenue Service
forms, shall be open for inspection and be released only-
1. To designated employees of the
department;
2. To the applicant
furnishing this information or to his/her representative as designated in
writing;
3. To the director of the
department or to his/her representative as designated in writing;
4. To the state auditor or his/her
representative as designated in writing;
5. To appropriate committees of the General
Assembly or their representatives as designated in writing;
6. In any judicial or administrative
proceeding brought under the Omnibus Nursing Home Act; or
7. When so ordered by a court of competent
jurisdiction.
(P) To
obtain a license for an additional level of care on the premises, the licensed
operator shall submit a written request by electronic mail to
LTCapplication@dhss.mo.gov, or mail to the department for the issuance of a
license for the desired level of care. The request shall indicate the level of
care, the number of beds desired, the name and address of the facility, the
name and address of the operator, and shall include the signature of the
operator. The request shall be signed by a person with the express authority to
sign on behalf of the operator, who shall attest by signature that the
information submitted is true and correct to the best of the operator's
knowledge and belief. The licensure fee shall accompany this request. Requests
are subject to department approval. The operator shall submit this request no
less than sixty (60) days prior to the initiation date of the new level of
care. The department shall coordinate this license's expiration date with that
of the original license and the department shall prorate the license fee
accordingly.
(Q) To request
issuance of an amended license or temporary operating permit currently in
effect, the operator shall-
1. Submit a
written request to the department containing the request for amendment, the
date the operator would like the amendment to be effective, and the number of
the license or temporary operating permit to be amended; and
2. Submit a fee for the issuance of the
amended license or temporary operating permit as required by subsection (1)(R)
of this rule.
(R) If an
operator initiates a request to amend a license or temporary operating permit
currently in effect, the department requires the following fees:
1. If the request is for an increase in bed
capacity, the operator shall submit a fee with the request which is the greater
of-
A. The amount that would have been
required by subsection (1)(I) of this rule if the increase in bed capacity has
been included in the application, less any amount actually paid under that
subsection; or
B. Fifty dollars
($50); and
2. If the
request is for a decrease in resident capacity or any other change, the
operator shall submit a fee of twenty-five dollars ($25) with the
request.
(S) The
department shall approve all requests for bed changes prior to issuance of an
amended license or temporary operating permit. The effective date of the
amended license or temporary operating permit shall be no earlier than the date
the department approved the request for bed change.
(T) If the department issues a temporary
operating permit, and then subsequently issues a regular license, the licensing
period shall include the period of operation under the temporary operating
permit. The licensing period shall also include any period during which the
department was enjoined or stayed from revoking or denying a license or
rendering the temporary operating permit null and void.
(U) Unless an operator indicates otherwise,
all the rooms and space on the premises and all persons eighteen (18) years of
age and over living on the premises shall be considered as part of the facility
and its licensed capacity or staff and shall be subject to compliance with all
rules governing the operation of a licensed facility. If an operator, when
applying or reapplying for a license, wants to exclude some portion of the
premises from being licensed or wants to exclude a relative as a resident, a
statement to that effect shall be filed as a separate document indicating the
use which will be made of that area of the premises and who or what occupies
the area, and what the relationship is of the relative(s) being excluded. The
statement shall be signed by a person with the express authority to sign on
behalf of the operator, who shall attest by signature that the information
submitted is true and correct to the best of the operator's knowledge and
belief.
(V) The operator shall not
provide care in any area on the premises to any related person who requires
protective oversight unless there has been a written request to the department
to consider any portion of the facility for private use and that indicates
facility staff shall not be used at any time to care for the relative(s). Prior
to the area being used in that manner, the operator shall submit the request
for the department's approval. The department, after investigation, shall
approve or disapprove the request in writing within thirty (30) days and shall
issue or reissue the license indicating clearly which portion of the premises
is excluded from licensure or which specific relative(s) is/are not considered
a resident(s).
(2) If a facility was licensed under Chapter 197 or 198, RSMo and was in operation before September 28, 1979, or if an application was on file or construction plans were approved prior to September 28, 1979, the facility shall comply with construction, fire safety and physical plant rules applicable to an existing or existing licensed facility provided there has been continuous operation of the facility under a license or temporary operating permit issued by the division. If, however, there was an interruption in the operation of the facility due to license denial, license revocation or voluntary closure, the facility may be relicensed utilizing the same fire safety, construction and physical plant rules that were applicable prior to the license denial, license revocation or voluntary closure; provided that the facility reapplies for a license within one (1) year of the date of the denial, revocation or voluntary closure. Regardless of licensure, application, or construction plan approval date, intermediate care facilities and skilled nursing facilities shall comply with the fire safety standards published in 19 CSR 30-85.022.
(A)
If a facility changes from a skilled nursing or intermediate care facility to
any other level, or if the facility changes from a an assisted living facility
to a residential care facility, the facility shall comply with construction,
fire safety and physical plant rules applicable to an existing or existing
licensed facility as defined in
19 CSR
30-83.010.
(B) If the facility changes from a
residential care facility to any other level or if an assisted living facility
changes to an intermediate care or skilled nursing facility, the facility shall
comply with construction, fire safety and physical plant rules applicable to a
new or newly licensed facility as defined in
19 CSR
30-83.010.
(C) The facility shall comply with the rules
applicable to a new or newly licensed facility if an application for
relicensure has not been filed with the department within one (1) year of the
license denial, license revocation or voluntary closure. All such facilities
seeking licensure as an assisted living facility shall also comply with the
requirements of
19
CSR 30-86.047 and, if applicable,
19
CSR 30-86.045.
(3) Licensed Facility Closures.
(A) If a licensed facility discontinues
operation as evidenced by the fact that no residents are in care or at any time
the department is unable to freely gain entry into the facility to conduct an
inspection, the facility shall be considered closed. The department shall
notify the operator in writing requesting the voluntary surrender of the
license. If the department does not receive the license within thirty (30)
days, it shall be void. If the operator should choose to again license the
facility, the operator shall submit a complete application. The provisions of
section (1) shall apply.
(B) If any
licensed skilled nursing facility or intermediate care facility is required to
temporarily close for two (2) years or less from the effective date of the
temporary closure due to staffing shortages as a result of a COVID-19 vaccine
mandate first issued in emergency regulation by the United States Department of
Health and Human Services, Centers for Medicare and Medicaid Services ("CMS")
on November 4, 2021, effective on November 5, 2021, or any amendment changes or
amendments thereafter, then the skilled nursing and intermediate care
facilities shall do the following:
1. The
facility operator shall submit a closure plan to the department which is in
compliance with state and federal law, including 42 CFR part 483.15(c)
(detailed in federal deficiency F623 in the State Operations Manual appendix
PP), 42 CFR part 483.70(l) (detailed in federal deficiency F845 in the State
Operations Manual appendix PP), and
42 CFR
483.70(m) (detailed in
federal deficiency F846 in the State Operations Manual appendix PP). The State
Operations Manual appendix PP revised November 22, 2017, which is incorporated
by reference in this rule, as published by the Centers for Medicare and
Medicaid Services and is available at
www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf
or the United States Centers for Medicare & Medicaid Services, 7500
Security Boulevard, Baltimore, Maryland 21244. This rule does not incorporate
any subsequent amendments or additions. After review of the temporary closure
plan, the department shall either approve or disapprove the plan;
2. Facilities with approved closure plans by
the department shall ensure that all residents residing at the facility are
provided discharge notices in accordance with federal and state law and the
facility shall assist all residents with discharge planning in accordance with
federal and state law;
3.
Facilities with approved closure plans by the department shall enter into a
consent agreement with the department for a probationary license. These
facilities shall agree to discharge all residents by the effective date of the
temporary closure and to admit no residents while the facility is temporarily
closed;
4. Temporary closure of
facilities shall not be allowed past two (2) years from the effective date of
the temporary closure. The effective date of the temporary closure is the date
the last resident left the facility;
5. Facilities shall be reopened within two
(2) years of the effective date of the temporary closure. Prior to reopening,
the department shall conduct a full survey/inspection and the facility may be
approved by the department to reopen after this survey or inspection.
Facilities shall not reopen until approved by the department;
6. Facilities shall be reopened by the
facility operator which initiated the temporary closure and a change of
operator may not occur during this period of temporary closure;
7. Facilities shall submit plans of
corrections, applications, licensure and certification fees in accordance with
state law regardless of temporary closure status;
8. Facilities approved by the department to
be temporarily closed will be noted as temporarily closed on state directories.
The department will communicate temporary closure status of these facilities
approved for temporary closure to CMS; and
9. Facilities not approved for temporary
closure by the department which have closed or those facilities which stayed
closed longer than two (2) years from the effective date of the temporary
closure shall be considered closed. The department shall notify the operator in
writing requesting the voluntary surrender of the license. If the department
does not receive the license within thirty (30) days, it shall be void. If the
operator should choose to again license the facility, the operator shall submit
a complete application. The provisions of section (1) shall apply.
(4) The department may grant exceptions for specified periods of time to any rule imposed by the department if the department has determined that the exception to the rule would not potentially jeopardize the health, safety or welfare of any residents of a long-term care facility.
(A) The owner
or operator of the facility shall make requests for exceptions in writing to
the director of the department. These requests shall contain-
1. A copy of the latest Statement of
Deficiencies which shows a violation of the rule being cited, if the exception
request is being made as a result of a deficiency issued during an inspection
of the facility;
2. The section
number and text of the rule being cited;
3. If applicable, specific reasons why
compliance with the rule would impose an undue hardship on the operator,
including an estimate of any additional cost that might be involved;
4. An explanation of any extenuating factors
that may be relevant; and
5. A
complete description of the individual characteristics of the facility or
residents, or of any other factors that would safeguard the health, safety and
welfare of the residents if the exception were granted.
(B) With the advice of the division's
licensure inspection field staff, the department will consider any requests
that contain all the information required in subsection (4)(A). The department
shall notify the operator, in writing, of the decision on any request for an
exception, stating the reason(s) for acceptance or denial, and, if granted, the
length of time the exception is to be in effect and any additional corrective
factors upon which acceptance may be conditioned.
(C) The department shall only grant
exceptions to licensure requirements set out in rules imposed by the department
and cannot grant exceptions to requirements established by state statute or
federal regulations. Operators wishing to obtain waivers of regulations under
Title XVIII or Title XIX of the Social Security Act shall follow procedures
established by the Centers for Medicare and Medicaid (CMS).
(5) When the department issues a notice of noncompliance to a facility pursuant to the Omnibus Nursing Home Act (section 198.026, RSMo), the department, only after affording the facility operator a reasonable opportunity to remedy the situation, shall-
(A) Make every reasonable effort to provide
residents of the facility or their legally authorized representatives or
designees, if any-
1. A written notice of the
noncompliance;
2. A list of other
licensed facilities appropriate to the resident's needs; and
3. A list of agencies that will assist the
resident if he/she moves from the facility; and
(B) After providing the information required
by subsection (5)(A) and allowing a time period for the residents of the
facility to relocate if they wish, notify the Social Security Administration in
writing that a notice of noncompliance has been issued to the facility, and the
effective date of the notice. If the facility achieves substantial compliance
with standards and rules later, the department shall notify the Social Security
Administration of the effective date of the facility's substantial
compliance.
(6) A licensed facility shall comply with the provisions of Title VI of the Civil Rights Act 1964, as amended; Section 504 of the Rehabilitation Act of 1973; Title IX of the Education Amendment of 1972; the Age Discrimination Act of 1975; the Omnibus Budget and Reconciliation Act of 1982; the Americans with Disabilities Act of 1990; and the Keyes Amendment to the Social Security Act. No person shall be denied admission to, be denied benefits of, or be subjected to discrimination under any program, activity or service provided by the facility based on his/her race, color, national origin, sex, religion, age or disability, including Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS). Every licensed facility shall complete and sign form MO 580-2622 (9-05), Assurance of Compliance, incorporated by reference in this rule and available through the department's website at www.dhss.mo.gov or by telephone at (573) 526-8505 and file the form with the application for licensure or relicensure. This rule does not incorporate any subsequent amendments or additions.
(7) The department shall make available by Internet at www.dhss.mo.gov to interested individuals or without charge a single copy of-
(A) A
complete set of the standards promulgated for each type of facility;
(B) An explanation of the procedures used in
the state to ensure the enforcement of standards;
(C) A list of any facilities granted
exception from a standard, including the justification for the exception;
and
(D) A list of any facilities
issued notices of noncompliance, including the details of the
noncompliance.
(8) Every skilled nursing facility, intermediate care facility, residential care facility and assisted living facility issued a license or temporary operating permit by the department shall submit the required certificate of need quarterly surveys to the department on or before the fifteenth day of the first month following the previous Social Security quarter. (For example, for the Social Security quarter ending December 31, the due date is by January 15; for the Social Security quarter ending March 31, the due date is by April 15; for the Social Security quarter ending June 30, the due date is by July 15; and for the Social Security quarter ending September 30, the due date is by October 15). The information shall be submitted on the ICF/SNF Certificate of Need Quarterly Survey form or the RCF/ALF Certificate of Need Quarterly Survey form obtained from the Missouri Certificate of Need Program, PO Box 570, Jefferson City, MO 65102.
*Original authority: 198.018, RSMo 1979, amended 1984, 1987, 1988, 1994, 2007; 198.073, RSMo 1979, amended 1984, 1992, 1999, 2006, 2007; 198.076, RSMo 1979, amended 1984, 2007; and 198.079, RSMo 1979, amended 2007 .
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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