☰ Revisor of Missouri


Chapter 197

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  197.305.  Definitions. — As used in sections 197.300 to 197.366, the following terms mean:

  (1)  "Affected persons", the person proposing the development of a new institutional health service, the public to be served, and health care facilities within the service area in which the proposed new health care service is to be developed;

  (2)  "Agency", the certificate of need program of the Missouri department of health and senior services;

  (3)  "Capital expenditure", an expenditure by or on behalf of a health care facility which, under generally accepted accounting principles, is not properly chargeable as an expense of operation and maintenance;

  (4)  "Certificate of need", a written certificate issued by the committee setting forth the committee's affirmative finding that a proposed project sufficiently satisfies the criteria prescribed for such projects by sections 197.300 to 197.366;

  (5)  "Develop", to undertake those activities which on their completion will result in the offering of a new institutional health service or the incurring of a financial obligation in relation to the offering of such a service;

  (6)  "Expenditure minimum" shall mean:

  (a)  For beds in existing or proposed health care facilities licensed pursuant to chapter 198 and long-term care beds in a hospital as described in subdivision (3) of subsection 1 of section 198.012, six hundred thousand dollars in the case of capital expenditures, or four hundred thousand dollars in the case of major medical equipment, provided, however, that prior to January 1, 2003, the expenditure minimum for beds in such a facility and long-term care beds in a hospital described in section 198.012 shall be zero, subject to the provisions of subsection 7* of section 197.318;

  (b)  For beds or equipment in a long-term care hospital meeting the requirements described in 42 CFR, Section 412.23(e), the expenditure minimum shall be zero; and

  (c)  For health care facilities, new institutional health services or beds not described in paragraph (a) or (b) of this subdivision one million dollars in the case of capital expenditures, excluding major medical equipment, and one million dollars in the case of medical equipment;

  (7)  "Health service area", a geographic region appropriate for the effective planning and development of health services, determined on the basis of factors including population and the availability of resources, consisting of a population of not less than five hundred thousand or more than three million;

  (8)  "Major medical equipment", medical equipment used for the provision of medical and other health services;

  (9)  "New institutional health service":

  (a)  The development of a new health care facility costing in excess of the applicable expenditure minimum;

  (b)  The acquisition, including acquisition by lease, of any health care facility, or major medical equipment costing in excess of the expenditure minimum;

  (c)  Any capital expenditure by or on behalf of a health care facility in excess of the expenditure minimum;

  (d)  Predevelopment activities as defined in subdivision (12) hereof costing in excess of one hundred fifty thousand dollars;

  (e)  Any change in licensed bed capacity of a health care facility licensed under chapter 198 which increases the total number of beds by more than ten or more than ten percent of total bed capacity, whichever is less, over a two-year period, provided that any such health care facility seeking a nonapplicability review for an increase in total beds or total bed capacity in an amount less than described in this paragraph shall be eligible for such review only if the facility has had no patient care class I deficiencies within the last eighteen months and has maintained at least an eighty-five percent average occupancy rate for the previous six quarters;

  (f)  Health services, excluding home health services, which are offered in a health care facility and which were not offered on a regular basis in such health care facility within the twelve-month period prior to the time such services would be offered;

  (g)  A reallocation by an existing health care facility of licensed beds among major types of service or reallocation of licensed beds from one physical facility or site to another by more than ten beds or more than ten percent of total licensed bed capacity, whichever is less, over a two-year period;

  (10)  "Nonsubstantive projects", projects which do not involve the addition, replacement, modernization or conversion of beds or the provision of a new health service but which include a capital expenditure which exceeds the expenditure minimum and are due to an act of God or a normal consequence of maintaining health care services, facility or equipment;

  (11)  "Person", any individual, trust, estate, partnership, corporation, including associations and joint stock companies, state or political subdivision or instrumentality thereof, including a municipal corporation;

  (12)  "Predevelopment activities", expenditures for architectural designs, plans, working drawings and specifications, and any arrangement or commitment made for financing; but excluding submission of an application for a certificate of need.


(L. 1979 H.B. 222 § 2, A.L. 1982 S.B. 481, A.L. 1983 H.B. 825, A.L. 1994 H.B. 1408, A.L. 1996 H.B. 905 merged with H.B. 1362, A.L. 1997 S.B. 373, A.L. 1998 S.B. 963, A.L. 1999 S.B. 326, A.L. 2010 H.B. 1516 Revision merged with H.B. 1965, A.L. 2018 H.B. 2183 merged with S.B. 951)

*Subsection 7 of section 197.318 does not exist.


Health care facilities, definition, 197.366

(1995)  Acquisition cost for major medical equipment for purposes of minimum expenditure necessary to subject expenditure to certificate of need law, refers to cost to hospital and not original purchase price.  Cost of land and construction costs for building were attributable to separate commercial enterprise and not made by, or on behalf of, health care facility where hospital leased space for outpatient radiation therapy services.  SSM Health Care v. Missouri Health Facilities Review Committee, 894 S.W.2d 674 (Mo. en banc).

(2004) Nursing facility's proposal to add twelve beds constituted a new institutional health service requiring certificate of need, even though the proposed capital expenditure was below the expenditure minimum.  McKnight Place v. Missouri Health Facilities Review Committee, 142 S.W.3d 228 (Mo.App.W.D.).

---- end of effective  28 Aug 2018 ----

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197.305 8/28/2018
197.305 8/28/2010 8/28/2018
197.305 7/1/1999 8/28/2010

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