Frequently Asked Questions

Adult Day Care Program
Certificate of Need
Construction and Remodeling
Nursing Home Certification
Nursing Home General Information
Nursing Home Licensure
Nursing Home Resources
How do I obtain an ADC application and regulations?

Adult Day Care Program

What is an adult day care program?
How do I obtain an adult day care application and regulations?
What is the difference between a medical and social model adult day care?
How do I obtain a list of adult day care programs in Missouri?
Is there an adult day care association in Missouri?
Can adult day care programs be reimbursed for providing services to clients?

What is an adult day care program?
An adult day care program is a group program designed to provide care and supervision to meet the needs of five (5) or more functionally impaired adults for periods of less than twenty-four (24) hours but more than two (2) hours per day in a place other than the adult's own home.

How do I obtain an adult day care application and regulations?
An adult day care application and regulations can be obtained by contacting us or by viewing Adult Day Care 19 CSR 30-90.

How do I obtain a listing of adult day care programs in Missouri?
By visiting the Adult Day Care directory or by contacting us.

Is there an adult day care association in Missouri?
Yes, the Missouri Adult Day Services Association's address is 2420 Hyde Park, Suite A, Jefferson City, MO 65109. The telephone number is (573) 634-3566.

Can adult day care programs be reimbursed for providing services to clients?
Reimbursement is regulated by the MO HealthNet Division within the Department of Social Services. For specific information, contact the DMS Provider Communications Unit at (573) 751-3425 or on line at http://dss.mo.gov/mhd.

Certificate of Need

What is Certificate of Need?
Is Certificate of Need required to open a long-term care facility?
Where can information regarding Certificate of Need be obtained?
What is the occupancy rate for facilities licensed by the Section for Long Term Care?

What is Certificate of Need?
Certificate of Need is a program administered by the Missouri Health Facilities Review Committee and designed to restrain unnecessary health care expenditures while addressing issues of community need, accessibility, financing, and high health costs.

Is Certificate of Need required to open a long-term care facility?
A facility cannot be licensed without first receiving Certificate of Need approval; therefore, it is a crucial step in the process. Compliance with Certificate of Need requirements is required before any new Skilled Nursing Facility, Intermediate Care Facility, Assisted Living Facility, or Residential Care Facility can be licensed as well as for the addition of beds to existing licensed facilities

Where can information regarding Certificate of Need be obtained?
Information regarding Certificate of Need requirements can be obtained by contacting the Certificate of Need office at (573) 751-6403 or visit their web site.

What is the occupancy rate for facilities licensed by the Section for Long Term Care?
The Department of Health and Senior Services collects occupancy data through use of a survey instrument submitted on a quarterly basis from every licensed Skilled Nursing Facility, Intermediate Care Facility, Assisted Living Facility, or Residential Care Facility. The data collected is supplied to the Certificate of Need Program where it is compiled into statistical reports and used for Certificate of Need purposes. Current statistical reports are posted on the Certificate of Need web site.

 

Construction and Remodeling

When are construction plans required?
Do construction plans need to be drawn, signed and sealed by a registered architect?
Where are plans submitted?
What is the process for new construction or renovations?
Can a single-family dwelling (house) be converted into a licensed RCF?
What does it mean that an operator should follow the strictest standards among federal, state, and local guidelines and regulations?
What about exception requests?

When are construction plans required?
Plans for all new long-term care homes, additions or remodeling of existing long-term care homes need to be submitted to the Engineering Consultation Unit (ECU) within the Section for Long-Term Care Regulation (SLCR) for review, per 19 CSR 85.012 (2) and 19 CSR 86.012 (2). This is an opportunity for a professional review and is available to all long-term care providers at no charge.

Do construction plans need to be drawn, signed and sealed by a registered architect?
All Skilled Nursing Facility (SNF) and Intermediate Care Facility (ICF) architectural plans must be prepared by a registered architect. All mechanical and electrical plans must be prepared by a registered professional engineer. An Assisted Living Facility (ALF) or a Residential Care Facility (RCF) that is to be licensed for more than nine residents must have its architectural plans prepared by a registered architect. All mechanical and electrical plans must be prepared by a registered professional engineer.

Where are plans submitted?
Submit plans to: Engineering Consultation Unit, Section for Long-Term Care Regulation, 3418 Knipp Dr., Ste. F, Jefferson City, Mo. 65109. If you would like to bring your plans into the ECU office, it is to your advantage to call SLCR at 573-526-8524 and schedule a time to bring them in.

What is the process for new construction or renovations?
The first step is to apply for a Certificate of Need (CON) or request a letter from the CON program indicating that a CON is not required. A CON or non-applicability letter is required for all new facilities, any renovations to existing facilities, and to add, purchase, or replace beds to an existing facility. Prior to applying for a CON or requesting a non-applicability letter, you must have a good idea of your overall project, such as the requirements to meet building standards and estimated project cost. For more information about the CON application process, visit the CON program online at http://health.mo.gov/information/boards/certificateofneed/, or contact CON staff at 573-751-6403.

Once you receive CON approval or a non-applicability letter, final construction plans shall be submitted to the ECU to obtain plan approval. After you receive written approval from the ECU, construction may begin. If you are considering any construction modifications to your home, please contact SLCR for guidance.

Can a single-family dwelling (house) be converted into a licensed RCF?
A single-family dwelling can be converted to a licensed RCF. However, substantial remodeling would likely be required in order to comply with new construction regulations. Please refer to 19 CSR Division 30, Chapter 86.

What does it mean that an operator should follow the strictest standards among federal, state, and local guidelines and regulations?
Providers are required to comply with all applicable federal, state, and local laws and regulations. If these standards differ, the provider must comply with the most restrictive standard. Plans for skilled nursing and intermediate care homes may be reviewed to ensure compliance with the federal standards required for participation in Medicare or Medicaid programs, in addition to state standards. The long-term care provider must work directly with their local jurisdiction to assure compliance with local laws and regulations.

What about exception requests?
The department can only grant exceptions to licensure requirements established in rules imposed by the department. The department cannot grant exceptions to requirements established by state statute or federal regulations. Per 19 CSR 30-82.010 (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."

Examples of exception requests:

If you install a wireless nurse call system that is not in accordance with all the required elements listed in 19 CSR 30-85.012 (124), you will need to apply for an exception to that regulation. The regulation applies to both existing and new intermediate care and skilled nursing facilities.

If you remove a required nurses’ station (work area) that no longer complies with 19 CSR 30-85.012 (47), you will need to apply for an exception to that regulation. The exception could also affect regulation 19 CSR 30-85.012 (37), regarding location of resident room doors more than 140 ft. from the nurses’ station and the dirty utility room.

If you convert a required “central” bathroom into a storage room, office, etc., and the new space no longer complies with 19 CSR 30-85.012 (52), you will need to apply for an exception to that regulation. The exception could also affect regulations 19 CSR 30-85.012 (54) and 19 CSR 30-85.032 (21), regarding the aggregate number of tubs or showers, and regulation 19 CSR 30-85.012 (51), regarding training or handicap toilets per nursing unit.

The home’s operator or owner may request an exception to a long-term care regulation. If you wish to apply for or renew an exception request, the "Instructions for Exceptions Request" form is available online at http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

If you are considering a renovation or remodeling project, please contact SLCR first. You may contact us at 573-526-8524 or contact the SLCR policy unit at 573-526-8570.

 

Nursing Home Certification

How can a facility be certified for participation in the Medicare and/ or Medicaid program? How do I obtain an application?
What are the requirements for changes in certified bed status such as an increase or decrease?

How can a facility be certified for participation in the Medicare and/ or Medicaid program? How do I obtain an application?
A facility must be licensed as a Skilled Nursing Facility to be certified to participate in the Medicare program. A facility licensed as a Skilled Nursing Facility or an Intermediate Care Facility can be certified to participate in the Medicaid program.

Application forms for Medicare can be obtained thru the CMS (Centers for Medicare and Medicaid Services) web site. The following forms and number of forms to be downloaded are as follows: 3 copies-CMS 1561, 3 copies-HHS 690, 1 copy-CMS 671, 1 copy- CMS 855. The CMS 855 can be downloaded at the web site above or a hard copy can be obtained by contacting your fiscal intermediary. In addition, an intermediary preference form and state form DA 113 must be completed. You may obtain these forms by calling the Certification Unit in the Section for Long Term Care at 573-526-8507. The CMS 855 form must be completed and sent directly to your designated Fiscal Intermediary. The remaining forms are to be returned to the Certification Unit of the Section for Long Term Care. Hard copies of the first three forms can be obtained by calling the Certification Unit in the Section for Long Term Care at 573-526-8507.

For Medicaid, only the CMS 671 and DA 113 form are required. You may obtain these forms by calling the Certification Unit in the Section for Long Term Care at 573-526-8507.

Regulations covering initial Medicare and Medicaid certification can be found at state regulation 19 CSR 30-81.010 (2).

What are the requirements for changes in certified bed status such as an increase or decrease?
Information regarding federal requirements for changes in certified bed status can be found at the CMS web site.

In addition, state requirements changes in certified bed status can be found in the certification section of the state regulations at 19 30-81.010 (9).

 

Nursing Home General Information

Which agency is responsible for inspecting and licensing long-term care facilities?
What types of long-term care facilities are licensed in Missouri?
How many long-term care facilities does the Section for Long-Term Care Regulation license?
Where can information be found which outlines the differences between the types of long-term care facilities?
What is the difference between licensure and certification?

Which agency is responsible for inspecting and licensing long-term care facilities?
The Section for Long-Term Care Regulation within the Division of Regulation and Licensure is responsible for the inspection and licensure of long-term care facilities. The Licensure and Certification Unit located in the central office in Jefferson City reviews applications for licensure to assure requirements are met and issues licenses to long-term care facilities whenever both application and inspection requirements are met. Seven regional offices located throughout the state inspect facilities for compliance with applicable laws and regulations and conduct complaint investigations as needed.

What types of long-term care facilities are licensed in Missouri?
There are four types of long-term care facilities defined under Missouri law. These four types of facilities are: Skilled Nursing Facilities, Intermediate Care Facilities, Assisted Living Facilities, and Residential Care Facilities. The Section for Long-Term Care Regulation also licenses Adult Day Care Facilities.

How many long-term care facilities does the Section for Long-Term Care Regulation license?
As of May 1, 2014, the Section for Long-Term Care Regulation licensed 1,144 long-term care facilities. This includes 500 Skilled Nursing Facilities, 30 Intermediate Care Facilities, 397 Residential Care Facilities, and 217 Assisted Living Facilities.

Where can information be found which outlines the differences between the types of long-term care facilities?
The differences between the four types of facilities are outlined in both statutory and regulatory definitions. The state laws and regulations that govern the licensing of long-term care facilities are on the Department of Health and Senior Services web site for Nursing Homes.

What is the difference between licensure and certification?
Licensure is a state term referring to licensing of nursing homes under state law and regulations.

Certification refers to the process followed in certifying nursing homes for participation in the Medicare and/or Medicaid programs under federal laws and regulations. Regulations, procedures, and other information can be obtained at the Centers for Medicare and Medicaid Services (CMS).

 

Nursing Home Licensure

What are the requirements for opening up a long-term care facility?
How many persons can I care for before I need a license to operate a long-term care facility?
When opening a new facility, when will an inspection be conducted?
Where can the state laws and regulations for licensing long-term care facilities be found on the Department of Health and Senior Services web site?
Who needs to be notified and what are required if there is a change of administrator in a facility? What about a change in the Director of Nursing?
How do I report a change of operator to the Department of Health & Senior Services?
How do I increase the number of licensed beds in my facility?
How do I decrease the number of licensed beds in my facility?
What do I need to do if I wish to change the level of care my facility provides?
What do I need to do if I wish to close my facility?
Are there grants available to start a long-term care facility?
Can I receive Medicaid or Medicare in an RCF or ALF?

What are the requirements for opening up a long-term care facility?
All applicable statutory and regulatory requirements must be met before a new facility can be licensed. This includes achieving compliance with regulatory standards in the areas of construction, fire safety, physical plant, administration and resident care, sanitation, resident's rights and handling resident funds. In addition, the operator must meet general licensure requirements and must submit an application for licensure.

Certificate of Need approval is also required and is a crucial first step in the process. Information regarding Certificate of Need requirements can be obtained by contacting the Certificate of Need office at (573) 751-6403 or visit this Department of Health and Senior Services web site.

Questions regarding construction, physical plant, and fire safety requirements should be directed to (573) 526-8515.

The regulatory and statutory requirements for each of the four types of facilities can be found under the Licensing and Certification link on the Department of Health and Senior Services web site for Nursing Homes. To obtain a hard copy, contact us (there is a cost for this publication).

An application for licensure can be obtained at the above Licensing and Certification link on the web site or by contacting the licensure unit at (573) 526-8508. An application will be sent to you either electronically or by mail.

How many persons can I care for before I need a license to operate a long-term care facility?
A license will be required if you provide services as described in any of the definitions of the four types of long-term care facilities to 3 or more persons.

When opening a new facility, when will an inspection be conducted?
Staff from one of the Section for Long-Term Care Regulation regional offices will conduct an inspection to determine if requirements are met only after an application for licensure has been submitted to the Licensure Unit and has been approved.

Where can the state laws and regulations for licensing long-term care facilities be found on the Department of Health and Senior Services web site?
The state laws and regulations that govern the licensing of long-term care facilities can be found on the Department of Health and Senior Services web site for Nursing Homes. Either of the links in the right hand column, "Rules & Regulations" or "Licensing and Certification", contains all of the laws and regulations governing long-term care facilities.

Who needs to be notified and what are required if there is a change of administrator in a facility? What about a change in the Director of Nursing?
For a change of administrator, the Licensure and Certification Unit must be notified in writing. The letter must include the name of the new administrator and license number; the effective date the new administrator took the position; the name of facility; and a copy of administrator's license.

For changes in Director of Nursing in facilities certified to participate in the Medicare and/or Medicaid programs, the Licensure and Certification Unit in the Section for Long-Term Care Regulation must be notified in writing. The letter must include the name of the new Director of Nursing; the effective date the new Director of Nursing took the position; and the name of the facility.

How do I report a change of operator to the Department of Health & Senior Services?
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 in accordance with 19 CSR 30-82.010 (1) (H). The application shall be submitted to the Licensure Unit of the Section for Long-Term Care Regulation. Accountants in the Licensure Unit will then review the application to determine if sufficient information was included in the application to support the change. If sufficient information has been provided, a temporary permit will be issued to the new operator. Full review of the application will then be completed during the period of time the temporary operating permit is in effect.

In the situation where 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, the operator is required to submit an application for a new license within ten (10) working days of the effective date of that change to the Licensure Unit. The operator can also submit the required application information using form DA-636, Corrections For Long-Term Care Facility License. This form can be located on the Department of Health and Senior Services web site.

How do I increase the number of licensed beds in my facility?
An operator can request an increase in licensed bed capacity by submitting a letter of request to the Licensure Unit in the Section for Long-Term Care Regulation. Included with the request must be documentation obtained from the Certificate of Need Program indicating approval for the increase. In addition, a fee must be submitted with the request. The amount will be the greater of either $50.00 or the amount that would have been required if the increase in bed capacity had been included in the application, less any amount actually paid. (For example, for a facility licensed with a capacity between 26 and 100 beds, the licensure fee is $300.00. If this facility requests an increase in licensed capacity to more than 100 beds, the licensure fee increases from $300.00 to $600.00. Since the operator had already paid $300.00, the fee required for the increase in capacity would be the difference of $300.00. If this facility requests an increase in capacity that does not exceed 100 beds, the fee would be $50.00.)

After the Licensure Unit receives the request with required documentation and fee, an inspection will be conducted by staff from one of the Section for Long-Term Care regional offices to determine if requirements are met. An amended license or temporary operating permit will be issued if the facility is determined to be in substantial compliance with requirements. The effective date will be no earlier than when the regional office determined the facility was in compliance with requirements.

How do I decrease the number of licensed beds in my facility?
An operator can request a decrease in licensed bed capacity by submitting a letter of request to the Licensure Unit in the Section for Long-Term Care Regulation. A fee of $25.00 must be included with the request. All requirements of the Certificate of Need program must be met before the request will be processed. An inspection may be required by staff from one of the Section for Long-Term Care regional offices to assure that requirements are met. An amended license or temporary operating permit will be issued if the facility is in compliance with requirements.

What do I need to do if I wish to change the level of care my facility provides?
An operator can request a change in level of care by submitting a letter of request to the Licensure Unit in the Section for Long-Term Care Regulation. A fee of $25.00 must be included with the request. In addition, if the request is for a change from residential care facility or assisted living facility to skilled nursing facility or intermediate care facility or from skilled nursing facility or intermediate care facility to assisted living facility or residential care facility, the request shall include documentation from the Certificate of Need program indicating approval for the change. After the Licensure Unit receives the request with required documentation and fee, an inspection will be conducted by staff from one of the Section for Long-Term Care regional offices to determine if the appropriate requirements for the level of care requested are met.

If the change is from a skilled nursing or intermediate care facility to any other level, or if the change is from an assisted living facility to a residential care facility, the facility must 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. If the change is 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 must 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. An original license for the change in level of care will be issued if the facility is in compliance with appropriate requirements.

What do I need to do if I wish to close my facility?
An operator of a licensed facility who decides to discontinue operation of the facility must notify the Licensure Unit in the Section for Long-Term Care Regulation of the decision and the effective date and reason for closure. At least 30 days prior to closure, all residents of the facility, the next of kin, or a legally authorized representative or Designee, and the resident's attending physician and the responsible agency, if any, shall be notified in writing of the decision in accordance with discharge requirements outlined in 19 CSR 30-88.010. The facility shall also notify the appropriate Regional Coordinator of the Missouri State Ombudsman's Office and the appropriate Section for Long-Term Care Regional Office. The names, addresses, and phone numbers of the State Ombudsman Regional Coordinators can be found at this web site under Region Maps: LTC Ombudsman Regions. The addresses and phone numbers for the Section for Long-Term Care Regional Offices can be found here under Nursing Homes: Long Term Care Regions.

Are there grants available to start a long-term care facility?
The Section for Long-Term Regulation is unaware of any grants available to start a long-term care facility.

Can I receive Medicaid or Medicare in an RCF or ALF?
Though an RCF or ALF facility is not eligible to participate in the Medicare or Medicare vendor programs, residents may be eligible to receive personal care services through Medicaid (known as personal care in an RCF). To request additional information, please contact the Division of Senior and Disability Services at 866-835-3505.

 

Nursing Home Resources

Where can I find the necessary application forms used for licensure for a long-term care facility?
How can I obtain a regulation book?
Where can I obtain a directory of nursing homes?
Where can I obtain a directory of certified facilities?
How do I obtain the names and addresses for facilities by county?
How do I obtain a listing of facilities with Alzheimer's Special Care Unit?

Where can I find the necessary application forms used for licensure for a long-term care facility?
The forms can be found at this Department of Health and Senior Services web site.

How can I obtain a regulation book?
The state laws and regulations that govern the licensing of long-term care facilities can be found on the Department of Health and Senior Services web site for Nursing Homes. Either of the links in the left hand column, "Rules & Regulations" or "Licensing and Certification," contains all of the laws and regulations governing long-term care facilities.

Where can I obtain a directory of nursing homes?
A directory may be found on the Department of Health and Senior Services web site at directory of all licensed facilities.

Where can I obtain a directory of certified facilities?
A directory may be found on the Department of Health and Senior Services web site at directory of all licensed facilities. The directory includes the certification status of all long-term facilities. This information can also be obtained by county, city, or zip code by using the Locate a Long Term Care Facility feature on the Show Me Long Term Care web site at Show Me Long Term Care.

How do I obtain the names and addresses for facilities by county?
To obtain the names and addresses of licensed facilities, go to the Show-Me Long Term Care web site at Show-Me Long-Term Care. Information regarding all licensed facilities in Missouri is provided by county and city. Using the drop down keys, locate the city or county and click on ShowMe Results! This will provide a listing of facilities and the facility level of care. Further information on each facility can be obtained by clicking on the facility name. In addition, A directory may be found on the Department of Health and Senior Services web site at directory of all licensed facilities.

How do I obtain a listing of facilities with Alzheimer's Special Care Unit?
A listing of Alzheimer's Special Care Units may be found on the Department of Health and Senior Services web site at listing of Alzheimer's Special Care Units.