Definitions and Procedures for Licensing Abortion Facilities

PURPOSE: This rule defines terminology used in 19 CSR 30-30.060 and 19 CSR 30-30.070, and establishes the procedures for applying for an abortion facility license. (1) The following definitions shall be used in the interpretation and enforcement of 19 CSR 30-30.060 and 19 CSR 30-30.070: (A) Abortion—The act of using or prescribing any instrument, device, medicine, drug, or any other means or substance with the intent to destroy the life of an embryo or fetus in his or her mother’s womb; or, the intentional termination of the pregnancy of a mother by using or prescribing any instrument, device, medicine, drug, or other means or substance with an intention other than to increase the probability of a live birth or to remove a dead or dying unborn child; (B) Abortion facility—Any clinic, physician’s office, or any other place or facility in which abortions are performed or induced other than a hospital; (C) Administrator—A person who is designated by an abortion facility to provide daily supervision over the abortion facility and who is a physician licensed in Missouri, a registered nurse licensed in Missouri, or an individual who has at least one (1) year of administrative experience in health care; (D) Complication—Includes, but is not limited to, incomplete abortion, hemorrhage, endometritis, parametritis, pyrexia, pelvic abscess, uterine perforation, failed abortion, cervical lacerations, retained products, or diagnosable psychiatric condition; (E) Department—The Missouri Department of Health and Senior Services; (F) Discharge summary—A statement completed by a physician or registered nurse regarding the condition of the patient at the time of discharge; (G) First trimester—The first thirteen (13) weeks of gestation, based upon gestational age; (H) Gestational age—The length of pregnancy measured from the onset of the last menstrual period, and except in the case of a medical emergency as defined in section 188.015, RSMo, determined by a physician in a manner consistent with accepted obstetrical and neonatal practices and standards after performing or causing to be performed such medical examinations, imaging studies, and tests as a reasonably prudent physician, knowledgeable about the medical facts and conditions of both the woman and the unborn child involved, would consider necessary to perform and consider in making an accurate diagnosis; (I) Health assessment—A determination of a patient’s physical and mental status; (J) Licensed practical nurse (LPN)—A person licensed to practice practical nursing pursuant to Chapter 335, RSMo; (K) OB/GYN—A physician who is board-certified or boardeligible by the American Board of Obstetrics and Gynecology or the American Osteopathic Board of Obstetrics and Gynecology; (L) Person—Any individual, firm, partnership, corporation, association, or other business entity; (M) Physician—Any person licensed to practice medicine pursuant to Chapter 334, RSMo; (N) Registered professional nurse—An individual who is a graduate of an approved school of nursing and who is licensed to practice professional nursing under Chapter 335, RSMo; and (O) Surgical technologist—An individual who is certified by the National Board of Surgical Technology and Surgical Assisting. (2) Procedures for Licensing Abortion Facilities. (A) No abortion shall be performed or induced in any place or facility including a clinic or physician’s office, without a license issued by the department, except that abortions may be performed or induced in hospitals without a separate abortion facility license issued by the department. (B) Application for an abortion facility license shall be made in writing to the department on forms provided by the department by the person who will operate the facility. The forms shall require at least the following information: date of application; name of facility to appear on license; street address, city, county, zip code, telephone number, and email address of facility; facility website address, if any; name of person who will operate facility; organizational chart showing ownership and control of facility; name of chief officer of governing body of facility; name and qualifications of administrator; name and qualifications of OB/GYN consultant; types of abortions that will be performed at the facility (i.e., surgical and/or drug- or chemically-induced); estimated number of each type of abortion that will be performed and/or induced annually at facility; number of facility staff; number of physicians on staff; number of physicians routinely performing or inducing abortions at facility; number of anesthesiologists or CRNAs on staff, if any; usual days and hours of facility operation; usual days and times that abortions are induced or performed at facility; number of procedure rooms; and notarized certification by chief officer of governing body and administrator that application is accurate and facility will follow all applicable laws and regulations. (C) Each application for an abortion facility license shall be sent to the Missouri Department of Health and Senior Services, Bureau of Ambulatory Care, PO Box 570, Jefferson City, MO 65102, and shall be accompanied by an annual fee of two hundred dollars ($200). (D) Each license, unless sooner suspended or revoked, shall be issued for a period of one (1) year. (E) Each license shall be issued only for the persons and premises named in the application. (F) The facility shall notify the department in writing if the operator of the facility, name of the facility, or premises of the facility changes. The facility shall provide the notification at least thirty (30) days before the change. (G) Separate licenses are required for abortion facilities maintained on separate sites even if operated by the same person. (H) The abortion facility license shall be conspicuously posted in a public area in the facility. (I) No license shall be issued or renewed by the department until the department has inspected the facility and determined that it is in compliance with all requirements of applicable regulations and statutes. AUTHORITY: section 197.225, RSMo Supp. 2017.* Original rule filed July 15, 1987, effective Oct. 25, 1987. Amended: Filed Oct. 24, 2017, effective April 30, 2018. *Original authority: 197.225, RSMo 1975, amended 1986, 2017.