Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: The committee is amending this rule to
define what is acceptable for aboveground construction, add budget requirements
for cost overrun requests, add owner, operator, and site change requirements,
and add Applicant Identification form.
(1) Applicants who have been granted a
Certificate of Need (CON) or a Non-Applicability CON letter shall file reports
by mail or email with the Missouri Health Facilities Review Committee
(committee), using Periodic Progress Report (Form MO 580-1871), included
herein. A report shall be filed within ten (10) days following the end of each
six- (6-) month period after CON approval, or issuance of a Non-Applicability
CON letter, until the project is complete which includes the licensing of all
new beds, installation of equipment, and/or completion of renovations. All
Periodic Progress Reports must contain a complete and accurate accounting of
all expenditures for the report period. Final project costs with third-party
verification must be provided on a Periodic Progress Report (Form MO 5801871),
included herein.
(2) Applicants who
have been granted a CON and fail to incur a capital expenditure within six (6)
months may request an extension of six (6) months by submitting a written
request to the committee outlining the reasons for the failure, with a listing
of the actions to be taken within the requested extension period to insure
compliance. The Certificate of Need Program (CONP) staff on behalf of the
committee will analyze the request and grant an extension, if appropriate.
Applicants may request additional extensions by submitting a completed Request
for Extension (Form MO 580-1872), included herein, and must provide financial
information plus other documentation describing delays.
(3) A Non-Applicability CON letter is valid
for six (6) months from the date of issuance. Failure to incur a capital
expenditure or purchase the proposed equipment within that time frame shall
result in the Non-Applicability CON letter becoming null and void. The
applicant may request one (1) six (6)-month extension unless otherwise
constrained by statutory changes. Failure to file the required Periodic
Progress Report shall result in the Non-Applicability CON letter becoming null
and void.
(4) A CON shall be
subject to forfeiture for failure to-
(A)
Incur a project-specific capital expenditure within twelve (12) months after
the date the CON was issued through initiation of project aboveground
construction by any of the following: installation of structural support;
installation of structural steel; installation of framing; establishing
foundations and a wall or lease/purchase of the proposed equipment since a
capital expenditure, according to generally accepted accounting principles,
must be applied to a capital asset; or
(B) File the required Periodic Progress
Report.
(5) If the CONP
staff finds that a CON may be subject to forfeiture-
(A) Not less than thirty (30) calendar days
prior to a committee meeting, the CONP shall notify the applicant in writing of
the possible forfeiture, the reasons for it, and its placement on the committee
agenda for action; and
(B) After
receipt of the notice of possible forfeiture, the applicant may submit
information to the committee within ten (10) calendar days to show compliance
with this rule or other good cause as to why the CON shall not be
forfeited.
(6) If the
committee forfeits a CON, or a Non-Applicability CON letter becomes null and
void, CONP staff shall notify all affected state agencies of this
action.
(7) Cost overrun review
procedures implement the CON statute section 197.315.7, RSMo. Immediately upon
discovery that a project's actual costs would exceed approved project costs by
more than ten percent (10%), the applicant shall apply for approval of the cost
variance. A nonrefundable fee in the amount of one-tenth of one percent (0.1%)
of the additional project cost above the approved amount made payable to
"Missouri Health Facilities Review Committee" shall be required. The
information requirements for a cost overrun review are required as follows:
(A) Amount and justification for cost overrun
shall document-
1. Why and how the approved
project costs would be exceeded, including a detailed listing of the areas
involved;
2. Any changes that have
occurred in the scope of the project as originally approved; and
3. The alternatives to incurring this overrun
that were considered and why this particular approach was selected;
and
(B) Provide a Proposed
Project Budget (Form MO 580-1863), included herein, and budget detail including
all methods and assumptions used. Documentation of costs may be
requested.
(8) Applicants
may request a project owner change. The information requirements for an owner
change review are as follows:
(A) Reason for
owner change;
(B) Statement as to
whether or not the proposed owner is an affiliate of the current owner, and
explanation of relationship;
(C)
Evidence that the existing owner agrees to the change. This can be a statement
or a contract;
(D) Documentation
that the proposed owner owns the site, or has an executed option to purchase or
lease the real property;
(E)
Documentation that the proposed owner(s) is registered to do business in
Missouri;
(F) Documentation that
sufficient financing would be available to assure completion of the
project;
(G) Provide a complete and
signed Applicant Identification and Certification (Form MO 580-1861), included
herein, with the proposed owner listed.
(9) Applicants may request a project operator
change. The information requirements for an operator change review are as
follows:
(A) Reason for operator
change;
(B) Statement as to whether
or not the proposed operator is an affiliate of the current operator, and
explanation of relationship;
(C)
Evidence that the existing operator agrees to the change. This can be a
statement or a contract;
(D)
Documentation that the proposed operator(s) is registered to do business in
Missouri;
(E) The proposed operator
must provide a brief explanation of their ability and experience operating a
long-term care facility;
1. State if the
license of the proposed operator or any affiliate of the proposed operator has
been revoked within the previous five (5) years;
2. If the license of the proposed operator or
any affiliate of the proposed operator has been revoked within the previous
five (5) years, provide the name and address of the facility whose license was
revoked;
3. State if the Medicare
and/or Medicaid certification of any facility owned or operated by the proposed
operator or any affiliate of the proposed operator has been revoked within the
previous five (5) years; and
4. If
the Medicare and/or Medicaid certification of any facility owned or operated by
the proposed operator or any affiliate of the proposed operator has been
revoked within the previous five (5) years, provide the name and address of the
facility whose Medicare and/or Medicaid certification was revoked;
and
(F) Provide a
complete and signed Applicant Identification and Certification (Form MO
580-1861), included herein, with the proposed operator listed.
(10) Applicants may request a
project site change. The information requirements for a site change review are
as follows:
(A) Reason for site
change;
(B) Documentation the
proposed site is within fifteen (15) miles as the crow flies of the existing
site;
(C) Documentation that the
owner owns the site, or has an executed option to purchase or lease the real
property;
(D) Documentation of the
cost of the proposed site;
(E) A
legible street or road map showing the exact location of the facility or health
service, and a copy of the site plan showing the relation of the project to
existing structures and boundaries;
(F) Statement as to whether or not the
project cost would change. If the project cost would change, submit a revised
proposed budget and fee if applicable;
(G) Provide the population-based long-term
care bed need methodology for the fifteen- (15-) mile radius of the proposed
site;
(H) Provide a complete and
signed Applicant Identification and Certification (Form MO 580-1861), included
herein, with the proposed site listed;
(I) List of any additional changes to the
project as originally presented to the committee, such as-
1. Decrease in the number of beds. If a
decrease, how many beds would be licensed;
2. Change to the building structure(s). If
there would be a change, a description of the change(s), the total square
footage, and revised schematics of the proposed building(s) with all use of
space marked; and
3. The timeline
of events for the project, from site change approval through project
completion;
(J) Statement
of how consumers were made aware of the proposed site change. All feedback
received from consumers regarding the proposed site; and
(K) Documentation that sufficient financing
would be available to assure completion of the project.
(11) Any applicant who requests an owner,
operator or site change or cost overrun must still comply with sections (1) and
(2) of this rule.
(12) At any time
during the process from Letter of Intent to project completion, the applicant
is responsible for notifying the committee of any change in the designated
contact person. If a change is necessary, the applicant must file a Contact
Person Correction (Form MO 580-1870), included herein.
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*Original authority: 197.320, RSMo 1979, amended 1993,
1995, 1999.
