Summary of the House Committee Version of the Bill


SPONSOR:  Rohrbach (Hoppe)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Local
Government and Related Matters by a vote of 15 to 2.


This substitute makes numerous changes and additions to the
Missouri Certificate of Need Law.  The substitute:

(1)  Adds long-term care beds in hospitals to the definition of
"health care facilities."  It removes from the definition
hospitals, health maintenance organizations, tuberculosis
hospitals, psychiatric hospitals, kidney disease treatment
centers, diagnostic imaging centers, radiation therapy centers,
and ambulatory surgical facilities and removes the current
exclusion of the private offices of doctors, dentists, and
practitioners of the healing arts;

(2)  Removes new hospital facilities from the list of facilities
required to obtain a certificate of need when the facility
provides for something less than what was sought in the initial

(3)  Adds a new section of definitions involving requirements
for certification associated with acute care facilities and
first-time services;

(4)  Sets out requirements for the Health Facilities Review
Committee in the review certification process.  The requirements
involve notification of applicants for review certification,
conducting public hearings, issuing written findings, and
specifying issues to be considered in determining whether to
grant review certification;

(5)  Requires that individuals who propose the development of an
acute care service or first-time service submit a letter of
intent to the committee and that a fee be paid for each
application for review certification;

(6)  Allows an applicant to file an appeal within 30 days of the
committee's decision and for the appeal to be heard by the
Administrative Hearing Commission.  It also establishes the
venue for subsequent appeals in the circuit court of the county
where the acute care service or facility is proposed to be

(7)  Adds new provisions dealing with requirements for obtaining
review certification prior to offering services.  An individual
who proposes to develop or offer new institutional acute care
services or who proposes a first-time service is required to
obtain a review certification from the committee prior to
offering the services.  A review certification must also be
obtained when there is a proposal to add new beds to an existing
hospital.  A review certification is not transferable from the
premises and persons named in the application without the
consent of the committee.  Project cost increases in excess of
10% over the initial estimate must have the consent of the
committee.  Applicants who have been granted a review
certification are required to provide periodic reports to the
committee until the project is completed.  A review
certification is subject to forfeiture if costs equal to 10% of
the total approved cost of the project are not incurred within 6
months of the date of the order.  The applicant is allowed to
request an extension of up to 6 months to avoid forfeiture;

(8)  Prohibits state agencies from licensing acute care
facilities that are developed and required to have a review
certification if the review certification is not first obtained,
and they may not grant or appropriate funds to a facility that
has not obtained all required review certifications.  Review
certifications may not be denied because of the applicant's
refusal to provide abortion services or information.  The
transfer of ownership of an existing, operational acute care
facility does not require a review certification;

(9)  Specifies certain circumstances where review certification
is not required;

(10)  Makes certain requirements for reimbursement to facilities
that provide services to individuals who are eligible for
Medical Assistance Benefits; and

(11)  Allows the committee to promulgate rules to effectuate the
objectives of Sections 197.370 through 197.384, RSMo.


Following the initial election of a nursing home district board
of directors, the substitute allows county commissions to choose
to elect subsequent directors at large.  Under current law,
county commissions must divide nursing home districts into 6
election districts and elect one director from each district.


The substitute establishes the Office of State Ombudsman for
Mental Health Facility Residents within the Office of the
Lieutenant Governor.  The purpose of the ombudsman is to help
assure the adequacy of care received by residents of mental
health facilities, to protect the rights of recipients of mental
health services, and to improve their quality of life.  The
substitute outlines the duties and responsibilities of the
ombudsman.  The ombudsman is also responsible for the
appointment of a 5-member board and the employment of a staff to
assist in the duties of the office.

FISCAL NOTE:  Not available at time of printing.

PROPONENTS:  Supporters say that it is sometimes difficult to
find persons to serve as nursing home directors.  The bill will
allow choosing the directors from a larger area.

Testifying for the bill was Senator Rohrbach.

OPPONENTS:  There was no opposition voiced to the committee.

Steve Bauer, Legislative Analyst

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Missouri House of Representatives
Last Updated November 26, 2001 at 11:47 am