Frequently Asked Questions

Adult Day Care Program
Certificate of Need
Construction Plan Review
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 Plan Review

When are construction plans required?
Do the plans need to be architecturally drawn and signed?
Where are plans to be submitted?
Can a single-family dwelling be converted into a small RCF?
What is the process for new construction and/or major remodeling?
Are there other permits needed to open a long-term care facility?
Please describe the requirement that an operator follow the strictest standard between federal, state, and local guidelines?

When are construction plans required?
Plans for all new facilities, all additions to existing facilities, and all remodeling of existing facilities need to be submitted to the Engineering Unit in the Section for Long-Term Care Regulation for review. Architectural plans must be prepared be a registered architect and all mechanical and electrical plans must be prepared by a registered professional engineer.

Do the plans need to be architecturally drawn and signed?
Plans for any facility housing more than nine residents must be prepared by a registered architect or by a registered professional engineer. Final plans submitted for review and approval must be signed and sealed by registered architect or engineer.

Where are plans to be submitted?
All construction plans are to be submitted to David East, Mechanical Engineer, Section for Long-Term Care Regulation, PO Box 570, Jefferson City, MO, 65102-0570. Because there is usually a backlog of plans submitted for review, it is to your advantage to call David at 573 526 8521 and set up a time to bring your plans in for review.

Can a single-family dwelling be converted into a small RCF?
A single-family dwelling may be converted to a licensed RCF, however, the following must be considered. First, approval through the Certificate of Need Program is required for any facility that will cost more that $600,000 to develop. In addition, in order for a single-family dwelling to comply with new fire safety standards, substantial remodeling will likely be required.

What is the process for new construction and/or major remodeling?
The first step that must be taken is to obtain a Certificate of Need for the project or to obtain a letter from the Certificate of Need Program indicating that a Certificate of Need is not required for the project. Also, plans, in preliminary form and then in final form, must be submitted to the Engineering Unit in the Section for Long-Term Care Regulation to obtain a plan approval. When the project is about 80% complete, facility construction will be inspected by one of the engineers in the Engineering Unit. This will be followed up by another inspection when the project is100% complete. In addition, a licensure inspection will be conducted by staff from one of the Section for Long-Term Care Regulation regional offices. If the facility is in compliance with licensure standards and if all application requirements have been met, the facility will be licensed.

Are there other permits needed to open a long-term care facility?
Certificate of Need approval is required for all new facilities with costs of more that $600,000, for all additions to existing facilities that will cost more than $600,000, and for additions that will add more that 10% to the bed capacity of the facility. Building permits as required by local authorities will also be required.

Describe the requirement that an operator follow the strictest standard between federal, state, and local guidelines?
Providers are required to comply with all applicable federal, state, and local laws and regulations. Where standards differ, the facility must comply with the strictest standard. For Skilled Nursing Facilities and Intermediate Care Facilities, the Engineering Unit in the Section for Long-Term Care Regulation will review plans for compliance with standards required for participation in the Medicare or Medicaid programs as well as state standards. The provider must work directly with local authorities to assure compliance with local laws and regulations.

 

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 June 1, 2008, the Section for Long-Term Care Regulation licensed 1,146 long-term care facilities. This includes 495 Skilled Nursing Facilities, 35 Intermediate Care Facilities, 471 Residential Care Facilities, and 145 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 the provisions of a Medicaid waiver (known as the RCF PC program). To request additional information, please contact the Division of Senior and Disability Services at 1-800-392-0210.

 

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.