SB 906 - This act modifies several provisions relating to health care facilities, including: (1) Missouri Health Facilities Review Committee; (2) certificates of need (CON) for major medical equipment; (3) CON applications; (4) long-term care CON need formula; (5) CON appeals; and (6) long-term care facility Medicaid per diem reimbursement rates. MISSOURI HEALTH FACILITIES REVIEW COMMITTEE Currently, the Missouri Health Facilities Review Committee administers the CON process in Missouri. This act repeals the committee and places the responsibility over CON with the Department of Health and Senior Services. CON FOR MAJOR MEDICAL EQUIPMENT (Sections 197.305 and 197.315) This act removes the requirement to obtain a certificate of need for major medical equipment. CON APPLICATIONS (Sections 197.315 and 197.330) Under current law, a CON can be forfeited if no capital expenditure on an approved project is incurred within 6 months of approval. The applicant may seek an extension from the Missouri Health Facilities Review Committee. This act prohibits the granting of an extension for approved long-term care projects for which no substantial capital expenditure has been incurred within 3 years of the original approval date. Any applicant whose request for an extension is not granted under this act shall be permitted to apply for a new certificate of need. Under current law, the Missouri Health Facilities Review Committee issues a written decision on a CON application within 100 days of filing. Failure to do so shall constitute approval of and final administrative action on the application. This act removes that provision so that the Department's failure to act within the statutory time frame to issue a decision on an application shall not constitute approval of the application. LONG-TERM CARE CON NEED FORMULA (Sections 197.315, 197.318, and 197.323) This act removes the word "available" when referencing licensed long-term care beds. Under this act, the Department shall apply the following when determining whether or not to grant a CON for any new or additional licensed long-term care beds: • No consideration shall be given to any other licensed beds located more than 15 miles from the applying facilities in all non-urban areas and 10 miles in all urban areas; • Within the 10 or 15-mile service area, the following need formula shall apply: (1) for intermediate care and skilled nursing facilities (ICF/SNF), 53 beds per 1,000 population aged 65 and older minus the current number of ICF/SNF beds; (2) for residential care and assisted living facilities (RCF/ALF), 25 beds per 1,000 population aged 65 and older minus the current number RCF/ALF beds; and (3) for long-term care hospital beds (LTCH), one-tenth of a bed per 1,000 population minus the current number of LTCH beds; and • No CON shall be granted unless the applicant can demonstrate that the average occupancy of all facilities in the same category within the service area of the project site has been equal to or greater than 80% during the four most recent quarters. CON APPEALS (Section 197.335) Under current law, a CON applicant may appeal the decision of the Missouri Health Facilities Review Committee within 30 days of the issuance of the committee's decision. This act allows any affected person who is a provider of the same services as those offered by the CON applicant to appeal the Department's decision within the same time frame. LONG-TERM CARE FACILITY MEDICAID PER DIEM REIMBURSEMENT RATES (Section 208.225) Under this act, any intermediate care facility or skilled nursing facility participating in MO HealthNet that incurs total capital expenditures in excess of $2,000 per bed shall be entitled to obtain a recalculation of its Medicaid per diem reimbursement rate based on its additional capital costs or all costs incurred during the facility fiscal year during which such capital expenditures were made. This act also makes technical changes to the CON statutes. Provisions of this act are substantially similar to SB 779 (2018) and SB 397 (2017). SARAH HASKINS