19 CSR 30-82

General Licensure Requirements

This Missouri regulation establishes general licensure application procedures for long-term care facilities, specifically skilled nursing facilities, intermediate care facilities, assisted living facilities, and residential care facilities. Operators must submit detailed applications including financial disclosures, ownership information, and supporting documents, and pay tiered fees based on resident capacity. The rule also covers license amendments, temporary operating permits, facility closures (including COVID-19-related temporary closures), exception requests, and noncompliance notification procedures. Facilities providing Alzheimer's/dementia special care units must submit additional disclosure forms.

CODE OF STATE REGULATIONS 1
Denny Hoskins (3/31/26)
Secretary of State
rules of
Department of Health and Senior 
Services
Division 30—Division of Regulation and Licensure
Chapter 82—General Licensure Requirements
 Title Page
19 CSR 30-82.010 General Licensure Requirements .................................... 3
19 CSR 30-82.015 Long-Term Care Receiverships ...................................... 8
19 CSR 30-82.020 Classification of Rules .............................................. 9
19 CSR 30-82.030 Assessment of Availability of Beds (Rescinded March 30, 2020) ........ 10
19 CSR 30-82.050 Transfer and Discharge Procedures ................................. 10
19 CSR 30-82.060 Hiring Restrictions—Good Cause Waiver ............................ 12
19 CSR 30-82.070 Alzheimer’s Demonstration Projects (Rescinded September 30, 2013) ...15
19 CSR 30-82.080 Nursing Facility Quality of Care Improvement Program ..............15
 CODE OF STATE REGULATIONS 3
Denny Hoskins (3/31/26)
Secretary of State
19 CSR 30-82—DEPARTMENT OF HEALTH AND DIVISION 30—DIVISION OF REGULATION
 SENIOR SERVICES AND LICENSURE
TITLE 19—DEPARTMENT OF HEALTH AND SENIOR 
SERVICES
Division 30—Division of Regulation and Licensure
Chapter 82—General Licensure Requirements
19 CSR 30-82.010 General Licensure Requirements 
PURPOSE: This rule sets forth general licensure and application 
procedures and outlines the request for an exception procedure 
related to long-term care facility licensure. 
PUBLISHER’S NOTE: The secretary of state has determined that the 
publication of the entire text of the material which is incorporated 
by reference as a portion of this rule would be unduly cumbersome 
or expensive. This material as incorporated by reference in this 
rule shall be maintained by the agency at its headquarters and 
shall be made available to the public for inspection and copying 
at no more than the actual cost of reproduction. This note applies 
only to the reference material. The entire text of the rule is printed 
here.
(1) Persons wishing to operate a skilled nursing facility, 
intermediate care facility, assisted living facility, or residential 
care facility shall complete form MO 580-2631 (8-07), Application 
for License to Operate a Long-Term Care Facility, incorporated 
by reference in this rule and available through the Department 
of Health and Senior Services’ (department’s) website at www.
dhss.mo.gov, or by mail at: Department of Health and Senior 
Services, Section for Long-Term Care Regulation, Licensure 
Unit, PO Box 570, Jefferson City, MO 65102-0570, telephone: 
(573) 526-8524. This rule does not incorporate any subsequent 
amendments or additions. The application shall be signed by 
a person with the express authority to sign on behalf of the 
operator, who shall attest by signature that the information 
submitted is true and correct to the best of the applicant’s 
knowledge and belief and that all required documents are 
either included with the application or are currently on file 
with the department. The completed application form may be 
submitted by mail or electronically. If submitted electronically, 
send the completed application to LTCapplication@dhss.
mo.gov. The application fee for application processing should 
be submitted by separate mail. If submitted by mail, send the 
application form and fee to Department of Health and Senior 
Services, Section for Long-Term Care Regulation, Fee Receipts, 
PO Box 570, 920 Wildwood, Jefferson City, MO 65102. One (1) 
application may be used to license multiple facilities if located 
on the same premises.
(A) The applicant shall submit the following documents and 
information as listed in the application:
1. Financial information demonstrating that the applicant 
has the financial capacity to operate the facility;
2. A document disclosing the location, capacity, and type 
of licensure and certification of any support buildings, wings, 
or floors housing residents on the same or adjoining premises 
or plots of ground;
3. A document disclosing the name, address, and type of 
license of all other long-term care facilities owned or operated 
by either the applicant or by the owner of the facility for which 
the application is being submitted;
4. A copy of any executed management contracts between 
the applicant and the manager of the facility;
5. A copy of any executed contract conveying the legal 
right to the facility premises, including, but not limited to, 
leases, subleases, rental agreements, contracts for deed, and 
any amendments to those contracts;
6. A copy of any contract by which the facility’s land, 
building, improvements, furnishings, fixtures, or accounts re -
ceivable are pledged in whole or in part as security, if the value 
of the asset pledged is greater than five hundred dollars ($500);
7. A nursing home surety bond or noncancelable escrow 
agreement, if the applicant holds or will hold facility residents’ 
personal funds in trust;
8. A document disclosing the name, address, title, and per-
centage of ownership of each affiliate of any general partner -
ship, limited partnership, general business corporation, non -
profit corporation, limited liability company, or governmental 
entity which owns or operates the facility or is an affiliate of 
an entity which owns or operates the facility. If an affiliate is a 
corporation, partnership, or LLC, a list of the affiliate’s affiliates 
must also be submitted. As used in this rule, the word “affili -
ate” means:
A. With respect to a partnership, each partner thereof;
B. With respect to a limited partnership, the general 
partner and each limited partner with an interest of five 
percent (5%) or more in the limited partnership;
C. With respect to a corporation, each person who owns, 
holds, or has the power to vote five percent (5%) or more of any 
class of securities issued by the corporation, and each officer 
and director;
D. With respect to an LLC, the LLC managers and 
members with an interest of five percent (5%) or more;
9. If applicable, a document stating the name and nature 
of any additional businesses in operation on the facility 
premises and the document issued by the division giving its 
prior written approval for each business;
10. A list of all principals in the operation of the facility 
and their addresses and titles and, so that the department 
may verify the information disclosed pursuant to paragraphs 
(1)(A)11. and (1)(A)12. of this rule, the Social Security numbers 
or employer identification numbers of the operator and all 
principals in the operation of the facility. As used in this 
rule, “principal” means officer, director, owner, partner, key 
employee, or other person with primary management or 
supervisory responsibilities;
11. Disclosure concerning whether the operator or any 
principals in the operation of the facility are excluded from 
participation in the Title XVIII (Medicare) or Title XIX (Medicaid) 
program of any state or territory;
12. Disclosure concerning whether the operator or any 
principals in the operation of the facility have ever been 
convicted of a felony in any state or federal court concerning 
conduct involving either management of a long-term care 
facility or the provision or receipt of health care services; 
13. Emergency telephone, fax, and email contact 
information for the facility administrator, director of nursing, 
and the operator’s corporate office; and
14. Disclosure concerning whether the facility has a 
Department of Mental Health (DMH) license.
(B) Every facility that provides specialized Alzheimer’s or 
dementia care services, as defined in sections 198.500 to 
198.515, RSMo, by means of an Alzheimer’s special care unit 
or program shall submit to the department with the licensure 
application or renewal, the following:
1. Form MO 580-2637, Alzheimer’s Special Care Services 
Disclosure (2-07), incorporated by reference in this rule and 
available through the department’s website: www.dhss.mo.gov, 
or by mail at: Department of Health and Senior Services, 
Section for Long-Term Care Regulation, Licensure Unit, PO Box 
570, Jefferson City, MO 65102-0570, telephone: (573) 526-8524. 
This rule does not incorporate any subsequent amendments or 
4 CODE OF STATE REGULATIONS 
(3/31/26) Denny Hoskins
Secretary of State
DIVISION 30—DIVISION OF REGULATION 19 CSR 30-82—DEPARTMENT OF HEALTH AND
AND LICENSURE SENIOR SERVICES
additions. The form shall be completed showing how the care 
provided by the special care unit or program differs from care 
provided in the rest of the facility in the following areas:
A. The Alzheimer’s special care unit’s or program’s 
written statement of its overall philosophy and mission which 
reflects the needs of residents afflicted with dementia;
B. The process and criteria for placement in, or transfer 
or discharge from, the unit or program;
C. The process used for assessment and establishment of 
the plan of care and its implementation, including the method 
by which the plan of care evolves and is responsive to changes 
in condition;
D. Staff training and continuing education practices;
E. The physical environment and design features 
appropriate to support the functioning of cognitively impaired 
adult residents;
F. The frequency and types of resident activities;
G. The involvement of families and the availability of 
family support programs;
H. The costs of care and any additional fees; and
I. Safety and security measures; and
2. Form Guide to Selecting an Alzheimer’s Special Care Unit 
(6/06) #455, incorporated by reference in this rule and available 
through the department’s website: at http://www.dhss.mo.gov/
Ombudsman, or by mail at: Department of Health and Senior 
Services, Section for Long-Term Care Regulation, Licensure 
Unit, PO Box 570, Jefferson City, MO 65102-0570, telephone: 
(573) 526-8524 or a document of choice which contains, but 
is not limited to, all information on selecting an Alzheimer’s 
special care unit or program that is contained in the Guide 
to Selecting an Alzheimer’s Special Care Unit (6/06) #455. This 
rule does not incorporate any subsequent amendments or 
additions.
(C) If, after filing an application, the operator identifies an 
error or if any information changes the issuance of the license, 
including but not limited to, a change in the administrator, 
board of directors, officers, level of care, number of beds, or 
change in the name of the operating entity, the operator 
shall—
1. Submit the correction or additional information to the 
department’s Licensure and Certification Unit in a letter. The 
letter shall be signed by a person with express authority to 
sign on behalf of the operator attesting by signature that the 
information being submitted is true and correct to the best of 
the operator’s knowledge and belief; or
2. Submit the correction or additional information to the 
department’s Licensure and Certification Unit. The additional 
information may be submitted electronically or by mail. 
Information shall be submitted using form MO 580-2623 (8-07), 
Corrections For Long-Term Care Facility License Application, 
incorporated by reference in this rule and available through 
the Department of Health and Senior Services’ (department’s) 
website at www.dhss.mo.gov, or by mail at: Department 
of Health and Senior Services, Section for Long-Term Care 
Regulation, Licensure Unit, PO Box 570, Jefferson City, MO 
65102-0570, telephone: (573) 526-8524. This rule does not 
incorporate any subsequent amendments or additions. The 
completed correction form shall be signed by a person with 
express authority to sign on behalf of the operator attesting by 
signature that the information submitted is true and correct 
to the best of the operator’s knowledge and belief and shall be 
submitted by electronic mail to LTCapplication@dhss.mo.gov, 
or by mail to: Department of Health and Senior Services, 
Section for Long-Term Care Regulation, Fee Receipts, PO Box 
570, 920 Wildwood, Jefferson City, MO 65102.
(D) If, as a result of an application review, the department 
requests a correction or additional information, the operator, 
within ten (10) working days of receipt of the written request 
shall—
1. Submit the correction or additional information to 
the department in a letter attesting by signature that the 
information being submitted is true and correct to the best of 
the operator’s knowledge and belief; or
2. Submit the correction or additional information using 
form MO 580-2623 (8-07), Corrections For Long-Term Care 
Facility License Application referenced in paragraph (1)(C)2. of 
this rule.
(E) A new facility shall submit an application for an original 
license not less than thirty (30) days before the anticipated 
opening date. The department must approve the application 
before a licensure inspection is scheduled. Sixty (60) days after 
its receipt, the department shall consider any application for 
an original license withdrawn if it is submitted without all the 
required information and documents. If intending to continue 
with licensure, the operator shall submit a new application and 
fee along with all necessary documents.
(F) An operator shall submit a relicensure application thirty 
(30) to ninety (90) days prior to the existing license’s expiration 
date.
(G) If, during the license’s effective period, 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, 
within ten (10) working days of the effective date of that 
change, the operator shall submit an application for a new 
license.
(H) The department shall issue each license only for the 
premises and operator named in the application. This license 
shall cover the entire premises unless stipulated otherwise and 
shall not be transferable. 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. A 
change of operator shall include a change in form of business 
as well as a change of person. Upon receipt of the application 
and receipt of confirmation that the change of operator has 
taken place, the department shall grant the new operator a 
temporary operating permit of sufficient duration to allow 
the department time to evaluate the application, conduct any 
necessary inspection(s) to determine substantial compliance 
with the law and the rules, and to either issue or deny a license 
to the new operator. The new operator shall be subject to all 
the terms and conditions under which the previous operator’s 
license or temporary operating permit was issued. This includes 
any existing statement of deficiencies, plans of correction 
and compliance with any additional requirements imposed 
by the department as a result of any existing substantial 
noncompliance. The new operator, however, shall apply to the 
department for renewal in his/her/its name for any exception 
to the rules that had been granted the previous operator under 
the provisions of section (3) of this rule. 
(I) The operator shall accompany each application for a 
license to operate a long-term care facility (skilled nursing 
facility, intermediate care facility, assisted living facility or 
residential care facility) with a license fee of one hundred 
dollars ($100) for those facilities which have a resident capacity 
of at least three (3) but less than twenty-five (25), three hundred 
dollars ($300) for those facilities which have a resident capacity 
of twenty-five through one hundred (25–100), and six hundred 
dollars ($600) for those facilities with a capacity of over one 
 CODE OF STATE REGULATIONS 5
Denny Hoskins (3/31/26)
Secretary of State
19 CSR 30-82—DEPARTMENT OF HEALTH AND DIVISION 30—DIVISION OF REGULATION
 SENIOR SERVICES AND LICENSURE
hundred (100+). The operator shall submit a separate fee for 
each facility’s license application. This fee is nonrefundable 
unless the facility withdraws the application within ten (10) 
days of receipt by the department. The department will issue 
a license for a period of no more than two (2) years for the 
premises and operator named in the application. If the license 
is for less than two (2) years, the department will prorate the 
fees accordingly. 
(J) An operator may apply for licenses for two (2) or more 
different levels of care located on the same premises either 
by submitting one (1) application or by submitting a separate 
application for each level of care. If an operator elects to 
submit one (1) application for two (2) or more levels of care 
located on the same premises—
1. The application shall specify separately the number of 
beds of each level of care being applied for; 
2. The application shall be accompanied by a license fee 
for each level of care applied for, as required by subsection (1)
(I) of this rule; and
3. An application for two (2) or more levels of care on the 
same premises shall indicate one (1) facility name only. 
(K) The department shall issue a separate license for each 
level of care located on the same premises, whether applied 
for by one (1) application or more than one (1). If the operator 
uses one (1) application for two (2) or more levels of care on the 
same premises, the department shall issue licenses with one (1) 
expiration date. If two (2) or more levels of care have existing 
licenses with different expiration dates and the operator elects 
to apply for licenses for the levels of care by submitting one 
(1) relicensure application, the expiration dates of the licenses 
issued shall be two (2) years subsequent to the expiration date 
of the license of the level of care expiring earliest following 
receipt of the application by the department. Fees for unused 
portions of licenses resulting from the submission of one (1) 
application for two (2) or more levels of care are nonrefundable. 
(L) After receiving a license application, the department 
shall review the application, investigate the applicant and the 
statements sworn to in the application for license and conduct 
any necessary inspections. A license shall be issued if—
1. The department has determined that the application is 
complete, and that all necessary documents have been filed 
with the application including an approved nursing home 
bond or noncancelable escrow agreement if personal funds of 
residents are held in trust; 
2. The department has determined that the statements in 
the application are true and correct; 
3. The department has determined that the facility and the 
operator are in substantial compliance with the provisions of 
sections 198.003–198.096, RSMo, and the corresponding rules; 
4. The department has determined that the applicant has 
the financial capacity to operate the facility; 
5. The department has verified that the administrator of a 
residential care facility that was licensed as a residential care 
facility II on August 27, 2006 and chooses to continue to meet 
all laws, rules, and regulations that were in place on August 
27, 2006 for a residential care facility II, assisted living facility, 
an intermediate care facility, or a skilled nursing facility is 
currently licensed by the Missouri Board of Nursing Home 
Administrators under the provisions of Chapter 344, RSMo;
6. The department has received the fee required by 
subsection (1)(I) of this rule; 
7. The applicant meets the definition of operator as 
defined in 19 CSR 30-83.010;
8. The applicant has received a Certificate of Need, if 
required, or has received a determination from the Certificate 
of Need Program that no certificate is required, has completed 
construction, and is in substantial compliance with the 
licensure rules and laws;
9. The department has determined that neither the 
operator, owner, or any principals in the operation of the 
facility have ever been convicted of an offense concerning 
the operation of a long-term care facility or other health 
care facility or, while acting in a management capacity, ever 
knowingly acted or knowingly failed to perform any duty 
which materially and adversely affected the health, safety, 
welfare, or property of a resident;
10. The department has determined that neither the 
operator, owner, or any principals in the operation of the facility 
are excluded from participation in the Title XVIII (Medicare) or 
Title XIX (Medicaid) program of any state or territory;
11. The department has determined that neither the 
operator, owner, or any principals in the operation of the facility 
have ever been convicted of a felony in any state or federal 
court concerning conduct involving either management of a 
long-term care facility or the provision or receipt of health care 
services; and 
12. The department has determined that all fees due the 
state have been paid.
(M) If, during the period in which a license is in effect, a 
change occurs which causes the statements in the application 
to no longer be correct, including change of administrator, or if 
any document is executed which replaces, succeeds or amends 
any of the documents filed with the application, within ten (10) 
working days of the effective date of the change, the operator 
shall—
1. Submit a letter to the department’s Licensure and 
Certification Unit that contains a correction of the application 
with notification of the effective date of the change and a copy 
of any new documents. The operator must ensure the letter 
is signed by a person with the express authority to sign on 
behalf of the operator, who shall attest by signature that the 
information being submitted is true and correct to the best of 
the operator’s knowledge and belief; or
2. Submit to the department a correction of the application 
and a copy of any new documentation and information 
by submitting form Corrections for Long-Term Care Facility 
License Application referenced in paragraph (1)(C)2. of this rule.
(N) If from an analysis of financial information submitted 
with the application, or if from information obtained during 
the term of a license, the operator appears insolvent or shows 
a tendency toward insolvency, the department shall have the 
right to request additional financial information from the 
operator. Within ten (10) working days after receiving a written 
request from the department, the operator shall—
1. Submit to the department the additional information 
requested in a letter accompanied by a statement attesting 
by signature that the information being submitted is true and 
correct to the best of the operator’s knowledge and belief; or
2. Submit the financial information to the department 
on form Corrections for Long-Term Care Facility License 
Application referenced in paragraph (1)(C)2. of this rule.
(O) A license applicant’s financial information, data, and 
records submitted to the department as required by this rule, 
including, but not limited to, copies of any Internal Revenue 
Service forms, shall be open for inspection and be released 
only—
1. To designated employees of the department; 
2. To the applicant furnishing this information or to his/her 
representative as designated in writing; 
3. To the director of the department or to his/her 
6 CODE OF STATE REGULATIONS 
(3/31/26) Denny Hoskins
Secretary of State
DIVISION 30—DIVISION OF REGULATION 19 CSR 30-82—DEPARTMENT OF HEALTH AND
AND LICENSURE SENIOR SERVICES
representative as designated in writing; 
4. To the state auditor or his/her representative as 
designated in writing; 
5. To appropriate committees of the General Assembly or 
their representatives as designated in writing; 
6. In any judicial or administrative proceeding brought 
under the Omnibus Nursing Home Act; or 
7. When so ordered by a court of competent jurisdiction. 
(P) To obtain a license for an additional level of care on the 
premises, the licensed operator shall submit a written request 
by electronic mail to LTCapplication@dhss.mo.gov, or mail to 
the department for the issuance of a license for the desired level 
of care. The request shall indicate the level of care, the number 
of beds desired, the name and address of the facility, the name 
and address of the operator, and shall include the signature 
of the operator. The request shall be signed by a person with 
the express authority to sign on behalf of the operator, who 
shall attest by signature that the information submitted is true 
and correct to the best of the operator’s knowledge and belief. 
The licensure fee shall accompany this request. Requests are 
subject to department approval. The operator shall submit this 
request no less than sixty (60) days prior to the initiation date 
of the new level of care. The department shall coordinate this 
license’s expiration date with that of the original license and 
the department shall prorate the license fee accordingly.
(Q) To request issuance of an amended license or temporary 
operating permit currently in effect, the operator shall—
1. Submit a written request to the department containing 
the request for amendment, the date the operator would like 
the amendment to be effective, and the number of the license 
or temporary operating permit to be amended; and
2. Submit a fee for the issuance of the amended license or 
temporary operating permit as required by subsection (1)(R) of 
this rule.
(R) If an operator initiates a request to amend a license or 
temporary operating permit currently in effect, the department 
requires the following fees: 
1. If the request is for an increase in bed capacity, the 
operator shall submit a fee with the request which is the 
greater of—
A. The amount that would have been required by 
subsection (1)(I) of this rule if the increase in bed capacity has 
been included in the application, less any amount actually 
paid under that subsection; or 
B. Fifty dollars ($50); and 
2. If the request is for a decrease in resident capacity or 
any other change, the operator shall submit a fee of twenty-five 
dollars ($25) with the request. 
(S) The department shall approve all requests for bed 
changes prior to issuance of an amended license or temporary 
operating permit. The effective date of the amended license or 
temporary operating permit shall be no earlier than the date 
the department approved the request for bed change.
(T) If the department issues a temporary operating permit, 
and then subsequently issues a regular license, the licensing 
period shall include the period of operation under the 
temporary operating permit. The licensing period shall also 
include any period during which the department was enjoined 
or stayed from revoking or denying a license or rendering the 
temporary operating permit null and void.
(U) Unless an operator indicates otherwise, all the rooms 
and space on the premises and all persons eighteen (18) years 
of age and over living on the premises shall be considered as 
part of the facility and its licensed capacity or staff and shall be 
subject to compliance with all rules governing the operation of 
a licensed facility. If an operator, when applying or reapplying 
for a license, wants to exclude some portion of the premises 
from being licensed or wants to exclude a relative as a resident, 
a statement to that effect shall be filed as a separate document 
indicating the use which will be made of that area of the 
premises and who or what occupies the area, and what the 
relationship is of the relative(s) being excluded. The statement 
shall be signed by a person with the express authority to sign 
on behalf of the operator, who shall attest by signature that 
the information submitted is true and correct to the best of the 
operator’s knowledge and belief.
(V) The operator shall not provide care in any area on 
the premises to any related person who requires protective 
oversight unless there has been a written request to the 
department to consider any portion of the facility for private 
use and that indicates facility staff shall not be used at any 
time to care for the relative(s). Prior to the area being used 
in that manner, the operator shall submit the request for the 
department’s approval. The department, after investigation, 
shall approve or disapprove the request in writing within thirty 
(30) days and shall issue or reissue the license indicating clearly 
which portion of the premises is excluded from licensure or 
which specific relative(s) is/are not considered a resident(s). 
(2) If a facility was licensed under Chapter 197 or 198, RSMo, 
and was in operation before September 28, 1979, or if an 
application was on file or construction plans were approved 
prior to September 28, 1979, the facility shall comply with 
construction, fire safety and physical plant rules applicable 
to an existing or existing licensed facility provided there has 
been continuous operation of the facility under a license or 
temporary operating permit issued by the division. If, however, 
there was an interruption in the operation of the facility due 
to license denial, license revocation, or voluntary closure, 
the facility may be relicensed utilizing the same fire safety, 
construction, and physical plant rules that were applicable 
prior to the license denial, license revocation, or voluntary 
closure provided that the facility reapplies for a license within 
one (1) year of the date of the denial, revocation, or voluntary 
closure. Regardless of licensure, application, or construction 
plan approval date, intermediate care facilities and skilled 
nursing facilities shall comply with the fire safety standards 
published in 19 CSR 30-85.022.
(A) If a facility changes from a skilled nursing or intermediate 
care facility to any other level, or if the facility changes from 
a an assisted living facility to a residential care facility, the 
facility shall 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. 
(B) If the facility changes 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 shall 
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.
(C) The facility shall comply with the rules applicable to a 
new or newly licensed facility if an application for relicensure 
has not been filed with the department within one (1) year of 
the license denial, license revocation, or voluntary closure. All 
such facilities seeking licensure as an assisted living facility 
shall also comply with the requirements of 19 CSR 30-86.047 
and, if applicable, 19 CSR 30-86.045.
(3) Licensed Facility Closures.
(A) If a licensed facility discontinues operation as evidenced 
 CODE OF STATE REGULATIONS 7
Denny Hoskins (3/31/26)
Secretary of State
19 CSR 30-82—DEPARTMENT OF HEALTH AND DIVISION 30—DIVISION OF REGULATION
 SENIOR SERVICES AND LICENSURE
by the fact that no residents are in care or at any time the 
department is unable to freely gain entry into the facility to 
conduct an inspection, the facility shall be considered closed. 
The department shall notify the operator in writing requesting 
the voluntary surrender of the license. If the department does 
not receive the license within thirty (30) days, it shall be void. 
If the operator should choose to again license the facility, the 
operator shall submit a complete application. The provisions of 
section (1) shall apply.
(B) If any licensed skilled nursing facility or intermediate care 
facility is required to temporarily close for two (2) years or less 
from the effective date of the temporary closure due to staffing 
shortages as a result of a COVID-19 vaccine mandate first issued 
in emergency regulation by the United States Department 
of Health and Human Services, Centers for Medicare and 
Medicaid Services (CMS) on November 4, 2021, effective on 
November 5, 2021, or any amendment changes or amendments 
thereafter, then the skilled nursing and intermediate care 
facilities shall do the following: 
1. The facility operator shall submit a closure plan to the 
department which is in compliance with state and federal law, 
including 42 CFR part 483.15(c) (detailed in federal deficiency 
F623 in the State Operations Manual appendix PP), 42 CFR 
part 483.70(l) (detailed in federal deficiency F845 in the State 
Operations Manual appendix PP), and 42 CFR 483.70(m) (detailed 
in federal deficiency F846 in the State Operations Manual 
appendix PP). The State Operations Manual appendix PP revised 
November 22, 2017, is incorporated by reference in this rule, as 
published by the Centers for Medicare and Medicaid Services 
and is available at www.cms.gov/Regulations-and-Guidance/
Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.
pdf or the United States Centers for Medicare & Medicaid 
Services, 7500 Security Boulevard, Baltimore, Maryland 21244. 
This rule does not incorporate any subsequent amendments 
or additions. After review of the temporary closure plan, the 
department shall either approve or disapprove the plan; 
2. Facilities with approved closure plans by the department 
shall ensure that all residents residing at the facility are provided 
discharge notices in accordance with federal and state law and 
the facility shall assist all residents with discharge planning in 
accordance with federal and state law;
3. Facilities with approved closure plans by the department 
shall enter into a consent agreement with the department for 
a probationary license. These facilities shall agree to discharge 
all residents by the effective date of the temporary closure and 
to admit no residents while the facility is temporarily closed;
4. Temporary closure of facilities shall not be allowed past 
two (2) years from the effective date of the temporary closure. 
The effective date of the temporary closure is the date the last 
resident left the facility;
5. Facilities shall be reopened within two (2) years of the 
effective date of the temporary closure. Prior to reopening, 
the department shall conduct a full survey/inspection and the 
facility may be approved by the department to reopen after this 
survey or inspection. Facilities shall not reopen until approved 
by the department;
6. Facilities shall be reopened by the facility operator which 
initiated the temporary closure and a change of operator may 
not occur during this period of temporary closure;
7. Facilities shall submit plans of corrections, applications, 
licensure, and certification fees in accordance with state law 
regardless of temporary closure status; 
8. Facilities approved by the department to be temporarily 
closed will be noted as temporarily closed on state directories. 
The department will communicate temporary closure status 
of these facilities approved for temporary closure to CMS; and
9. Facilities not approved for temporary closure by the 
department which have closed or those facilities which stayed 
closed longer than two (2) years from the effective date of the 
temporary closure shall be considered closed. The department 
shall notify the operator in writing requesting the voluntary 
surrender of the license. If the department does not receive the 
license within thirty (30) days, it shall be void. If the operator 
should choose to again license the facility, the operator shall 
submit a complete application. The provisions of section (1) 
shall apply.
(4) The department may grant exceptions for specified 
periods of time to any rule imposed by the department if the 
department has determined that the exception to the rule 
would not potentially jeopardize the health, safety, or welfare 
of any residents of a long-term care facility. 
(A) The owner or operator of the facility shall make requests 
for exceptions in writing to the director of the department. 
These requests shall contain—
1. A copy of the latest Statement of Deficiencies which 
shows a violation of the rule being cited, if the exception 
request is being made as a result of a deficiency issued during 
an inspection of the facility; 
2. The section number and text of the rule being cited; 
3. If applicable, specific reasons why compliance with 
the rule would impose an undue hardship on the operator, 
including an estimate of any additional cost that might be 
involved; 
4. An explanation of any extenuating factors that may be 
relevant; and 
5. A complete description of the individual characteristics 
of the facility or residents, or of any other factors that would 
safeguard the health, safety, and welfare of the residents if the 
exception were granted. 
(B) With the advice of the division’s licensure inspection field 
staff, the department will consider any requests that contain all 
the information required in subsection (4)(A). The department 
shall notify the operator, in writing, of the decision on any 
request for an exception, stating the reason(s) for acceptance 
or denial, and, if granted, the length of time the exception is to 
be in effect and any additional corrective factors upon which 
acceptance may be conditioned. 
(C) The department shall only grant exceptions to licensure 
requirements set out in rules imposed by the department and 
cannot grant exceptions to requirements established by state 
statute or federal regulations. Operators wishing to obtain 
waivers of regulations under Title XVIII or Title XIX of the Social 
Security Act shall follow procedures established by the Centers 
for Medicare and Medicaid (CMS). 
(5) When the department issues a notice of noncompliance 
to a facility pursuant to the Omnibus Nursing Home Act 
(section 198.026, RSMo), the department, only after affording 
the facility operator a reasonable opportunity to remedy the 
situation, shall—
(A) Make every reasonable effort to provide residents of the 
facility or their legally authorized representatives or designees, 
if any—
1. A written notice of the noncompliance; 
2. A list of other licensed facilities appropriate to the 
resident’s needs; and 
3. A list of agencies that will assist the resident if he/she 
moves from the facility; and 
(B) After providing the information required by subsection (5)
8 CODE OF STATE REGULATIONS 
(3/31/26) Denny Hoskins
Secretary of State
DIVISION 30—DIVISION OF REGULATION 19 CSR 30-82—DEPARTMENT OF HEALTH AND
AND LICENSURE SENIOR SERVICES
(A) and allowing a time period for the residents of the facility to 
relocate if they wish, notify the Social Security Administration 
in writing that a notice of noncompliance has been issued to 
the facility, and the effective date of the notice. If the facility 
achieves substantial compliance with standards and rules later, 
the department shall notify the Social Security Administration 
of the effective date of the facility’s substantial compliance. 
(6) A licensed facility shall comply with the provisions of 
Title VI of the Civil Rights Act 1964, as amended; Section 504 
of the Rehabilitation Act of 1973; Title IX of the Education 
Amendment of 1972; the Age Discrimination Act of 1975; the 
Omnibus Budget and Reconciliation Act of 1982; the Americans 
with Disabilities Act of 1990; and the Keyes Amendment to the 
Social Security Act. No person shall be denied admission to, 
be denied benefits of, or be subjected to discrimination under 
any program, activity, or service provided by the facility based 
on his/her race, color, national origin, sex, religion, age, or 
disability, including Human Immunodeficiency Virus (HIV) or 
Acquired Immunodeficiency Syndrome (AIDS). Every licensed 
facility shall complete and sign form MO 580-2622 (9-05), 
Assurance of Compliance, incorporated by reference in this 
rule and available through the department’s website at www.
dhss.mo.gov or by telephone at (573) 526-8505 and file the form 
with the application for licensure or relicensure. This rule does 
not incorporate any subsequent amendments or additions.
(7) The department shall make available by Internet at www.
dhss.mo.gov to interested individuals or without charge a 
single copy of—
(A) A complete set of the standards promulgated for each 
type of facility; 
(B) An explanation of the procedures used in the state to 
ensure the enforcement of standards; 
(C) A list of any facilities granted exception from a standard, 
including the justification for the exception; and 
(D) A list of any facilities issued notices of noncompliance, 
including the details of the noncompliance. 
(8) Every skilled nursing facility, intermediate care facility, 
residential care facility, and assisted living facility issued a 
license or temporary operating permit by the department shall 
submit the required certificate of need quarterly surveys to the 
department on or before the fifteenth day of the first month 
following the previous Social Security quarter. (For example, 
for the Social Security quarter ending December 31, the due 
date is by January 15; for the Social Security quarter ending 
March 31, the due date is by April 15; for the Social Security 
quarter ending June 30, the due date is by July 15; and for the 
Social Security quarter ending September 30, the due date is 
by October 15). The information shall be submitted on the ICF/
SNF Certificate of Need Quarterly Survey form or the RCF/ALF 
Certificate of Need Quarterly Survey form obtained from the 
Missouri Certificate of Need Program, PO Box 570, Jefferson 
City, MO 65102.
AUTHORITY: sections 198.018, 198.073, 198.076, and 198.079, 
RSMo 2016.* This rule was originally filed as 13 CSR 15-10.010. 
Emergency rule filed Sept. 7, 1979, effective Sept. 28, 1979, expired 
Jan. 24, 1980. Original rule filed Sept. 7, 1979, effective Jan. 12, 
1980. Emergency amendment filed Jan. 15, 1980, effective Jan. 25, 
1980, expired May 1, 1980. Amended: Filed Jan. 15, 1980, effective 
May 11, 1980. Amended: Filed Dec. 10, 1980, effective May 11, 1981. 
Amended: Filed Dec. 7, 1981, effective May 11, 1982. Rescinded and 
readopted: Filed July 13, 1983, effective Oct. 13, 1983. Emergency 
amendment filed Aug. 1, 1984, effective Aug. 13, 1984, expired Dec. 
10, 1984. Amended: Filed Sept. 12, 1984, effective Dec. 13, 1984. 
Amended: Filed June 17, 1986, effective Oct. 24, 1986. Amended: 
Filed Aug. 1, 1988, effective Nov. 10, 1988. Emergency amendment 
filed Aug. 14, 1992, effective Aug. 28, 1992, expired Dec. 25, 1992. 
Rescinded and readopted: Filed April 14, 1993, effective Oct. 10, 
1993. Amended: Filed Feb. 13, 1998, effective Sept. 30, 1998. Moved 
to 19 CSR 30-82.010, effective Aug. 28, 2001. Amended: Filed Aug. 
23, 2006, effective April 30, 2007. Amended: Filed March 13, 2008, 
effective Oct. 30, 2008. ** Emergency amendment filed Nov. 10, 
2021, effective Nov. 29, 2021, expired May 27, 2022. Amended: Filed 
Nov. 10, 2021, effective May 30, 2022.
*Original authority: 198.018, RSMo 1979, amended 1984, 1987, 1988, 1994, 2007, 2014; 
198.073, RSMo 1979, amended 1984, 1992, 1999, 2006, 2007; 198.076, RSMo 1979, 
amended 1984, 2007; and 198.079, RSMo 1979, amended 2007.
**Pursuant to Executive Order 21-07, 19 CSR 30-82.010, paragraphs (4)(A)1.-3. and subsection (4)(B) 
was suspended from April 22, 2020 through August 31, 2021.
19 CSR 30-82.015 Long-Term Care Receiverships
PURPOSE: This rule establishes guidelines for the determination 
of qualified receivers, maintenance of the list of receivers, and the 
selection and removal of receivers.
(1) A person requesting to act as a receiver shall submit a 
completed application to the department. The application 
shall include the following information:
(A) Full name of the receiver, date of birth and Social Security 
number;
(B) Information that establishes the receiver has the necessary 
experience to operate a long-term care facility or the ability to 
contract with another party for the operation of a facility; and
(C) Information that establishes the receiver has the financial 
capacity to operate a long-term care facility as a receiver in 
compliance with state laws and regulations.
(2) Based on the information submitted in the application, 
if the applicant has the necessary experience to operate a 
long-term care facility or the ability to contract with another 
party for the operation of a facility and the financial capacity 
to operate a facility, and the applicant does not have any 
disqualifying characteristics, the applicant will be approved to 
be a receiver. Disqualifying characteristics are defined as:
(A) The applicant has been convicted of a felony offense in 
any state or federal court arising out of conduct involving the 
operation or management of a long-term care facility or other 
health care facility or the provision or receipt of health care;
(B) The applicant has ever knowingly acted or knowingly 
failed to perform any duty which materially and adversely 
affected the health, safety, welfare or property of a resident 
of a long-term care facility, while acting in a management 
capacity; or
(C) The applicant is under exclusion from participation in the 
Title XVIII (Medicare) or Title XIX (Medicaid) program of any 
state or territory.
(3) Once a completed application is received and approved, 
the person will be placed on the list of qualified receivers. 
Receivers will be placed on the list in the order their completed 
application was received. If two (2) or more completed 
applications are received on the same day, and any two (2) or 
more are approved, they will be placed on the list of qualified 
receivers in alphabetical order according to the receivers’ last 
 CODE OF STATE REGULATIONS 9
Denny Hoskins (3/31/26)
Secretary of State
19 CSR 30-82—DEPARTMENT OF HEALTH AND DIVISION 30—DIVISION OF REGULATION
 SENIOR SERVICES AND LICENSURE
names.
(4) If any of the information in an application changes, or if a 
qualified receiver has any change of status, including a change 
in disqualifying characteristics, that could affect his/her ability 
to serve as a receiver, he/she must notify the department in 
writing within ten (10) working days. Given the additional 
information, the department will make a determination as 
to whether the receiver remains qualified to act as a receiver. 
If the receiver is no longer qualified, his/her name will be 
removed from the list of qualified receivers. The department 
will notify the receiver in writing of the removal.
(5) If the department otherwise becomes aware of a change in 
any information in the application or a change in status of a 
qualified receiver that affects the receiver’s ability to serve as a 
receiver, the department may remove the receiver from the list 
of qualified receivers. The department will notify the receiver 
in writing of the removal.
(6) If a receiver no longer wishes to be included on the list of 
qualified receivers, the receiver shall notify the department in 
writing of his/her desire to be removed from the list and the 
effective date of the removal.
AUTHORITY: sections 198.009, RSMo 2000 and 198.105, RSMo 
Supp. 2003.* Emergency rule filed Sept. 12, 2003, effective Sept. 22, 
2003, expired March 19, 2004. Original rule filed Sept. 12, 2003, 
effective Feb. 29, 2004.
*Original authority: 198.009, RSMo 1979, amended 1993, 1995 and 198.105, RSMo 
1979, amended 1984, 2003.
19 CSR 30-82.020 Classification of Rules
PURPOSE: This rule adds to the classification of the standards for 
long-term care facilities as cited in chapters 13 CSR 15-12, 13 CSR 
15-14, 13 CSR 15-15 and 13 CSR 15-16 and as required in section 
198.085.1, RSMo.
(1) All rules relating to long-term care facilities licensed 
by the Division of Aging, other than those rules which are 
informational in character, shall be followed by a notation at 
the end of each rule, section, subsection or pertinent part. This 
notation shall consist of a Roman numeral(s). These Roman 
numerals refer to the class (either class I, class II or class III) of 
standard as designated in section 198.085.1, RSMo and will be 
used when that rule, section, subsection or portion of a rule 
carrying the notation is violated by the facility.
(2) In those instances where a particular rule, section, subsec -
tion or portion of a rule is followed by a notation consisting 
of more than one (1) Roman numeral, the lower classification 
shall be applied unless the division can show that the higher 
classification is merited because of the extent of the violation, 
the violations effect on residents or the impact when combined 
with other deficiencies. The division, on the Statement of 
Deficiency, shall indicate for the operator which classification 
has been applied and if the higher one is used, for what reason.
(3) A violation of a class I standard is one which would present 
either an imminent danger to the health, safety or welfare of 
any resident or a substantial probability that death or serious 
physical harm would result. If a violation of a class I standard is 
not immediately corrected, or corrective action instituted, the 
division shall proceed as required under section 198.029, RSMo. 
The division shall also take all other necessary steps to protect 
the health, safety or welfare of a resident which may include: 
initiation of license revocation action under section 198.036, 
RSMo; initiation of an action under section 198.067, RSMo; 
injunctive relief or assessment of a civil penalty, initiation of an 
action under section 198.070.6, RSMo; protection of residents 
from further abuse or neglect; initiation of an action under 
section 198.105 or 198.108, RSMo for appointment of a receiver; 
and appointment of a monitor under section 198.103, RSMo.
(4) A violation of a class II standard is one which has a direct 
or immediate relationship to the health, safety or welfare of 
any resident, but which does not create any imminent danger. 
When a violation is noted, the operator shall either correct the 
violation immediately or prior to the time of the reinspection 
or shall be correcting it in accordance with the time schedules 
set out in the operator’s approved plan of correction, as 
provided for under section 198.026.2, RSMo. If not, or the plan 
of correction is not approved and the violation not corrected, 
the violation will constitute substantial noncompliance under 
the Omnibus Nursing Home Act. After review by the division 
director or his/her designee, the division may initiate any 
action authorized by law, including those provided for in 
sections 198.026, 198.036, 198.067, 198.070.6, 198.103, 198.105 
and 198.108, RSMo. Where specific standards are set out 
in sections 198.003–198.186, RSMo and are not otherwise 
classified, those standards will be treated as class II standards.
(5) A violation of a class III standard is one which has an 
indirect or a potential impact on the health, safety or welfare 
of any resident. When a violation is noted, the operator shall 
either correct the violation immediately or prior to the time of 
the reinspection, or shall be correcting it in accordance with 
the time schedules set out in the operator’s approved plan of 
correction as provided for under section 198.026, RSMo. If not, 
if the plan of correction is not approved and the violation not 
corrected, a point value of one (1) point each will be noted 
for violations of each distinct class III standard not corrected; 
however, the points will not be assessed if there are five (5) or 
fewer class III standards violated.
(A) If the points total twenty (20) or more points, the facility 
will be deemed to be in substantial noncompliance under the 
Omnibus Nursing Home Act and the division may initiate any 
action as authorized by law, including issuance of a notice of 
noncompliance, as provided under section 198.026, RSMo.
(B) If the points total less than twenty (20) points, the 
points will remain on the facility’s record until the time the 
violations are corrected and are noted as corrected during a 
reinspection. If during the reinspection a class III standard 
violated in the prior inspection continues to be violated, the 
previously assessed points will be doubled unless the operator 
immediately corrects the violation. If after the reinspection the 
points for all previously noted and left uncorrected violations 
of distinct class III standards total twenty (20) or more, the 
facility will be deemed to be in substantial noncompliance 
under the Omni-bus Nursing Home Act and the division may 
take action as provided under section 198.026, RSMo.
(C) The division shall not revoke an operator’s license to 
operate a long-term care facility for violations of class III 
standards unless—
1. The uncorrected violations taken all together present 
either an imminent danger to the health, safety or welfare of 
any resident or a substantial probability of death or serious 
10 CODE OF STATE REGULATIONS 
(3/31/26) Denny Hoskins
Secretary of State
DIVISION 30—DIVISION OF REGULATION 19 CSR 30-82—DEPARTMENT OF HEALTH AND
AND LICENSURE SENIOR SERVICES
physical harm; or
2. The operator or his/her agent knowingly acted or 
knowingly omitted any duty which would materially and 
adversely affect the health, safety, welfare or property of a 
resident.
(D) Points will not be assessed for class III violations if the 
operator can show that the violation had been corrected since 
it was initially noted, that the operator made a good faith 
effort, as judged by the division, to stay in compliance and that 
the violation again occurred for reasons beyond the operator’s 
control.
(6) The division shall not initiate any action against an 
operator as authorized by law, including issuance of a notice 
of noncompliance for uncorrected violations of class II or III 
standards, unless the facility’s record, the cited violations and 
the circumstances are reviewed by the director of the division 
or his/her designee.
AUTHORITY: sections 198.009 and 198.085.1, RSMo 1986.* This 
rule was originally filed as 13 CSR 15-10.020. Original rule filed 
Dec. 10, 1981, effective May 13, 1982. Amended: Filed July 13, 1983, 
effective Oct. 13, 1983. Moved to 19 CSR 30-82.020, effective Aug. 
28, 2001.
*Original authority: 198.009, RSMo 1979 and 198.085, RSMo 1979, amended 1984.
19 CSR 30-82.030 Assessment of Availability of Beds
(Rescinded March 30, 2020)
AUTHORITY: sections 197.318, RSMo Supp. 1992 and 198.009, RSMo 
1986. This rule was originally filed as 13 CSR 15-10.030. Emergency 
rule filed June 17, 1986, effective June 27, 1986, expired Oct. 24, 
1986. Original rule filed June 17, 1986, effective Oct. 24, 1986. 
Moved to 19 CSR 30-82.030, effective Aug. 28, 2001. Rescinded: 
Filed Aug. 28, 2019, effective March 30, 2020.
19 CSR 30-82.050 Transfer and Discharge Procedures
PURPOSE: This rule provides instructions for persons who are dis-
charged from a licensed long-term care facility under involuntary 
circumstances. When this proposed rule becomes effective it will 
replace 13 CSR 15-9.010(17) which will be rescinded by subsequent 
rulemaking. This rule also includes the provisions of section 
198.088, RSMo, applicable to transfer or discharge and the notice 
and due process required of all licensed facilities.
(1) For the purposes of this rule, the following terms shall be 
defined as follows:
(A) Transfer means moving a resident from one institutional 
setting to another institutional setting for care and under 
circumstances where the releasing facility has decided 
that it will not readmit the resident or a legally authorized 
representative of the resident has not consented or agreed with 
the transfer. Unless indicated otherwise from the context of 
this rule, a transfer shall be deemed the same as a discharge;
(B) Discharge means releasing from a facility or refusing 
to readmit a resident from a community setting under 
circumstances where the resident or a legally authorized 
representative of the resident has not consented or agreed 
with the move or decision to refuse readmittance. Refusal to 
readmit a former resident shall not constitute a discharge if 
the former resident has been absent from the facility for more 
than ninety (90) days;
(C) Consent to or agreement with transfer or discharge 
means one of the following:
1. The resident or a legally authorized representative of 
the resident has consented to, agreed with, or requested the 
discharge; or
2. The resident’s treating physician has ordered the transfer 
and the releasing facility intends to readmit the resident if 
requested to do so;
(D) Consent of the resident means that the resident, with 
sufficient mental capacity to fully understand the effects 
and consequences of the transfer or discharge, consents to or 
agrees with the transfer or discharge; and
(E) Legally authorized representative of a resident means 
a duly appointed guardian or an attorney-in-fact who has 
current and valid power to make health care decisions for the 
resident.
(2) The facility shall permit each resident to remain in the 
facility unless—
(A) The transfer or discharge is appropriate because the 
resident’s welfare and the resident’s needs cannot be met by 
the facility;
(B) The transfer or discharge is appropriate because the 
resident’s health has improved sufficiently so the resident no 
longer needs the services provided by the facility;
(C) The safety of individuals in the facility is endangered;
(D) The health of individuals in the facility would otherwise 
be endangered;
(E) The resident has failed, after reasonable and appropriate 
notice, to pay for (or have paid under Medicare or Medicaid) 
a stay at the facility. For a resident who becomes eligible for 
Medicaid after admission to a facility, the facility may charge 
that resident only allowable charges under Medicaid; or
(F) The facility ceases to operate.
(3) When the facility transfers or discharges a resident under 
any of the circumstances specified in subsections (2)(A)–(E), 
the resident’s clinical record shall be documented. The facility 
shall ensure that documentation for the transfer or discharge 
is obtained from—
(A) The resident’s personal physician when transfer or 
discharge is necessary under subsections (2)(A)–(B); and
(B) A physician when transfer or discharge is necessary under 
subsection (2)(D); and
(C) The facility administrator or the facility director of 
nursing in all circumstances.
(4) Before a facility transfers or discharges a resident, the 
facility shall—
(A) Send written notice to the resident in a language 
and manner reasonably calculated to be understood by the 
resident. The notice must also be sent to any legally authorized 
representative of the resident and to at least one (1) family 
member. In the event that there is no family member known 
to the facility, the facility shall send a copy of the notice to 
the appropriate regional coordinator of the Missouri State 
Ombudsman’s office;
(B) Include in the written notice the following information:
1. The reason for the transfer or discharge;
2. The effective date of transfer or discharge;
3. The resident’s right to appeal the transfer or discharge 
notice to the director of the Department of Health and Senior 
Services or his/her designated hearing official within thirty (30) 
days of the receipt of the notice; 
 CODE OF STATE REGULATIONS 11
Denny Hoskins (3/31/26)
Secretary of State
19 CSR 30-82—DEPARTMENT OF HEALTH AND DIVISION 30—DIVISION OF REGULATION
 SENIOR SERVICES AND LICENSURE
4. That a request for a hearing should be sent to Department 
of Health and Senior Services Appeals Unit, PO Box 570, 912 
Wildwood Drive 3rd floor, Jefferson City, Missouri 65102-0570, 
by fax to (573) 751-0247, or by email to DHSS.Appeals@health.
mo.gov and the phone number for the appeals unit is (573) 
522-1699;
5. That filing an appeal will allow a resident to remain in 
the facility until the hearing is held unless a hearing official 
finds otherwise;
6. The location to which the resident is being transferred 
or discharged;
7. The name, address, and telephone number of the 
designated regional long-term care ombudsman office;
8. For Medicare and Medicaid certified facility residents 
with developmental disabilities, the mailing address and 
telephone number of the Missouri Protection and Advocacy 
Agency, 925 South Country Club Drive, Jefferson City, MO 
65109, (573) 893-3333, or the current address and telephone 
number of the protection advocacy agency if it has changed. 
The protection and advocacy agency is responsible for 
the protection and advocacy of developmentally disabled 
individuals established under Part C of the Developmental 
Disabilities Assistance and Bill of Rights Act. For Medicare 
and Medicaid certified facility residents with mental illness, 
the address and telephone number of Missouri Protection and 
Advocacy Agency, the agency responsible for persons with 
mental illness under the Protection and Advocacy for Mentally 
Ill Individuals Act; and
(C) Record and document in detail in each affected resident’s 
record the reason for the transfer or discharge. The recording 
of the reason for the transfer or discharge shall be entered into 
the resident’s record prior to the date the resident receives 
notice of the transfer or discharge, or prior to the time when 
the transferring or discharging facility decides to transfer or 
discharge the resident.
(5) The notice of transfer or discharge described in this rule 
shall be made by the facility no less than thirty (30) days before 
the resident is to be transferred or discharged. In the case of 
an emergency discharge, the notice shall be made as soon as 
practicable before the discharge when it is specifically alleged 
in the notice that—
(A) The safety of individuals in the facility would be 
endangered under subsection (2)(C) of this rule and the notice 
contains specific facts upon which the facility has based its 
determination that the safety of said individuals would be so 
endangered;
(B) The health of individuals in the facility would be 
endangered under subsection (2)(D) of this rule and the notice 
contains specific facts upon which the facility has based its 
determination that the safety of said individuals would be so 
endangered;
(C) The resident’s health has improved sufficiently to allow 
a more immediate transfer or discharge under subsection (2)
(B) of this rule;
(D) An immediate transfer or discharge is required by the 
resident’s urgent medical needs under subsection (2)(A) of this 
rule; or
(E) The resident has not resided in the facility for thirty (30) 
days.
(6) Any resident of a facility who receives notice of discharge 
from the facility in which he/she resides may file an appeal of 
the notice with the Department of Health and Senior Services 
Appeals Unit, PO Box 570, 912 Wildwood Drive 3rd floor, 
Jefferson City, Missouri 65102-0570, by fax to (573) 751-0247, or 
by email to DHSS.Appeals@health.mo.gov within thirty (30) 
days of the date the resident received the discharge notice 
from the facility. The resident’s legal guardian, the resident’s 
attorney-in-fact appointed under sections 404.700–404.725, 
RSMo (Durable Power of Attorney Law of Missouri) or pursuant 
to sections 404.800–404.865, RSMo (Durable Power of Attorney 
for Health Care Act), or any other individual may file an 
appeal on the resident’s behalf. A Nursing Facility Transfer or 
Discharge Hearing Request form (MO Form 886-3245) to request 
a hearing may be obtained from the Department of Health and 
Senior Services or the regional ombudsman. However, the use 
of a form is not required in order to file a request for a hearing. 
The request for a hearing shall be verified in writing by the 
resident, his/her legal guardian, attorney-in-fact, or any other 
party requesting a hearing on the resident’s behalf by attesting 
to the truth of the resident’s request for a hearing.
(7) The director of the Department of Health and Senior 
Services shall designate a hearing official to hear and decide 
the resident’s appeal.
(A) The designated hearing official shall notify the resident, 
the state long-term care ombudsman and the facility that the 
request for a hearing has been received and that a hearing has 
been scheduled.
(B) The hearing may be held by telephone conference call or 
in person at any location the designated hearing official deems 
reasonably appropriate to accommodate the resident’s needs.
(8) The discharge of the resident shall be stayed at the time 
the request for a hearing was filed unless the facility can 
show good cause why the resident should not remain in the 
facility until a written hearing decision has been issued by the 
designated hearing official. Good cause shall include, but is not 
limited to, those exceptions when the facility may notify the 
resident of a discharge from the facility with less than thirty 
(30) days notice as set forth in section (5) of this rule.
(A) The facility may show good cause for discharging the 
resident prior to a hearing decision being issued by the 
designated hearing official by filing a written Motion to Set 
Aside the Stay with the Department of Health and Senior 
Services Appeals Unit at the address, fax number, or email 
address in paragraph (4)(B)4. The facility must provide a copy 
of the Motion to Set Aside the Stay to the resident, or to the 
resident’s legally authorized representative and to at least 
one (1) family member, if one is known. In the event that 
a resident has no legally authorized representative and no 
known family members, then a copy of the Motion to Set Aside 
the Stay must be provided to the Missouri State Long-Term Care 
Ombudsman’s Office.
(B) Within five (5) days after a written Motion to Set Aside 
the Stay has been filed with the Department of Health and 
Senior Services Appeals Unit the designated hearing official 
shall schedule a hearing to determine whether the facility has 
good cause to discharge the resident prior to a written hearing 
decision being issued. Notice of the good cause hearing need 
not be in writing. All parties and representatives who received 
a copy of the Motion to Set Aside the Stay under subsection (8)
(A) of this rule shall also be notified of the good cause hearing.
1. The designated hearing official shall have the discretion 
to consolidate the facility’s good cause hearing with the 
discharge hearing requested by the resident. In the case of an 
emergency discharge, an expedited hearing shall be held upon 
the request of the resident, legally authorized representative, 
family member, and in a case where notice was required to be 
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Secretary of State
DIVISION 30—DIVISION OF REGULATION 19 CSR 30-82—DEPARTMENT OF HEALTH AND
AND LICENSURE SENIOR SERVICES
sent to the regional ombudsman, to the state long-term care 
ombudsman, so long as the parties waive the ten- (10-) day 
notice requirement specified in section (9).
2. Subsequent to the good cause hearing, the designated 
hearing official shall issue an order granting or denying the 
facility’s Motion to Set Aside the Stay. If the facility’s good 
cause hearing and the resident’s discharge hearing were 
consolidated, the order shall also set forth whether the facility 
may discharge the resident.
(9) Written notice of a hearing shall contain the date and time 
for the hearing and shall be mailed to the facility, the resident 
or the resident’s legally authorized representative, and to any 
and all parties in interest, including any family members 
who received notice of the discharge, that are known to the 
designated hearing official. The written notice shall be mailed 
to the parties at least ten (10) days prior to the hearing.
(10) If the facility’s good cause hearing and the resident’s 
discharge hearing were not consolidated and the designated 
hearing official issues an order denying the facility’s Motion 
to Set Aside the Stay, the designated hearing official shall 
schedule the discharge hearing subsequent to the date the 
order which denied the facility’s motion was issued. After the 
hearing, the designated hearing official shall issue a written 
decision setting forth whether the facility may discharge the 
resident. The written decision shall be mailed to the facility, 
the resident or the resident’s legally authorized representative 
and counsels for all parties, if any. If the state long-term care 
ombudsman’s office received notice of the discharge, a copy of 
the hearing decision shall be sent to the ombudsman’s office. 
If a member of the resident’s family received notice of the 
discharge, a copy of the hearing decision shall be mailed to the 
family member upon request.
(11) The burden of showing that the facility has complied with 
all requirements for appropriate discharge of the resident shall 
be upon the facility. The resident may provide any additional 
evidence competent to show that the facility has not met its 
burden.
(12) The resident may obtain legal counsel, represent him/
herself or use a relative, a friend or other spokesperson. All 
natural parties, including residents, sole proprietors of a 
facility and a partner of a facility operated in the partnership 
form of business, may represent themselves in a pro se capacity 
on behalf of the facility. Corporate operators of a facility may 
only be represented by an attorney licensed to practice law in 
Missouri.
(13) Hearings shall be subject to the hearing procedures found 
in 42 CFR Chapter IV , Part 483, subpart E, and the Missouri 
Administrative Procedures Act, specifically sections 536.070 
through 536.080, RSMo, which include, but are not limited 
to, oral and written evidence, witnesses, objections, official 
notices, affidavits, transcripts, depositions and other discovery 
methods, sanctions, oral arguments and written briefs. Written 
medical statements by a physician, psychiatrist or psychologist 
shall be admitted as relevant and probative evidence and shall 
be given due weight in consideration by the director or his/
her designated hearing official. An audiotape recording of the 
hearing shall be made unless it is agreed by both parties to 
substitute a certified transcript.
(14) If the decision is that there is no cause for discharge, the 
resident shall be permitted to remain in the facility. If the 
decision is in the facility’s favor, the resident shall be granted 
an additional ten (10) days after the decision is received for 
purpose of relocation, and the facility shall assist the resident 
in making suitable arrangements for relocation. If the resident 
prevails and has already been discharged, the facility shall 
notify the resident, the qualified representative, or any other 
responsible party who will assure that the resident is made 
aware of the decision and that the resident may return to the 
facility. In the event that there are no beds available, the facility 
shall admit the resident to occupy the first available bed 
without regard to any waiting list maintained by the facility.
AUTHORITY: sections 192.2000, 198.009, and 198.088, RSMo 
2016.* This rule was originally filed as 13 CSR 15-10.050. Original 
rule filed Feb. 13, 1998, effective Sept. 30, 1998. Moved to 19 CSR 
30-82.050, effective Aug. 28, 2001. Amended: Filed Sept. 1, 2021, 
effective March 30, 2022.
Original authority: 192.2000, RSMo 1984, amended 2014; 198.009, RSMo 1979, 
amended 1993, 1995; and 198.088, RSMo 1997, amended 1988, 1989, 1994.
19 CSR 30-82.060 Hiring Restrictions—Good Cause Waiver
PURPOSE: This rule establishes the procedure by which persons 
with criminal convictions may seek a waiver allowing them to be 
employed by health care and mental health providers despite the 
hiring restrictions found in section 192.2495, RSMo. The waivers 
are to be for “good cause” as defined by that statute. This rule sets 
forth both the procedure for seeking waivers and the facts and 
circumstances to be considered by the Department of Health and 
Senior Services in determining “good cause.” 
(1) Definitions.
(A) Applicant means a person who has been or would be 
rejected for employment by a provider due to the hiring 
restrictions found in section 192.2495, RSMo.
(B) Department means the Department of Health and Senior 
Services.
(C) Determination means the decision issued by the director 
of the Department of Health and Senior Services or the 
director’s designee based on the factual, procedural, or causal 
issues of the request for waiver.
(D) Director means the director of the Department of Health 
and Senior Services.
(E) Good cause waiver means a finding that is reasonable to 
believe that the restrictions imposed by section 192.2495, RSMo, 
on the employment of an applicant may be waived after an 
examination of the applicant’s prior work history and other rel-
evant factors is conducted and demonstrates that such appli -
cant does not present a risk to the health or safety of residents, 
patients, or clients if employed by a provider.
(F) Provider means any person, corporation or association 
who—
1. Is licensed as an operator pursuant to Chapter 198, RSMo;
2. Provides in-home services under contract with the 
Department of Health and Senior Services;
3. Employs nurses or nursing assistants for temporary or 
intermittent placement in health care facilities; 
4. Is an entity licensed pursuant to Chapter 197, RSMo;
5. Is a public or private facility, day program, residential 
facility or specialized service operated, funded or licensed by 
the Department of Mental Health; or
6. Is a licensed adult day care provider.
 CODE OF STATE REGULATIONS 13
Denny Hoskins (3/31/26)
Secretary of State
19 CSR 30-82—DEPARTMENT OF HEALTH AND DIVISION 30—DIVISION OF REGULATION
 SENIOR SERVICES AND LICENSURE
(G) Reference means a written statement of character, 
qualification or ability issued on behalf of the applicant by 
a person who is not related to or residing with the applicant 
requesting a good cause waiver.
(H) Sponsor means the current or potential employer of the 
applicant, or a training program, agency, or school in which 
the applicant is or was a student enrolled for the purpose 
of earning a professional license, certification, or otherwise 
becoming qualified to perform the duties of an occupation.
(2) Any person who is not eligible for employment by a provider 
due to the hiring restrictions found in section 192.2495, RSMo, 
may apply to the director for a good cause waiver. If the director 
or the director’s designee determines that the applicant has 
demonstrated good cause, such restrictions prohibiting such 
persons from being hired by a provider shall be waived, 
and such persons may be so employed unless rejected for 
employment on other grounds. Hiring restrictions based on 
the Department of Health and Senior Services’ employee 
disqualification list are not subject to a waiver. 
(3) The director, or the director’s designee, shall accept an 
application for a good cause waiver only if the application—
(A) Is submitted in writing by the applicant on the form 
provided by the department;
(B) Is legible;
(C) Is signed by the applicant;
(D) Includes an indication of the type of waiver that is being 
requested;
(E) Includes a complete history of residency since the earliest 
disqualifying offense or incident;
(F) Includes a complete employment history since the age of 
eighteen (18) years;
(G) Includes an attached explanation written by the applicant 
as to why the applicant believes he or she no longer poses a risk 
to the health, safety, or welfare of residents, patients or clients;
(H) Includes an attached description written by the applicant 
of the events that resulted in each disqualifying offense or 
incident;
(I) Includes attached documentation on the applicant’s 
professional, vocational, or occupational licensure, certification, 
or registration history and current status, if any, in this state 
and any other state;
(J) Includes at least one (1) reference letter from a sponsor. 
If the applicant is not able to obtain a sponsor, the applicant 
shall so state, shall identify those potential sponsors who have 
been approached by the applicant, and shall submit three 
(3) reference letters from individuals knowledgeable of the 
applicant’s character or work history who are not related to or 
residing with the applicant;
(K) Includes a criminal history record from the Missouri State 
Highway Patrol if requesting a waiver of disqualifying criminal 
offenses; 
(L) Includes a certified court document for each disqualifying 
criminal offense. If such document is not obtainable, a written 
and signed statement from the court indicating that no such 
record exists must be submitted;
(M) Includes certified investigative reports from the 
Department of Social Services if requesting a waiver of child 
abuse or neglect findings or a waiver of foster parent license 
denial, revocation, or involuntary suspension;
(N) Includes certified investigative reports or other docu -
mentation of the incident(s) which resulted in the applicant’s 
inclusion on all other lists in the Family Care Safety Registry for 
which waiver is requested; and
(O) If in addition to the criminal offense(s) for which the ap -
plicant is requesting a waiver the applicant has any pending 
felony or misdemeanor charges, includes a statement explain -
ing the circumstances and certified copies of the charging 
documents for all pending criminal charges; and, in the case 
of an applicant seeking a position with an in-home services 
provider agency or home health agency, if in addition to the 
circumstances related to the listing on any of the background 
checklists of the Family Care Safety Registry for which the ap -
plicant is requesting a waiver the applicant has any pending 
circumstances which if established would lead to an additional 
listing on any of the background checklists of the Family Care 
Safety Registry, includes a statement explaining the circum -
stances and certified copies of documents relating to those 
circumstances.
(4) The director, or the director’s designee, will not consider any 
application for a good cause waiver unless it is fully completed, 
signed by the applicant, and contains all required attachments.
(5) Each completed application will be reviewed by a good 
cause waiver committee of two (2) or more employees of 
the department. The director shall determine the size of the 
committee and shall, from time to time, appoint members to 
serve on the committee. 
(A) If the applicant seeks a good cause waiver of placement 
on the disqualification list maintained by the Department of 
Mental Health, the director shall appoint an employee of the 
Department of Mental Health recommended by the director of 
the Department of Mental Health to serve on the good cause 
waiver committee. 
(B) A member of the good cause waiver committee shall 
recuse himself or herself in a good cause waiver review 
in which the member’s impartiality might reasonably be 
questioned, including but not limited to instances where the 
committee member has a personal bias or prejudice concerning 
the applicant, or personal knowledge of evidentiary facts 
concerning the application for good cause waiver.
(6) The department may, at any time during the application 
process or review thereof, request additional information from 
the applicant. If the applicant fails to supply any requested 
additional information within thirty (30) calendar days of 
the date of the request, unless the applicant requests and the 
department grants an extension, the department will consider 
the application for good cause waiver to be withdrawn by the 
applicant.
(7) The department may request that the applicant, prior to the 
completion of the review, appear in person to answer questions 
about his or her application. If the applicant is requested to 
appear in person, the department, in its sole discretion, shall 
determine the location for the appearance and may conduct 
any such proceedings using electronic means, including 
but not limited to telephonic or video conferencing. The 
department shall review and may investigate the information 
contained in each application for completeness, accuracy, and 
truthfulness. The burden of proof shall be on the applicant 
to demonstrate that he or she no longer poses a risk to the 
health, safety, or welfare of residents, patients, or clients. The 
following factors shall be considered in determining whether 
a good cause waiver should be granted:
(A) The applicant’s age at the time the crime was committed 
or at the time the incident occurred that resulted in the 
applicant being listed on the background checklists in the 
14 CODE OF STATE REGULATIONS 
(3/31/26) Denny Hoskins
Secretary of State
DIVISION 30—DIVISION OF REGULATION 19 CSR 30-82—DEPARTMENT OF HEALTH AND
AND LICENSURE SENIOR SERVICES
Family Care Safety Registry;
(B) The circumstances surrounding the crime or surrounding 
the incident that resulted in the applicant being listed on the 
background checklists in the Family Care Safety Registry;
(C) The length of time since the conviction or since the 
occurrence of the incident that resulted in the applicant being 
listed on the background checklists in the Family Care Safety 
Registry;
(D) The length of time since the applicant completed his or 
her sentence for the disqualifying conviction(s), whether or not 
the applicant was confined, conditionally released, on parole 
or probation;
(E) The applicant’s entire criminal history and entire history 
of all incidents that resulted in the applicant being listed on 
the background checklists in the Family Care Safety Registry, 
including whether that history shows a repetitive pattern of 
offenses or incidents;
(F) The applicant’s prior work history;
(G) Whether the applicant had been employed in good 
standing by a provider but subsequently became ineligible for 
employment due to the hiring restrictions in section 192.2495, 
RSMo;
(H) Whether the applicant has been convicted or found 
guilty of, or pled guilty or nolo contendere to any offense 
displaying extreme brutality or disregard for human welfare 
or safety;
(I) Whether the applicant has omitted a material fact or 
misrepresented a material fact pertaining to his or her criminal 
or employment history or to his or her history of incidents that 
resulted in his or her being listed on the background checklists 
in the Family Care Safety Registry;
(J) Whether the applicant has ever been listed on the 
Employee Disqualification List maintained by the department;
(K) Whether the applicant’s criminal offenses were commit-
ted, or the incidents that resulted in the applicant being listed 
on the background checklists in the Family Care Safety Registry 
occurred, during the time he or she was acting as a provider or 
as an employee for a provider;
(L) Whether the applicant has, while disqualified from 
employment by a provider, obtained employment by 
fraud, deceit, deception or misrepresentation, including 
misrepresentation of his or her identity; 
(M) Whether the applicant has ever had a professional or 
occupational license, certification, or registration revoked, 
suspended, or otherwise disciplined;
(N) Any other information relevant to the applicant’s 
employment background or past actions indicating whether 
he or she would pose a risk to the health, safety, or welfare of 
residents, patients, or clients; and
(O) Whether the applicant has supplied all information 
requested by the department.
(8) If, at the time of an application for a waiver or during the 
waiver consideration process, the applicant has been charged 
or indicted for, but not convicted of, any of the crimes covered 
under the provisions of section 192.2495, RSMo, the division 
will hold the request for waiver in abeyance while such 
charges are pending or until a court of competent jurisdiction 
enters a judgment or order disposing of the matter.
(9) Each applicant who submits a waiver application meeting 
the requirements of section (3) of this rule shall be notified in 
writing by the director, or the director’s designee, as to whether 
his or her application has resulted in a determination of good 
cause or no good cause. Such notification shall be effective if 
sent to the applicant’s address given on the application. 
(10) Any good cause waiver granted to an applicant applies 
only to—
(A) The specific disqualifying conviction(s), finding(s) of 
guilt, plea(s) of guilty or nolo contendere, as contained in the 
certifying copies of the court documents which are required in 
the application; and/or
(B) The incident(s) that resulted in the applicant being 
listed on the background checklists in the Family Care Safety 
Registry, as contained in the investigative reports or other 
supporting documentation required in the application or 
subsequently requested by the department.
(11) Any good cause waiver granted to applicant applies only 
to those disqualifying criminal convictions on incidents that 
resulted in the applicant being listed on the background 
checklists in the Family Care Safety Registry, as covered under 
the provisions of section 192.2495, RSMo, and shall not apply to 
any other hiring restriction or exclusion imposed by any other 
federal or state laws or regulations. 
(12) The director or the director’s designee may withdraw a 
good cause waiver if he or she receives information or finds 
that—
(A) The applicant has omitted a material fact or misrepresented 
a material fact in seeking a good cause waiver;
(B) The applicant has been subsequently convicted or found 
guilty of or pled guilty or nolo contendere to any class A or 
B felony violation of Chapter 565, 566, or 569, RSMo, or any 
violation of subsection 3 of section 198.070, RSMo, or section 
568.020, RSMo, in this state or any other state;
(C) Such applicant is a prospective or current employee of 
an in-home services provider or home health agency and has 
been subsequently involved in an incident that results in the 
applicant being listed on any of the background checklists in 
the Family Care Safety Registry;
(D) The applicant has omitted, misrepresented, or failed to 
disclose or provide any of the information required by section 
192.2495, RSMo, or the provisions of this rule; or
(E) There has been a material change in the circumstances 
upon which the good cause waiver was granted.
(13) If the good cause waiver is withdrawn by the department, 
the notice of such withdrawal shall be mailed by the department 
to the applicant’s last known address, with a copy of the notice 
sent to the applicant’s last known employer, if any.
(14) No applicant may be employed in a direct care or direct 
service position with a provider during the pendency of a 
request for waiver unless the applicant has been continuously 
employed by that provider prior to August 28, 2003. If an 
applicant is employed on or after August 28, 2003, he or she 
may be employed following submission of a completed waiver 
application on a conditional basis to provide in-home services 
or home health services to any in-home services client or home 
health patient during the pendency of that waiver application 
if—
(A) The disqualifying crime is not one that would preclude 
employment pursuant to subsection 6 of section 192.2495, 
RSMo; and
(B) The applicant is not listed on the Department of Health 
and Senior Services’ employee disqualification list.
(15) If a waiver is denied to an applicant employed on or 
 CODE OF STATE REGULATIONS 15
Denny Hoskins (3/31/26)
Secretary of State
19 CSR 30-82—DEPARTMENT OF HEALTH AND DIVISION 30—DIVISION OF REGULATION
 SENIOR SERVICES AND LICENSURE
after August 28, 2003, on a conditional basis, the conditional 
employment shall immediately terminate.
(16) Applicants who have been denied a good cause waiver, 
or who have had their good cause waivers withdrawn by the 
department, may reapply one (1) time every twelve (12) months, 
or whenever the circumstances related to the disqualifying 
conviction(s) have changed.
(17) Each provider shall be responsible for—
(A) Requesting criminal background checks on all prospective 
employees, regardless of waiver status, in accordance with the 
provisions of sections 192.2495 and 43.540, RSMo; and
(B) Contacting the department to confirm the validity of a 
prospective employee’s good cause waiver prior to hiring the 
prospective employee if the prospective employee reveals the 
existence of a good cause waiver or reveals the existence of an 
otherwise disqualifying circumstance.
(18) Each in-home services provider or home health provider 
shall also be responsible for—
(A) Requesting Family Care Safety Registry background 
screenings on all prospective employees, regardless of waiver 
status, in accordance with the provisions of section 192.2495, 
RSMo; and
(B) Contacting the department to confirm the validity of a 
prospective employee’s good cause waiver prior to hiring the 
prospective employee if the prospective employee reveals the 
existence of a good cause waiver or reveals the existence of an 
otherwise disqualifying circumstance.
(19) All applications for good cause waivers and related 
documents shall become permanent records maintained by 
the department.
AUTHORITY: sections 192.006 and 192.2000, RSMo 2016, and 
section 192.2495, RSMo Supp. 2025 .* This rule was originally filed 
as 13 CSR 15-10.060. Emergency rule filed March 1, 1999, effective 
March 30, 1999, expired Jan. 10, 2000. Original rule filed March 1, 
1999, effective Sept. 30, 1999. Moved to 19 CSR 30-82.060, effective 
Aug. 28, 2001. Emergency amendment filed Oct. 15, 2003, effective 
Oct. 26, 2003, expired April 22, 2004. Amended: Filed Oct. 15, 2003, 
effective April 30, 2004. Amended: Filed Aug. 27, 2025, effective 
April 30, 2026.
*Original authority: 192.006, RSMo 1993, amended 1995; 192.2000, RSMo 1984, 
amended 1988, 1992, 1993, 1994, 1995, 2001, 2014; and 192.2495, RSMo 1996, 
amended 1997, 1998, 2003, 2014, 2016, 2018.
19 CSR 30-82.070 Alzheimer’s Demonstration Projects
(Rescinded September 30, 2013)
AUTHORITY: section 198.534, RSMo Supp. 1999. This rule was 
originally filed as 13 CSR 15-10.070. Emergency rule filed April 14, 
2000, effective April 24, 2000, expired Feb. 1, 2001. Original rule 
filed April 14, 2000, effective Nov. 30, 2000. Moved to 19 CSR 30-
82.070, effective Aug. 28, 2001. Rescinded: Filed March 11, 2013, 
effective Sept. 30, 2013. 
19 CSR 30-82.080 Nursing Facility Quality of Care 
Improvement Program
PURPOSE: This rule explains the requirements for receiving 
funding from the Nursing Facility Quality of Care (NFQC) Fund to 
improve the quality of service the facility provides to its residents. 
(1) Definitions.
(A) Qualified Facility—Any facility licensed pursuant to 
Chapter 198, RSMo, that has received a Class I or Uncorrected 
Class II Notice of Noncompliance within the past twelve (12) 
months in one (1) of the following areas:
1. For Residential Care Facility I (RCF I) and Residential Care 
Facility II (RCF II):
A. Administrative, Personnel and Resident Care (19 CSR 
30-86.042);
B. Dietary (19 CSR 30-86.052); or
C. Resident Rights (19 CSR 30-88.010);
2. For Skilled Nursing Facility (SNF) and Intermediate Care 
Facility (ICF):
A. Administration and Resident Care (19 CSR 30-85.042)
B. Dietary (19 CSR 30-85.052); or
C. Resident Rights (19 CSR 30-88.010).
(B) Quality Improvement Project for Missouri (QIPMO) 
consultation—Provides technical assistance and support to 
nursing facility staff throughout the state in order to improve 
the quality of care in nursing facilities using the Minimum 
Data Set (MDS) and on-site clinical consultation.
(2) Selection of Qualified Facilities.
(A) Qualified facilities may submit a written request to the 
department for funds from the Nursing Facility Quality of Care 
(NFQC) Fund to pay for QIPMO assistance and support. The 
department will provide a written response to the qualified 
facility’s request approving or disapproving the use of NFQC 
funding for QIPMO assistance. In the absence of extraordinary 
circumstances, a qualified facility shall receive no more than 
one thousand dollars ($1,000) per request. A qualified facility 
which wishes to receive more than one thousand dollars 
($1,000) per request must separately justify reimbursement 
in excess of one thousand dollars ($1,000) by setting forth 
the extraordinary circumstances justifying reimbursement in 
excess of one thousand dollars ($1,000). The department may, 
in its sole discretion, approve reimbursement in excess of one 
thousand dollars ($1,000).
(B) Qualified facilities may also submit to the department 
proposals describing implementation of a quality improvement 
program, in lieu of the QIPMO Program. Such proposals shall 
address areas of noncompliance that have been cited in 
the notice of noncompliance issued in the past twelve (12) 
months. Upon approval of the proposal by the department, 
the department may use funds in the NFQC Fund that have 
been collected from state civil money penalties to fund the 
qualified facility’s proposal. In the absence of extraordinary 
circumstances, a qualified facility shall receive no more than 
one thousand dollars ($1,000) per proposal. A qualified facility 
which wishes to receive more than one thousand dollars 
($1,000) per proposal must separately justify reimbursement 
in excess of one thousand dollars ($1,000) by setting forth 
the extraordinary circumstances justifying reimbursement in 
excess of one thousand dollars ($1,000). The department may, 
in its sole discretion, approve reimbursement in excess of one 
thousand dollars ($1,000).
(C) The department may impose upon a qualified facility 
a directed plan of correction, as set forth in section 198.066, 
RSMo, which includes QIPMO consultation. Funding for the 
QIPMO consultation may be taken from the NFQC Fund, not to 
exceed one thousand dollars ($1,000), unless the department, 
in its sole discretion, determines reimbursement in excess 
of one thousand dollars ($1,000) is justified by extraordinary 
16 CODE OF STATE REGULATIONS 
(3/31/26) Denny Hoskins
Secretary of State
DIVISION 30—DIVISION OF REGULATION 19 CSR 30-82—DEPARTMENT OF HEALTH AND
AND LICENSURE SENIOR SERVICES
circumstances.
(3) The qualified facility will submit to the department the 
paid invoice(s) for the QIPMO consultation or other quality 
improvement program. The department will reimburse the 
qualified facility for the amount granted.
AUTHORITY: section 198.067.6, RSMo Supp. 2003.* Emergency 
rule filed Sept. 12, 2003, effective Sept. 22, 2003, expired March 
19, 2004. Original rule filed Sept. 12, 2003, effective Feb. 29, 2004.
*Original authority: 198.067, RSMo 1979, amended 1989, 1996, 1999, 2003.