Applications & Forms
Persons are encouraged to contact CON staff early in the project planning process.
All forms are interactive PDF forms, which can be typed into, and where applicable, check boxes may be checked and numerical fields are self-calculating. Once completed, forms need to be printed, signed (where applicable), included with other applications/forms and e-mailed or mailed to the Certificate of Need Program Office. If problems are encountered, contact CON staff.
*Forms 1860, 2501, 2502, 2503 and 2506 were updated 3/31/2020
- MO 580-1860 Letter of Intent
For a new LTC bed proposal needing a CON, the average occupancy of all licensed and available beds in the radius is required. Also, if the bed need standard is met, the bed need calculation and supporting documentation is required. Or if special exceptions apply, an explanation is required. Contact CONP for instructions at least one month in advance of the LOI filing if new to the process.
For a non-applicability proposal to establish a LTC facility, add LTC beds under the 10/10% rule, replace LTC beds, or renovate/modernize a LTC facility, contact the DHSS Licensure and Engineering units for regulations prior to filing the Letter of Intent.
- MO 580-2375 Proposed Expenditures
- MO 580-2351 LTC Facility Expansion Certification
Applicant Completeness Checklists
- MO 580-2501 New Hospital Application
- MO 580-2502 New or Additional Long Term Care Bed Application
- MO 580-2503 New or Additional Equipment Application
- MO 580-2504 Expedited LTC Bed Replacement/Expansion Application
- MO 580-2505 Expedited LTC Renovation/Modernization Application
- MO 580-2506 Equipment Replacement Application
- MO 580-1861 Applicant Identification and Certification
- MO 580-1869 Representative Registration
- MO 580-1863 Proposed Project Budget
- MO 580-2352 Purchase Agreement
- MO 580-1865 Service-Specific Revenues and Expenses
- MO 580-1866 RS Means Cost Data