Proposed Rules
The following are summaries and other information related to Proposed Rules that the Missouri Department of Health & Senior Services has submitted to the Secretary of State for Publication in the Missouri Register. These rules will not go into effect until the public has had an opportunity to submit written comments, and to attend a public hearing if one is scheduled.
Any person may offer comments on a Proposed Rule. The instructions for submitting comments, and the location and date of a hearing if one is scheduled, are located after the text of each rule. Note that the official text of a Proposed Rule is the version that appears in the Missouri Register, not the draft copy on this site. Refer to the official copy if you wish to submit comments.
We hope you find this site helpful and informative.
Section 536.175, RSMo, requires a five year rolling review by all departments of their existing rules. DHSS was required to begin their review no later than July 1, 2018, and to complete said review no later than June 30, 2019. As a result, the department reviewed 759 rules, received zero comments, and prepared the above report, which was timely filed with the Joint Committee on Administrative Rules.
- DHSS Periodic Rule Review - 2024
- Appendix - Comments Received from Public on Department of Health and Senior Services Rules
Section 536.175, RSMo, requires a five year rolling review by all departments of their existing rules. DHSS was required to begin their review no later than July 1, 2023, and to complete said review no later than June 30, 2024. As a result, the department reviewed approximately 804 rules, received four (4) public comments, and prepared the above report and appendix, which was timely filed with the Joint Committee on Administrative Rules.
To submit feedback on a draft rule that is not yet in the formal rulemaking process, please visit the Pre-Rulemaking – Stakeholder Feedback page.
| Proposed Rule | Summary | Fiscal Note(s) |
Material Incorporated by Reference |
Link to Missouri Register |
Date Posted |
|---|---|---|---|---|---|
| 19 CSR 60-50.300 Definitions for the Certificate of Need Process | This proposed rule amends the provision that provides definitions used in the certificate of need process. Particularly, this rule provides definition for the terms “LTC bed expansion review”, “major medical equipment to be replaced”, and “request to relicense”. | N/A | N/A | Volume 50, Number 19 | Sept. 20, 2025 |
| 19 CSR 60-50.400 Letter of Intent Process | This proposed rule amends the letter of intent process used in the Certificate of Need process to make all letters of intent valid for 6 months, removes LTC bed expansion information from the rule and places it in another CON regulation, cleans up verbiage related to long-term care bed projects, makes various statutory reference clean-ups, and renumbers the rule accordingly. | N/A | N/A | Volume 50, Number 19 | Sept. 20, 2025 |
| 19 CSR 60-50.410 Letter of Intent Package | This proposed rule amends the letter of intent package rule to remove long-term care bed need and special exception requirements from the LOI, places LTC bed expansion process and requirements under this regulation, requires evidence architectural plans have been submitted to DHSS Engineering Consultation Unit for non-applicability projects, updates statutory references and renumbers the rule accordingly. | N/A | N/A | Volume 50, Number 19 | Sept. 20, 2025 |
| 19 CSR 60-50.420 Review Process | This proposed rule amends the certificate of need rule governing the review process to remove outdated processes and other regulatory references, update date filing timeframes, applicant response time, add detail related to rejection of a CON Application, accept a decrease in beds within a CON application, and renumbers the rule accordingly. | N/A | N/A | Volume 50, Number 19 | Sept. 20, 2025 |
| 19 CSR 60-50.430 Application Package | This proposed rule amends the certificate of need rule governing the application package to remove LTC Bed Expansion from the MO 580-2504 application checklist, remove expedited replacement equipment projects without a valid CON, adds clarification requirements for hospital, long-term care, and equipment projects, and requires third party documentation of costs. | N/A | N/A | Volume 50, Number 19 | Sept. 20, 2025 |
| 19 CSR 60-50.450 Criteria and Standards for Long-Term Care | This proposed rule amendment clarifies a replacement facility in its entirety cannot be used by any person or entity for long-term care services, removes current section (3) and places it in another CON regulation, and makes other intersectional references as needed. | N/A | N/A | Volume 50, Number 19 | Sept. 20, 2025 |
| 19 CSR 60-50.470 Criteria and Standards for Financial Feasibility | This proposed rule amendment amends this rule to ensure the amount of financing is listed on documentation from a financial institution for a proposal. | N/A | N/A | Volume 50, Number 19 | Sept. 20, 2025 |
| 19 CSR 60-50.500 Additional Information | This proposed rule amendment extends the timeframe CON staff notify an applicant of an incomplete application, and requires letters in support, opposition and neutral be submitted to the CON office five business days before a scheduled CON meeting. | N/A | N/A | Volume 50, Number 19 | Sept. 20, 2025 |
| 19 CSR 60-50.700 Post-Decision Activity | This proposed rule amendment adds detail for the LTC bed expansion process and details acceptable capital expenditure requirements for each type of CON project. | N/A | N/A | Volume 50, Number 19 | Sept. 20, 2025 |
| 19 CSR 60-50.800 Meeting Procedures | This proposed rule amendment expedites applicant response time to staff findings, committee questions, or adverse information submitted within support, opposition or neutral letters before a scheduled CON meeting. The proposed rule amendment shortens the response time from 10 days to 3 business days. | N/A | N/A | Volume 50, Number 19 | Sept. 20, 2025 |
| 19 CSR 30-1.006 List of Exempt Anabolic Steroid Products | This proposed rule exempts certain anabolic steroid products from the licensing, distribution, recordkeeping, and reporting provisions of 19 CSR 30 (Controlled Substances) if the products have received approval as an exempt anabolic steroid product pursuant to 21 C.F.R. 1308.34. This proposed amendment modifies and updates 19 CSR 30-1.006 to reflect the current exemption list of anabolic steroid products provided by federal regulation. Persons who handle anabolic steroid products on the exemption list are exempt from the registration, records, reports, prescriptions, physical security and import and export requirements associated with Schedule III substances. | N/A | N/A | Volume 50, Number 17 | July 25, 2025 |
| 19 CSR 30-30.062 Complication Plans for Certain Drug- and Chemically- Induced Abortions | This rule establishes the standards governing complication plans required by section 188.021, RSMo. This rule also explains the process for submitting such complication plans to the Department of Health and Senior Services for approval. | N/A | Volume 50, Number 8 | March 17, 2025 | |
| 19 CSR 40-10.020 Sexual Assault Forensic Exams with Telehealth Statewide Network (SAFEvT Network) | This proposed rule outlines the requirements for training and experience for the statewide telehealth network for forensic examinations of victims of sexual offenses. | Fiscal Note | N/A | Volume 50, Number 3 | January 31, 2025 |
| 19 CSR 10-4.060 Substance Use Disorder Grant Program | This proposed rule establishes guidelines for implementing the Substance Use Disorder (SUD) Grant Program that will increase access to evidence-based low-barrier drug addiction treatment, support overdose prevention education, and support job placement, housing, and counseling for those with substance use disorders. | Fiscal Note | N/A | Volume 50, Number 3 | January 31, 2025 |
| 19 CSR 20-8.030 Lead Poisoning Assessment, Testing, Follow-Up, and Reporting | This proposed rule establishes criteria for the screening and follow up activities of children less than seventy-two (72) months of age for lead poisoning in Missouri. | Fiscal Note | N/A | Volume 49, Number 21 | January 31, 2025 |
19 CSR 30-110.010 Prescribed Pediatric Extended Care Facilities Definitions |
This proposed rule defines terms as set forth in 19 CSR 30-110 and sections 192.2550-192.2560, RSMo. The rules and statutes require the department to issue licenses to providers operating Prescribed Pediatric Extended Care facilities. Missouri law requires that these providers be licensed by August 28, 2025 to continue providing services after that date. | N/A | N/A | Volume 50, Number 3 | December 31, 2024 |
19 CSR 30-110.020 Licensure Management |
This rule describes the licensure, inspection, plan of correction, and variance processes for Prescribed Pediatric Extended Care facilities. | 110.020 Form | N/A | Volume 50, Number 3 | December 31, 2024 |
19 CSR 30-110.030 Prescribed Pediatric Extended Care Facilities Operations |
This rule defines the minimum requirements for the provision of care in licensed Prescribed Pediatric Extended Care facilities. | Private Fiscal Note | N/A | Volume 50, Number 3 | December 31, 2024 |
19 CSR 10-10.030 Filing a Delayed Birth Certificate Application/Certification to Record Birth AFter 12th Birthday |
This proposed amendment establishes procedures for registering a birth certificate for an individual when a birth certificate is not registered within the prescribed time period and establishes the delayed birth certificate form to be registered with the Department of Health and Senior Services for each birth occurring in this state. | N/A | N/A | Volume 49, Number 21 | October 4, 2024 |
19 CSR 30-1.002 Schedules of Controlled Substances |
This proposed and emergency amendment updates the Schedules of Controlled Substances to be consistent with 21 CFR Part 1308. | N/A | N/A | Volume 49, Number 21 | September 24, 2024 |
19 CSR 20-80.010 Training Standards Relating to the Office of the Coroner |
This proposed rule establishes the training standards related to the office of the county coroner. The training standards relate to the operation of the office, the legal responsibilities of the office, and the technical skills and knowledge required of the office. | N/A | N/A | Volume 49, Number 13 | May 31, 2024 |
19 CSR 30-40.600 Outside the Hospital Do-Not-Resuscitate (OHDNR) |
This amendment allows for an outside the hospital do-not-resuscitate order to be executed for patients who are under 18 years of age. In 2023, there were changes made to sections 190.600 to 190.621, RSMo to broaden the age group to those under the age of 18. This amendment allows EMS personnel to comply with outside the hospital do-not-resuscitate orders and protocol for this age group when a patient is not in a hospital. This amendment instructs when EMS shall not comply with outside the hospital do-not-resuscitate orders and outside the hospital do-not-resuscitate protocol for patients under 18 years of age. | N/A | N/A | Volume 49, Number 13 | May 22, 2024 |
| 19 CSR 60-50.450 Criteria and Standards for Long-Term Care. | The rule is being amended to remove the actual projected year from the language of the rule. This will prevent the necessity to amend the rule every five years just to change the year number. | N/A | N/A | Volume 49, Number 11 | April 22, 2024 |
| 19 CSR 60-50.440 Criteria and Standards for Equipment and New Hospitals. | The rule is being amended to remove the actual projected year from the language of the rule. This will prevent the necessity to amend the rule every five years just to change the year number. | N/A | N/A | Volume 49, Number 11 | April 22, 2024 |
| 19 CSR 60-50.430 Application Package. | The rule is being amended to remove the actual projected year from the language of the rule. This will prevent the necessity to amend the rule every five years just to change the year number. | N/A | N/A | Volume 49, Number 11 | April 22, 2024 |
19 CSR 30-1.064 |
In July of 2023, the DEA issued its final rule amending its regulations for partial filling of prescriptions for schedule II substances. The federal regulations were promulgated in response to the passage of the Comprehensive Addiction and Recovery Act of 2016 (“CARA”). Under CARA, physicians or patients may request pharmacists to partially fill prescriptions for schedule II substances and to allow remaining quantities to be filled up to 30 days after issuance of the prescription. This amendment simply updates Missouri’s regulation to be consistent with the federal regulation. | N/A |
N/A | Volume 49, Number 7 | February 27, 2024 |
19 CSR 30-40.810 |
This proposed and emergency rule establishes training and transport requirements for ground ambulances to transport patients to Missouri Department of Mental Health designated behavioral health crisis centers and other locations for those patients who do not require transport to a hospital and whose health needs can be met by behavioral health crisis centers or other locations where patients are transported. | N/A (But see attached Small Business Regulatory Fairness Board Small Business Impact Statement) |
N/A | Volume 49, Number 7 | February 26, 2024 |