Post-Decision Activity

PURPOSE: This rule describes the procedure for filing Periodic Progress Reports after approval of Certificate of Need (CON) applications, CONs subject to forfeiture, and the procedure for requesting a cost overrun. (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 ex tension 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 documenta tion 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 initia tion of project aboveground construction by any of the follow ing: 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 cap ital 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; SENIOR SERVICES (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; and (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. 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. SENIOR SERVICES SENIOR SERVICES SENIOR SERVICES SENIOR SERVICES AUTHORITY: section 197.320, RSMo 2016.* Original rule filed June 2, 1994, effective Nov. 30, 1994. Emergency rescission and rule filed Aug. 29, 1997, effective Sept. 8, 1997, expired March 6, 1998. Rescinded and readopted: Filed Aug. 29, 1997, effective March 30, 1998. Amended: Filed Oct. 19, 1999, effective April 30, 2000. Emergency rescission and rule filed Dec. 14, 2001, effective Jan. 1, 2002, expired June 29, 2002. Rescinded and readopted: Filed Dec. 14, 2001, effective June 30, 2002. Emergency rescission and rule filed Dec. 16, 2002, effective Jan. 1, 2003, expired June 29, 2003. Amended: Filed June 9, 2003, effective Nov. 30, 2003. Emergency amendment filed Aug. 14, 2006, effective Aug. 28, 2006, expired Feb. 23, 2007. Amended: Filed Aug. 14, 2006, effective March 30, 2007. Amended: Filed Oct. 1, 2010, effective May 30, 2011. Amended: Filed Aug. 9, 2019, effective March 30, 2020. Amended: Filed June 29, 2022, effective Jan. 30, 2023. *Original authority: 197.320, RSMo 1979, amended 1993, 1995, 1999.