Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 82 - General Licensure Requirements › Section 19 CSR 30-82.010 - General Licensure Requirements

Current through Register Vol. 49, No. 14, July 15, 2024
This amendment creates a temporary closure procedure
				  for those Medicare and Medicaid federally certified facilities (skilled nursing
				  facilities and intermediate care facilities) licensed in Missouri which
				  experience staffing shortages from the COVID-19 vaccine mandate issued by the
				  United States Department of Health and Human Services, Centers for Medicare and
				  Medicaid Services emergency regulation 42 CFR part 483 for long term care
				  facilities and intermediate care facilities on November 4, 2021, with an
				  effective date of November 5, 2021.
(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 non-cancelable 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.