Current through Register Vol. 49, No. 6, March 15, 2024
(1) The Letter of
Intent (LOI) (Form MO 580-1860), included herein, shall be completed as
follows:
(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);
(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;
(C) Type of Review:
the applicant shall indicate if the review is for a full review, expedited
review, or a non-applicability review;
(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;
(E) Estimated
Project Cost: total proposed expenditures necessary to achieve the
application's objectives-not required for long-term care (LTC) bed expansions
pursuant to section 197.318.4(1), RSMo;
(F) Authorized Contact Person Identification:
the full name, title, address (including association), telephone number, email,
fax number, signature, and date of signature;
(G) Applicability: page 2 of the LOI must be
filled out by applicants requesting a non-applicability review to provide the
reason and rationale for the non-applicability review request; and
(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) If a
non-applicability review is sought, the applicant shall submit the following
additional information:
(A) Proposed
Expenditures (Form MO 580-2375), included herein;
(B) Information which details all methods and
assumptions used to estimate project costs. Documentation of costs may be
requested;
(C) Schematic drawings
and evidence of site control, with appropriate documentation; and
(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) 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) 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.
(5) The LOI must have an
original signature for the contact person, which can be an electronic
signature.
Click to
view image
Click to
view image
Click to
view image
*Original authority: 197.320, RSMo 1979, amended 1993,
1995, 1999.
