SCS/SB 1087 - This act revises certificate of need law and enacts a review certification procedure for acute care facilities.

This act changes the definition of "health care facilities" by removing its reference to non-long term care related facilities and adding long term care beds or hospitals. "Health service area" is changed to refer to new institutional health services. The definition for and mention of "major medical equipment" is removed. A provision pertaining to hospital beds converted to long term care beds is contained in the term "new institutional health service" (Section 197.305).

Current law establishes the Missouri Health Facilities Review Committee. This act removes the Committee's ability to hire staff and reassigns employment decisions and oversight to the Department of Health and Senior Services. In addition, Committee members may not accept political donations from certificate of need (CON) or review certification applicants; this language replaces section 197.311, which is repealed (Section 197.310).

Current law outlines procedures to obtain a CON. The exclusion from a CON for new medical technology is removed and relocated to the review certification sections in 197.387. Section 197.366 is repealed due to expiration on 12/31/2001. Section 197.367 is repealed regarding RCFs I or II with low occupancy levels (Section 197.315).

Currently, the issuance of a CON to certain facilities is prohibited. This act includes hospital beds converted to long term care beds in the list (Section 197.317).

Currently, individuals must register as lobbyists if they are paid to support or oppose a project before the Committee. This act clarifies the use of influence on the Committee (Section 197.326).

Sections 197.375 through 197.397 contain new language regarding review certification and are similar to language contained in SB 235 (2001). This section provides definitions relating to review certification, such as "acute care facilities," "first-time services," "metropolitan statistical area," and "review certification" (Section 197.375).

Duties of the Committee are outlined, including the review and approval or disapproval of all applications for review certification. Reviews of expedited projects must be issued within 45 days (Section 197.378). The procedure for application submission is outlined. A letter of intent should be submitted 30 days before filing an application, with certain exceptions, and a fee must accompany the application (Section 197.381).

Any person proposing a new institutional acute care service must obtain a review certification before services are offered, unless the service:

- Will replace an existing facility, Be constructed within a permissible distance from the existing facility's boundary, and The license of the existing facility will be terminated or transferred to the new facility.

Any person proposing to develop or offer a first-time service must obtain a review certification before services are offered, unless the service regards a piece of equipment that: Is a similar replacement or additional piece of equipment and Will be placed in the same licensed location as the previously certified piece of equipment.

At least 60 days before construction begins, an applicant must conduct a public hearing on the project. Notice must be given 4 weeks before the hearing date. Other acute care facilities in the are must be notified 30 days in advance.

Any person proposing new, not previously licensed beds to an existing hospital must obtain review certification, but allowable addition or transfer of beds will not be precluded. Any person proposing an acute care facility over $20 million must obtain a review certification. Non-transferable certification will be granted to those meeting the health needs of the community. If costs exceed 10% of the approved amount, the Committee must consent to the increase. Applicants must submit periodic reports and the Committee may revoke certification in certain situations. A review certification may be forfeited for failure to incur any capital expenditures within 12 months. State agencies may not license, certify, or provide funds to an acute care facility without that facility first obtaining review certification, if required to do so. Review certification may not be denied based on an applicant's refusal to provide abortion services or information. Review certification may not be required for transfer of ownership in a facility's entirety or for the conversion of mobile to permanent first-time services. A review certification may be granted for less than requested in the original application. The purchase and use of new medical technology is exempted from review certification (Section 197.384).

Within 30 days of a decision, the applicant may appeal (Section 197.387). A review certification will not be required for facilities run by the state, nor for nonsubstantive projects (Section 197.390).

Reimbursement for new institutional acute care service project costs over 10% of the initial estimate will not be paid for the first 3 years that a facility receives payments for services through Medicaid. A review certification must be granted before payment for excess project costs will be made. The Committee is given rule authority to enforce these sections (Section 197.393 and 197.397).
ERIN MOTLEY