19 CSR 30-82.010
General Licensure Requirements
PURPOSE: This rule sets forth general licensure and application
procedures and outlines the request for an exception procedure
related to long-term care facility licensure.
PUBLISHER’S NOTE: The secretary of state has determined that the
publication of the entire text of the material which is incorporated
by reference as a portion of this rule would be unduly cumbersome
or expensive. This material as incorporated by reference in this
rule shall be maintained by the agency at its headquarters and
shall be made available to the public for inspection and copying
at no more than the actual cost of reproduction. This note applies
only to the reference material. The entire text of the rule is printed
here.
(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 noncancelable 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
SENIOR SERVICES
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 LTCapplication@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
SENIOR SERVICES
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, 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)
SENIOR SERVICES
(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.
AUTHORITY: sections 198.018, 198.073, 198.076, and 198.079,
RSMo 2016.* This rule was originally filed as 13 CSR 15-10.010.
Emergency rule filed Sept. 7, 1979, effective Sept. 28, 1979, expired
Jan. 24, 1980. Original rule filed Sept. 7, 1979, effective Jan. 12,
1980. Emergency amendment filed Jan. 15, 1980, effective Jan. 25,
1980, expired May 1, 1980. Amended: Filed Jan. 15, 1980, effective
May 11, 1980. Amended: Filed Dec. 10, 1980, effective May 11, 1981.
Amended: Filed Dec. 7, 1981, effective May 11, 1982. Rescinded and
readopted: Filed July 13, 1983, effective Oct. 13, 1983. Emergency
amendment filed Aug. 1, 1984, effective Aug. 13, 1984, expired Dec.
10, 1984. Amended: Filed Sept. 12, 1984, effective Dec. 13, 1984.
Amended: Filed June 17, 1986, effective Oct. 24, 1986. Amended:
Filed Aug. 1, 1988, effective Nov. 10, 1988. Emergency amendment
filed Aug. 14, 1992, effective Aug. 28, 1992, expired Dec. 25, 1992.
Rescinded and readopted: Filed April 14, 1993, effective Oct. 10,
1993. Amended: Filed Feb. 13, 1998, effective Sept. 30, 1998. Moved
to 19 CSR 30-82.010, effective Aug. 28, 2001. Amended: Filed Aug.
23, 2006, effective April 30, 2007. Amended: Filed March 13, 2008,
effective Oct. 30, 2008. ** Emergency amendment filed Nov. 10,
2021, effective Nov. 29, 2021, expired May 27, 2022. Amended: Filed
Nov. 10, 2021, effective May 30, 2022.
*Original authority: 198.018, RSMo 1979, amended 1984, 1987, 1988, 1994, 2007, 2014;
198.073, RSMo 1979, amended 1984, 1992, 1999, 2006, 2007; 198.076, RSMo 1979,
amended 1984, 2007; and 198.079, RSMo 1979, amended 2007.
**Pursuant to Executive Order 21-07, 19 CSR 30-82.010, paragraphs (4)(A)1.-3. and subsection (4)(B)
was suspended from April 22, 2020 through August 31, 2021.