Missouri Revised Statutes - PDF

Document Sample
Missouri Revised Statutes - PDF Powered By Docstoc
					Statutes


              Missouri Revised Statutes
                   Chapter 196 — Food, Drugs and Tobacco


              Chapter 197 — Medical Treatment Facility Licenses


           Chapter 198 — Convalescent, Nursing and Boarding Homes




                                                                    1
                            Missouri Revised Statutes
Statutes


                       Missouri Revised Statutes

                    TITLE XII
           PUBLIC HEALTH AND WELFARE
                  August 28, 2009

              Chapter 196 -- Food, Drugs and Tobacco

                                    Section 196.010. Definitions.

                              Section 196.015. Certain acts prohibited.

            Section 196.020. Injunction will lie to restrain violations of section 196.015.

                      Section 196.025. Punishment for violations, exceptions.

  Section 196.030. Agent of department of health and senior services shall tag, detain and embargo
                            adulterated, tainted, or misbranded articles.

                           Section 196.035. Duty of prosecuting attorney.

  Section 196.040. Department of health and senior services not required to report minor violations,
                                              when.

  Section 196.045. Authority for enforcement vested in department of health and senior services—
                                      rulemaking, procedure.

     Section 196.050. Not to prescribe more stringent regulations than prescribed by federal act.

   Section 196.055. Access to places in which food, drugs, devices or cosmetics are manufactured.

                                                                                                    2
                                       Missouri Revised Statutes
Statutes


    Section 196.060. Carriers in interstate commerce shall permit access to records of shipments.

           Section 196.065. Publication of reports of judgments, decrees and court orders.

                         Section 196.070. Food, when deemed adulterated.

                         Section 196.075. Food, when deemed misbranded.

Section 196.080. Permits governing manufacture, processing or packing of certain foods—suspension
                                       and reinstatement.

                   Section 196.085. Use of poisonous or deleterious substances.

      Section 196.090. Sections 196.010 to 196.120. not applicable to animal food or garbage.

                         Section 196.095. When drug or device adulterated.

                        Section 196.100. When drug or device misbranded.

               Section 196.105. Provisions governing selling or delivering new drug.

                      Section 196.110. When a cosmetic deemed adulterated.

                      Section 196.115. When a cosmetic deemed misbranded.

                       Section 196.120. Advertisement, when deemed false.

     Section 196.150. Sale of horse and mule meat prohibited except when labeled as such meat.

                                     Section 196.155. Penalty.

                         Section 196.160. Lawful to sell goat meat, when.

    Section 196.165. Falsely representing food to be kosher prohibited, penalty—kosher defined.

                            Section 196.170. Mixed flour to be branded.

                                     Section 196.175. Penalty.
                                                                                                    3
                                      Missouri Revised Statutes
Statutes


                  Section 196.180. Board of flour inspectors—duties (St. Louis).

                           Section 196.190. To what places law applies.

             Section 196.195. Contents of places and utensils used must be protected.

                             Section 196.210. Toilet rooms provided.

                         Section 196.220. Not used for sleeping purposes.

            Section 196.225. Employees with communicable disease prohibited, where.

                       Section 196.230. Abatement of violations by director.

                                     Section 196.235. Penalty.

                Section 196.240. Authorization by director to close health menace.

                 Section 196.245. Order to specify what—revocation—reopening.

                         Section 196.250. Construction of the word close.

                              Section 196.265. Penalty for violation.

                 Section 196.271. Food manufacturers or distributors may register.

 Section 196.291. Food sold at religious events or charitable functions exempt from food inspection
                                    laws and regulations, when.

                                   Section 196.311. Definitions.

                    Section 196.313. License to sell eggs required—exceptions.

      Section 196.316. License requirements—applications—kinds of licenses—fees—posting.

                            Section 196.318. Licensees to keep records.

                        Section 196.321. Standards and grades to be fixed.
                                                                                                 4
                                      Missouri Revised Statutes
Statutes


                         Section 196.323. Kinds of eggs which may be sold.

                      Section 196.326. Egg containers to be marked or labeled.

                    Section 196.328. Containers not required to be marked, when.

                        Section 196.331. Sign required on sale from bulk lots.

              Section 196.333. Markings in case of eggs from different species of fowl.

                  Section 196.336. Advertisements of price to give size and quality.

           Section 196.338. Dealer to furnish retailer with invoice showing size and quality.

  Section 196.341. Processing plants kept clean—standards—inspection—rulemaking, procedure.

                    Section 196.343. Inspection of business premises and records.

                         Section 196.346. Stop-sale orders, effect—appeals.

              Section 196.348. Court may order seizure of eggs, when—condemnation.

             Section 196.351. License suspended or revoked, when, procedure—appeal.

              Section 196.354. Duties of director of agriculture—rules and regulations.

                            Section 196.357. Violations may be enjoined.

                              Section 196.361. Violation a misdemeanor.

                                     Section 196.450. Definitions.

                              Section 196.455. Annual license required.

                          Section 196.465. Semiannual inspection of plants.

                           Section 196.470. Form and expiration of license.


                                                                                                5
                                        Missouri Revised Statutes
Statutes

                Section 196.475. Gas masks, alarm bell, and illumination required.

                    Section 196.480. Requirements before issuance of license.

                     Section 196.485. Temperature requirements and record.

                 Section 196.490. Food to be quick frozen before placed in locker.

                      Section 196.495. Record of name and address of user.

                Section 196.500. Accurate and complete report of weight of food.

                Section 196.505. Designation of food not for human consumption.

     Section 196.510. Operator to have lien on property for rentals—furnish content insurance.

                      Section 196.515. Revocation of license—enforcement.

                                   Section 196.520. Short title.

                                   Section 196.525. Definitions.

                                    Section 196.527. Purposes.

                           Section 196.530. Standards to be maintained.

   Section 196.540. Administration by state milk board—rules, promulgation —exempt products.

                                Section 196.542. Fees for licenses.

                        Section 196.545. Unlawful sale of dairy products.

           Section 196.550. Grading of products—right to protest accuracy, procedure.

                      Section 196.555. The state milk board’s right of access.

                         Section 196.560. Records of purchases and sales.

                     Section 196.565. The state milk board may take samples.

                                                                                                 6
                                      Missouri Revised Statutes
Statutes

                     Section 196.570. Condemnation of illegal dairy products.

                     Section 196.575. Unidentified products subject to seizure.

                  Section 196.580. Confiscated products released to owner, when.

                       Section 196.585. Inspection, interference prohibited.

                      Section 196.590. Suspension or revocation of licenses.

               Section 196.595. Substandard products, sale or production prohibited.

                              Section 196.610. Penalty for violation.

  Section 196.612. Contract with the United States Department of Agriculture to inspect plants and
                                          grade products.

   Section 196.614. State contracted manufacturing dairy plant inspection and grading fee fund—
          purpose—interest—unexpended balance, transfer to general revenue prohibited.

                               Section 196.695. Filled milk defined.

                            Section 196.700. Emulsified cream defined.

                     Section 196.705. Fat or oil other than milk fat prohibited.

                   Section 196.710. Emulsified cream and filled milk prohibited.

                              Section 196.715. Penalty for violation.

                  Section 196.725. Words prohibited in sale of butter substitutes.

                       Section 196.730. Violation a misdemeanor—penalty.

                               Section 196.735. Labeling of cheese.

                    Section 196.740. Labeling for shipments of skimmed milk.

                             Section 196.750. Imitation butter defined.
                                                                                                  7
                                      Missouri Revised Statutes
Statutes


                    Section 196.755. Coloring of imitation butter prohibited.

                         Section 196.760. Labeling of imitation butter.

               Section 196.765. Shipment of imitation butter under its true name.

                 Section 196.770. Labeling of butter and oleomargarine, mixed.

                         Section 196.775. Branding of renovated butter.

               Section 196.780. Possession of substitute for butter—presumption.

                            Section 196.785. Sale of imitation butter.

                            Section 196.790. Penalties for violation.

           Section 196.795. Certificate of professor of chemistry prima facie evidence.

                        Section 196.800. Who may not maintain action.

                        Section 196.805. Effacing mark a misdemeanor.

                                 Section 196.810. Enforcement.

                             Section 196.815. Receptacles defined.

                            Section 196.820. Receptacles kept clean.

                        Section 196.825. Return of shipping containers.

                Section 196.830. Receptacle cleaned and returned to distributor.

                                    Section 196.835. Penalty.

                Section 196.840. Examination and tuberculin test of cattle, when.

                           Section 196.845. Violation a misdemeanor.

                        Section 196.851. Applicability—purpose of law.
                                                                                          8
                                     Missouri Revised Statutes
Statutes


                      Section 196.856. Definitions of products subject to law.

  Section 196.866. Manufacturer’s license required, exceptions—application, fees, investigation—
            expires when—license withheld or revoked, notice, hearing—judicial review.

             Section 196.868. Nonresident manufacturer to obtain broker’s license, fee.

    Section 196.872. Rules and regulations for minimum sanitation to be established, procedure.

 Section 196.881. Samples for analysis to be furnished the department of health and senior services,
                                               when.

                           Section 196.886. Sale regulations—labeling.

                         Section 196.895. Violation of law a misdemeanor.

                                   Section 196.931. Definitions.

                           Section 196.933. Certain products exempted.

     Section 196.935. State milk inspection required on all graded fluid milk or milk products—
                                 pasteurization required, exception.

            Section 196.937. Penalty—violation by employee is violation by employer.

Section 196.939. Rules and regulations—inspection by political subdivisions prohibited, exceptions—
                                hearings, notice—rules, procedure.

            Section 196.941. State milk board, membership, qualifications, appointment.

Section 196.943. Appointments, when made—authority to act, when—failure of senate consent, effect
                                            of.

     Section 196.945. Inspection fee, payable when—hearing and notice before fee established.

   Section 196.947. State milk inspection fee fund created—funds, how expended, not to revert to
                                          general revenue.

           Section 196.949. State inspection of milk or milk products not required, when.
                                                                                                   9
                                      Missouri Revised Statutes
Statutes


           Section 196.951. State milk board official rating agencuy--survey made, when, how.

                              Section 196.953. Injunctive relief authorized.

           Section 196.955. Valid grade A milk permit holder may continue to sell grade A milk.

                             Section 196.957. Only one inspection required.

                  Section 196.959. Appeal from order or regulation of board, how taken.

                                    Section 196.970. Citation of law.

                                      Section 196.973. Definitions.

               Section 196.976. Prescription drug repository program established, criteria.

               Section 196.979. Donation of prescription drugs to the program, procedure.

                     Section 196.981. Immunity from civil or criminal liability, when.

                     Section 196.984. Administrative rules, authority to promulgate.

                                     Section 196.1000. Definitions.

                                        196.1003. Requirements.

    Section 196.1100. Trust fund established, purpose—reversion to general revenue prohibited.

 Section 196.1103. Board established—appointment, terms, qualifications, expenses, appointment to
                life sciences committee not to disqualify for membership on board.

 Section 196.1106. Centers to be established—definition—areas in which centers to be established—
     approval by board—screening committee appointed for each area—rules, powers and duties.

                    Section 196.1109. Moneys appropriated from trust fund, purposes.

Section 196.1112. Projects for centers to be determined by board, subject to peer review—distribution
                                    of funds, amounts authorized.

                                                                                                  10
                                         Missouri Revised Statutes
Statutes


              Section 196.1115. Board’s powers, duties and limitation on expenditures.

   Section 196.1118. Annual audit by state auditor or private accounting firm—audit available to
 public—every three years comprehensive report for governor and general assembly, content—audit
                             and report not administrative expense.

Section 196.1121. Reimbursement of costs allowed if four-part test met—institutions or organizations
receiving grants or awards to retain title to all inventions, data and discoveries—rulemaking authority.

 Section 196.1124. Board members not to be employed by public or private entity receiving financial
               support from trust fund—conflict of interest guidelines to be developed.

              Section 196.1127. Appropriation to board subject to certain requirements.

     Section 196.1129. Umbilical cord blood banks, grants awarded, when—eligibility criteria.

                         Section 196.1130. Rules to become effective, when.




                                                                                                    11
                                       Missouri Revised Statutes
Statutes

Section 196.010                                     (6) The term "federal act" means the Fed-           determining whether the labeling is mislead-
                                                    eral Food, Drug and Cosmetic Act (Title 21          ing, there shall be taken into account, among
                                                    U.S.C. 301 et seq.; 52 Stat. 1040 et seq.);         other things, not only representations made
Definitions.                                                                                            or suggested by statement, word, design,
                                                    (7) The term "food" means articles used for         device, sound, or in any combination thereof,
196.010 1. For the purpose of sections              food or drink for man or other animals, chew-       but also the extent to which the labeling fails
196.010 to 196.120:                                 ing gum, and articles used for components of        to reveal facts material in the light of such
                                                    any such article;                                   representations or material with respect to
(1) The term "contaminated with filth" ap-                                                              consequences which may result from the use
plies to any food, drug, device, or cosmetic        (8) The term "immediate container" does not         of the article to which the labeling relates
not securely protected from dust, dirt, and         include package liners;                             under the conditions of use prescribed in the
as far as may be necessary by all reasonable                                                            labeling thereof or under such conditions of
means, from all foreign or injurious contami-       (9) The term "label" means a display of             use as are customary or usual.
nations;                                            written, printed, or graphic matter upon the
                                                    immediate container of any article; and a           3. The representation of a drug, in its label-
(2) The term "cosmetic" means articles              requirement made by or under authority of           ing, as an antiseptic shall be considered to be
intended to be rubbed, poured, sprinkled,           sections 196.010 to 196.120 that any word,          a representation that it is a germicide, except
or sprayed on, introduced into, or otherwise        statement, or other information appearing on        in the case of a drug purporting to be, or rep-
applied to the human body or any part thereof       the label shall not be considered to be com-        resented as, an antiseptic for inhibitory use as
for cleansing, beautifying, promoting at-           plied with unless such word, statement, or          a wet dressing, ointment, dusting powder, or
tractiveness, or altering the appearance, and       other information also appears on the outside       such other use as involves prolonged contact
articles intended for use as a component of         container or wrapper, if any there be, of the       with the body.
any such articles, except that such term shall      retail package of such article, or is easily leg-
not include soap;                                   ible through the outside container or wrapper;      4. The provisions of sections 196.010 to
                                                                                                        196.120 regarding the selling of food, drugs,
(3) The term "device" except when used in           (10) The term "labeling" means all labels and       devices, or cosmetics, shall be considered to
subsection 2 of this section and in sections        other written, printed, or graphic matter upon      include the manufacture, production, process-
196.015(10), 196.075(6), 196.100(3) and             any article or any of its containers or wrap-       ing, packing, exposure, offer, possession,
196.115(3), means instruments, apparatus,           pers, or accompanying such article;                 and holding of any such article for sale and
and contrivances, including their compo-                                                                the sale, dispensing, and giving of any such
nents, parts, and accessories, intended for use     (11) The term "new drug" means any drug the         article, and the supplying of any such articles
in the diagnosis, cure, mitigation, treatment,      composition of which is such that such drug         in the conduct of any food, drug, or cosmetic
or prevention of disease in man or other ani-       is not generally recognized, among experts          establishment.
mals; or to affect the structure or any function    qualified by scientific training and experience
of the body of man or other animals;                to evaluate the safety of drugs, as safe for        (L. 1943 p. 559 § 9857)
                                                    use under the conditions prescribed, recom-
                                                    mended or suggested in the labeling thereof;
(4) The term "department" shall be construed
                                                    or any drug the composition of which is such
                                                                                                        Section 196.015
to mean the department of health and senior
services;                                           that such drug, as a result of investigations to
                                                    determine its safety for use under such condi-      Certain acts prohibited.
(5) The term "drug" means (a) articles recog-       tions, has become so recognized, but which
nized in the official United States Pharmaco-       has not, otherwise than in such investigations,     196.015 The following acts and the caus-
poeia, official Homeopathic Pharmacopoeia           been used to a material extent or for a mate-       ing thereof within the state of Missouri are
of the United States, or official National          rial time under such conditions;                    hereby prohibited:
Formulary, or any supplement to any of them;
and (b) articles intended for use in the diag-      (12) The term "official compendium" means           (1) The manufacture, sale, or delivery, hold-
nosis, cure, mitigation, treatment, or preven-      the official United States Pharmacopoeia,           ing or offering for sale of any food, drug,
tion of disease in man or other animals; and        official Homeopathic Pharmacopoeia of the           device, or cosmetic that is adulterated or
(c) articles, other than food, intended to affect   United States, official National Formulary, or      misbranded;
the structure or any function of the body of        any supplement to any of them;
man or other animals; and (d) articles in-                                                              (2) The adulteration or misbranding of any
tended for use as a component of any articles       (13) The term "person" includes individual,         food, drug, device, or cosmetic;
specified in clause (a), (b), or (c); but does      partnership, corporation, and association.
not include devices or their components, parts                                                          (3) The receipt in commerce of any food,
or accessories;                                     2. If an article is alleged to be misbranded        drug, device, or cosmetic that is adulterated
                                                    because the labeling is misleading, then in
                                                                                                                                                   12
                                                          Missouri Revised Statutes
Statutes

or misbranded, and the delivery or proffered         196.105 concerning any method or process           of this state residing in the United States, or
delivery thereof for pay or otherwise;               which as a trade secret is entitled to protec-     a resident of this state engaged in interstate
                                                     tion.                                              commerce with reference to the product
(4) The sale, delivery for sale, holding for                                                            involved, that the food, drug, device, or cos-
sale, or offering for sale of any article in vio-    (L. 1943 p. 559 § 9858)                            metic is not adulterated or misbranded within
lation of section 196.080 or 196.105;                CROSS REFERENCE:                                   the meaning of an act of congress entitled
                                                                                                        “An act to prohibit the movement in interstate
(5) The dissemination of any false advertise-        Sales prohibited by itinerant vendors and          commerce of adulterated and misbranded
ment;                                                peddlers of baby food, drugs, cosmetics, cer-      food, drugs, devices, and cosmetics, and for
                                                     tain devices, penalty, RSMo 150.465                other purposes” approved June 25, 1938, and
(6) The refusal to permit entry or inspection,                                                          the supplements and amendments thereto.
or to permit the taking of a sample, as autho-
rized by section 196.055;
                                                     Section 196.020
                                                                                                        3. No publisher, radio broadcast licensee, or
                                                                                                        agency or medium for the dissemination of
(7) The giving of a guaranty or undertak-            Injunction will lie to restrain                    an advertisement, except the manufacturer,
ing referred to in section 196.025(2), which                                                            packer, distributor, or seller of the article
guaranty or undertaking is false; except by a        violations of section 196.015.                     to which a false advertisement relates shall
person who relied on a guaranty or undertak-                                                            be liable under this section by reason of the
ing to the same effect signed by, and contain-       196.020. In addition to the remedies herein        dissemination by him of such false advertise-
ing the name and address of the person resid-        provided the department of health and senior       ment, unless he has refused, on the request of
ing in the state of Missouri or in the United        services is hereby authorized to apply to the      the department of health and senior services
States, from whom he received in good faith          circuit court for, and such court shall have ju-   to furnish the said department the name and
the food, drug, device, or cosmetic;                 risdiction upon hearing and for cause shown,       post-office address of the manufacturer, pack-
                                                     to grant a temporary or permanent injunction       er, distributor, seller, or advertising agency,
(8) The removal or disposal of a detained            restraining any person from violating any          residing in the state of Missouri, or in the
or embargoed article in violation of section         provision of section 196.015; irrespective         United States, who caused him to disseminate
196.030;                                             of whether or not there exists an adequate         such advertisement.
                                                     remedy at law.
(9) The alteration, mutilation, destruction,                                                            (L. 1943 p. 559 § 9860)
obliteration, or removal of the whole or any         (L. 1943 p. 559 § 9859)
part of the labeling of, or the doing of any
                                                                                                        Section 196.030
other act with respect to a food, drug, device,      Section 196.025
or cosmetic, if such act is done while such ar-
ticle is held for sale and results in such article                                                      Agent of department of health
being misbranded;                                    Punishment for violations,
                                                                                                        and senior services shall tag,
                                                     exceptions.
(10) Forging, counterfeiting, simulating, or                                                            detain and embargo adulter-
falsely representing, or without proper au-
thority using any mark, stamp, tag, label, or
                                                                                                        ated, tainted, or misbranded
                                                     196.025 1. Any person who violates any of
other identification device authorized or re-        the provisions of section 196.015 shall, on        articles.
quired by regulations promulgated under the          conviction, be adjudged guilty of a misde-
provisions of sections 196.010 to 196.120;           meanor, and punished by a fine of not more
                                                     than one thousand dollars, or imprisonment         196.030 1. Whenever a duly authorized
(11) The using, on the labeling of any drug          for not more than one year or by both such         agent of the department of health and senior
or in any advertising relating to such drug,         fine and imprisonment.                             services finds or has probable cause to be-
of any representation or suggestion that an                                                             lieve, that any food, drug, device, or cosmetic
application with respect to such drug is effec-      2. No person shall be subject to the penalties     is adulterated, or so misbranded as to be
tive under section 196.105, or that such drug        of subsection 1 of this section for having vio-    dangerous or fraudulent, within the mean-
complies with the provisions of such section;        lated section 196.015(1) or 196.015(3), if he      ing of sections 196.010 to 196.120, he shall
                                                     establishes a guaranty or undertaking signed       affix to such article a tag or other appropriate
(12) The using by any person to his own              by the person from whom he purchased the           marking, giving notice that such article is, or
advantage, or revealing, other than to the           food, drug, device, or cosmetic; if a resident     is suspected of being, adulterated or mis-
department, or to the courts when relevant           of this state, that the food, drug, device, or     branded and has been detained or embargoed,
in any judicial proceeding under sections            cosmetic is not adulterated or misbranded          and warning all persons not to remove or
196.010 to 196.120, any information acquired         within the meaning of sections 196.010 to          dispose of such article by sale or otherwise
under authority of sections 196.055, 196.080,        196.120, designating it, or, if a nonresident
                                                                                                                                                   13
                                                           Missouri Revised Statutes
Statutes

until permission for removal or disposal is         health or otherwise unsafe, the department of      196.010 to 196.120 is reported to any such
given by such agent or the court. It shall be       health and senior services, or its authorized      attorney for the institution of a criminal
unlawful for any person to remove or dispose        agent, shall forthwith condemn or destroy the      proceeding, the person against whom such
of such detained or embargoed article by sale       same or in any other manner render the same        proceeding is contemplated shall be given ap-
or otherwise without such permission.               unsalable as human food if the person found        propriate notice and an opportunity to present
                                                    in possession of same or claiming possession       his views before the department of health and
2. When an article detained or embargoed            or ownership of same shall agree to such ac-       senior services or its designated agent, either
under subsection 1 has been found by such           tion; provided that if any such person refuse      orally or in writing, in person, or by attorney,
agent to be adulterated, or misbranded, he          to permit such action by the department of         with regard to such contemplated proceed-
shall petition any circuit or associate cir-        health and senior services or its agent, such      ing. The court at any time after seizure up
cuit judge, in whose jurisdiction the article       agent may serve such person with a writ-           to a reasonable time before trial, shall, by
is detained or embargoed for an order for           ten notice directing him to hold or store any      order allow any party to a condemnation
condemnation of such article. When such             such articles for a period not longer than         proceeding, his attorney or agent, to obtain
agent has found that an article so detained or      three days from the date of service of such        a representative sample of the article seized,
embargoed is not adulterated or misbranded,         notice. Such notice shall also prohibit any        and as regards fresh fruit or vegetables, a true
he shall remove the tag or other marking.           such person from selling or in any manner          copy of the analysis on which the proceed-
                                                    disposing of such articles of food during the      ing is based and the identifying marks or
3. If the court finds that a detained or em-        prescribed period. The department of health        numbers, if any, of the packages from which
bargoed article is adulterated or misbranded        and senior services or its agent after issuing     the samples analyses were obtained.
within the meaning of sections 196.010 to           any such notice shall immediately apply to
196.120, such article shall, after entry of the     the circuit court in whose jurisdiction such       (L. 1943 p. 559 § 9862)
decree, be destroyed or sold under the super-       articles of food may be found or held for an
vision of such agent, as the court may direct,      order to condemn or destroy same. Upon the
but no such article shall be sold contrary to       application for such order the court shall im-     Section 196.040
any provisions of said sections, and the pro-       mediately hold a summary hearing and at the
ceeds thereof, if sold, less the legal costs and    conclusion thereof shall either grant the order    Department of health and
charges, shall be paid into the general fund        requested or shall order the articles of food
of the state of Missouri; provided, that when       in question released to the person claiming        senior services not required to
the adulteration or misbranding can be cor-         ownership or possession thereof. Upon the          report minor violations, when.
rected by proper labeling or processing of the      application for any such order, the court may
article, the court, after entry of the decree and   make such orders for the custody, storage, or       196.040 Nothing in sections 196.010 to
after such costs, fees, and expenses have been      temporary preservation of any of such articles     196.120 shall be construed as requiring the
paid and a good and sufficient bond, condi-         of food as may under the circumstances be          department of health and senior services to
tioned that such article shall be so labeled or     deemed proper. After the hearing prescribed        report for the institution of proceedings under
processed, has been executed, may by order          for herein, if the court find the complaint to     sections 196.010 to 196.120, minor viola-
direct that such article be delivered to the        be sustained, the court may direct the articles    tions of said sections, whenever the depart-
claimant thereof for such labeling or process-      of food to be disposed of as provided for by       ment of health and senior services believes
ing under the supervision of an agent of the        subsection 3 of this section.                      that the public interest will be adequately
department of health and senior services. The                                                          served in the circumstances by a suitable
expense of such supervision shall be paid by        (L. 1943 p. 559 § 9861, A.L. 1978 H.B.             written notice or warning.
the claimant. When the article is no longer in      1634)
violation of sections 196.010 to 196.120, and       Effective 1-2-79                                   (L. 1943 p. 559 § 9863)
the expenses of such supervision have been
paid, the department of health and senior           Section 196.035                                    Section 196.045
services shall present these facts to the court,
and such bond shall be then returned to the
claimant of the article.                            Duty of prosecuting attorney.                      Authority for enforcement
4. Whenever the department of health and            196.035 It shall be the duty of the prosecut-      vested in department of health
senior services or any of its authorized agents     ing attorney in any county or city in the state,   and senior services--rulemak-
shall find in any room, building, vehicle of        when called upon by the department of health
transportation or other structure, any meat,
                                                                                                       ing, procedure.
                                                    and senior services, or any of its assistants,
seafood, poultry, vegetable, fruit or other per-    to render any legal assistance in his power to     196.045 1. The authority to promulgate
ishable articles which are unsound, or contain      execute the laws and to prosecute cases rising     regulations for the efficient enforcement
any filthy, decomposed, or putrid substance,        under the provisions of sections 196.010 to        of sections 196.010 to 196.120 is hereby
or that may be poisonous or deleterious to          196.120. Before any violation of sections
                                                                                                                                                   14
                                                          Missouri Revised Statutes
Statutes

vested in the department of health and senior    196.055. The department of health and senior      shall not be used in a criminal prosecution
services. The department shall make the          services or its duly authorized agent shall       of the person from whom obtained; provided
regulations promulgated under said sections      have free access at all reasonable hours to       further, that carriers shall not be subject to
conform, insofar as practicable, with those      any factory, warehouse, or establishment in       the other provisions of sections 196.010 to
promulgated under the federal act.               which foods, drugs, devices, or cosmetics are     196.120 by reason of their receipt, carriage,
                                                 manufactured, processed, packed, or held for      or delivery of foods, drugs, devices, cosmet-
2. Hearings authorized or required by sec-       introduction into commerce, or to enter any       ics, or advertising matter in the usual course
tions 196.010 to 196.120 shall be conducted      vehicle being used to transport or hold such      of business as carriers.
by the department of health and senior servic-   foods, drugs, devices, or cosmetics in com-
es or such officer, agent, or employee as the    merce, for the purposes:                          (L. 1943 p. 559 § 9878)
department may designate for the purpose.
                                                 (1) Of inspecting such factory, warehouse, es-    Section 196.065
3. Regulations shall be promulgated pursu-       tablishment, or vehicle to determine if any of
ant to the requirements of this section and      the provisions of sections 196.010 to 196.120
chapter 536, RSMo. No rule or portion of a       are being violated; and                           Publication of reports of judg-
rule promulgated under the authority of this
chapter shall become effective unless it has     (2) To secure samples or specimens of any         ments, decrees and court
been promulgated pursuant to the provisions      food, drug, device, or cosmetic after paying      orders.
of section 536.024, RSMo.                        or offering to pay for such sample. It shall
                                                 be the duty of the department of health and       196.065 1. The department of health and
(L. 1943 p. 559 § 9875, A.L. 1993 S.B. 52,       senior services to make or cause to be made       senior services may cause to be published
A.L. 1995 S.B. 3)                                examinations or analyses of samples secured       from time to time reports summarizing all
                                                 under the provisions of this section to deter-    judgments, decrees, and court orders which
Section 196.050                                  mine whether or not any provision of sections     have been rendered under sections 196.010
                                                 196.010 to 196.120 is being violated.             to 196.120, including the nature of the charge
                                                                                                   and the disposition thereof.
Not to prescribe more strin-                     (L. 1943 p. 559 § 9876)
                                                                                                   2. The department may also cause to be
gent regulations than pre-                                                                         disseminated such information regarding
                                                 Section 196.060
scribed by federal act.                                                                            foods, drugs, devices, and cosmetics as the
                                                                                                   department deems necessary in the interest of
196.050 In no event shall the said depart-       Carriers in interstate com-                       public health and the protection of the con-
ment of health and senior services prescribe                                                       sumer against fraud. Nothing in this section
or promulgate any regulation fixing or es-       merce shall permit access to                      shall be construed to prohibit the department
tablishing any definitions or standards which    records of shipments.                             from collecting, reporting, and illustrating
are more rigid or more stringent than those                                                        the results of the investigations of the said
prescribed by the federal act applying to any    196.060 For the purpose of enforcing the          department.
commodity covered by sections 196.010 to         provisions of sections 196.010 to 196.120,
196.120 and if any product or commodity          carriers engaged in interstate commerce, and      (L. 1943 p. 559 § 9877)
covered by said sections shall comply with       persons receiving foods, drugs, devices, or
the definitions and standards prescribed by      cosmetics in interstate commerce, shall upon      Section 196.070
the federal act for such product or com-         the request of an officer or employee duly
modity, such product or commodity shall be       designated by the department of health and
deemed in all respects to comply with sec-       senior services, permit such officer or em-       Food, when deemed adulter-
tions 196.010 to 196.120.                        ployee to have access to and copy all records
                                                 showing the movement in interstate com-           ated.
(L. 1943 p. 559 § 9864)                          merce of any food, drug, device, or cosmetic,
                                                 and the quantity, shipper and consignee           196.070. A food shall be deemed to be adul-
                                                 thereof; and it shall be unlawful for any such    terated:
Section 196.055                                  carrier or person to fail to permit such access
                                                 to and copying of any such record so re-          (1) If it bears or contains any poisonous or
                                                 quested when such request is accompanied by       deleterious substance which may render it
Access to places in which food,                  a definite statement in writing specifying the    injurious to health; but in case the substance
                                                 nature or kind of food, drug, device, or cos-     is not an added substance such food shall not
drugs, devices or cosmetics are                  metic to which such request relates; provided,    be considered adulterated under this subdivi-
manufactured.                                    that evidence obtained under this section
                                                                                                                                             15
                                                       Missouri Revised Statutes
Statutes

sion if the quantity of such substance in such     apply to any confectionery, by reason of its        in the labeling, and in such terms as to render
food does not ordinarily render it injurious to    containing less than five percent by weight of      it likely to be read and understood by the or-
health; or                                         alcohol, or to any chewing gum by reason of         dinary individual under customary conditions
                                                   its containing harmless nonnutritive mastica-       of purchase and use;
(2) If it bears or contains any added poison-      tory substances; or
ous or added deleterious substance which                                                               (7) If it purports to be or is represented as a
is unsafe within the meaning of section            (12) If it bears or contains a coal tar color       food for which a definition and standard of
196.085; or                                        other than one from a batch which has been          identity has been prescribed by regulations
                                                   certified under authority of the federal act.       as provided by section 196.050, unless it
(3) If it consists, in whole or in part, of any                                                        conforms to such definition and standard, and
diseased, contaminated, filthy, putrid, or         (L. 1943 p. 559 § 9865, A.L. 1994 S.B. 474)         its label bears the name of the food specified
decomposed substance, or if it is otherwise                                                            in the definition and standard, and, insofar
unfit for food; or                                 Section 196.075                                     as may be required by such regulations, the
                                                                                                       common names of optional ingredients, other
(4) If it has been produced, prepared, packed,                                                         than spices, flavoring, and coloring, present
or held under insanitary conditions whereby        Food, when deemed mis-                              in such food;
it may have become contaminated with filth
or whereby it may have been rendered dis-          branded.                                            (8) If it purports to be or is represented as:
eased, unwholesome, or injurious to health;
or                                                 A food shall be deemed to be misbranded:
                                                                                                       (a) A food for which a standard of quality has
                                                                                                       been prescribed by regulations as provided
(5) If it is, in whole or in part, the product     (1) If its labeling is false or misleading in any
                                                                                                       by section 196.050 and its quality falls below
of a diseased animal or of an animal which         particular;
                                                                                                       such standard unless its label bears, in such
has died otherwise than by slaughter, or that                                                          manner and form as such regulations specify,
has been fed upon the uncooked offal from a        (2) If it is offered for sale under the name of
                                                                                                       a statement that it falls below such standard;
slaughterhouse; or                                 another food;
                                                                                                       (b) A food for which a standard or standards
(6) If its container is composed, in whole         (3) If it is an imitation of another food, un-
                                                                                                       of fill of container have been prescribed by
or in part, of any poisonous or deleterious        less its label bears, in type of uniform size
                                                                                                       regulation as provided by section 196.050,
substance which may render the contents            and prominence, the word, “imitation”, and,
                                                                                                       and it falls below the standard of fill of
injurious to health; or                            immediately thereafter, the name of the food
                                                                                                       container applicable thereto, unless its label
                                                   imitated;
                                                                                                       bears, in such manner and form as such regu-
(7) If any valuable constituent has been in                                                            lations specify, a statement that it falls below
whole or in part omitted or abstracted there-      (4) If its container is so made, formed or
                                                                                                       such standard;
from; or                                           filled as to be misleading;
                                                                                                       (9) If it is not subject to the provisions of
(8) If any substance has been substituted          (5) If in package form, unless it bears a label
                                                                                                       subdivision (7) of this section, unless it bears
wholly or in part therefor; or                     containing:
                                                                                                       labeling clearly giving:

(9) If damage or inferiority has been con-         (a) The name and place of business of the
                                                                                                       (a) The common or usual name of the food, if
cealed in any manner; or                           manufacturer, packer or distributor;
                                                                                                       any there be; and

(10) If any substance has been added thereto       (b) An accurate statement of the quantity of
                                                                                                       (b) In case it is fabricated from two or more
or mixed or packed therewith so as to in-          the contents in terms of weight, measure, or
                                                                                                       ingredients, the common or usual name of
crease its bulk or weight, or reduce its quality   numerical count; provided, that under clause
                                                                                                       each such ingredient, except that spices,
or strength or make it appear better or of         (b) of this subdivision reasonable variations
                                                                                                       flavorings, and colorings, other than those
greater value than it is; or                       shall be permitted, and exemptions as to
                                                                                                       sold as such, may be designated as spices, fla-
                                                   small packages shall be established, by regu-
                                                                                                       vorings, and colorings, without naming each;
(11) If it is confectionery and it bears or        lations prescribed by the department of health
                                                                                                       provided, that, to the extent that compliance
contains any alcohol or nonnutritive article or    and senior services;
                                                                                                       with the requirements of paragraph (b) of this
substance except harmless coloring, harm-                                                              subdivision is impractical or results in decep-
less flavoring, harmless resinous glaze not in     (6) If any word, statement, or other informa-
                                                                                                       tion or unfair competition, exemptions shall
excess of four-tenths of one percent, harmless     tion required by or under authority of sections
                                                                                                       be established by regulations promulgated by
natural wax not in excess of four-tenths of        196.010 to 196.120 to appear on the label or
                                                                                                       the department of health and senior services;
one percent, harmless natural gum, and pec-        labeling is not prominently placed thereon
                                                                                                       provided further, that the requirements of
tin; provided, that this subdivision shall not     with such conspicuousness, as compared with
                                                   other words, statements, designs, or devices,                                                   16
                                                         Missouri Revised Statutes
Statutes

paragraph (b) of this subdivision shall not         class of food may, by reason of contamination
apply to any carbonated beverage the ingre-         with microorganisms during manufacture,
                                                    processing, or packing thereof in any locality,
                                                                                                       Use of poisonous or deleteri-
dients of which have been fully and correctly
disclosed, to the extent prescribed by said         be injurious to health, and that such injurious    ous substances.
paragraph (b) to the department of health and       nature cannot be adequately determined after
senior services in an affidavit;                    such articles have entered commerce, it then,      196.085 Any poisonous or deleterious sub-
                                                    and in such case only, shall promulgate regu-      stance added to any food except where such
(10) If it purports to be or is represented for     lations providing for the issuance, to manu-       substance is required in the production there-
special dietary uses, unless its label bears        facturers, processors, or packers of such class    of or cannot be avoided by good manufactur-
such information concerning its vitamin,            of food in such locality, of permits to which      ing practice, shall be deemed to be unsafe for
mineral, and other dietary properties as the        shall be attached such conditions governing        purposes of the application of subdivision (2)
department of health and senior services de-        the manufacture, processing, or packing of         of section 196.070; but when such substance
termines to be, and by regulations prescribed,      such class of food, for such temporary period      is so required or cannot be so avoided, the
as necessary in order to fully inform purchas-      of time, as may be necessary to protect the        department of health and senior services shall
ers as to its value for such uses;                  public health; and after the effective date of     promulgate regulations limiting the quan-
                                                    such regulations, and during such temporary        tity therein or thereon to such extent as the
(11) If it bears or contains any artificial         period, no person shall introduce or deliver       department finds necessary for the protection
flavoring, coloring, or chemical preserva-          for introduction into commerce any such food       of public health, and any quantity exceed-
tive, unless it bears labeling stating that fact;   manufactured, processed, or packed by any          ing the limits so fixed shall also be deemed
provided, that to the extent that compliance        such food manufacturer, processor, or packer       to be unsafe for purposes of the application
with the requirements of this subdivision is        unless such manufacturer, processor or pack-       of subdivision (2) of section 196.070. While
impracticable, exemptions shall be estab-           er holds a permit issued by the department         such a regulation is in effect limiting the
lished by regulations promulgated by the            of health and senior services as provided by       quantity of any such substance in the case of
department of health and senior services;           such regulations.                                  any food, such food shall not, by reason of
and provided further, that subdivision (11)                                                            bearing or containing any added amount of
shall not apply to artificial coloring in butter,   2. The department of health and senior ser-        such substance, be considered to be adulter-
cheese or ice cream;                                vices is authorized to suspend immediately         ated within the meaning of subdivision (1) of
                                                    upon notice any permit issued under authority      section 196.070. In determining the quantity
(12) The department is hereby directed to           of this section if it is found that any of the     of such added substance to be tolerated in or
promulgate regulations exempting from any           conditions of the permit have been violated.       on different articles of food, the department
labeling requirement of sections 196.010 to         The holder of a permit so suspended shall be       shall take into account the extent to which the
196.120 small open containers of fresh fruits       privileged at any time to apply for the rein-      use of such substance is required or cannot be
and vegetables and food which is, in ac-            statement of such permit, and the department       avoided in the production of each such article
cordance with the practice of the trade, to be      of health and senior services shall, immedi-       and the other ways in which the consumer
processed, labeled, or repacked in substantial      ately after prompt hearing and an inspection       may be affected by the same or other poison-
quantities at establishments other than those       of the establishment, reinstate such permit if     ous or deleterious substances.
where originally processed or packed, on            it is found that adequate measures have been
condition that such food is not adulterated         taken to comply with and maintain the condi-       (L. 1943 p. 559 § 9868)
or misbranded under the provisions of said          tions of the permit, as originally issued, or as
sections upon removal from such processing,         amended.                                           Section 196.090
labeling or repackaging establishment.
                                                    3. Any officer or employee duly designated
(L. 1943 p. 559 § 9866)                             by the department of health and senior             Sections 196.010 to 196.120
                                                    services shall have access to any factory or
                                                    establishment, the operator of which holds
                                                                                                       not applicable to animal food
Section 196.080                                     a permit from the department of health and         or garbage.
                                                    senior services for the purpose of ascertaining
Permits governing manufac-                          whether or not the conditions of the permit        196.090 Nothing in sections 196.010 to
                                                    are being complied with, and denial of ac-         196.120 shall apply to any ordinary animal
ture, processing or packing of                      cess for such inspection shall be ground for       food grown on a farm; nor to any prepared
certain foods--suspension and                       suspension of the permit until such access is      food for animals the contents of which are
                                                    freely given by the operator.                      stated on a label attached to the package or
reinstatement.                                                                                         container in which such prepared food is
                                                    (L. 1943 p. 559 § 9867)                            contained; nor garbage fed to hogs.
196.080 1. Whenever the department of
health and senior services finds after investi-
gation that the distribution in Missouri of any     Section 196.085                                                                              17
                                                          Missouri Revised Statutes
Statutes

(L. 1943 p. 559 § 9868a)                            of the United States and not to those of the       vices are not adulterated or misbranded under
                                                    United States Pharmacopoeia;                       the provisions of said sections upon removal
Section 196.095                                                                                        from such processing, labeling, or repacking
                                                    (6) If it is not subject to the provisions of      establishment.
                                                    subdivision (5) of this section and its strength
When drug or device adulter-                        differs from, or its purity or quality falls       (L. 1943 p. 559 § 9870, A.L. 2001 H.B. 796
                                                    below, that which it purports or is represented    merged with S.B. 514)
ated.                                               to possess;
196.095 A drug or device shall be deemed to                                                            Section 196.105
                                                    (7) If it is a drug and any substance has been
be adulterated:
                                                    mixed or packed therewith so as to reduce its
(1) If it consists in whole or in part of any
                                                    quality or strength, or substituted wholly or in   Provisions governing selling or
                                                    part therefor.
filthy, putrid, or decomposed substance; or                                                            delivering new drug.
                                                    (L. 1943 p. 559 § 9869)
(2) If it has been produced, prepared, packed,                                                         196.105 1. No person shall sell, deliver, offer
or held under insanitary conditions whereby                                                            for sale, hold for sale or give away any new
it may have been contaminated with filth, or        Section 196.100                                    drug unless:
whereby it may have been rendered injurious
to health; or                                                                                          (1) An application with respect thereto has
                                                    When drug or device mis-                           become effective under 21 U.S.C.A. § 355; or
(3) If it is a drug and its container is com-       branded.
posed in whole or in part, of any poisonous or                                                         (2) When not subject to the federal act unless
deleterious substance which may render the          196.100 1. Any manufacturer, packer, dis-          such drug has been tested and has not been
contents injurious to health; or                    tributor or seller of drugs or devices in this     found to be unsafe for use under the condi-
                                                    state shall comply with the current federal la-    tions prescribed, recommended, or suggested
(4) If it is a drug and it bears or contains, for   beling requirements contained in the Federal       in the labeling thereof, and prior to selling
purposes of coloring only, a coal tar color         Food, Drug and Cosmetic Act, as amended,           or offering for sale such drug, there has been
other than one from a batch certified under         and any federal regulations promulgated            filed with the department an application set-
the authority of the federal act;                   thereunder. Any drug or device which con-          ting forth full reports of investigations which
                                                    tains labeling that is not in compliance with      have been made to show whether or not such
(5) If it purports to be or is represented as a     the provisions of this section shall be deemed     drug is safe for use; a full list of the articles
drug the name of which is recognized in an          misbranded.                                        used as components of such drug; a full state-
official compendium, and its strength differs                                                          ment of the composition of such drug; a full
from, or its quality or purity falls below, the     2. A drug dispensed on a written prescrip-         description of the methods used in, and the
standard set forth in such compendium. Such         tion signed by a licensed physician, dentist,      facilities and controls used for, the manufac-
determination as to strength, quality, or purity    or veterinarian, except a drug dispensed in        ture, processing, and packing of such drug;
shall be made in accordance with the tests          the course of the conduct of a business of         such samples of such drug and of the articles
or methods of assay set forth in such com-          dispensing drugs pursuant to a diagnosis by        used as components thereof as the department
pendium, or in the absence of or inadequacy         mail, shall be exempt from the requirements        may require; and specimens of the labeling
of such tests or methods of assay, those            of this section if such physician, dentist, or     proposed to be used for such drug.
prescribed under authority of the federal act.      veterinarian is licensed by law to administer
No drug defined in an official compendium           such drug, and such drug bears a label con-        2. An application provided for in subdivision
shall be deemed to be adulterated under this        taining the name and place of business of the      (2) of subsection 1 shall become effective
subdivision because it differs from the stan-       dispenser, the serial number and date of such      on the sixtieth day after the filing thereof,
dard of strength, quality, or purity therefor set   prescription, and the name of such physician,      except that if the department finds after due
forth in such compendium, if its difference in      dentist, or veterinarian.                          notice to the applicant and giving him an
strength, quality, or purity from such stan-                                                           opportunity for a hearing, that the drug is not
dard is plainly stated on its label. Whenever       3. The department is hereby directed to            safe for use under the conditions prescribed,
a drug is recognized in both the United             promulgate regulations exempting from any          recommended, or suggested in the proposed
States Pharmacopoeia and the Homeopathic            labeling or packaging requirement of sections      labeling thereof, the department shall, prior
Pharmacopoeia of the United States it shall         196.010 to 196.120, drugs and devices which        to the effective date of the application, issue
be subject to the requirements of the United        are, in accordance with the practice of the        an order refusing to permit the application to
States Pharmacopoeia unless it is labeled and       trade, to be processed, labeled, or repacked in    become effective.
offered for sale as a homeopathic drug, in          substantial quantities at establishments other
which case it shall be subject to the provi-        than those where originally processed or           3. This section shall not apply:
sions of the Homeopathic Pharmacopoeia              packed, on condition that such drugs and de-                                                  18
                                                          Missouri Revised Statutes
Statutes

                                                  (2) If it consists in whole or in part of any       dinary individual under customary conditions
(1) To a drug intended solely for investiga-      filthy, putrid, or decomposed substance;            of purchase and use;
tional use by experts qualified by scientific
training and experience to investigate the        (3) If it has been produced, prepared, packed,      (4) If its container is so made, formed, or
safety in drugs provided the drug is plainly      or held under insanitary conditions whereby         filled as to be misleading;
labeled “For investigational use only”; or        it may have become contaminated with filth,
                                                  or whereby it may have been rendered injuri-        (5) The department is hereby directed to
(2) To a drug sold in this state at any time      ous to health;                                      promulgate regulations exempting from any
prior to the enactment of sections 196.010 to                                                         labeling requirement of sections 196.010 to
196.120 or introduced into interstate com-        (4) If its container is composed, in whole          196.120 cosmetics which are, in accordance
merce at any time prior to the enactment of       or in part, of any poisonous or deleterious         with the practice of the trade, to be processed,
the federal act; or                               substance which may render the contents             labeled, or repacked in substantial quanti-
                                                  injurious to health;                                ties at establishments other than those where
(3) To any drug which is licensed under the                                                           originally processed or packed, on condi-
Virus, Serum, and Toxin Act of July 1, 1902       (5) If it is not a hair dye and it bears or con-    tion that such cosmetics are not adulterated
(U.S.C. 1934 cd. title 42. Chapter 4).            tains a coal tar color other than one from a        or misbranded under the provisions of said
                                                  batch which has been certified under author-        sections upon removal from such processing,
4. An order refusing to permit an application     ity of the federal act.                             labeling or repackaging establishment.
under this section to become effective may
be revoked by the department of health and        (L. 1943 p. 559 § 9872)                             (L. 1943 p. 559 § 9873)
senior services.
                                                  Section 196.115                                     Section 196.120
(L. 1943 p. 559 § 9871)

Section 196.110                                   When a cosmetic deemed mis-                         Advertisement, when deemed
                                                  branded.                                            false.
When a cosmetic deemed                            196.115 A cosmetic shall be deemed to be            196.120 An advertisement of a food, drug,
adulterated.                                      misbranded:                                         device, or cosmetic shall be deemed to be
                                                                                                      false if it is false or misleading in any mate-
196.110 A cosmetic shall be deemed to be          (1) If its labeling is false or misleading in any   rial respect.
adulterated:                                      particular;
                                                                                                      (L. 1943 p. 559 § 9874)
(1) If it bears or contains any poisonous or      (2) If in package form unless it bears a label
deleterious substance which may render it         containing:                                         Section 196.150
injurious to users under the conditions of use
prescribed in the labeling or advertisement       (a) The name and place of business of the
thereof, or under such conditions of use as       manufacturer, packer, or distributor; and           Sale of horse and mule meat
are customary or usual; provided, that this
provision shall not apply to coal tar hair dye,   (b) An accurate statement of the quantity of        prohibited except when la-
the label of which bears the following legend     the contents in terms of weight, measure, or        beled as such meat.
conspicuously displayed thereon:                  numerical count; provided, that under (b) of
                                                  this subdivision reasonable variations shall        196.150 It shall hereafter be unlawful for
“Caution--This product contains ingredients       be permitted, and exemptions as to small            any person, firm, association, or corporation
which may cause skin irritation on certain        packages shall be established by regulations        to sell or offer for sale, either in wholesale
individuals and a preliminary test according      prescribed by the department of health and          or retail lots, any horse or mule meat under
to accompanying directions should first be        senior services;                                    the guise or name of beef or any other animal
made. This product must not be used for dye-                                                          flesh under the guise or name of any meat
ing the eyelashes or eyebrows; to do so may       (3) If any word, statement, or other informa-       or meat product except that which in fact
cause blindness.” and the labeling of which       tion required by or under authority of sections     and truth it may be, without having attached
bears adequate directions for such prelimi-       196.010 to 196.120 to appear on the label or        thereto, a tag or other mark for identification
nary testing. For the purposes of this subdivi-   labeling is not prominently placed thereon          plainly and legibly setting forth the true name
sion and subdivision (5), the term “hair dye”     with such conspicuousness, as compared with         of the animal from which such meat or flesh
shall not include eyelash dyes or eyebrow         other words, statements, designs, or devices,       was taken or without having prominently dis-
dyes;                                             in the labeling, and in such terms as to render     played over or in conjunction with such meat
                                                  it likely to be read and understood by the or-                                                    19
                                                        Missouri Revised Statutes
Statutes

or flesh, a legible sign or placard containing    be consumed on the premises where prepared         kosher meat and food only, is prima facie evi-
the true name of the animal from which the        and sold, or whether same is taken or carried      dence that the person in possession exposes
same was taken and without also advising          elsewhere for consumption, falsely represents      the same for sale with intent to defraud in
the purchaser thereof by verbal, written or       such food or food preparation to be kosher,        violation of the provisions of this section.
printed notice of the true name of the animal     that is, that same is prepared under and of
from which such meat or flesh was taken.          products sanctioned by the orthodox Hebrew         (RSMo 1939 § 9887, A.L. 1976 S.B. 512)
                                                  religious rules and requirements; or who           Prior revision: 1929 § 13038
(RSMo 1939 § 9884)                                shall falsely represent that such meat or meat
Prior revisions: 1929 § 13035; 1919 § 5683        preparation, food or food product is, or will      *Word “fails” appears in original rolls.
                                                  be prepared and served in accordance with
Section 196.155                                   such orthodox Hebrew religious rules and           Section 196.170
                                                  requirements, by displaying a sign or signs,
                                                  in, on, or about said person’s place of busi-
Penalty.                                          ness or establishment, or by advertisement in      Mixed flour to be branded.
                                                  any newspaper, magazine, or periodical, or
196.155 Any person violating the provisions       by publication in any other manner whatso-         196.170 No person shall sell or offer for sale
of section 196.150 shall be deemed guilty of      ever, the intent and purpose whereof shall         any flour, meal, grits or hominy, made from
a misdemeanor.                                    be to represent to the public by such adver-       the admixture or adulteration of grains, un-
                                                  tisement, or any other manner whatsoever,          less there shall have been first branded upon
(RSMo 1939 § 9885)                                that kosher meat or meat preparations, or          each of the barrels or packages containing the
Prior revisions: 1929 § 13036; 1919 § 5684        food or food products are prepared and sold        same, the kind of grains composing said ad-
                                                  in such place of business or establishment,        mixture, the quality and weight thereof, and
                                                  or served therein, or prepared or sold to be       the name and place of business of the person
Section 196.160                                   taken for consumption elsewhere than on            manufacturing the same; provided, always,
                                                  said premises; or who prepares, sells, serves,     that the admixture of the several grades or
Lawful to sell goat meat,                         or prepares for sale, either to be consumed        kinds of wheat shall not be construed to be
                                                  on the premises, or elsewhere, both kosher         mixed or adulterated grains.
when.                                             and nonkosher meat or meat preparations, or
                                                  food or food products in the same place of         (RSMo 1939 § 9917)
196.160 It shall hereafter be lawful for any      business, who fails to keep separate kitchens      Prior revisions: 1929 § 13077; 1919 § 5723;
person, firm, association, or corporation to      and dining rooms, wherein meat or meat             1909 § 6617
sell or offer for sale either in wholesale or     preparations, or food or food products are
retail lots, goat meat; provided, the same is     prepared and served; or who fails to keep and      CROSS REFERENCE:
branded goat meat or chevon.                      use separate and distinctly labeled or marked
                                                  dishes and utensils wherein such meat or           Flour, meal, grits, or hominy to be branded
(RSMo 1939 § 9886)                                meat preparation of food or food product is        and filed with recorder, penalty for violation,
Prior revision: 1929 § 13037                      prepared and served; or who shall fail to in-      RSMo 417.100, 417.130, 417.140
                                                  dicate on all signs and display advertising, in,
Section 196.165                                   on, or about said person’s premises, in block
                                                                                                     Section 196.175
                                                  letters, at least four inches in height, “kosher
                                                  and nonkosher food prepared and sold here”,
Falsely representing food to be                   as the case may be, or persons dealing in          Penalty.
kosher prohibited, penalty--                      kosher meat or meat preparations, kosher
                                                  food or food products only and persons             196.175 Any person doing any of the acts
kosher defined.                                   dealing in both kosher and nonkosher meat          prohibited in section 196.170, or omitting
                                                  or meat preparations, kosher and nonkosher         to do any of the acts therein commanded,
196.165 Any hotel, inn, delicatessen, grocery     food or food products who fail* to adhere          shall be guilty of a misdemeanor, and for
or butcher shop, or restaurant keeper, or any     to and abide by orthodox Hebrew religious          each and every offense shall be punished by
individual, firm or corporation, carrying         rules and requirements, shall be guilty of a       a fine of not less than twenty nor more than
on and conducting a boardinghouse, eating         misdemeanor, punishable by a fine of not less      two hundred dollars, one-half of which shall
house, lunchroom business, or engaged in          than twenty-five dollars, nor more than five       be paid to the person who shall be named as
the catering business (all hereinafter referred   hundred dollars, or by imprisonment of not         prosecuting witness.
to as “person”), who shall with intent to         less than thirty days nor more than one year,
defraud, sell, prepare or expose for sale, any    or both. Possession of nonkosher meat or           (RSMo 1939 § 9922, A. 1949 S.B. 1053)
meat or meat preparation, articles of food        meat preparation, or food or food product in       Prior revisions: 1929 § 13082; 1919 § 5728;
or food products, either raw or prepared for      any place of business advertising the sale of
human consumption, whether the same is to                                                                                                       20
                                                        Missouri Revised Statutes
Statutes

1909 § 6622                                        Contents of places and utensils                     may be displayed on the sidewalk; but the
                                                                                                       sidewalk display of meat or meat products is
                                                   used must be protected.                             prohibited.
Section 196.180
                                                   196.195 1. The floors, sidewalks, ceilings,         (RSMo 1939 § 9889)
                                                   lockers, closets, furniture, receptacles, imple-
Board of flour inspectors--                        ments and machinery of every establishment
                                                                                                       Prior revisions: 1929 § 13040; 1919 § 5686
duties (St. Louis).                                or place where food is manufactured, packed,
                                                   stored, sold or distributed, and all cars, trucks   Section 196.210
196.180 The chamber of commerce of the             and vehicles used in the transportation of
city of St. Louis is hereby authorized to ap-      food products, shall at no time be kept in an
point a board of flour inspectors for the city     unclean, unhealthy or insanitary condition,
                                                                                                       Toilet rooms provided.
of St. Louis, for the purpose of inspecting        and for the purpose of sections 196.190 to
flour designed for shipment, under such rules                                                          196.210 1. Every building, room, basement
                                                   196.265, unclean, unhealthful and insanitary
and regulations as it may see fit to establish,                                                        or cellar, occupied or used for the prepara-
                                                   conditions shall be deemed to exist:
whose brands, between buyer and seller, shall                                                          tion, manufacture, packing, canning, sale or
be evidence of the quality of the flour they                                                           distribution of food, shall have convenient
                                                   (1) If food in the process of manufacture,
represent, and which may have been subject-                                                            toilet or toilet rooms, separate and apart from
                                                   preparation, packing, storing, sale, distribu-
ed to said inspection.                                                                                 the room or rooms where the process of
                                                   tion or transportation is not securely protect-
                                                                                                       production, manufacture, packing, canning,
                                                   ed from flies, dust, dirt and, as far as may be
(RSMo 1939 § 15741)                                                                                    selling or distributing is conducted.
                                                   necessary, by all reasonable means from all
Prior revision: 1929 § 14793                       other foreign or injurious contamination; and
                                                                                                       2. The floors of such toilet rooms shall be
                                                                                                       of cement, tile, wood, brick or other nonab-
Section 196.190                                    (2) If the refuse, dirt and waste products,
                                                                                                       sorbent material and shall be furnished with
                                                   subject to decomposition and fermentation,
                                                                                                       separate ventilating flush or pipes, discharg-
                                                   incident to the manufacture, preparation,
                                                                                                       ing into soil pipes, or on outside of the build-
To what places law applies.                        packing, storing, selling, distributing and
                                                                                                       ing in which they are situated.
                                                   transporting of food, are not removed daily;
196.190 Every building, room, basement, or         and
                                                                                                       3. Lavatories and washrooms shall be adja-
cellar occupied or used as a bakery, confec-                                                           cent to toilet rooms, and shall be supplied
tionery, cannery, packinghouse, slaughter-         (3) If all trucks, trays, boxes, baskets, buckets
                                                                                                       with soap, running water and towels, and
house, restaurant, hotel, dining car, grocery,     and other receptacles, chutes, platforms,
                                                                                                       shall be maintained in a sanitary condition.
meat market, dairy, creamery, butter factory,      racks, tables, troughs, shelves and all knives,
cheese factory, or other place or apartment        saws, cleavers and other utensils, and ma-
                                                                                                       4. Operatives, employees, clerks and all other
used for the preparation for sale, manufac-        chinery used in moving, handling, cutting,
                                                                                                       persons who handle the material from which
ture, packing, storage, sale or distribution of    chopping, mixing, canning and all other
                                                                                                       food is prepared, or the finished product, be-
any food, shall be properly lighted, drained,      processes are not fairly cleaned daily; and
                                                                                                       fore beginning work or after visiting toilets,
plumbed and ventilated and conducted with                                                              shall wash their hands and arms thoroughly
strict regard to the influence of such condition   (4) If the clothing of operatives, employees,
                                                                                                       with soap and clean water.
upon the health of the operatives, employees,      clerks or other persons therein employed is
clerks or other persons therein employed,          unclean.
                                                                                                       (RSMo 1939 § 9892)
and the purity and wholesomeness of the                                                                Prior revisions: 1929 § 13043; 1919 § 5689
food therein produced; and for the purpose of      2. The placing of vinegar or other liquid, used
sections 196.190 to 196.265, the term “food”,      as food or drink, in open vessels without cov-
                                                                                                       Section 196.220
as used herein, shall include all articles used    ering the same is forbidden. The use of sec-
for food, drink, confectionery condiment,          ondhand bottles for vinegar or other liquids,
                                                                                                       Not used for sleeping purposes.
whether simple, mixed or compound, and all         used as food or drink, is forbidden unless the
substances or ingredients used in the prepara-     same are first sterilized with live steam.
                                                                                                       No person or persons shall be allowed to live
tion thereof.                                                                                          or sleep in any room of a bakeshop, kitchen,
                                                   3. The sidewalk display of food products is
                                                                                                       dining room, confectionary or place where
(RSMo 1939 § 9888)                                 prohibited unless such products are enclosed
                                                                                                       food is prepared, served or sold.
Prior revisions: 1929 § 13039; 1919 § 5685         in a showcase or similar device, which will
                                                   protect the same from flies, dust or other
                                                                                                       (RSMo 1939 § 9894)
                                                   contamination; provided, that food products
Section 196.195                                    that necessarily have to be peeled, pared or
                                                                                                       Prior revisions: 1929 § 13045; 1919 § 5691
                                                   cooked before they are fit for consumption
                                                                                                                                                  21
                                                         Missouri Revised Statutes
Statutes

Section 196.225                                     called upon by the director of the department
                                                    of health and senior services to do so, all such   Section 196.245
                                                    cases of offenses arising under the provi-
Employees with communica-                           sions of sections 196.190 to 196.265. When
ble disease prohibited, where.                      complaint is made by the said director of the      Order to specify what--revoca-
                                                    department of health and senior services,
                                                    security for costs shall not be required of the
                                                                                                       tion--reopening.
196.225 No employer shall require or permit
                                                    complainant in any case at any time of the
person, nor shall a person work, affected                                                              196.245 Any order issued by the director of
                                                    prosecution or trial.
with any disease in a communicable form or                                                             the department of health and senior services
while a carrier of such disease, to work in any                                                        for the closing of any place or places men-
                                                    (RSMo 1939 § 9896)
building or vehicle occupied or used for the                                                           tioned in section 196.240, shall specify the
                                                    Prior revisions: 1929 § 13047; 1919 § 5693
production, preparation, manufacture, pack-                                                            cause or causes for which such order was
ing, storage, sale, distribution, and transporta-                                                      issued, and the time during which same shall
tion of food in any capacity which brings the       Section 196.235                                    be in effect. The director shall revoke such
person into contact with the food.                                                                     order before the time specified therein for its
                                                                                                       expiration; provided, that the cause for which
(RSMo 1939 § 9895, A.L. 1977 S.B. 262)              Penalty.                                           such order was issued is removed, and if the
Prior revisions: 1929 § 13046; 1919 § 5692                                                             director is satisfied that such place or places
                                                    196.235 Any person who violates any of the         may be reopened without endangering the
                                                    provisions of sections 196.190 to 196.230,         public health.
Section 196.230                                     shall be guilty of a misdemeanor, and, on
                                                    conviction, shall be punished for the first of-    (RSMo 1939 § 9899)
                                                    fense by a fine of not less than ten dollars nor
Abatement of violations by                          more than one hundred dollars, or be impris-
                                                                                                       Prior revisions: 1929 § 13050; 1919 § 5696
director.                                           oned in the county jail not exceeding thirty
                                                    days, or both, in the discretion of the court.     Section 196.250
196.230 The director of the department of
health and senior services and his assistants       (RSMo 1939 § 9897)
or agents by him appointed, the state, county,      Prior revisions: 1929 § 13048; 1919 § 5694
                                                                                                       Construction of the word
city and town health officers shall have full                                                          close.
power at any time to enter and inspect every
building, room, basement or cellar, occupied
                                                    Section 196.240                                    196.250 The word “close”, as used in sec-
or used, or suspected of being used, for the                                                           tions 196.190 to 196.265, shall be construed
production for sale, manufacture for sale,          Authorization by director to                       to mean a suspension of business, and it shall
storage, sale, distribution or transportation                                                          be unlawful for the proprietor, manager, or
of food and all utensils, fixtures, furniture       close health menace.                               person having charge of any place mentioned
and machinery used as aforesaid, and if upon                                                           in section 196.240 to transact any business
inspection any food producing or distributing       196.240 It shall be the duty of the director of    in violation of any order of the director of
establishment, conveyance, employer, opera-         the department of health and senior services,      the department of health and senior services
tive, employee, clerk, driver or other person       and he is hereby authorized and empowered,         closing same.
is found to be violating any of the provisions      to close any market place, grocery store,
of sections 196.190 to 196.265, or if the           general store, bakery, confectionery, butcher      (RSMo 1939 § 9901)
production, cooking, preparation, manufac-          shop, slaughterhouse, dining car, refrigerator     Prior revisions: 1929 § 13052; 1919 § 5698
ture, packing, storing, sale, distribution or       car, cold storage plant or warehouse, hotel
transportation of food is being conducted           dining room or kitchen, cafe, restaurant,
                                                    lunch counter, drug store, or any other place,     Section 196.265
in a manner detrimental to the health of the
employees and operatives and the character          or places, where articles or commodities
                                                    intended for human food, or for human
or quality of the food therein being produced,
                                                    consumption as medicine, are manufactured,
                                                                                                       Penalty for violation.
manufactured, packed, stored, sold, distrib-
uted or conveyed, the officer or inspector,         sold, stored or prepared for sale, or wherever
                                                                                                       196.265 Any person who shall fail, or
making the examination or inspection, shall         food and drink is served, where such places
                                                                                                       refuse, to obey any order of the director of
furnish evidence of said violation to the           shall, in the judgment of said director, consti-
                                                                                                       the department of health and senior services
prosecuting attorney of the county in which         tute a menace to the public health, by reason
                                                                                                       to close any place, or places, mentioned
the violation occurs, and it shall be the duty      of dirt, filth, or other insanitary cause.
                                                                                                       in section 196.240, or who shall exhibit or
of all prosecuting attorneys to represent and                                                          expose for sale in any show window upon
prosecute, in behalf of the people, when            (RSMo 1939 § 9898)
                                                    Prior revisions: 1929 § 13049; 1919 § 5695                                                   22
                                                          Missouri Revised Statutes
Statutes

any sidewalk, any vegetables or other articles
or commodities whatsoever intended for             (1) “Consumer” means any person who               (11) “Sell” means offer for sale, expose for
human food, in violation of any order of the       purchases eggs for his or her own family          sale, have in possession for sale, exchange,
director, or who shall, in any way, resist or      use or consumption; or any restaurant, hotel,     barter, or trade.
interfere with the director in the enforcement     boardinghouse, bakery, or other institution or
of sections 196.190 to 196.265, or any order       concern which purchases eggs for serving to       (L. 1955 p. 701 § 196.310)
of the director made pursuant to the author-       guests or patrons thereof, or for its own use
ity of this law, shall be deemed guilty of a       in cooking, baking, or manufacturing their
misdemeanor.                                       products;
                                                                                                     Section 196.313
(RSMo 1939 § 9904)                                 (2) “Container” means any box, case, basket,
Prior revisions: 1929 § 13055; 1919 § 5701         carton, sack, bag, or other receptacle. “Sub-     License to sell eggs required--
                                                   container” means any container when being
                                                   used within another container;                    exceptions.
Section 196.271
                                                   (3) “Dealer” means any person who pur-            196.313 No person shall buy, sell, trade or
                                                                                                     traffic in eggs in this state without a license
Food manufacturers or dis-                         chases eggs from the producers thereof, or
                                                                                                     with the following exceptions:
                                                   another dealer, for the purpose of selling
tributors may register.                            such eggs to another dealer, a processor, or
                                                   retailer;                                         (1) Those who sell only eggs produced by
196.271. All establishments engaged in the                                                           their own flocks, provided such eggs are not
manufacture of food or distribution of foods       (4) “Denatured” means eggs (a) made unfit         sold at an established place of business away
to wholesale accounts may register with the        for human food by treatment or the addition       from the premises of such producer;
department of health and senior services as a      of a foreign substance, or (b) with one-half or
food manufacturer or food distributor.             more of the shell’s surface covered by a per-     (2) Hatcheries which purchase eggs used
                                                   manent black, dark purple or dark blue dye;       exclusively for hatching purposes;
(L. 1977 S.B. 262 § 196.270)
                                                   (5) “Director” means the director of the de-      (3) Hotels, restaurants, and other public
Section 196.291                                    partment of agriculture;                          eating places where all eggs purchased are
                                                                                                     served in the establishment;
                                                   (6) “Eggs” means eggs in the shell from
Food sold at religious events                      chickens;                                         (4) Bakeries, confectioneries, and ice cream
                                                                                                     manufacturers purchasing eggs for use and
or charitable functions exempt                                                                       used only in the manufacture of their prod-
                                                   (7) “Inedible eggs” means eggs which are
from food inspection laws and                      defined as such in the rules and regulations of   ucts.
regulations, when.                                 the director adopted under sections 196.311
                                                   to 196.361, which definition shall conform        (L. 1955 p. 701 § 196.332)
196.291 All sales of foods which are not           to the specifications adopted therefor by the
potentially hazardous foods, as defined by         United States Department of Agriculture;          Section 196.316
regulation, sold by religious, charitable, or
nonprofit organizations at their religious         (8) “Person” means and includes any indi-
events or at charitable functions and activities   vidual, firm, partnership, exchange, associa-     License requirements--appli-
shall be exempt from all state laws and regu-      tion, trustee, receiver, corporation or any       cations--kinds of licenses--
lations relating to food inspection, pursuant      other business organization, and any member,
to sections 196.190 to 196.271.                    officer or employee thereof;                      fees--posting.

(L. 2005 S.B. 355)                                 (9) “Processor” means any person engaged in       196.316 1. All persons engaged in buying,
                                                   breaking eggs or manufacturing or processing      selling, trading or trafficking in, or processing
                                                   egg liquids, whole egg meats, yolks, whites,      eggs, except those listed in section 196.313,
Section 196.311                                    or any mixture of yolks and whites, with or       shall be required to be licensed under sections
                                                   without the addition of other ingredients,        196.311 to 196.361. Such persons shall file an
                                                                                                     annual application for such license on forms
Definitions.                                       whether chilled, frozen, condensed, concen-
                                                                                                     to be prescribed by the director, and shall ob-
                                                   trated, dried, powdered or desiccated;
                                                                                                     tain an annual license for each separate place
196.311 Unless otherwise indicated by the                                                            of business from the director. The following
context, when used in sections 196.311 to          (10) “Retailer” means any person who sells
                                                   eggs to a consumer;                               types of licenses shall be issued:
196.361:
                                                                                                                                                 23
                                                         Missouri Revised Statutes
Statutes

                                                                                                                grades, shall be established by the director
(1) A “retailer’s license” shall be required                (b) More than 50 and less than 250 cases            through the promulgation and issuance of
of any person defined as a retailer in section              ........ 50.00                                      regulations; provided, the quality standards
196.311. A holder of a retailer’s license shall                                                                 and designations, size standards and designa-
not, by virtue of such license, be permitted                (c) More than 250 and less than 1000 cases          tions, and tolerances within grades shall not
or authorized to buy eggs from any person                   ...... 75.00                                        be lower than those established by the United
other than a licensed dealer, and any retailer                                                                  States Department of Agriculture.
desiring to buy eggs from persons other                     (d) More than 1000 cases ........................
than licensed dealers, shall obtain a dealer’s              100.00                                              (L. 1955 p. 701 § 196.312)
license in addition to a retailer’s license.
                                                            3. All licenses shall be conspicuously posted
(2) A “dealer’s license” shall be required                  in the place of business to which it applies.
of any person defined as a dealer in section                The license year shall be twelve months, or         Section 196.323
196.311. A holder of a dealer’s license shall               any fraction thereof, beginning July first and
not, by virtue of such license, be authorized               ending June thirtieth.                              Kinds of eggs which may be
or permitted to sell eggs to consumers, and
any dealer desiring to sell eggs to consumers               4. No license shall be transferable, but it may     sold.
shall obtain a retailer’s license in addition to            be moved from one place to another by the
a dealer’s license.                                         consent of the director.                            196.323 1. Only eggs of the quality standard
                                                                                                                designated Grade “AA”, Grade “A”, Grade
(3) A “processor’s license” shall be required               5. All moneys received from license fees            “B”, or Grade “C”, shall be sold to any con-
of any person defined as a processor in                     collected hereunder shall be deposited in the       sumer by any person.
section 196.311. A holder of a processor’s                  state treasury to the credit of the agricultural
license shall not, by virtue of such license,               fees fund.                                          2. Inedible eggs shall not be bought, sold or
be authorized or permitted to sell eggs in the                                                                  trafficked in and any inedible eggs found in
shell to other persons, and any person desir-               (L. 1955 p. 701 § 196.335)                          the hands of any person are declared to be
ing to sell eggs in the shell to other persons,                                                                 contraband and shall be destroyed as contra-
shall obtain a dealer’s license in addition to a                                                                band. The director, by regulation, may permit
                                                            Section 196.318                                     the sale and use of denatured inedible eggs
processor’s license.
                                                                                                                for purposes other than human food.
2. The annual license fee shall be:                         Licensees to keep records.
                                                                                                                (L. 1955 p. 701 §§ 196.315, 196.317)
(1) Retailers .................................... $ 5.00   196.318 All persons licensed under the
                                                            provisions of sections 196.311 to 196.361
(2) Dealers--License fees for dealers shall be              shall keep records of purchases and sales of        Section 196.326
determined on the basis of cases (30 dozen                  eggs, of the grades of eggs bought and sold,
per case) of eggs sold in the shell in any one              and other related information necessary for
week, as follows:                                           the proper enforcement of sections 196.311          Egg containers to be marked
                                                            to 196.361, in the manner and form, and for         or labeled.
(a) 1 to 25 cases ................................ $ 5.00   such reasonable period of time, as may be
                                                            prescribed by the rules and regulations of the      196.326 Eggs, which have been graded as to
(b) 26 to 50 cases ............................... 12.50    director.                                           quality and size for sale to consumers, shall
                                                                                                                not be prepared, packed, placed, delivered for
(c) 51 to 100 cases .............................. 25.00    (L. 1955 p. 701 § 196.337)                          shipment or sale, loaded, shipped, trans-
                                                                                                                ported, or sold in bulk or in containers or
(d) more than 100 cases ..........................                                                              subcontainers:
50.00
                                                            Section 196.321
                                                                                                                (1) Unless each container and subcontainer
(3) Processors--License fees for processors                                                                     of eggs is marked with the full, correct and
shall be determined on the basis of cases (30               Standards and grades to be                          unabbreviated designation of size and quality
dozen per case) of eggs, or the equivalent in                                                                   of the eggs therein, according to the standards
liquid or frozen eggs, processed in any one                 fixed.
                                                                                                                established by the director, together with the
day, as follows:                                                                                                name and address of the producer, dealer, re-
                                                            196.321 The quality standards for grades
                                                            of eggs, the size designation and standards         tailer, or agent by or for whom the eggs were
(a) Less than 50 cases .......................... $                                                             graded or marked;
25.00                                                       therefor by weight, and tolerances within
                                                                                                                                                          24
                                                                   Missouri Revised Statutes
Statutes

                                                                                                      Advertisements of price to
(2) Unless all markings on any container            (2) When sales are made without advertising,
which do not properly and accurately apply to       by the producer, from eggs produced on his        give size and quality.
the eggs placed or packed therein have been         own premises and are not sold at an estab-
removed, erased or obliterated;                     lished place of business away from premises       196.336 No person shall advertise by sign,
                                                    of such producer;                                 placard, or otherwise, the price at which eggs
(3) Which are mislabeled by the placing or                                                            are offered for sale without marking the full,
presence of any false, deceptive or mislead-        (3) On containers of fifteen dozen or more        correct, and unabbreviated designation of size
ing mark, term, statement, design, device, in-      eggs which contain properly marked subcon-        and quality of such eggs on such advertise-
scription, or any other designation, upon any       tainers.                                          ment, in conjunction with the price. Such
eggs or upon any container or subcontainer of                                                         designations of size and quality shall be in
eggs, or upon the label or lining or wrapper        (L. 1955 p. 701 § 196.322)                        boldface type or other conspicuous letters,
thereof, or upon any placard or sign used in                                                          and at least one-half the size of the letters or
connection therewith, or in connection with                                                           figures used to designate the price of such
                                                    Section 196.331                                   eggs.
any bulk lot or display having reference to
eggs;
                                                                                                      (L. 1955 p. 701 § 196.330)
                                                    Sign required on sale from
(4) Which are deceptive by any arrangement
of the contents of any container, or subcon-        bulk lots.                                        Section 196.338
tainer, or of any lot, load, or display, in which
the eggs in the outer layer or in any portion       196.331 Eggs shall not be sold to consumers,
exposed to view are in quality, size, condi-        from bulk lots without displaying a plainly       Dealer to furnish retailer with
                                                    legible sign or placard conspicuously placed
tion, or in any other respect so superior to
                                                    and posted in such a position as to clearly       invoice showing size and qual-
those in the interior or unexposed portion as
to materially misrepresent the contents or any      and accurately identify the eggs designated       ity.
part thereof as to size, quality, condition, or     thereby, marked with the full, correct and
any other respects;                                 unabbreviated designation of quality and          196.338. Every dealer selling eggs to a
                                                    size of such eggs in boldface type letters not    retailer shall furnish an invoice showing the
(5) Unless designations of size and quality         less than one inch in height, according to the    size and quality of such eggs according to the
upon containers and subcontainers of eggs           standards established by the director.            standards prescribed by sections 196.311 to
shall be plainly and conspicuously marked                                                             196.361 and by the rules and regulations of
in boldface type letters on a contrasting           (L. 1955 p. 701 § 196.325)                        the director.
background of (a) not less than three-eighths
of an inch in height on the outside top face        Section 196.333                                   (L. 1955 p. 701 § 196.340)
of each container holding less than fifteen
dozen eggs, and (b) not less than two inches                                                          Section 196.341
in height on one outside end of any oblong          Markings in case of eggs from
container holding fifteen dozen or more eggs,       different species of fowl.
and on one outside side of any other contain-                                                         Processing plants kept clean-
er holding fifteen dozen or more eggs.              196.333. No person shall sell or represent        -standards--inspection--rule-
                                                    eggs from any other species of fowl as
(L. 1955 p. 701 § 196.320)                          chicken eggs, or sell mixed eggs from more
                                                                                                      making, procedure.
                                                    than one species of fowl, or eggs from ducks,
                                                                                                      196.341 The premises, plants and facilities
Section 196.328                                     turkeys, geese, or any species of fowl other
                                                                                                      operated and maintained by egg processors
                                                    than chickens, without marking the contain-
                                                                                                      shall be operated and maintained in a clean
                                                    ers and subcontainers of such eggs or other-
                                                                                                      and sanitary condition. The director shall
Containers not required to be                       wise indicating fully by sign, placard or other
                                                                                                      adopt and promulgate rules and regulations
marked, when.                                       inscription the species of fowl from which
                                                                                                      pursuant to this section and chapter 536,
                                                    such eggs were produced.
                                                                                                      RSMo, establishing standards of cleanliness
196.328 No markings are required on con-                                                              and sanitation for such premises, plants and
tainers or subcontainers of eggs:                   (L. 1955 p. 701 § 196.327)
                                                                                                      facilities, and the director, or his authorized
                                                                                                      agents or representatives, are authorized and
(1) When sold at retail from a properly                                                               empowered to inspect such premises, plants
marked bulk display and packaged in the             Section 196.336                                   and facilities in order to enforce such cleanli-
presence of the purchaser for the immediate
purpose of the sale;                                                                                                                             25
                                                          Missouri Revised Statutes
Statutes

ness and sanitation requirements. No rule          judgment as to the justification of such order      hereunder. Any such dealer, processor, retail-
or portion of a rule promulgated under the         and for the discharge of such eggs from the         er, or applicant shall have full rights to have
authority of sections 196.311 to 196.361 shall     order prohibiting the sale in accordance with       counsel, to produce witnesses in his behalf
become effective unless it has been promul-        the findings of the court.                          at such hearing, and to have ten days’ notice
gated pursuant to the provisions of section                                                            in writing of the date, time and place of such
536.024, RSMo.                                     (L. 1955 p. 701 § 196.347, A.L. 1978 H.B.           hearing, and the charges and grounds upon
                                                   1634)                                               which his license is sought to be revoked or
(L. 1955 p. 701 § 196.342, A.L. 1993 S.B.          Effective 1-2-79                                    suspended, or to be refused a license. The
52, A.L. 1995 S.B. 3)                                                                                  order of suspension, revocation, or refusal to
                                                   Section 196.348                                     issue a license, shall not become final until
                                                                                                       ten days after the date thereof, and after the
Section 196.343                                                                                        party to the proceeding has been notified in
                                                   Court may order seizure of                          writing of the action of the director. Any par-
Inspection of business prem-                       eggs, when--condemnation.
                                                                                                       ty to the proceedings that is aggrieved by any
                                                                                                       final decision or order of the director, may
ises and records.                                                                                      appeal such order in the manner provided for
                                                   196.348 Any eggs found in the possession of         such appeals in the Administrative Procedure
196.343 The director, or his authorized            an owner or custodian and not in compliance         Act of Missouri (Chapter 536).
agents or representatives, may enter, during       with the provisions of sections 196.311 to
the regular business hours, any establishment      196.361, or the rules or regulations adopted        (L. 1955 p. 701 § 196.352)
where eggs are bought, stored, sold, offered       hereunder, shall be subject to seizure upon
for sale, or processed, in order to inspect        complaint of the director to the circuit court
and examine eggs, the products of eggs, egg        of the county or city in which such eggs are        Section 196.354
containers, and the premises, and to examine       located. Such seizure shall not be made until
the records of such establishments relating        the owner or custodian of the eggs has been
thereto.                                           given forty-eight hours from the time of a          Duties of director of agricul-
                                                   “Stop-Sale” order to bring the eggs into com-       ture--rules and regulations.
(L. 1955 p. 701 § 196.345)                         pliance with sections 196.311 to 196.361, or
                                                   the rules and regulations adopted hereunder.        196.354. The duty of enforcing sections
                                                   In the event the court finds that the eggs do       196.311 to 196.361 is vested in the director
Section 196.346                                    not comply with sections 196.311 to 196.361,        who shall adopt and promulgate such rules
                                                   or the rules and regulations adopted hereun-        and regulations as are necessary to secure the
Stop-sale orders, effect--ap-                      der, it shall order the condemnation thereof,       enforcement of and carry out the provisions
                                                   and the eggs shall be denatured, processed,         of sections 196.311 to 196.361. No rule or
peals.                                             destroyed, regraded, relabeled, or otherwise        portion of a rule promulgated under the au-
                                                   disposed of by the court.                           thority of this section shall become effective
196.346 The director, or his authorized                                                                unless it has been promulgated pursuant to
agents or representatives, are authorized and      (L. 1955 p. 701 § 196.350, A.L. 1978 H.B.           the provisions of section 536.024, RSMo.
empowered to issue and enforce a written           1634)
or printed “Stop-Sale” order to the owner          Effective 1-2-79                                    (L. 1955 p. 701 § 196.355, A.L. 1995 S.B. 3)
or custodian of any eggs which are found to
be in violation of any of the provisions of
sections 196.311 to 196.361, or the rules or       Section 196.351                                     Section 196.357
regulations adopted under the authority of
sections 196.311 to 196.361, which order
shall prohibit the further sale of such eggs
                                                   License suspended or revoked, Violations may be enjoined.
until sections 196.311 to 196.361 have been        when, procedure--appeal.
                                                                                                       196.357 In addition to the remedies pro-
complied with and the owner or custodian
                                                   196.351 The director is hereby authorized           vided for in sections 196.311 to 196.361
shall have the right to take such steps as may
                                                   and empowered to suspend or revoke the              or by law, the prosecuting attorney of any
be possible to bring the eggs into compliance,
                                                   license of any dealer, processor, or retailer,      county in which a violation of any provision
such as regrading or relabeling, and, pro-
                                                   or to refuse to issue a license to any applicant    of sections 196.311 to 196.361 occurs or the
vided that in respect to eggs that have been
                                                   therefor if the director, after a public hearing,   attorney general of the state, is hereby au-
denied sale as provided in sections 196.311
                                                   has found that such dealer, processor, retailer,    thorized to apply to any court of competent
to 196.361, the owner or custodian of such
                                                   or applicant for a license, has violated any        jurisdiction for, and such court shall have ju-
eggs shall have the right to appeal from such
                                                   of the provisions of sections 196.311 to            risdiction upon hearing and for cause shown
order to the circuit court of the county or city
                                                   196.361, or the rules and regulations adopted       to grant, a temporary or permanent injunc-
in which the eggs are located, praying for a
                                                                                                                                                  26
                                                         Missouri Revised Statutes
Statutes

tion to restrain any person from violating any     is rented for the storage of food;                 a license accompanied by the required fee,
provision of sections 196.311 to 196.361.                                                             the department shall inspect the plant to be
                                                   (8) “Locker room” means that space or room         licensed and if it finds that such plant com-
(L. 1955 p. 701)                                   in a locker plant which contains individual        plies with the provisions of law, the depart-
                                                   lockers or compartments which are for rent         ment shall issue such license. The persons
                                                                                                      designated by the department to make such
Section 196.361                                    for the storage of frozen food;
                                                                                                      inspection shall be persons having practical
                                                   (9) “Operator” means any person, copartner-        knowledge of the operation of cold storage
Violation a misdemeanor.                           ship, firm or corporation operating or main-       plants and the storage of food therein, and
                                                   taining a locker plant;                            shall be thoroughly familiar with the provi-
196.361 Any person who violates any of the                                                            sions of the law applicable to locker plants
provisions of sections 196.311 to 196.361          (10) “Quick or sharp freeze” means the freez-      and the applicable rules and regulations of the
shall, upon conviction, be deemed guilty of a      ing of food in a room in which the tempera-        department. The department shall inspect all
misdemeanor.                                       ture is zero or lower;                             locker plants licensed under sections 196.450
                                                                                                      to 196.515 at least once each six months, and
(L. 1955 p. 701 § 196.360)                         (11) “Quick or sharp freezing room” means          may make such additional inspections as the
                                                   that space in a locker plant in which food         department deems necessary. The department
                                                   is quick or sharp frozen prior to storage in       and its representatives shall have access to
Section 196.450                                    lockers;                                           locker plants at all reasonable times for the
                                                                                                      purpose of making inspections.
Definitions.                                       (12) “Quick or sharp frozen” means the
                                                                                                      (L. 1945 p. 940 § 4)
                                                   condition of food which has been thoroughly
196.450. When used in sections 196.450             frozen in a quick or sharp freezing room;
to 196.515, unless the context otherwise                                                              Section 196.470
requires:                                          (13) “Temperature” means degrees shown on
                                                   Fahrenheit thermometer.
(1) “Chill room” means a room or space in                                                             Form and expiration of li-
a locker plant, artificially cooled, provided      (L. 1945 p. 940 § 1)                               cense.
for the temporary holding or storage of food
prior to its processing or freezing for storage;   Section 196.455                                    196.470 The license issued under sections
                                                                                                      196.450 to 196.515 shall be in such form as
(2) “Cutting or processing room” means a                                                              the department may prescribe. Licenses shall
separate room or space in a locker plant in        Annual license required.                           expire December thirty-first following date
which food products are prepared for quick                                                            of issue. All licenses must be conspicuously
or sharp freezing;                                 196.455 It shall be unlawful for any person,       displayed by the licensee in locker plants.
                                                   firm, copartnership or corporation to oper-
(3) “Department” means department of agri-         ate a locker plant in this state unless such       (L. 1945 p. 940 § 5)
culture of the state of Missouri;                  person, firm, copartnership or corporation
                                                   has secured an annual license therefor from
(4) “Director” means the director of the           the department. A separate license shall be        Section 196.475
department of agriculture of the state of Mis-     secured for each locker plant. The application
souri;                                             for such license shall be in writing on forms      Gas masks, alarm bell, and il-
                                                   prescribed and furnished by the department.
(5) “Food” means all articles used for food,       A license issued for a locker shall be transfer-   lumination required.
drink, confectionery or condiment by man,          able upon written permission of the director.
whether simple, mixed or compound, and any                                                            196.475 1. Any plant using a toxic gas
substance used as a constituent in the manu-       (L. 1945 p. 940 § 2, A. 1949 S.B. 1053)            refrigerant shall have at least one gas mask
facture thereof;                                                                                      of a type approved by the department and
                                                                                                      shall keep the same where it will be readily
                                                   Section 196.465                                    accessible.
(6) “Locker” means the individual sections or
compartments of a capacity of not to exceed
fifty cubic feet, in the locker room of a locker   Semiannual inspection of                           2. An alarm bell or buzzer provided with a
plant;                                                                                                suitable button shall be placed just inside the
                                                   plants.                                            door of each locker room in a conspicuous
(7) “Locker plant” means a location or estab-                                                         place. Illumination shall be provided in the
                                                   196.465 Upon receipt of the application for
lishment in which space in individual lockers                                                                                                    27
                                                         Missouri Revised Statutes
Statutes

locker room at all times while open to the        of installation for a reasonable time after put-
public, the switch operating same shall be        ting fresh food into the freezer;
accessible only to the operator.
                                                                                                     Section 196.500
                                                  (3) Locker room, temperatures of zero
(L. 1945 p. 940 § 6)                              degrees or lower, with a tolerance of five
                                                  degrees above zero degrees.                        Accurate and complete report
Section 196.480                                                                                      of weight of food.
                                                  3. The locker room shall be equipped with a
                                                  self-registering, accurate recording thermom-
                                                                                                     196.500. If requested by the user, the locker
Requirements before issuance                      eter. Chill room and sharp freeze room shall
                                                                                                     plant operator shall supply the person deliver-
                                                  be equipped with an accurate, direct reading
of license.                                       thermometer.                                       ing the carcass or parts of carcasses an accu-
                                                                                                     rate and complete report showing the carcass
196.480 No locker plant shall be licensed                                                            weight at time of delivery, and disposition
                                                  4. Thermometer charts shall be available for
if located in insanitary, unclean or contami-                                                        of carcass, including the quantity used for
                                                  inspection at the locker plant by agents of
nating surroundings which might endanger                                                             sausage or other meat products. Likewise, the
                                                  the commission and shall be preserved for at
public health, and all rooms and equipment of                                                        operator shall supply a complete and accurate
                                                  least a period of one year from date of record-
a locker plant shall at all times be maintained                                                      record showing the weights and quantity of
                                                  ing.
in a clean and sanitary condition consistent                                                         any fruits or vegetables received and the size
with the purpose for which such rooms and                                                            and number of containers of finished products
                                                  (L. 1945 p. 940 § 8)
equipment are used. Locker plants shall have                                                         packed.
ample and sanitary water and toilet facilities.
All employees handling food shall have an         Section 196.490                                    (L. 1945 p. 940 § 12)
approved health certificate.

(L. 1945 p. 940 § 7)                              Food to be quick frozen before Section 196.505
                                                  placed in locker.
Section 196.485                                                                                Designation of food not for hu-
                                                  196.490 All food, before being placed in
                                                  a locker shall be quick or sharp frozen in a man consumption.
Temperature requirements                          quick or sharp freeze room, unless the locker
                                                                                                     196.505. Any food not intended for human
                                                  room temperature is maintained at not more
and record.                                       than the maximum temperature required by           consumption, if acceptable by the operator
                                                  sections 196.450 to 196.515 for a quick or         for storage, may be stored in the chill room,
196.485 1. The refrigeration system for a                                                            sharp freeze room or locker room of any
                                                  sharp freeze room. No food shall be placed
locker plant shall be equipped with accurate                                                         locker plant only when such items of animal
                                                  in a locker unless previously inspected by the
and reliable controls for the automatic main-                                                        or vegetable matter have been inspected and
                                                  operator and each portion shall be wrapped
tenance of uniform temperatures, provided                                                            approved by the representatives of the Bureau
                                                  and be marked or stamped showing contents,
this shall not apply to locker plants having                                                         of Animal Industry of the United States
                                                  correct locker number and date of wrapping.
constant temperature supervision.                                                                    Department of Agriculture or a representative
                                                  All fruits and vegetables shall be prepared by
                                                  an approved method before being quick or           of the department of agriculture of this state.
2. Temperatures shall be maintained in the                                                           Such food not intended for human consump-
                                                  sharp frozen.
respective rooms as follows:                                                                         tion also shall bear a label or tag showing
                                                  (L. 1945 p. 940 § 9)                               plainly and conspicuously in letters not less
(1) Chill room, temperatures within two                                                              than three-eighths of an inch in height the
degrees plus or minus of thirty-seven degrees                                                        words:
or lower with a tolerance of ten degrees for a    Section 196.495
reasonable time after fresh food is placed in                                                        “NOT FOR HUMAN CONSUMPTION.”
the chill room;
                                                  Record of name and address                         (L. 1945 p. 940 § 13)
(2) Quick or sharp freeze room--quick or          of user.
sharp freeze compartments: Temperatures
of ten degrees below zero or lower in rooms
                                                                                                     Section 196.510
                                                  196.495 Every operator of a locker plant
where still air cooling is employed and tem-      shall keep an accurate record of the name and
peratures of zero degrees or lower in rooms       address of the user of each locker.                Operator to have lien on prop-
where forced air circulation is employed,
with a tolerance of ten degrees for either type   (L. 1945 p. 940 § 11)                              erty for rentals--furnish con-
                                                                                                                                  28
                                                        Missouri Revised Statutes
Statutes

tent insurance.                                   provisions of sections 196.450 to 196.515          processing or manufacturing plant utilizing
                                                  shall authorize and empower the director to        milk, or a major ingredient thereof, in the
196.510 1. Every operator shall have a lien       refuse to license or to revoke or suspend any      production of products for human consump-
upon all property of every kind stored in the     license of the offending operator.                 tion. The items pertaining to ice cream and
locker plant for all locker rentals, process-                                                        frozen dessert products manufacturing plants
ing, handling, and other charges due from         2. Injunction may issue by any court of com-       regulated by the department of health and
owner of such property; and the locker plant      petent jurisdiction to enforce the provisions      senior services contained in sections 196.851
operator may enforce the lien by suit and         hereof.                                            to 196.918, and pertaining to grade “A” fluid
shall have authority to prevent removal of                                                           milk plants regulated by the state milk board
food stored pending the outcome of suit to        (L. 1945 p. 940 § 16)                              contained in sections 196.931 to 196.959 are
enforce said lien. Operators of locker plants                                                        exempt from this definition;
shall not be construed to be warehousemen,        Section 196.520
nor shall receipts or other instruments issued                                                       (5) “Dairy product” means any product or
by such persons in the operation contracts of                                                        by-product which has as its precursor milk
their business be construed to be warehouse       Short title.                                       or an ingredient exclusive to milk, with the
receipts or subject to the laws applicable                                                           exception of products or by-products which
thereto, nor shall the provisions of sections     196.520 Sections 196.520 to 196.610 shall          are subject to the provisions of sections
196.450 to 196.515 apply to any warehouse-        be known as “The Missouri Manufacturing            196.851 to 196.918, relating to ice cream and
man licensed under the provisions of chapter      Milk and Dairy Market Testing Law”.                frozen food products, and sections 196.931 to
415, RSMo.                                                                                           196.959, as regulated by the state milk board;
                                                  (RSMo 1939 § 14097, A.L. 1981 H.B. 52)
2. The operators of all locker plants shall                                                          (6) “Department” or “department of agricul-
furnish satisfactory locker content insurance                                                        ture” means the department of agriculture of
                                                  Section 196.525                                    the state of Missouri;
to indemnify users against loss, issued by
companies duly authorized and licensed to do
and transact business in the state of Missouri,   Definitions.                                       (7) “Director” means the ranking authority or
in a minimum amount for each locker or                                                               administrator of the department of agricul-
locker plant to be determined by the director;    196.525. Definitions, terminology, and stan-       ture, or the representative or agent of the
provided, however, that such operator may,        dards of identity provided in Title 7, Code of     director;
and is hereby authorized to, collect the pro      Federal Regulations, Agriculture, Part 2858,
rata amount of the premium for such insur-        subpart A-V and Title 21, Code of Federal          (8) “Department of health and senior ser-
ance from the user in addition to the locker      Regulations, Food and Drugs, Parts 131 and         vices” means the department of health and
rental as an additional service.                  133, shall have precedence unless further de-      senior services of the state of Missouri;
                                                  fined herein. Additions and exceptions to the
(L. 1945 p. 940 § 14)                             definitions contained therein shall include:       (9) “Fieldman” means any qualified person
(1964) Renters of locker space could not                                                             who is duly authorized as a field representa-
maintain class action of all renters for value    (1) “Agent” means any duly authorized              tive of a processing or manufacturing plant or
of food spoiled when refrigeration system         representative of the Missouri department of       producer cooperative, whose responsibilities
failed where plaintiffs did not introduce the     agriculture under the authority of the director;   include procurement and quality control, and
alleged policy whose proceeds were claimed                                                           who is duly licensed by the department;
to constitute a common fund, or plead or          (2) “Bulk milk truck operator” means any
prove its terms and conditions, and where in-     qualified individual who, as operator of a         (10) “Grader” means any qualified individual
surance company was not a party and denied        bulk milk transportation vehicle, is licensed      licensed by the department to sample, test
liability on the policy. (Opinion in Barnard v.   by the department to make organoleptic             and grade milk or cream;
Murphy, 365 S.W.2d 614, reconsidered and          inspection, and to sample and test milk as it is
withdrawn.) Barnard v. Murphy (Mo.), 378          collected from dairy farm bulk milk cooling        (11) “Manufacturing milk” is all milk and
S.W.2d 446.                                       tanks;                                             cream produced and made available for mar-
                                                                                                     ket that is not under the inspection supervi-
                                                                                                     sion of the Missouri state milk board as it
Section 196.515                                   (3) “Dairy farm” means any place or prem-
                                                                                                     administers sections 196.931 to 196.959;
                                                  ises where one or more cows or goats are
                                                  kept, and from which a part or all of the milk
Revocation of license--enforce-                   or milk products are provided, sold or offered     (12) “Person” shall mean any individual,
                                                  for sale to a milk plant, transfer station or      plant operator, partnership, corporation, com-
ment.                                                                                                pany, firm, trustee, association or institution;
                                                  receiving station for manufacturing purposes;
196.515 1. Failure on the part of any locker
plant operator to properly comply with the        (4) “Dairy manufacturing plant” means any                                                     29
                                                        Missouri Revised Statutes
Statutes

(13) “Producer” means one who milks or            **See Reorganization Plan No. 5 of 1982 on       handle and process manufacturing milk in
supervises the milking of one or more cows        file with the Secretary of State.                conformity with basic requirements and
or goats, and is legally entitled to market the                                                    specifications prescribed by such regulations
production therefrom;                                                                              as may be issued hereunder in effectuation of
                                                  Section 196.530
                                                                                                   the intent hereof;
(14) “Receiving plant or station” means the
delivery point for milk and cream collected       Standards to be maintained.                      (5) Inspect and license laboratories involved
from, or delivered by, one or more producers;                                                      in market testing of milk at first point of sale;
                                                  196.530 The standards of quality and purity
(15) “Regulations” means the rules and of-        associated with healthful and wholesome          (6) Require the keeping of appropriate books
ficial orders authorized and promulgated by       milk and dairy products shall be maintained      and records by plants, farms, and laboratories
the director of agriculture according to the      for manufactured dairy products. All regula-     licensed hereunder; and
provisions of chapter 536, RSMo, in accor-        tions adopted shall be equal or superior to
dance with the provisions of sections 196.520     those of the United States Department of Ag-     (7) License qualified milk graders, fieldmen,
to 196.610, along with other regulations of       riculture, “Milk for Manufacturing Purposes      and bulk milk truck operators.
state and federal agencies;                       and Its Production and Processing Recom-
                                                  mended Requirements”, as published in the        2. No rule or portion of a rule promulgated
(16) “State milk board” means the board           Federal Register of April 7, 1972, Volume        under the authority of sections 196.520 to
created by section 196.941, and authorized to     37, Number 68, Part II, or the latest revision   196.614 shall become effective unless it has
administer the provisions of sections 196.931     thereof.                                         been promulgated pursuant to the provisions
to 196.959;                                                                                        of section 536.024, RSMo.
                                                  (RSMo 1939 § 14099, A.L. 1945 p. 83, A.L.
(17) “Test or analysis” means the inclusion       1981 H.B. 52)                                    3. Exempt from the provisions of sections
of prescribed sampling, sample preservation                                                        196.520 to 196.610 shall be ice cream and
and preparation with appropriate analytical                                                        frozen desserts which are under the author-
procedure to reach the desired objective; such    Section 196.540                                  ity of the department of health and senior
procedures shall be used as are set forth in                                                       services, which administers sections 196.851
the latest editions of the “Official Methods of                                                    to 196.918***; and grade “A” fluid milk
Analysis of the Association of Official Ana-
                                                  Administration by state milk
                                                                                                   products, which are under the authority of the
lytical Chemists” and the “Standard Methods       board--rules, promulgation                       state milk board pursuant to sections 196.931
for the Examination of Dairy Products”.           --exempt products.                               to 196.959.

(RSMo 1939 § 14098, A.L. 1945 p. 83, A.L.         196.540 1. The state milk board** shall          (L. 1981 H.B. 52, A.L. 1993 S.B. 52, A.L.
1959 H.B. 126, A.L. 1967 p. 287, A.L. 1981        administer the provisions of sections 196.520    1995 S.B. 3)
H.B. 52)                                          to 196.610, and is hereby authorized to:         *No continuity with § 196.540 shown re-
                                                                                                   pealed by L. 1981 H.B. 52.
Section 196.527                                   (1) Promulgate those regulations neces-
                                                  sary to fulfill the intent of sections 196.520   **See Reorganization Plan No. 5 of 1982 on
                                                  to 196.610 as related to the production,         file with the Secretary of State.
Purposes.                                         transportation, grading, use and processing
                                                  of manufacturing milk; to the packaging,         ***Section 196.918 was repealed by S.B.
196.527 It shall be the responsibility of the     labeling and storage of dairy products made      707 § 1, 1980.
state milk board** to encourage orderly and       therefrom; and to the measuring, weighing,
sanitary production, transportation, process-     sampling and testing of all milk, grade “A”      Section 196.542
ing and grading of manufactured milk and its      fluid milk and manufacturing milk, at first
products, to assure wholesome, stable, and        point of sale; provided, such regulations are
high-quality dairy products; and to provide       promulgated according to the provisions of       Fees for licenses.
the basis for measuring, weighing and testing     this section and chapter 536, RSMo;
all milk, including grade “A” fluid milk and                                                       196.542. The state milk board* shall establish
manufacturing milk, to determine its value at     (2) Inspect manufacturing dairy farms and        the fees for all licenses by regulation promul-
first point of sale.                              dairy manufacturing plants;                      gated in accordance with chapter 536, RSMo.

(L. 1981 H.B. 52)                                 (3) Certify dairy farms for the production and   (L. 1981 H.B. 52)
*No continuity with § 196.527 shown re-           sale of manufacturing milk;
pealed by L. 1981 H.B. 52.
                                                  (4) License dairy manufacturing plants to
                                                                                                                                               30
                                                        Missouri Revised Statutes
Statutes

Section 196.545                                    to keep the record thereof, or to pay for such     sales.
                                                   milk or cream on other than the true measure-
                                                   ment, grade, weight and test; provided that,       196.560 Persons engaged in the purchase
Unlawful sale of dairy prod-                       any person selling milk or cream who is dis-       and sale of milk for manufacturing and pro-
ucts.                                              satisfied with the grade or test designated for    cessing shall keep receipts of sale and records
                                                   his milk or cream shall be entitled to receive     of all such purchases of milk and cream for
It shall be unlawful to sell, offer or expose      pay for such milk or cream on the grade or         a period of at least one year. Records of such
for sale, or deliver manufacturing milk or         test as made and reported to him without           purchases shall include date received, weight,
any dairy products made from manufacturing         waiving his right to protest the accuracy          results of all tests to determine value or
milk which:                                        thereof. Such seller shall have the right to       grade, and price paid. The state milk board**
                                                   have his milk or cream officially graded or        shall have access to these records all of which
(1) Are produced by animals afflicted with a       tested under a procedure whereby he and the        shall be kept confidential as to individual
contagious or infectious disease deleterious       buyer thereof jointly take a sample of such        items or totals of an individual person or
to man or detrimental to milk quality;             milk or cream and submit such sample to an         plant.
                                                   appropriate laboratory chosen by the director.
(2) Are not colostrum free or which have           The results of the test conducted shall be final   (L. 1981 H.B. 52)
been taken from a cow fed or in contact with       and either the buyer or the seller shall be en-    *No continuity with § 196.560 shown re-
any substance that is unhealthful or that may      titled to receive any financial adjustment due     pealed by L. 1981 H.B. 52.
produce unhealthful, impure or unwholesome         him on the basis of the test made as provided
milk;                                              in this section.                                   **See Reorganization Plan No. 5 of 1982 on
                                                                                                      file with the Secretary of State.
(3) Are adulterated by the addition of any un-     (L. 1981 H.B. 52)
authorized substance including water or other      *No continuity with § 196.550 shown re-
                                                   pealed by L. 1981 H.B. 52.
material foreign to milk;                                                                             Section 196.565
(4) Have been handled by any person af-
flicted with an infectious or contagious           Section 196.555                                    The state milk board may take
disease; or                                                                                           samples.
(5) Are produced in unhealthy or unsanitary        The state milk board’s right of
                                                                                                      196.565. The state milk board may, for the
surroundings or held in unclean or unsanitary      access.                                            purpose of examination or testing for the
containers.                                                                                           enforcement of this law, procure at any time
                                                   196.555 The state milk board** shall have          samples of milk or its products whether
(RSMo 1939 § 14102, A.L. 1981 H.B. 52)             access to all dairy farms producing manufac-       produced within this state or shipped into and
                                                   turing milk, dairy manufacturing plants and        offered, exposed for sale or sold in the state.
                                                   dairy receiving stations; to all equipment;        Any samples taken shall be carefully sealed
Section 196.550                                    and to all vehicular conveyances used in the       and labeled with the name, or brand name;
                                                   production, transportation and manufacture of      the name and address of the owner from
                                                   milk and its products when offered, exposed        whose stock it was taken; the date and place
Grading of products--right to                      for sale or sold; and to locations where mar-      where the sample was obtained; and bear the
protest accuracy, procedure.                       ket sampling, measuring, weighing, or testing      signature of the person taking the sample.
                                                   is done for the first point of sale.               Upon request a duplicate sample sealed and
 196.550 Whenever milk or cream, whether                                                              labeled in the same manner shall be delivered
it be grade “A” fluid or of manufacturing          (L. 1981 H.B. 52)                                  to the owner or owner’s representative.
grade, is bought or sold, market tests con-        *No continuity with § 196.555 shown re-
forming to sampling and testing procedures         pealed by L. 1981 H.B. 52.                         (L. 1981 H.B. 52)
as prescribed by the most recent edition of                                                           *No continuity with § 196.565 shown re-
the “Official Methods of Analysis of the           **See Reorganization Plan No. 5 of 1982 on         pealed by L. 1981 H.B. 52.
Association of Official Analytical Chemists”       file with the Secretary of State.
and the “Standard Method for the Exami-                                                               **See Reorganization Plan No. 5 of 1982 on
nation of Dairy Products” shall be used to                                                            file with the Secretary of State.
determine the desired component content. It        Section 196.560
shall be unlawful for any person to manipu-
late, underread, or overread the test, or any                                                         Section 196.570
other contrivance for determining the quality      Records of purchases and
or value of milk or cream, or to falsify or fail                                                                                                31
                                                         Missouri Revised Statutes
Statutes

                                                   supervision of the director.
Condemnation of illegal dairy                      (L. 1981 H.B. 52)                                 Substandard products, sale or
products.                                          *No continuity with § 196.580 shown re-           production prohibited.
                                                   pealed by L. 1981 H.B. 52.
196.570 The state milk board** or its agent                                                           196.595 Beginning September 28, 1981, no
is authorized to condemn any illegal manu-                                                           person shall produce, sell, offer for sale or
factured dairy product as defined in section       Section 196.585                                   process milk or cream for the manufacture
196.545, which is offered, exposed for sale,                                                         of human food except in accordance with the
or sold for human food purposes, and shall                                                           provisions of sections 196.520 to 196.610
identify same as an unlawful product. It shall     Inspection, interference pro-                     and the regulations promulgated hereunder.
be unlawful to remove or deface any identifi-
cation placed upon the container of a con-         hibited.                                          (L. 1981 H.B. 52)
demned milk supply or upon a condemned                                                               *No continuity with § 196.595 shown re-
product. A harmless food coloring may be           196.585. It is unlawful for any person to hin-    pealed by L. 1981 H.B. 52.
used to identify a supply of illegal milk.         der, obstruct or in any manner interfere with
                                                   the state milk board** in the performance of
                                                   inspection or any other duty under sections       Section 196.610
(L. 1981 H.B. 52)
*No continuity with § 196.570 shown re-            196.520 to 196.610.
pealed by L. 1981 H.B. 52.
                                                   (L. 1981 H.B. 52)                                 Penalty for violation.
**See Reorganization Plan No. 5 of 1982 on         *No continuity with § 196.585 shown re-
                                                   pealed by L. 1981 H.B. 52.                        196.610 1. Any person who violates any pro-
file with the Secretary of State.                                                                    vision of sections 196.520 to 196.610 shall,
                                                   **See Reorganization Plan No. 5 of 1982 on        upon conviction, be guilty of an infraction.
Section 196.575                                    file with the Secretary of State.
                                                                                                     2. Any person who knowingly violates any
                                                                                                     provision of sections 196.520 to 196.610
Unidentified products subject                      Section 196.590                                   shall, upon conviction, be guilty of a class A
to seizure.                                                                                          misdemeanor.
                                                   Suspension or revocation of                       3. Nothing in sections 196.520 to 196.610
196.575 Any articles found in the possession
of any person which are not identified as to       licenses.                                         shall be so construed as to prohibit any
the name and address of the manufacturer, the                                                        dairy farmer who holds a valid permit at the
name of the product, and the list of ingredi-      196.590 The state milk board** may for            inception of sections 196.520 to 196.610 to
ents, as required for specific product identity,   good cause, after notice and opportunity for      produce and sell manufactured grade milk.
may be seized and held until properly graded       hearing in accordance with the provisions
and labeled.                                       of chapter 536, RSMo, suspend or revoke           (L. 1981 H.B. 52)
                                                   certifications and licenses issued hereunder;     *No continuity with § 196.610 shown re-
(L. 1981 H.B. 52)                                  provided, that nothing in sections 196.520        pealed by L. 1981 H.B. 52.
*No continuity with § 196.575 shown re-            to 196.610 shall be construed to prevent the
pealed by L. 1981 H.B. 52.                         temporary suspension of the operation of any      Section 196.612
                                                   production or manufacturing facility prior to
                                                   a hearing when such action is necessary to
                                                   stop the production, distribution, purchase or    Contract with the United
Section 196.580                                    sale of illegal milk or illegal dairy products.
                                                                                                     States Department of Agri-
                                                   (L. 1981 H.B. 52)                                 culture to inspect plants and
Confiscated products released                      *No continuity with § 196.590 shown re-           grade products.
to owner, when.                                    pealed by L. 1981 H.B. 52.
                                                                                                     196.612 The state milk board may contract
196.580. Any condemned or seized milk or           **See Reorganization Plan No. 5 of 1982 on        with the United States Department of Agri-
dairy products shall be released to the owner      file with the Secretary of State.                 culture regarding the inspection of manufac-
upon determination of satisfactory grade                                                             turing milk plants, the grading of product, or
and identification, upon assurance that such                                                         both. Fees paid to the board from the depart-
products will not be used for human food, or       Section 196.595                                   ment for inspection or grading services are
upon their destruction by the owner under the
                                                                                                                                               32
                                                         Missouri Revised Statutes
Statutes

to be set forth by contractual agreement and      fat, so that the resulting product is in imita-   or its agent or servant, or as the servant or
paid according to the board’s performance of      tion or semblance of milk, cream or skim          as agent of another to manufacture, sell or
the required inspections as stipulated by the     milk, whether or not condensed, evaporated,       exchange, or have in possession with the
Federal Register guidelines.                      concentrated, powdered, dried or desiccated,      intent to sell or exchange, any milk, cream,
                                                  which has been melted or refined by heating,      emulsified cream, skim milk, buttermilk, con-
(L. 1985 H.B. 291 § 1)                            boiling or mixing; provided, that the above       densed or evaporated milk, powdered milk,
                                                  definition shall not include any distinctive      condensed skim milk, or any of the fluid
                                                  proprietary food compound, not readily            derivatives thereof, or any of them, to which
                                                  mistaken in tests for milk or cream, or for       has been added any fat or oil other than milk
Section 196.614                                                                                     fat, either under the name of said product or
                                                  evaporated, condensed or powdered milk or
                                                  cream; provided, however, that such com-          articles or the derivatives thereof, or under
State contracted manufactur-                      pound is prepared and designed for feeding        any fictitious or trade name whatsoever.
                                                  infants and young children and customarily
ing dairy plant inspection and                    used on the order of a physician; is packed       (RSMo 1939 § 14061)
grading fee fund--purpose--                       in individual cans containing not more than       Prior revision: 1929 § 12408
interest--unexpended balance,                     sixteen and one-half ounces and bearing the

transfer to general revenue
                                                  label in bold type, that the contents are to be   Section 196.710
                                                  used only for said purposes; is shipped in
prohibited.                                       interstate or foreign commerce exclusively
                                                  to physicians, wholesale or retail druggists,     Emulsified cream and filled
                                                  orphan asylums, child welfare associations,
196.614 1. All moneys received by the state
                                                  hospitals and similar institutions and gener-
                                                                                                    milk prohibited.
milk board from the United States Depart-
ment of Agriculture for contracted manu-          ally distributed by them.
                                                                                                    196.710. It shall be unlawful to use the article
facturing dairy plant inspection or grading                                                         known as emulsified cream in milk, or in any
shall be deposited in the state treasury and      (RSMo 1939 § 14062)
                                                                                                    milk product, or any purpose whatsoever. It is
credited to the “State Contracted Manufactur-     Prior revision: 1929 § 12409
                                                                                                    hereby declared that filled milk, and emulsi-
ing Dairy Plant Inspection and Grading Fee                                                          fied cream as herein defined, are adulterated
Fund”, which is hereby established, subject                                                         articles of food injurious to the public health
to appropriations by the general assembly.        Section 196.700                                   and its sale constitutes a fraud upon the
Amounts appropriated to the fund shall be                                                           public. It shall be unlawful for any person,
paid to the state milk board and used exclu-                                                        firm or corporation to manufacture or ship
sively for the purpose of defraying the cost of   Emulsified cream defined.                         or deliver to any person within this state any
the contracted manufacturing milk inspection                                                        filled milk or emulsified cream.
and grading program. All interest generated       196.700 The term “emulsified cream” means
by the fund shall be credited to the fund.        any milk, cream or skimmed milk, whether          (RSMo 1939 § 14064)
                                                  or not condensed, evaporated, concentrated,       Prior revision: 1929 § 12411
2. Notwithstanding the provisions of section      powdered, dried or desiccated, to which has
33.080, RSMo, to the contrary, any unex-          been added that which is commonly known           (1940) This section forbids sale of filled milk
pended balance remaining in the fund shall        as process butter, or butter which has been       only if the resulting product is in imitation or
not be transferred or placed to the credit of     clarified or refined by heating, boiling or       semblance of milk, cream or skim milk. Thus
the ordinary revenue fund of the state by the     by mixing under pressure, or otherwise, so        wholesome and nutritious product under label
state treasurer at the end of each biennium.      that the resulting product is in imitation or     stating nature of product and that it is “not
                                                  semblance of pure cream arising from pure         to be sold for evaporated milk” may be sold
(L. 1985 H.B. 291 §§ 2, 3)                        fresh milk.                                       without violating this section. State ex rel.
                                                                                                    McKittrick v. Carolene Products Co., 346
Section 196.695                                   (RSMo 1939 § 14063)                               Mo. 1049, 144 S.W.2d 153.
                                                  Prior revision: 1929 § 12410

Filled milk defined.                                                                                Section 196.715
                                                  Section 196.705
196.695 The term “filled milk” means any                                                            Penalty for violation.
milk, cream or skim milk, whether or not          Fat or oil other than milk fat
condensed, evaporated, concentrated, pow-         prohibited.                                       196.715. Any person violating any provi-
dered, dried or desiccated, to which has been                                                       sion of sections 196.695 to 196.710 shall
added, or which has been blended or com-          196.705 It shall be unlawful for any person,
pounded with, any fat or oil other than milk      firm or corporation, by himself or itself, his                                               33
                                                        Missouri Revised Statutes
Statutes

be deemed guilty of a misdemeanor. When           Prior revision: 1929 § 12415                       1909 § 646
construing and enforcing the provisions of
sections 196.695 to 196.710, the act, omis-                                                          Section 196.750
sion, or failure of any person acting for or      Section 196.735
employed by any individual, partnership or
corporation, or association, within the scope     Labeling of cheese.                                Imitation butter defined.
of his employment or office, shall in every
case be deemed the violation of sections          196.735 No person or persons, corporation,         196.750 For the purpose of sections 196.750
196.695 to 196.710, by such individual, part-     company or other association or congrega-          to 196.810, every article, substitute or
nership, corporation, or association, as well     tion of individuals shall manufacture, sell        compound, other than that produced from
as the act of such person.                        or offer for sale, directly or indirectly, at      pure milk, or cream from the same, made
                                                  retail or at wholesale in this state any article   in the semblance of butter and designed to
(RSMo 1939 § 14065, A.L. 1945 p. 98)              to be known or denominated cheese, not             be used as a substitute for butter made from
Prior revision: 1929 § 12412                      made from pure cream or unskimmed milk             pure milk, or cream from the same, is hereby
                                                  or cream of the milk, unless such person, or       declared to be “imitation butter”.
Section 196.725                                   persons, corporation, company or association
                                                  of individuals manufacturing the same, or of-      (RSMo 1939 § 14072)
                                                  fering the same for sale, or selling the same,     Prior revisions: 1929 § 12433; 1919 § 12004;
Words prohibited in sale of                       shall brand or label such cheese or articles so    1909 § 650
butter substitutes.                               offered for sale denominated a cheese, with
                                                  black letters not less than one inch in length     Section 196.755
196.725 It shall be unlawful for any person,      in a conspicuous place and of large size in the
firm or corporation to use in any way, in         English language as follows: “Skimmed milk
connection or association with the sale, or       cheese”, or with the words “not full cream         Coloring of imitation butter
exposure for sale, or advertisement of any        cheese”, giving the true name of such article      prohibited.
substance designed to be used as a substitute     called cheese so manufactured or offered for
for butter, the word “butter”, “creamery”,        sale, clearly and indelibly branded, marked        196.755 1. No person shall combine any
or “dairy”, except as otherwise required by       or labeled thereon, so that the same can be        animal fat or vegetable oil or other substance
the laws of this state; or the name or repre-     distinctly read and fully comprehended, at all     with butter, or combine therewith or with ani-
sentation of any breed of dairy cattle, or any    stores or places or factories where the same       mal fat or vegetable oil or combination of the
combination of such word, or words and            may be offered for sale.                           two, or with either one, any other substance
representation, or any other words or sym-                                                           or substances whatever, any annatto or com-
bols, or combination thereof, commonly used       (RSMo 1939 § 14069)                                pound of the same, or any other substance or
in the sale of butter.                            Prior revisions: 1929 § 12418; 1919 § 11989;       substances, for the purpose or with the effect
                                                  1909 § 643                                         of imparting thereto a yellow color, or any
(RSMo 1939 § 14067)                                                                                  shade of yellow, so that such substitute shall
Prior revision: 1929 § 12414                      Section 196.740                                    resemble yellow or any shade of genuine
                                                                                                     yellow butter, nor introduce any such color-
Section 196.730                                                                                      ing matter or such substance or substances
                                                  Labeling for shipments of                          into any of the articles of which the same is
                                                  skimmed milk.                                      composed; provided, nothing in said sections
Violation a misdemeanor--                                                                            196.750 to 196.810 shall be construed to
penalty.                                          196.740 No person by himself or another            prohibit the use of salt and harmless coloring
                                                  shall ship, consign or forward by any com-         matter for coloring the substitutes for butter
196.730 Any person who violates any of the        mon carrier, whether public or private, any        manufactured for export or sale outside the
provisions of section 196.725 is guilty of a      substance designed to be used as cheese, not       state.
misdemeanor and upon conviction thereof           made from pure, unskimmed milk or cream
shall be punished by a fine of not less than      of the same, testing at least three percent        2. No person shall, by himself, his agents or
fifty dollars nor more than one hundred           butterfat, unless such cheese is marked or         employees, produce or manufacture any sub-
dollars, or by imprisonment in the county         labeled “skimmed milk cheese”, or with             stance in imitation or semblance of natural
jail for a term of not less than sixty days nor   the words “not full cream cheese”, labeled         butter, nor sell, nor keep for sale, nor offer for
more than one year, or by both such fine and      thereon, or labeled as prescribed in sections      sale, any imitation butter made or manufac-
imprisonment.                                     196.695 to 196.845.                                tured, compounded or produced in violation
                                                                                                     of this section, whether such imitation butter
(RSMo 1939 § 14068, A.L. 1965 p. 327)             (RSMo 1939 § 14070)                                shall be made or produced in this state or
                                                  Prior revisions: 1929 § 12420; 1919 § 11991;                                                   34
                                                        Missouri Revised Statutes
Statutes

elsewhere.
                                                  (RSMo 1939 § 14075)                                 (RSMo 1939 § 14077)
3. This section shall not be construed to         Prior revisions: 1929 § 12436; 1919 § 12007;        Prior revisions: 1929 § 12438; 1919 § 12009;
prohibit the manufacture and sale, under the      1909 § 653                                          1909 § 655
regulations herein provided, of substances
designed to be used as a substitute for butter,
and not manufactured or colored as herein         Section 196.770                                     Section 196.780
prohibited.
                                                  Labeling of butter and oleo-                        Possession of substitute for
(RSMo 1939 § 14073)
Prior revisions: 1929 § 12434; 1919 § 12005;      margarine, mixed.                                   butter--presumption.
1909 § 651
                                                  196.770. No person shall mix oleomargarine,         196.780 No person shall have in his pos-
                                                  suine, butterine, beef fat, lard or other foreign   session or under his control, any substance
Section 196.760                                   substance with any butter or cheese intended        designed to be used as a substitute for butter,
                                                  for human food without distinctly marking           unless the tub, firkin, box or other package
Labeling of imitation butter.                     or stamping or labeling the article or package      containing the same be clearly and durably
                                                  containing the same with the true and appro-        marked, as provided by section 196.765; pro-
196.760 Every person who lawfully manu-           priate name of such article, and the percent-       vided, that this section shall not be deemed
factures any substance designed to be used as     age in which such oleomargarine or other            to apply to persons who have the same in
a substitute for butter shall mark, by brand-     such substance enters into its composition.         their possession for the actual consumption of
ing, stamping or stenciling upon the top and      Every person offering for sale must inform          themselves and family. Every person hav-
side of each tub, firkin, box or other pack-      the purchaser of contents and makeup of             ing in possession or control any substance
age in which such article shall be kept, and      article. Whoever shall violate the provisions       designed to be used as a substitute for butter,
in which it shall be removed from the place       of this section shall be punished as provided       which is not marked as required by the provi-
where it is produced, in a clean and durable      for by section 196.790.                             sions of sections 196.750 to 196.810, shall be
manner, in the English language, the words,                                                           presumed to have known, during the time of
“substitute for butter”, in printed letters, in   (RSMo 1939 § 14076)                                 such possession or control, the true character
plain roman type, each of which shall not be      Prior revisions: 1929 § 12437; 1919 § 12008;        and name, as fixed by said sections of such
less than one inch in length and one-half inch    1909 § 654                                          product.
in width.
                                                  Section 196.775                                     (RSMo 1939 § 14078)
(RSMo 1939 § 14074)                                                                                   Prior revisions: 1929 § 12439; 1919 § 12010;
Prior revisions: 1929 § 12435; 1919 § 12006;                                                          1909 § 656
1909 § 652                                        Branding of renovated butter.

Section 196.765
                                                  196.775. No person, firm or corporation,            Section 196.785
                                                  agent or employee shall sell, offer or expose
                                                  for sale, or deliver to any purchaser, any
Shipment of imitation butter                      boiled, process or renovated butter, unless         Sale of imitation butter.
                                                  the words “renovated butter” shall be plainly
under its true name.                              branded in bold face letters, at least three-       No person, by himself or another, shall sell
                                                  fourths of an inch in length, on the top and        or offer for sale any substance designed to
196.765 No person, by himself, or another,        side of each tub, or box or pail, or other kind     be used for a substitute for butter under the
shall ship, consign or forward by any com-        of case or package, or on the wrapper or            name of or under the pretense that the same
mon carrier, whether public or private, any       prints or rolls of bulk packages in which it is     is butter.
substance designed to be used as a substitute     put up. If such butter is exposed for sale un-
for butter, and no carrier shall knowingly        covered or not in a case or package, a placard      (RSMo 1939 § 14079)
receive the same for the purpose of for-          containing a label so printed shall be attached     Prior revisions: 1929 § 12440; 1919 § 12011;
warding or transporting, unless it shall be       to the mass of butter in such a manner as to        1909 § 657
manufactured and marked as provided in            be easily seen and read by the purchaser. The
section 196.760, and unless it be consigned       branding or marking of all packages shall be
by the carrier and receipted for by its true                                                          Section 196.790
                                                  in the English language and in a conspicuous
name; provided, that said sections 196.750        place, so as to be easily read by the purchaser.
to 196.810 shall not apply to any goods in        Whoever shall violate the provisions of this        Penalties for violation.
transit between foreign states across the state   section shall be punished as provided for by
of Missouri.                                      section 196.790.                                                                              35
                                                        Missouri Revised Statutes
Statutes

                                                   196.790.                                          Section 196.815
196.790 Every person, firm or corporation
who shall violate any of the provisions of         (RSMo 1939 § 14081)
sections 196.755 to 196.765, 196.780 and           Prior revisions: 1929 § 12442; 1919 § 12013;      Receptacles defined.
196.785, shall forfeit and pay to the state of     1909 § 659
Missouri, for the use of the school fund for                                                         196.815 As used in sections 196.820 to
every such violation, the sum of fifty dollars                                                       196.830, the term “receptacle” shall include
and costs of suit, to be recovered by civil        Section 196.800                                   not only bottles, siphons, tins, kegs, barrels
action in the name of the state of Missouri on                                                       of all sizes, boxes, ice cream cabinets, cans
the relation of any person having knowledge                                                          and tubs, but all other receptacles used for
of the facts before an associate circuit judge,    Who may not maintain action.                      holding any of the commodities named in
or circuit judge assigned to hear the cause,                                                         said sections.
of the city or county where such violation         196.800 No action can be maintained on
occurs, subject to the right of an application     account of any sale or other contract made in     (RSMo 1939 § 14093, A. 1949 S.B. 1053)
for trial de novo or appeal, as the case may       violation of or with intent to violate sections   Prior revisions: 1929 § 12454; 1919 § 12025
be, as in other civil cases; and it is further     196.750 to 196.810, by or through any person
enacted that every person, firm or corporation     who was knowingly a party to such wrongful        Section 196.820
who shall violate the provisions of sections       sale or other contract.
196.750 to 196.810, in addition to the civil li-
ability to the state of Missouri herein provid-    (RSMo 1939 § 14082)                               Receptacles kept clean.
ed, shall be deemed guilty of a misdemeanor,       Prior revisions: 1929 § 12443; 1919 § 12014;
and shall for the first offense be punished by     1909 § 660                                        196.820 Every person delivering milk, cream
a fine of not less than fifty dollars nor more                                                       or ice cream to creameries, cheese factories,
than one hundred dollars or by imprisonment        Section 196.805                                   common carriers, or any person, persons,
not exceeding thirty days, and for each sub-                                                         copartnership, association or corporation,
sequent offense, by a fine of not less than two                                                      in cans, bottles or other vessels, shall have
hundred and fifty dollars nor more than five       Effacing mark a misdemeanor.                      such cans, bottles or other vessels free from
hundred dollars, or by imprisonment in the                                                           deleterious substance, filth or rust, and in a
county jail not less than thirty days nor more     196.805 Whoever shall efface, erase, cancel       wholesome condition for containing such
than six months, or by both such fine and          or remove any mark provided for by sections       milk, cream or ice cream.
imprisonment, in the discretion of the court.      196.750 to 196.810, with intent to mislead,
                                                   deceive, or to violate any of the provisions      (RSMo 1939 § 14085)
(RSMo 1939 § 14080, A.L. 1978 H.B. 1634)           of said sections, shall be deemed guilty of a     Prior revisions: 1929 § 12446; 1919 § 12017
Prior revisions: 1929 § 12441; 1919 § 12012;       misdemeanor.
1909 § 658

Effective 1-2-79
                                                   (RSMo 1939 § 14083)                               Section 196.825
                                                   Prior revisions: 1929 § 12444; 1919 § 12015;
                                                   1909 § 661
Section 196.795                                                                                      Return of shipping containers.
                                                   Section 196.810                                   196.825 Every person receiving milk, cream
Certificate of professor of                                                                          or ice cream from a common carrier in cans,
chemistry prima facie evi-                                                                           bottles or other vessels which are to be re-
                                                   Enforcement.                                      turned to the shipper shall cause such vessels
dence.                                                                                               to be promptly emptied, cleansed and deliv-
                                                   196.810 The state department of agricul-          ered to the common carrier to be returned to
196.795 A certificate of an analysis of            ture shall be and is hereby charged with the      the shipper, and it shall be the duty of such
any dairy product or adulteration imitation        enforcement of sections 196.750 to 196.810.       common carrier receiving the same to have
thereof, when duly signed by a professor of        Actions under said sections shall be brought      said cans, bottles or other vessels in transit
chemistry connected with any of the depart-        in any court of competent jurisdiction.           within not to exceed twenty-four hours after
ments of the state university or experiment                                                          receiving the same.
station, shall, when acknowledged before any       (RSMo 1939 § 14084)
person authorized to administer an oath, be        Prior revisions: 1929 § 12445; 1919 § 12016;      (RSMo 1939 § 14086)
received in the courts of this state as prima      1909 § 662                                        Prior revisions: 1929 § 12447; 1919 § 12018
facie evidence of the facts stated therein, in
all civil actions, as provided for in section
                                                                                                                                                36
                                                         Missouri Revised Statutes
Statutes

                                                    physical examination and the tuberculin test      products within their purview are defined as
                                                    by an official, duly authorized by this state     follows, and in each instance it is implied that
Section 196.830                                     or by the federal government; provided, that      the product is clean and sound:
                                                    said examination and tuberculin test shall
Receptacle cleaned and re-                          incur no expense whatever to the owner of         (1) “Ice cream” is the food prepared by freez-
                                                    said herd.                                        ing, while stirring, a pasteurized mix com-
turned to distributor.                                                                                posed of one or more of the optional dairy
                                                    (RSMo 1939 § 14095)                               ingredients specified in subdivision (2) of
196.830 Every person receiving milk, cream          Prior revision: 1929 § 12456                      this section, sweetened with one or more of
or ice cream from a manufacturer or distribu-                                                         the optional sweetening ingredients specified
tor of the same in cans, bottles or other ves-                                                        in subdivision (3) of this section, flavored
sels which are to be returned to the manufac-
turer or distributor, shall cause such vessels,     Section 196.845                                   with one or more of the optional flavoring
                                                                                                      ingredients specified in subdivision (4) of
after being emptied, to be promptly cleansed                                                          this section; one or more of the optional egg
and returned.
                                                    Violation a misdemeanor.                          ingredients specified in subdivision (5) may
                                                                                                      be used; one or more of the optional stabiliz-
(RSMo 1939 § 14087)                                                                                   ing ingredients specified in subdivision (6)
                                                    196.845 Any person, firm or corporation,
Prior revisions: 1929 § 12448; 1919 § 12019                                                           may be used; one or more of the optional
                                                    who violates any of the provisions of section
                                                    196.840 shall be deemed guilty of a misde-        acidity standardizing ingredients specified in
Section 196.835                                     meanor.                                           subdivision (7) may be used subject to the
                                                                                                      conditions set forth in subdivisions (5), (6)
                                                    (RSMo 1939 § 14096)                               and (7), as the case may be. U.S. certified
Penalty.                                            Prior revision: 1929 § 12457                      food color may be added. The mix may be
                                                                                                      seasoned with salt and may be homogenized.
196.835 Any person offending against any                                                              Water may be added. The kind and quantity
provision of sections 196.820 to 196.830            Section 196.851                                   of optional dairy ingredients used, and the
shall be deemed guilty of a misdemeanor,                                                              content of milk fat and total milk solids are
and upon conviction thereof by a court of
competent jurisdiction shall be punished by
                                                    Applicability--purpose of law.                    such that the weight of milk fat and total
                                                                                                      milk solids are not less than ten percent and
a fine of not less than five dollars nor more                                                         twenty percent, respectively, of the weight
                                                    196.851 The provisions of sections 196.851
than twenty-five dollars, and each receptacle                                                         of the finished ice cream. If one or more of
                                                    to 196.895 shall apply to all ice cream and re-
unlawfully dealt with as herein provided shall                                                        the optional flavoring ingredients specified
                                                    lated frozen food products defined in section
be deemed and held to constitute a separate                                                           in paragraphs (d), (e), (f), (g), (h) and (i) of
                                                    196.856; and the purpose of sections 196.851
offense.                                                                                              subdivision (4) of this section are used, the
                                                    to 196.895 is declared to be to secure the
                                                    wholesomeness and purity of such products,        weight of milk fat and total milk solids are
(RSMo 1939 § 14092, A. 1949 S.B. 1053)                                                                not to be less than ten percent and twenty per-
                                                    and to prevent confusion, fraud and deception
Prior revisions: 1929 § 12453; 1919 § 12024                                                           cent, respectively, except for such reduction
                                                    in connection with their manufacture and sale
                                                    and to make unlawful the misbranding and          in milk fat and in total milk solids as is due
Section 196.840                                     adulteration of such products.                    to the addition of one or more of the optional
                                                                                                      ingredients specified in paragraphs (d), (e),
                                                    (L. 1955 p. 708 § 196.850, A.L. 1980 S.B.         (f), (g), (h) and (i) of subdivision (4) of this
Examination and tuberculin                          707)                                              section but in no case shall it contain less
test of cattle, when.                                                                                 than eight percent of milk fat nor less than
                                                                                                      sixteen percent of total milk solids. Ice cream
                                                                                                      shall contain not less than one and six-tenths
196.840 No person, firm or corporation              Section 196.856                                   pounds of total food solids per gallon and
owning, or in charge of, any herd of cattle
containing five head of cows or more, after                                                           shall weigh not less than four and one-half
                                                                                                      pounds per gallon.
January 1, 1922, shall sell, offer for sale, give   Definitions of products subject
away, or deliver any milk, cream, butter, or
buttermilk from any of the cows of such herd,
                                                    to law.                                           (2) The optional dairy ingredients are sweet
unless all the herd of cattle containing such                                                         cream, dried cream, butter, butter oil, con-
                                                    196.856 Only ingredients or products              centrated milk fat, milk, concentrated milk,
five head of cows or more, owned by, or in
                                                    recognized by the department of health and        evaporated milk, sweetened condensed milk,
possession of, such person, firm or corpora-
                                                    senior services in properly adopted rules         superheated condensed milk, dried milk, skim
tion have been duly inspected and tested
                                                    may be used in addition to those ingredients      milk, concentrated (evaporated or condensed)
and found free from tuberculosis and other
                                                    or products defined in this section. For the
communicable diseases, as determined by a
                                                    purpose of sections 196.851 to 196.895 the                                                   37
                                                          Missouri Revised Statutes
Statutes

skim milk, superheated condensed skim milk,                                                            more of the optional egg ingredients permit-
sweetened condensed skim milk, sweetened            (5) Optional egg ingredients are liquid eggs,      ted by subdivision (5) are used in such quan-
condensed partly skimmed milk, nonfat dry           frozen eggs, dried eggs, egg yolks, frozen         tity that the total weight of egg yolk solids
milk solids, edible dry whey, cheese whey,          yolks, dried yolks; however, the total weight      therein is not less than one and four-tenths
sweet cream buttermilk, condensed sweet             of egg yolk solids used singly, or in combi-       percent of the weight of the finished French
cream buttermilk, dried sweet cream but-            nation of two or more, must be less than the       ice cream, except when any of the optional
termilk, and any of the foregoing products          minimum prescribed in subdivision (8) for          flavoring ingredients specified in paragraphs
from which all or a portion of the lactose          French ice cream.                                  (d), (e), (f), (g), (h) and (i) of subdivision (4)
has been removed after crystallization or the                                                          of this section are used, in which case the
lactose has been converted to simple sugars         (6) The optional stabilizing ingredients are       weight of the egg yolk solids is not less than
by hydrolysis. Harmless optional ingredients        gelatin, algin, extractive of Irish moss, psyl-    one and twelve-hundredths percent of the
may be used to prevent fat oxidation in any         lium seed husk, agar-agar, gum acacia, gum         weight of the finished French ice cream.
of the foregoing optional dairy ingredients         karaya, locust bean gum, gum tragacanth,
in an amount not exceeding five-thousandths         cellulose gum, guar seed gum, monoglycer-          (9) “Ice milk” conforms in all respects to
of one percent of the weight of the milk fat        ides or diglycerides or both of fat forming        the definition and standard of identity for ice
present in any of such dairy ingredients. Sour      fatty acids or other harmless stabilizers or       cream prescribed in subdivision (1), except
cream shall never be used as an ingredient.         emulsifiers; but the total weight of the active    that it contains not less than two percent
                                                    material contained in the solids of any such       but not more than seven percent of milk fat
(3) The optional sweetening ingredients are         ingredient used singly, or of any combina-         and not less than fourteen percent total milk
sugar, liquid sugar, dextrose, invert sugar         tion of two or more such ingredients used, is      solids and except that it contains not less than
(paste or sirup), lactose, fructose, corn sugar,    not more than one-half of one percent of the       one and three-tenths pounds of food solids
dried or liquid corn sirup, maple sirup, maple      weight of the finished ice cream.                  per gallon.
sugar, honey, brown sugar, malt sirup, dried
malt extract, molasses (other than blackstrap)      (7) The following harmless optional ingredi-       (10) “Sherbet” is the food prepared by freez-
and any other nutritive sweetening ingredi-         ents or combination of such ingredients may        ing, while stirring, a mix composed of one
ent approved by the federal Food and Drug           be added to control viscosity, adjust protein      or a combination of the optional pasteurized
Administration.                                     stability and adjust pH of the combined mix        dairy ingredients specified in subdivision
                                                    ingredients:                                       (2), one or more of the optional sweeten-
(4) The optional flavoring ingredients are:                                                            ing ingredients specified in subdivision (3),
                                                    (a) Sodium bicarbonate;                            fruit, fruit juice, or flavoring as hereinafter
(a) Natural food flavoring;                                                                            provided. It may contain one or more of the
                                                    (b) Magnesium oxide as such or as carbonate        optional stabilizing ingredients specified in
(b) Artificial food flavoring;                      or hydroxide;                                      subdivision (6) or pectin provided the weight
                                                                                                       of such stabilizer is not more than one-half
(c) Fruit juices, which may be fresh, frozen,       (c) Calcium oxide as such or as hydroxide or       of one percent of the weight of the finished
canned, concentrated or dried and which may         sucrate;                                           sherbet. The kind and quantity of optional
be sweetened and thickened with one or more                                                            dairy ingredients used is such that the total
of the optional stabilizing ingredients speci-      (d) Sodium citrate;                                milk solids content is not more than five per-
fied in subdivision (6);                                                                               cent by weight of the finished sherbet and the
                                                    (e) Sodium phosphates. The total ingredients       milk fat content is not more than two percent
(d) Chocolate;                                      (a) through (c) shall not exceed one-tenth of      and not less than one percent by weight of the
                                                    one percent by weight of the finished mix;         finished sherbet. It contains fruit or fruit juice
(e) Cocoa;                                          nor shall the weight of ingredients (d) and (e)    as prescribed in subdivisions (1), (2), (3) and
                                                    exceed two-tenths of one percent by weight         (6) of subsection 4 of this section. It may
(f) Fruit which may be fresh, frozen, canned,       of the finished mix. It is further provided that   contain citric, tartaric, malic, phosphoric, or
concentrated, shredded, pureed, commi-              the percentage of developed lactic acid in the     lactic acid. The acidity of the finished sherbet
nuted or dried and which may be sweetened,          mix prior to the addition of the above listed      shall be not less than thirty-five hundredths of
thickened with stabilizer, and acidulated with      optional ingredients shall not exceed three        one percent of acid as determined by titrating
citric, tartaric, malic, lactic or ascorbic acid;   one-thousandths of one percent by weight for       with standard alkali and expressed as lactic
                                                    each one percent of milk-solids-not-fat pres-      acid. It weighs not less than six pounds per
(g) Nut meats;                                      ent in the mix.                                    gallon.

(h) Confectionery; and                              (8) “French ice cream”, “frozen custard”,          (11) “Water ice” conforms in all respects to
                                                    “French custard ice cream” conforms to the         the definition and standard of identity for
(i) Vanilla flavoring may be fortified with         definition and standard of identity prescribed     sherbet prescribed in subdivision (10) except
vanillin only.                                      for ice cream by subdivision (1) that one or
                                                                                                                                                    38
                                                          Missouri Revised Statutes
Statutes

that it does not contain any of the optional        and minerals.                                      fifty thousand gallons and not in excess of
dairy ingredients and consequently does                                                                one hundred thousand gallons, seventy-five
not meet the provision respecting total milk        (L. 1955 p. 708 § 196.855, A.L. 1957 p. 699,       dollars; in excess of one hundred thousand
solids and milk fat.                                A.L. 1980 S.B. 707)                                gallons and not in excess of two hundred
                                                                                                       thousand gallons, one hundred dollars; in
(12) “Mellorine” is a vegetable fat frozen                                                             excess of two hundred thousand gallons and
dessert product which is a clean, frozen            Section 196.866                                    not in excess of four hundred thousand gal-
or semifrozen food prepared by freezing,                                                               lons, one hundred twenty-five dollars; over
while stirring, a pasteurized mix composed                                                             four hundred thousand gallons, one hundred
of edible vegetable fats, milk solids not fat,
                                                    Manufacturer’s license re-                         fifty dollars, and shall be made to the direc-
sugar or optional sweetening ingredients and        quired, exceptions--appli-                         tor of the department of health and senior
optional flavoring ingredients as defined in        cation, fees, investigation--                      services, upon such forms and shall show
section 196.856. It may contain one or more         expires when--license withheld                     such information as may be demanded by
optional stabilizing ingredients and emulsifi-      or revoked, notice, hearing--                      the department of health and senior services,
ers as specified in subdivision (6) of this sec-    judicial review.                                   and the said director of the department of
tion, in an amount not exceeding one percent                                                           health and senior services, upon receipt of
of active ingredients, whether used singly or       196.866 1. Every person, firm, association         application for such license, shall cause to be
in combination, of the weight of the finished       or corporation, before engaging in the busi-       investigated the equipment and the sanitary
product.                                            ness of manufacturing or freezing ice cream,       conditions of the plant or place of business
                                                    mellorine, frozen dessert products or any          for which the license is applied. If the condi-
(13) “Edible fats”, the edible natural fats         other product defined in sections 196.851          tion of the plant or place of business is found
derived from vegetable or milk sources              to 196.895, shall first obtain a license from      to be satisfactory, a license shall be issued by
including only such milk fat as is normally         the director of the department of health and       the director of the department of health and
contained in the products enumerated in             senior services of the state of Missouri. A        senior services to such applicant.
subdivision (2) of this section; the food fats      license shall be obtained for each plant or
may be hydrogenated or nonhydrogenated.             place of business where ice cream, ice cream       3. Each license so issued shall expire one
Harmless optional ingredients may be used           mix, ice milk, sherbet, frozen malt, ice milk      year following the date of issuance. All li-
to prevent fat oxidation in an amount not           mix, mellorine, edible fat frozen dessert or       censes for plants or places of business, when
exceeding five-thousandths percent of the           ices are manufactured or frozen. Hotels,           the manufacture of ice cream, ice cream
weight of the fat used.                             motels, restaurants, boardinghouses, or other      mix, ice milk, sherbets, or ices is continued
                                                    concerns or agents which shall manufacture         after the expiration of such licenses, shall be
(14) “Milk solids not fat”, skim milk, concen-      or freeze ice cream, or related frozen food        renewed annually.
trated (evaporated or condensed) skim milk,         products defined in sections 196.851 to
superheated condensed skim milk, sweet-             196.895 for the use of their patrons, guests,      4. The director of the department of health
ened condensed skim milk, nonfat dry milk           or servants, shall be required to take out the     and senior services may withhold and refuse
solids, edible dry whey, cheese whey, sweet         license herein provided for; provided, that        to issue a license for any plant or place of
cream buttermilk (whether fluid, condensed          nothing in this section shall apply to private     business that has not been conducted or is
or dried), and any of the foregoing products        homes, hospitals, churches, or fraternal           not prepared to be conducted in accordance
from which all or a portion of the lactose          organizations manufacturing such products          with the requirements of sections 196.851
has been removed after crystallization or the       for their own use or to retailers dealing in ice   to 196.895 or any rules issued hereunder.
lactose has been converted to simple sugar by       cream or frozen dessert products received in       The director of the department of health and
hydrolysis.                                         the final frozen form from a licensed manu-        senior services shall have the power to revoke
                                                    facturer.                                          any license issued under sections 196.851 to
(15) “Mix” or “mixes”, the liquid which con-                                                           196.895 whenever it is determined by him
tains the ingredients of a vegetable or milk fat    2. Applications for such licenses, both frozen     that any of the provisions of sections 196.851
frozen dessert product and which, after freez-      dessert and mellorine, shall be accompanied        to 196.895 have been violated. Any person,
ing, becomes the vegetable or milk fat frozen       by a statutory fee as follows: For each plant      firm, association or corporation, whose
dessert product.                                    producing annually not in excess of five           license has been so revoked, shall discon-
                                                    thousand gallons, ten dollars; in excess of        tinue operation of the business for which
(16) “Frozen dietary dairy dessert” and “fro-       five thousand gallons and not in excess of         the license was issued until such time as the
zen dietary desserts” is a food for any special     fifteen thousand gallons, fifteen dollars; in      provisions of sections 196.851 to 196.895
dietary use, prepared by freezing, with or          excess of fifteen thousand gallons and not         have been complied with and a new license
without agitation, composed of a pasteurized        in excess of twenty-five thousand gallons,         granted by the director of the department of
mix which may contain edible fat, protein,          twenty-five dollars; in excess of twenty-five      health and senior services. Before revoking
carbohydrates, natural or artificial sweeten-       thousand gallons and not in excess of fifty        any such license, the director of the depart-
ers, flavoring stabilizers, emulsifiers, vitamins   thousand gallons, fifty dollars; in excess of                                                 39
                                                          Missouri Revised Statutes
Statutes

ment of health and senior services shall give        Section 196.872
written notice to the licensee affected, stating
that he contemplates revocation of the same                                                          Sale regulations--labeling.
and giving his reasons therefor. Said notice         Rules and regulations for
shall appoint a time and place for hearing                                                           196.886 No person, firm, association or
                                                     minimum sanitation to be                        corporation shall:
and shall be mailed by registered mail to the
licensee at least ten days before the date set       established, procedure.
for the hearing or personal service rendered.                                                        (1) Manufacture and sell ice cream, and re-
The licensee may present to the director of          196.872 The department of health and            lated frozen food products defined in sections
the department of health and senior services         senior services shall promulgate rules,         196.851 to 196.895 in containers unless each
such evidence as may have a bearing on the           pursuant to the provisions of this section      container shall bear the name of the manufac-
case, and, after hearing of the testimony, the       and chapter 536, RSMo, setting forth the        turer or packer or distributor on the body or
director of the department of health and senior      minimum sanitation requirements of manu-        lid of such container. When the name of the
services shall decide the question in such           facturing ice cream or other related frozen     distributor is used, the national assigned plant
manner as to him appears just and right.             food products. No person, firm, association     number identifying location of the manu-
                                                     or corporation shall manufacture ice cream      facturer shall appear on the container or*
5. Any licensee who feels aggrieved at the           or other related frozen food products defined   consumer purchasing unit; or
decision of the director of the department of        in sections 196.851 to 196.895 in any room
health and senior services may appeal from           or other place that is not maintained in        (2) Sell or offer for sale or have in his or its
said decision within sixty days by writ of           compliance with these rules as determined       possession with intent to sell, any product
certiorari to the circuit court of the county        by the director of the department of health     defined in sections 196.851 to 196.895 in
in which such person resides or in case of a         and senior services or his agents. No rule or   or from a container which is falsely labeled
firm, association or corporation, the county in      portion of a rule promulgated under the au-     or branded as to the manufacturer of such
which is located its principal place of busi-        thority of sections 196.851 to 196.895 shall    product; or
ness.                                                become effective unless it has been promul-
                                                     gated pursuant to the provisions of section     (3) Sell any product defined in sections
6. All fees collected under this section shall       536.024, RSMo.                                  196.851 to 196.895 from a container or
be deposited in the state treasury, subject to                                                       compartment of a fountain or cabinet which
appropriation by the general assembly.               (L. 1980 S.B. 707, A.L. 1993 S.B. 52, A.L.      contains any article of food other than such
                                                     1995 S.B. 3)                                    products; or
(L. 1955 p. 708 § 196.880, A.L. 1980 S.B.
707)                                                                                                 (4) Use any container furnished or used
                                                                                                     for containing products defined in sections
                                                     Section 196.881                                 196.851 to 196.895 for any other purposes.

Section 196.868                                                                                      (L. 1955 p. 708 § 196.870, A.L. 1980 S.B.
                                                     Samples for analysis to be
                                                                                                     707)
                                                     furnished the department of                     *Original rolls contain word “on”.
Nonresident manufacturer to
                                                     health and senior services,
obtain broker’s license, fee.
                                                     when.
                                                                                                     Section 196.895
196.868. Any person who operates a plant
manufacturing or freezing ice cream, mellor-         196.881 It shall be the duty of every person,
                                                     firm, company, copartnership, or corporation
ine, frozen dessert products or any other prod-
                                                     to whom sections 196.851 to 196.895 apply,      Violation of law a misdemean-
uct defined in sections 196.851 to 196.895,
located outside of this state and sells, offers      at the request of the director of the depart-   or.
for sale or distributes the products in this state   ment of health and senior services or his
shall obtain a broker’s license from the direc-      agents, to furnish such samples of manufac-     196.895. Any person who violates any
tor and pay a broker’s license fee, equivalent       tured products defined in section 196.856,      provision of sections 196.851 to 196.895
to the license fee provided in section 196.866,      as said director may require for purpose of     shall, upon conviction, be deemed guilty of a
on all sales in this state, and shall be subject     analysis.                                       misdemeanor.
to the other provisions of sections 196.851 to
196.895.                                             (L. 1955 p. 708 § 196.885, A.L. 1980 S.B.       (L. 1955 p. 708 § 196.887)
                                                     707)
(L. 1959 H.B. 281 § 1, A.L. 1980 S.B. 707)
                                                     Section 196.886                                 Section 196.931
                                                                                                                                                  40
                                                          Missouri Revised Statutes
Statutes

                                                 processed, stored, bottled, pasteurized and        Section 196.933
                                                 prepared for distribution, except an establish-
Definitions.                                     ment where graded fluid milk products are
                                                 sold at retail as purchased from a milk plant;     Certain products exempted.
196.931 As used in sections 196.931 to
196.953 unless the context clearly indicates     (6) “Milk plant operator”, any person, firm,       The provisions of sections 196.931 through
otherwise, the following words and terms         corporation or association operating any milk      196.953 and regulations promulgated
shall have the meaning indicated:                plant;                                             thereunder do not apply to manufacturing
                                                                                                    raw milk and manufactured dairy products,
(1) “Grade A pasteurized milk”, grade A          (7) “Milk producer”, any person who oper-          including, but not limited to, butter, con-
raw milk for pasteurization which has been       ates a dairy farm and provides, sells, or offers   densed milk, evaporated milk, sterilized
pasteurized, cooled, and placed in the final     milk for sale to a milk plant, receiving sta-      milk or milk products in hermetically sealed
container in a milk plant and conforming with    tion, or transfer station;                         containers and not requiring refrigeration, all
the sanitation and bacteriological standards                                                        types of cheese, nonfat dry milk, dry whole
authorized by sections 196.931 to 196.953        (8) “Official rating agency”, the state milk       milk and part fat dry milk unless used in the
and regulations promulgated thereunder;          board;                                             preparation of graded fluid milk or fluid milk
                                                                                                    products.
(2) “Grade A raw milk for pasteurization”,       (9) “Official rating survey”, the survey con-
raw milk for pasteurization from producer        ducted by the official state rating agency, as     (L. 1972 H.B. 1280 § 3)
dairies and conforming with all of the sanita-   required by sections 196.931 to 196.953;
tion and bacteriological standards authorized
by sections 196.931 to 196.953 and regula-       (10) “Person” shall mean an individual or
tions which are promulgated thereunder;                                                             Section 196.935
                                                 individuals, or a firm, partnership, company,
                                                 corporation, trustee, or association;
(3) “Graded fluid milk and fluid milk prod-
ucts”, milk products include cream, light                                                           State milk inspection required
                                                 (11) “Political subdivision”, any municipal-
cream, coffee cream, table cream, whipping       ity, city, incorporated town, village, county,     on all graded fluid milk or
cream, light whipping cream, heavy cream,        township, district or authority, or any portion    milk products--pasteurization
heavy whipping cream, whipped cream,             or combination of two or more thereof;
whipped light cream, whipped coffee cream,                                                          required, exception.
whipped table cream, sour cream, cultured        (12) “State department of agriculture”, the
sour cream, half-and-half, sour half-and-                                                           196.935 No person shall sell, offer for sale,
                                                 department of agriculture of Missouri;             expose for sale, transport, or deliver any
half, cultured half-and-half, reconstituted or
recombined milk and milk products, concen-                                                          graded fluid milk or graded fluid milk prod-
                                                 (13) “State department of health and senior        ucts in this state unless the milk or milk prod-
trated milk, concentrated milk products, skim    services”, the department of health and senior
milk, skimmed milk, lowfat milk, fortified                                                          ucts are graded and produced, transported,
                                                 services of Missouri;                              processed, manufactured, distributed, labeled
milk and milk products, vitamin D milk and
milk products, homogenized milk, flavored                                                           and sold under state milk inspection and the
                                                 (14) “State milk board”, an appointed state        same has also been produced or pasteurized
milk or milk products, eggnog, eggnog            agency functioning as administrator of state
flavored milk, eggnog flavored lowfat milk,                                                         as required by a regulation authorized by
                                                 milk inspection; and                               section 196.939 and under proper permits
buttermilk, cultured buttermilk, cultured
milk, cultured whole milk buttermilk, and                                                           issued thereunder. Only pasteurized graded
                                                 (15) “State milk inspection”, the services of      fluid milk and fluid milk products as defined
acidified milk and milk products, and other      inspection, regulation, grading, and program
fluid milk and fluid milk products so declared                                                      in subdivision (3) of section 196.931 shall be
                                                 evaluation of fluid milk and fluid milk prod-      sold to the final consumer, or to restaurants,
by the board which are sold, offered for sale,   ucts by agents, representatives or employees
exposed for sale, delivered or advertised as                                                        soda fountains, grocery stores, or similar
                                                 of the state milk board under the terms and        establishments; except an individual may pur-
graded milk and milk products;                   provisions of sections 196.931 to 196.959          chase and have delivered to him for his own
                                                 and regulations adopted to regulate the pro-       use raw milk or cream from a farm.
(4) “Manufacturing raw milk”, milk that does     duction, transportation, processing, manufac-
not meet the requirements of grade A raw         ture, distribution and sale of graded fluid milk
milk for pasteurization as defined in sections                                                      (L. 1972 H.B. 1280 § 4)
                                                 and fluid milk products.
196.931 to 196.959;
                                                 (L. 1972 H.B. 1280 § 2, A.L. 1994 S.B. 546,
(5) “Milk plant”, any place, premises or         A.L. 2006 S.B. 1017)                               Section 196.937
establishment where graded fluid milk or
fluid milk products are collected, handled,
                                                                                                                                              41
                                                       Missouri Revised Statutes
Statutes

Penalty--violation by employ-                     cal investigations by the proper authorities       tion; and one member shall be a consumer
                                                  of any political subdivision. A public hear-       at large. Not more than six of the twelve
ee is violation by employer.                      ing shall be held prior to the adoption of any     board members shall be members of the same
                                                  regulation or modification thereof, upon no-       political party. The consumer at large or his
196.937 Any person violating any provision        tice published at least thirty days prior to the   spouse shall not be affiliated with any of the
of section 196.935 is guilty of a misdemean-      public hearings. At the public hearing, any        above-mentioned groups. The director of the
or. When construing and enforcing the provi-      person shall be permitted to appear and to be      state department of health and senior services
sions of sections 196.931 through 196.953,        heard on the proposed regulations or modifi-       or his designated representative and the state
the act, omission or failure of any person        cations thereof. The standards of a regulation     director of the department of agriculture or
acting for or employed by an individual, part-    may exceed but shall not be less than those        his designated representative shall serve as
nership, corporation, or association within the   contained in the current edition of the Grade      members. The term of service of each board
scope of his employment or office shall, in       A Pasteurized Milk Ordinance of the United         member shall expire September twenty-eight
every case, be deemed a violation of sections     States Public Health Service as it exists or as    of the fourth year after appointment. How-
196.931 through 196.953, by the individual,       it may be amended. The board may employ            ever, the term of the first members appointed
partnership, corporation or association, as       an executive secretary and adequate staff for      shall expire September twenty-eight of the
well as the violations of sections 196.931        administering sections 196.931 to 196.959,         first to fourth year after appointment as
through 196.953, by the person.                   the cost of which shall be paid from the milk      specified by the governor and as equally as
                                                  inspection fee fund.                               possible. Provisions of sections 196.931 to
(L. 1972 H.B. 1280 § 5)                                                                              196.959 shall be implemented within one
                                                  2. No rule or portion of a rule promulgated        year of August 13, 1972. Board members
                                                  under the authority of sections 196.931 to         shall serve without financial compensation.
Section 196.939                                   196.959 shall become effective unless it has
                                                  been promulgated pursuant to the provisions        (L. 1972 H.B. 1280 § 7, A.L. 1986 H.B. 1554
                                                  of section 536.024, RSMo.                          Revision)
Rules and regulations--inspec-
tion by political subdivisions                    (L. 1972 H.B. 1280 § 6, A.L. 1993 S.B. 52,         Section 196.943
                                                  A.L. 1994 S.B. 546, A.L. 1995 S.B. 3)
prohibited, exceptions--hear-
ings, notice--rules, procedure.                                                                      Appointments, when made--
                                                  Section 196.941                                    authority to act, when--failure
196.939 1. The state milk board shall pro-
mulgate, adopt, and file with the secretary of                                                       of senate to consent, effect of.
state as prescribed by law such regulations as    State milk board, member-
deemed necessary for the purpose of sections
196.931 to 196.953. Such regulations shall        ship, qualifications, appoint-                     196.943 Within thirty days after August 13,
be enforced by the state milk board through       ment.                                              1972, the governor shall appoint ten persons
either contractual agreements with political                                                         as members of the state milk board as set
subdivisions of the state or employees of the     196.941 There is hereby created a board            forth in section 196.941 and their authority
state milk board. The adoption of regulations     to be known as the “State Milk Board” to           to act shall commence upon receiving the
for the purpose of establishing a milk inspec-    consist of twelve members to be nominated          advice and consent of the senate, if the senate
tion program other than one under contrac-        by the director of the department of agricul-      shall be in session, but if the senate not be in
tual agreement with the state milk board by       ture and shall be appointed by the governor,       session, the authority to act as an acting board
any political subdivision is prohibited. Milk     with the advice and consent of the senate,         member shall commence immediately upon
inspection by any political subdivision of        four of whom shall be representatives and          appointment by the governor, but shall ter-
the state except under contractual arrange-       active members of the staff of each of four        minate if advice and consent is not received
ments with the board is prohibited; provided      local health jurisdictions including St. Louis     within thirty days after the senate convenes.
the duly authorized official of any political     County, Missouri, health department; St.           If advice and consent is not given, such per-
subdivision of this state may take samples of     Louis City, Missouri, health division; Kansas      son shall not be reappointed by the governor
such products which have been moved into,         City, Missouri, health department; Spring-         to the board. To be eligible for appointment
distributed within, or sold within the bound-     field, Missouri, health department. Four grade     by the governor, the board member must be a
aries of such political subdivisions of this      A milk producers shall represent dairy pro-        citizen of the United States and a resident of
state for the sole purpose of determining that    ducers through a registered milk producer or-      the state. Advice and consent may be with-
such milk and milk products comply with the       ganization or farm organization with no more       drawn with regard to the appointment of a
standards developed by the state milk board.      than one representing any one organization;        member of the state milk board by a majority
Nothing in sections 196.931 to 196.959 shall      one member shall represent dairy processors        vote of the elected members of the senate.
be construed as prohibiting any epidemiologi-     through a recognized processor organiza-
                                                                                                                                               42
                                                        Missouri Revised Statutes
Statutes

(L. 1972 H.B. 1280 § 8)                            and used exclusively for the purpose of de-        prohibit the state or local health officer from
                                                   fraying the cost of state milk inspection and      satisfying himself or herself that the govern-
                                                   to other state agencies for such services in       mental agency having jurisdiction over the
                                                   addition thereto that are provided by the state    production and processing is properly enforc-
Section 196.945                                                                                       ing such provisions.
                                                   government. The state milk board shall remit
                                                   to the treasury of the local jurisdictions for
Inspection fee, payable when-                      which it may contract to provide services for      (L. 1972 H.B. 1280 § 11, A.L. 2006 S.B.
                                                   administering milk inspection if other than        1017)
-hearing and notice before fee                     by its own employees, moneys not exceeding
established.                                       five cents per one hundred pounds of milk or       Section 196.951
                                                   milk products. The unexpended balance in
196.945 An inspection fee shall be annually        the state milk inspection fee fund at the end
established by the board not to exceed five        of the biennium shall not be transferred to        State milk board official rat-
cents on each one hundred pounds of grade A        the general revenue fund of the state treasury
raw milk for pasteurization produced under         and, accordingly, shall be exempt from the
                                                                                                      ing agency--survey made,
state milk inspection and* shall be paid by        provisions of section 33.080, RSMo, relating       when, how.
the milk plant to the state milk board. Milk       to the transfer of funds to the general revenue
dealers, processors, or distributors selling       fund of the state by the state treasurer. The      196.951 The state milk board is hereby
graded fluid milk and fluid milk products in       financial proceedings of the board shall be        designated as the official rating agency. At
the state as provided for by section 196.949       subject to an annual audit by a certified pub-     least biannually, or as often as necessary, the
shall pay a fee, to be established annually by     lic accountant and the audit report shall be a     state milk board shall make an official rating
the board, not to exceed five cents on each        public record, subject to the inspection by the    survey to determine if there is appropriate
one hundred pounds of milk or milk prod-           general public.                                    and effective enforcement of the standards
ucts to the state milk board; provided that                                                           and provisions of sections 196.931 through
no milk producer, person, milk dealer, milk        (L. 1972 H.B. 1280 § 10, A.L. 1994 S.B. 546)       196.953 and such other surveys as may be
processor or milk distributor shall be liable      Effective 5-10-94                                  necessary to assure enforcement of sec-
for inspection fees on fluid milk and fluid                                                           tions 196.931 through 196.953 throughout
milk products for which fees have previously                                                          the state. Unsatisfactory conditions shall
been paid to the state milk board. Such fees                                                          be deemed to exist when a rating below the
                                                   Section 196.949                                    minimum acceptable rating established by the
shall be paid to the state milk board on or
before the twentieth day of each month for                                                            state milk board is found by the official rating
the preceding calendar month. The annual           State inspection of milk or                        survey. Violation of sections 196.931 through
inspection fees shall be set by the board after                                                       196.953 shall be deemed to exist when the
holding a public hearing giving thirty days’       milk products not required,                        unsatisfactory conditions causing the rating
public notice.                                     when.                                              to fall below the minimum acceptable rating
                                                                                                      are not corrected within ninety days. The
(L. 1972 H.B. 1280 § 9)                            196.949 Graded fluid milk or fluid milk prod-      minimum acceptable rating shall be ninety
*Word “and” does not appear in original            ucts not inspected under state milk inspection     percent for the pasteurized milk supply as
rolls.                                             may be sold, offered for sale, exposed for         determined by rating methods recognized by
                                                   sale, and delivered in the state of Missouri, or   the United States Public Health Service Food
                                                   any municipality thereof, if approved by the       and Drug Administration. The state milk
                                                   state milk board as provided for by regula-        board shall promulgate and adopt a single
Section 196.947                                                                                       method of making official rating surveys
                                                   tions adopted by the state milk board; pro-
                                                   vided that, the graded fluid milk or fluid milk    of all milksheds. Official surveys shall be
State milk inspection fee fund                     products from other states shall be produced       made by a method substantially equivalent to
                                                   and processed under the supervision of a duly      procedures outlined in United States Govern-
created--funds, how expend-                        authorized governmental agency operating           mental Printing Office Publication Number
ed, not to revert to general                       under the provisions of an ordinance, statute,     678, titled “Methods of Making Sanitation
                                                   or regulation substantially equivalent to the      Ratings of Milksheds”.
revenue.
                                                   regulations promulgated and adopted by the
                                                   state milk board and enforced with equal           (L. 1972 H.B. 1280 § 12, A.L. 2006 S.B.
196.947 All moneys received for state milk
                                                   effectiveness as determined by an official         1017)
inspection shall be deposited in the state trea-
sury and credited to the “State Milk Inspec-       rating survey, and products meet applicable
tion Fee Fund”, which is hereby created, sub-      temperature, bacteriological and composition
ject to appropriation by the general assembly      standards when sampled on arrival at point         Section 196.953
                                                   of retail sale. Nothing in this section shall
and to be appropriated to the state milk board                                                                                                   43
                                                         Missouri Revised Statutes
Statutes

                                                  tion of board, how taken. |
Injunctive relief authorized.                                                                      (3) “Nonprofit clinic”, a facility organized as
                                                  196.959 Any person aggrieved by an order         not for profit in which advice, counseling, di-
196.953 In addition to the remedies provided      or regulation of the milk board may appeal       agnosis, treatment, surgery, care, or services
in sections 196.931 through 196.953, or by        directly to the circuit court having jurisdic-   relating to the preservation or maintenance of
law, the attorney general of the state or the     tion over his principal place of business. The   health are provided on an outpatient basis for
prosecuting attorney of any county in which       case shall be placed at the head of the docket   a period of less than twenty-four consecutive
a violation of any provisions of sections         for a de novo hearing.                           hours to persons not residing or confined at
196.931 through 196.953 occurs is authorized                                                       such facility;
to apply to any court of competent jurisdic-      (L. 1972 H.B. 1280 § 16)
tion for, and the court shall have jurisdiction                                                    (4) “Out-of-state charitable repository”, any
                                                                                                   of the following:
upon hearing and for cause shown to grant, a      Section 196.970
temporary or permanent injunction to restrain
any person, partnership, corporation, or as-                                                       (a) A bona fide charitable, religious, or
sociation from violating any provisions of        Citation of law.                                 nonprofit organization, licensed or registered
sections 196.931 through 196.953.                                                                  in this state as an out-of-state wholesale
                                                  196.970 Sections 196.970 to 196.984 shall        drug distributor under sections 338.210 to
(L. 1972 H.B. 1280 § 13)                          be known and may be cited as the “Prescrip-      338.370, RSMo, and that otherwise quali-
                                                  tion Drug Repository Program Act”.               fies as an exempt organization under Section
                                                                                                   501(c)(3) of Title 26, United States Code, as
                                                  (L. 2004 S.B. 1160)                              amended; or
Section 196.955
                                                                                                   (b) A foreign medical aid mission group that
                                                                                                   distributes pharmaceuticals and health care
Valid grade A milk permit                         Section 196.973                                  supplies to needy persons abroad;
holder may continue to sell
grade A milk.                                     Definitions.                                     (5) “Prescription drug”, a drug which may
                                                                                                   be dispensed only upon prescription by an
196.955. Nothing in sections 196.931 to                                                            authorized prescriber and which is approved
                                                  196.973 As used in sections 196.970 to
196.959 shall be so construed as to prohibit                                                       for safety and effectiveness as a prescription
                                                  196.984, the following terms shall mean:
any grade A dairyman, who holds a valid                                                            drug under Section 505 or 507 of the Federal
grade A milk permit at the inception of sec-                                                       Food, Drug, and Cosmetic Act.
                                                  (1) “Health care professional”, any of the
tions 196.931 to 196.959, to continue to sell     following persons licensed and authorized to
grade A milk.                                                                                      (L. 2004 S.B. 1160, A.L. 2006 H.B. 1687)
                                                  prescribe and dispense drugs and to provide
                                                  medical, dental, or other health-related diag-
(L. 1972 H.B. 1280 § 14)                          noses, care, or treatment:                       Section 196.976
Section 196.957                                   (a) A licensed physician or surgeon;
                                                                                                   Prescription drug repository
                                                  (b) A registered nurse or licensed practical     program established, criteria.
Only one inspection required.                     nurse;
                                                                                                   196.976 1. By January 1, 2005, the depart-
196.957 It is expressly provided that any         (c) A physician assistant;                       ment of health and senior services shall
milk or milk products once inspected and                                                           establish the “Prescription Drug Repository
approved under sections 196.931 to 196.959        (d) A dentist;                                   Program” to accept and dispense prescription
shall be freely marketable anywhere in the                                                         drugs donated for the purpose of being dis-
state of Missouri without any further inspec-     (e) A dental hygienist;                          pensed to persons who are residents of Mis-
tion.                                                                                              souri and who meet eligibility requirements
                                                  (f) An optometrist;                              established by rules promulgated pursuant to
(L. 1972 H.B. 1280 § 15)                                                                           section 196.984.
                                                  (g) A pharmacist; and
                                                                                                   2. The following criteria shall be used in ac-
                                                  (h) A podiatrist;
Section 196.959                                                                                    cepting drugs for use in the program:

                                                  (2) “Hospital”, the same meaning as such
Appeal from order or regula-                      term is defined in section 197.020, RSMo;                                                  44
                                                        Missouri Revised Statutes
Statutes

(1) Only prescription drugs in their original                                                         professional disciplinary action for matters
sealed and tamper-evident unit dose packag-        2. A pharmacy, hospital, or nonprofit clinic       related to donating, accepting, or dispensing
ing shall be accepted and dispensed pursuant       which meets the eligibility requirements           prescription drugs under the prescription drug
to the program;                                    established in section 196.984 may dispense        repository program:
                                                   prescription drugs donated under the program
(2) The packaging must be unopened; except         to persons who are residents of Missouri and       (1) The department of health and senior
that prescription drugs packaged in single-        who meet the eligibility requirements of the       services;
unit doses may be accepted and dispensed           program, or to other governmental entities
when the outside packaging is opened if the        and nonprofit private entities to be dispensed     (2) The director of the department of health
single-unit-dose packaging is undisturbed;         to persons who meet the eligibility require-       and senior services;
                                                   ments of the program. A prescription drug
(3) Prescription drugs donated by individuals      shall be dispensed only pursuant to a pre-         (3) Any prescription drug manufacturer, gov-
shall bear the manufacturer’s lot number and       scription issued by a health care professional     ernmental entity, or person donating prescrip-
an expiration date that is less than six months    who is authorized by statute to prescribe          tion drugs to the program;
from the date the prescription drug is donated     drugs. A pharmacy, hospital, or nonprofit
shall not be accepted or dispensed; and            clinic which accepts donated prescription          (4) Any pharmacy, hospital, nonprofit clinic,
                                                   drugs shall comply with all applicable federal     out-of-state charitable repository, or health
(4) A prescription drug shall not be accepted      and state laws dealing with the storage and        care professional that prescribes, accepts
or dispensed if there is reason to believe that    distribution of dangerous drugs and shall          or dispenses prescription drugs under the
the drug is adulterated as described in section    inspect all prescription drugs prior to dis-       program; and
196.095;                                           pensing the prescription drugs to determine
                                                   that they are not adulterated as described in      (5) Any pharmacy, hospital, nonprofit clinic,
(5) Subject to the limitations specified in this   section 196.095. The pharmacy, hospital, or        or out-of-state charitable repository that
section, unused prescription drugs dispensed       nonprofit clinic may charge persons receiving      employs or has a hospital medical staff af-
for purposes of a medical assistance program       donated prescription drugs a handling fee, not     filiation with a health care professional who
may be accepted and dispensed under the pre-       to exceed a maximum of two hundred percent         accepts or dispenses prescription drugs under
scription drug repository program.                 of the Medicaid dispensing fee, established        the program.
                                                   by rule of the department promulgated pursu-
(L. 2004 S.B. 1160)                                ant to section 196.984. Prescription drugs         2. A prescription drug manufacturer shall
                                                   donated to the program shall not be resold.        not, in the absence of bad faith, be subject to
                                                   Any individual who knowingly resells any           criminal or civil liability for injury, death, or
Section 196.979                                                                                       loss to person or property for matters related
                                                   donated prescription drugs pursuant to sec-
                                                   tions 196.970 to 196.984 shall be guilty of a      to the donation, acceptance, or dispensing of
Donation of prescription                           class D felony.                                    a prescription drug manufactured by the pre-
                                                                                                      scription drug manufacturer that is donated
drugs to the program, proce-                       3. Drugs donated under this section that are       by any person under the program, includ-
dure--distribution to out-of-                      not used or accepted by any pharmacy, hos-         ing but not limited to liability for failure to
                                                   pital, or nonprofit clinic in this state may be    transfer or communicate product or consumer
state charitable repositories,                                                                        information or the expiration date of the
                                                   distributed to out-of-state charitable reposi-
when.                                              tories for use outside of this state. Such do-     donated prescription drug.
                                                   nated drugs may be repackaged in a manner
196.979 1. Any person, including but not           appropriate for distribution by participating      (L. 2004 S.B. 1160, A.L. 2006 H.B. 1687)
limited to a prescription drug manufacturer        pharmacies, hospitals, and nonprofit clinics.
or health care facility, may donate prescrip-                                                         Section 196.984
tion drugs to the prescription drug repository     (L. 2004 S.B. 1160, A.L. 2006 H.B. 1687)
program. The drugs shall be donated at a
pharmacy, hospital, or nonprofit clinic that
                                                   Section 196.981                                    Administrative rules, author-
elects to participate in the prescription drug
repository program and meets the criteria for                                                         ity to promulgate.
participation established by rule of the depart-   Immunity from civil or crimi-                      196.984.
ment pursuant to section 196.984. Participa-
tion in the program by pharmacies, hospitals,      nal liability, when.                               196.984 1. In consultation with the board
and nonprofit clinics shall be voluntary.                                                             of pharmacy, the director of the department
Nothing in sections 196.970 to 196.984 shall       196.981. 1. The following persons and              of health and senior services shall adopt and
require any pharmacy, hospital, or nonprofit       entities when acting in good faith shall not       promulgate rules to implement the prescrip-
clinic to participate in the program.              be subject to criminal or civil liability for      tion drug repository program. Such rules shall
                                                   injury, death, or loss to person or property, or                                               45
                                                         Missouri Revised Statutes
Statutes

include:
                                                      (9) For prescription drugs donated to the           (c) “Allocable share” means Allocable Share
(1) Eligibility criteria for pharmacies, hos-         program by health care facilities, a list of        as that term is defined in the Master Settle-
pitals, and nonprofit clinics to receive and          prescription drugs, arranged by category or         ment Agreement.
dispense donated prescription drugs under the         by individual drug, that the program will and
program;                                              will not accept from health care facilities. If     (d) “Cigarette” means any product that
                                                      a drug is ineligible for donation, the list must    contains nicotine, is intended to be burned or
(2) Standards and procedures for accept-              include a statement as to the reason the drug       heated under ordinary conditions of use, and
ing, safely storing, and dispensing donated           is ineligible for donation; and                     consists of or contains (1) any roll of tobacco
prescription drugs;                                                                                       wrapped in paper or in any substance not
                                                      (10) Any other standards and procedures the         containing tobacco; or (2) tobacco, in any
(3) Standards and procedures for inspecting           department deems appropriate or necessary to        form, that is functional in the product, which,
donated prescription drugs to determine that          implement the provisions of sections 196.970        because of its appearance, the type of tobacco
the original single-unit-dose packaging is            to 196.984.                                         used in the filler, or its packaging and label-
sealed and tamper-evident and that the pre-                                                               ing, is likely to be offered to, or purchased
scription drugs are unadulterated, safe, and          2. Any rule or portion of a rule, as that term is   by, consumers as a cigarette; or (3) any roll
suitable for dispensing;                              defined in section 536.010, RSMo, that is cre-      of tobacco wrapped in any substance contain-
                                                      ated under the authority delegated in sections      ing tobacco which, because of its appearance,
(4) Eligibility requirements for recipients           196.970 to 196.984 shall become effective           the type of tobacco used in the filler, or its
in the program shall be based on economic             only if it complies with and is subject to all of   packaging and labeling, is likely to be offered
need for persons to receive prescription drugs        the provisions of chapter 536, RSMo, and, if        to, or purchased by, consumers as a cigarette
under the program. For purposes of this               applicable, section 536.028, RSMo. Sections         described in clause (1) of this definition.
subdivision, “economic need” means a net              196.970 to 196.984 and chapter 536, RSMo,           The term “cigarette” includes “roll-your-
family income below three hundred percent             are nonseverable and if any of the powers           own” (i.e., any tobacco which, because of its
of the federal poverty level;                         vested with the general assembly pursuant to        appearance, type, packaging, or labeling is
                                                      chapter 536, RSMo, to review, to delay the          suitable for use and likely to be offered to, or
(5) An identification card by which a person          effective date, or to disapprove and annul a        purchased by, consumers as tobacco for mak-
who is eligible to receive donated prescrip-          rule are subsequently held unconstitutional,        ing cigarettes). For purposes of this definition
tion drugs under the program may demon-               then the grant of rulemaking authority and          of “cigarette,” 0.09 ounces of “roll-your-
strate eligibility to the pharmacy, hospital, or      any rule proposed or adopted after August 28,       own” tobacco shall constitute one individual
nonprofit clinic;                                     2004, shall be invalid and void.                    “cigarette.”

(6) A form that a person receiving a prescrip-        (L. 2004 S.B. 1160)                                 (e) “Master Settlement Agreement” means
tion drug from the program must sign before           *Word “establish” appears in original rolls.        the settlement agreement (and related
receiving the drug to confirm that such person                                                            documents) entered into on November 23,
understands the criminal and civil immunity                                                               1998 by the State and leading United States
from liability provisions of the program;             Section 196.1000
                                                                                                          tobacco product manufacturers.

(7) Establishing* a maximum handling fee              Definitions.                                        (f) “Qualified escrow fund” means an escrow
that pharmacies, hospitals, and nonprofit                                                                 arrangement with a federally or State char-
clinics may charge to drug recipients to cover        196.1000 (a) “Adjusted for inflation” means         tered financial institution having no affilia-
restocking and dispensing costs;                      increased in accordance with the formula for        tion with any tobacco product manufacturer
                                                      inflation adjustment set forth in Exhibit C to      and having assets of at least $1,000,000,000
(8) For prescription drugs donated to the             the Master Settlement Agreement.                    where such arrangement requires that such
program by individuals:                                                                                   financial institution hold the escrowed funds’
                                                      (b) “Affiliate” means a person who directly         principal for the benefit of releasing parties
(a) A list of prescription drugs, arranged by         or indirectly owns or controls, is owned or         and prohibits the tobacco product manu-
category or by individual drug, that the pro-         controlled by, or is under common ownership         facturer placing the funds into escrow from
gram will and will not accept from individu-          or control with, another person. Solely for         using, accessing or directing the use of the
als. If a drug is ineligible for donation, the list   purposes of this definition, the terms “owns,”      funds’ principal except as consistent with sec-
must include a statement as to the reason the         “is owned” and “ownership” mean owner-              tion 2(b)(2) of this Act.
drug is ineligible for donation; and                  ship of an equity interest, or the equivalent
                                                      thereof, of ten percent or more, and the term       (g) “Released claims” means Released
(b) A form each donor must sign stating that          “person” means an individual, partnership,          Claims as that term is defined in the Master
the donor is the owner of the prescription            committee, association, corporation or any          Settlement Agreement.
drugs and intends to voluntarily donate such          other organization or group of persons.
drugs to the program;                                                                                                                                46
                                                            Missouri Revised Statutes
Statutes

                                                  (L. 1999 H.B. 814 § 1)                            they were placed into escrow and (ii) only to
(h) “Releasing parties” means Releasing           Effective 7-1-99                                  the extent and at the time necessary to make
Parties as that term is defined in the Master     Section 196.1100                                  payments required under such judgment or
Settlement Agreement.                                                                               settlement;
                                                  Section 196.1003
(i) “Tobacco Product Manufacturer” means                                                            (B) to the extent that a tobacco product man-
an entity that after the date of enactment of                                                       ufacturer establishes that the amount it was
this Act directly (and not exclusively through    Requirements.                                     required to place into escrow in a particular
any affiliate):                                                                                     year was greater than the State’s allocable
                                                  196.1003. Requirements.                           share of the total payments that such manu-
(1) manufactures cigarettes anywhere that                                                           facturer would have been required to make in
such manufacturer intends to be sold in the       Any tobacco product manufacturer sell-            that year under the Master Settlement Agree-
United States, including cigarettes intended      ing cigarettes to consumers within the State      ment (as determined pursuant to section IX(i)
to be sold in the United States through an        (whether directly or through a distributor,       (2) of the Master Settlement Agreement, and
importer (except where such importer is an        retailer or similar intermediary or intermedi-    before any of the adjustments or offsets de-
original participating manufacturer (as that      aries) after the date of enactment of this Act    scribed in section IX(i)(3) of that Agreement
term is defined in the Master Settlement          shall do one of the following:                    other than the Inflation Adjustment) had it
Agreement) that will be responsible for the                                                         been a participating manufacturer, the excess
payments under the Master Settlement Agree-       (a) become a participating manufacturer (as       shall be released from escrow and revert back
ment with respect to such cigarettes as a         that term is defined in section II(jj) of the     to such tobacco product manufacturer; or
result of the provisions of subsection II(mm)     Master Settlement Agreement) and generally
of the Master Settlement Agreement and that       perform its financial obligations under the       (C) to the extent not released from escrow
pays the taxes specified in subsection II(z) of   Master Settlement Agreement; or                   under subparagraphs (A) or (B), funds shall
the Master Settlement Agreement, and pro-                                                           be released from escrow and revert back to
vided that the manufacturer of such cigarettes    (b) (1) place into a qualified escrow fund        such tobacco product manufacturer twenty-
does not market or advertise such cigarettes      by April 15 of the year following the year        five years after the date on which they were
in the United States);                            in question the following amounts (as such        placed into escrow.
                                                  amounts are adjusted for inflation)--
(2) is the first purchaser anywhere for resale                                                      (3) Each tobacco product manufacturer that
in the United States of cigarettes manufac-       1999: $.0094241 per unit sold after the date      elects to place funds into escrow pursuant
tured anywhere that the manufacturer does         of enactment of this Act;                         to this subsection shall annually certify to
not intend to be sold in the United States; or                                                      the Attorney General that it is in compliance
                                                  2000: $.0104712 per unit sold;                    with this subsection. The Attorney General
(3) becomes a successor of an entity de-                                                            may bring a civil action on behalf of the
scribed in paragraph (1) or (2).                  for each of 2001 and 2002: $.0136125 per          State against any tobacco product manufac-
                                                  unit sold;                                        turer that fails to place into escrow the funds
The term “Tobacco Product Manufacturer”                                                             required under this section. Any tobacco
shall not include an affiliate of a tobacco       for each of 2003 through 2006: $.0167539          product manufacturer that fails in any year to
product manufacturer unless such affiliate        per unit sold;                                    place into escrow the funds required under
itself falls within any of (1)-(3) above.                                                           this section shall--
                                                  for each of 2007 and each year thereafter:
(j) “Units sold” means the number of in-          $.0188482 per unit sold.                          (A) be required within 15 days to place
dividual cigarettes sold in the State by the                                                        such funds into escrow as shall bring it into
applicable tobacco product manufacturer           (2) A tobacco product manufacturer that plac-     compliance with this section. The court, upon
(whether directly or through a distributor, re-   es funds into escrow pursuant to paragraph        a finding of a violation of this subsection,
tailer or similar intermediary or intermediar-    (1) shall receive the interest or other appre-    may impose a civil penalty to be paid to the
ies) during the year in question, as measured     ciation on such funds as earned. Such funds       State’s general revenue fund in an amount not
by excise taxes collected by the State on         themselves shall be released from escrow          to exceed 5 percent of the amount improperly
packs (or “roll-your-own” tobacco contain-        only under the following circumstances--          withheld from escrow per day of the viola-
ers) bearing the excise tax stamp of the State.                                                     tion and in a total amount not to exceed 100
The department of revenue shall promulgate        (A) to pay a judgment or settlement on any        percent of the original amount improperly
such regulations as are necessary to ascertain    released claim brought against such tobacco       withheld from escrow;
the amount of State excise tax paid on the        product manufacturer by the State or any re-
cigarettes of such tobacco product manufac-       leasing party located or residing in the State.   (B) in the case of a knowing violation, be
turer for each year.                              Funds shall be released from escrow under         required within 15 days to place such funds
                                                  this subparagraph (i) in the order in which
                                                                                                                                              47
                                                        Missouri Revised Statutes
Statutes

into escrow as shall bring it into compliance      sions of section 33.080, RSMo, to the con-         current research trends and developments
with this section. The court, upon a finding of    trary, the moneys in the fund shall not revert     with either technical or scientific expertise
a knowing violation of this subsection, may        to the credit of general revenue at the end of     in life sciences and with an understanding of
impose a civil penalty to be paid to the State’s   the biennium.                                      the application of the results of life sciences
general revenue fund in an amount not to                                                              research. The appointment of a person to the
exceed 15 percent of the amount improperly         2. Moneys in the life sciences research trust      life sciences research committee created by
withheld from escrow per day of the viola-         fund shall be used strategically, in coopera-      Executive Order 01-10 issued by the gover-
tion and in a total amount not to exceed 300       tion with other governmental and not-for-          nor on July 23, 2001*, shall not disqualify a
percent of the original amount improperly          profit private entities, to enhance the capacity   person from serving as a member, either con-
withheld from escrow; and                          of the state of Missouri’s ability to perform      temporaneously or later, on the life sciences
                                                   research to better serve the health and welfare    research board;
(C) in the case of a second knowing viola-         of the residents of the state of Missouri as a
tion, be prohibited from selling cigarettes to     center of life sciences research and develop-      (3) No member of the life sciences research
consumers within the State (whether directly       ment by building on the success of research        board shall serve more than two consecutive
or through a distributor, retailer or similar      institutions located in Missouri, creating in      full four-year terms;
intermediary) for a period not to exceed 2         and attracting to Missouri new research and
years.                                             development institutions, commercializing          (4) The members of the life sciences re-
                                                   the life sciences technologies developed by        search board shall receive no salary or other
Each failure to make an annual deposit             such institutions, and enhancing their capac-      compensation for their services as a member
required under this section shall constitute       ity to carry out their respective missions.        of the board, but shall receive reimburse-
a separate violation. Any tobacco product                                                             ment for their actual and necessary expenses
manufacturer that violates the provisions          (L. 2003 H.B. 688)                                 incurred in performance of their duties as
of this section shall pay the State’s cost and                                                        members of the board.
attorney’s fees incurred during a successful
prosecution under this section.                    Section 196.1103
                                                                                                      (L. 2003 H.B. 688)
                                                                                                      *Original rolls contain “2002”.
(L. 1999 H.B. 814 § 2)                             Board established--appoint-
Effective 7-1-99
                                                   ment, terms, qualifications,                       Section 196.1106
Section 196.1100                                   expenses, appointment to life
                                                   sciences committee not to                          Centers to be established--def-
Trust fund established, pur-                       disqualify for membership on                       inition--areas in which centers
pose--reversion to general                         board.                                             to be established--approval by
revenue prohibited.                                                                                   board--screening committee
                                                   196.1103 The management, governance, and
                                                   control of moneys appropriated from the life       appointed for each area--rules,
196.1100 1. There is hereby established in         sciences research trust fund shall be vested in    powers and duties.
the state treasury the “Life Sciences Research     the “Life Sciences Research Board” which is
Trust Fund” to be held separate and apart          hereby created in the office of administration     196.1106 Centers for life sciences research
from all other public moneys and funds of          as a type III division and which shall consist     shall be established and shall be subject to the
the state, including but not limited to the        of seven members. The following provisions         following provisions:
tobacco securitization settlement trust fund       shall apply to the life sciences research board
established in section 8.550, RSMo. The state      and its members:                                   (1) A “center for excellence for life sciences
treasurer shall deposit into the fund twenty-                                                         research” means a system or regional con-
five percent of all moneys received from the       (1) Each member shall be appointed by the          sortium of public and private not-for-profit
master settlement agreement, as defined in         governor with the advice and consent of the        academic, research, or health care institu-
section 196.1000, beginning in fiscal year         senate pursuant to the procedures herein set       tions or organizations engaged in competitive
2007 and in perpetuity thereafter. Moneys          forth for a term of four years; except that, of    research in targeted fields consistent with the
in the fund shall not be subject to appropria-     the initial members of the board appointed,        strategic purposes of life sciences research as
tion for purposes other than those provided        three shall be appointed for two-year terms        provided in sections 196.1100 to 196.1130;
in sections 196.1100 to 196.1130 without a         and four shall be appointed to four-year
majority vote in each house of the general         terms;                                             (2) The life sciences research board shall
assembly. All moneys in the fund shall be                                                             monitor and adopt such rules as are necessary
used for the purposes of sections 196.1100 to      (2) The members of the board shall be              to assure quality and accountability in the
196.1130 only. Notwithstanding the provi-          generally familiar with the life sciences and
                                                                                                                                                48
                                                         Missouri Revised Statutes
Statutes

operation of the centers for excellence for life   (8) Before any center for excellence is con-        sciences research trust fund shall be appro-
sciences research;                                 sidered to be a center for excellence for life      priated to the life sciences research board
                                                   sciences research under sections 196.1100 to        to increase the capacity for quality of life
(3) One St. Louis area center for excellence       196.1130, its composition and organizational        sciences research at public and private not-
may be established within the geographical         structure shall be approved by the life sci-        for-profit institutions in the state of Missouri
area encompassing the city of St. Louis and        ences research board;                               and to thereby:
St. Louis, St. Charles, Jefferson, and Frank-
lin counties. If any part of a municipality is     (9) Any center for excellence for life sciences     (1) Improve the quantity and quality of life
located within any one such county and also        research that is established within a geo-          sciences research at public and private not-
encompasses a part of another county in this       graphical area specified in sections 196.1100       for-profit institutions, including but not lim-
state, the entire area encompassed within the      to 196.1130 shall be comprised of a con-            ited to basic research (including the discovery
city limits of such municipality shall be a part   sortium of public and private not-for-profit        of new knowledge), translational research
of the geographical area of the St. Louis area     academic, research, or health care institutions     (including translating knowledge into a us-
center for excellence;                             or organizations that have collectively at          able form), and clinical research (including
                                                   least fifteen million dollars in annual research    the literal application of a therapy or inter-
(4) One Kansas City area center for excel-         expenditures in the life sciences, including a      vention to determine its efficacy), including
lence may be established within the geo-           collective minimum of two million dollars in        but not limited to health research in human
graphical area encompassing Jackson, Clay,         basic research in life sciences;                    development and aging, cancer, endocrine,
Andrew, Buchanan, and Platte counties. If                                                              cardiovascular, neurological, pulmonary,
any part of a municipality is located within       (10) Each center for excellence for life sci-       and infectious disease, and plant sciences,
any one such county and also encompasses a         ences research shall appoint a screening com-       including but not limited to nutrition and food
part of another county in this state, the entire   mittee. The centers, through their screening        safety; and
area encompassed within the city limits of         committees, shall solicit, collect, prioritize,
such municipality shall be a part of the geo-      and forward to the life sciences research           (2) Enhance technology transfer and technol-
graphical area of the Kansas City area center      board proposed research initiatives for con-        ogy commercialization derived from research
for excellence;                                    sideration for funding by the board. Members        at public and private not-for-profit institu-
                                                   of each screening committee shall generally         tions within the centers for excellence. For
(5) One Springfield center for excellence may      be familiar with the life sciences and current      purposes of sections 196.1100 to 196.1130,
be established within the geographical area        trends and developments with either technical       “technology transfer and technology com-
encompassing Greene, Christian, and Webster        or scientific expertise in the life sciences with   mercialization” includes stages of the regular
counties;                                          an understanding of life sciences and with          business cycle occurring after research and
                                                   an understanding of the application of the          development of a life science technology,
(6) A Missouri statewide center for excel-         results of life sciences research. No member        including but not limited to reduction to prac-
lence may be established that shall encom-         of a screening committee shall be employed          tice, proof of concept, and achieving federal
pass the institutions, agricultural research       by any public or private entity eligible to re-     Food and Drug Administration, United States
centers dedicated to the development of            ceive financial support from the life sciences      Department of Agriculture, or other regula-
plant-made pharmaceuticals, and campuses           research trust fund; and                            tory requirements in addition to the definition
within the University of Missouri system and                                                           in section 348.251, RSMo.
those regions of Missouri not encompassed          (11) The centers for excellence for life sci-
within another center for excellence; pro-         ences research shall have any and all pow-          Funds received by the board may be used for
vided that the University of Missouri-Kansas       ers attendant to carrying out the operations        purposes authorized in sections 196.1100 to
City and the University of Missouri-St. Louis      that are not contrary to the provisions of          196.1130 and shall be subject to the restric-
shall participate in the centers for excellence    sections 196.1100 to 196.1130 or any rules,         tions of sections 196.1100 to 196.1130,
in their respective geographical regions;          guidelines, or decisions adopted by the life        including but not limited to the costs of per-
                                                   sciences research board.                            sonnel, supplies, equipment, and renovation
(7) The life sciences research board shall                                                             or construction of physical facilities; pro-
receive and review suggestions for the forma-      (L. 2003 H.B. 688)                                  vided that in any single fiscal year no more
tion and composition of the initial centers for                                                        than ten percent of the moneys appropriated
excellence. After receiving and reviewing          Section 196.1109                                    shall be used for the construction of physi-
such suggestions, the life sciences research                                                           cal facilities and further provided that in any
board shall determine the initial composition,                                                         fiscal year eighty percent of the moneys shall
and shall consider and approve the organiza-       Moneys appropriated from                            be appropriated to build research capacity at
tional plan and structure of the St. Louis area,                                                       public and private not-for-profit institutions
Kansas City area, Springfield area, and Mis-       trust fund, purposes.                               and twenty percent of the moneys shall be ap-
souri statewide centers for excellence;                                                                propriated for grants to public or private not-
                                                   196.1109 All moneys that are appropri-
                                                   ated by the general assembly from the life                                                      49
                                                         Missouri Revised Statutes
Statutes

for-profit institutions to promote life science    the life sciences research board that are not
technology transfer and technology commer-         distributed by the board in any fiscal year to a
cialization. Of the moneys appropriated to         center for excellence or a center for excel-       Annual audit by state auditor
build research capacity, twenty percent of the     lence endorsed program pursuant to section         or private accounting firm--
moneys shall be appropriated to promote the        196.1112, if any, shall be held in reserve by
development of research of tobacco-related                                                            audit available to public--ev-
                                                   the board or shall be awarded on the basis of
illnesses.                                         peer review panel recommendations for ca-          ery three years comprehensive
                                                   pacity building initiatives proposed by public     report for governor and gen-
(L. 2003 H.B. 688)                                 and private not-for-profit academic, research,
                                                   or health care institutions or organizations, or   eral assembly, content--audit
Section 196.1112                                   individuals engaged in competitive research        and report not administrative
                                                   in targeted fields consistent with the provi-      expense.
                                                   sions of sections 196.1100 to 196.1130.
Projects for centers to be                                                                            196.1118 The life sciences research board
determined by board, subject                       2. The life sciences research board may, in        shall make provision for and secure the state
                                                   view of the limitations expressed in section       auditor or outside public accounting firm
to peer review--distribution of                    196.1130:                                          an annual audit of its financial affairs and
funds, amounts authorized.                                                                            the moneys expended from the life sciences
                                                   (1) Award and enter into grants or contracts       research trust fund. Such audit shall be
                                                   relating to increasing Missouri’s research         performed on a fiscal year basis and the cost
196.1112 In determining projects to autho-         capacity at public or private not-for-profit
rize, the life sciences research board shall                                                          of such audit shall not be considered as an
                                                   institutions;                                      administrative expense for purposes of sub-
consider those proposals endorsed by a center
for excellence, subject to a process of peer                                                          section 3 of section 196.1115. The board shall
                                                   (2) Make provision for peer review panels to       make copies of each audit available to the
review conducted under the auspices of the         recommend and review research projects;
board, and shall also consider the potential                                                          public. Every three years the board, with the
of any proposal to bring both health and                                                              assistance of its staff or independent contrac-
                                                   (3) Contract for administrative and support        tors as determined by the board, shall prepare
economic benefits to the people of Missouri.       services;
Specifically, at least eighty percent of the                                                          a comprehensive report assessing the work
moneys that are appropriated to the board in                                                          and progress of the life sciences research pro-
                                                   (4) Lease or acquire facilities and equipment;     gram. Such assessment report shall analyze
each fiscal year shall be distributed to public
and private not-for-profit institutions or orga-                                                      the impact of the board’s programs, grants,
                                                   (5) Employ administrative staff; and               and contracts performed, shall be provided to
nizations whose programs and proposals have
been recommended by a center for excel-                                                               the governor and the general assembly, and
                                                   (6) Receive, retain, hold, invest, disburse or     shall be available to the public. The cost of
lence that meets the requirements set forth in     administer any moneys that it receives from
subdivisions (8) and (9) of section 196.1106.                                                         such assessment report shall not be consid-
                                                   appropriations or from any other source.           ered an administrative expense for purposes
Collectively, the institutions or organizations
within a single center for excellence shall                                                           of subsection 3 of section 196.1115.
                                                   3. The life sciences research board shall
receive in a single fiscal year no more than       utilize as much of the moneys as reason-
fifty percent of the moneys appropriated to                                                           (L. 2003 H.B. 688)
                                                   ably possible for building capacity at public
the board during such fiscal year. No single       and private not-for-profit institutions to
institution or organization shall receive in       do research rather than for administrative         Section 196.1121
any consecutive three-fiscal-year period more      expenses. The board shall not in any fiscal
than forty percent of the moneys appropri-         year expend more than two percent of the
ated to the board during such three-fiscal-year    total moneys appropriated to it and of the         Reimbursement of costs al-
period.                                            moneys that it has in reserve or has received      lowed if four-part test met--
                                                   from other sources for its own administrative      institutions or organizations
(L. 2003 H.B. 688)                                 expenses; provided, however, that the general
                                                   assembly by appropriation from the life            receiving grants or awards to
Section 196.1115                                   sciences research trust fund may authorize a       retain title to all inventions,
                                                   limited amount of additional moneys to be
                                                   expended for administrative costs.                 data and discoveries--rule-
Board’s powers, duties and                                                                            making authority.
limitation on expenditures.                        (L. 2003 H.B. 688)
                                                                                                      196.1121. Grant or contract awards made
196.1115 1. The moneys appropriated to             Section 196.1118                                                                             50
                                                         Missouri Revised Statutes
Statutes

with moneys appropriated from the life sci-        of interest guidelines to be                       human being at any of the stages of biologi-
ences research trust fund shall provide for the                                                       cal development of an unborn child from
reimbursement of costs. Whether reimburse-
                                                   developed.
                                                                                                      conception or inception onward;
ment of specific costs is allowed depends on
                                                   196.1124 No member of the life sciences
the application of a four-part test balancing                                                         (3) “Conception”, the same meaning as such
                                                   research board shall be employed by any
which shall include:                                                                                  term is defined in section 188.015, RSMo;
                                                   public or private not-for-profit entity entitled
                                                   to receive financial support from the life sci-
(1) The reasonableness of the cost;                                                                   (4) “Facilities and administrative costs”,
                                                   ences research trust fund, or participate in the
                                                   making of any decision by the board to make        those costs that are incurred for common or
(2) The connection to the grant or contract;                                                          joint objectives and therefore cannot be iden-
                                                   any grant to the board member, any person
                                                   who is related to the board member within          tified readily and specifically with a particular
(3) The consistency demonstrated in assign-                                                           research project or any other institutional
                                                   the fourth degree of consanguinity or affinity,
ing costs to the grant or contract; and                                                               activity;
                                                   any public entity for which the board member
                                                   serves as an officer, director, or other member
(4) Conformance with the specific terms and                                                           (5) “Human cloning”, the creation of a hu-
                                                   of the entity’s governing body, or any private
conditions of the award or contract.                                                                  man being by any means other than by the
                                                   entity for which the board member or the
                                                   member’s spouse is employed, serves as             fertilization of an oocyte of a human female
The life sciences research board may from                                                             by a sperm of a human male;
                                                   an officer, director, or other member of the
time to time issue rules and guidelines consis-
                                                   entity’s governing body. The board may from
tent with such four-part test and provide grant                                                       (6) “Prohibited human research”, research in
                                                   time to time issue conflict of interest guide-
and contract recipients with a list or other                                                          a research project in which there is the taking
                                                   lines and requirements with respect to the
explanation of regularly permitted costs.                                                             or utilization of the organs, tissues, or cellular
                                                   administration of the life sciences research
                                                   program, to govern the actions of its employ-      material of:
2. Grant and contract recipients shall preserve
                                                   ees and agents, and to implement the provi-
research freedom, ensure timely disclosure of                                                         (a) A deceased child, unless consent is given
                                                   sions of this section.
their research findings to the scientific com-                                                        by the parents in a manner provided in sec-
munity, including through publications and                                                            tions 194.210 to 194.290, RSMo, relating to
                                                   (L. 2003 H.B. 688)
presentations at scientific meetings, and pro-                                                        anatomical gifts, and neither parent caused
mote utilization, commercialization, and pub-                                                         the death of such child or consented to an-
lic availability of their inventions and other     Section 196.1127                                   other person causing the death of such child;
intellectual property developed as a general
institutional policy. Institutions or organiza-                                                       (b) A living child, when the intended or likely
tions receiving grant or contract awards shall     Appropriation to board sub-                        result of such taking or utilization is to kill or
retain all right, title, and interest, including   ject to certain requirements.                      cause harm to the health, safety, or welfare of
all intellectual property rights, in and to any                                                       such child, or when the purpose is to target
and all inventions, ideas, data, improve-          196.1127 1. The moneys appropriated to the         such child for possible destruction in the
ments, modifications, know-how, creations,         life sciences research board pursuant to sec-      future;
copyrightable material, trade secrets, meth-       tions 196.1100 to 196.1124 shall be subject to
ods, processes, discoveries, and derivatives,      the provisions of this section.                    (7) “Public funds”, include:
regardless of patentability, that are made in
the performance of work under a grant award.       2. As used in this section, the following terms    (a) Any moneys received or controlled by the
The life sciences research board shall adopt       shall mean:                                        state of Missouri or any official, department,
reasonable rules to ensure that any such intel-                                                       division, agency, or political subdivision
lectual property rights are utilized reasonably    (1) “Abortion services” include perform-           thereof, including but not limited to moneys
and in a manner that is in the public interest.    ing, inducing, or assisting with abortions,        derived from federal, state, or local taxes,
                                                   as defined in section 188.015, RSMo, or            gifts, or grants from any source, settlements
(L. 2003 H.B. 688)                                 encouraging patients to have abortions, refer-     of any claims or causes of action, public or
                                                   ring patients for abortions not necessary to       private, bond proceeds, federal grants or pay-
Section 196.1124                                   save the life of the mother, or development of     ments, or intergovernmental transfers;
                                                   drugs, chemicals, or devices intended to be
                                                   used to induce an abortion;                        (b) Any moneys received or controlled by an
Board members not to be                                                                               official, department, division, or agency of
                                                   (2) “Child”, a human being recognized as a         state government or any political subdivision
employed by public or private                      minor pursuant to the laws of this state, in-      thereof, or to any person or entity pursuant
entity receiving financial sup-                    cluding if in vivo, an unborn child as defined     to appropriation by the general assembly or
port from trust fund--conflict                     in section 188.015, RSMo, and if in vitro, a
                                                                                                                                                  51
                                                         Missouri Revised Statutes
Statutes

governing body of any political subdivision        ect, person, or entity unless included in the      establish a program to award grants for the
of this state;                                     original application for the award of public       establishment of umbilical cord blood banks
                                                   funds or in subsequent amendments or re-           to be located in this state and for the expan-
(8) “Research project”, research proposed          quests to use separate contractors. A research     sion of existing umbilical cord blood banks
to be funded by an award of public funds           project that receives an award of public funds     located in this state. The purposes and activi-
conducted under the auspices of the entity         shall maintain financial records that demon-       ties of umbilical cord blood banks eligible
or entities that applied for and received such     strate strict compliance with this subsection.     for grants for this program shall be directed
award, regardless of whether the research is       Any audit conducted pursuant to any grant          towards gathering, collecting, and preserv-
funded in whole or in part by such award.          or contract awarding public funds shall also       ing umbilical cord and placental blood only
Such research shall include basic research,        certify whether there is compliance with this      from live births and providing such blood
including the discovery of new knowledge;          subsection and shall note any noncompliance        and blood components primarily to recipients
translational research, including translational    as a material audit finding.                       who are unrelated to the donors of the blood,
knowledge in a usable form; and clinical                                                              and towards persons and institutions conduct-
research, including but not limited to health      4. The provisions of this section shall inure to   ing scientific research requiring sources of
research in human development and aging,           the benefit of all residents of this state. Any    human stem cells.
cancer, endocrine, cardiovascular, neurologi-      taxpayer of this state or any political subdivi-
cal, pulmonary, and infectious disease.            sion of this state shall have standing to bring    3. The board shall, by rule, establish eligibil-
                                                   suit against the state of Missouri or any offi-    ity criteria for awarding grants under this
3. Public funds shall not be expended, paid,       cial, department, division, agency, or political   section. In awarding grants, the board shall
or granted to or on behalf of an existing          subdivision of this state, and any recipient       consider:
or proposed research project that involves         of public funds who or which is in violation
abortion services, human cloning, or pro-          of this subsection in any circuit court with       (1) The ability of the applicant to establish,
hibited human research. A research project         jurisdiction to enforce the provisions of this     operate, and maintain an umbilical cord blood
that receives an award of public funds shall       section.                                           bank and to provide related services;
not share costs with another research proj-
ect, person, or entity not eligible to receive     5. This section shall not be construed to          (2) The experience of the applicant in operat-
public funds pursuant to this subsection;          permit or make lawful any conduct that is          ing similar facilities; and
provided that a research project that receives     otherwise unlawful pursuant to the laws of
an award of public funds may pay a pro rata        this state.                                        (3) The applicant’s commitment to continue
share of facilities and administrative costs                                                          to operate and maintain an umbilical cord
determined in the award of public funds ac-        6. Any provision of this section is not sever-     blood bank after the expiration of the terms
cording to standards that ensure that public       able from any appropriation subject to this        of the contract required by subsection 4 of
funds do not in any way subsidize facilities       section or any application declared by any         this section.
and administrative costs of other research         court to be subject to this section. If any pro-
projects, persons, or entities not eligible to     vision of this section is found to be invalid or   4. Recipients of grants awarded shall enter
receive public funds pursuant to this subsec-      unconstitutional, any appropriation subject to     into contracts under which each recipient
tion. The application for an award of public       this section or any appropriation declared by      agrees to:
funds shall set forth the proposed rates of pro    any court to be subject to this section shall be
rata cost reimbursement and shall provide          void, invalid, and unenforceable.                  (1) Operate and maintain an umbilical cord
supporting data and rationale for such rates.                                                         blood bank in this state at least until the
All applicants for and recipients of awards        (L. 2003 H.B. 688)                                 eighth anniversary of the date of the award of
of public funds shall comply with the cost                                                            the grant;
accounting principles set forth in Part 9905 of    Section 196.1129
Title 48 of the Code of Federal Regulations,                                                          (2) Gather, collect, and preserve umbilical
or successor regulations, in connection with                                                          cord blood only from live births; and
the application for and administration of the      Umbilical cord blood banks,
research project. All moneys derived from an                                                          (3) Comply with any financial or reporting
award of public funds shall be expended only       grants awarded, when--eligi-                       requirements imposed on the recipient under
by checks, drafts, or electronic transfers using   bility criteria.                                   rules adopted by the board.
a separate accounting process maintained for
each research project. No moneys derived           196.1129 1. For purposes of this section,          5. The grants authorized under this section
from an award of public funds shall be used        the term “board” shall mean the life sciences      shall be awarded subject to funds specifically
to cover costs for any other research project      research board established under section           appropriated for that purpose.
or to any other person or entity. No moneys        196.1103.
derived from an award of public funds shall                                                           (L. 2005 S.B. 323)
be passed through to any other research proj-      2. Subject to appropriations, the board shall
                                                                                                                                                  52
                                                         Missouri Revised Statutes
Statutes


Section 196.1130

Rules to become effective,
when
196.1130. No rule or portion of a rule pro-
mulgated pursuant to the authority of sections
196.1100 to 196.1130 shall become effective
unless it has been promulgated pursuant to
chapter 536, RSMo.

(L. 2003 H.B. 688)




                                                                             53
                                                 Missouri Revised Statutes
Statutes


                       Missouri Revised Statutes

                    TITLE XII
           PUBLIC HEALTH AND WELFARE
                  August 28, 2009
    Chapter 197 -- Medical Treatment Facility Licenses
                                 Section 197.010. Citation of law.

                                   Section 197.020. Definitions.

                                 Section 197.030. Purposes of law.

Section 197.032. Hospitals and medical personnel may refuse abortions—no denial of public benefits
                               for such refusal—civil action, when.

                           Section 197.040. License for hospital required.

                      Section 197.050. Application for license, contents—fee.

            Section 197.060. License to issue, when—annual renewal—not transferable.

                   Section 197.070. Denial, suspension or revocation of license.

                  Section 197.071. Review by administrative hearing commission.

                   Section 197.080. Rules, procedure—regulations and standards.

              Section 197.090. Existing hospitals to be allowed time to meet standards.

 Section 197.100. Inspections by department of health and senior services and certain other agencies
                                                                                                 54
                                      Missouri Revised Statutes
Statutes

              accepted, when—department to determine life safety, and building codes.

    Section 197.120. Operating hospital without license a misdemeanor—proceedings to restrain.

                     Section 197.150. Procedures for compliance, requirements.

 Section 197.152. Protection for reporting infection control concerns, reporting required—authority
  of infection control officers, review of orders—good faith reporting of infection control concerns
                                               protected.

                 Section 197.154. Regulation review and update required, standards.

                   Section 197.156. Definition of nosocomial infection outbreaks.

                  Section 197.158. Complaint procedure to be provided to patients.

Section 197.160. Infection data to be available to department of health and senior services, violation,
                              effect, state payments suspended, when.

   Section 197.162. Infection control practices to be considered in licensure process, annual report
                                              required.

  Section 197.165. Infection control advisory panel appointed—members—expenses, fund created.

                                    Section 197.200. Definitions.

                            Section 197.205. License required to operate.

                       Section 197.210. Application, form of—fee, exception.

Section 197.215. License to issue, when—transfer or assignment of license, when—display required.

                    Section 197.220. Denial, suspension or revocation of license.

   Section 197.221. Review of license denial or revocation by administrative hearing commission.

       Section 197.225. Department of health and senior services may promulgate regulations.

 Section 197.230. Department may inspect and investigate—delegation of such authority authorized,
                                                                                                    55
                                       Missouri Revised Statutes
Statutes

                                                when.

 Section 197.235. Failure to have license a misdemeanor—attorney general to act for department—
                           advertising, cannot imply state operation, fine.

    Section 197.240. Accident and health insurers to cover care in an ambulatory surgical center,
                                           exceptions.

                                    Section 197.250. Definitions.

                         Section 197.252. Certificate required—standards.

 Section 197.254. Application for certificate—fee, how determined—temporary permit —survey and
                         approval—posting of certificate—branch offices.

  Section 197.256. Renewal, when required, form, fee—survey, approval, renewal of certificate—
                   certificate not renewed is void—statistical reports required.

   Section 197.258. Department authorized to make surveys, when required—visiting of homes—
 survey of other governmental agency, requirements—reciprocal agreements with bordering states—
                      maintenance of branch office in Missouri required, when.

Section 197.260. Report of compliance, service—disclosure of reports, confidentiality of information.

                     Section 197.262. Denial of application, grounds—review.

           Section 197.264. Client’s bill of rights, contents—discharge planning, contents.

                            Section 197.266. Abuse and neglect, penalty.

                           Section 197.268. Complaints, grounds, review.

                         Section 197.270. Promulgation of rules, procedure.

Section 197.272. State hospice advisory council established—members, qualifications—appointment,
                          terms, reappointment—compensation—duties.

                      Section 197.274. Action to enjoin violations, where filed.

                                Section 197.276. Violations, penalty.
                                                                                                    56
                                       Missouri Revised Statutes
Statutes


             Section 197.278. Department responsibility for inspection and certification.

                  Section 197.280. Order authorizing entry for survey, grounds for.

   Section 197.285. Protections for hospital and ambulatory surgical center employees for certain
       disclosures—written policy required—procedures for disclosure—anonymous reports.

Section 197.287. Training programs related to quality of patient care and safety required—standards
                      developed by department of health and senior services.

      Section 197.289. Adequate nurse staffing, methodology required, minimum requirements.

   Section 197.291. Technical advisory committee on quality of patient care and nursing practices
                           established, members, appointment, duties.

   Section 197.293. Licensure regulations, standards used by the department of health and senior
                                    services for enforcement.

 Section 197.294. Use of certain information to establish standard of care prohibited in private civil
                                              actions.

                    Section 197.295. Licensure enforcement, appeals, procedure.

           Section 197.297. Rulemaking authority, department of health and senior services.

                                   Section 197.300. Citation of law.

                                     Section 197.305. Definitions.

             Section 197.310. Review committee, members, terms, compensation, duties.

      Section 197.311. Political contributions to committee members by applicants prohibited.

 Section 197.312. Certificate of need not required for St. Louis residential care facilities and assisted
                           certain other facilities, certificate not required.

   Section 197.314. Inapplicability of sections to dementia care units in certain counties (including
                     Jackson County) and to certain not-for-profit corporations.

                                                                                                      57
                                        Missouri Revised Statutes
Statutes

Section 197.315. Certificate of need granted, when—forfeiture, grounds—application for certificate,
                                 fee—certificate not required, when.

 Section 197.316. Certificate of need not required for nursing homes treating only AIDS patients—
                                        violations, penalty.

 Section 197.317. Certificate not to be issued for certain facilities—utilization of demographic data.

 Section 197.318. Certification ineligibility not to apply, when—department certification of no need
 final—ethnic and religious composition of residents may be considered—no expenditure minimum,
 expiration date—licensed and available, defined—review of letters of intent —application of law in
                            pending court cases—expansion procedures.

                                 Section 197.320. Rules and regulations.

                               Section 197.325. Submission of applications.

   Section 197.326. Lobbyist and interest registration required, when, contents, penalty —general
assembly member prohibited from accepting contributions, when—certain persons may not offer gifts,
                                           when, penalty.

 Section 197.327. Certificate issued for additional beds for Medicaid patients, use for nonMedicaid
                               patients, penalty—procedure to collect.

                              Section 197.330. Duties of review committee.

                                     Section 197.335. Appeals, venue.

                                  Section 197.340. Notices to committee.

                  Section 197.345. Actions taken prior to October 1, 1980, not affected.

                 Section 197.355. Certificate required before funds may be appropriated.

 Section 197.357. Reimbursement for project cost-overrun in excess of ten percent, eligible when—
                                         requirements.

           Section 197.366. Health care facilities, definition, effective after December 31, 2001.

                        Section 197.367. Licensed bed limitation imposed, when.
                                                                                                     58
                                          Missouri Revised Statutes
Statutes


                                    Section 197.400. Definitions.

                     Section 197.405. Home health agencies, license required.

                           Section 197.410. Application for license, fee.

                     Section 197.415. License issued or renewed, requirements.

    Section 197.416. Out-of-state applicants for licensure, compliance history may be requested.

   Section 197.420. License not transferable or assignable on sale or transfer of ownership—new
                       application, requirement—temporary license, when.

                     Section 197.425. Survey inspections by department, when.

    Section 197.430. Report on survey, list of deficiencies, content—plan of correction filed with
                    department—resurvey and administrative review procedure.

                              Section 197.435. Complaint procedure.

      Section 197.440. Refusal to issue, suspension or revocation of license, grounds —right to
                                       administrative review.

                         Section 197.445. Rules and regulations, procedure.

    Section 197.450. Home health services advisory council—members—terms, qualifications—
                             appointment—vacancies—expenses.

                                Section 197.455. Injunctions, venue.

                   Section 197.460. Exempt persons and religious organizations.

                     Section 197.465. Funds to be deposited in general revenue.

    Section 197.470. Reports or investigations open to public, exception—requests for material,
                                         procedure, fee.

                                Section 197.475. Violations, penalty.

Section 197.477. Reports of inspections by department of health and senior services may be available
                                                                                                 59
                                       Missouri Revised Statutes
Statutes

                    to public, when—certain information to remain confidential.

 Section 197.478. Home health agency information to be provided on department Internet web site.

Section 197.480. In-home health care providers, transfer of assets or bequests, rebuttable presumption
                                    of undue influence, when.

                  Section 197.500. Employee disqualification list to be maintained.

   Section 197.700. Medical staff membership to be considered on individual basis, discrimination
                                           prohibited.

   Section 197.705. Health care facilities personnel required to wear identification badges, when.




                                                                                                     60
                                       Missouri Revised Statutes
Statutes

Section 197.010                                                                                      nate against another for refusal to perform or
                                                                                                     participate in an abortion shall be liable to the
                                                  Section 197.030                                    party injured in an action at law, suit in equity
Citation of law.                                                                                     or other redress.
                                                  Purposes of law.
197.010 This law may be cited and re-                                                                (L. 1973 H.B. 731 & 793 §§ 1, 2, 3)
ferred to as the "Hospital Licensing Law".        197.030 The purpose of this law is to pro-
                                                  vide for the development, establishment and
(L. 1953 p. 631 § 1)                              enforcement of standards for the care and          Section 197.040
                                                  treatment of individuals in hospitals and for
                                                  the construction, maintenance and operation
                                                  of hospitals, which, in the light of advancing     License for hospital required.
Section 197.020                                   knowledge, will promote safe and adequate
                                                  treatment of such individuals in hospitals.        197.040 After ninety days from the date this
                                                                                                     law becomes effective, no person or govern-
Definitions.                                                                                         mental unit, acting severally or jointly with
                                                  (L. 1953 p. 631 § 3)
                                                                                                     any other person or governmental unit, shall
197.020 1. "Governmental unit" means any                                                             establish, conduct or maintain a hospital in
county, municipality or other political subdi-                                                       this state without a license under this law
vision or any department, division, board or      Section 197.032                                    issued by the department of health and senior
other agency of any of the foregoing.                                                                services.

2. "Hospital" means a place devoted primar-       Hospitals and medical per-                         (L. 1953 p. 631 § 4)
ily to the maintenance and operation of facili-   sonnel may refuse abortions-
ties for the diagnosis, treatment or care for
not less than twenty-four consecutive hours       -no denial of public benefits
in any week of three or more nonrelated           for such refusal--civil action,                    Section 197.050
individuals suffering from illness, disease,
injury, deformity or other abnormal physical      when.
conditions; or a place devoted primarily to                                                          Application for license, con-
provide for not less than twenty-four consec-     197.032 1. No physician or surgeon, reg-           tents--fee.
utive hours in any week medical or nursing        istered nurse, practical nurse, midwife or
care for three or more nonrelated individuals.    hospital, public or private, shall be required
                                                                                                     197.050 Application for a license shall be
The term "hospital" does not include conva-       to treat or admit for treatment any woman
                                                                                                     made to the department of health and senior
lescent, nursing, shelter or boarding homes as    for the purpose of abortion if such treatment
                                                                                                     services upon forms provided by it and shall
defined in chapter 198, RSMo.                     or admission for treatment is contrary to the
                                                                                                     contain such information as the department
                                                  established policy of, or the moral, ethi-
                                                                                                     of health and senior services requires, which
3. "Person" means any individual, firm, part-     cal or religious beliefs of, such physician,
                                                                                                     may include affirmative evidence of ability to
nership, corporation, company or association      surgeon, registered nurse, midwife, practical
                                                                                                     comply with such reasonable standards, rules
and the legal successors thereof.                 nurse or hospital. No cause of action shall
                                                                                                     and regulations as are lawfully prescribed
                                                  accrue against any such physician, surgeon,
                                                                                                     hereunder. Until June 30, 1989, each applica-
(L. 1953 p. 631 § 2, A.L. 1959 S.B. 19, A.L.      registered nurse, midwife, practical nurse or
                                                                                                     tion for a license, except applications from
1994 H.B. 1408 merged with H.B. 1427)             hospital on account of such refusal to treat or
                                                                                                     governmental units, shall be accompanied by
Effective 6-3-94 (H.B. 1408) 8-28-94 (H.B.        admit for treatment any woman for abortion
                                                                                                     an annual license fee of two hundred dol-
1427)                                             purposes.
                                                                                                     lars plus two dollars per bed for the first one
                                                                                                     hundred beds and one dollar per bed for each
(1995) Outpatient radiation therapy services      2. No person or institution shall be denied or
                                                                                                     additional bed. Beginning July 1, 1989, each
operated by hospital in commercial building       discriminated against in the reception of any
                                                                                                     application for a license, except applications
was not open twenty-four hours in any day         public benefit, assistance or privilege whatso-
                                                                                                     from governmental units, shall be accompa-
and is not a hospital, therefore is not subject   ever or in any employment, public or private,
                                                                                                     nied by an annual license fee of two hundred
to certificate of need law. SSM Health Care v.    on the grounds that they refuse to undergo
                                                                                                     fifty dollars plus three dollars per bed for the
Missouri Health Facilities Review Commit-         an abortion, to advise, consent to, assist in or
                                                                                                     first four hundred beds and two dollars per
tee, 894 S.W.2d 674 (Mo. en banc).                perform an abortion.
                                                                                                     bed for each additional bed. All license fees
                                                                                                     shall be paid to the director of revenue and
                                                  3. Any person who shall deny or discrimi-

                                                                                                                                                61
                                                        Missouri Revised Statutes
Statutes

deposited in the state treasury to the credit of   Section 197.071                                    Section 197.090
the general revenue fund.

(L. 1953 p. 631 § 5, A.L. 1961 p. 517, A.L.        Review by administrative                           Existing hospitals to be al-
1982 S.B. 575, A.L. 1988 H.B. 1134)                hearing commission.                                lowed time to meet standards.
Effective 5-4-88
                                                   197.071 Any person aggrieved by an official        197.090 Any hospital which is in operation
                                                   action of the department of health and senior      at the time of the promulgation of any appli-
Section 197.060                                    services affecting the licensed status of a per-   cable rule or regulation or minimum standard
                                                   son under the provisions of sections 197.010       under this law shall be given a reasonable
                                                   to 197.120, including the refusal to grant,        time under the particular circumstances not
License to issue, when--annual                     the grant, the revocation, the suspension, or      to exceed two years from the date of such
                                                   the failure to renew a license, may seek a         promulgation within which to comply with
renewal--not transferable.                         determination thereon by the administrative        such rules and regulations and minimum
                                                   hearing commission pursuant to the provi-          standards.
197.060 1. Upon receipt of an application for      sions of section 621.045, RSMo, and it shall
a license, the department of health and senior     not be a condition to such determination that      (L. 1953 p. 631 § 9)
services shall issue a license if the applicant    the person aggrieved seek a reconsideration,
and hospital facilities meet the requirements      a rehearing, or exhaust any other procedure
established under this law. A license, unless      within the department of health and senior
sooner suspended or revoked, shall be renew-                                                          Section 197.100
                                                   services.
able annually upon receipt of an application
for a license and the license fee from the         (L. 1978 S.B. 661)                                 Inspections by department
licensee and approval by the department of
health and senior services.                                                                           of health and senior services
                                                   Section 197.080                                    and certain other agencies
2. Each license shall be issued only for the
premises and persons or governmental units                                                            accepted, when--department
named in the application, and shall not be         Rules, procedure--regulations                      to determine life, safety, and
transferable or assignable except with the                                                            building codes.
written approval of the department of health       and standards.
and senior services. Licenses shall be posted                                                         197.100 1. Any provision of chapter 198,
in a conspicuous place on the licensed prem-       197.080 The department of health and senior
                                                   services, with the advice of the state advisory    RSMo, and chapter 338, RSMo, to the
ises.                                                                                                 contrary notwithstanding, the department of
                                                   council and pursuant to the provisions of this
                                                   section and chapter 536, RSMo, shall adopt,        health and senior services shall have sole au-
(L. 1953 p. 631 § 6)                                                                                  thority, and responsibility for inspection and
                                                   amend, promulgate and enforce such rules,
                                                   regulations and standards with respect to all      licensure of hospitals in this state including,
                                                   hospitals or different types of hospitals to be    but not limited to all parts, services, func-
Section 197.070                                    licensed hereunder as may be designed to           tions, support functions and activities which
                                                   further the accomplishment of the purposes         contribute directly or indirectly to patient
                                                   of this law in promoting safe and adequate         care of any kind whatsoever. The department
Denial, suspension or revoca-                                                                         of health and senior services shall annually
                                                   treatment of individuals in hospitals in the
tion of license.                                   interest of public health, safety and welfare.     inspect each licensed hospital and shall make
                                                   No rule or portion of a rule promulgated           any other inspections and investigations as it
197.070 The department of health and senior        under the authority of sections 197.010 to         deems necessary for good cause shown. The
services may deny, suspend or revoke a             197.280 shall become effective unless it has       department of health and senior services shall
license in any case in which it finds that there   been promulgated pursuant to the provisions        accept reports of hospital inspections from
has been a substantial failure to comply with      of section 536.024, RSMo.                          governmental agencies and recognized ac-
the requirements established under this law.                                                          crediting organizations in whole or in part for
                                                   (L. 1953 p. 631 § 8, A.L. 1993 S.B. 52, A.L.       licensure purposes if:
(L. 1953 p. 631 § 7, A.L. 1978 S.B. 661)           1995 S.B. 3)
                                                                                                      (1) The inspection is comparable to an
                                                                                                      inspection performed by the department of
                                                                                                      health and senior services;

                                                                                                                                                62
                                                         Missouri Revised Statutes
Statutes

                                                  (L. 1953 p. 631 § 12)                             full benefits of that section. Such infection
(2) The hospital meets minimum licensure                                                            control officers shall report any interference
standards; and                                                                                      in the performance of their duties by their
                                                                                                    supervisors to the hospital or ambulatory
(3) The inspection was conducted within one
                                                  Section 197.150                                   surgical center compliance officer established
year of the date of license renewal.                                                                by and empowered to act pursuant to section
                                                  Procedures for compliance,                        197.285.
The department of health and senior services
shall attempt to schedule inspections and         requirements.                                     2. Infection control officers as defined in
evaluations required by this section so as not                                                      federal regulation shall also have the author-
to cause a hospital to be subject to more than    197.150 The department shall require that         ity to order the cessation of a practice that
one inspection in any twelve-month period         each hospital, ambulatory surgical center, and    falls outside accepted practices as defined
from the department of health and senior          other facility have in place procedures for       by appropriate state and federal regulatory
services or any agency or accreditation orga-     monitoring and enforcing compliance with          agencies, accreditation organizations, or the
nization the reports of which are accepted for    infection control regulations and standards.      standards adopted by the Centers for Disease
licensure purposes pursuant to this section,      Such procedures shall be coordinated with         Control and Prevention or the Association
except for good cause shown.                      administrative staff, personnel staff, and the    of Professionals in Infection Control and
                                                  quality improvement program. Such proce-          Epidemiology. The hospital or ambulatory
2. Other provisions of law to the contrary        dures shall include, at a minimum, require-       surgical center may require that such a ces-
notwithstanding, the department of health and     ments for the facility's infection control        sation order of an infection control officer
senior services shall be the only state agency    program to conduct surveillance of personnel      be endorsed by the hospital or ambulatory
to determine life safety and building codes       with a portion of the surveillance to be done     surgical center chief executive officer or his
for hospitals defined or licensed pursuant        in such manner that employees and medical         or her designee before taking effect. The hos-
to the provisions of this chapter, including      staff are observed without their knowledge of     pital or ambulatory surgical center infection
but not limited to sprinkler systems, smoke       such observation, provided that this unob-        control committee shall convene as soon as
detection devices and other fire safety related   served surveillance requirement shall not be      possible to review such cessation order and
matters so long as any new standards shall        considered to be grounds for licensure en-        may overrule or sustain the directive of the
apply only to new construction.                   forcement action by the department until the      infection control officer. The department shall
                                                  department establishes clear and verifiable       promulgate rules governing documentation of
(L. 1953 p. 631 § 10, A.L. 1988 H.B. 1134)        criteria for determining compliance. Such         such events.
Effective 5-4-88                                  surveillance also may include monitoring of
                                                  the rate of use of hand hygiene products.         3. Members of the medical staff who report
                                                                                                    in good faith infection control concerns to
                                                  (L. 2004 S.B. 1279)                               the hospital or ambulatory surgical center ad-
Section 197.120                                                                                     ministration or medical staff leadership shall
                                                                                                    not be subject to retaliation or discrimination
                                                  Section 197.152                                   for doing so. Nothing in this section shall
Operating hospital without                                                                          prevent or shield medical staff members from
                                                                                                    being subject to professional review actions
license a misdemeanor--pro-                       Protection for reporting infec-                   for substandard care or breach of standards
ceedings to restrain.                             tion control concerns, report-                    established in hospital policy, rules, or medi-
                                                                                                    cal staff bylaws.
197.120 1. Any person establishing, conduct-      ing required--authority of in-
ing, managing or operating any hospital with-     fection control officers, review (L. 2004 S.B. 1279)
out a license under this law shall be guilty of
a misdemeanor.
                                                  of orders--good faith reporting
                                                  of infection control concerns
2. The attorney general shall represent the       protected.                       Section 197.154
department of health and senior services, who
may institute an action in the name of the
state for injunction or other process against     197.152 1. Infection control officers as de-      Regulation review and update
any person or governmental unit to restrain or    fined in federal regulation and other hospital    required, standards.
prevent the establishment, conduct, manage-       and ambulatory surgical center employees
ment or operation of a hospital without a         shall be protected against retaliation by the     197.154. No later than July 1, 2005, the de-
license under this law.                           hospital or ambulatory surgical center for        partment shall review and update its current
                                                  reporting infection control concerns pursuant
                                                  to section 197.285 and shall be entitled to the                                             63
                                                        Missouri Revised Statutes
Statutes

regulations governing hospital and ambulato-      Complaint procedure to be                          be considered in licensure pro-
ry surgical center infection control programs.
Such standards shall be based upon nationally     provided to patients.                              cess, annual report required.
recognized standards and shall include, but
                                                  197.158 Every hospital and ambulatory              197.162 The department shall in its licensure
not be limited to, standards for:
                                                  surgery center shall, beginning June 1, 2006,      of hospitals and ambulatory surgical centers
                                                  provide each patient an opportunity to submit      give special attention to infection control
(1) Maintaining databases to be used for
                                                  to the hospital or ambulatory surgical center      practices and shall direct hospitals and am-
infection tracking;
                                                  administration complaints, comments, and           bulatory surgical centers to set quantifiable
                                                  suggestions related to the care they received      measures of performance for reducing the
(2) Developing hospital protocols related
                                                  or their personal observations related to the      incidence of nosocomial infections in Mis-
to aseptic technique and infection control
                                                  quality of care provided. The department           souri. The department shall prepare an annual
practices including but not limited to hand
                                                  shall promulgate rules to implement this sec-      report on infection control standards and
washing, isolation, and other infection control
                                                  tion.                                              compliance, which shall be shared with the
policies;
                                                                                                     governor and the general assembly.
(3) Developing appropriate corrective action      (L. 2004 S.B. 1279)
                                                                                                     (L. 2004 S.B. 1279)
plans and follow-ups for any deficiencies
identified in hospital infection control prac-
tices;                                            Section 197.160
                                                                                                     Section 197.165
(4) Conducting root cause analysis and
follow-up of sentinel events, as defined by       Infection data to be available
                                                                                                     Infection control advisory
the Joint Commission on Accreditation of          to department of health and
Health Organizations, attributable to nosoco-                                                        panel appointed--members--
mial infections; and                              senior services, violation, ef-
                                                                                                     expenses, fund created.
                                                  fect, state payments suspend-
(5) Ensuring that hospital and ambulatory         ed, when.                                          197.165 1. The department shall appoint an
surgical center policies and medical staff
                                                                                                     "Infection Control Advisory Panel" for the
bylaws are in place to promote and enforce        197.160 The department of health and senior        purposes of implementing sections 192.131
compliance with infection control policies.       services shall have access to all data and         and 192.667, RSMo.
                                                  information held by hospitals, ambulatory
(L. 2004 S.B. 1279)                               surgical centers, and other facilities related     2. Members of the infection control advisory
                                                  to their infection control practices, rates, or    panel shall include:
                                                  treatments of infections. Failure to provide
Section 197.156                                   such access shall be grounds for full or partial   (1) Two public members;
                                                  licensure suspension or revocation pursu-
                                                  ant to section 197.293, sections 197.010 to        (2) Three board-certified or board-eligible
Definition of nosocomial infec-                   197.100, or sections 197.200 to 197.240. If        physicians licensed pursuant to chapter 334,
tion outbreaks.                                   the department determines that the hospital,       RSMo, who are affiliated with a Missouri
                                                  ambulatory surgical center, or other facility      hospital or medical school, active members of
197.156 For purposes of reporting nosoco-         is willfully impeding access to such informa-      the Society for Health Care Epidemiology of
mial infection outbreaks as required by de-       tion, the department shall be authorized to        America, and have demonstrated interest and
partment rule, the term "nosocomial infection     direct all state agencies to suspend all or a      expertise in health facility infection control;
outbreaks" shall mean infections as defined       portion of state payments to such hospital
by the national Centers for Disease Control       until such time as the desired information is      (3) One physician licensed pursuant to chap-
and Prevention within a defined time period.      obtained by the department.                        ter 334, RSMo, who is active in the practice
The time period shall be defined by the de-                                                          of medicine in Missouri and who holds medi-
partment based upon the number of infected        (L. 2004 S.B. 1279)                                cal staff privileges at a Missouri hospital;
patients in a facility.
                                                                                                     (4) Four infection control practitioners certi-
(L. 2004 S.B. 1279)                                                                                  fied by the certification board of infection
                                                  Section 197.162                                    control and epidemiology, at least two of
                                                                                                     whom shall be practicing in a rural hospital
                                                                                                     or setting and at least two of whom shall be
Section 197.158
                                                  Infection control practices to                     registered professional nurses licensed under
                                                                                                                                                64
                                                          Missouri Revised Statutes
Statutes

chapter 335, RSMo;                                                                                    Section 197.210
                                                  (2) "Dentist", any person currently licensed
(5) A medical statistician with an advanced       to practice dentistry pursuant to chapter 332,
degree in such specialty; *                       RSMo;                                               Application, form of--fee, ex-
(6) A clinical microbiologist with an ad-
                                                                                                      ception.
                                                  (3) "Department", the department of health
vanced degree in such specialty;                  and senior services;                                197.210. 1. Application for a license shall be
                                                                                                      made to the department upon forms provided
(7) Three employees of the department, rep-       (4) "Governmental unit", any city, county or        by the department and shall contain such
resenting the functions of hospital and ambu-     other political subdivision of this state, or any   information as the department may require.
latory surgical center licensure, epidemiology    department, division, board or other agency         The department of health and senior services
and health data analysis, who shall serve as      of any political subdivision of this state;         may require affirmative evidence of ability to
ex officio nonvoting members of the panel.
                                                                                                      comply with such reasonable standards, rules
                                                  (5) "Person", any individual, firm, partner-        and regulations as are lawfully prescribed
3. Reasonable expenses of the panel shall be      ship, corporation, company, or association          under the provisions of sections 197.200 to
paid from private donations made specifically     and the legal successors thereof;                   197.240.
for that purpose to the "Infection Control Ad-
visory Panel Fund", which is hereby created       (6) "Physician", any person currently licensed      2. Each application for a license, except
in the state treasury. If such donations are      to practice medicine pursuant to chapter 334,       applications from governmental units, shall
not received from private sources, then the       RSMo;                                               be accompanied by an annual license fee of
provisions of this act** shall be implemented
                                                                                                      two hundred dollars. All license fees shall be
without the advisory panel.                       (7) "Podiatrist", any person currently licensed     deposited in the state treasury to the credit of
                                                  to practice podiatry pursuant to chapter 330,       general revenue.
(L. 2004 S.B. 1279)                               RSMo.
*Word "and" appears in original rolls.
                                                                                                      (L. 1975 S.B. 1 § 3, A.L. 1982 S.B. 575)
                                                  (L. 1975 S.B. 1 § 1, A.L. 1986 H.B. 1162,
**"This act" (S.B. 1279, 2004) contained          A.L. 1991 H.B. 444, A.L. 2007 H.B. 1055)
numerous sections. Consult Disposition of
Sections table for a definitive listing.                                                              Section 197.215
                                                  Section 197.205
                                                                                                      License to issue, when--trans-
Section 197.200                                   License required to operate.                        fer or assignment of license,
                                                                                                      when--display required.
                                                  197.205 1. No person or governmental unit
Definitions.                                      acting severally or jointly with any other          197.215 1. Upon receipt of an application for
                                                  person or governmental unit shall establish,        a license, the department of health and senior
197.200 As used in sections 197.200 to
                                                  conduct or maintain an ambulatory surgical          services shall issue a license if the applicant
197.240, unless the context clearly indicates
                                                  center in this state without a license under        and ambulatory surgical center facilities meet
otherwise, the following terms mean:
                                                  sections 197.200 to 197.240 issued by the           the requirements established under sections
                                                  department of health and senior services.           197.200 to 197.240, and have provided af-
(1) "Ambulatory surgical center", any public
or private establishment operated primarily                                                           firmative evidence that:
                                                  2. Nothing in sections 197.200 to 197.240
for the purpose of performing surgical proce-
                                                  shall be construed to impair or abridge the         (1) Each member of the surgical staff is a
dures or primarily for the purpose of perform-
                                                  authority of a governmental unit to license         physician, dentist or podiatrist currently
ing childbirths, or any establishment operated
                                                  ambulatory surgical centers, provided that          licensed to practice in Missouri;
for the purpose of performing or inducing
                                                  any ordinance of a governmental unit shall
any second or third-trimester abortions or five
                                                  require compliance with all rules, regulations,     (2) Surgical procedures shall be performed
or more first-trimester abortions per month,
                                                  and standards adopted by the department to          only by physicians, dentists or podiatrists,
and which does not provide services or other
                                                  implement the provisions of sections 197.200        who at the time are privileged to perform sur-
accommodations for patients to stay more
                                                  to 197.240.                                         gical procedures in at least one licensed hos-
than twenty-three hours within the establish-
ment, provided, however, that nothing in this                                                         pital in the community in which the ambula-
                                                  (L. 1975 S.B. 1 § 2, A.L. 1986 H.B. 1162)           tory surgical center is located, thus providing
definition shall be construed to include the
offices of dentists currently licensed pursuant                                                       assurance to the public that patients treated
to chapter 332, RSMo;
                                                                                                                                                 65
                                                        Missouri Revised Statutes
Statutes

in the center shall receive continuity of care    license in any case in which the department         hearing commission pursuant to the provi-
should the services of a hospital be required;    finds that there has been a substantial failure     sions of section 621.045, RSMo, and it shall
alternatively, applicant shall submit a copy of   to comply with the requirements of sections         not be a condition to such determination that
a current working agreement with at least one     197.200 to 197.240, or in any case in which         the person aggrieved seek a reconsideration,
licensed hospital in the community in which       the director of the department makes a find-        a rehearing, or exhaust any other procedure
the ambulatory surgical center is located,        ing that:                                           within the department of health and senior
guaranteeing the transfer and admittance of                                                           services.
patients for emergency treatment whenever         (1) The applicant, or if the applicant is a firm,
necessary;                                        partnership or association, any of its mem-         (L. 1978 S.B. 661, A.L. 1986 H.B. 1162, A.L.
                                                  bers, or if a corporation, any of its officers or   1993 S.B. 52)
(3) Continuous physician services or regis-       directors, or the person designated to manage
tered professional nursing services are pro-      or supervise the facility, has been finally ad-
vided whenever a patient is in the facility;      judicated and found guilty, or entered a plea
                                                  of guilty or nolo contendere, in a criminal
                                                                                                      Section 197.225
(4) Adequate medical records for each patient     prosecution under the laws of any state or
are to be maintained.                             of the United States, for any offense reason-       Department of health and se-
                                                  ably related to the qualifications, functions,
2. Upon receipt of an application for a           or duties of an ambulatory surgical center, or      nior services may promulgate
license, or the renewal thereof, the depart-      for any offense an essential element of which       regulations.
ment shall issue or renew the license if the      is fraud, dishonesty, or an act of violence, or
applicant and program meet the require-           for any offense involving moral turpitude,          197.225 The department of health and senior
ments established under sections 197.200 to       whether or not sentence is imposed;                 services may adopt such reasonable rules,
197.240. Each license shall be issued only for                                                        regulations, and standards for the types of
the persons and premises named in the ap-         (2) The licensure status or record of the appli-    services provided as are necessary to carry
plication. A license, unless sooner suspended     cant, or if the applicant is a firm, partnership    out the provisions of sections 197.200 to
or revoked, shall be issued for a period of one   or association, of any of its members, or if a      197.240, and to assure quality patient care
year.                                             corporation, of any of its officers or direc-       and patient safety, which shall include, but
                                                  tors, or of the person designated to manage         not be limited to:
3. Each license shall be issued only for the      or supervise the facility, from any other state,
premises and persons or governmental units        federal district or land, territory or com-         (1) Construction of the facility including,
named in the application, and shall not be        monwealth of the United States, or of any           but not limited to, plumbing, heating, light-
transferable or assignable except with the        foreign country where the applicant has done        ing, and ventilation which should insure
written consent of the department. Licenses       business in a similar capacity indicates that       the health, safety, comfort, and privacy of
shall be posted in a conspicuous place on the     granting a license to the applicant would be        patients and protection from fire hazard;
licensed premises.                                detrimental to the interests of the public.
                                                                                                      (2) Number, qualifications, and organization
4. If, during the period in which an ambula-      (L. 1975 S.B. 1 § 5, A.L. 1978 S.B. 661, A.L.       of all personnel, having responsibility for any
tory surgical center license is in effect, the    1986 H.B. 1162)                                     part of the care provided to the patients;
license holder or operator legally transfers
operational responsibilities by any process to                                                        (3) Equipment essential to the health, wel-
another person as defined in section 197.200,     Section 197.221                                     fare, and safety of the patients;
an application shall be made for the issuance
of a new license to become effective on the                                                           (4) Facilities, programs, and services to be
transfer date.                                    Review of license denial or                         provided in connection with the care of pa-
                                                                                                      tients in ambulatory surgical centers; and
(L. 1975 S.B. 1 § 4, A.L. 1986 H.B. 1162)         revocation by administrative
                                                  hearing commission.                                 (5) Procedures for peer review and for receiv-
                                                                                                      ing and investigating complaints regard-
Section 197.220                                   197.221 Any person aggrieved by an official         ing any ambulatory surgical center or any
                                                  action of the department of health and senior       physician, dentist, podiatrist, nurse, assistant,
                                                  services affecting the licensed status of a per-    manager, supervisor, or employee practicing
Denial, suspension or revoca-                     son under the provisions of sections 197.200        or working in any such facility.
                                                  to 197.240, including the refusal to grant,
tion of license.                                  the grant, the revocation, the suspension, or       (L. 1975 S.B. 1 § 6, A.L. 1986 H.B. 1162)
                                                  the failure to renew a license, may seek a
197.220 The department of health and senior       determination thereon by the administrative
services may deny, suspend or revoke a                                                                                                           66
                                                        Missouri Revised Statutes
Statutes

                                                   prevent the establishment, conduct, manage-        tient service, except as provided in section
Section 197.230                                    ment, or operation of an ambulatory surgical       376.805, RSMo. Nothing in this section shall
                                                   center without a license issued pursuant to the    apply to a group contract, plan or trust which
                                                   provisions of sections 197.200 to 197.240.         provides health care and surgical care directly
Department may inspect and                                                                            to its members and their dependents. Nothing
                                                   3. Any person operating, conducting, manag-        in this section shall be construed to mandate
investigate--delegation of such                                                                       coverage under an individual or group health
                                                   ing, or establishing an ambulatory surgical
authority authorized, when.                        center who, in the course of advertising,          insurance policy of insurance providing
                                                   promoting, or otherwise publicizing the            coverage on an expense incurred basis, or an
197.230 The department of health and               activities, business, location, or any other       individual or group service or indemnity type
senior services shall make, or cause to be         matter concerning the operations of said           contract issued by a nonprofit corporation, or
made, such inspections and investigations          ambulatory surgical center, uses or employs        any self-insured group health benefit plan or
as it deems necessary. The department may          in any manner the words "State, Missouri,          trust, of any kind or description, to provide
delegate its powers and duties to investigate      State of Missouri, Department of Health            health insurance for services which are usu-
and inspect ambulatory surgical centers to         and Senior Services, the initials 'Mo.'," or       ally performed in a physician's office.
an official of a political subdivision having a    any emblem of the state of Missouri or the
population of at least four hundred fifty thou-    department of health and senior services, for      (L. 1975 S.B. 1 § 9, A.L. 1986 H.B. 1162)
sand if such political subdivision is deemed       the purpose of conveying or in any manner
qualified by the department to inspect and         reasonably calculated to convey the false
investigate ambulatory surgical centers. The
official so designated shall submit a written
                                                   impression that the state of Missouri or any       Section 197.250
                                                   department, agency, bureau, or instrumen-
report of his findings to the department and       tality thereof is involved in the business of
the department may accept the recommenda-          said ambulatory surgical center, or took part      Definitions.
tions of such official if it determines that the   in said advertisement, promotion, publicity,
facility inspected meets minimum standards         or other statement, shall be subject to a fine     197.250 As used in sections 197.250 to
established pursuant to sections 197.200 to        of one hundred dollars per day for each day        197.280, the following terms mean:
197.240.                                           during the period beginning with the day said
                                                   advertisement, promotion, publication, or          (1) "Abuse", any physical, emotional, or
(L. 1975 S.B. 1 § 7)                               statement first appears and ending on the day      sexual maltreatment;
                                                   on which it is withdrawn.
                                                                                                      (2) "Branch office", a location or site from
                                                   (L. 1975 S.B. 1 § 8, A.L. 1986 H.B. 1162)          which a hospice provides services within a
Section 197.235                                                                                       portion of the total geographic area served
                                                                                                      by the parent agency where the area served is
Failure to have license a mis-                     Section 197.240                                    contiguous to or part of the area served by the
                                                                                                      whole agency;
demeanor--attorney general to
act for department--advertis-                      Accident and health insurers                       (3) "Council", the state hospice advisory
                                                                                                      council created in section 197.272;
ing, cannot imply state opera-                     to cover care in an ambulatory
tion, fine.                                        surgical center, exceptions.                       (4) "Department", the department of health
                                                                                                      and senior services;
197.235 1. Any person operating, conduct-          197.240 After September 28, 1975, no
ing, managing, or establishing an ambulatory       individual or group health insurance policy        (5) "Hospice", a coordinated program of
surgical center without a license required by      of insurance providing coverage on an              palliative and supportive services provided
sections 197.200 to 197.240 is guilty of a         expense incurred basis, nor individual or          in both home and inpatient settings which
class A misdemeanor and, upon conviction,          group service or indemnity type contract           provides for physical, psychological, social
shall be subject to a fine of not more than        issued by a nonprofit corporation, nor any         and spiritual care for dying persons and their
five hundred dollars. Each day of continuing       self-insured group health benefit plan or trust,   families where services are provided by a
violation shall constitute a separate offense.     of any kind or description, shall be issued        medically directed interdisciplinary team of
                                                   or payment accepted therefor in renewal or         professionals and volunteers and bereave-
2. The attorney general shall represent the        continuation thereof unless coverage for any       ment care is available to the family following
department of health and senior services and       service performed in an ambulatory surgical        the death of the person;
shall institute an action in the name of the       center is provided for therein if such service
state for injunctive or other relief against any   would have been covered under the terms of         (6) "Neglect", the failure to provide, or
person or governmental unit to restrain or         the policy or contract as an eligible inpa-
                                                                                                                                                  67
                                                         Missouri Revised Statutes
Statutes

arrange for the provisions of, the services        Application for certificate--fee,
which are reasonable and necessary to main-                                                           7. Branch offices shall be located sufficiently
tain the physical and mental health of a client    how determined--temporary                          close to share administration and supervision
when such failure presents either an immi-         permit --survey and approval-                      and services in a manner that renders it un-
nent danger to the health, safety or welfare       -posting of certificate--branch                    necessary for it to be separately certificated,
of the client or a substantial probability that                                                       except as otherwise provided in sections
death or serious physical harm would result.       offices.                                           197.250 to 197.280.
Such failure shall not constitute neglect if the
failure results from circumstances which:          197.254 1. Any person or other entity desir-       (L. 1992 H.B. 899 § 3, A.L. 1996 S.B. 916)
                                                   ing to provide hospice care shall file, with the
(a) Are beyond the control of the person or        department of health and senior services, a
entity failing to provide such services; and       written application for a certificate on a form
                                                   to be prescribed by the director of the depart-    Section 197.256
(b) Render it impossible for the person or         ment. Such application shall be accompanied
entity to provide such services and to arrange     by a fee to be determined by the department        Renewal, when required,
for the provision of such services;                of health and senior services with input from
                                                   the hospice advisory council. The fee will be      form, fee--survey, approval,
(7) "Parent agency", the agency that develops      based on a sliding scale with a minimum of         renewal of certificate--certifi-
and maintains administrative control of sub-       two hundred fifty dollars, maximum seven
                                                   hundred fifty dollars. Any person or entity        cate not renewed is void--sta-
units and branch offices, and also maintains
supervisory control of branch offices;             which exacts no charge shall be exempt             tistical reports required.
                                                   from the provisions of sections 197.250 to
(8) "Physician", a person licensed by the          197.280.                                           197.256. 1. A hospice shall apply for renewal
state board of registration for the healing arts                                                      of its certificate not less than once every
under the provisions of chapter 334, RSMo,         2. The department may issue a temporary op-        twelve months. In addition, such hospice
to practice in this state as a physician and       erating permit to any hospice which has filed      shall apply for renewal not less than thirty
surgeon;                                           an application, pending the approval of such       days before any change in ownership or
                                                   application. Any temporary operating permit        management of the hospice. Such applica-
(9) "Residence", the client's actual dwelling      or certificate issued pursuant to sections         tion shall be accompanied by the appropriate
place, including institutional dwelling places.    197.250 to 197.280 shall be issued only for        fee as set forth in subsection 1 of section
                                                   the person or entity listed on the application.    197.254. Application shall be made upon a
(L. 1992 H.B. 899 § 1)                                                                                form prescribed by the department.
                                                   3. Upon the receipt of the application and the
                                                   fee, if one is required, the department shall      2. Upon receipt of the application and fee, if a
                                                   conduct a survey to evaluate the quality of        fee is required, the department shall conduct
Section 197.252                                    services rendered by an applicant for certi-       a survey to evaluate the quality of services
                                                   fication. The department shall approve the         rendered by an applicant for renewal. The
Certificate required--stan-                        application of and issue a certificate to any      department shall approve the application and
                                                   applicant which is in compliance with all the      renew the certificate of any applicant which
dards.                                             provisions of sections 197.250 to 197.280          is in compliance with sections 197.250 to
                                                   and the rules made pursuant thereto, and           197.280 and the rules made pursuant thereto
197.252 1. No person or other entity shall         which passes the department's survey.              and which passes the department's survey.
provide hospice care, or hold himself out as a
hospice, unless such person has a certificate      4. The hospice shall post the temporary op-        3. The certificate of any hospice which has
pursuant to sections 197.250 to 197.280.           erating permit or certificate under which it is    not been renewed as required by this section
                                                   operating in a conspicuous place in its main       shall be void.
2. All skilled care provided by a hospice shall    office.
be provided in accordance with profession-                                                            4. The department shall require all certifi-
ally accepted standards.                           5. Any certificate issued pursuant to this sec-    cated hospices to submit statistical reports.
                                                   tion shall be subject to renewal as provided in    The content, format, and frequency of such
(L. 1992 H.B. 899 § 2)                             section 197.256.                                   reports shall be prescribed by the department.

                                                   6. Any pharmacy operated by a licensed             (L. 1992 H.B. 899 § 4)
Section 197.254                                    hospice shall be licensed and inspected by
                                                   the board of pharmacy as provided in chapter
                                                   338, RSMo.
                                                                                                                                                68
                                                         Missouri Revised Statutes
Statutes

Section 197.258                                   tion shall maintain a branch office in Mis-
                                                  souri. Such branch office shall maintain all      (L. 1992 H.B. 899 § 6)
                                                  records required by the department for survey
Department authorized to                          and shall be certificated as a hospice.
make surveys, when required-                                                                        Section 197.262
                                                  (L. 1992 H.B. 899 § 5)
-visiting of homes--survey of
other governmental agency,                                                                          Denial of application,
requirements--reciprocal                          Section 197.260                                   grounds--review.
agreements with bordering
                                                                                                    197.262 1. The department may deny any
states--maintenance of branch                     Report of compliance, service-                    hospice application for certification or renew-
office in Missouri required,                      -disclosure of reports, confi-                    al or may suspend or revoke such agency's
when.                                             dentiality of information.                        certificate or invoke intermediate sanctions, if
                                                                                                    the hospice:
197.258. 1. In addition to any survey pursu-      197.260 1. Upon the completion of a survey,
                                                  the department shall prepare a report of          (1) Is out of compliance with any of the pro-
ant to sections 197.250 to 197.280, the de-
                                                  the department's findings with respect to         visions of sections 197.250 to 197.280 and
partment may make such surveys as it deems
                                                  whether the hospice is in compliance or out       the rules made pursuant thereto; or
necessary during normal business hours. The
department shall survey every hospice not         of compliance with the provisions of sections
                                                  197.250 to 197.280 and the rules made pursu-      (2) Obtained its certificate through misrepre-
less than once annually. The hospice shall
                                                  ant thereto. The report shall contain a list of   sentation of, or concealment of, any fact.
permit the department's representatives to
enter upon any of its business premises dur-      deficiencies found and cite each statute or
                                                  rule with which the hospice is found to be out    2. Any hospice may seek a review of any
ing normal business hours for the purpose of
                                                  of compliance. A copy of the report shall be      denial, suspension, or revocation of its certi-
a survey.
                                                  served upon the hospice not later than fifteen    fication or renewal before the administrative
                                                  working days after the survey is completed.       hearing commission, as provided in chapter
2. As a part of its survey of a hospice, the
                                                  The hospice shall inform the department of        621, RSMo.
department may visit the home of any client
of such hospice with such client's consent.       the time necessary for compliance and shall
                                                  file a plan of correction with the department     (L. 1992 H.B. 899 § 7)
3. In lieu of any survey required by sections     within ten days of the receipt of the defi-
197.250 to 197.280, the department may            ciency list. As used in this subsection, "days"
accept in whole or in part the survey of any      shall exclude weekends and state holidays.        Section 197.264
state or federal agency, or of any professional
accrediting agency, if such survey:               2. The department of health and senior ser-
                                                  vices may disclose to the public final reports    Client's bill of rights, contents-
(1) Is comparable in scope and method to the      of the inspections or surveys showing the         -discharge planning, contents.
department's surveys; and                         standards by which inspections or surveys
                                                  were conducted, whether such standards were
                                                  met, and, if such standards were not met, in      197.264 1. The hospice shall submit to the
(2) Is conducted within one year of initial
                                                  what manner they were not met and how the         department for approval a bill of rights that
application for or renewal of the hospice's
                                                  facility proposed to correct or did correct the   shall be equally applicable to all clients. This
certificate.
                                                  deficiencies. All other information whatsoev-     bill of rights shall at least include the client's
                                                  er, including information and reports submit-     right to be fully informed about his care alter-
4. The department shall not be required to
                                                  ted to the department of health and senior        natives, including choice of service provid-
survey any hospice providing service to Mis-
                                                  services by governmental agencies and recog-      ers, charges and payment resources, the right
souri residents through an office located in
                                                  nized accrediting organizations in whole or       to be a full participant in the development
a state bordering Missouri if such bordering
                                                  in part for certification purposes pursuant to    of his plan of care and the right to be treated
state has a reciprocal agreement with Mis-
                                                  sections 197.250 to 197.280, collected during     with dignity and respect. The hospice shall
souri on hospice certification and the area
                                                  such inspections or surveys or information        provide each client with a copy of its bill of
served in Missouri by the agency is contigu-
                                                  which is derived as a result of such inspec-      rights. The hospice shall ensure that each of
ous to the area served in the bordering state.
                                                  tions or surveys shall be confidential and        its clients can fully receive each provision of
                                                  shall be disclosed only to the person or orga-    its approved bill of rights.
5. Any hospice which has its parent office
in a state which does not have a reciprocal       nization which is the subject of the inspection
agreement with Missouri on hospice certifica-     or survey or a representative thereof.
                                                                                                                                                69
                                                        Missouri Revised Statutes
Statutes

2. Discharge planning shall be an ongoing        State hospice advisory council                      in carrying out the administration of sections
responsibility of the agency. Appropriate                                                            197.250 to 197.280, and shall:
discharge activity shall include reasonable      established--members, quali-
notice of discharge to the client or respon-     fications--appointment, terms,                      (1) Consult and advise with the department
sible party or both.                                                                                 in matters of policy affecting administration
                                                 reappointment--compensa-                            of sections 197.250 to 197.280, and in the
(L. 1992 H.B. 899 § 8)                           tion--duties.                                       development of rules, regulations and stan-
                                                                                                     dards provided for under sections 197.250 to
                                                 197.272 1. There is hereby established a            197.280;
                                                 "State Hospice Advisory Council" which
Section 197.266                                  shall guide, advise and make recommenda-            (2) Review and make recommendations with
                                                 tions to the department of health and senior        respect to rules, regulations and standards
Abuse and neglect, penalty.                      services.                                           authorized under sections 197.250 to 197.280
                                                                                                     prior to their promulgation by the department
                                                 2. Members of the council shall be United           of health and senior services.
197.266 Any hospice or employee of a hos-        States citizens and residents of the state for a
pice who knowingly abuses or neglects any        period of not less than one year. The coun-         (L. 1992 H.B. 899 § 12, A.L. 2002 H.B.
client, or misappropriates the property of any   cil shall consist of five members who have          1953)
client, shall be guilty of a class D felony.     experience with hospices. Of the members
                                                 appointed to the council at least one shall be
(L. 1992 H.B. 899 § 9)                           employed by or associated with each of the
                                                 following:
                                                                                                     Section 197.274

Section 197.268                                  (1) A home health agency-based hospice;             Action to enjoin violations,
                                                 (2) A hospital-based hospice; and                   where filed.
Complaints, grounds, review.
                                                 (3) A hospice based in a rural area.                197.274 The department may file an action
197.268 The department shall receive,                                                                to enjoin any violation of sections 197.250
process, and dispose of complaints against       3. All members of the council shall be ap-          to 197.280, or of the rules made pursuant
a hospice. Any person may complain of any        pointed by the director of the department. The      thereto, or both. Such action shall be filed in
suspected abuse, neglect, or misappropriation    term of office of each member shall be for          the circuit court of the county in which such
by a hospice or employee of a hospice. The       five years. Before a member's term expires,         hospice has its parent office, or in which such
department shall make rules providing for the    the director of the department shall appoint        violation is alleged to have occurred.
processing of such complaints.                   a successor to assume the member's duties
                                                 on the expiration of his or her predecessor's       (L. 1992 H.B. 899 § 13)
(L. 1992 H.B. 899 § 10)                          term. A vacancy in the office of a member
                                                 shall be filled by appointment for the unex-
                                                 pired term. The members of the council shall        Section 197.276
Section 197.270                                  annually designate one member to serve as
                                                 chairperson and another to serve as secretary.
                                                                                                     Violations, penalty.
Promulgation of rules, proce-                    4. No member of the council who has served
                                                 two full terms may be reappointed to the            197.276. Any person who violates any provi-
dure.                                            council until at least one year after the expira-   sion of sections 197.250 to 197.280 shall be
                                                 tion of the member's most recent full term of       guilty of a class A misdemeanor, except as
The department shall promulgate rules as                                                             otherwise provided in section 197.266.
                                                 office.
provided in section 197.080 and chapter 536,
RSMo, to effectuate the provisions of sec-                                                           (L. 1992 H.B. 899 § 14)
                                                 5. Members of the council shall receive no
tions 197.250 to 197.280.
                                                 compensation for their service, but shall, sub-
                                                 ject to appropriations, be reimbursed for their
(L. 1992 H.B. 899 § 11, A.L. 1993 S.B. 52)
                                                 actual and necessary expenses incurred in the       Section 197.278
                                                 performance of their duties.

Section 197.272                                  6. The council shall advise and consult with        Department responsibility for
                                                 the department of health and senior services
                                                                                                                                70
                                                       Missouri Revised Statutes
Statutes

inspection and certification.                      cal centers shall establish and implement          maintained pursuant to this subsection and
                                                   a written policy adopted by each hospital          pursuant to the written policy requirements of
197.278. Any provision of chapter 198,             and ambulatory surgical center relating to         this section shall be accessible to the depart-
RSMo, to the contrary notwithstanding, the         the protections for employees who disclose         ment of health and senior services at all times
department shall have sole authority and           information pursuant to subsection 2 of this       and shall be reviewed by the department of
responsibility for inspection and certification    section. This policy shall include a time          health and senior services at least annually.
of hospices in this state, including, but not      frame for completion of investigations related     Complainants shall be notified of the depart-
limited to, the physical facilities.               to complaints, not to exceed thirty days, and      ment of health and senior services' access to
                                                   a method for notifying the complainant of the      such information and of the complainant's
(L. 1992 H.B. 899 § 15)                            disposition of the investigation. This policy      right to notify the department of health and
                                                   shall be submitted to the department of health     senior services of any information concern-
                                                   and senior services to verify implementation.      ing alleged violations of applicable federal or
                                                   At a minimum, such policy shall include the        state laws or administrative rules concerning
Section 197.280                                    following provisions:                              patient care, patient safety or facility safety.

                                                   (1) No supervisor or individual with author-       3. Prior to any disclosure to individuals or
Order authorizing entry for                        ity to hire or fire in a hospital or ambulatory    agencies other than the department of health
survey, grounds for.                               surgical center shall prohibit employees from      and senior services, employees wishing to
197.280. Whenever the depart-                      disclosing information pursuant to subsection      make a disclosure pursuant to the provisions
                                                   2 of this section;                                 of this section shall first report to the individ-
ment has reasonable grounds                                                                           ual or individuals designated by the hospital
to believe that a hospice re-                      (2) No supervisor or individual with author-       or ambulatory surgical center pursuant to
                                                   ity to hire or fire in a hospital or ambulatory    subsection 1 of this section.
quired to be certificated under                    surgical center shall use or threaten to use
sections                                           his or her supervisory authority to knowingly      4. If the compliance officer, compliance com-
                                                   discriminate against, dismiss, penalize or in      mittee or management official discovers cred-
197.250 to 197.280 is operating without a          any way retaliate against or harass an em-         ible evidence of misconduct from any source
certificate, and the department is not permit-     ployee because the employee in good faith re-      and, after a reasonable inquiry, has reason
ted access to survey the hospice, or when a        ported or disclosed any information pursuant       to believe that the misconduct may violate
certificated hospice refuses to permit access      to subsection 2 of this section, or in any way     criminal, civil or administrative law, then the
to the department to survey the hospice, the       attempt to dissuade, prevent or interfere with     hospital or ambulatory surgical center shall
department shall apply to the circuit court of     an employee who wishes to report or disclose       report the existence of misconduct to the
the county in which the premises are lo-           such information;                                  appropriate governmental authority within a
cated for an order authorizing entry for such                                                         reasonable period, but not more than seven
survey. The court shall issue the order if it      (3) Establish a program to identify a compli-      days after determining that there is credible
finds reasonable grounds for the survey or if      ance officer who is a designated person re-        evidence of a violation.
it finds that a certificated hospice has refused   sponsible for administering the reporting and
to permit the department access to survey the      investigation process and an alternate person      5. Reports made to the department of health
hospice.                                           should the primary designee be implicated in       and senior services shall be subject to the
                                                   the report.                                        provisions of section 197.477, provided that
(L. 1992 H.B. 899 § 16)                                                                               the restrictions of section 197.477 shall not
                                                   2. This section shall apply to information         be construed to limit the employee's ability to
                                                   disclosed or reported in good faith by an          subpoena from the original source the infor-
Section 197.285                                    employee concerning:                               mation reported to the department pursuant to
                                                                                                      this section.
                                                   (1) Alleged facility mismanagement or
Protections for hospital and                       fraudulent activity;                               6. Each written policy shall allow employees
ambulatory surgical center                                                                            making a report who wish to remain anony-
                                                   (2) Alleged violations of applicable federal or    mous to do so, and shall include safeguards
employees for certain disclo-                      state laws or administrative rules concerning      to protect the confidentiality of the employee
sures--written policy required-                    patient care, patient safety or facility safety;   making the report, the confidentiality of
                                                   or                                                 patients and the integrity of data, information
-procedures for disclosure--                                                                          and medical records.
anonymous reports.                                 (3) The ability of employees to successfully
                                                   perform their assigned duties.                     7. Each hospital and ambulatory surgical
197.285 1. Hospitals and ambulatory surgi-
                                                   All information disclosed, collected and                                                        71
                                                           Missouri Revised Statutes
Statutes

center shall, within forty-eight hours of the      nursing personnel.                                 ing health and appropriations committees
receipt of a report, notify the employee that                                                         of the general assembly and the department
his or her report has been received and is be-     2. There shall be sufficient licensed and ancil-   of health and senior services no later than
ing reviewed.                                      lary nursing personnel on duty on each nurs-       December thirty-first of each year.
                                                   ing unit to meet the needs of each patient in
(L. 2000 S.B. 788 §§ 197.285, B, A.L. 2001         accordance with accepted standards of quality      3. The department of health and senior
H.B. 328 & 88 merged with H.B. 762)                patient care.                                      services shall provide such support as the
                                                                                                      committee members require to aid it in the
                                                   (L. 2000 S.B. 788 § 2)                             performance of its duties.
Section 197.287
                                                   Section 197.291                                    4. Committee members shall not be compen-
                                                                                                      sated for their services but shall be reim-
Training programs related                                                                             bursed for their actual and necessary expens-
                                                   Technical advisory committee                       es incurred in the performance of their duties.
to quality of patient care and
                                                   on quality of patient care and
safety required--standards                                                                            5. The provisions of this section shall expire
                                                   nursing practices established,                     on December 31, 2011.
developed by department of
                                                   members, appointment, du-
health and senior services.                                                                           (L. 2000 S.B. 788 § 3, A.L. 2006 S.B. 1155)
                                                   ties.                                              Expires 12-31-11
197.287 By July 1, 2001, all hospitals and
ambulatory surgical centers shall provide          197.291. 1. There is hereby established a
training programs, with measurable minimal         "Technical Advisory Committee on the Qual-
training outcomes relating to quality of pa-       ity of Patient Care and Nursing Practices"
tient care and patient safety, to all unlicensed   within the department of health and senior         Section 197.293
staff providing patient care in their facility     services. The committee shall be comprised
within ninety days of the beginning date of        of nine members appointed by the director of
                                                   the department of health and senior services,      Licensure regulations, stan-
employment. Standards for such training
shall be established by the department of          one of whom shall be a representative of the       dards used by the department
health and senior services by rule. It shall       department of health and senior services and       of health and senior services
be a requirement of hospital and ambula-           one of whom shall be a representative of the
tory surgical center licensure pursuant to         general public. In addition, the director shall    for enforcement.
this chapter that all hospitals and ambulatory     appoint three members representing licensed
surgical centers submit documentation to the       registered nurses from a list of recommended       197.293 1. In addition to the powers estab-
department of health and senior services on        appointees provided by the Missouri Nurses         lished in sections 197.070 and 197.220, the
the training program used.                         Association, one member representing li-           department of health and senior services shall
                                                   censed practical nurses from a list of recom-      use the following standards for enforcing
(L. 2000 S.B. 788 § 1)                             mended appointees provided by the Missouri         hospital and ambulatory surgical center licen-
                                                   Licensed Practical Nurses Association, two         sure regulations promulgated to enforce the
                                                   members from a list of recommended ap-             provisions of sections 197.010 to 197.120,
                                                   pointees provided by the Missouri Hospital         sections 197.150 to 197.165, and sections
Section 197.289                                    Association, and one member representing           197.200 to 197.240:
                                                   licensed physicians from a list of recom-
                                                   mended appointees provided by the Missouri         (1) Upon notification of a deficiency in
Adequate nurse staffing, meth-                                                                        meeting regulatory standards, the hospital or
                                                   State Medical Association.
odology required, minimum                                                                             ambulatory surgical center shall develop and
requirements.                                      2. The committee shall work with hospitals,        implement a plan of correction approved by
                                                   nurses, physicians, state agencies, community      the department which includes, but is not lim-
197.289 1. All hospitals and ambulatory            groups and academic researchers to develop         ited to, the specific type of corrective action
surgical centers shall develop and implement       specific recommendations related to staffing,      to be taken and an estimated time to complete
a methodology which ensures adequate nurse         improving the quality of patient care, and         such action;
staffing that will meet the needs of patients.     insuring the safe and appropriate employ-
At a minimum, there shall be on duty at all        ment of licensed nurses within hospitals and       (2) If the plan as implemented does not
times a sufficient number of licensed regis-       ambulatory surgical centers. The committee         correct the deficiency, the department may
tered nurses to provide patient care requiring     shall develop recommendations and submit           either:
the judgment and skills of a licensed regis-       an annual report based on such recommenda-
tered nurse and to oversee the activities of all   tions to the governor, chairpersons of stand-                                                72
                                                         Missouri Revised Statutes
Statutes

(a) Direct the hospital or ambulatory surgical      absence of the director.                         197.071 or section 197.221, an official action
center to develop and implement a plan of                                                            of the department made pursuant to sections
correction pursuant to subdivision (1) of this      (L. 2000 S.B. 788 § 4, A.L. 2004 S.B. 1279)      197.010 to 197.120 or sections 197.200 to
subsection; or                                                                                       197.240 may be appealed to a departmental
                                                                                                     hearing officer. The department of health and
(b) Require the hospital or ambulatory surgi-                                                        senior services shall promulgate rules speci-
cal center to implement a plan of correction
                                                    Section 197.294                                  fying the qualifications of such a hearing of-
developed by the department;                                                                         ficer, establish procedures to ensure impartial
                                                    Use of certain information to                    decisions and provide for comparable appeal
(3) If there is a continuing deficiency after                                                        remedies when a departmental hearing officer
implementation of the plan of correction pur-       establish standard of care pro-                  is unavailable.
suant to subdivision (2) of this subsection and     hibited in private civil actions.
the hospital or ambulatory surgical center has                                                       (L. 2000 S.B. 788 § 5)
had an opportunity to correct such deficiency,      197.294 No information disclosed by the
the department may restrict new inpatient ad-       department to the public pursuant to sec-
missions or outpatient entrants to the service      tions 192.019, 192.020, 192.067, 192.131,        Section 197.297
or services affected by such deficiency;            192.138, 192.665, and 192.667, RSMo, and
                                                    sections 197.150, 197.152, 197.154, 197.156,
(4) If there is a continuing deficiency after the   197.158, 197.160, 197.162, 197.165, and          Rulemaking authority, de-
department restricts new inpatient admis-           197.293 shall be used to establish a standard
sions or outpatient entrants to the service or      of care in a private civil action.
                                                                                                     partment of health and senior
services pursuant to subdivision (3) of this                                                         services.
subsection and the hospital or ambulatory           (L. 2004 S.B. 1279)
surgical center has had an opportunity to cor-                                                       197.297 1. The department of health and
rect such deficiency, the department may sus-                                                        senior services may adopt rules necessary to
pend operations in all or part of the service or                                                     implement the provisions of sections 197.287
services affected by such deficiency;
                                                    Section 197.295                                  to 197.297.

(5) If there is a continuing deficiency after       Licensure enforcement, ap-                       2. No rule or portion of a rule promulgated
suspension of operations pursuant to subdivi-                                                        pursuant to the authority of sections 197.287
sion (4) of this subsection, the department         peals, procedure.                                to 197.297 shall become effective unless it
may deny, suspend or revoke the hospital's or                                                        has been promulgated pursuant to the provi-
ambulatory surgical center's license pursuant       197.295 1. A hospital or ambulatory surgical     sions of chapter 536, RSMo. Any rule or
to section 197.070 or section 197.220.              center aggrieved by a decision of the depart-    portion of a rule, as that term is defined in
                                                    ment pursuant to the provisions of paragraph     section 536.010, RSMo, that is created under
2. Notwithstanding the provisions of sub-           (b) of subdivision (2) and subdivisions (3),     the authority delegated in this section shall
section 1 of this section to the contrary, if       (4) and (5) of subsection 1 of section 197.293   become effective only if it complies with and
a deficiency in meeting licensure standards         may appeal such decision to the administra-      is subject to all of the provisions of chap-
presents an immediate and serious threat to         tive hearing commission pursuant to sec-         ter 536, RSMo, and, if applicable, section
the patients' health and safety, the department     tion 197.071 or section 197.221, and seek        536.028, RSMo. This section and chapter
may, based on the scope and severity of the         judicial review pursuant to section 621.145,     536, RSMo, are nonseverable and if any of
deficiency, restrict access to the service or       RSMo. An appeal of an action to restrict new     the powers vested with the general assembly
services affected by the deficiency until the       inpatient admissions or outpatient entrants,     pursuant to chapter 536, RSMo, to review, to
hospital or ambulatory surgical center has          suspend operations or revoke a license shall     delay the effective date or to disapprove and
developed and implemented an approved plan          be heard on an expedited basis by the admin-     annul a rule are subsequently held unconstitu-
of correction. Decisions as to whether a defi-      istrative hearing commission. The hospital       tional, then the grant of rulemaking author-
ciency constitutes an immediate and serious         or ambulatory surgical center may apply to       ity and any rule proposed or adopted after
threat to the patients' health and safety shall     the administrative hearing commission for an     August 28, 2000, shall be invalid and void.
be made in accordance with guidelines estab-        order to stay or suspend any such departmen-
lished pursuant to regulation of the depart-        tal action pending the commission's findings     (L. 2000 S.B. 788 § 6)
ment of health and senior services and such         and ruling as authorized by section 621.035,
decisions shall be approved by the bureau           RSMo.
of health facility licensing in the department                                                       Section 197.300
of health and senior services, or its succes-       2. If both the department and the hospital
sor agency, or by a person authorized by the        or ambulatory surgical center agree to do
regulations to approve such decisions in the        so, prior to an appeal to the administrative
                                                    hearing commission pursuant to section                                                     73
                                                          Missouri Revised Statutes
Statutes

Citation of law.                                   six hundred thousand dollars in the case           development of health services, determined
                                                   of capital expenditures, or four hundred           on the basis of factors including population
197.300 Sections 197.300 to 197.366 shall          thousand dollars in the case of major medical      and the availability of resources, consisting
be known as the "Missouri Certificate of           equipment, provided, however, that prior to        of a population of not less than five hundred
Need Law".                                         January 1, 2003, the expenditure minimum           thousand or more than three million;
                                                   for beds in such a facility and long-term
(L. 1979 H.B. 222 § 1, A.L. 1996 H.B. 1362)        care beds in a hospital described in section       (9) "Major medical equipment", medical
Effective 7-12-96                                  198.012, RSMo, shall be zero, subject to the       equipment used for the provision of medical
                                                   provisions of subsection 7 of section 197.318;     and other health services;

                                                   (b) For beds or equipment in a long-term care      (10) "New institutional health service":
                                                   hospital meeting the requirements described
Section 197.305                                    in 42 CFR, Section 412.23(e), the expendi-         (a) The development of a new health care
                                                   ture minimum shall be zero; and                    facility costing in excess of the applicable
Definitions.                                                                                          expenditure minimum;
                                                   (c) For health care facilities, new institu-
197.305 As used in sections 197.300 to             tional health services or beds not described       (b) The acquisition, including acquisition by
197.366, the following terms mean:                 in paragraph (a) or (b) of this subdivision one    lease, of any health care facility, or major
                                                   million dollars in the case of capital expen-      medical equipment costing in excess of the
(1) "Affected persons", the person proposing       ditures, excluding major medical equipment,        expenditure minimum;
the development of a new institutional health      and one million dollars in the case of medical
service, the public to be served, and health       equipment;                                         (c) Any capital expenditure by or on behalf of
care facilities within the service area in which                                                      a health care facility in excess of the expendi-
the proposed new health care service is to be      (7) "Health care facilities", hospitals, health    ture minimum;
developed;                                         maintenance organizations, tuberculosis
                                                   hospitals, psychiatric hospitals, intermedi-       (d) Predevelopment activities as defined in
(2) "Agency", the certificate of need program      ate care facilities, skilled nursing facilities,   subdivision (13) hereof costing in excess of
of the Missouri department of health and           residential care facilities and assisted living    one hundred fifty thousand dollars;
senior services;                                   facilities, kidney disease treatment centers,
                                                   including freestanding hemodialysis units,         (e) Any change in licensed bed capacity of a
(3) "Capital expenditure", an expenditure by       diagnostic imaging centers, radiation therapy      health care facility which increases the total
or on behalf of a health care facility which,      centers and ambulatory surgical facilities, but    number of beds by more than ten or more
under generally accepted accounting princi-        excluding the private offices of physicians,       than ten percent of total bed capacity, which-
ples, is not properly chargeable as an expense     dentists and other practitioners of the healing    ever is less, over a two-year period;
of operation and maintenance;                      arts, and Christian Science sanatoriums, also
                                                   known as Christian Science Nursing facilities      (f) Health services, excluding home health
(4) "Certificate of need", a written certifi-      listed and certified by the Commission for         services, which are offered in a health care
cate issued by the committee setting forth         Accreditation of Christian Science Nursing         facility and which were not offered on a regu-
the committee's affirmative finding that a         Organization/Facilities, Inc., and facilities      lar basis in such health care facility within the
proposed project sufficiently satisfies the cri-   of not-for-profit corporations in existence on     twelve-month period prior to the time such
teria prescribed for such projects by sections     October 1, 1980, subject either to the provi-      services would be offered;
197.300 to 197.366;                                sions and regulations of Section 302 of the
                                                   Labor-Management Relations Act, 29 U.S.C.          (g) A reallocation by an existing health care
(5) "Develop", to undertake those activities       186 or the Labor-Management Reporting              facility of licensed beds among major types
which on their completion will result in the       and Disclosure Act, 29 U.S.C. 401-538, and         of service or reallocation of licensed beds
offering of a new institutional health service     any residential care facility or assisted living   from one physical facility or site to another
or the incurring of a financial obligation in      facility operated by a religious organization      by more than ten beds or more than ten per-
relation to the offering of such a service;        qualified pursuant to Section 501(c)(3) of the     cent of total licensed bed capacity, whichever
                                                   federal Internal Revenue Code, as amended,         is less, over a two-year period;
(6) "Expenditure minimum" shall mean:              which does not require the expenditure of
                                                   public funds for purchase or operation, with       (11) "Nonsubstantive projects", projects
(a) For beds in existing or proposed health        a total licensed bed capacity of one hundred       which do not involve the addition, replace-
care facilities licensed pursuant to chapter       beds or fewer;                                     ment, modernization or conversion of beds
198, RSMo, and long-term care beds in a                                                               or the provision of a new health service but
hospital as described in subdivision (3) of        (8) "Health service area", a geographic region     which include a capital expenditure which
                                                   appropriate for the effective planning and
subsection 1 of section 198.012, RSMo,                                                                                                           74
                                                         Missouri Revised Statutes
Statutes

exceeds the expenditure minimum and are                                                             without compensation but shall be reim-
due to an act of God or a normal consequence                                                        bursed for necessary expenses incurred in the
                                                   Section 197.310                                  performance of their duties.
of maintaining health care services, facility or
equipment;
                                                   Review committee, members,                       8. Notwithstanding the provisions of subsec-
(12) "Person", any individual, trust, estate,                                                       tion 4 of section 610.025*, RSMo, the pro-
partnership, corporation, including associa-       terms, compensation, duties.                     ceedings and records of the facilities review
tions and joint stock companies, state or po-                                                       committee shall be subject to the provisions
litical subdivision or instrumentality thereof,    197.310 1. The "Missouri Health Facilities       of chapter 610, RSMo.
including a municipal corporation;                 Review Committee" is hereby established.
                                                   The agency shall provide clerical and ad-        (L. 1979 H.B. 222 § 3, A.L. 1999 S.B. 326)
(13) "Predevelopment activities", expendi-         ministrative support to the committee. The       Effective 7-1-99
tures for architectural designs, plans, working    committee may employ additional staff as it
drawings and specifications, and any arrange-      deems necessary.                                 *Section 610.025 was repealed by S.B. 2,
ment or commitment made for financing; but                                                          1987.
excluding submission of an application for a       2. The committee shall be composed of:
certificate of need.
                                                   (1) Two members of the senate appointed by
                                                   the president pro tem, who shall be from dif-    Section 197.311
(L. 1979 H.B. 222 § 2, A.L. 1982 S.B. 481,
A.L. 1983 H.B. 825, A.L. 1994 H.B. 1408,           ferent political parties; and
A.L. 1996 H.B. 905 merged with H.B. 1362,
                                                   (2) Two members of the house of representa-
                                                                                                    Political contributions to com-
A.L. 1997 S.B. 373, A.L. 1998 S.B. 963, A.L.
1999 S.B. 326)                                     tives appointed by the speaker, who shall be     mittee members by applicants
Effective 7-01-99                                  from different political parties; and            prohibited.
*Reprinted due to editorial change required        (3) Five members appointed by the governor       197.311 No member of the Missouri health
by § 198.005.                                      with the advice and consent of the senate, not   facilities review committee may accept a
                                                   more than three of whom shall be from the        political donation from any applicant for a
CROSS REFERENCE:                                   same political party.                            license.

Health care facilities, definition, effective      3. No business of this committee shall be per-   (L. 1994 H.B. 1408 § 1)
after December 31, 2001, RSMo 197.366              formed without a majority of the full body.      Effective 6-3-94

(1995) Acquisition cost for major medical          4. The members shall be appointed as soon as
equipment for purposes of minimum expen-           possible after September 28, 1979. One of the
                                                   senate members, one of the house members
diture necessary to subject expenditure to
                                                   and three of the members appointed by the        Section 197.312
certificate of need law, refers to cost to hos-
pital and not original purchase price. Cost of     governor shall serve until January 1, 1981,
                                                   and the remaining members shall serve until
land and construction costs for building were
                                                   January 1, 1982. All subsequent members
                                                                                                    Certificate of need not re-
attributable to separate commercial enterprise
and not made by, or on behalf of, health care      shall be appointed in the manner provided in     quired for St. Louis residen-
facility where hospital leased space for outpa-    subsection 2 of this section and shall serve     tial care facilities and assisted
                                                   terms of two years.
tient radiation therapy services. SSM Health                                                        living facilities--certain other
Care v. Missouri Health Facilities Review
Committee, 894 S.W.2d 674 (Mo. en banc).           5. The committee shall elect a chairman at       facilities, certificate not re-
                                                   its first meeting which shall be called by the
                                                   governor. The committee shall meet upon the
                                                                                                    quired.
(2004) Nursing facility's proposal to add
twelve beds constituted a new institutional        call of the chairman or the governor.
                                                                                                    197.312 A certificate of need shall not be
health service requiring certificate of need,                                                       required for any institution previously owned
even though the proposed capital expendi-          6. The committee shall review and approve
                                                                                                    and operated for or in behalf of a city not
ture was below the expenditure minimum.            or disapprove all applications for a certifi-
                                                                                                    within a county which chooses to be licensed
McKnight Place v. Missouri Health Facilities       cate of need made under sections 197.300 to
                                                                                                    as a facility defined under subdivision (21) or
Review Committee, 142 S.W.3d 228 (Mo.              197.366. It shall issue reasonable rules and
                                                                                                    (22) of section 198.006, RSMo, for a facility
App. W.D.).                                        regulations governing the submission, review
                                                                                                    of ninety beds or less that is owned or oper-
                                                   and disposition of applications.
                                                                                                    ated by a not-for-profit corporation which
                                                   7. Members of the committee shall serve                                                    75
                                                         Missouri Revised Statutes
Statutes

is exempt from federal income tax as an           cated in a tax increment financing district es-   charged by statute to license or certify health
organization described in section 501(c)(3) of    tablished prior to 1990 within any county of      care facilities shall issue a license to or cer-
the Internal Revenue Code of 1986, which is       the first classification with a charter form of   tify any such facility, or distinct part of such
controlled directly by a religious organization   government containing a city with a popula-       facility, that is developed without obtaining a
and which has received approval by the divi-      tion of over three hundred fifty thousand and     certificate of need.
sion of aging of plans for construction of such   which district also has within its boundaries a
facility by August 1, 1995, and is licensed       skilled nursing facility.                         4. If any person proposes to develop any
by the division of aging by July 1, 1996, as a                                                      new institutional health care service without
facility defined under subdivision (21) or (22)   2. The provisions of sections 197.300 to          a certificate of need as required by sections
of section 198.006, RSMo, or for a facility,      197.366 shall not apply, as hereinafter stated,   197.300 to 197.366, the committee shall
serving exclusively mentally ill, homeless        to a skilled nursing facility that is owned       notify the attorney general, and he shall apply
persons, of sixteen beds or less that is owned    or operated by a not-for-profit corpora-          for an injunction or other appropriate legal
or operated by a not-for-profit corporation       tion which was created by a special act of        action in any court of this state against that
which is exempt from federal income tax           the Missouri general assembly, is exempt          person.
which is described in section 501(c)(3) of        from federal income tax as an organization
the Internal Revenue Code of 1986, which is       described in Section 501(c)(3) of the Inter-      5. After October 1, 1980, no agency of state
controlled directly by a religious organiza-      nal Revenue Code of 1986, is owned by a           government may appropriate or grant funds
tion and which has received approval by the       religious organization and is to be operated as   to or make payment of any funds to any per-
division of aging of plans for construction of    part of a continuing care retirement commu-       son or health care facility which has not first
such facility by May 1, 1996, and is licensed     nity offering independent living, residential     obtained every certificate of need required
by the division of aging by July 1, 1996, as      care and skilled care. This exemption shall       pursuant to sections 197.300 to 197.366.
a facility defined under subdivision (21) or      authorize no more than twenty additional
(22) of section 198.006, RSMo, or an assisted     skilled nursing beds at each of two facilities    6. A certificate of need shall be issued only
living facility located in a city not within a    which do not have any skilled nursing beds as     for the premises and persons named in the
county operated by a not for profit corpora-      of January 1, 1999.                               application and is not transferable except by
tion which is exempt from federal income                                                            consent of the committee.
tax which is described in section 501(c)(3) of    (L. 1999 S.B. 326 §§ 12, 13)
the Internal Revenue Code of 1986, which is                                                         7. Project cost increases, due to changes in
controlled directly by a religious organization                                                     the project application as approved or due to
and which is licensed for one hundred beds or
less on or before August 28, 1997.
                                                  Section 197.315                                   project change orders, exceeding the initial
                                                                                                    estimate by more than ten percent shall not be
                                                                                                    incurred without consent of the committee.
(L. 1995 S.B. 108 § 1 subsec. 5, A.L. 1996        Certificate of need granted,
H.B. 1362)                                                                                          8. Periodic reports to the committee shall
Effective 7-12-96                                 when--forfeiture, grounds--                       be required of any applicant who has been
                                                  application for certificate, fee--                granted a certificate of need until the project
*Reprinted due to editorial change required
by § 198.005.
                                                  certificate not required, when.                   has been completed. The committee may
                                                                                                    order the forfeiture of the certificate of need
                                                  197.315 1. Any person who proposes to             upon failure of the applicant to file any such
                                                  develop or offer a new institutional health       report.
                                                  service within the state must obtain a certifi-
Section 197.314                                   cate of need from the committee prior to the      9. A certificate of need shall be subject
                                                  time such services are offered.                   to forfeiture for failure to incur a capital
                                                                                                    expenditure on any approved project within
Inapplicability of sections to                    2. Only those new institutional health ser-       six months after the date of the order. The
dementia care units in certain                    vices which are found by the committee to be      applicant may request an extension from the
                                                  needed shall be granted a certificate of need.    committee of not more than six additional
counties (including Jackson                       Only those new institutional health services      months based upon substantial expenditure
County) and to certain not-                       which are granted certificates of need shall      made.
for-profit corporations.                          be offered or developed within the state. No
                                                                                                    10. Each application for a certificate of need
                                                  expenditures for new institutional health ser-
                                                  vices in excess of the applicable expenditure     must be accompanied by an application
197.314 1. The provisions of sections                                                               fee. The time of filing commences with the
197.300 to 197.366 shall not apply to any         minimum shall be made by any person unless
                                                  a certificate of need has been granted.           receipt of the application and the applica-
sixty-bed stand-alone facility designed and                                                         tion fee. The application fee is one thousand
operated exclusively for the care of residents
with Alzheimer's disease or dementia and lo-      3. After October 1, 1980, no state agency                                                    76
                                                        Missouri Revised Statutes
Statutes

dollars, or one-tenth of one percent of the        used in a clinical trial that has received writ-    (L. 1995 S.B. 108 § 1 subsecs. 1 to 4, A.L.
total cost of the proposed project, which-         ten approval from a duly constituted institu-       1999 S.B. 326)
ever is greater. All application fees shall be     tional review board of an accredited school of      Effective 7-1-99
deposited in the state treasury. Because of the    medicine or osteopathy located in Missouri to
loss of federal funds, the general assembly        establish its safety and efficacy and does not
will appropriate funds to the Missouri health      increase the bed complement of the institu-
facilities review committee.                       tion in which the equipment is to be located.
                                                   After the clinical trial has been completed,
                                                                                                       Section 197.317
11. In determining whether a certificate of        a certificate of need must be obtained for
need should be granted, no consideration           continued use in such facility.                     Certificate not to be issued for
shall be given to the facilities or equipment
of any other health care facility located more     (L. 1979 H.B. 222 § 4, A.L. 1982 S.B. 481,          certain facilities--utilization of
than a fifteen-mile radius from the applying       A.L. 1983 H.B. 825, A.L. 1987 S.B. 1, A.L.          demographic data.
facility.                                          1999 S.B. 326)
                                                   Effective 7-1-99                                    197.317 1. After July 1, 1983, no certificate
12. When a nursing facility shifts from a                                                              of need shall be issued for the following:
skilled to an* intermediate level of nursing       *Word "a" appears in original rolls.
care, it may return to the higher level of care                                                        (1) Additional residential care facility, as-
if it meets the licensure requirements, without                                                        sisted living facility, intermediate care facility
obtaining a certificate of need.                                                                       or skilled nursing facility beds above the
                                                                                                       number then licensed by this state;
13. In no event shall a certificate of need be     Section 197.316
denied because the applicant refuses to pro-                                                           (2) Beds in a licensed hospital to be reallo-
vide abortion services or information.                                                                 cated on a temporary or permanent basis to
                                                   Certificate of need not re-                         nursing care or beds in a long-term care hos-
14. A certificate of need shall not be required    quired for nursing homes                            pital meeting the requirements described in
for the transfer of ownership of an existing       treating only AIDS patients--                       42 CFR, Section 412.23(e), excepting those
and operational health facility in its entirety.                                                       which are not subject to a certificate of need
                                                   violations, penalty.                                pursuant to paragraphs (e) and (g) of subdivi-
15. A certificate of need may be granted to                                                            sion (10) of section 197.305; nor
a facility for an expansion, an addition of        197.316 1. The provisions of subsection 10
services, a new institutional service, or for      of section 197.315 and sections 197.317 and         (3) The reallocation of intermediate care
a new hospital facility which provides for         197.318 shall not apply to facilities which are     facility or skilled nursing facility beds of
something less than that which was sought in       licensed pursuant to the provisions of chapter      existing licensed beds by transfer or sale of
the application.                                   198, RSMo, which are designed and operated          licensed beds between a hospital licensed
                                                   exclusively for the care and treatment of per-      pursuant to this chapter or a nursing care
16. The provisions of this section shall not       sons with acquired human immunodeficiency           facility licensed pursuant to chapter 198,
apply to facilities operated by the state, and     syndrome, AIDS.                                     RSMo; except for beds in counties in which
appropriation of funds to such facilities by                                                           there is no existing nursing care facility. No
the general assembly shall be deemed in com-       2. If a facility is granted a certificate of need   certificate of need shall be issued for the real-
pliance with this section, and such facilities     and is found to be exempt from the provi-           location of existing residential care facility or
shall be deemed to have received an appropri-      sions of subsection 10 of section 197.315 and       assisted living facility, or intermediate care
ate certificate of need without payment of any     sections 197.317 and 197.318 pursuant to            facilities operated exclusively for the men-
fee or charge.                                     the provisions of subsection 1 of this section,     tally retarded to intermediate care or skilled
                                                   then only AIDS patients shall be residents of       nursing facilities or beds. However, after
17. Notwithstanding other provisions of this       such facility and no others.                        January 1, 2003, nothing in this section shall
section, a certificate of need may be issued                                                           prohibit the Missouri health facilities review
after July 1, 1983, for an intermediate care       3. Any facility that violates the provisions of     committee from issuing a certificate of need
facility operated exclusively for the mentally     subsection 2 of this section shall be liable for    for additional beds in existing health care
retarded.                                          a fine of one hundred dollars per resident per      facilities or for new beds in new health care
                                                   day for each such violation.                        facilities or for the reallocation of licensed
18. To assure the safe, appropriate, and cost-                                                         beds, provided that no construction shall be-
effective transfer of new medical technology       4. The attorney general shall, upon request of      gin prior to January 1, 2004. The provisions
throughout the state, a certificate of need        the department of health and senior services,       of subsections 16 and 17 of section 197.315
shall not be required for the purchase and         bring an action in a circuit court of competent     shall apply to the provisions of this section.
operation of research equipment that is to be      jurisdiction for violation of this section.
                                                                                                                                                   77
                                                         Missouri Revised Statutes
Statutes

                                                    certification that there is no need for addition-
2. The health facilities review committee           al beds shall serve as the final determination      (a) Submitting a letter of intent to expand to
shall utilize demographic data from the office      and decision of the committee. In determin-         the division of aging and the health facilities
of social and economic data analysis, or its        ing ninety percent occupancy, residential care      review committee;
successor organization, at the University of        facility and assisted living facility shall be
Missouri as their source of information in          one separate classification and intermediate        (b) Certification from the division of aging
considering applications for new institutional      care and skilled nursing facilities are another     that the facility:
long-term care facilities.                          separate classification.
                                                                                                        a. Has no patient care class I deficiencies
(L. 1986 S.B. 553 & 775 § 5, A.L. 1987 S.B.         2. The Missouri health facilities review com-       within the last eighteen months; and
1, A.L. 1990 H.B. 1725, A.L. 1994 H.B.              mittee may, for any facility certified to it by
1408, A.L. 1996 H.B. 1362, A.L. 1999 S.B.           the department, consider the predominant            b. Has maintained a ninety-percent average
326)                                                ethnic or religious composition of the resi-        occupancy rate for the previous six quarters;
Effective 7-01-99                                   dents to be served by that facility in consider-
                                                    ing whether to grant a certificate of need.         (c) Has made an effort to purchase beds for
*Reprinted due to editorial change required                                                             eighteen months following the date the letter
by § 198.005.                                       *3. There shall be no expenditure minimum           of intent to expand is submitted pursuant to
                                                    for facilities, beds, or services referred to       paragraph (a) of this subdivision. For purpos-
                                                    in subdivisions (1), (2) and (3) of section         es of this paragraph, an "effort to purchase"
                                                    197.317. The provisions of this subsection          means a copy certified by the offeror as an
Section 197.318                                     shall expire January 1, 2003.                       offer to purchase beds from another licensed
                                                                                                        facility in the same licensure category; and
                                                    4. As used in this section, the term "licensed
Certification ineligibility not                     and available" means beds which are actu-           (d) If an agreement is reached by the selling
                                                    ally in place and for which a license has been      and purchasing entities, the health facilities
to apply, when--department                          issued.                                             review committee shall issue a certificate of
certification of no need final-                                                                         need for the expansion of the purchaser facil-
-ethnic and religious com-                          5. The provisions of section 197.317 shall not      ity upon surrender of the seller's license; or
                                                    apply to any facility where at least ninety-five
position of residents may be                        percent of the patients require diets meet-         (e) If no agreement is reached by the selling
considered--no expenditure                          ing the dietary standards defined by section        and purchasing entities, the health facilities
                                                    196.165, RSMo.                                      review committee shall permit an expansion
minimum, expiration date--li-                                                                           for:
censed and available, defined-                      6. The committee shall review all letters of
-review of letters of intent                        intent and applications for long-term care          a. A facility with more than forty beds may
                                                    hospital beds meeting the requirements              expand its licensed bed capacity within
--application of law in pending                     described in 42 CFR, Section 412.23(e) under        the same licensure category by twenty-five
court cases--expansion proce-                       its criteria and standards for long-term care       percent or thirty beds, whichever is greater, if
                                                    beds.                                               that same licensure category in such facility
dures.                                                                                                  has experienced an average occupancy of
                                                    7. Sections 197.300 to 197.366 shall not            ninety-three percent or greater over the previ-
197.318 1. The provisions of section 197.317        be construed to apply to litigation pending         ous six quarters;
shall not apply to a residential care facil-        in state court on or before April 1, 1996, in
ity, assisted living facility, intermediate         which the Missouri health facilities review         b. A facility with fewer than forty beds may
care facility or skilled nursing facility only      committee is a defendant in an action con-          expand its licensed bed capacity within the
where the department of social services has         cerning the application of sections 197.300 to      same licensure category by twenty-five per-
first determined that there presently exists a      197.366 to long-term care hospital beds meet-       cent or ten beds, whichever is greater, if that
need for additional beds of that classification     ing the requirements described in 42 CFR,           same licensure category in such facility has
because the average occupancy of all licensed       Section 412.23(e).                                  experienced an average occupancy of ninety-
and available residential care facility, assisted
                                                                                                        two percent or greater over the previous six
living facility, intermediate care facility and     8. Notwithstanding any other provision of           quarters;
skilled nursing facility beds exceeds ninety        this chapter to the contrary:
percent for at least four consecutive calendar
                                                                                                        c. A facility adding beds pursuant to sub-
quarters, in a particular county, and within a      (1) A facility licensed pursuant to chapter         paragraphs a. or b. of this paragraph shall
fifteen-mile radius of the proposed facility,       198, RSMo, may increase its licensed bed            not expand by more than fifty percent of its
and the facility otherwise appears to qualify       capacity by:
for a certificate of need. The department's                                                                                                           78
                                                          Missouri Revised Statutes
Statutes

then licensed bed capacity in the qualifying       (3) The existing facility and proposed facil-        with and is subject to all of the provisions of
licensure category;                                ity shall have the same owner or owners,             chapter 536, RSMo, and, if applicable, sec-
                                                   regardless of corporate or business structure,       tion 536.028, RSMo. All rulemaking author-
(2) Any beds sold shall, for five years from       and such owner or owners shall stipulate in          ity delegated prior to August 28, 1999, is of
the date of relicensure by the purchaser,          writing that the existing facility beds to be        no force and effect and repealed. Nothing
remain unlicensed and unused for any               replaced will not later be used to provide           in this section shall be interpreted to repeal
long-term care service in the selling facility,    long-term care services. If the facility is be-      or affect the validity of any rule filed or
whether they do or do not require a license;       ing operated under a lease, both the lessee          adopted prior to August 28, 1999, if it fully
                                                   and the owner of the existing facility shall         complied with all applicable provisions of
(3) The beds purchased shall, for two years        stipulate the same in writing.                       law. This section and chapter 536, RSMo, are
from the date of purchase, remain in the bed                                                            nonseverable and if any of the powers vested
inventory attributed to the selling facility and   10. Nothing in this section shall prohibit a         with the general assembly pursuant to chapter
be considered by the department of social ser-     health care facility licensed pursuant to chap-      536, RSMo, to review, to delay the effective
vices as licensed and available for purposes       ter 198, RSMo, from being replaced in its            date or to disapprove and annul a rule are
of this section;                                   entirety within fifteen miles of its existing site   subsequently held unconstitutional, then the
                                                   so long as the existing facility and proposed        grant of rulemaking authority and any rule
(4) Any residential care facility** licensed       or replacement facility have the same owner          proposed or adopted after August 28, 1999,
pursuant to chapter 198, RSMo, may relocate        or owners regardless of corporate or business        shall be invalid and void.
any portion of such facility's current licensed    structure and the health care facility being
beds to any other facility to be licensed          replaced remains unlicensed and unused for           (L. 1979 H.B. 222 § 5, A.L. 1993 S.B. 52,
within the same licensure category if both         any long-term care services whether they do          A.L. 1995 S.B. 3, A.L. 1999 S.B. 326)
facilities are under the same licensure owner-     or do not require a license from the date of         Effective 7-1-99
ship or control, and are located within six        licensure of the replacement facility.
miles of each other;
                                                   (L. 1986 S.B. 553 & 775 § 6, A.L. 1992 S.B.
(5) A facility licensed pursuant to chapter        573 & 634, A.L. 1994 H.B. 1408, A.L. 1996
198, RSMo, may transfer or sell individual         S.B. 575, A.L. 1996 H.B. 1362, A.L. 1997
                                                                                                        Section 197.325
long-term care licensed beds to facilities         S.B. 373, A.L. 1999 S.B. 326)
qualifying pursuant to paragraphs (a) and (b)      Effective 7-01-99                                    Submission of applications.
of subdivision (1) of this subsection. Any
facility which transfers or sells licensed beds    *Subsection 3 expires 1-01-03                        197.325 Any person who proposes to devel-
shall not expand its licensed bed capacity in                                                           op or offer a new institutional health service
that licensure category for a period of five       **Revisor's note: The term "residential care         shall submit a letter of intent to the commit-
years from the date the licensure is relin-        facility" may include "assisted living facil-        tee at least thirty days prior to the filing of the
quished.                                           ity", see section 198.005 regarding changes to       application.
                                                   name reference.
9. Any existing licensed and operating health                                                           (L. 1979 H.B. 222 § 6, A.L. 1999 S.B. 326)
care facility offering long-term care services                                                          Effective 7-1-99
may replace one-half of its licensed beds at
the same site or a site not more than thirty       Section 197.320
miles from its current location if, for at least
the most recent four consecutive calendar
quarters, the facility operates only fifty per-    Rules and regulations.                               Section 197.326
cent of its then licensed capacity with every
resident residing in a private room. In such
case:
                                                   197.320 The committee shall have the power           Lobbyist and interest registra-
                                                   to promulgate reasonable rules, regulations,
                                                   criteria and standards in conformity with this       tion required, when, contents,
(1) The facility shall report to the division      section and chapter 536, RSMo, to meet the           penalty --general assembly
of aging vacant beds as unavailable for            objectives of sections 197.300 to 197.366
occupancy for at least the most recent four        including the power to establish criteria and
                                                                                                        member prohibited from ac-
consecutive calendar quarters;                     standards to review new types of equipment           cepting contributions, when--
(2) The replacement beds shall be built to
                                                   or service. Any rule or portion of a rule,           certain persons may not offer
                                                   as that term is defined in section 536.010,
private room specifications and only used for      RSMo, that is created under the authority            gifts, when, penalty.
single occupancy; and                              delegated in sections 197.300 to 197.366
                                                   shall become effective only if it complies
                                                                                                                                                     79
                                                         Missouri Revised Statutes
Statutes

197.326 1. Any person who is paid either as        penalty--procedure to collect.                    sions of law, and its approval or denial of the
part of his normal employment or as a lob-                                                           certificate of need; provided, that the commit-
byist to support or oppose any project before      197.327 1. If a facility is granted a certifi-    tee may grant an extension of not more than
the health facilities review committee shall       cate of need pursuant to sections 197.300 to      thirty days on its own initiative or upon the
register as a lobbyist pursuant to chapter 105,    197.365 based on an application stating a         written request of any affected person;
RSMo, and shall also register with the staff       need for additional Medicaid beds, such beds
of the health facilities review committee for      shall be used for Medicaid patients and no        (5) Cause to be served upon the applicant, the
every project in which such person has an          other.                                            respective health system agency, and any af-
interest and indicate whether such person                                                            fected person who has filed his prior request
supports or opposes the named project. The         2. Any person who violates the provisions of      in writing, a copy of the aforesaid findings,
registration shall also include the names and      subsection 1 of this section shall be liable to   conclusions and decisions;
addresses of any person, firm, corporation or      the state for civil penalties of one hundred
association that the person registering rep-       dollars for every day of such violation. Each     (6) Consider the needs and circumstances of
resents in relation to the named project. Any      nonMedicaid patient placed in a Medicaid          institutions providing training programs for
person violating the provisions of this subsec-    bed shall constitute a separate violation.        health personnel;
tion shall be subject to the penalties specified
in section 105.478, RSMo.                          3. The attorney general shall, upon the           (7) Provide for the availability, based on
                                                   request of the department, bring an action in     demonstrated need, of both medical and os-
2. A member of the general assembly who            a circuit court of competent jurisdiction to      teopathic facilities and services to protect the
also serves as a member of the health facili-      recover the civil penalty. The department may     freedom of patient choice; and
ties review committee is prohibited from so-       bring such an action itself. The civil action
liciting or accepting campaign contributions       may be brought in the circuit court of Cole       (8) Establish by regulation procedures to re-
from any applicant or person speaking for an       County or, at the option of the director, in      view, or grant a waiver from review, nonsub-
applicant or any opponent to any application       another county which has venue of an action       stantive projects.
or persons speaking for any opponent while         against the person under other provisions of
such application is pending before the health      law.                                              The term "filed" or "filing" as used in this
facilities review committee.                                                                         section shall mean delivery to the staff of the
                                                   (L. 1988 H.B. 1368)                               health facilities review committee the docu-
3. Any person regulated by chapter 197 or                                                            ment or documents the applicant believes
198, RSMo, and any officer, attorney, agent                                                          constitute an application.
and employee thereof, shall not offer to any
committee member or to any person em-              Section 197.330                                   2. Failure by the committee to issue a written
ployed as staff to the committee, any office,                                                        decision on an application for a certificate of
appointment or position, or any present, gift,                                                       need within the time required by this section
                                                   Duties of review committee.                       shall constitute approval of and final admin-
entertainment or gratuity of any kind or any
campaign contribution while such application                                                         istrative action on the application, and is
                                                   197.330 1. The committee shall:
is pending before the health facilities review                                                       subject to appeal pursuant to section 197.335
committee. Any person guilty of knowingly                                                            only on the question of approval by operation
                                                   (1) Notify the applicant within fifteen days of
violating the provisions of this section shall                                                       of law.
                                                   the date of filing of an application as to the
be punished as follows: For the first offense,     completeness of such application;
such person is guilty of a class B misde-                                                            (L. 1979 H.B. 222 § 7, A.L. 1986 S.B. 553 &
meanor; and for the second and subsequent                                                            775, A.L. 1987 H.B. 384 Revision, A.L. 1999
                                                   (2) Provide written notification to affected
offenses, such person is guilty of a class D                                                         S.B. 326)
                                                   persons located within this state at the
felony.                                                                                              Effective 7-1-99
                                                   beginning of a review. This notification may
                                                   be given through publication of the review
(L. 1992 S.B. 573 & 634)                                                                             (1987) Failure of Health Facilities Review
                                                   schedule in all newspapers of general circula-
                                                                                                     Committee to issue decision on application
                                                   tion in the area to be served;
                                                                                                     within the time allotted by this section consti-
                                                                                                     tutes approval of application and pendency of
Section 197.327                                    (3) Hold public hearings on all applications
                                                                                                     prior application by same applicant for larger
                                                   when a request in writing is filed by any af-
                                                                                                     hospital at same location is irrelevant. Platte
                                                   fected person within thirty days from the date
                                                                                                     County Medical Center, Inc. v. Mo. Health F.
Certificate issued for addition-                   of publication of the notification of review;
                                                                                                     Review, 734 S.W.2d 608 (Mo. App.).
al beds for Medicaid patients,                     (4) Within one hundred days of the filing
use for nonMedicaid patients,                      of any application for a certificate of need,
                                                   issue in writing its findings of fact, conclu-                                               80
                                                         Missouri Revised Statutes
Statutes

                                                 Section 197.345                                   which the original certificate of need was
                                                                                                   obtained or, in the case of facilities for which
Section 197.335                                                                                    a binding construction or purchase contract
                                                 Actions taken prior to October                    was executed prior to October 1, 1980, the
Appeals, venue.                                  1, 1980, not affected.                            amount of that contract. Reimbursement for
                                                                                                   these excess costs after the first three years
197.335 Within thirty days of the decision       197.345 Any health facility with a project        shall not be made until a certificate of need
of the committee, the applicant may file an      for facilities or services for which a bind-      has been granted for the excess project costs.
appeal to be heard de novo by the administra-    ing construction or purchase contract has         The provisions of this section shall apply
tive hearing commissioner, the circuit court     been executed prior to October 1, 1980, or        only to facilities which file an application for
of Cole County or the circuit court in the       health care facility which has commenced          a certificate of need or make application for
county within which such health care service     operations prior to October 1, 1980, shall be     cost-overrun review of their original applica-
or facility is proposed to be developed.         deemed to have received a certificate of need,    tion or waiver after August 13, 1982.
                                                 except that such certificate of need shall be
(L. 1979 H.B. 222 § 8, A.L. 1986 S.B. 553 &      subject to forfeiture under the provisions of     (L. 1982 H.B. 1086)
775, A.L. 1987 H.B. 384 Revision, A.L. 1999      subsections 8 and 9 of section 197.315.
S.B. 326)
Effective 7-1-99                                 (L. 1979 H.B. 222 § 10)                           Section 197.366
(1984) While a competing facility may be an
"affected person" under sections 197.300 to      Section 197.355                                   Health care facilities, defini-
197.365, it has no right to appeal a decision                                                      tion, effective after December
of the Health Facilities Review Committee.
St. Joseph's Hill Infirmary, Inc. v. Mandl       Certificate required before                       31, 2001.
(Mo. App.) 682 S.W.2d 821.
                                                 funds may be appropriated.                        197.366 The provisions of subdivision (8)
(1987) Competitor of applicant for certificate                                                     of section 197.305 to the contrary notwith-
                                                 197.355 The legislature may not appropriate       standing, after December 31, 2001, the term
of need to construct nursing home lacked
                                                 any money for capital expenditures for health     "health care facilities" in sections 197.300 to
standing to appeal administrative decision to
                                                 care facilities until a certificate of need has   197.366 shall mean:
grant certificate since this section expressly
                                                 been issued for such expenditures.
limits participants in an appeal to applicant
and the health service agency within the af-                                                       (1) Facilities licensed under chapter 198,
                                                 (L. 1979 H.B. 222 § 12)                           RSMo;
fected area. Comm. Care Ctrs. v. Health Fac.
                                                 Effective 10-1-80
Rev. Com., 735 S.W.2d 13 (Mo. App.).
                                                                                                   (2) Long-term care beds in a hospital as de-
                                                                                                   scribed in subdivision (3) of subsection 1 of
                                                                                                   section 198.012, RSMo;

Section 197.340                                  Section 197.357
                                                                                                   (3) Long-term care hospitals or beds in a
                                                                                                   long-term care hospital meeting the re-
Notices to committee.                            Reimbursement for project                         quirements described in 42 CFR, section
                                                                                                   412.23(e); and
                                                 cost-overrun in excess of ten
197.340 Any health facility providing a          percent, eligible when--re-                       (4) Construction of a new hospital as defined
health service must notify the committee         quirements.                                       in chapter 197.
of any discontinuance of any previously
provided health care service, a decrease in      197.357 For the purposes of reimbursement         (L. 1996 H.B. 1362)
the number of licensed beds by ten percent or    under section 208.152, RSMo, project costs        Effective 7-12-96
more, or the change in licensure category for    for new institutional health services in excess
any such facility.                               of ten percent of the initial project estimate    CROSS REFERENCE:
                                                 whether or not approval was obtained under
(L. 1979 H.B. 222 § 9)                           subsection 7 of section 197.315 shall not be      Health care facilities defined until December
Effective 10-1-80                                eligible for reimbursement for the first three    31, 2001, RSMo 197.305
                                                 years that a facility receives payment for ser-
                                                 vices provided under section 208.152, RSMo.
                                                 The initial estimate shall be that amount for
                                                                                                                                                81
                                                       Missouri Revised Statutes
Statutes

Section 197.367                                    providing of home health services in an inter-     197.400 to 197.475.
                                                   rupted interval sequence on the average of
                                                   not to exceed three hours in any twenty-four-      (L. 1983 H.B. 51 § 2)
Licensed bed limitation im-                        hour period;
posed, when.
                                                   (6) "Patient's residence", the actual place of
                                                   residence of the person receiving home health
                                                                                                      Section 197.410
197.367 Upon application for renewal by
any residential care facility or assisted living   services, including institutional residences as
facility which on the effective date of this       well as individual dwelling units;                 Application for license, fee.
act** has been licensed for more than five
years, is licensed for more than fifty beds        (7) "Physician", a person licensed by the          197.410 1. Persons desiring to receive a li-
and fails to maintain for any calendar year its    state board of registration for the healing arts   cense to operate a home health agency in the
occupancy level above thirty percent of its        pursuant to the provisions of chapter 334,         state of Missouri shall file a written applica-
then licensed beds, the division of aging shall    RSMo, to practice in this state as a physician     tion with the department of health and senior
license only fifty beds for such facility.         and surgeon;                                       services on a form prescribed by the director
                                                                                                      of the department.
(L. 1999 S.B. 326 § 8)                             (8) "Plan of treatment", a plan reviewed and
*Reprinted due to editorial change required        signed as often as medically necessary by a        2. The application shall be accompanied by a
by § 198.005.                                      physician or podiatrist, not to exceed sixty       six hundred dollar license fee.
                                                   days in duration, prescribing items and ser-
**"This act" (S.B. 326, 1999) contained more       vices for an individual patient's condition;       (L. 1983 H.B. 51 § 3)
than one effective date.
                                                   (9) "Podiatrist", a person licensed by the state
                                                   board of podiatry pursuant to the provisions
                                                   of chapter 330, RSMo, to practice in this state    Section 197.415
                                                   as a podiatrist;
Section 197.400
                                                   (10) "Subunit" or "subdivision", any organi-
                                                                                                      License issued or renewed,
                                                   zational unit of a larger organization which       requirements.
Definitions.                                       can be clearly defined as a separate entity
                                                   within the larger structure, which can meet        197.415 1. The department shall review the
197.400 As used in sections 197.400 to                                                                applications and shall issue a license to ap-
                                                   all of the requirements of sections 197.400 to
197.475, unless the context otherwise re-                                                             plicants who have complied with the require-
                                                   197.475 independent of the larger organiza-
quires, the following terms mean:                                                                     ments of sections 197.400 to 197.475 and
                                                   tion, which can be held accountable for the
                                                   care of patients it is serving, and which pro-     have received approval of the department.
(1) "Council", the home health services
                                                   vides to all patients care and services meeting
advisory council created by sections 197.400                                                          2. A license shall be renewed annually upon
                                                   the standards and requirements of sections
to 197.475;                                                                                           approval of the department when the follow-
                                                   197.400 to 197.475.
                                                                                                      ing conditions have been met:
(2) "Department", the department of health
                                                   (L. 1983 H.B. 51 § 1, A.L. 1997 H.B. 642)
and senior services;                                                                                  (1) The application for renewal is accompa-
                                                                                                      nied by a six-hundred-dollar license fee;
(3) "Home health agency", a public agency
or private organization or a subdivision or        Section 197.405                                    (2) The home health agency is in compliance
subunit of an agency or organization that pro-                                                        with the requirements established pursu-
vides two or more home health services at the
residence of a patient according to a physi-       Home health agencies, license                      ant to the provisions of sections 197.400 to
                                                                                                      197.475 as evidenced by a survey inspection
cian's written and signed plan of treatment;       required.                                          by the department which shall occur at least
                                                                                                      every thirty-six months for agencies that
(4) "Home health services", any of the fol-        197.405 No home health agency, including           have been in operation thirty-six consecutive
lowing items and services provided at the          Medicare and Medicaid providers, shall pro-        months from initial inspection. The frequency
residence of the patient on a part-time or         vide two or more of the home health services       of inspections for agencies in operation at
intermittent basis: nursing, physical therapy,     covered by subdivision (4) of section 197.400      least thirty-six consecutive months from the
speech therapy, occupational therapy, home         or shall hold itself out as providing such         initial inspection shall be determined by such
health aid, or medical social service;             home health services or as a home health           factors as number of complaints received
                                                   agency unless it is licensed and registered in
(5) "Part-time or intermittent basis", the         accordance with the provisions of sections                                                    82
                                                           Missouri Revised Statutes
Statutes

and changes in management, supervision or                                                           hours for the purpose of conducting the sur-
ownership. The frequency of each survey in-                                                         vey inspection.
spection for any agency in operation less than
thirty-six consecutive months from the initial    Section 197.420                                   (L. 1983 H.B. 51 § 5)
inspection shall occur and be conducted at
least every twelve months;                        License not transferable or
(3) The application is accompanied by a           assignable on sale or transfer                    Section 197.430
statement of any changes in the information       of ownership--new applica-
previously filed with the department pursuant
to section 197.410.                               tion, requirement--temporary                      Report on survey, list of defi-
                                                  license, when.                                    ciencies, content--plan of cor-
3. Each license shall be issued only for the                                                        rection filed with department-
home health agency listed in the application.     197.420 A license shall not be transferable
Licenses shall be posted in a conspicuous         or assignable. When a home health agency is       -resurvey and administrative
place in the main offices of the licensed home    sold or ownership or management is trans-         review procedure.
health agency.                                    ferred, or the corporate legal organization
                                                  status is substantially changed, the license of   197.430 After completion of each depart-
4. In lieu of any survey required by sections     the agency shall be voided and a new license      ment survey, a written report of the findings
197.400 to 197.475, the department may ac-        obtained. Application for a new license shall     with respect to compliance or noncompliance
cept in whole or in part written reports of the   be made to the department in writing, at least    with the provisions of sections 197.400 to
survey of any state or federal agency, or of      ninety days prior to the effective date of the    197.475 and the standards established hereun-
any professional accrediting agency, if such      sale, transfer, or change in corporate status.    der as well as a list of deficiencies found shall
survey:                                           The application for a new license shall be on     be prepared. A copy of the report and the list
                                                  the same form, containing the same infor-         of deficiencies found shall be served upon the
(1) Is comparable in scope and method to the      mation required for an original license, and      home health agency within fifteen business
department's surveys; and                         shall be accompanied by a license fee of six      days following the survey inspection. The
                                                  hundred dollars. The department may issue a       list of deficiencies shall specifically state the
(2) Is conducted within one year of initial       temporary operating permit for the continu-       statute or rule which the home health agency
application or within thirty-six months for       ation of the operation of the home health         is alleged to have violated. If the home health
the renewal of the home health license as         agency for a period of not more than ninety       agency acknowledges the deficiencies found
required by subdivision (2) of subsection 2 of    days pending the survey inspection and            by the survey inspection, the home health
this section.                                     the final disposition of the application. The     agency shall inform the department of the
                                                  department shall require all licensed home        time necessary for compliance and shall file a
(L. 1983 H.B. 51 § 4, subsecs. 1, 2, 3, A.L.      health agencies to submit statistical reports.    plan of correction with the department. If the
1997 H.B. 643 merged with S.B. 373)               The content, format, and frequency of such        home health agency does not acknowledge
                                                  reports shall be determined by the department     the deficiencies, it may request a resurvey
                                                  with council approval.                            by the department. If, after the resurvey, the
Section 197.416                                                                                     home health agency still does not agree with
                                                  (L. 1983 H.B. 51 § 4, subsec. 4)                  the findings of the department, it may seek a
                                                                                                    review of the findings of the department by
Out-of-state applicants for                                                                         the administrative hearing commission.
licensure, compliance history                     Section 197.425                                   (L. 1983 H.B. 51 § 6)
may be requested.
197.416 Whenever the department is inspect-       Survey inspections by depart-
ing a home health agency in response to an        ment, when.                                       Section 197.435
application from an applicant located outside
of Missouri not previously licensed by the        197.425. In addition to the survey inspection
department, the department may request from       required for licensing or license renewal, the    Complaint procedure.
the applicant the past five years compliance      department may make other survey inspec-
history of all home health agencies owned by      tions during normal business hours. Each          197.435 Any person wishing to make a
the applicant located outside of this state.      home health agency shall allow the depart-        complaint against a home health agency
                                                  ment or its authorized representatives to enter   licensed under the provisions of sections
(L. 2003 S.B. 556 & 311)                          upon its premises during normal business                                                      83
                                                        Missouri Revised Statutes
Statutes

197.400 to 197.475 may file the complaint in      Rules and regulations, proce-                    years. No member may serve more than
writing with the department setting forth the                                                      two successive full terms. One member of
details and facts supporting the complaint.       dure.                                            the council shall be a representative of the
If the department determines the charges                                                           department, and such member shall serve
are sufficient to warrant a hearing to deter-     197.445 1. The department may adopt              as chairman of the council. Three members
mine whether the license of the home health       reasonable rules and standards necessary to      shall be citizens selected from the state at
agency should be suspended or revoked, the        carry out the provisions of sections 197.400     large and shall have no connection with any
department shall fix a time and place for a       to 197.477. The rules and standards adopted      home health agency. Five members shall be
hearing and require the home health agency        shall not be less than the standards estab-      representatives of home health agencies and
to appear and defend against the complaint.       lished by the federal government for home        one of these five members shall be selected
A copy of the complaint shall be given to the     health agencies under Title XVIII of the Fed-    from each of the following types of home
home health agency at the time it is notified     eral Social Security Act. The reasonable rules   health agencies:
of the hearing. The notice of the hearing shall   and standards shall be initially promulgated
be given at least twenty days prior to the date   within one year of September 28, 1983.           (1) Public sponsored home health agencies;
of the hearing. The hearing shall be conduct-
ed by the administrative hearing commission       2. The rules and standards adopted by the        (2) Institutional sponsored home health agen-
in accordance with the provisions of chapter      department pursuant to the provisions of         cies;
621, RSMo.                                        sections 197.400 to 197.477 shall apply to all
                                                  health services covered by sections 197.400      (3) Voluntary nonprofit home health agencies;
(L. 1983 H.B. 51 § 7)                             to 197.477 rendered to any patient being
                                                  served by a home health agency regardless of     (4) Private nonprofit home health agencies;
                                                  source of payment for the service, patient's     and
                                                  condition, or place of residence, at which
Section 197.440                                   the home health services are ordered by the      (5) For-profit home health agencies.
                                                  physician or podiatrist. No rule or portion of
                                                  a rule promulgated pursuant to the authority     3. All members of the council shall be ap-
Refusal to issue, suspension or                   of sections 197.400 to 197.477 shall become      pointed by the director of the department.
revocation of license, grounds                    effective unless it has been promulgated         The term of office of each member shall
                                                  pursuant to the provisions of section 536.024,   be for three years or until his successor is
--right to administrative re-                     RSMo.                                            appointed; except that, of the members first
view.                                                                                              appointed, three shall be selected for one
                                                  (L. 1983 H.B. 51 § 9, A.L. 1993 S.B. 52, A.L.    year, three shall be selected for two years,
197.440 1. The department shall refuse to         1995 S.B. 3, A.L. 1997 H.B. 642)                 and three shall be selected for three years.
issue or shall suspend or shall revoke the                                                         Before a member's term expires, the director
license of any home health agency for failure                                                      of the department shall appoint a successor
to comply with any provision of sections                                                           to assume his duties on the expiration of his
197.400 to 197.475 or with any rule or
                                                  Section 197.450                                  predecessor's term. A vacancy in the office of
standard of the department adopted under the                                                       a member shall be filled by appointment for
provisions of sections 197.400 to 197.475 or      Home health services advisory                    the unexpired term.
for obtaining the license by means of fraud,
misrepresentation, or concealment of material     council--members--terms,                         4. The council shall meet not less than quar-
facts.                                            qualifications--appointment--                    terly each year at a place, day and hour deter-
                                                                                                   mined by the council. The council may also
2. Any home health agency which has been
                                                  vacancies--expenses.                             meet at such other times and places as may
refused a license or which has had its license                                                     be designated by the chairman, or upon the
revoked or suspended by the department may        197.450 1. There is hereby created the           request of the majority of the other members
seek a review of the department's action by       "Home Health Services Advisory Council",         of the council.
the administrative hearing commission.            which shall guide, advise and make recom-
                                                  mendations to the department relating to the     5. Members of the council shall receive no
(L. 1983 H.B. 51 § 8)                             rules and standards adopted and the imple-       compensation for their services, but shall be
                                                  mentation and administration of sections         reimbursed, subject to appropriations, for
                                                  197.400 to 197.475.                              their actual and necessary expenses incurred
                                                                                                   in the performance of their duties.
Section 197.445                                   2. Members of the council shall be residents
                                                  of this state. The council shall consist of      (L. 1983 H.B. 51 § 10, A.L. 2002 H.B. 1953)
                                                  members who shall serve for a term of three
                                                                                                                                             84
                                                        Missouri Revised Statutes
Statutes

                                                 (L. 1983 H.B. 51 § 12, A.L. 1990 S.B. 524)         (L. 1983 H.B. 51 § 15)
                                                 Effective 1-1-91
Section 197.455
                                                                                                    Section 197.477
Injunctions, venue.
                                                 Section 197.465                                    Reports of inspections by de-
197.455 The department may file                                                                     partment of health and senior
an action in the circuit court for the           Funds to be deposited in gen-                      services may be available to
county in which any home health                  eral revenue.                                      public, when--certain informa-
agency alleged to be violating the
provisions of sections 197.400 to                197.465 All funds received by the depart-          tion to remain confidential.
197.475 resides or may be found for              ment under the provisions of sections
an injunction to restrain the home
                                                 197.400 to 197.475 shall be deposited in the       197.477 Upon the completion of the final
                                                 state treasury to the credit of general revenue.   report of an inspection or evaluation of a
health agency from continuing the                                                                   health facility or agency or any part thereof
violation.                                       (L. 1983 H.B. 51 § 13)                             pursuant to sections 190.235 to 190.249,
                                                                                                    RSMo, sections 197.010 to 197.120, sections
(L. 1983 H.B. 51 § 11)                                                                              197.200 to 197.240, or sections 197.400 to
                                                                                                    197.475, including any amendments thereto
                                                 Section 197.470                                    which may hereinafter be enacted by the
                                                                                                    general assembly or rule or regulation pro-
Section 197.460                                  Reports or investigations open                     mulgated pursuant thereto, the department of
                                                                                                    health and senior services may disclose to the
                                                 to public, exception--requests                     public reports of the inspections or evalu-
Exempt persons and religious                     for material, procedure, fee.                      ations showing the standards by which the
organizations.                                                                                      inspections or evaluations were conducted,
                                                 197.470 All reports or documents collected         whether such standards were met, and, if such
                                                 by the department, or findings and decisions       standards were not met, in what manner they
197.460 1. The provisions of sections
                                                 made by the department, under the provi-           were not met and how the facility proposed
197.400 to 197.475 shall not apply to indi-
                                                 sions of sections 197.400 to 197.475, unless       to correct or did correct the deficiencies.
viduals who personally provide one or more
                                                 declared to be a confidential record under any     All other information whatsoever, includ-
home health services if such persons are not
                                                 other provision of law, shall be available to      ing information and reports submitted to
under the direct control and doing work for
                                                 public inspection upon written request. The        the department of health and senior services
and employed by a home health agency.
                                                 material requested shall be made available         by governmental agencies and recognized
                                                 within thirty days after receipt of the request.   accrediting organizations in whole or in part
2. The provisions of sections 197.400 to
                                                 The department may charge a reasonable fee         for licensure purposes pursuant to sections
197.475 shall not apply to any person or or-
                                                 for the copying of any material.                   190.235 to 190.249, RSMo, sections 197.010
ganization conducting a home health agency
                                                                                                    to 197.120, sections 197.200 to 197.240, or
by and for the adherents of any recognized
                                                                                                    sections 197.400 to 197.475, collected during
church or religious denomination or sect for     (L. 1983 H.B. 51 § 14)
                                                                                                    such inspections or evaluations or informa-
the purpose of providing services for the care
                                                                                                    tion which is derived as a result of such
or treatment of the sick or infirm who depend
                                                                                                    inspections or evaluations shall be confiden-
upon prayer or spiritual means for healing in
the practice of the religion of such church or   Section 197.475                                    tial and shall be disclosed only to the person
                                                                                                    or organization which is the subject of the
religious denomination or sect.
                                                                                                    inspection or evaluation or a representative
3. The provisions of sections 197.400 to         Violations, penalty.                               thereof.
197.475 shall not apply to any person or
                                                 197.475 Any person who violates any of the         (L. 1988 H.B. 1134 § 2)
other entity which provides services pursuant
                                                 provisions of sections 197.400 to 197.475 is       Effective 5-4-88
to subdivision (18) of subsection 1 of section
208.152, RSMo, or provides in-home ser-          guilty of a class A misdemeanor and, upon
vices pursuant to subdivision (21) of subsec-    conviction, shall be punished as provided by
tion 2 of section 660.050, RSMo.                 law.
                                                                                                    Section 197.478
                                                                                                                                             85
                                                       Missouri Revised Statutes
Statutes

                                                   of consanguinity. Such presumption shall not      basis, discrimination prohib-
                                                   apply to reasonable payments for services
Home health agency informa-                        rendered nor to transfers of less than five       ited.
tion to be provided on depart-                     percent of the assets of the grantor.
                                                                                                     197.700 In the selection of medical staff
ment Internet web site.                                                                              members licensed under chapter 334, RSMo,
                                                   (L. 2004 H.B. 1511 § 1)
                                                                                                     no medical staff bylaws, departmental bylaws
197.478 1. The department of health and                                                              or hospital licensed under this chapter shall
senior services shall provide through their                                                          discriminate against any practitioner of the
Internet web site:                                 Section 197.500                                   healing arts who holds a license to practice
                                                                                                     medicine and surgery in this state for reasons
(1) The most recent survey of all home health                                                        based solely upon the practitioner's branch of
agencies and any such findings of deficien-        Employee disqualification list                    the healing arts or the school or health care
cies and the effect the deficiency would have      to be maintained.                                 facility in which the practitioner received
on such agencies. If such survey is in dispute,                                                      medical schooling, postgraduate training or
the survey shall not be posted on the web site     197.500 1. The department shall maintain an       certification if such medical schooling or
until the agency's dispute has been resolved       employee disqualification list and place on       postgraduate training was accredited by the
and the department shall, upon request of          the employee disqualification list the names      American Osteopathic Association or the
the home health agency, post the agency's          of any persons who are or who have been           American Medical Association. Each ap-
response;                                          employed by any entity licensed pursuant to       plicant for medical staff membership shall be
                                                   this chapter and who have been finally deter-     considered on an individual basis pursuant
(2) The home health agency's proposed plan         mined by the department pursuant to section       to objective criteria applied equally to each
of correction;                                     660.315, RSMo, to have knowingly or reck-         applicant.
                                                   lessly abused or neglected a patient. For the
(3) A link to the federal web site that provides   purpose of this section, "abuse" and "neglect"    (L. 1993 S.B. 54 § 1)
a summary of home health agency surveys            shall have the same meanings as such terms
conducted over the last three years; and           are defined in section 198.006, RSMo. For
(4) Information on how to obtain a copy of
                                                   purposes of this section only, "knowingly"        Section 197.705
                                                   and "recklessly" shall have the meanings that
a complete home health agency survey con-          are ascribed to them in this section. A person
ducted over the last three years.                  acts "knowingly" with respect to the person's     Health care facilities person-
                                                   conduct when a reasonable person should           nel required to wear identifi-
2. Nothing in this section shall be construed      be aware of the result caused by his or her
as requiring the department to post any            conduct. A person acts "recklessly" when the      cation badges, when.
information on its Internet web site that is       person consciously disregards a substantial
prohibited from disclosure pursuant to the         and unjustifiable risk that the person's con-     197.705 All hospitals and health care facili-
federal Health Insurance Portability and Ac-       duct will result in serious physical injury and   ties, defined in sections 197.020 and 197.305,
countability Act, as amended.                      such disregard constitutes a gross deviation      shall require all personnel providing ser-
                                                   from the standard of care that a reasonable       vices in such facilities to wear identification
(L. 2003 S.B. 556 & 311)                           person would exercise in the situation.           badges while acting within the scope of their
                                                                                                     employment. The identification badges of
                                                   2. The department shall compile and maintain      all personnel shall prominently display the
Section 197.480                                    an employee disqualification list in the same     licensure status of such personnel.
                                                   manner as the employee disqualification list
                                                   compiled and maintained by the department         (L. 1997 H.B. 762 § 1)
In-home health care provid-                        pursuant to section 660.315, RSMo.
ers, transfer of assets or be-
                                                   (L. 2003 S.B. 556 & 311)
quests, rebuttable presump-
tion of undue influence, when.
                                                   Section 197.700
197.480 There shall be a rebuttable presump-
tion of undue influence for any transfer of
assets or bequest or devise to the benefit of      Medical staff membership to
any in-home health care provider who is not        be considered on individual
related to the grantor within the third degree                                                                                                 86
                                                         Missouri Revised Statutes
Statutes



                        Missouri Revised Statutes

                    TITLE XII
           PUBLIC HEALTH AND WELFARE
                  August 28, 2009

   Chapter 198 -- Convalescent, Nursing and Boarding Homes
                                    Section 198.003. Citation of law.

   Section 198.005. Assisted living facilities, statutory references to residential care facilities to be
                                   changed by revisor of statutes.

                                      Section 198.006. Definitions.

 Section 198.009. Department of social services to administer—promulgation of rules, procedure—
                                 cooperation of other agencies.

Section 198.012. Provisions of sections 198.003 to 198.136 not to apply, when—exempt entities may
                                            be licensed.

  Section 198.015. License, when required—duration—content—effect of change of ownership—
                            temporary permits—penalty for violation.

  Section 198.018. Applications for license, how made—fees—affidavit—documents required to
  be filed—nursing facility quality of care fund created—facilities may not be licensed by political
                                 subdivisions, but they may inspect.

  Section 198.022. Duty of department on receipt of application—duty upon denial—department
 may copy records at its expense—removal of records prohibited—inspection, when—court order to
              inspect—out-of-state applicants, compliance history may be requested.
                                                                                            87
                                         Missouri Revised Statutes
Statutes


 Section 198.026. Noncompliance, how determined—procedure to correct—notice —reinspection—
                                    probationary license.

                         Section 198.027. On-site revisit not required, when.

 Section 198.029. Noncompliance—notice to operator and public, when—notice of noncompliance
                                          posted.

                     Section 198.030. Posting of inspection reports at the facility.

Section 198.032. Records, what confidential, what subject to disclosure—procedure—central registry
     to receive complaints of abuse and neglect, procedure—hotline caller log to be maintained.

                  Section 198.036. Revocation of license—grounds—notice required.

   Section 198.039. License refused or revoked—review by administrative hearing commission—
                                          judicial review.

    Section 198.042. Medical supervision for residents relying on spiritual healing not required.

  Section 198.045. Participation in Medicare or Medicaid optional—survey for certification at same
                                     time as license inspection.

       Section 198.048. Different classifications of facility may exist on same premises, when.

    Section 198.052. Records of facilities—when examined or audited—retention, how long—to
                              accompany resident on transfer, when.

      Section 198.055. Inspection by department valid for certain mental health patients, when.

Section 198.058. Certain facilities exempt from construction standards, when—report by department.

    Section 198.061. Penalty for providing services without license—penalty for interfering with
                                        enforcement of law.

           Section 198.064. Duplicate payments—how determined—procedures for repayment.

                         Section 198.066. Sanctions for violations authorized.
                                                                                                    88
                                        Missouri Revised Statutes
Statutes

Section 198.067. Noncompliance with law—injunction, when—civil penalties, how calculated, where
                                         deposited.

   Section 198.069. Resident returned to facility from a medical facility, physician orders, duty of
                                               facility.

   Section 198.070. Abuse or neglect of residents—reports, when, by whom—contents of report—
failure to report, penalty—investigation, referral of complaint, removal of resident—confidentiality of
report—immunity exception—prohibition against retaliation—penalty—employee list—self-reporting
                                  of incidents, investigations, when.

           Section 198.071. Death of a resident, persons to contact prior to transfer of deceased.

Section 198.073. Persons eligible for care in residential care facility I or residential care facility II—
                      facility requirements for care of Alzheimer’s patients.

            Section 198.074. Sprinkler system requirements -- fire alarm system requirements.

                 Section 198.075. Fire safety standards loan fund created, use of moneys.

 Section 198.076. Department of social services to establish standards and regulation for residential
                         care facilities I and residential care facilities II.

                  Section 198.077. Department to maintain facility compliance records.

Section 198.079. Department of social services to establish standards and regulations for intermediate
                                care and skilled nursing facilities.

               Section 198.080. Assessment procedures developed—rulemaking authority.

Section 198.082. Nursing assistant training programs—training incomplete, special requirements and
                            supervision for assistant beginning duties.

                Section 198.085. Categories of standards for each type of licensed facility.

   Section 198.086. Demonstration project, Alzheimer’s licensure category—department duties—
                             accommodations for family members.

      Section 198.087. Uniformity of application of regulation standards, department’s duties.

                                                                                                       89
                                          Missouri Revised Statutes
Statutes

Section 198.088. Facilities to establish policies and procedures, scope, content —rights of residents—
                                         complaint—procedure.

    Section 198.090. Personal possessions may be held in trust, requirements, disposal of —written
statements required when, penalty—prohibitions, penalties —misappropriation, report, investigation—
                                   employee disqualification list.

       Section 198.093. Violations of resident’s rights—complaints—legal action—damages.

  Section 198.096. Bond required for facility holding resident’s property in trust —exception, cash
                                 deposit held in insured escrow.

       Section 198.097. Misappropriation of funds of elderly nursing home residents, penalty.

                     Section 198.099. Petition for appointment of receiver—when.

                          Section 198.103. Department may appoint monitor.

 Section 198.105. Petition for appointment of receiver, contents—hearing—appointment of receiver.

     Section 198.108. Ex parte appointment of receiver in emergency, when—notice—hearing.

                                 Section 198.112. Powers of receiver.

       Section 198.115. Executory contracts, receiver not required to honor—when—hearing.

                              Section 198.118. Compensation of receiver.

                                  Section 198.121. Bond of receiver.

           Section 198.124. License may be issued to facility operated by receiver—duration.

                         Section 198.128. Termination of receivership, when.

  Section 198.132. Accounting by receiver, when—contents—liability for deficiency —priority of
                                      deficiency judgment.

 Section 198.136. Operator or affiliate not liable for acts of receiver—liability of operator or affiliate
                                        otherwise not relieved.

                                                                                                       90
                                         Missouri Revised Statutes
Statutes

                 Section 198.139. Medicaid moneys not to be used for other purposes.

   Section 198.142. Health care provider and vendor not to misrepresent or conceal fact or convert
                                      benefits for payments.

                   Section 198.145. Kickbacks, bribes and rebates prohibited, when.

           Section 198.148. Offering or making kickbacks, bribes or rebates prohibited, when.

  Section 198.151. Usual trade discounts and employment benefits not kickbacks, bribes or rebates.

              Section 198.155. False statements by health care provider prohibited, when.

                Section 198.158. Penalties for violation of sections 198.139 to 198.155.

Section 198.161. Fraud investigation division created—director—compensation —assistance by local
                                            prosecutors.

               Section 198.165. Medicaid payments stopped by division, when—hearing.

Section 198.168. Fraud investigation director may petition for appointment of receiver, when—court
                                              hearing.

                      Section 198.171. Civil restitution of Medicaid funds, when.

Section 198.174. Fraud investigation director may hold hearings, take oaths—procedure on failure to
                         testify—confidentiality of recorders—penalties.

                 Section 198.177. Compelling of testimony—grant of immunity, when.

                   Section 198.180. Audit and inspection of records, when—warrant.

 Section 198.183. State agencies and law enforcement officers to cooperate with fraud investigation
                                             division.

                  Section 198.186. Local crime investigation powers not diminished.

                     198.187. Criminal background checks for residents permitted.

Section 198.189. Medicaid payment system for assisted living facilities to be implemented -- options.
                                                                                                  91
                                        Missouri Revised Statutes
Statutes


     Section 198.200. District created, how—territory included—name—nursing home defined.

                Section 198.210. Petition of voters for district, where filed, contents.

                  Section 198.220. Notice of hearing on petition—costs of notice.

              Section 198.230. Procedure where several petitions filed—amendment.

            Section 198.240. If petition sufficient county commission to order election.

                           Section 198.250. Notice of election, contents.

                                  Section 198.260. Form of ballot.

           Section 198.263. Increase in tax levy, procedure—ballot of submission, form.

                          Section 198.270. Results of election to be filed.

  Section 198.280. Election districts—election of directors—terms—qualifications —declaration of
                 candidacy—appointed if no candidate—no election required when.

Section 198.290. Powers of board of directors—first meeting—officers—bylaws—time for meetings.

                         Section 198.300. Powers of nursing home district.

 Section 198.301. Whistleblower protection for employees—availability of information on rights of
                                   persons retaliated against.

                     Section 198.305. Unsuitable site, may be changed, when.

      Section 198.310. Indebtedness for nursing home—election—ballot—limits—tax to pay.

                        Section 198.312. Revenue bonds authorized, when.

           Section 198.314. Revenue bonds not an indebtedness of the issuing authority.

       Section 198.316. Revenue bonds, form of, interest rate—to be negotiable instruments.


                                                                                               92
                                       Missouri Revised Statutes
Statutes


   Section 198.318. Board of directors to prescribe form, make necessary covenants, restrictions—
         bondholders, remedies of—revenue bonds, not to be exclusive method of financing.

                      Section 198.320. Annexation of territory to district—election.

                Section 198.330. Records of district—officers and employees to give bond.

            Section 198.340. Board as trustee may accept and hold property donated—duties.

    Section 198.345. Apartments for seniors, districts may establish (Marion and Ralls counties).

                                    Section 198.350. Citation of law.

                                 Section 198.360. Dissolution of district.

                 Section 198.401. Nursing facility reimbursement allowance, definitions.

                               Section 198.403. Formula set forth in rules.

 Section 198.406. Records required, transmittal to department—elements of report, determinations.

      Section 198.409. Determination of amount due—notification, payments—offset allowed.

           Section 198.412. Finality of determination, protest—hearing, reconsideration, appeal.

                           Section 198.416. Forms and content set forth in rule.

 Section 198.418. Remittance of amount—nursing facility reimbursement allowance fund purpose,
              restrictions—nursing facility quality of care fund, purpose restrictions.

    Section 198.421. Allowance period, notification by department, delinquent allowance—lien,
                          enforcement, sanctions—effect upon license.

                           Section 198.424. No effect upon tax-exempt status.

              Section 198.427. Medicaid provider agreements, payments, rate, computation.

  Section 198.428. Medicaid eligibility presumed pending approval or denial of application, when.

                                                                                                    93
                                         Missouri Revised Statutes
Statutes

      Section 198.431. Contingent application of requirements—disbursement of fund, when.

                          Section 198.433. Imposition of allowance, when.

                   Section 198.436. Rules, regulations, promulgation, procedure.

                                 Section 198.439. Expiration date.

                                 Section 198.500. Citation of law.

                                   Section 198.505. Definitions.

Section 198.510. Disclosure required, by whom—licensing department, duties—department of social
                 services, duties—department of health and senior service duties.

   Section 198.515. Alzheimer’s facilities, informational documents required—division of aging,
                           duties—licensing department, verification.

               Section 198.525. Inspection of certain long-term care facilities, when.

Section 198.526. Biannual inspections—reevaluation of inspection process—reduction in inspection
         schedule, when—disclosure of inspection schedule limited, penalty for violation.

 Section 198.527. Inspectors and surveyors of long-term care facilities—uniformity of application of
                                       regulation standards.

Section 198.528. Long-term care facility information to be provided on department Internet web site.

  Section 198.530. Managed care services provided in long-term care facilities, when, conditions—
                            reimbursement rate—services included.

           198.531. Aging-in-place pilot program established--program requirements and
                                monitoring--rulemaking authority.

               Section 198.532. Investigation of complaints—results provided, when.

                      Section 198.533. Conflict of interest, state investigators.

                              Section 198.534. Rulemaking authority.

                                                                                                  94
                                       Missouri Revised Statutes
Statutes

            198.545. Definitions--contracting with third parties--department to establish
                         IDR process, procedures--rulemaking authority.

     Section 198.600. Uniform data management pilot program established, purpose, monitoring.




                                                                                                95
                                      Missouri Revised Statutes
Statutes

Section 198.003                                     Definitions.                                       tion training under 19 CSR 30-86042(18),
                                                                                                       and dementia training under section 660.050,
                                                                                                       RSMo, and twenty-four hours of additional
                                                    198.006 As used in sections 198.003 to
Citation of law.                                    198.186, unless the context clearly indicates
                                                                                                       training, approved by the department, consist-
                                                                                                       ing of definition and assessment of activities
                                                    otherwise, the following terms mean:               of daily living, assessment of cognitive abil-
198.003 Sections 198.003 to 198.186 shall
be known and may be cited as the "Omnibus                                                              ity, service planning, and interview skills;
                                                    (1) "Abuse", the infliction of physical, sexual,
Nursing Home Act".                                  or emotional injury or harm;                       (6) "Assisted living facility", any premises,
(L. 1979 S.B. 328, et al. § 2)                                                                         other than a residential care facility, interme-
                                                    (2) "Activities of daily living" or "ADL", one     diate care facility, or skilled nursing facility,
                                                    or more of the following activities of daily       that is utilized by its owner, operator, or man-
Section 198.005                                     living:                                            ager to provide twenty-four-hour care and
                                                                                                       services and protective oversight to three or
                                                    (a) Eating;                                        more residents who are provided with shelter,
Assisted living facilities, statu-                                                                     board, and who may need and are provided
                                                    (b) Dressing;
tory references to residential                                                                         with the following:
care facilities to be changed by                    (c) Bathing;                                       (a) Assistance with any activities of daily
revisor of statutes.                                                                                   living and any instrumental activities of daily
                                                    (d) Toileting;                                     living;
198.005 The term "residential care facility
                                                    (e) Transferring; and                              (b) Storage, distribution, or administration of
I" shall be referred to as a "residential care
facility", and the term "residential care facil-                                                       medications; and
                                                    (f) Walking;
ity II" shall be referred to as "assisted living
facility". The revisor of statutes shall make                                                          (c) Supervision of health care under the
                                                    (3) "Administrator", the person who is in          direction of a licensed physician, provided
the appropriate changes to all such references
                                                    general administrative charge of a facility;       that such services are consistent with a social
in the revised statutes, except that references
to residential care facilities as defined in sec-                                                      model of care;
                                                    (4) "Affiliate":
tion 210.481, RSMo, or residential facilities
licensed by the department of mental health                                                            Such term shall not include a facility where
                                                    (a) With respect to a partnership, each partner    all of the residents are related within the
shall not be changed.
                                                    thereof;                                           fourth degree of consanguinity or affinity to
(L. 2006 S.B. 616)                                                                                     the owner, operator, or manager of the facil-
                                                    (b) With respect to a limited partnership,         ity;
*Revisor's note: The following sections con-
                                                    the general partner and each limited partner
taining references to "residential care facil-
                                                    with an interest of five percent or more in the    (7) "Community-based assessment", docu-
ity", "residential care facilities", "residential
                                                    limited partnership;                               mented basic information and analysis pro-
facility", or "residential facilities" were not
changed:                                                                                               vided by appropriately trained and qualified
                                                    (c) With respect to a corporation, each person     individuals describing an individual's abilities
                                                    who owns, holds or has the power to vote five      and needs in activities of daily living, in-
115.287, 135.600, 167.020, 167.183,
                                                    percent or more of any class of securities is-     strumental activities of daily living, vision/
191.656, 197.318, 199.033, 199.041,
                                                    sued by the corporation, and each officer and      hearing, nutrition, social participation and
199.043, 208.152, 210.150, 210.211,
                                                    director;                                          support, and cognitive functioning using an
210.481, 210.484, 210.485, 210.486,
210.491, 210.496, 210.501, 210.506,                                                                    assessment tool approved by the department
                                                    (d) With respect to a natural person, any par-     of health and senior services that is designed
210.511, 210.516, 210.900, 211.063, 219.021,
                                                    ent, child, sibling, or spouse of that person;     for community-based services and that is not
355.066, 355.626, 404.830, 404.835,
631.050, 632.005, 633.025, 633.110, 633.115,                                                           the nursing home minimum data set;
                                                    (5) "Appropriately trained and qualified
660.050, 660.115, 660.317, and all references
                                                    individual", an individual who is licensed         (8) "Dementia", a general term for the loss
in chapter 630.
                                                    or registered with the state of Missouri in        of thinking, remembering, and reasoning so
                                                    a health care-related field or an individual       severe that it interferes with an individual's
                                                    with a degree in a health care-related field or    daily functioning, and may cause symptoms
Section 198.006                                     an individual with a degree in a health care,      that include changes in personality, mood,
                                                    social services, or human services field or        and behavior;
                                                    an individual licensed under chapter 344,
                                                    RSMo, and who has received facility orienta-                                                  96
                                                           Missouri Revised Statutes
Statutes

                                                   providing such services as hiring and train-
(9) "Department", the Missouri department of       ing personnel, purchasing supplies, keeping       (21) "Resident", a person who by reason of
health and senior services;                        financial records, and making reports;            aging, illness, disease, or physical or mental
                                                                                                     infirmity receives or requires care and ser-
(10) "Emergency", a situation, physical con-       (16) "Medicaid", medical assistance under         vices furnished by a facility and who resides
dition or one or more practices, methods or        section 208.151, RSMo, et seq., in compli-        or boards in or is otherwise kept, cared for,
operations which presents imminent danger          ance with Title XIX, Public Law 89-97, 1965       treated or accommodated in such facility for
of death or serious physical or mental harm to     amendments to the Social Security Act (42         a period exceeding twenty-four consecutive
residents of a facility;                           U.S.C. 301, et seq.), as amended;                 hours;

(11) "Facility", any residential care facil-       (17) "Neglect", the failure to provide, by        (22) "Residential care facility", any premises,
ity, assisted living facility, intermediate care   those responsible for the care, custody, and      other than an assisted living facility, interme-
facility, or skilled nursing facility;             control of a resident in a facility, the ser-     diate care facility, or skilled nursing facility,
                                                   vices which are reasonable and necessary to       which is utilized by its owner, operator or
(12) "Health care provider", any person            maintain the physical and mental health of        manager to provide twenty-four-hour care to
providing health care services or goods to         the resident, when such failure presents either   three or more residents, who are not related
residents and who receives funds in payment        an imminent danger to the health, safety or       within the fourth degree of consanguinity or
for such goods or services under Medicaid;         welfare of the resident or a substantial prob-    affinity to the owner, operator, or manager
                                                   ability that death or serious physical harm       of the facility and who need or are provided
(13) "Instrumental activities of daily living",    would result;                                     with shelter, board, and with protective
or "IADL", one or more of the following                                                              oversight, which may include storage and
activities:                                        (18) "Operator", any person licensed or           distribution or administration of medica-
                                                   required to be licensed under the provisions      tions and care during short-term illness or
(a) Preparing meals;                               of sections 198.003 to 198.096 in order to        recuperation, except that, for purposes of
                                                   establish, conduct or maintain a facility;        receiving supplemental welfare assistance
(b) Shopping for personal items;                                                                     payments under section 208.030, RSMo, only
                                                   (19) "Owner", any person who owns an inter-       any residential care facility licensed as a resi-
(c) Medication management;                         est of five percent or more in:                   dential care facility II immediately prior to
                                                                                                     August 28, 2006, and that continues to meet
(d) Managing money;                                (a) The land on which any facility is located;    such licensure requirements for a residential
                                                                                                     care facility II licensed immediately prior to
(e) Using the telephone;                           (b) The structure or structures in which any      August 28, 2006, shall continue to receive
                                                   facility is located;                              after August 28, 2006, the payment amount
(f) Housework; and                                                                                   allocated immediately prior to August 28,
                                                   (c) Any mortgage, contract for deed, or other     2006, for a residential care facility II under
(g) Transportation ability;                        obligation secured in whole or in part by the     section 208.030;
                                                   land or structure in or on which a facility is
(14) "Intermediate care facility", any prem-       located; or                                       (23) "Skilled nursing facility", any prem-
ises, other than a residential care facility,                                                        ises, other than a residential care facility, an
assisted living facility, or skilled nursing       (d) Any lease or sublease of the land or struc-   assisted living facility, or an intermediate
facility, which is utilized by its owner, opera-   ture in or on which a facility is located.        care facility, which is utilized by its owner,
tor, or manager to provide twenty-four-hour                                                          operator or manager to provide for twenty-
accommodation, board, personal care, and           "Owner" does not include a holder of a            four-hour accommodation, board and skilled
basic health and nursing care services under       debenture or bond purchased at public issue       nursing care and treatment services to at least
the daily supervision of a licensed nurse and      nor does it include any regulated lender un-      three residents who are not related within the
under the direction of a licensed physician        less the entity or person directly or through a   fourth degree of consanguinity or affinity to
to three or more residents dependent for           subsidiary operates a facility;                   the owner, operator or manager of the facility.
care and supervision and who are not related                                                         Skilled nursing care and treatment services
within the fourth degree of consanguinity or       (20) "Protective oversight", an awareness         are those services commonly performed by or
affinity to the owner, operator or manager of      twenty-four hours a day of the location of        under the supervision of a registered profes-
the facility;                                      a resident, the ability to intervene on behalf    sional nurse for individuals requiring twenty-
                                                   of the resident, the supervision of nutrition,    four-hours-a-day care by licensed nursing
(15) "Manager", any person other than the          medication, or actual provisions of care,         personnel including acts of observation,
administrator of a facility who contracts or       and the responsibility for the welfare of the     care and counsel of the aged, ill, injured or
otherwise agrees with an owner or operator to      resident, except where the resident is on         infirm, the administration of medications and
supervise the general operation of a facility,     voluntary leave;
                                                                                                                                                97
                                                         Missouri Revised Statutes
Statutes

treatments as prescribed by a licensed physi-      pursuant to the provisions of section 536.024,
cian or dentist, and other nursing functions       RSMo.                                              (4) Any facility licensed pursuant to sections
requiring substantial specialized judgment                                                            630.705 to 630.760, RSMo, which provides
and skill;                                         2. All agencies of the state or any of its         care, treatment, habilitation and rehabilitation
                                                   political subdivisions shall assist and cooper-    exclusively to persons who have a primary
(24) "Social model of care", long-term care        ate with the department whenever necessary         diagnosis of mental disorder, mental illness,
services based on the abilities, desires, and      to carry out the department's responsibility       mental retardation or developmental disabili-
functional needs of the individual delivered       under sections 198.003 to 198.186.                 ties, as defined in section 630.005, RSMo;
in a setting that is more home-like than insti-
tutional and promotes the dignity, individual-     (L. 1979 S.B. 328, et al. § 4, A.L. 1993 S.B.      (5) Any provider of care under a life care
ity, privacy, independence, and autonomy           52, A.L. 1995 S.B. 3)                              contract, except to any portion of the pro-
of the individual. Any facility licensed as a                                                         vider's premises on which the provider offers
residential care facility II prior to August 28,   Section 198.012                                    services provided by an intermediate care
2006, shall qualify as being more home-like                                                           facility or skilled nursing facility as defined
than institutional with respect to construction                                                       in section 198.006. For the purposes of this
and physical plant standards;                      Provisions of sections 198.003                     section, "provider of care under a life care
                                                                                                      contract" means any person contracting with
(25) "Vendor", any person selling goods or         to 198.136 not to apply, when-                     any individual to furnish specified care and
services to a health care provider;                -exempt entities may be li-                        treatment to the individual for the life of the
                                                   censed.                                            individual, with significant prepayment for
(26) "Voluntary leave", an off-premise leave                                                          such care and treatment.
initiated by:                                      198.012 1. The provisions of sections
                                                   198.003 to 198.136 shall not apply to any of       2. Nothing in this section shall prohibit any
(a) A resident that has not been declared          the following entities:                            of these entities from applying for a license
mentally incompetent or incapacitated by a                                                            under sections 198.003 to 198.136.
court; or                                          (1) Any hospital, facility or other entity oper-
                                                   ated by the state or the United States;            (L. 1979 S.B. 328, et al. § 5, A.L. 1980 H.B.
(b) A legal guardian of a resident that has                                                           1724, A.L. 1982 S.B. 698, A.L. 1984 S.B.
been declared mentally incompetent or inca-        (2) Any facility or other entity otherwise li-     451, A.L. 1988 S.B. 602, A.L. 1989 H.B.
pacitated by a court.                              censed by the state and operating exclusively      210)
                                                   under such license and within the limits of        *Reprinted due to editorial change required
(L. 1979 S.B. 328, et al. § 3, A.L. 1984 S.B.      such license, unless the activities and services   by § 198.005.
451, A.L. 1987 S.B. 277, A.L. 2003 S.B. 534        are or are held out as being activities or ser-
merged with S.B. 556 & 311, A.L. 2006 S.B.         vices normally provided by a licensed facility     CROSS REFERENCE:
616)                                               under sections 198.003 to 198.186, 198.200,
                                                   208.030, and 208.159, RSMo, except hospi-          Missouri veterans homes, nursing home
Section 198.009                                    tals licensed under the provisions of chapter      license not required, RSMo 42.130
                                                   197, RSMo;

Department of social services                      (3) Any hospital licensed under the provi-         Section 198.015
to administer--promulgation                        sions of chapter 197, RSMo, provided that
                                                   the assisted living facility, intermediate care
of rules, procedure--coopera-                      facility or skilled nursing facility are physi-    License, when required--dura-
tion of other agencies.                            cally attached to the acute care hospital; and     tion--content--effect of change
                                                   provided further that the department of health
                                                   and senior services in promulgating rules,         of ownership--temporary
198.009 1. The provisions of sections
198.003 to 198.186 shall be administered by        regulations and standards pursuant to section      permits--penalty for violation.
the department. The department shall have          197.080, RSMo, with respect to such facili-
authority to promulgate rules and regulations      ties, shall establish requirements and stan-       198.015 1. No person shall establish, conduct
for the purposes of administering sections         dards for such hospitals consistent with the       or maintain a residential care facility, assisted
198.003 to 198.186. All such rules and regu-       intent of this chapter, and sections 198.067,      living facility, intermediate care facility, or
lations shall be promulgated in accordance         198.070, 198.090, 198.093 and 198.139 to           skilled nursing facility in this state without a
with this section and chapter 536, RSMo. No        198.180 shall apply to every assisted living       valid license issued by the department. Any
rule or portion of a rule promulgated under        facility, intermediate care facility or skilled    person violating this subsection is guilty of a
the authority of this chapter shall become         nursing facility regardless of physical prox-      class A misdemeanor. Any person violating
effective unless it has been promulgated           imity to any other health care facility;
                                                                                                                                                98
                                                         Missouri Revised Statutes
Statutes

this subsection wherein abuse or neglect of a      information and special limitations as the         inspect.
resident of the facility has occurred is guilty    department by rule may require.
of a class D felony. The department of health                                                         198.018 1. Applications for a license shall be
and senior services shall investigate any com-     7. The department shall notify the operator        made to the department by the operator upon
plaint concerning operating unlicensed facili-     at least sixty days prior to the expiration of     such forms and including such information
ties. For complaints alleging abuse or neglect,    an existing license of the date that the license   and documents as the department may rea-
the department shall initiate an investigation     application is due. Application for a license      sonably require by rule or regulation for the
within twenty-four hours. All other com-           shall be made to the department at least thirty    purposes of administering sections 198.003
plaints regarding unlicensed facilities shall be   days prior to the expiration of any existing       to 198.186, section 198.200, and sections
investigated within forty-five days.               license.                                           208.030 and 208.159, RSMo.

2. If the department determines the unli-          8. The department shall grant an operator a        2. The applicant shall submit all documents
censed facility is in violation of sections        temporary operating permit in order to allow       required by the department under this section
198.006 to 198.186, the department shall           for state review of the application and inspec-    attesting by signature that the statements
immediately notify the local prosecuting at-       tion for the purposes of relicensure if the        contained in the application are true and cor-
torney or attorney general's office.               application review and inspection process has      rect to the best of the applicant's knowledge
                                                   not been completed prior to the expiration of      and belief, and that all required documents
3. Each license shall be issued only for the       a license and the operator is not at fault for     are either included with the application or are
premises and persons named in the applica-         the failure to complete the application review     currently on file with the department.
tion. A license, unless sooner revoked, shall      and inspection process.
be issued for a period of up to two years, in                                                         3. The application shall be accompanied by
order to coordinate licensure with certifica-      9. The department shall grant an operator a        a license fee in an amount established by
tion in accordance with section 198.045.           temporary operating permit of sufficient dura-     the department. The fee established by the
                                                   tion to allow the department to evaluate any       department shall not exceed six hundred
4. If during the period in which a license is in   application for a license submitted as a result    dollars, and shall be a graduated fee based on
effect, a licensed operator which is a part-       of any change of operator.                         the licensed capacity of the applicant and the
nership, limited partnership, or corporation                                                          duration of the license. A fee of not more than
undergoes any of the following changes, or a       (L. 1979 S.B. 328, et al. § 6, A.L. 1984 S.B.      fifty dollars shall be charged for any amend-
new corporation, partnership, limited partner-     451, A.L. 1987 S.B. 277, A.L. 1988 S.B. 602,       ments to a license initiated by an applicant.
ship or other entity assumes operation of a        A.L. 1994 H.B. 1335 & 1381, A.L. 1999 S.B.         In addition, facilities certified to participate in
facility whether by one or by more than one        326, A.L. 2003 S.B. 556 & 311)                     the Medicaid or Medicare programs shall pay
action, the current operator shall notify the      *Editorial change required by § 198.005.           a certification fee of up to one thousand dol-
department of the intent to change operators                                                          lars annually, payable on or before October
and the succeeding operator shall within ten       CROSS REFERENCES:                                  first of each year. The amount remitted for the
working days of such change apply for a new                                                           license fee, fee for amendments to a license,
license:                                           License for administrator of assisted living       or certification fee shall be deposited in the
                                                   facilities required, limitations, RSMo 344.020     state treasury to the credit of the "Nursing
(1) With respect to a partnership, a change in                                                        Facility Quality of Care Fund", which is
the majority interest of general partners;         Skilled nursing care facilities, a license for     hereby created. All investment earnings of the
                                                   assisted living facilities insufficient, RSMo      nursing facility quality of care fund shall be
(2) With respect to a limited partnership, a       344.020                                            credited to such fund. All moneys in the nurs-
change in the general partner or in the major-                                                        ing facility quality of care fund shall, upon
ity interest of limited partners;                                                                     appropriation, be used by the division of
                                                   Section 198.018                                    aging for conducting inspections and surveys,
(3) With respect to a corporation, a change in                                                        and providing training and technical assis-
the persons who own, hold or have the power                                                           tance to facilities licensed under the provi-
to vote the majority of any class of securities    Applications for license,                          sions of this chapter. The unexpended balance
issued by the corporation.                                                                            in the nursing facility quality of care fund at
                                                   how made--fees--affidavit-                         the end of the biennium is exempt from the
5. Licenses shall be posted in a conspicuous       -documents required to be                          provisions of sections 33.080, RSMo. The
place on the licensed premises.                    filed--nursing facility quality                    unexpended balance in the nursing facility
                                                                                                      quality of care fund shall not revert to the
6. Any license granted shall state the maxi-       of care fund created--facilities                   general revenue fund, but shall accumulate in
mum resident capacity for which granted,           may not be licensed by politi-                     the nursing facility quality of care fund from
the person or persons to whom granted, the                                                            year to year.
date, the expiration date, and such additional     cal subdivisions, but they may
                                                                                                                                                    99
                                                         Missouri Revised Statutes
Statutes

                                                    cants, compliance history may
4. Within ten working days of the effective                                                              3. The department may inspect any facility
date of any document that replaces, succeeds,       be requested.                                        and any records and may make copies of
or amends any of the documents required by                                                               records, at the facility, at the department's
the department to be filed pursuant to this         198.022 1. Upon receipt of an application for        own expense, required to be maintained by
section, an operator shall file with the depart-    a license to operate a facility, the department      sections 198.003 to 198.096 or by the rules
ment a copy of such document. The operator          shall review the application, investigate the        and regulations promulgated thereunder at
shall attest by signature that the document is      applicant and the statements sworn to in the         any time if a license has been issued to or
true and correct. If the operator knowingly         application for license and conduct any nec-         an application for a license has been filed
fails to file a required document or provide        essary inspections. A license shall be issued if     by the operator of such facility. Copies of
any information amending any document               the following requirements are met:                  any records requested by the department
within the time provided for in this section,                                                            shall be prepared by the staff of such facility
a circuit court may, upon application of the        (1) The statements in the application are true       within two business days or as determined
department or the attorney general, assess a        and correct;                                         by the department. The department shall not
penalty of up to fifty dollars per document for                                                          remove or disassemble any medical record
each day past the required date of filing.          (2) The facility and the operator are in sub-        during any inspection of the facility, but may
                                                    stantial compliance with the provisions of           observe the photocopying or may make its
5. If an operator fails to file documents or        sections 198.003 to 198.096 and the stan-            own copies if the facility does not have the
amendments to documents as required pursu-          dards established thereunder;                        technology to make the copies. In accordance
ant to this section and such failure is part of a                                                        with the provisions of section 198.525, the
pattern or practice of concealment, such fail-      (3) The applicant has the financial capacity to      department shall make at least two inspec-
ure shall be sufficient grounds for revocation      operate the facility;                                tions per year, at least one of which shall be
of a license or disapproval of an application                                                            unannounced to the operator. The department
for a license.                                      (4) The administrator of an assisted living fa-      may make such other inspections, announced
                                                    cility, a skilled nursing facility, or an interme-   or unannounced, as it deems necessary to
6. Any facility defined in subdivision (8),         diate care facility is currently licensed under      carry out the provisions of sections 198.003
(15), (16) or (17) of section 198.006 that is       the provisions of chapter 344, RSMo;                 to 198.136.
licensed by the state of Missouri pursuant to
the provisions of section 198.015 may not be        (5) Neither the operator nor any principals in       4. Whenever the department has reasonable
licensed, certified or registered by any other      the operation of the facility have ever been         grounds to believe that a facility required
political subdivision of the state of Missouri      convicted of a felony offense concerning the         to be licensed under sections 198.003 to
whether or not it has taxing power, provided,       operation of a long-term health care facility        198.096 is operating without a license, and
however, that nothing in this subsection shall      or other health care facility or ever know-          the department is not permitted access to in-
prohibit a county or city, otherwise empow-         ingly acted or knowingly failed to perform           spect the facility, or when a licensed operator
ered under law, to inspect such facility for        any duty which materially and adversely              refuses to permit access to the department to
compliance with local ordinances of food            affected the health, safety, welfare or property     inspect the facility, the department shall apply
service or fire safety.                             of a resident, while acting in a management          to the circuit court of the county in which the
                                                    capacity. The operator of the facility or any        premises is located for an order authorizing
(L. 1979 S.B. 328, et al. § 7, A.L. 1984 S.B.       principal in the operation of the facility shall     entry for such inspection, and the court shall
451, A.L. 1987 S.B. 277, A.L. 1988 S.B. 602,        not be under exclusion from participation            issue the order if it finds reasonable grounds
A.L. 1994 H.B. 1335 & 1381, A.L. 2007 S.B.          in the Title XVIII (Medicare) or Title XIX           for inspection or if it finds that a licensed
397)                                                (Medicaid) program of any state or territory;        operator has refused to permit the department
                                                                                                         access to inspect the facility.
                                                    (6) Neither the operator nor any principals
                                                    involved in the operation of the facility have       5. Whenever the department is inspecting a
Section 198.022                                     ever been convicted of a felony in any state         facility in response to an application from
                                                    or federal court arising out of conduct involv-      an operator located outside of Missouri not
                                                    ing either management of a long-term care
Duty of department on re-                           facility or the provision or receipt of health
                                                                                                         previously licensed by the department, the
                                                                                                         department may request from the applicant
ceipt of application--duty                          care;                                                the past five years compliance history of
upon denial--department may                                                                              all facilities owned by the applicant located
                                                    (7) All fees due to the state have been paid.        outside of this state.
copy records at its expense--
removal of records prohibited-                      2. Upon denial of any application for a              (L. 1979 S.B. 328, et al. § 8, A.L. 1984 S.B.
                                                    license, the department shall so notify the
-inspection, when--court order                      applicant in writing, setting forth therein the
                                                                                                         451, A.L. 1988 S.B. 602, A.L. 1994 H.B.
                                                                                                         1335 & 1381, A.L. 2003 S.B. 556 & 311)
to inspect--out-of-state appli-                     reasons and grounds for denial.                                                                100
                                                           Missouri Revised Statutes
Statutes

*Editorial change required by § 198.005.           department shall give its written approval or        conspicuous location in the facility, and the
                                                   rejection of the plan and if the plan is accept-     department shall send a copy of the notice of
                                                   able, a reinspection shall be conducted within       noncompliance to the division of family ser-
                                                   twenty calendar days of the exit interview           vices of the department of social services, the
Section 198.026                                    to determine if deficiencies have been cor-          department of mental health, and any other
                                                   rected. If there was a violation of any class II     concerned federal, state or local governmen-
Noncompliance, how deter-                          standard and the plan of correction is accept-       tal agencies.
                                                   able, an unannounced reinspection shall be
mined--procedure to correct-                       conducted between forty and ninety calendar          (L. 1979 S.B. 328, et al. § 9, A.L. 1984 S.B.
-notice --reinspection--proba-                     days from the date of the exit conference to         451, A.L. 1988 S.B. 602, A.L. 1994 H.B.
                                                   determine the status of all previously cited         1335 & 1381)
tionary license.                                   deficiencies. If there was a violation of class
198.026 1. Whenever a duly authorized
                                                   III standards sufficient to establish that the       Section 198.027
                                                   facility was not in substantial compliance, an
representative of the department finds upon
                                                   unannounced reinspection shall be conducted
an inspection of a facility that it is not in
compliance with the provisions of sections
                                                   within one hundred twenty days of the exit           On-site revisit not required,
                                                   interview to determine the status of previ-
198.003 to 198.096 and the standards estab-
                                                   ously identified deficiencies.
                                                                                                        when.
lished thereunder, the operator or administra-
tor shall be informed of the deficiencies in an                                                         198.027 If a facility submits satisfactory
                                                   3. If, following the reinspection, the facility is
exit interview conducted with the operator or                                                           documentation that establishes correction of
                                                   found not in substantial compliance with sec-
administrator or his designee. The department                                                           any deficiency contained within the writ-
                                                   tions 198.003 to 198.096 and the standards
shall inform the operator or administrator, in                                                          ten report of deficiency required by section
                                                   established thereunder or the operator is not
writing, of any violation of a class I standard                                                         198.026, an on-site revisit of such deficiency
                                                   correcting the noncompliance in accordance
at the time the determination is made. A writ-                                                          may not be required.
                                                   with the approved plan of correction, the
ten report shall be prepared of any deficiency
                                                   department shall issue a notice of noncompli-
for which there has not been prompt remedial                                                            (L. 2003 S.B. 556 & 311)
                                                   ance, which shall be sent by certified mail or
action, and a copy of such report and a writ-
                                                   other delivery service that provides a dated
ten correction order shall be sent to the opera-
tor or administrator by certified mail or other
                                                   receipt of delivery to each person disclosed         Section 198.029
                                                   to be an owner or operator of the facility,
delivery service that provides a dated receipt
                                                   according to the most recent information or
of delivery at the facility address within ten
working days after the inspection, stating
                                                   documents on file with the department.               Noncompliance--notice to op-
separately each deficiency and the specific
                                                   4. The notice of noncompliance shall inform
                                                                                                        erator and public, when--no-
statute or regulation violated.                                                                         tice of noncompliance posted.
                                                   the operator or administrator that the depart-
                                                   ment may seek the imposition of any of the
2. The operator or administrator shall have                                                             198.029 The provisions of section 198.026
                                                   sanctions and remedies provided for in sec-
five working days following receipt of a                                                                notwithstanding, whenever a duly authorized
                                                   tion 198.067, or any other action authorized
written report and correction order regard-                                                             representative of the department finds upon
                                                   by law.
ing a violation of a class I standard and ten                                                           inspection of a licensed facility, and the direc-
working days following receipt of the report                                                            tor of the department finds upon review, that
                                                   5. At any time after an inspection is con-
and correction order regarding violations of                                                            the facility or the operator is not in substan-
                                                   ducted, the operator may choose to enter into
class II or class III standards to request any                                                          tial compliance with a standard or standards
                                                   a consent agreement with the department to
conference and to submit a plan of correction                                                           the violations of which would present either
                                                   obtain a probationary license. The consent
for the department's approval which contains                                                            an imminent danger to the health, safety or
                                                   agreement shall include a provision that the
specific dates for achieving compliance.                                                                welfare of any resident or a substantial prob-
                                                   operator will voluntarily surrender the license
Within five working days after receiving a                                                              ability that death or serious physical harm
                                                   if substantial compliance is not reached in ac-
plan of correction regarding a violation of a                                                           would result and which is not immediately
                                                   cordance with the terms and deadlines estab-
class I standard and within ten working days                                                            corrected, the department shall:
                                                   lished under the agreement. The agreement
after receiving a plan of correction regarding
                                                   shall specify the stages, actions and time span
a violation of a class II or III standard, the                                                          (1) Give immediate written notice of the non-
                                                   to achieve substantial compliance.
department shall give its written approval or                                                           compliance to the operator, administrator or
rejection of the plan. If there was a violation                                                         person managing or supervising the conduct
                                                   6. Whenever a notice of noncompliance has
of any class I standard, immediate correc-                                                              of the facility at the time the noncompliance
                                                   been issued, the operator shall post a copy
tive action shall be taken by the operator or                                                           is found;
                                                   of the notice of noncompliance and a copy
administrator and a written plan of correction
                                                   of the most recent inspection report in a
shall be submitted to the department. The                                                                                                          101
                                                         Missouri Revised Statutes
Statutes

                                                  medical, social, personal or financial records     the department for a period of one year after
(2) Make public the fact that a notice of         of any resident in any facility, except when       recording. The department shall in all cases
noncompliance has been issued to the facility.    disclosed in a manner which does not identify      attempt to obtain the name of any person
Copies of the notice shall be sent to appropri-   any resident, or when ordered to do so by a        making a report after obtaining relevant
ate hospitals and social service agencies;        court of competent jurisdiction. Such records      information regarding the alleged abuse or
                                                  shall be accessible without court order for ex-    neglect. The department shall also attempt
(3) Send a copy of the notice of noncompli-       amination and copying only to the following        to obtain the address of any person making a
ance to the division of family services of the    persons or offices, or to their designees:         report. The identity of the person making the
department of social services, the department                                                        report shall remain confidential.
of mental health, and any other concerned         (1) The department or any person or agency
federal, state or local government agencies.      designated by the department;                      (L. 1979 S.B. 328, et al. § 11, A.L. 1987 S.B.
The facility shall post in a conspicuous loca-                                                       277, A.L. 2003 S.B. 556 & 311)
tion in the facility a copy of the notice of      (2) The attorney general;
noncompliance and a copy of the most recent                                                          Section 198.036
inspection report.                                (3) The department of mental health for resi-
                                                  dents placed through that department;
(L. 1979 S.B. 328, et al. § 10)                                                                      Revocation of license--
                                                  (4) Any appropriate law enforcement agency;        grounds--notice required.
Section 198.030
                                                  (5) The resident, the resident's guardian, or      1. The department may revoke a license in
                                                  any other person designated by the resident;       any case in which it finds that:
Posting of inspection reports                     and
at the facility.                                  (6) Appropriate committees of the general
                                                                                                     198.036 (1) The operator failed or refused to
                                                                                                     comply with class I or II standards, as estab-
                                                  assembly and the state auditor, but only to the    lished by the department pursuant to section
198.030 Every residential care facility,
                                                  extent of financial records which the operator     198.085; or failed or refused to comply with
assisted living facility, intermediate care
                                                  is required to maintain pursuant to sections       class III standards as established by the de-
facility, and skilled nursing facility shall
                                                  198.088 and 198.090.                               partment pursuant to section 198.085, where
post the most recent inspection report of the
facility in a conspicuous place. If the opera-                                                       the aggregate effect of such noncompliances
                                                  2. Inspection reports and written reports of       presents either an imminent danger to the
tor determines that the inspection report of
                                                  investigations of complaints, of substantiated     health, safety or welfare of any resident or a
the facility contains individually identifiable
                                                  reports of abuse and neglect received in ac-       substantial probability that death or serious
health information, the operator may redact
                                                  cordance with section 198.070, and com-            physical harm would result;
such information prior to posting the inspec-
                                                  plaints received by the department relating to
tion report.
                                                  the quality of care of facility residents, shall   (2) The operator refused to allow representa-
                                                  be accessible to the public for examination        tives of the department to inspect the facil-
(L. 2003 S.B. 556 & 311)
                                                  and copying, provided that such reports are        ity for compliance with standards or denied
*Editorial change required by § 198.005.
                                                  disclosed in a manner which does not identify      representatives of the department access to
                                                  the complainant or any particular resident.        residents and employees necessary to carry
                                                  Records and reports shall clearly show what        out the duties set forth in this chapter and
Section 198.032                                   steps the department and the institution are       rules promulgated thereunder, except where
                                                  taking to resolve problems indicated in said       employees of the facility are in the process
                                                  inspections, reports and complaints.
Records, what confidential,                                                                          of rendering immediate care to a resident of
                                                                                                     such facility;
what subject to disclosure--                      3. The department shall maintain a central
                                                  registry capable of receiving and maintaining
procedure--central registry to                    reports received in a manner that facilitates
                                                                                                     (3) The operator knowingly acted or know-
                                                                                                     ingly omitted any duty in a manner which
receive complaints of abuse                       rapid access and recall of the information         would materially and adversely affect the
and neglect, procedure--                          reported, and of subsequent investigations         health, safety, welfare or property of a resi-
                                                  and other relevant information. The depart-
hotline caller log to be main-                    ment shall electronically record and main-
                                                                                                     dent;

tained.                                           tain a hotline caller log for the reporting of     (4) The operator demonstrated financial
                                                  suspected abuse and neglect in long-term care      incapacity to operate and conduct the facility
198.032 1. Nothing contained in sections          facilities. Any telephone report of suspected      in accordance with the provisions of sections
198.003 to 198.186 shall permit the public        abuse and neglect received by the department       198.003 to 198.096;
disclosure by the department of confidential      and such recorded reports shall be retained by
                                                                                                                                                102
                                                        Missouri Revised Statutes
Statutes

                                                   hearing commission--judicial
(5) The operator or any principals in the
                                                   review.                                            Section 198.042
operation of the facility have ever been con-
victed of, or pled guilty or nolo contendere to
                                                   198.039 1. Any person aggrieved by an of-
a felony offense concerning the operation of a
                                                   ficial action of the department either refusing    Medical supervision for resi-
long-term health care facility or other health
care facility, or ever knowingly acted or
                                                   to issue a license or revoking a license may       dents relying on spiritual heal-
                                                   seek a determination thereon by the admin-         ing not required.
knowingly failed to perform any duty which
                                                   istrative hearing commission pursuant to the
materially and adversely affected the health,
                                                   provisions of section 621.045, RSMo, et seq.,      198.042 Nothing in sections 198.003 to
safety, welfare, or property of a resident
                                                   except that the petition must be filed with the    198.096, or the rules and regulations ad-
while acting in a management capacity. The
                                                   administrative hearing commission within           opted pursuant thereto, shall be construed
operator of the facility or any principal in the
                                                   fifteen days after the mailing or delivery of      as authorizing the medical supervision,
operation of the facility shall not be under ex-
                                                   notice to the operator. It shall not be a condi-   regulation or control of the remedial care or
clusion from participation in the Title XVIII
                                                   tion to such determination that the person         treatment of those residents who rely solely
(Medicare) or Title XIX (Medicaid) program
                                                   aggrieved seek a reconsideration, a rehearing      upon treatment by prayer or spiritual means
of any state or territory; or
                                                   or exhaust any other procedure within the          in accordance with creed or tenets of any
                                                   department.                                        well-recognized church or religious denomi-
(6) The operator or any principals involved
in the operation of the facility have ever been                                                       nation. All remaining rules and regulations
                                                   2. The administrative hearing commission           and minimum standards not in conflict with
convicted of or pled guilty or nolo contendere
                                                   may stay the revocation of such license,           this section shall apply.
to a felony in any state or federal court aris-
                                                   pending the commission's findings and
ing out of conduct involving either man-
                                                   determination in the cause, upon such condi-       (L. 1979 S.B. 328, et al. § 14)
agement of a long-term care facility or the
                                                   tions as the commission deems necessary and
provision or receipt of health care.
                                                   appropriate including the posting of bond or
                                                   other security except that the commission
2. Nothing in subdivision (2) of subsection 1
                                                   shall not grant a stay or if a stay has already    Section 198.045
of this section shall be construed as allow-
                                                   been entered shall set aside its stay, if upon
ing the department access to information not
                                                   application of the department the commission
necessary to carry out the duties set forth in
                                                   finds reason to believe that continued opera-      Participation in Medicare or
sections 198.006 to 198.186.
                                                   tion of a facility pending the commission's fi-    Medicaid optional--survey for
                                                   nal determination would present an imminent        certification at same time as
3. Upon revocation of a license, the director
                                                   danger to the health, safety or welfare of any
of the department shall so notify the opera-
                                                   resident or a substantial probability that death   license inspection.
tor in writing, setting forth the reason and
                                                   or serious physical harm would result. In any
grounds for the revocation. Notice of such re-                                                        198.045 Participation in reimbursement
                                                   case in which the department has refused to
vocation shall be sent either by certified mail,                                                      programs under either Medicare or Medicaid,
                                                   issue a license, the commission shall have no
return receipt requested, to the operator at the                                                      Title XVIII and Title XIX of the Social Secu-
                                                   authority to stay or to require the issuance of
address of the facility, or served personally                                                         rity Act, (Title 42, United States Code, Sec.
                                                   a license pending final determination by the
upon the operator. The department shall pro-                                                          1395x or 1396d), or other federal laws, shall
                                                   commission.
vide the operator notice of such revocation at                                                        be at the option of the individual facility. A
least ten days prior to its effective date.                                                           skilled nursing facility or an intermediate
                                                   3. The administrative hearing commission
                                                   shall make the final decision as to the issu-      care facility which chooses to participate in
(L. 1979 S.B. 328, et al. § 12, A.L. 2003 S.B.                                                        such programs shall be surveyed for certifi-
                                                   ance or revocation of a license. Any person
556 & 311)                                                                                            cation for reimbursement and inspected for
                                                   aggrieved by a final decision of the admin-
(1987) It has been held that the legislature did                                                      state licensure at the same time.
                                                   istrative hearing commission, including the
not intend that a single non-life-threatening
                                                   department, may seek judicial review of such
incident would be sufficient to justify a                                                             (L. 1979 S.B. 328, et al. § 15)
                                                   decision by filing a petition for review in
license revocation under this section. Villines
                                                   the court of appeals for the district in which
v. Division of Aging, 722 S.W.2d 939 (Mo.
banc).
                                                   the facility is located. Review shall be had,      Section 198.048
                                                   except as modified herein, in accordance
                                                   with the provisions of sections 621.189 and
Section 198.039                                    621.193, RSMo.                                     Different classifications of fa-
                                                                                                      cility may exist on same prem-
                                                   (L. 1979 S.B. 328, et al. § 13)
License refused or revoked-                                                                           ises, when.
-review by administrative                                                                                                           103
                                                         Missouri Revised Statutes
Statutes

                                                    202.905, 208.030, or 208.159, RSMo, the             dations, board, health care or treatment, or
198.048 A skilled nursing, intermediate care,       state auditor shall have the right to examine       personal services for residents placed through
assisted living facility, or residential care       the records of any facility which he deems          the department of mental health. Inspec-
facility may exist on the same premises under       necessary in connection with any examina-           tions made pursuant to provisions of sections
the following circumstances:                        tion conducted pursuant to his statutory            198.003 to 198.096 shall also serve as the
                                                    authority, and to disclose the results of any       inspections required under the provisions of
(1) The skilled nursing, intermediate care,         such examination including the identity of          chapter 630, RSMo, except for inspections
assisted living facility or residential care        any facility examined, provided that the            and visits to determine appropriateness of
facility is an identifiable unit thereof, such as   identity of any resident of any such facility       resident placement, to develop and review
an entire ward or contiguous wards, wing or         shall not be divulged or made known by the          treatment plans, and to monitor the conditions
floor of a building or a separate contiguous        state auditor.                                      and status of residents.
building and such identifiable unit is ap-
proved in writing by the department;                5. All financial information, data and records      (L. 1979 S.B. 328, et al. § 18, A.L. 1984 S.B.
                                                    of facilities under the provisions of sec-          451)
(2) The identifiable unit meets all the reason-     tions 198.003 to 198.186, 198.200, 202.905,
able standards for such facility;                   208.030, or 208.159, RSMo, shall be open
                                                    upon request for inspection, examination and
                                                                                                        Section 198.058
(3) Central services and facilities such as         audit by the director of the department, the
management services, nursing and other              state auditor, appropriate committees of the        Certain facilities exempt from
patient-care services, building maintenance         general assembly, and their designees, at all
and laundry which are shared with other units       reasonable times.                                   construction standards, when-
are determined to be sufficient to meet the                                                             -report by department.
reasonable standards for such a facility.           6. Each facility shall retain medical records
                                                    of each resident for five years after he leaves     198.058 Any facility licensed under chapter
(L. 1979 S.B. 328, et al. § 16, A.L. 1984 S.B.      the facility. In the event the resident is less     197, RSMo, or chapter 198, which is in op-
451)                                                than twenty-one years of age, the records           eration before September 28, 1979, or whose
*Reprinted due to editorial change required         shall be retained for five years after the age of   application is on file, or whose construction
by § 198.005.                                       twenty-one years is reached. The time limita-       plans have been approved by the department
                                                    tions of this subsection shall not apply when       before September 28, 1979, shall be exempt
                                                    longer time limitations are specified in stan-      from construction standards developed by
                                                    dards for facilities certified under Medicare       the department subsequent to the date such
Section 198.052                                     or Medicaid, Title XVIII and Title XIX of the       facility became first licensed and including
                                                    Social Security Act, (Title 42, United States       those construction standards developed after
Records of facilities--when ex-                     Code, Sec. 1395x or 1396d).                         September 28, 1979, for buildings or other
                                                                                                        physical units which were in existence or
amined or audited--retention,                       7. In the event a new operator takes over           under construction on September 28, 1979.
how long--to accompany resi-                        a facility's operation, the original medical        Such facilities shall be licensed in accordance
                                                    records of the residents of such facility shall     with all other standards and regulations pro-
dent on transfer, when.                             be retained in the facility by the new operator.    mulgated under sections 198.003 to 198.096.
                                                                                                        The department shall survey all such facilities
198.052 1. The state auditor, at the request of     8. In the event a resident is transferred from      and shall prepare a report for submission to
the department or on his own initiative, may        the facility, the resident shall be accompanied     the general assembly on actions and stan-
examine and audit any records relating to the       by a copy of his medical records.                   dards necessary to bring such facilities into
operation of any facility.                                                                              full compliance. The report shall be filed with
                                                    (L. 1979 S.B. 328, et al. § 17)                     the speaker of the house and the president pro
2. The director of the department may exam-                                                             tem of the senate by January 1, 1982.
ine and audit, or cause to be examined and
audited, any records relating to the operation
of any facility.
                                                    Section 198.055                                     (L. 1979 S.B. 328, et al. § 19)


3. Each facility shall retain all financial         Inspection by department                            Section 198.061
information, data and records relating to the
operation and reimbursement of the facility         valid for certain mental health
for a period of not less than seven years.          patients, when.                                     Penalty for providing services
4. Notwithstanding anything to the contrary         198.055 A facility may provide accommo-
in sections 198.003 to 198.186, 198.200,                                                                                                         104
                                                          Missouri Revised Statutes
Statutes

without license--penalty for                        (L. 1979 S.B. 328, et al. § 21)                 department, or by the attorney general on
                                                                                                    his or her own volition or at the request of
interfering with enforcement                                                                        the department or any other appropriate state
of law.                                             Section 198.066                                 agency, to temporarily or permanently enjoin
                                                                                                    or restrain any violation of sections 198.003
198.061 1. No person shall, jointly or sever-                                                       to 198.096, to enjoin the acceptance of new
ally, offer, advertise or hold out to the public,   Sanctions for violations autho-                 residents until substantial compliance with
services subject to section 198.015 without                                                         sections 198.003 to 198.096 is achieved, or
a currently valid appropriate license issued        rized.                                          to enjoin any specific action or practice of
by the department to render the particular                                                          the facility. Any action brought pursuant to
services.                                           198.066 To encourage compliance with            the provisions of this section shall be placed
                                                    the provisions of this chapter and any rules    at the head of the docket by the court, and
2. No person, jointly or severally, shall           promulgated thereto, the department of health   the court shall hold a hearing on any action
interfere with or prevent any duly authorized       and senior services shall impose sanctions      brought pursuant to the provisions of this sec-
representative of the department or the attor-      commensurate with the seriousness of the        tion no less than fifteen days after the filing
ney general from lawful enforcement of sec-         violation which occurred. For class I, II, or   of the action.
tions 198.003 to 198.186, 198.200, 202.905,         III violations, the following remedies may be
208.030, or 208.159, RSMo.                          imposed:                                        2. The department may bring an action
                                                                                                    in circuit court to recover a civil penalty
3. Any person violating any provision of this       (1) A plan of correction;                       against the licensed operator of the facility
section shall be guilty of a class C misde-                                                         as provided by this section. Such action shall
meanor.                                             (2) Additional directed staff training;         be brought in the circuit court for the county
                                                                                                    in which the facility is located. The circuit
(L. 1979 S.B. 328, et al. § 20)                     (3) State monitoring;                           court shall determine the amount of penalty
                                                                                                    to be assessed within the limits set out in
                                                    (4) A directed plan of correction;              this section. Appeals may be taken from the
Section 198.064                                                                                     judgment of the circuit court as in other civil
                                                    (5) Denial of payment for new Medicaid          cases.
                                                    admissions;
Duplicate payments--how                             (6) A probationary license and consent agree-
                                                                                                    3. The operator of any facility which has been
                                                                                                    cited with a violation of sections 198.003 to
determined--procedures for                          ment as described in section 198.026;           198.096 or the regulations established pursu-
repayment.                                                                                          ant thereto, or of subsection (b), (c), or (d) of
                                                    (7) Recovery of civil monetary penalties        Section 1396r of Title 42 of the United States
198.064 1. No operator shall retain any             pursuant to section 198.067;                    Code or the regulations established pursuant
duplicate payment for the care of a resident                                                        thereto, is liable to the state for civil penalties
received from any state agency or agencies.         (8) Denial of payment for all new admissions;   of up to twenty-five thousand dollars for each
For the purposes of this section a duplicate                                                        day that the violations existed or continue to
payment is one which results in a total pay-        (9) Receivership pursuant to section 198.105;   exist. Violations shall be presumed to contin-
ment to the operator in excess of the per diem      or                                              ue to exist from the time they are found until
or monthly rate authorized by the agency or                                                         the time the department of health and senior
agencies. The operator shall report all such        (10) License revocation.                        services finds them to have been corrected.
duplicate payments to the paying agency or                                                          When applicable, the amount of the penalty
agencies within five business days after such       (L. 2003 S.B. 556 & 311)                        shall be determined as follows:
duplicate payment is discovered or reason-
ably should have been discovered.                                                                   (1) For each violation of a class I standard
                                                    Section 198.067                                 when applicable pursuant to subdivision (6)
2. The operator shall repay the excess amount                                                       of this subsection, not less than one thousand
in accordance with such procedures as the                                                           dollars nor more than ten thousand dollars;
paying agency or agencies shall reasonably          Noncompliance with law--in-
require, together with interest at the rate of      junction, when--civil penalties,                (2) For each violation of a class II standard,
one and five-tenths percent per month from                                                          not less than two hundred fifty dollars nor
the date the duplicate payment was discov-          how calculated, where depos-                    more than one thousand dollars;
ered or reasonably should have been discov-         ited.
ered.                                                                                               (3) For each violation of a class III standard,
                                                    198.067 1. An action may be brought by the
                                                                                                                                                 105
                                                          Missouri Revised Statutes
Statutes

not less than fifty dollars nor more than two                                                         the amount of the civil penalty recommended
hundred fifty dollars;                             5. The imposition of any remedy provided for       by the moving party in its petition shall
                                                   in sections 198.003 to 198.186 shall not bar       be reduced by twenty-five percent and the
(4) For each violation of a federal standard       the imposition of any other remedy.                confessed judgment shall be entered by the
which does not also constitute a violation of a                                                       circuit court at the reduced amount.
state law or regulation, not less than two hun-    6. Twenty-five percent of the penalties
dred fifty dollars nor more than five hundred      collected pursuant to this section shall be de-    9. The amount of any civil penalty assessed
dollars;                                           posited in the elderly home-delivered meals        by the circuit court pursuant to this section
                                                   trust fund as established in section 143.1002,     shall be reduced by the amount of any civil
(5) For each specific class I violation by the     RSMo. Twenty-five percent of the penalties         monetary penalty which the licensed opera-
same operator at a particular facility which       collected pursuant to this section shall be        tor of the facility may establish it has paid
has been previously cited within the past          deposited in the nursing facility quality of       pursuant to the laws of the United States for
twenty-four months and for each specific           care fund established in section 198.418 to        the breach of the same federal standards for
class II or III violation by the same operator     be used for the sole purpose of supporting         which the state action is brought.
at a particular facility which has been previ-     quality care improvement projects within
ously cited within the past twelve months,         the office of state ombudsman for long-term        10. In addition to the civil penalties speci-
double the amount last imposed;                    care facility residents, established pursuant to   fied in subdivision (1) of subsection 3 of
                                                   section 660.603, RSMo. The remaining fifty         this section, any facility which is cited with
(6) In accordance with the provisions of this      percent of the penalties collected pursuant to     a violation of a class I standard pursuant to
section, if the department imposes a civil         this section shall be deposited into the nurs-     subsection 1 of section 198.085, when such
monetary penalty for a class I violation, the      ing facility quality of care fund to be used       violation results in serious physical injury or
liability for such penalty shall be incurred im-   by the department for the sole purpose of          abuse of a sexual nature pursuant to subdivi-
mediately upon the imposition of the penalty       developing a program to assist qualified nurs-     sion (1) of section 198.006, to any resident
for the violation regardless of any subsequent     ing facilities to improve the quality of service   of that facility shall be liable to the state for a
correction of the violation by the facility. For   to their residents. The director of the depart-    civil penalty of one hundred dollars multi-
class II or III violations, if the department      ment shall, by rule, develop a definition of       plied by the number of beds licensed to the
imposes a civil monetary penalty, the liability    qualified facilities and shall establish proce-    facility, up to a maximum of ten thousand
for such penalty shall be incurred if a breach     dures for the selection of qualified facilities.   dollars pursuant to subsections 1 and 2 of
of a specific state or federal standard or         Any rule or portion of a rule, as that term is     this section. The liability of the facility for
statute remains uncorrected and not in accord      defined in section 536.010, RSMo, that is cre-     civil penalties pursuant to this section shall
with the accepted plan of correction at the        ated under the authority delegated in this sec-    be incurred immediately upon the citation of
time of the reinspection conducted pursu-          tion shall become effective only if it complies    the violation and shall not be affected by any
ant to subsection 3 of section 198.026 or the      with and is subject to all of the provisions of    subsequent correction of the violation. For
regulations established pursuant to Title 42 of    chapter 536, RSMo, and, if applicable, sec-        the purposes of this section, "serious physical
the United States Code.                            tion 536.028, RSMo. This section and chapter       injury" means physical injury that creates a
                                                   536, RSMo, are nonseverable and if any* of         substantial risk of death or that causes serious
A judgment rendered against the operator of a      the powers vested with the general assembly        disfigurement or protracted loss or impair-
facility pursuant to this subsection shall bear    pursuant to chapter 536, RSMo, to review, to       ment of the function of any part of the body.
interest as provided in subsection 1 of section    delay the effective date, or to disapprove and
408.040, RSMo.                                     annul a rule are subsequently held unconstitu-     11. The department shall not impose a fine for
                                                   tional, then the grant of rulemaking authority     self-reporting class II and class III violations
4. Any individual who willfully and know-          and any rule proposed or adopted after Au-         so long as each violation is corrected within
ingly certifies pursuant to subsection (b)(3)      gust 28, 2003, shall be invalid and void. Such     a specified period of time as determined by
(B)(i) of Section 1396r of Title 42 of the         penalties shall not be considered a charitable     the department and there is no reoccurrence
United States Code a material and false state-     contribution for tax purposes.                     of the particular violation for twelve months
ment in a resident assessment is subject to a                                                         following the date of the first self-reporting.
civil penalty of not more than one thousand        7. To recover any civil penalty, the moving
dollars with respect to each assessment. Any       party shall prove by clear and convincing          12. If a facility is sold or changes its opera-
individual who willfully and knowingly             evidence that the violation occurred.              tor, any civil penalty assessed shall not be
causes another individual to certify pursuant                                                         sold, transferred, or otherwise assigned to
to subsection (b)(3)(B)(i) of Section 1396r of     8. The licensed operator of a facility against     the successor operator but shall remain the
Title 42 of the United States Code a material      whom an action to recover a civil penalty is       sole liability of the operator at the time of the
and false statement in a resident assessment       brought pursuant to this section may confess       violation.
is subject to a civil penalty of not more than     judgment as provided in section 511.070,
five thousand dollars with respect to each         RSMo, at any time prior to hearing. If such        (L. 1979 S.B. 328, et al. § 22, A.L. 1989 S.B.
assessment.                                        licensed operator agrees to confess judgment,
                                                                                                                                                  106
                                                         Missouri Revised Statutes
Statutes

203 & 270, A.L. 1996 H.B. 781, A.L. 1999          chiropractor; Christian Science practitioner;       four hours and, as soon as possible during
H.B. 316, et al. merged with S.B. 326, A.L.       coroner; dentist; embalmer; employee of the         the course of the investigation, shall notify
2003 S.B. 556 & 311)                              departments of social services, mental health,      the resident's next of kin or responsible
*Word "an" appears in original rolls.             or health and senior services; employee of a        party of the report and the investigation and
                                                  local area agency on aging or an organized          further notify them whether the report was
Section 198.069                                   area agency on aging program; funeral direc-        substantiated or unsubstantiated unless such
                                                  tor; home health agency or home health agen-        person is the alleged perpetrator of the abuse
                                                  cy employee; hospital and clinic personnel          or neglect. As provided in section 565.186,
Resident returned to facility                     engaged in examination, care, or treatment of       RSMo, substantiated reports of elder abuse
                                                  persons; in-home services owner, provider,          shall be promptly reported by the department
from a medical facility, physi-                   operator, or employee; law enforcement              to the appropriate law enforcement agency
cian orders, duty of facility.                    officer; long-term care facility administra-        and prosecutor.
                                                  tor or employee; medical examiner; medical
198.069 For any resident of an assisted liv-      resident or intern; mental health professional;     7. If the investigation indicates possible abuse
ing facility who is released from a hospital      minister; nurse; nurse practitioner; optom-         or neglect of a resident, the investigator shall
or skilled nursing facility and returns to an     etrist; other health practitioner; peace officer;   refer the complaint together with the inves-
assisted living facility as a resident, such      pharmacist; physical therapist; physician;          tigator's report to the department director or
resident's assisted living facility shall im-     physician's assistant; podiatrist; probation or     the director's designee for appropriate action.
mediately, upon return, implement physician       parole officer; psychologist; social worker; or     If, during the investigation or at its comple-
orders in the hospital or discharge summary,      other person with the care of a person sixty        tion, the department has reasonable cause to
and within twenty-four hours of the patient's     years of age or older or an eligible adult has      believe that immediate removal is necessary
return to the facility, review and document       reasonable cause to believe that a resident of      to protect the resident from abuse or neglect,
such review of any physician orders related       a facility has been abused or neglected, he or      the department or the local prosecuting attor-
to the resident's hospital discharge care plan    she shall immediately report or cause a report      ney may, or the attorney general upon request
or the skilled nursing facility discharge care    to be made to the department.                       of the department shall, file a petition for
plan and modify the individual service plan                                                           temporary care and protection of the resident
for the resident accordingly. The department      2. The report shall contain the name and ad-        in a circuit court of competent jurisdiction.
of health and senior services may adjust          dress of the facility, the name of the resident,    The circuit court in which the petition is filed
personal care units authorized as described       information regarding the nature of the abuse       shall have equitable jurisdiction to issue an ex
in subsection 14 of section 208.152, RSMo,        or neglect, the name of the complainant, and        parte order granting the department author-
upon the effective date of the physicians         any other information which might be helpful        ity for the temporary care and protection of
orders to reflect the services required by such   in an investigation.                                the resident, for a period not to exceed thirty
orders.                                                                                               days.
                                                  3. Any person required in subsection 1 of this
(L. 2007 S.B. 577)                                section to report or cause a report to be made      8. Reports shall be confidential, as provided
                                                  to the department who knowingly fails to            pursuant to section 660.320, RSMo.
Section 198.070                                   make a report within a reasonable time after
                                                  the act of abuse or neglect as required in this     9. Anyone, except any person who has abused
                                                  subsection is guilty of a class A misdemeanor.      or neglected a resident in a facility, who
Abuse or neglect of residents-                                                                        makes a report pursuant to this section or
                                                  4. In addition to the penalties imposed by this     who testifies in any administrative or judicial
-reports, when, by whom--                         section, any administrator who knowingly            proceeding arising from the report shall be
contents of report--failure to                    conceals any act of abuse or neglect resulting      immune from any civil or criminal liability
report, penalty--investigation,                   in death or serious physical injury, as defined     for making such a report or for testifying
                                                  in section 565.002, RSMo, is guilty of a class      except for liability for perjury, unless such
referral of complaint, removal                    D felony.                                           person acted negligently, recklessly, in bad
of resident--confidentiality of                                                                       faith or with malicious purpose. It is a crime
                                                  5. In addition to those persons required to re-     pursuant to section 565.186 and 565.188,
report--immunity, exception-                      port pursuant to subsection 1 of this section,      RSMo, for any person to purposely file a
-prohibition against retalia-                     any other person having reasonable cause            false report of elder abuse or neglect.
tion--penalty--employee list-                     to believe that a resident has been abused or
                                                  neglected may report such information to the        10. Within five working days after a report
-self-reporting of incidents,                     department.                                         required to be made pursuant to this section is
investigations, when.                                                                                 received, the person making the report shall
                                                  6. Upon receipt of a report, the department         be notified in writing of its receipt and of the
198.070 1. When any adult day care worker;        shall initiate an investigation within twenty-
                                                                                                                                               107
                                                        Missouri Revised Statutes
Statutes

initiation of the investigation.                   substantiated report.
                                                                                                        (L. 2003 S.B. 556 & 311)
11. No person who directs or exercises any         (L. 1979 S.B. 328, et al. § 23, A.L. 1984 S.B.       *Editorial change required by § 198.005.
authority in a facility shall evict, harass,       451, A.L. 1987 S.B. 277, A.L. 1988 S.B. 602,
dismiss or retaliate against a resident or em-     A.L. 1990 H.B. 1370, et al., A.L. 1992 S.B.
ployee because such resident or employee or        573 & 634, A.L. 1994 H.B. 1335 & 1381,               Section 198.073
any member of such resident's or employee's        A.L. 1999 H.B. 316, et al. merged with S.B.
family has made a report of any violation or       326, A.L. 2003 S.B. 556 & 311)
suspected violation of laws, ordinances or         (1989) Owners and operators of nursing               Persons eligible for care in
regulations applying to the facility which the     home were convicted of knowing neglect
resident, the resident's family or an employee
                                                                                                        residential care facility or as-
                                                   where they had knowledge of neglect in
has reasonable cause to believe has been           administration of required care; but persons         sisted living facility--assisted
committed or has occurred. Through the             may not be convicted of knowing neglect              living facility licenses granted,
existing department information and refer-         simply because of ownership or supervisory
ral telephone contact line, residents, their       authority over a facility. (Mo. banc) State v.       requirements--facility admis-
families and employees of a facility shall be      Dale, 775 S.W.2d 126.                                sion, requirements, disclo-
able to obtain information about their rights,
protections and options in cases of eviction,
                                                                                                        sures--rulemaking authority.
                                                   (1989) Statute making it a Class D felony to
harassment, dismissal or retaliation due to a      knowingly abuse or neglect resident of nurs-         198.073 1. A residential care facility shall
report being made pursuant to this section.        ing care facility, held not unconstitutionally       admit or retain only those persons who are
                                                   vague. Owners or managers responsible for            capable mentally and physically of negotiat-
12. Any person who abuses or neglects a            known abuse or neglect. State v. Dale 775            ing a normal path to safety using assistive
resident of a facility is subject to criminal      S.W.2d 126 (Mo. banc).                               devices or aids when necessary, and who
prosecution under section 565.180, 565.182,
                                                                                                        may need assisted personal care within the
or 565.184, RSMo.                                  (1989) Where statute requires a finding of           limitations of such facilities, and who do not
                                                   knowing neglect and "neglect" is specifically        require hospitalization or skilled nursing care.
13. The department shall maintain the em-          defined in § 198.006, RSMo, statutes are not
ployee disqualification list and place on the      unconstitutionally vague. (Mo. banc) State v.        2. Notwithstanding the provisions of subsec-
employee disqualification list the names of        Dale, 775 S.W.2d 126.                                tion 1 of this section, those persons previ-
any persons who are or have been employed
                                                                                                        ously qualified for residence who may have a
in any facility and who have been finally de-      (2003) Subsection 10 of section implicitly           temporary period of incapacity due to illness,
termined by the department pursuant to sec-        creates a private cause of action for nursing        surgery, or injury, which period does not
tion 660.315, RSMo, to have knowingly or           home district employees terminated in viola-         exceed forty-five days, may be allowed to
recklessly abused or neglected a resident. For     tion of the statute. Bachtel v. Miller County        remain in a residential care facility or assisted
purposes of this section only, "knowingly"         Nursing Home District, 110 S.W.3d 799 (Mo.           living facility if approved by a physician.
and "recklessly" shall have the meanings that      banc).
are ascribed to them in this section. A person
                                                                                                        3. Any facility licensed as a residential
acts "knowingly" with respect to the person's
                                                                                                        care facility II on August 27, 2006, shall be
conduct when a reasonable person should
be aware of the result caused by his or her
                                                   Section 198.071                                      granted a license as an assisted living facil-
                                                                                                        ity, as defined in section 198.006, on August
conduct. A person acts "recklessly" when the
                                                                                                        28, 2006, regardless of the laws, rules, and
person consciously disregards a substantial        Death of a resident, persons                         regulations for licensure as an assisted living
and unjustifiable risk that the person's con-
duct will result in serious physical injury and    to contact prior to transfer of                      facility as long as such facility continues to
                                                                                                        meet all laws, rules, and regulations that were
such disregard constitutes a gross deviation       deceased.                                            in place on August 27, 2006, for a residential
from the standard of care that a reasonable
                                                                                                        care facility II. At such time that the average
person would exercise in the situation.
                                                   198.071 The staff of a residential care facil-       total reimbursement, not including residents'
                                                   ity, an assisted living facility, an intermediate    cost-of-living increases in their benefits from
14. The timely self-reporting of incidents to
                                                   care facility, or a skilled nursing facility shall   the Social Security Administration after Au-
the central registry by a facility shall con-
                                                   attempt to contact the resident's immediate          gust 28, 2006, for the care of persons eligible
tinue to be investigated in accordance with
                                                   family or a resident's responsible party, and        for Medicaid in an assisted living facility
department policy, and shall not be counted
                                                   shall contact the attending physician and            is equal to or exceeds forty-one dollars per
or reported by the department as a hot-line
                                                   notify the local coroner or medical examiner         day, all facilities with a license as an assisted
call but rather a self-reported incident. If the
                                                   immediately upon the death of any resident of        living facility shall meet all laws, rules, and
self-reported incident results in a regulatory
                                                   the facility prior to transferring the deceased
violation, such incident shall be reported as a
                                                   resident to a funeral home.
                                                                                                                                                  108
                                                         Missouri Revised Statutes
Statutes

regulations for licensure as an assisted living    the needs and preferences of the resident. The
facility. Nothing in this section shall be con-    individualized service plan will be reviewed        (9) Develops and implements a plan to
strued to allow any facility that has not met      with the resident, or legal representative          protect the rights, privacy, and safety of all
the requirements of subsections 4 and 6 of         of the resident, at least annually, or when         residents and to protect against the financial
this section to care for any individual with a     there is a significant change in the resident's     exploitation of all residents;
physical, cognitive, or other impairment that      condition which may require a change in
prevents the individual from safely evacuat-       services. The signatures of an authorized           (10) Complies with the training requirements
ing the facility.                                  representative of the facility and the resident,    of subsection 8 of section 660.050, RSMo.
                                                   or the resident's legal representative, shall be
4. Any facility licensed as an assisted living     contained on the individualized service plan        5. Exceptions to paragraphs (d) to (f) of
facility, as defined in section 198.006, except    to acknowledge that the service plan has been       subdivision (8) of subsection 4 of this sec-
for facilities licensed under subsection 3 of      reviewed and understood by the resident or          tion shall be made for residents on hospice,
this section, may admit or retain an individual    legal representative;                               provided the resident, designated representa-
for residency in an assisted living facility                                                           tive, or both, and the assisted living provider,
only if the individual does not require hospi-     (7) Makes available and implements self-            physician, and licensed hospice provider all
talization or skilled nursing placement, and       care, productive and leisure activity programs      agree that such program of care is appropriate
only if the facility:                              which maximize and encourage the resident's         for the resident.
                                                   optimal functional ability;
(1) Provides for or coordinates oversight and                                                          6. If an assisted living facility accepts or
services to meet the needs of the resident as      (8) Ensures that the residence does not accept      retains any individual with a physical, cogni-
documented in a written contract signed by         or retain a resident who:                           tive, or other impairment that prevents the
the resident, or legal representative of the                                                           individual from safely evacuating the facility
resident;                                          (a) Has exhibited behaviors that present a rea-     with minimal assistance, the facility shall:
                                                   sonable likelihood of serious harm to himself
(2) Has twenty-four-hour staff appropriate         or herself or others;                               (1) Have sufficient staff present and awake
in numbers and with appropriate skills to                                                              twenty-four hours a day to assist in the
provide such services;                             (b) Requires physical restraint;                    evacuation;

(3) Has a written plan for the protection of all   (c) Requires chemical restraint. As used in         (2) Include an individualized evacuation plan
residents in the event of a disaster, includ-      this paragraph, the following terms mean:           in the service plan of the resident; and
ing keeping residents in place, evacuating
residents to areas of refuge, evacuating resi-     a. "Chemical restraint", a psychopharma-            (3) Take necessary measures to provide
dents from the building if necessary, or other     cologic drug that is used for discipline or         residents with the opportunity to explore the
methods of protection based on the disaster        convenience and not required to treat medical       facility and, if appropriate, its grounds; and
and the individual building design;                symptoms;
                                                                                                       (4) Use a personal electronic monitoring
(4) Completes a pre-move-in screening with         b. "Convenience", any action taken by the fa-       device for any resident whose physician rec-
participation of the prospective resident;         cility to control resident behavior or maintain     ommends the use of such device.
                                                   residents with a lesser amount of effort by the
(5) Completes for each resident a communi-         facility and not in the resident's best interest;   7. An individual admitted or readmitted to
ty-based assessment, as defined in subdivi-                                                            the facility shall have an admission physical
sion (7) of section 198.006:                       c. "Discipline", any action taken by the facil-     examination by a licensed physician. Docu-
                                                   ity for the purpose of punishing or penalizing      mentation should be obtained prior to admis-
(a) Upon admission;                                residents;                                          sion but shall be on file not later than ten days
                                                                                                       after admission and shall contain information
(b) At least semiannually; and                     (d) Requires skilled nursing services as de-        regarding the individual's current medical
                                                   fined in subdivision (23) of section 198.006        status and any special orders or procedures
(c) Whenever a significant change has oc-          for which the facility is not licensed or able      that should be followed. If the individual is
curred in the resident's condition which may       to provide;                                         admitted directly from a hospital or another
require a change in services;                                                                          long-term care facility and is accompanied on
                                                   (e) Requires more than one person to simul-         admission by a report that reflects his or her
(6) Based on the assessment in subsection 7        taneously physically assist the resident with       current medical status, an admission physical
of this section and subdivision (5) of this sub-   any activity of daily living, with the excep-       shall not be required.
section, develops an individualized service        tion of bathing and transferring;
plan in partnership with the resident, or legal                                                        8. Facilities licensed as an assisted living
representative of the resident, that outlines      (f) Is bed-bound or similarly immobilized due
                                                   to a debilitating or chronic condition; and                                                   109
                                                         Missouri Revised Statutes
Statutes

facility shall disclose to a prospective resi-                                                          board and care occupancies of NFPA 101 life
dent, or legal representative of the resident,                                                          safety code.
information regarding the services the facility
is able to provide or coordinate, the costs of
                                                   Section 198.074                                      5. All skilled nursing and intermediate care
such services to the resident, and the resi-                                                            facilities not required prior to August 28,
dent conditions that will require discharge or     Sprinkler system require-                            2007, to install and maintain an approved
transfer, including the provisions of subdivi-                                                          sprinkler system shall install and maintain
sion (8) of subsection 4 of this section.          ments--fire alarm system                             an approved sprinkler system in accordance
                                                   requirements.                                        with NFPA 13 by December 31, 2012, unless
9. After January 1, 2008, no entity shall hold                                                          the facility receives an exemption from the
itself out as an assisted living facility or        198.074. 1. Effective August 28, 2007, all          department and presents evidence in writing
advertise itself as an assisted living facility    new facilities licensed under this chapter on        from a certified sprinkler system representa-
without obtaining a license from the depart-       or after August 28, 2007, or any section of a        tive or licensed engineer that the facility is
ment to operate as an assisted living facil-       facility licensed under this chapter in which        unable to install an approved National Fire
ity. Any residential care facility II licensed     a major renovation has been completed on             Protection Association 13 system due to the
under this chapter that does not use the term      or after August 28, 2007, as defined and ap-         unavailability of water supply requirements
assisted living in the name of its licensed        proved by the department, shall install and          associated with this system.
facility on or before May 1, 2006, shall be        maintain an approved sprinkler system in
prohibited from using such term after August       accordance with National Fire Protection As-         6. Facilities that take a substantial step,
28, 2006, unless such facility meets the           sociation (NFPA) 13.                                 as specified in subsections 4 and 5 of this
requirements for an assisted living facility                                                            section, to install an approved NFPA 13R
in subsection 4 of this section. Any facility      2. Facilities that were initially licensed and       or 13 system prior to December 31, 2012,
licensed as an intermediate care facility prior    had an approved sprinkler system prior to Au-        may apply to the state treasurer’s office for
to August 28, 2006, that provides the services     gust 28, 2007, shall continue to meet all laws,      a loan in accordance with section 198.075
of an assisted living facility, as described in    rules, and regulations for testing, inspection       to install such system. However, such loan
paragraphs (a), (b), and (c) of subdivision (6)    and maintenance of the sprinkler system that         shall not be available if by December 31,
of section 198.006, utilizing the social model     were in effect for such facilities on August         2009, the average total reimbursement for the
of care, may advertise itself as an assisted       27, 2007.                                            care of persons eligible for Medicaid public
living facility without obtaining a license                                                             assistance in an assisted living facility and
from the department to operate as an assisted      3. Multi-level assisted living facilities that ac-   residential care facility is equal to or exceeds
living facility.                                   cept or retain any individual with a physical,       fifty-two dollars per day. The average total re-
                                                   cognitive, or other impairment that prevents         imbursement includes room, board, and care
10. The department of health and senior            the individual from safely evacuating the            delivered by the facility, but shall not include
services shall promulgate rules to ensure          facility with minimal assistance shall install       payments to the facility for care or services
compliance with this section. Any rule or por-     and maintain an approved sprinkler system            not provided by the facility. If a facility under
tion of a rule, as that term is defined in sec-    in accordance with NFPA 13. Single-story             this subsection does not have an approved
tion 536.010, RSMo, that is created under the      assisted living facilities that accept or retain     sprinkler system installed by December 31,
authority delegated in this section shall be-      any individual with a physical, cognitive, or        2012, such facility shall be required to install
come effective only if it complies with and is     other impairment that prevents the individual        and maintain an approved sprinkler system in
subject to all of the provisions of chapter 536,   from safely evacuating the facility with mini-       accordance with NFPA 13 by December 31,
RSMo, and, if applicable, section 536.028,         mal assistance shall install and maintain an         2013. Such loans received under this subsec-
RSMo. This section and chapter 536, RSMo,          approved sprinkler system in accordance with         tion and in accordance with section 198.075,
are nonseverable and if any of the powers          NFPA 13R.                                            shall be paid in full as follows:
vested with the general assembly pursuant to
chapter 536, RSMo, to review, to delay the         4. All residential care and assisted living          (1) Ten years for those facilities approved for
effective date, or to disapprove and annul a       facilities with more than twenty residents           the loan and whose average total reimburse-
rule are subsequently held unconstitutional,       not included in subsection 3 of this section,        ment rate for the care of persons eligible for
then the grant of rulemaking authority and         which are initially licensed under this chapter      Medicaid public assistance is equal to forty-
any rule proposed or adopted after August 28,      prior to August 28, 2007, and that do not            eight and no more than forty-nine dollars per
2006, shall be invalid and void.                   have installed an approved sprinkler system          day;
                                                   in accordance with NFPA 13R or 13 prior to
(L. 1979 S.B. 328, et al. § 24, A.L. 1984 S.B.     August 28, 2007, shall install and maintain          (2) Eight years for those facilities approved
451, A.L. 1992 H.B. 899 merged with S.B.           an approved sprinkler system in accordance           for the loan and whose average total reim-
573 & 634 merged with S.B. 721, A.L. 1999          with NFPA 13R or 13 by December 31, 2012,            bursement rate for the care of persons eligible
S.B. 326, A.L. 2006 S.B. 616, A.L. 2007 H.B.       unless the facility meets the safety require-        for Medicaid public assistance is greater than
952 & 674)                                         ments of Chapter 33 of existing residential
                                                                                                                                                 110
                                                         Missouri Revised Statutes
Statutes

forty-nine and no more than fifty-two dollars       the length nor the width of the floor exceeds       subsections 4 and 5 of section 198.074. Mon-
per day; or                                         seventy-five feet, no smoke-stop partition          eys deposited in the fund shall be considered
                                                    shall be required. Facilities with a complete       state funds under article IV, section 15 of
(3) Five years for those facilities approved for    fire alarm system and smoke sections meeting        the Missouri Constitution. The state trea-
the loan and whose average total reimburse-         the requirements of this subsection prior to        surer shall be custodian of the fund and may
ment rate for the care of persons eligible for      August 28, 2007, shall continue to meet such        disburse moneys from the fund in accordance
Medicaid public assistance is greater than          requirements. Facilities initially licensed on      with sections 30.170 and 30.180, RSMo.
fifty-two dollars per day.                          or after August 28, 2007, shall comply with         Any moneys remaining in the fund at the end
                                                    such requirements beginning August 28,              of the biennium shall revert to the credit of
(4) No payments or interest shall be due until      2007, or on the effective date of licensure.        the general revenue fund. The state treasurer
the average total reimbursement rate for the                                                            shall invest moneys in the fund in the same
care of persons eligible for Medicaid public        (3) Except as otherwise provided in this            manner as other funds are invested. Any
assistance is equal to or greater than forty-       subsection, the requirements for complete fire      interest and moneys earned on such invest-
eight dollars.                                      alarm systems and smoke sections shall be           ments shall be credited to the fund.
                                                    enforceable on December 31, 2008.
7. (1) All facilities licensed under this chapter                                                       2. Qualifying facilities shall make an applica-
shall be equipped with a complete fire alarm        8. The requirements of this section shall be        tion to the state treasurer’s office upon forms
system in compliance with NFPA 101, Life            construed to supersede the provisions of            provided by the state treasurer’s office. Upon
Safety Code for Detection, Alarm, and               section 198.058 relating to the exemption of        receipt of an application for a loan, the state
Communication Systems, or shall maintain            facilities from construction standards.             treasurer’s office shall review the application
a system that was approved by the depart-                                                               before state funds are allocated for a loan.
ment when such facility was constructed so          9. Fire safety inspections of skilled nursing       For purposes of this section, a “qualifying
long as such system is a complete fire alarm        and intermediate care facilities licensed under     facility” shall mean a facility licensed under
system. A complete fire alarm system shall          this chapter for compliance with this section       this chapter that is in substantial compliance.
include, but not be limited to, interconnected      shall be conducted annually by the depart-          “Substantial compliance” shall mean a facil-
smoke detectors, automatic transmission to          ment. All department inspectors who inspect         ity that has no uncorrected deficiencies and is
the fire department, dispatching agency, or         facilities for compliance under this section        in compliance with department of health and
central monitoring company, manual pull             shall complete a fire inspector course, as          senior services rules and regulations govern-
stations at each required exit and attendant’s      developed by the division of fire safety within     ing such facility.
station, heat detectors, and audible and visual     the department of public safety, by December
alarm indicators. If a facility submits a plan      31, 2012. Fire safety inspections of residen-       3. The fund shall be a loan of which the inter-
of compliance for installation of a sprinkler       tial care and assisted living facilities licensed   est rate shall not exceed two and one-half
system required by this chapter, such facility      under this chapter for compliance with this         percent.
shall install a complete fire alarm system that     section shall be conducted annually by the
complies with NFPA 72 upon installation of          state fire marshal. The provisions of this          4. The fund shall be administered by the state
the sprinkler system. Until such time that the      section shall be enforced by the department         treasurer’s office.
sprinkler system is installed in the facility       or the state fire marshal, depending on which
which has submitted a plan of compliance,           entity conducted the inspection.                    (L. 2007 H.B. 952 & 674, A.L. 2009 H.B.
each resident room or any room designated                                                               395)
for sleeping in the facility shall be equipped      10. By July 1, 2008, all facilities licensed
with at least one battery-powered smoke             under this chapter shall submit a plan for          Section 198.076
alarm installed, tested, and maintained in ac-      compliance with the provisions of this section
cordance with NFPA 72. In addition, any such        to the state fire marshal.
facility shall be equipped with heat detec-                                                             Department of social services
tors interconnected to the fire alarm system        (L. 2007 H.B. 952 & 674, A.L. 2009 H.B.
which are installed, tested, and maintained in      395)
                                                                                                        to establish standards and
accordance with NFPA 72 in all areas subject                                                            regulations for residential care
to nuisance alarms, including but not limited                                                           facilities and assisted living
to kitchens, laundries, bathrooms, mechanical
                                                    Section 198.075
air handling rooms, and attic spaces.                                                                   facilities.
                                                    Fire safety standards loan                          198.076. The department shall promulgate
(2) In addition, each floor accessed by
residents shall be divided into at least two        fund created, use of moneys.                        reasonable standards and regulations for all
smoke sections by one-hour rated smoke                                                                  residential care facilities and all assisted liv-
partitions. No smoke section shall exceed           198.075. 1. There is hereby created in the          ing facilities. The standards and regulations
one hundred fifty feet in length. If neither        state treasury the “Fire Safety Standards Loan
                                                    Fund”, for implementing the provisions of                                                      111
                                                          Missouri Revised Statutes
Statutes

shall take into account the level of care pro-       such records any actions taken by the facility
vided and the number and type of residents           that are above and beyond what is minimally         (9) The construction of the facility, includ-
served by the facility to insure maximum             required for compliance.                            ing plumbing, heating, ventilation and other
flexibility. These standards and regulations                                                             housing conditions which shall insure the
shall relate to:                                     (L. 1999 H.B. 316, et al. § 4 merged with           health, safety and comfort of residents and
                                                     S.B. 326 § 15)                                      protection from fire hazards;
(1) The number and qualifications of em-             *Reprinted due to editorial change required
ployed and contract personnel having respon-         by § 198.005.                                       (10) Care of residents;
sibility for any of the services provided for
residents;                                                                                               (11) Social and rehabilitative service;
                                                     Section 198.079
(2) The equipment, facilities, services and                                                              (12) Staff training and continuing education.
supplies essential to the health and welfare of      Department to establish stan-
the residents;                                                                                           (L. 1979 S.B. 328, et al. § 26, A.L. 2007 H.B.
                                                     dards and regulations for                           952 & 674)
(3) Fire safety, including resident smoking          intermediate care and skilled
in designated areas only, unannounced fire
                                                     nursing facilities.                                 Section 198.080
drills, fire safety training, and notification to
the department of fires and fire watches;
                                                     198.079 The department shall promulgate
                                                     reasonable standards and regulations for all        Assessment procedures devel-
(4) Sanitation in the facility;
                                                     intermediate care facilities and all skilled        oped--rulemaking authority.
                                                     nursing facilities. The standards and regula-
(5) Diet, which shall be based on good nutri-
                                                     tions shall take into account the level of care     198.080 The division of aging shall develop
tional practice;
                                                     provided and the type of residents served by        flexible assessment procedures for individu-
                                                     the facility. These standards and regulations       als in long-term care and those considering
(6) Personal funds and property of residents;
                                                     shall relate to:                                    long-term care services which follow* the
                                                                                                         individual through the continuum of care, in-
(7) Resident rights and resident grievance
                                                     (1) The number and qualifications of em-            cluding periodic reassessment. By January 1,
procedures appropriate to the levels of care,
                                                     ployed and contract personnel having respon-        2002, the division of aging shall promulgate
size and type of facility;
                                                     sibility for any of the services provided for       rules and regulations to implement the new
                                                     residents;                                          assessment system and shall make a report
(8) Record keeping appropriate to the levels
                                                                                                         to the appropriate house and senate commit-
of care, size and type of facility;
                                                     (2) The equipment, facilities, services and         tees of the general assembly regarding the
                                                     supplies essential to the health and welfare of     new assessment system. Any rule or portion
(9) Construction of the facility;
                                                     the residents;                                      of a rule, as that term is defined in section
                                                                                                         536.010, RSMo, that is created under the
(10) Care of residents.
                                                     (3) Fire safety, including resident smoking         authority delegated in this section shall be-
                                                     in designated areas only, unannounced fire          come effective only if it complies with and is
(L. 1979 S.B. 328, et al. § 25, A.L. 1984 S.B.
                                                     drills, fire safety training, and notification to   subject to all of the provisions of chapter 536,
451, A.L. 2007 H.B. 952 & 674)
                                                     the department of fires and fire watches;           RSMo, and, if applicable, section 536.028,
Section 198.077                                                                                          RSMo. This section and chapter 536, RSMo,
                                                     (4) Sanitation in the facility;                     are nonseverable and if any of the powers
                                                                                                         vested with the general assembly pursuant to
Department to maintain facil-                        (5) Diet, which shall be related to the needs       chapter 536, RSMo, to review, to delay the
ity compliance records.                              of each resident and based on good nutrition-       effective date or to disapprove and annul a
                                                     al practice and on recommendations which            rule are subsequently held unconstitutional,
198.077 For any residential care facility, as-       may be made by the physician attending the          then the grant of rulemaking authority and
sisted living facility, intermediate care facility   resident;                                           any rule proposed or adopted after August 28,
or skilled nursing facility, if the department                                                           1999, shall be invalid and void.
of social services maintains records of site         (6) Personal funds and property of residents;
inspections and violations of statutes, rules,                                                           (L. 1999 S.B. 326 § 3)
or the terms or conditions of any license            (7) Resident rights and resident grievance          *Word "follows" appears in original rolls.
issued to such facility, the department shall        procedures;
also maintain records of compliance with                                                                 CROSS REFERENCE:
such statutes, rules, or terms or conditions of      (8) Record keeping, including clinical and
any license, and shall specifically record in        personnel records;                                                                            112
                                                            Missouri Revised Statutes
Statutes

Rulemaking authority, RSMo 198.534                 (1) A training program consisting of at least
                                                   seventy-five classroom hours of training on         (2) Class II standards are standards which
                                                   basic nursing skills, clinical practice, resident   have a direct or immediate relationship to the
Section 198.082                                    safety and rights, the social and psychologi-       health, safety or welfare of any resident, but
                                                   cal problems of residents, and the methods          which do not create imminent danger;
                                                   of handling and caring for mentally confused
Nursing assistant training                         residents such as those with Alzheimer's dis-       (3) Class III standards are standards which
                                                   ease and related disorders, and one hundred         have an indirect or a potential impact on the
programs--training incom-                          hours supervised and on-the-job training. The       health, safety or welfare of any resident.
plete, special requirements                        one hundred hours shall be completed within
and supervision for assistant                      four months of employment and may consist           (L. 1979 S.B. 328, et al. § 28, A.L. 1984 S.B.
                                                   of normal employment as nurse assistants            451, A.L. 1995 H.B. 574)
beginning duties.                                  under the supervision of a licensed nurse; and

198.082 1. Each nursing assistant hired to         (2) Continuing in-service training to assure
work in a skilled nursing or intermediate          continuing competency in existing and new
                                                                                                       Section 198.086
care facility after January 1, 1980, shall have    nursing skills. All nursing assistants trained
successfully completed a nursing assistant
training program approved by the department
                                                   prior to January 1, 1989, shall attend, by          Demonstration project, Al-
                                                   August 31, 1989, an entire special retrain-
or shall enroll in and begin the first available   ing program established by rule or regula-          zheimer's licensure category--
approved training program which is sched-          tion of the department which shall contain          department duties--accommo-
uled to commence within ninety days of the         information on methods of handling mentally
date of the nursing assistant's employment         confused residents and which may be offered
                                                                                                       dations for family members.
and which shall be completed within four           on premises by the employing facility.
months of employment. Training programs                                                                198.086 1. The department of health and
shall be offered at any facility licensed or ap-                                                       senior services shall develop and implement
                                                   4. Nursing assistants who have not success-
proved by the department of health and senior                                                          a demonstration project designed to establish
                                                   fully completed the nursing assistant training
services which is most reasonably accessible                                                           a licensure category for health care facilities
                                                   program prior to employment may begin du-
to the enrollees in each class. The program                                                            that wish to provide treatment to persons with
                                                   ties as a nursing assistant only after complet-
may be established by the skilled nursing or                                                           Alzheimer's disease or Alzheimer's-related
                                                   ing an initial twelve hours of basic orienta-
intermediate care facility, by a professional                                                          dementia. The division shall also:
                                                   tion approved by the department and may
organization, or by the department, and train-     provide direct resident care only if under the
ing shall be given by the personnel of the                                                             (1) Inform potential providers of the demon-
                                                   general supervision of a licensed nurse prior
facility, by a professional organization, by the                                                       stration project and seek letters of intent;
                                                   to completion of the seventy-five classroom
department, by any community college or by         hours of the training program.
the vocational education department of any                                                             (2) Review letters of intent and select
high school.                                                                                           provider organizations to participate in the
                                                   (L. 1979 S.B. 328, et al. § 27, A.L. 1988 S.B.
                                                                                                       demonstration project. Ten such organizations
                                                   602, A.L. 2003 S.B. 556 & 311)
2. As used in this section the term "nursing                                                           may develop such projects using an existing
assistant" means an employee, including a                                                              license and additional organizations shall be
nurse's aide or an orderly, who is assigned by                                                         newly licensed facilities with no more than
a skilled nursing or intermediate care facility    Section 198.085                                     thirty beds per project. One demonstration
to provide or assist in the provision of direct                                                        project shall be at a stand-alone facility of no
resident health care services under the super-                                                         more than one hundred twenty beds designed
vision of a nurse licensed under the nursing
                                                   Categories of standards for                         and operated exclusively for the care of resi-
practice law, chapter 335, RSMo. This sec-         each type of licensed facility.                     dents with Alzheimer's disease or dementia
tion shall not apply to any person otherwise                                                           within a county of the first classification with
licensed to perform health care services           198.085 In establishing standards for each          a charter form of government with a popula-
under the laws of this state. It shall not apply   type of facility, the department shall classify     tion over nine hundred thousand. A total of
to volunteers or to members of religious or        the standards into three categories for each        not more than three hundred beds may be
fraternal orders which operate and administer      type of licensed facility as follows:               newly licensed through the demonstration
the facility, if such volunteers or members                                                            projects. All projects shall maintain their pilot
work without compensation.                         (1) Class I standards are standards the viola-      status until a complete evaluation is complet-
                                                   tion of which would present either an immi-         ed by the division of aging, in conjunction
3. The training program after January 1,           nent danger to the health, safety or welfare of     with a qualified Missouri school or university,
1989, shall consist of at least the following:     any resident or a substantial probability that      and a written determination is made from
                                                   death or serious physical harm would result;                                                113
                                                         Missouri Revised Statutes
Statutes

such evaluation that the pilot project is suc-                                                       with all life, health, and safety standards of
cessful;                                           (2) Provide care only to persons who have         the facility.
                                                   been diagnosed with Alzheimer's disease or
(3) Monitor the participants' compliance with      Alzheimer's-related dementia;                     (L. 1999 S.B. 326 § 5, A.L. 2003 S.B. 556 &
the criteria established in this section;                                                            311, A.L. 2007 H.B. 952 & 674)
                                                   (3) Have buildings and furnishings that are       CROSS REFERENCE:
(4) Recommend legislation regarding the            designed to provide for the resident's safety.
licensure of dementia-specific residential         Facilities shall have indoor and outdoor          Rulemaking authority, RSMo 198.534
care based on the results of the demonstration     activity areas, and electronically controlled
project; and                                       exits from the buildings and grounds to allow
                                                   residents the ability to explore while prevent-
                                                                                                     Section 198.087
(5) Submit a report regarding the division's       ing them from exiting the facility's grounds
activities and recommendations for adminis-        unattended;                                       Uniformity of application of
trative or legislative action on or before No-
vember fifteenth of each year to the governor,     (4) Be staffed twenty-four hours a day by the     regulation standards, depart-
the president pro tem of the senate and the        appropriate number and type of personnel          ment's duties.
speaker of the house of representatives.           necessary for the proper care of residents and
                                                   upkeep of the facility;                           198.087. To ensure uniformity of applica-
2. The director of the division shall:                                                               tion of regulation standards in long-term care
                                                   (5) Conduct special staff training relating to    facilities throughout the state, the department
(1) Develop a reimbursement methodology            the needs, care and safety of persons with        of social services shall:
to reasonably and adequately compensate the        Alzheimer's disease or Alzheimer's-related
pilot projects for the costs of operation of the   dementia within the first thirty days of em-      (1) Evaluate the requirements for inspec-
project, and require the filing of annual cost     ployment;                                         tors or surveyors of facilities, including the
reports by each participating facility which                                                         eligibility, training and testing requirements
shall include, but not be limited to, the cost     (6) Utilize personal electronic monitoring        for the position.
equivalent of unpaid volunteer or donated          devices for any resident whose physician
labor;                                             recommends use of such device;                    Based on the evaluation, the department shall
                                                                                                     develop and implement additional training
(2) Process the license applications of project    (7) Permit the resident's physician, in con-      and knowledge standards for inspectors and
participants;                                      sultation with the family members or health       surveyors;
                                                   care advocates of the resident, to determine
(3) Monitor each participant to assure its         whether the facility meets the needs of the       (2) Periodically evaluate the performance
compliance with the requirements and that          resident; and                                     of the inspectors or surveyors regionally
the life, health and safety of residents are                                                         and statewide to identify any deviations or
assured;                                           (8) Implement a social model for the residen-     inconsistencies in regulation application. At
                                                   tial environment rather than an institutional     a minimum, the Missouri on-site surveyor
(4) Require each participating facility to         medical model.                                    evaluation process, and the number and type
complete a minimum data set form for each                                                            of actions overturned by the informal dispute
resident occupying a pilot bed;                    4. For purposes of this section, "health care     resolution process and formal appeal shall be
                                                   facilities for persons with Alzheimer's disease   used in the evaluation. Based on such evalu-
(5) Require the division of aging to assign a      or Alzheimer's-related dementia" means            ation, the department shall develop standards
single team of the same surveyors to inspect       facilities that are specifically designed and     and a retraining process for the region,
and survey all participating facilities at least   operated to provide elderly individuals who       state, or individual inspector or surveyor, as
twice a year for the entire period of the proj-    have chronic confusion or dementia illness,       needed;
ect; and                                           or both, with a safe, structured but flexible
                                                   environment that encourages physical activity     (3) In addition to the provisions of subdivi-
(6) Submit to the president pro tem of the         through a well-developed recreational and         sions (1) and (2) of this section, the depart-
senate and speaker of the house of representa-     aging-in-place and activity program. Such         ment shall develop a single uniform compre-
tives copies of any statements of deficiencies,    program shall continually strive to promote       hensive and mandatory course of instruction
plans of correction and complaint investiga-       the highest practicable physical and mental       for inspectors/surveyors on the practical ap-
tion reports applying to project participants.     abilities and functioning of each resident.       plication of enforcement of statutes, rules and
                                                                                                     regulations. Such course shall also be open
3. Project participants shall:                     5. Nothing in this section shall be construed     to attendance by administrators and staff of
                                                   to prohibit project participants from accom-      facilities licensed pursuant to this chapter;
(1) Be licensed by the division;                   modating a family member or other caregiver
                                                   from residing with the resident in accordance                                              114
                                                           Missouri Revised Statutes
 Statutes

                                                    of services, basic rate and charges for any          available to anyone upon request;
(4) With the full cooperation of and in con-        services not covered by the basic rate, if any,
junction with the department of health and          and a list of names, addresses and occupa-           (b) Is fully informed in writing, prior to or
senior services, evaluate the implementation        tion of all individuals who have a proprietary       at the time of admission and during stay,
and compliance of the provisions of subdivi-        interest in the facility;                            of services available in the facility, and of
sion (3) of subsection 1 of section 198.012                                                              related charges including any charges for
in which rules, requirements, regulations           (2) Policies relating to admission, transfer,        services not covered under the federal or
and standards pursuant to section 197.080,          and discharge of residents shall assure that:        state programs or not covered by the facility's
RSMo, for assisted living facilities, inter-                                                             basic per diem rate;
mediate care facilities and skilled nursing         (a) Only those persons are accepted whose
facilities attached to an acute care hospital are   needs can be met by the facility directly or         (c) Is fully informed by a physician of his
consistent with the intent of this chapter. A       in cooperation with community resources or           health and medical condition unless medical-
report of the differences found in the evalu-       other providers of care with which it is affili-     ly contraindicated, as documented by a physi-
ation conducted pursuant to this subdivision        ated or has contracts;                               cian in his resident record, and is afforded the
shall be made jointly by the departments of                                                              opportunity to participate in the planning of
social services and health and senior services      (b) As changes occur in their physical or            his total care and medical treatment and to
to the governor and members of the general          mental condition, necessitating service or           refuse treatment, and participates in experi-
assembly by January 1, 2008; and                    care which cannot be adequately provided by          mental research only upon his informed writ-
                                                    the facility, residents are transferred promptly     ten consent;
(5) With the full cooperation and in con-           to hospitals, skilled nursing facilities, or other
junction with the department of health and          appropriate facilities; and                          (d) Is transferred or discharged only for medi-
senior services, develop rules and regula-                                                               cal reasons or for his welfare or that of other
tions requiring the exchange of information,        (c) Except in the case of an emergency, the          residents, or for nonpayment for his stay. No
including regulatory violations, between            resident, his next of kin, attending physi-          resident may be discharged without notice of
the departments to ensure the protection of         cian, and the responsible agency, if any, are        his right to a hearing and an opportunity to be
individuals who are served by health care           consulted at least thirty days in advance of         heard on the issue of whether his immediate
providers regulated by either the department        the transfer or discharge of any resident, and       discharge is necessary. Such notice shall be
of health and senior services or the depart-        casework services or other means are utilized        given in writing no less than thirty days in
ment of social services.                            to assure that adequate arrangements exist for       advance of the discharge except in the case
                                                    meeting his needs through other resources;           of an emergency discharge. In emergency
(L. 1999 S.B. 326 § 11, A.L. 2006 S.B. 616)                                                              discharges a written notice of discharge and
                                                    (3) Policies define the uses of chemical and         right to a hearing shall be given as soon as
                                                    physical restraints, identify the professional       practicable and an expedited hearing shall be
Section 198.088                                     personnel who may authorize the application          held upon request of the resident, next of kin,
                                                    of restraints in emergencies and describe the        legal guardian, or nursing facility;
                                                    mechanism for monitoring and controlling
Facilities to establish policies                    their use;                                           (e) Is encouraged and assisted, throughout
and procedures, scope, content                                                                           his period of stay, to exercise his rights as a
--rights of residents--com-                         (4) Policies define procedures for submittal of      resident and as a citizen, and to this end may
plaint--procedure.                                  complaints and recommendations by resi-              voice grievances and recommend changes in
                                                    dents and for assuring response and disposi-         policies and services to facility staff or to out-
198.088 1. Every facility, in accordance with       tion;                                                side representatives of his choice, free from
the rules applying to each particular type of                                                            restraint, interference, coercion, discrimina-
facility, shall ensure that:                        (5) There are written policies governing ac-         tion, or reprisal;
                                                    cess to, duplication of, and dissemination of
(1) There are written policies and procedures       information from the resident's records;             (f) May manage his personal financial affairs,
available to staff, residents, their families                                                            and, to the extent that the facility assists in
or legal representative and the public which        (6) Each resident admitted to the facility:          such management, has his personal financial
govern all areas of service provided by the fa-                                                          affairs managed in accordance with section
cility. The facility shall also retain and make     (a) Is fully informed of his rights and respon-      198.090;
available for public inspection at the facility     sibilities as a resident. Prior to or at the time
to staff, residents, their families or legal rep-   of admission, a list of resident rights shall        (g) Is free from mental and physical abuse,
resentative and the public a complete copy of       be provided to each resident, or his desig-          and free from chemical and physical re-
each official notification from the department      nee, next of kin, or legal guardian. A list of       straints except as follows:
of violations, deficiencies, licensure approv-      resident rights shall be posted in a conspicu-
als, disapprovals, and responses, a description     ous location in the facility and copies shall be
                                                                                                                                                   115
                                                            Missouri Revised Statutes
Statutes

a. When used as a part of a total program of        per diem or monthly rate from a supplier of        ment may in such instances refer the com-
care to assist the resident to attain or maintain   his own choice;                                    plaint to the staff person who is designated
the highest practicable level of physical, men-                                                        by the facility to receive all grievances when
tal or psychosocial well-being;                     (7) The resident or his designee, next of kin      they are first made. In such instances the
                                                    or legal guardian receives an itemized bill for    department shall assure appropriate response
b. When authorized in writing by a physician        all goods and services actually rendered;          from the facility, assure resolution at a subse-
for a specified period of time; and                                                                    quent on-site visit and provide a report to the
                                                    (8) A written account, available to residents      complainant. The designee shall confer with
c. When necessary in an emergency to protect        and their families, is maintained on a current     persons involved in the occurrence and with
the resident from injury to himself or to oth-      basis for each resident with written receipts      any other witnesses and, no later than three
ers, in which case restraints may be autho-         for all personal possessions and funds re-         days after the grievance, give a written expla-
rized by designated professional personnel          ceived by or deposited with the facility and       nation of findings and proposed remedies, if
who promptly report the action taken to the         for all disbursements made to or on behalf of      any, to the complainant and to the aggrieved
physician. When restraints are indicated,           the resident.                                      party, if someone other than the complainant.
devices that are least restrictive, consistent                                                         Where appropriate because of the mental or
with the resident's total treatment program,        2. Each facility and the department shall          physical condition of the complainant or the
shall be used;                                      encourage and assist residents in the free         aggrieved party, the written explanation shall
                                                    exercise of the resident's rights to civil and     be accompanied by an oral explanation.
(h) Is ensured confidential treatment of all        religious liberties, including knowledge of
information contained in his records, includ-       available choices and the right to independent     (4) The department shall establish and
ing information contained in an automatic           personal decision. Each resident shall be          implement procedures for the making and
data bank, and his written consent shall be         given a copy of a statement of his rights and      transmission of complaints to the depart-
required for the release of information to          responsibilities, including a copy of the facil-   ment by any person alleging violation of the
persons not otherwise authorized under law          ity's rules and regulations. Each facility shall   provisions of sections 198.003 to 198.186,
to receive it;                                      prepare a written plan to ensure the respect       198.200, 208.030, and 208.159, RSMo,
                                                    of each resident's rights and privacy and shall    and the standards established thereunder.
(i) Is treated with consideration, respect, and     provide appropriate staff training to imple-       The department shall promptly review each
full recognition of his dignity and individual-     ment the plan.                                     complaint. In the case of a refusal to inves-
ity, including privacy in treatment and in care                                                        tigate, the department shall promptly notify
for his personal needs;                             3. (1) Each facility shall establish written       the complainant of its refusal and the reasons
                                                    procedures approved by the department by           therefor; and in every other case, the depart-
(j) Is not required to perform services for the     which complaints and grievances of residents       ment shall, following investigation, notify
facility;                                           may be heard and considered. The procedures        the complainant of its investigation and any
                                                    shall provide for referral to the department of    proposed action.
(k) May communicate, associate and meet             any complaints or grievances not resolved by
privately with persons of his choice, unless to     the facility's grievance procedure.                4. Whenever the department finds upon
do so would infringe upon the rights of other                                                          investigation that there have been viola-
residents, and send and receive his personal        (2) Each facility shall designate one staff        tions of the provisions of sections 198.003
mail unopened;                                      member, employed full time, referred to in         to 198.186, 198.200, 208.030, and 208.159,
                                                    this subsection as the "designee", to receive      RSMo, or the standards established thereun-
(l) May participate in activities of social,        all grievances when they are first made.           der by any person licensed under the provi-
religious and community groups at his                                                                  sions of chapter 330, 331, 332, 334, 335,
discretion, unless contraindicated for reasons      (3) If anyone wishes to complain about treat-      336, 337, 338, or 344, RSMo, the department
documented by a physician in the resident's         ment, conditions, or violations of rights, he      shall forward a report of its findings to the
medical record;                                     shall write or cause to be written his griev-      appropriate licensing or examining board for
                                                    ance or shall state it orally to the designee      further investigation.
(m) May retain and use his personal clothing        no later than fourteen days after the occur-
and possessions as space permits;                   rence giving rise to the grievance. When the       5. Each facility shall maintain a complete
                                                    department receives a complaint that does          record of complaints and grievances made
(n) If married, is ensured privacy for visits by    not contain allegations of abuse or neglect        against such facility and a record of the final
his or her spouse; if both are residents in the     or allegations which would, if substantiated,      disposition of the complaints and grievances.
facility, they are permitted to share a room;       constitute violation of a class I or class II      Such record shall be open to inspection by
and                                                 standard as defined in section 198.085, and        representatives of the department during
                                                    the complainant indicates that the complaint       normal business hours.
(o) Is allowed the option of purchasing or          was not filed with the facility prior to the
renting goods or services not included in the       reporting of it to the department, the depart-
                                                                                                                                                116
                                                          Missouri Revised Statutes
Statutes

6. Nothing in this section shall be construed     sions and funds received by or deposited with      a complete account of all the resident's per-
as requiring a resident to exhaust grievance      the facility and for all disbursements made to     sonal funds and possessions and deliver to the
procedures established by the facility or by      or on behalf of the resident;                      fiduciary all possessions of the resident and
the department prior to filing a complaint                                                           the balance of the resident's funds. If, after
pursuant to section 198.090.                      (5) Provide each resident or his designee or       one year from the date of death, no fiduciary
                                                  guardian with a quarterly accounting of all        makes claim upon such funds or possessions,
(L. 1979 S.B. 328, et al. § 29, A.L. 1988 S.B.    financial transactions made on behalf of the       the operator shall notify the department that
602, A.L. 1989 S.B. 203 & 270, A.L. 1994          resident;                                          the funds remain unclaimed. Such unclaimed
H.B. 1335 & 1381)                                                                                    funds or possessions shall be disposed of as
                                                  (6) Within five days of the discharge of a         follows:
                                                  resident, provide the resident, or his designee
Section 198.090                                   or guardian, with an up-to-date accounting of      (a) If the unclaimed funds or possessions
                                                  the resident's personal funds and return to the    have a value totaling one hundred and fifty
                                                  resident the balance of his funds and all his      dollars or less, the funds or the proceeds of
Personal possessions may be                       personal possessions;                              the sale of the possessions may be deposited
                                                                                                     in a fund to be used for the benefit of all resi-
held in trust, requirements,                      (7) Upon the death of a resident who has been      dents of the facility by providing the residents
disposal of --written state-                      a recipient of aid, assistance, care, services,    social or educational activities. The facility
ments required when, pen-                         or who has had moneys expended on his              shall keep an accounting of the acquisitions
                                                  behalf by the department of social services,       and expenditure of these funds; or
alty--prohibitions, penalties                     provide the department a complete account of
--misappropriation, report,                       all the resident's personal funds within sixty     (b) If the unclaimed funds or possessions
                                                  days from the date of death. The total amount      have a value greater than one hundred and
investigation--employee dis-                      paid to the decedent or expended upon his          fifty dollars, the funds or possessions shall
qualification list.                               behalf by the department shall be a debt due       be immediately presumed to be abandoned
                                                  the state and recovered from the available         property under sections 447.500 to 447.585,
198.090 1. An operator may make avail-            funds upon the department's claim on such          RSMo, and the procedures provided for in
able to any resident the service of holding in    funds. The department shall make a claim on        those sections shall apply notwithstanding
trust personal possessions and funds of the       the funds within sixty days from the date of       any other provisions of those sections which
resident and shall, as authorized by the resi-    the accounting of the funds by the facility.       require a period greater than two years for a
dent, expend the funds to meet the resident's     The nursing facility shall pay the claim made      presumption of abandonment;
personal needs. In providing this service the     by the department of social services from the
operator shall:                                   resident's personal funds within sixty days.       (9) Upon ceasing to be the operator of a
                                                  Where the name and address are reason-             facility, all funds and property held in trust
(1) At the time of admission, provide each        ably ascertainable, the department of social       pursuant to this section shall be transferred
resident or his next of kin or legal guardian     services shall give notice of the debt due the     to the new operator in accordance with sound
with a written statement explaining the resi-     state to the person whom the recipient had         accounting principles, and a closeout report
dent's rights regarding personal funds;           designated to receive the quarterly accounting     signed by both the outgoing operator and the
                                                  of all financial transactions made under this      successor operator shall be prepared. The
(2) Accept funds and personal possessions         section, or the resident's guardian or conser-     closeout report shall include a list of cur-
from or for a resident for safekeeping and        vator or the person or persons listed in nurs-     rent balances of all funds held for residents
management, only upon written authorization       ing home records as a responsible party or the     respectively and an inventory of all property
by the resident or by his designee, or guard-     fiduciary of the resident's estate. If any funds   held for residents respectively. If the outgoing
ian in the case of an adjudged incompetent;       are available after the department's claim, the    operator refuses to sign the closeout report,
                                                  remaining provisions of this section shall ap-     he shall state in writing the specific reasons
(3) Deposit any personal funds received           ply to the balance, unless the funds belonged      for his failure to so sign, and the successor
from or on behalf of a resident in an account     to a person other than the resident, in which      operator shall complete the report and attach
separate from the facility's funds, except that   case the funds shall be paid to that person;       an affidavit stating that the information con-
an amount to be established by rule of the                                                           tained therein is true to the best of his knowl-
division of aging may be kept in a petty cash     (8) Upon the death of a resident who has not       edge and belief. Such report shall be retained
fund for the resident's personal needs;           been a recipient of aid, assistance, care, ser-    with all other records and accounts required
                                                  vices, or who has not had moneys expended          to be maintained under this section;
(4) Keep a written account, available to a        on his behalf by the department of social
resident and his designee or guardian, main-      services or the department has not made a          (10) Not be required to invest any funds re-
tained on a current basis for each resident,      claim on the funds, provide the fiduciary of       ceived from or on behalf of a resident, nor to
with written receipts, for all personal posses-   resident's estate, at the fiduciary's request,
                                                                                                                                              117
                                                        Missouri Revised Statutes
Statutes

increase the principal of any such funds.         to obtain the name and address of the facility,    1086, A.L. 1989 S.B. 203 & 270, A.L. 1992
                                                  the name of the facility employee, the name        S.B. 573 & 634, A.L. 1993 H.B. 564)
2. Any owner, operator, manager, employee,        of the resident, information regarding the         (2003) Violation of written report provision
or affiliate of an owner or operator who re-      nature of the misappropriation, the name of        of subsection 2 of section does not automati-
ceives any personal property or anything else     the complainant, and any other information         cally constitute misappropriation of resident's
of value from a resident, shall, if the thing     which might be helpful in an investigation.        funds under subsection 15 of section. Wells v.
received has a value of ten dollars or more,                                                         Dunn, 104 S.W.3d 792 (Mo.App. W.D.).
make a written statement giving the date it       9. Upon receipt of a report, the department
was received, from whom it was received,          shall initiate an investigation.
and its estimated value. Statements required
to be made pursuant to this subsection shall      10. If the investigation indicates probable        Section 198.093
be retained by the operator and shall be made     misappropriation of property or funds of a
available for inspection by the department, or    resident, the investigator shall refer the com-
by the department of mental health when the       plaint together with his report to the depart-     Violations of resident's rights-
resident has been placed by that department,      ment director or his designee for appropriate
and by the resident, and his designee or legal    action.                                            -complaints--legal action--
guardian. Any person who fails to make a                                                             damages.
statement required by this subsection is guilty   11. Reports shall be confidential, as provided
of a class C misdemeanor.                         under section 660.320, RSMo.                       198.093 1. Any resident or former resident
                                                                                                     who is deprived of any right created by
3. No owner, operator, manager, employee, or      12. Anyone, except any person participating        sections 198.088 and 198.090, or the estate
affiliate of an owner or operator shall in one    in or benefiting from the misappropriation of      of a former resident so deprived, may file a
calendar year receive any personal property       funds, who makes a report pursuant to this         written complaint within one hundred eighty
or anything else of value from the residents      section or who testifies in any administrative     days of the alleged deprivation or injury with
of any facility which have a total estimated      or judicial proceeding arising from the report     the office of the attorney general describing
value in excess of one hundred dollars.           shall be immune from any civil or criminal         the facts surrounding the alleged deprivation.
                                                  liability for making such a report or for tes-     A copy of the complaint shall be sent to the
4. Subsections 2 and 3 of this section shall      tifying except for liability for perjury, unless   department by the attorney general.
not apply if the property or other thing of       such person acted negligently, recklessly, in
value is held in trust in accordance with         bad faith, or with malicious purpose.              2. The attorney general shall review each
subsection 1 of this section, is received in                                                         complaint and may initiate legal action as
payment for services rendered or pursuant to      13. Within five working days after a report        provided under sections 198.003 to 198.186.
the terms of a lawful contract, or is received    required to be made under this section is
from a resident who is related to the recipient   received, the person making the report shall       3. If the attorney general fails to initiate a
within the fourth degree of consanguinity or      be notified in writing of its receipt and of the   legal action within sixty days of receipt of the
affinity.                                         initiation of the investigation.                   complaint, the complainant may, within two
                                                                                                     hundred forty days of filing the complaint
5. Any operator who fails to maintain records     14. No person who directs or exercises any         with the attorney general, bring a civil action
or who fails to maintain any resident's per-      authority in a facility shall evict, harass,       in an appropriate court against any owner, op-
sonal funds in an account separate from the       dismiss or retaliate against a resident or         erator or the agent of any owner or operator
facility's funds as required by this section      employee because he or any member of his           to recover actual damages. The court may, in
shall be guilty of a class C misdemeanor.         family has made a report of any violation          its discretion, award punitive damages which
                                                  or suspected violation of laws, ordinances         shall be limited to the larger of five hundred
6. Any operator, or any affiliate or employee     or regulations applying to the facility which      dollars or five times the amount of special
of an operator, who puts to his own use or the    he has reasonable cause to believe has been        damages, unless the deprivation complained
use of the facility or otherwise diverts from     committed or has occurred.                         of is the result of an intentional act or omis-
the resident's use any personal funds of the                                                         sion causing physical or emotional injury to
resident shall be guilty of a class A misde-      15. The department shall maintain the em-          the resident, and may award to the prevailing
meanor.                                           ployee disqualification list and place on the      party attorney's fees based on the amount of
                                                  employee disqualification list the names of        time reasonably expended, and may provide
7. Any person having reasonable cause to          any persons who have been finally deter-           such equitable relief as it deems necessary
believe that a misappropriation of a resident's   mined by the department, pursuant to section       and proper; except that, an attorney who is
funds or property has occurred may report         660.315, RSMo, to have misappropriated any         paid in whole or part from public funds for
such information to the department.               property or funds of a resident while em-          his representation in any cause arising under
                                                  ployed in any facility.                            this section shall not be awarded any attorney
8. For each report the division shall attempt
                                                  (L. 1979 S.B. 328, et al. § 30, A.L. 1982 H.B.
                                                        Missouri Revised Statutes
Statutes

fees.                                             thousand dollars, in the residents’ personal       elderly or disabled nursing
                                                  funds account or accounts kept pursuant to
4. No owner or operator who pleads and            subdivision (3) of subsection 1 of section         home residents, penalty.
proves as an affirmative defense that he exer-    198.090 for the preceding twelve months. In
cised all care reasonably necessary to prevent    the case of a new facility or of an operator       198.097 1. Any person who assumes the
the deprivation and injury for which liability    not previously holding in trust the personal       responsibility of managing the financial af-
is asserted shall be liable under this section.   funds of residents, the department shall           fairs of an elderly or disabled person who is
                                                  determine the amount of bond to be required,       a resident of any facility licensed under this
5. Persons bringing suit to recover against a     taking into consideration the size and type        chapter is guilty of a class D felony if such
bond for personal funds pursuant to section       of facility, the number of residents, and the      person misappropriates the funds and fails
198.096 shall not be required to first file a     experience of comparable facilities.               to pay for the facility care of the elderly or
complaint with the attorney general pursu-                                                           disabled person. For purposes of this subsec-
ant to subsection 1 of this section, nor shall    2. The required bond shall be conditioned to       tion, a person assumes the responsibility of
subsection 1 be construed to limit in any way     secure to every resident or former resident,       managing the financial affairs of an elderly
the right to recover on such bond.                or the estate of a former resident, the return     person when he or she receives, has access
                                                  of any moneys held in trust of which the resi-     to, handles, or controls the elderly or disabled
6. Nothing contained in sections 198.003 to       dent has been wrongfully deprived by acts of       person's monetary funds, including but not
198.186 shall be construed as abrogating,         the operator or any affiliates or employees of     limited to Social Security income, pension,
abridging or otherwise limiting the right         the operator. The liability of the surety to any   cash, or other resident income.
of any person to bring appropriate legal          and all persons shall not exceed the stated
actions in any court of competent jurisdic-       amount of the bond regardless of the period        2. Evidence of misappropriating funds and
tion to insure or enforce any legal right or      of time the bond has been in effect.               failure to pay for the care of an elderly or dis-
to seek damages, nor shall any provision                                                             abled person may include but not be limited
of the above-named sections be construed          3. Whenever the director determines that the       to proof that the facility has sent, by certified
as preventing or discouraging any person          amount of any bond which is filed pursuant         mail with confirmation receipt requested,
from filing a complaint with the department       to this subsection is insufficient to adequately   notification of failure to pay facility care
or notifying the department of any alleged        protect the money of residents which is being      expenses incurred by a resident to the person
deficiency or noncompliance on the part of        handled, or whenever the amount of any such        who has assumed responsibility of managing
any facility.                                     bond is impaired by any recovery against the       the financial affairs of the resident.
                                                  bond, the director may require the operator
(L. 1979 S.B. 328, et al. § 31)                   to file an additional bond in such amount as       3. Nothing in subsection 2 of this section
(2003) Failure by relatives of deceased           necessary to adequately protect the money of       shall be construed as limiting the investiga-
nursing home resident to file written com-        residents being handled.                           tions or prosecutions of violations of subsec-
plaint with Attorney General precluded filing                                                        tion 1 of this section or the crime of financial
wrongful death claim against nursing home.        4. In the event that any such bond includes a      exploitation of an elderly or disabled person
Dickerson v. Deaconess Long Term Care of          provision allowing the surety to cancel after      as defined by section 570.145, RSMo.
Missouri, Inc., 279 F.Supp.2d 1068 (E.D.          notice, the bond shall provide for a minimum
Mo.).                                             of sixty days’ notice to the department.           (L. 1987 S.B. 277 § 1, A.L. 2007 S.B. 577)

Section 198.096                                   5. The operator may, in lieu of a bond, place a
                                                  cash deposit equal to the amount of the bond
                                                  required in this section with an insured lend-
                                                                                                     Section 198.099
Bond required for facility                        ing institution pursuant to a noncancelable
holding resident's property in
                                                  escrow agreement with the lending institu-         Petition for appointment of
                                                  tion if the written agreement is submitted to
trust --exception, cash deposit                   and approved by the department. No escrow          receiver--when.
held in insured escrow.                           agreement shall be approved without verifica-
                                                  tion of cash deposit.                              198.099 The attorney general, either on
                                                                                                     his own initiative or upon the request of the
198.096. 1. The operator of any facility who                                                         department or of any other state governmen-
holds in trust personal funds of residents as     (L. 1979 S.B. 328, et al. § 32, A.L. 1988 S.B.
                                                  602, A.L. 2009 H.B. 395)                           tal agency having an interest in the matter,
provided in section 198.090 shall obtain and                                                         a resident or residents or the guardian of a
file with the department a bond in a form                                                            resident of a facility or the owner or operator
approved by the department in an amount           Section 198.097                                    of a facility may petition for appointment of a
equal to one and one-half times the aver-                                                            receiver for a facility when any of the follow-
age monthly balance or average total of the
monthly balances, rounded to the nearest one      Misappropriation of funds of
                                                        Missouri Revised Statutes
Statutes

ing conditions exist:                              Petition for appointment of                           tional, then the grant of rulemaking author-
                                                                                                         ity and any rule proposed or adopted after
(1) The operator is operating without a            receiver, contents--hearing--                         August 28, 2003, shall be invalid and void.
license;                                           appointment of receiver.
                                                                                                         3. The director of the department shall
(2) The department has revoked the license of      198.105 1. Any petition for appointment               maintain a list of persons who have submit-
an operator or refused to grant an application     of a receiver shall be verified and shall be          ted a written request in accordance with the
for a license to the operator;                     accompanied by an affidavit or affidavits             provisions of this subsection and the rules
                                                   setting forth material facts showing there            promulgated by the department to act as
(3) The department has initiated revocation        exists one or more of the conditions speci-           receiver pursuant to section 198.099. When a
procedures and has determined that the lives,      fied in section 198.099. The petition shall be        petition is filed seeking the appointment of a
health, safety, or welfare of the residents        filed in the circuit court of Cole County or in       receiver, the director of the department shall
cannot be adequately assured pending a full        the county where the facility is located. If the      select the first name on the list. The director
hearing on license revocation;                     petition is not filed by the attorney general, a      of the department shall inform such person of
                                                   copy of the petition shall be served upon the         his or her selection, the name of the facility,
(4) The facility is closing or intends to close    department and upon the attorney general.             and the grounds for seeking receivership of
and adequate arrangements for relocation of        The court shall hold a hearing on the petition        such facility. Such person may elect not to be
residents have not been made at least thirty       within five days of the filing of the petition        appointed, in which case the director of the
days prior to closure;                             and determine the matter within fifteen days          department shall choose the next consecutive
                                                   of the initial hearing. The petition and notice       name on the list, continuing until a person
(5) An emergency exists in the facility;           of the hearing shall be served on the operator        has agreed to serve as the receiver. The
                                                   or administrator of the facility or, if personal      director shall provide the name of the person
(6) The operator is insolvent; or                  service is impossible, shall be posted in a           selected and agreeing to serve as the receiver
                                                   conspicuous place in the facility not later than      to the judge of the court wherein the petition
(7) An owner of the land or structure is insol-    three days before the time specified for the          for receivership is filed. For each additional
vent and such insolvency substantially affects     hearing, unless a different period is fixed by        petition filed seeking the appointment of a
the operation of the facility.                     order of the court.                                   receiver, names shall be chosen from the list
                                                                                                         in consecutive order beginning with the next
(L. 1979 S.B. 328, et al. § 33)                    2. The court shall appoint a person, selected         name that follows the last name chosen. If
Effective 7-1-79                                   in accordance with the provisions of this             none of the persons on the list agree to serve
                                                   subsection and the rules promulgated pursu-           as the receiver, the court shall appoint a per-
                                                   ant to this section, to act as receiver if it finds   son determined by the court to be qualified to
                                                   that any ground exists which would authorize          act as receiver.
                                                   the appointment of a receiver under section
Section 198.103                                    198.099 and that appointment of a receiver            (L. 1979 S.B. 328, et al. § 35, A.L. 1984 S.B.
                                                   will contribute to the continuity of care or          451, A.L. 2003 S.B. 556 & 311)
                                                   the orderly and safe transfer of residents in
Department may appoint                             the facility. The department shall, within six
monitor.                                           months of August 28, 2003, promulgate rules
                                                   to establish guidelines for the determina-
                                                                                                         Section 198.108
198.103 In any situation described in section      tion of qualified receivers, procedures for
198.099, the department may place a person         maintaining the list of qualified receivers that      Ex parte appointment of re-
to act as a monitor in the facility. The monitor   requested in writing to act as a receiver, and
shall observe operation of the facility and        the selection or removal of such receivers.           ceiver in emergency, when--
shall advise it on how to comply with state        Any rule or portion of a rule, as that term is        notice--hearing.
laws and regulations, and shall submit a writ-     defined in section 536.010, RSMo, that is cre-
ten report periodically to the department on       ated under the authority delegated in this sec-       198.108 If it appears from the petition filed
the operation of the facility.                     tion shall become effective only if it complies       under section 198.105, or from an affidavit
                                                   with and is subject to all of the provisions of       or affidavits filed with the petition, or from
(L. 1979 S.B. 328, et al. § 34)                    chapter 536, RSMo, and, if applicable, sec-           testimony of witnesses under oath when the
Effective 7-1-79                                   tion 536.028, RSMo. This section and chapter          court determines that this is necessary, that
                                                   536, RSMo, are nonseverable and if any of             there is probable cause to believe that an
                                                   the powers vested with the general assembly           emergency exists in the facility, the court
                                                   pursuant to chapter 536, RSMo, to review, to          shall immediately issue the requested order
Section 198.105                                    delay the effective date, or to disapprove and        for appointment of a receiver, ex parte and
                                                   annul a rule are subsequently held unconstitu-
                                                                                                                                                  120
                                                          Missouri Revised Statutes
Statutes

without further hearing. Notice of the petition     of which the receiver takes possession, or the    shall preserve all property, assets and records
and order shall be served on the operator or        proceeds of any transfer thereof, and may use     of residents of which the receiver takes
administrator of the facility or, if personal       them only in the performance of the pow-          possession and shall provide for the prompt
service is impossible, shall be posted in           ers and duties set forth in this section and by   transfer of the property, assets and records to
a conspicuous place in the facility within          order of the court;                               the alternative placement of any transferred
twenty-four hours after issuance of the order.                                                        or discharged resident;
If the petition is not filed by the attorney gen-   (5) May use the building, fixtures, furnishings
eral, a copy of the petition shall be served on     and any accompanying consumable goods in          (13) Shall provide, if upgrading of the facility
the department and upon the attorney general.       the provision of care and services to residents   or correction of the deficiencies is not pos-
A hearing on the petition shall be held within      and to any other persons receiving services       sible, for the orderly transfer of all residents
three days after notice is served or posted         from the facility at the time the petition for    in the facility to other suitable facilities, or
unless the operator consents to a later date.       receivership was filed. The receiver shall col-   make other provisions for their continued
After the hearing, the court may terminate,         lect payments for all goods and services pro-     health, safety and welfare;
continue or modify the temporary order.             vided to residents or others during the period
                                                    of receivership, at the same rate of payment      (14) Shall, if any resident is transferred or
(L. 1979 S.B. 328, et al. § 36)                     as was charged by the operators at the time       discharged, provide for:
Effective 7-1-79                                    the petition for receivership was filed, unless
                                                    a different rate is set by the court;             (a) Transportation of the resident and the
                                                                                                      resident's belongings and medical records to
Section 198.112                                     (6) May let contracts and hire agents and         the place to which the resident is being trans-
                                                    employees, including legal counsel, to carry      ferred or discharged;
                                                    out the powers and duties created under this
Powers of receiver.                                 section or by the court;                          (b) Aid in locating an alternative placement
                                                                                                      and in discharge planning;
198.112 A receiver appointed under this             (7) May hire or discharge any employees,
section:                                            including the administrator;                      (c) If the resident is being transferred, prepa-
                                                                                                      ration for transfer to mitigate transfer trauma;
(1) May exercise those powers and shall per-        (8) Shall receive and expend in a reasonable
form those duties set out by the court;             manner the revenues of the facility due on the    (15) Shall, if any resident is to be transferred,
                                                    date of the order of appointment as receiver,     permit participation by the resident or the
(2) May, in his discretion, either:                 and to become due during the receivership;        resident's guardian in the selection of the
                                                                                                      resident's alternative placement;
(a) Assume the role of administrator or             (9) Shall do all acts necessary or appropri-
manager and take control of all day-to-day          ate to conserve the property and promote the      (16) Shall, unless emergency transfer is nec-
operations; or                                      health, safety or care of the residents of the    essary, prepare a resident under subdivisions
                                                    facility;                                         (14)(c) and (15) by explaining alternative
(b) Name an administrator or manager to con-                                                          placements, and by providing orientation to
duct the day-to-day operations of the facility      (10) Except as hereinafter specified in section   the placement chosen by the resident or the
subject to the supervision and direction of the     198.115, shall honor all leases, mortgages,       resident's guardian.
receiver;                                           secured transactions or other wholly or
                                                    partially executory contracts entered into by     (L. 1979 S.B. 328, et al. § 37)
(3) May upgrade deficient homes by any              the facility's operator or administrator while    Effective 7-1-79
methods, procedures, or actions he deems            acting in that capacity, but only to the extent
                                                    of payments which become due or are for the
necessary; provided, however, that expendi-
                                                    use of the property during the period of the
                                                                                                      Section 198.115
tures in excess of three thousand dollars, or in
excess of any amount set by the court, be first     receivership;
approved by the court;                                                                                Executory contracts, receiver
                                                    (11) Shall be responsible, to the same extent
(4) Shall have the same rights to possession        as the operator would have been, for taxes        not required to honor--when--
of the building in which the facility is located    which accrue during the period of the receiv-     hearing.
and of all goods and fixtures in the building at    ership;
the time the petition for receivership is filed                                                       198.115 1. A receiver may not be required to
as the operator would have had if the receiver      (12) Shall be entitled to and shall take pos-     honor any lease, mortgage, secured transac-
had not been appointed. The receiver shall          session of all property or assets of residents    tion or other wholly or partially executory
take such action as is reasonably necessary         which are in possession of an operator or         contract entered into by the facility's operator
to protect and conserve the assets or property      administrator of the facility. The receiver
                                                                                                                                                121
                                                          Missouri Revised Statutes
Statutes

or administrator while acting in that capacity,    Effective 7-1-79                                 tions complained of from recurring.
if the agreement is unconscionable. Factors
which shall be considered in determining the                                                        (L. 1979 S.B. 328, et al. § 42)
unconscionability include, but are not limited     Section 198.121                                  Effective 7-1-79
to, the following:

(1) The person seeking payment under the
                                                   Bond of receiver.                                Section 198.132
agreement was an affiliate of the operator or
                                                   198.121 A receiver may be required by the
owner at the time the agreement was made;                                                           Accounting by receiver, when-
                                                   court to post a bond, which shall be consid-
(2) The rental, price, or rate of interest
                                                   ered a necessary expense of the receivership.    -contents--liability for defi-
required to be paid under the agreement was
                                                   (L. 1979 S.B. 328, et al. § 40)                  ciency --priority of deficiency
substantially in excess of a reasonable rental,
price or rate of interest at the time the agree-
                                                   Effective 7-1-79                                 judgment.
ment was entered into.
                                                   Section 198.124                                  198.132 1. Within thirty days after termina-
2. If the receiver is in possession of real                                                         tion or such other time as the court may set,
estate or goods subject to a lease, mortgage
or security interest which the receiver is         License may be issued to fa-                     the receiver shall give the court a complete
                                                                                                    accounting of all property of which the
permitted to avoid under subsection 1 of           cility operated by receiver--                    receiver has taken possession, of all funds
this section, and if the real estate or goods
are necessary for the continued operation
                                                   duration.                                        collected under section 198.108 and of the
                                                                                                    expenses of the receivership.
of the facility, the receiver may apply to the
                                                   198.124 Other provisions of sections
court to set a reasonable rental, price or rate                                                     2. If the operating funds collected by the
                                                   198.003 to 198.096 notwithstanding, the
of interest to be paid by the receiver during                                                       receiver under section 198.112 exceed the
                                                   department may issue a license to a facility
the duration of the receivership. The court                                                         reasonable expenses of the receivership, the
                                                   being operated by a receiver under sections
shall hold a hearing on the application within                                                      court shall order the payment of the surplus
                                                   198.099 to 198.136. The duration of a license
fifteen days. The receiver shall send notice of                                                     to the operator. If the operating funds are
                                                   issued under this subsection is limited to the
the application to any known owners of the                                                          insufficient to cover reasonable expenses of
                                                   duration of the receivership.
property involved at least ten working days                                                         the receivership, the operator shall be liable
prior to the hearing. Payment by the receiver                                                       for the deficiency. The operator may apply to
                                                   (L. 1979 S.B. 328, et al. § 41)
of the amount determined by the court to be                                                         the court to determine the reasonableness of
                                                   Effective 7-1-79
reasonable is a defense to any action against                                                       any expense of the receivership. The operator
the receiver for payment or for possession of                                                       shall not be responsible for expenses in ex-
the goods or real estate subject to the lease      Section 198.128                                  cess of what the court finds to be reasonable.
or mortgage involved by any person who re-
ceived such notice, but the payment does not
relieve the owner or operator of the facility      Termination of receivership,                     3. If a deficiency exists under subsection 2
                                                                                                    of this section, the receiver may apply to the
of any liability for the difference between the    when.                                            court for such a determination. If after notice
amount paid by the receiver and the amount                                                          to all interested parties and a hearing the
due under the original lease or mortgage           198.128 The court may terminate a receiver-      court finds that in fact a deficiency does exist,
involved.                                          ship:                                            then the court shall enter judgment in favor
                                                                                                    of the receiver and against the appropriate
(L. 1979 S.B. 328, et al. § 38)                    (1) Upon a motion by any party to the peti-      party or parties as set forth in subsection 2 of
Effective 7-1-79                                   tion, by the department, or by the receiver,     this section for the amount of such deficiency.
                                                   and a finding by the court that the deficien-    Any judgment obtained under this subsection
Section 198.118                                    cies and violations in the facility have been    shall be treated as any other judgment and
                                                   substantially eliminated or remedied; or         may be enforced according to law.

Compensation of receiver.                          (2) If all residents in the facility have been   4. Any judgment for a deficiency obtained in
                                                   provided alternative modes of health care,       accordance with this section by the receiver
198.118 The court shall set the compensation       either in another facility or otherwise. The     or any portion thereof may be assigned
of the receiver, which shall be considered a       court may immediately terminate the receiv-      wholly or in part upon approval of the court.
necessary expense of a receivership.               ership, or may terminate the receivership
                                                   subject to such terms as the court deems         5. The judgment shall have priority over
(L. 1979 S.B. 328, et al. § 39)                    necessary or appropriate to prevent the condi-
                                                                                                                                           122
                                                         Missouri Revised Statutes
Statutes

any other judgment or lien or other interest        regulations or statutes governing Medicaid          or receive any payment, including, without
which originates subsequent to the filing of a      reimbursement.                                      limitation, any kickback, bribe or rebate,
petition for receivership under the provisions                                                          directly or indirectly, overtly or covertly, in
of sections 198.099 to 198.136 except for a         (L. 1979 S.B. 328, et al. § 45)                     cash or in kind, from any vendor or health
construction or mechanic's lien arising out of      Effective 7-1-79                                    care provider:
work performed with the express consent of
the receiver.                                       Section 198.142                                     (1) In return for referring an individual to a
                                                                                                        person for the furnishing or arranging for the
(L. 1979 S.B. 328, et al. § 43)                                                                         furnishing of any item or service for which
Effective 7-1-79                                    Health care provider and                            payment may be made in whole or in part
                                                                                                        under Medicaid; or
                                                    vendor not to misrepresent or
Section 198.136
                                                    conceal facts or convert ben-                       (2) In return for purchasing, leasing, ordering
                                                    efits for payments.                                 or arranging for or recommending purchas-
Operator or affiliate not liable                                                                        ing, leasing or ordering any good, facility,
                                                                                                        service or item for which payment may be
for acts of receiver--liability of                  198.142 A health care provider or vendor
                                                                                                        made in whole or in part under Medicaid.
                                                    shall not knowingly:
operator or affiliate otherwise
not relieved.                                       (1) Make or cause to be made any false state-       (L. 1979 S.B. 328, et al. § 47)
                                                    ment or representation of a material fact in        Effective 7-1-79
198.136 No operator or affiliate may be held        any application for any benefit or payment
liable for acts or omissions of the receiver or     under Medicaid for services provided to any
the receiver's employees during the term of         resident;                                           Section 198.148
the receivership. Nothing in sections 198.099
to 198.136 shall be deemed to relieve any           (2) Make or cause to be made any false state-
operator or any affiliate of an operator of a       ment or representation of any material fact         Offering or making kickbacks,
facility placed in receivership of any civil        for use in determining the person's eligibility     bribes or rebates prohibited,
or criminal liability incurred, or any duty         for any benefit or payment under Medicaid
imposed by law, by reason of acts or omis-          for services provided to any resident;              when.
sions of the operator or affiliates of the opera-
tor prior to the appointment of a receiver          (3) Conceal or fail to disclose any material        198.148 A health care provider or vendor
under section 198.105 or 198.108, nor shall         fact that affects his eligibility for any benefit   shall not purposely offer or make any pay-
anything contained in sections 198.099 to           or payment under Medicaid for services pro-         ment, including without limitation, any kick-
198.136 be construed to suspend during the          vided to any resident or affects the eligibility    back, bribe or rebate, directly or indirectly,
receivership any obligation of the operator         of another for whom he applies or for whom          overtly or covertly, in cash or in kind, to any
or any affiliate of an operator for payment         he receives such benefit or payment, with the       person to induce the person:
of taxes or other operating and maintenance         intent to secure the benefit or payment in a
expenses of the facility, nor of the operator or    greater quantity than is due or to secure the       (1) To refer an individual to a person for the
affiliates of the operator for the payment of       benefit or payment when none is permitted;          furnishing or arranging for the furnishing of
mortgages or liens.                                                                                     any item or service for which payment may
                                                    (4) Convert a benefit or payment he receives        be made in whole or in part under Medicaid;
(L. 1979 S.B. 328, et al. § 44)                     under Medicaid for services provided to a           or
Effective 7-1-79                                    resident for a use or benefit other than that for
                                                    which it was specifically intended.                 (2) To purchase, lease, order or arrange for or
                                                                                                        recommend purchasing, leasing or ordering
Section 198.139                                                                                         any good, facility, service or item for which
                                                    (L. 1979 S.B. 328, et al. § 46)
                                                    Effective 7-1-79                                    payment may be made in whole or in part
                                                                                                        under Medicaid.
Medicaid moneys not to be
used for other purposes.                            Section 198.145                                     (L. 1979 S.B. 328, et al. § 48)
                                                                                                        Effective 7-1-79
198.139 A health care provider or vendor
shall not knowingly use any moneys paid to          Kickbacks, bribes and rebates
him under Medicaid for services provided            prohibited, when.                                   Section 198.151
to any resident for any purpose other than
that permitted by the provisions of chapter         198.145 A person shall not purposely solicit
208, RSMo, or state regulations or federal                                                                                                        123
                                                          Missouri Revised Statutes
Statutes

                                                   tions 198.139 to 198.155.                          to appropriation by the general assembly. The
                                                                                                      director of the fraud investigation division
Usual trade discounts and                                                                             may employ such attorneys, accountants,
                                                   198.158. 1. A person committing any act in
employment benefits not kick-                      violation of any provision of sections 198.139     investigators and such other personnel as
backs, bribes or rebates.                          to 198.155 is guilty of a class D felony.          are necessary to conduct the activities of the
                                                                                                      division. A team approach to the operations
                                                   2. A vendor or health care provider convicted      of the division shall be utilized wherever
198.151 Sections 198.145 and 198.148 do            of a criminal violation of sections 198.139        practicable.
not apply to:                                      to 198.155 shall be prohibited from receiv-
                                                   ing future moneys under Medicaid or from           2. The director of the fraud investigation divi-
(1) Any usual trade discount which is depen-       providing services under Medicaid for or           sion, with such assistance as he may require
dent solely upon time of payment or quantity       on behalf of any other health care provider.       from the appropriate county prosecuting at-
buying to wholesalers which is obtained by         However, the director of the department or         torney, shall investigate suspected violations
a health care provider regardless of whether       his designee shall review this prohibition         of sections 198.139 to 198.155 and any civil
reflected in the cost claimed or charges made      upon the petition of a vendor or health care       liabilities due the state as a result of any such
by the health care provider under Medicaid;        provider so convicted and, for good cause          violation. Evidence of actions which may
and                                                shown, may reinstate the vendor or health          constitute criminal violations under sections
                                                   care provider as being eligible to receive         198.139 to 198.155 shall be referred to the
(2) Any amount paid by an employer to an           funds under Medicaid. The decision of the          appropriate county prosecuting attorney. If
employee, who has a bona fide employment           director or his designee shall be made in          the prosecuting attorney fails or refuses to
relationship with the employer, for employ-        writing after the director of the fraud investi-   initiate prosecution on a cause referred to him
ment in the provision of covered services or       gation division is allowed the opportunity to      by the director of the fraud investigation divi-
items.                                             state his position concerning such petition.       sion within sixty days after he is made aware
                                                                                                      by complaint of an alleged violation, the
(L. 1979 S.B. 328, et al. § 49)                    3. A vendor or health care provider com-           prosecuting attorney shall so notify the attor-
Effective 7-1-79                                   mitting any act or omission in violation of        ney general, who may take full charge of the
                                                   sections 198.139 to 198.155 shall be civilly       prosecution and may initiate prosecution by
                                                   liable to the state for any moneys obtained        information or indictment for the violation.
Section 198.155                                    under Medicaid as a result of such act or
                                                   omission.                                          (L. 1979 S.B. 328, et al. § 52)
                                                                                                      Effective 7-1-79
False statements by health                         (L. 1979 S.B. 328, et al. § 51)
care provider prohibited,                          Effective 7-1-79
when.                                                                                                 Section 198.165
                                                   Section 198.161
198.155 1. A health care provider shall not                                                           Medicaid payments stopped
knowingly make or cause to be made any
false statement or representation of material      Fraud investigation division                       by division, when--hearing.
fact in order to qualify either upon initial       created--director--compensa-
certification or upon recertification to receive                                                      198.165 1. When the director of the investi-
                                                   tion --assistance by local pros-                   gation division has probable cause to believe
funds under Medicaid.
                                                   ecutors.                                           that a health care provider is committing any
2. A health care provider shall not knowingly                                                         act or omission in violation of any provision
induce or seek to induce any such false state-     198.161 1. There is hereby created within the      of sections 198.139 to 198.186, he may peti-
ment or representation of material fact for        department of social services a "Fraud Inves-      tion an appropriate court for an order to stop
consideration, whether the consideration is        tigation Division". The fraud investigation        payments under Medicaid to the health care
direct or indirect.                                division shall be headed by a division director    provider pending completion of the investiga-
                                                   appointed by the director of the department        tion and litigation under sections 198.139 to
(L. 1979 S.B. 328, et al. § 50)                    of social services. The director of the fraud      198.186.
Effective 7-1-79                                   investigation division shall be an attorney
                                                   at law licensed to practice in this state and      2. The court shall allow the health care pro-
                                                   shall have substantial experience in criminal      vider the opportunity to be heard on the re-
Section 198.158                                    prosecution or defense. The director of the        quest of the director of the fraud investigation
                                                   fraud investigation division shall receive such    division and shall decide, in writing, whether
Penalties for violation of sec-                    compensation as the director of the depart-        to stop payments to the health care provider.
                                                   ment of social services may designate subject                                                124
                                                         Missouri Revised Statutes
Statutes

                                                  Civil restitution of Medicaid                     The court may make any order which justice
(L. 1979 S.B. 328, et al. § 53)                                                                     requires to protect any person from undue
Effective 7-1-79                                  funds, when.                                      annoyance, embarrassment, expense or op-
                                                                                                    pression. Failure to obey the order of the court
                                                  198.171 The director of the fraud investiga-      may be punished by the court as a contempt
                                                  tion division may seek civil restitution of       of court.
                                                  any moneys dispensed under Medicaid for
Section 198.168                                   services provided to any resident or under        3. Notwithstanding the provisions of sec-
                                                  section 208.030, RSMo, which have been            tion 326.151, RSMo, the accountant-client
                                                  misappropriated, fraudulently obtained, or
Fraud investigation director                      constitute overpayments. The authority of
                                                                                                    privilege recognized therein shall not, upon
                                                                                                    a knowing and intelligent waiver by any
may petition for appointment                      the director of the fraud investigation divi-     person subject to sections 198.003 to 198.186,
of receiver, when--court hear-                    sion under sections 198.139 to 198.186 to         constitute a defense and shall not apply to a
                                                  seek civil restitution does not diminish the      subpoena under this section and shall not ap-
ing.                                              authority of the department to seek restitu-      ply in court proceedings instituted pursuant to
                                                  tion.                                             sections 198.139 to 198.186.
198.168 If the director of the fraud investiga-
tion division has probable cause to believe       (L. 1979 S.B. 328, et al. § 55)                   4. Information or documents obtained under
that any acts or omissions in violation of        Effective 7-1-79                                  this section by the director of the fraud inves-
sections 198.139 to 198.155 have been com-                                                          tigation division shall not be disclosed except
mitted by a person who is in control of assets    Section 198.174                                   in the course of civil or criminal litigation
purchased, in whole or in part, directly or                                                         or to another prosecutorial or investigative
indirectly, with funds from Medicaid and is                                                         agency, or to the divisions of the department.
likely to convert, destroy or remove those        Fraud investigation direc-
assets, the director of the fraud investigation   tor may hold hearings, take                       5. Anyone improperly disclosing information
division can petition the circuit court of the                                                      obtained under this section is guilty of a class
county in which those assets may be found         oaths--procedure on failure                       A misdemeanor.
to appoint a receiver to manage those assets      to testify--confidentiality of
until the investigation and any litigation are                                                      6. The provisions of this section do not repeal
completed. The circuit court immediately          recorders--penalties.
                                                                                                    existing provisions of law and shall be con-
upon receipt of the petition of the director of                                                     strued as supplementary thereto.
the fraud investigation division shall enjoin     198.174 1. For the purpose of any investiga-
the person in control of the assets from con-     tion or proceeding under sections 198.158
                                                  to 198.171, the director of fraud investiga-      (L. 1979 S.B. 328, et al. § 56)
verting, destroying or removing those assets.                                                       Effective 7-1-79
A hearing for the appointment of a receiver       tion or any officer designated by him may
shall be held within ten days of the filing       administer oaths and affirmations, subpoena
of the petition. If the court finds that there    witnesses, compel their attendance, take          Section 198.177
is probable cause to believe the person has       testimony, require answers to written inter-
committed any acts or omissions in viola-         rogatories and require production of any
                                                  books, papers, correspondence, memoranda,         Compelling of testimony--
tion of any provisions of sections 198.139 to
198.155 and that the assets are likely to be      agreements or other documents or records          grant of immunity, when.
converted, destroyed or removed, the circuit      which the director of fraud investigation
court shall appoint a receiver to manage the      deems relevant and material to the inquiry.       198.177 1. In any investigation or proceed-
assets until the investigation and any litiga-                                                      ing under sections 198.139 to 198.186 in
tion are completed. The court shall maintain      2. In the case of contumacy by, or refusal        which any person has been or may be called
continuing jurisdiction over the assets and       to obey a subpoena issued to, any person,         to testify, produce evidence or provide other
may modify its orders as circumstances            the circuit court of any county of the state      information by means of a subpoena or before
require. The order appointing a receiver shall    or the city of St. Louis, upon application by     a court or grand jury, if the person refuses
be a final order for purposes of appeal.          the division director may issue to the person     to answer any question or produce evidence
                                                  an order requiring him to appear before the       or material of any kind on the ground that
(L. 1979 S.B. 328, et al. § 54)                   division director, or the officer designated by   he may be incriminated thereby, the director
Effective 7-1-79                                  him, there to produce documentary evidence        of the fraud investigation division may, in
                                                  if so ordered or to give testimony or answer      writing, request the circuit court of the county
                                                  interrogatories touching the matter under         in which the proceeding is held to order the
Section 198.171                                   investigation or in question in accordance        person to answer the question or produce
                                                  with the forms and procedures otherwise
                                                  authorized by the Rules of Civil Procedure.                                                 125
                                                        Missouri Revised Statutes
Statutes

the evidence. Upon receipt of the request,         the fraud investigation division shall have the    which relates to Medicaid services provided
the court shall hold a hearing on said writ-       right to audit and to inspect the records of any   to any resident. The department shall make
ten request after written notice to the person     health care provider or vendor. If the health      available to the director of the fraud inves-
specifying the nature of the request and the       care provider or vendor refuses to allow such      tigation division electronic data processing
time and place of the hearing, and advis-          audit or inspection or if there is reason to       services pertaining to such Medicaid infor-
ing the person of his right to be present and      believe that the records are in danger of being    mation.
his right to counsel at such hearing. At the       destroyed, altered or secreted, the director of
hearing the director of the fraud investiga-       the fraud investigation division may make          (L. 1979 S.B. 328, et al. § 59)
tion division and the person may participate.      written application under oath to any court        Effective 7-1-79
The burden of proof is on the director of the      in the county where the records in question
division to demonstrate to the court (1) the       are being kept, or in Cole County, and if the
necessity for and (2) the reasonableness of        judge shall be satisfied that there is reason-
the request to order the person to answer the
                                                                                                      Section 198.186
                                                   able cause for the audit or inspection or
question or produce the evidence or both.          reasonable cause to believe that the records
If the court is satisfied that such burden has     are in danger of being destroyed, altered or       Local crime investigation pow-
been met, it may issue an order requiring the      secreted, he shall issue a warrant to search for
person to answer the questions or produce the      and seize such records.                            ers not diminished.
evidence, or both, which he refuses to give or
produce on the basis of his privilege against      (L. 1979 S.B. 328, et al. § 58)                    198.186 The powers of the director of the
self-incrimination. If the court believes such     Effective 7-1-79                                   fraud investigation division under sections
burden has not been met, it shall dismiss the                                                         198.139 to 198.186 shall not diminish the
request. When the order is communicated to                                                            powers of local authorities to investigate
the person, the person may not refuse to com-                                                         criminal conduct within their jurisdiction.
ply with the order on the basis of his privilege
                                                   Section 198.183
against self-incrimination. After complying                                                           (L. 1979 S.B. 328, et al. § 60)
                                                                                                      Effective 7-1-79
with the order and giving the testimony or         State agencies and law en-
producing the evidence, no testimony or
other evidence or information obtained or          forcement officers to cooper-                      Section 198.187
any information directly or indirectly derived     ate with fraud investigation
from the testimony or evidence may be used
against the person in any proceeding or
                                                   division.                                          Criminal background checks
                                                   .
prosecution for any offense concerning which
                                                   198.183 1. All state agencies shall cooperate      for residents permitted.
he gave answer or produced evidence under
                                                   with the director of the fraud investigation
court order, except a prosecution for per-                                                            198.187. Any long-term care facility licensed
                                                   division in his efforts to enforce the provi-
jury, false swearing or contempt committed                                                            under this chapter may request criminal back-
                                                   sions of sections 198.139 to 198.186. All
in answering or failing to answer, or in the                                                          ground checks under chapter 43, RSMo, of a
                                                   officers of the state of Missouri charged with
producing or failing to produce evidence in                                                           resident in such facility.
                                                   the enforcement of criminal law shall also
accordance with the order.
                                                   render and furnish to the director of the fraud
                                                   investigation division, when requested, all        (L. 2009 H.B. 395)
2. If any person refuses to testify after being
                                                   information and assistance in their posses-
granted immunity from prosecution under
sections 198.139 to 198.186 and after being
                                                   sion or within their power relating to sections    Section 198.189
                                                   198.139 to 198.186.
ordered to testify or produce evidence, the
court may find the person in contempt.
                                                   2. The department and all of its other divi-       Medicaid payment system for
                                                   sions shall promptly notify the director of the    assisted living facilities to be
(L. 1979 S.B. 328, et al. § 57)
                                                   fraud investigation division of any substantial
Effective 7-1-79
                                                   complaint or allegation of possible fraudulent     implemented--options.
                                                   activity on the part of a health care provider
Section 198.180                                    or vendor under Medicaid and shall refer to        198.189 The department of social services,
                                                   the director of the fraud investigation divi-      division of medical services and the depart-
                                                   sion all suspected cases of fraud in Medicaid      ment of health and senior services, division
Audit and inspection of re-                        services provided to any resident.                 of senior and disability services shall work
cords, when--warrant.                                                                                 together to implement a new Medicaid pay-
                                                   3. The director of the fraud investigation         ment system for assisted living facilities
198.180 During any investigation under             division shall be allowed access to all infor-     defined in section 198.006. The departments
sections 198.139 to 198.186, the director of       mation in the possession of the department                                                126
                                                         Missouri Revised Statutes
Statutes

shall look at possible options including but      tory contained within the corporate limits of         (4) The population of the district, which shall
not limited to federal Medicaid waivers,          an existing nursing home district shall not be        not be less than two thousand inhabitants;
state plan amendments, and provisions of the      incorporated in another nursing home district.
federal Deficit Reduction Act of 2005 that                                                              (5) The assessed valuation of the area, which
will allow a tiered rate system via a bundled     2. When a nursing home district is organized          shall not be less than two million five hun-
monthly rate for all services not included in     it shall be a body corporate and political            dred thousand dollars; and
the room and board function of the facil-         subdivision of the state and shall be known
ity, including but not limited to: adult day      as "........ Nursing Home District", and in that      (6) A request that the question be submitted
care/socialization activities, escort services,   name may sue and be sued, levy and col-               to the voters residing within the limits of the
essential shopping, health maintenance            lect taxes within the limitations of sections         proposed nursing home district whether they
activities, housekeeping activities, meal         198.200 to 198.350 and the constitution and           will establish a nursing home district under
preparation, laundry services, medication as-     issue bonds as herein provided.                       sections 198.200 to 198.350, to be known as
sistance (set-up and administration), personal                                                          "......... Nursing Home District" for the pur-
care services, assistance with activities of      3. For the purposes of sections 198.200 to            pose of constructing and maintaining a public
daily living and instrumental activities of       198.360, "nursing home" shall mean a resi-            nursing home.
daily living, transportation services, nursing    dential care facility, an assisted living facility,
supervision, health promotion and exercise        an intermediate care facility, or a skilled nurs-     (L. 1963 p. 368 § 3, A.L. 1978 H.B. 971)
programming, emergency call systems, in-          ing facility as defined in section 198.006.
continence supplies, and companion services.
The amount of the personal funds allowance        (L. 1963 p. 368 § 2, A.L. 1979 S.B. 328, et           Section 198.220
for the Medicaid recipient residing in an         al., A.L. 1984 S.B. 451)
assisted living facility shall include enough     *Reprinted due to editorial change required
money for over-the-counter medications and        by § 198.005.                                         Notice of hearing on petition--
co-payments for Medicaid and Medicare
Part D services. The departments shall work                                                             costs of notice.
with assisted living facility provider groups     Section 198.210
in developing this new payment system. The                                                              198.220 1. Upon the filing of the petition
department of social services shall submit all                                                          with the county clerk, he shall present it to
                                                                                                        the commissioners of the county commission
necessary applications for implementing this      Petition of voters for district,                      who shall thereupon set the petition for hear-
new system singularly or within a multiser-
vice state Medicaid waiver application to the     where filed, contents.                                ing within not less than thirty nor more than
secretary of the federal Department of Health                                                           forty days after the filing.
and Human Services by July 1, 2007.               198.210 Whenever the creation of a nursing
                                                  home district is desired, a number of voters          2. Notice shall be given by the commis-
(L. 2006 S.B. 616 § 1)                            residing in the proposed district equal to ten        sioner of the county commission of the time
                                                  percent of the vote cast for governor in the          and place where the hearing will be held, by
                                                  proposed district in the next preceding gu-           publication on three separate days in one or
                                                  bernatorial election, may file with the county        more newspapers having a general circulation
Section 198.200                                   clerk in which the territory or the greater part      within the territory proposed to be incor-
                                                  thereof is situated, a petition requesting the        porated as a nursing home district, the first
                                                  creation thereof. In case the proposed district       of which publications shall be not less than
District created, how--terri-                     which shall be contiguous is situated in two          twenty days prior to the date set for the hear-
tory included--name--nursing                      or more counties, the petition shall be filed in      ing and if there is no such newspaper, then
home defined.                                     the office of the county clerk of the county in       notice shall be posted in ten of the most pub-
                                                  which the greater part of the area is situated,       lic places in the territory, not less than twenty
198.200. 1. A nursing home district may           and the commissioners of the county com-              days prior to the date set for the hearing.
be created, incorporated and managed as           mission of the county shall set the petition for      This notice shall include a description of the
provided in sections 198.200 to 198.350 and       public hearing. The petition shall set forth:         territory as set out in the petition, names of
may exercise the powers herein granted or                                                               municipalities located therein and the name
necessarily implied. A nursing home district      (1) A description of the territory to be em-          of the proposed district and the question of
may include municipalities or territory not in    braced in the proposed district;                      creating a nursing home district.
municipalities or both or territory in one or
more counties; except, that the provisions of     (2) The names of the municipalities located           3. The costs of printing and publication or
sections 198.200 to 198.350 are not effective     within the area;                                      posting of notices of public hearing thereon
in counties having a population of more than                                                            shall be paid in advance by the petitioners,
four hundred thousand inhabitants. The terri-     (3) The name of the proposed district;                and, if a district is organized under sections
                                                                                                                                                  127
                                                         Missouri Revised Statutes
Statutes

198.200 to 198.350, they shall be reimbursed       (L. 1963 p. 368 § 6, A.L. 1978 H.B. 971)            dure--ballot of submission,
out of the funds received by the district from     *Words "and shall" appear in original rolls.
taxation or other sources.
                                                                                                       form.
                                                   Section 198.250                                     198.263. Any district which has a lower tax
(L. 1963 p. 368 § 4)
                                                                                                       levy than the maximum levy authorized by
                                                                                                       section 198.250 may increase its levy up to,
                                                   Notice of election, contents.                       but not in excess of, such maximum levy if a
Section 198.230                                                                                        majority of the voters of the district who vote
                                                   198.250 Each notice shall state briefly the         on the increase approve the increase. The bal-
                                                   purpose of the election, setting forth the          lot of submission for a tax increase under this
Procedure where several peti-                      proposition to be voted upon and a descrip-         section shall be in substantially the following
tions filed--amendment.                            tion of the territory. The notice shall further     form:
                                                   state that any district upon its establishment
198.230 If two or more petitions covering          shall have the powers, objects and purposes         Shall the ................. Nursing Home District
in part the same territory are filed prior to      provided by sections 198.200 to 198.350,            be authorized to increase the annual rate of
the public hearing upon the petition which is      and shall have the power to levy a property         property tax from ........ cents to ........ cents
first filed, the petitions shall be consolidated   tax not to exceed thirty-five cents on the one      on the hundred dollars assessed valuation?
for public hearing, and hearing thereon may        hundred dollars valuation.
be continued to permit the giving of notice                                                            [ ] Yes
of any subsequent petitions. At the public         (L. 1963 p. 368 § 7, A.L. 1978 H.B. 971, A.L.
hearing upon the petitions, the petitioners in     1985 S.B. 100)                                      [ ] No (Place an "X" in the square opposite
the petition first filed may move to amend the                                                         the answer for which you wish to vote.) If a
petition to include any part of the territory                                                          majority of the qualified voters casting votes
described in the subsequent petitions, either      Section 198.260                                     thereon are in favor of the increase, the board
as originally filed or as amended. Any such                                                            of directors of the district shall levy the an-
motion shall be allowed by the commission-                                                             nual rate of tax approved; but if a majority of
ers of the county commission. The public           Form of ballot.                                     the voters casting votes thereon are opposed
hearing shall proceed upon the first petition                                                          to the increase, any annual tax rate in effect
as originally filed or as so amended, and          198.260 The question of whether or not a            at the time of the election shall remain in ef-
further proceedings upon any other petitions       nursing home shall be organized shall be sub-       fect; provided, however, that if the voters of
subsequently filed shall be stayed and held in     mitted in substantially the following form:         the district have previously approved a levy
abeyance until the termination of all proceed-                                                         and the levy has not been imposed, the board
ings upon the first petition, or any petition      Shall there be organized in the counties of         of directors may impose such previously
may be dismissed or withdrawn upon motion          ........., state of Missouri, a nursing home dis-   approved levy or portion thereof, subject to
of the petitioners therein by their representa-    trict for the establishment and operation of a      other provisions of the law with respect to
tives.                                             nursing home to be located within the bound-        limitation on tax revenues.
                                                   aries of the proposed district and having the
(L. 1963 p. 368 § 5)                               power to impose a property tax not to exceed        (L. 1985 S.B. 100)
                                                   the annual rate of thirty-five cents on the hun-
                                                   dred dollars assessed valuation without voter
Section 198.240                                    approval, and such additional tax as may be
                                                   approved hereafter by vote thereon, to be
                                                                                                       Section 198.270
If petition sufficient county                      known as "......... Nursing Home District" as

commission to order election.
                                                   prayed for by petition filed with the county        Results of election to be filed.
                                                   clerk of ......... County, Missouri, on the ....
                                                   day of ......, 20.....?                             198.270 The order determining and declar-
198.240 If the territory, petition and pro-
                                                                                                       ing results of the election shall be entered
ceedings meet the requirements of sections         (L. 1963 p. 368 § 8, A.L. 1978 H.B. 971, A.L.       upon the records of the commission and a
198.200 to 198.350, the commissioners of the       1985 S.B. 100)                                      certified copy thereof shall be filed with the
county commission shall in and by the order
                                                                                                       county clerk of each other county in which
finding and determining the sufficiency of
                                                                                                       the proposed district lies who shall cause the
the petition and that the territory meets the
requirements of sections 198.200 to 198.350        Section 198.263                                     same to be spread upon the records of the
                                                                                                       county commission. If the order shows that
* order the question to be submitted to the
                                                                                                       the question to organize the district received
voters of the proposed district.                   Increase in tax levy, proce-                        a majority of the votes cast, the order shall
                                                                                                                                                   128
                                                         Missouri Revised Statutes
Statutes

declare the district organized.                   to hold office until the expiration of the term     H.B. 881)
                                                  of the sixth director whose term expires after
(L. 1963 p. 368 § 9, A.L. 1978 H.B. 971)          August 28, 1994, at which time both such
                                                  directors shall be elected for a term of three      Section 198.290
                                                  years. All directors shall serve until their suc-
Section 198.280                                   cessors are elected and qualified. If a vacancy
                                                  occurs, the board shall select a successor who      Powers of board of directors--
                                                  shall serve until the next regular election of
                                                                                                      first meeting--officers--bylaws-
Election districts--election of                   a director is to be held in that nursing home
                                                  or election district. If no candidate files a       -time for meetings.
directors--terms--qualifica-                      declaration of candidacy for a nursing home
tions --declaration of candida-                   or election district, a majority of the board       198.290 1. The board of directors of a district
cy--appointed if no candidate--                   of directors may, after the election in that        shall possess and exercise all of its legisla-
                                                  nursing home or election district would have        tive and executive powers. Within thirty days
no election required when.                        regularly been held, appoint any resident           after the election of the initial directors, the
                                                  of the nursing home district who otherwise          board shall meet. The time and place of the
198.280 1. After the nursing home district        qualifies pursuant to subsection 3 of this sec-     first meeting of the board shall be designated
has been declared organized, the declaring        tion to fill that vacancy.                          by the county commission. At its first meet-
county commission shall either:                                                                       ing the board shall elect a chairman from its
                                                  2. Following the initial election establishing      members and select a secretary, treasurer and
(1) Divide the district into six election dis-    the nursing home district board of directors        such officers or employees as it deems ex-
tricts as equal in population as possible, and    pursuant to subsection 1 of this section, the       pedient or necessary for the accomplishment
shall by lot number the districts from one to     circuit court may choose to elect the board of      of its corporate objects. The secretary and
six, inclusive. The county commission shall       directors at large.                                 treasurer need not be members of the board.
cause an election to be held in the nursing                                                           At the meeting the board, by ordinance, shall
home district within ninety days after the        3. Candidates for director of the nursing           define the first and subsequent fiscal years of
order establishing the nursing home district      home district shall be citizens of the United       the district, and shall adopt a corporate seal
to elect nursing home district directors. The     States, resident taxpayers of the nursing           and bylaws, which shall determine the times
election shall be called, held and conducted      home district who have resided within the           for the annual election of officers and of other
and notice shall be given as provided in          state for one year next preceding the election      regular and special meetings of the board and
sections 198.240 to 198.270, and each voter       and who are at least twenty-four years of age.      shall contain the rules for the transaction of
shall vote for the director from his or her       All candidates shall file their declarations of     other business of the district and for amend-
district; or                                      candidacy with the county commission call-          ing the bylaws.
                                                  ing the election at least twenty days prior to
(2) Cause an election to be held in the nurs-     the special election.                               2. Each director of any district shall devote
ing home district within ninety days after the                                                        such time to the duties of the office as the
order establishing the nursing home district      4. Notwithstanding any other provisions of          faithful discharge thereof may require and
to elect six at-large nursing home district       law to the contrary, if the number of candi-        shall serve without compensation.
directors. The election shall be called, held     dates for the office of director is equal to the
and conducted and notice shall be given as        number of directors to be elected, no election      (L. 1963 p. 368 § 11)
provided in sections 198.240 to 198.270. Af-      shall be held, and the candidates shall assume
ter August 28, 1994, directors shall be elected   the responsibility of their offices at the same
for a term of three years. The first director
whose term expires after August 28, 1994,
                                                  time and in the same manner as if they have         Section 198.300
                                                  been elected; however, if any vacancies are
shall continue to hold office until the expira-   created after local certification and prior to
tion of the term of the second director whose     the deadline provided in subdivision (4) of         Powers of nursing home dis-
term expires after August 28, 1994, at which      section 115.453, RSMo, which cause the
time both such directors shall be elected for a   number of filed candidates to be less than the
                                                                                                      trict.
term of three years. The third director whose     number of vacancies to be filled, an election
term expires after August 28, 1994, shall                                                             198.300 1. A nursing home district shall
                                                  shall be held, and write-in candidates for
continue to hold office until the expiration                                                          have and exercise the following governmen-
                                                  such positions shall be eligible as otherwise
of the term of the fourth director whose term                                                         tal powers, and all other powers incidental,
                                                  provided by law.
expires after August 28, 1994, at which time                                                          necessary, convenient or desirable to carry
both such directors shall be elected for a term                                                       out and effectuate the express powers:
                                                  (L. 1963 p. 368 § 10, A.L. 1978 H.B. 971,
of three years. The fifth director whose term     H.B. 1208, A.L. 1982 S.B. 526, A.L. 1986
expires after August 28, 1994, shall continue     S.B. 527, A.L. 1994 H.B. 1221, A.L. 2001
                                                                                                                                               129
                                                        Missouri Revised Statutes
Statutes

(1) To establish and maintain a nursing home       the greatest number; to exclude from the use         such resident or employee or any member
within its corporate limits, and to construct,     of the nursing home all persons who willfully        of such resident's or employee's family has
acquire, develop, expand, extend and im-           disregard any of the rules and regulations           made a report of any violation or suspected
prove the nursing home;                            so established; to extend the privileges and         violation of laws, ordinances, or regulations
                                                   use of the nursing home to persons resid-            applying to the facility which the resident, the
(2) To acquire or convey land or structures        ing outside the area of the district upon such       resident's family, or an employee has reason-
in fee simple, rights in land and easements        terms and conditions as the board of directors       able cause to believe has been committed or
upon, over or across land and leasehold            prescribes by its rules and regulations;             has occurred. Through the existing depart-
interests in land and tangible and intangible                                                           ment information and referral telephone
personal property used or useful for the loca-     (8) To police its property and to exercise           contact line, residents, their families, and
tion, establishment, maintenance, develop-         police powers in respect thereto or in respect       employees of a facility shall be able to obtain
ment, expansion, extension or improvement          to the enforcement of any rule or regulation         information about their rights, protections,
of any nursing home. The acquisition may           provided by the ordinances of the district and       and options in cases of eviction, harassment,
be by dedication, purchase, gift, agreement,       to employ and commission police officers             dismissal, or retaliation due to a report being
lease, use or adverse possession or by con-        and other qualified persons to enforce the           made pursuant to this section.
demnation. The conveyance may be by deed           same.
or lease;                                                                                               (L. 2003 S.B. 556 & 311)
                                                   2. The use of any nursing home of a district
(3) To operate, maintain and manage the            shall be subject to the reasonable regulation
nursing home, and to make and enter into           and control of the district and upon such
contracts for the use, operation or manage-        reasonable terms and conditions as shall be          Section 198.305
ment of and to provide rules and regulations       established by its board of directors.
for the operation, management or use of the
nursing home;                                      3. A regulatory ordinance of a district adopted      Unsuitable site, may be
                                                   under any provision of this section may              changed, when.
(4) To fix, charge and collect reasonable fees     provide for a suspension or revocation of
and compensation for the use or occupancy          any rights or privileges within the control of       198.305 1. If, after acquiring a site for a
of the nursing home or any part thereof, and       the district for a violation of any regulatory       nursing home or a nursing home, the board of
for nursing care, medicine, attendance, or         ordinance.                                           the district by resolution determines that the
other services furnished by the nursing home,                                                           site or nursing home acquired is unsuitable
according to the rules and regulations pre-        4. Nothing in this section or in other provi-        or unnecessary for the purpose, or it is in the
scribed by the board from time to time;            sions of sections 198.200 to 198.350 shall be        best interest of the district, that the property
                                                   construed to authorize the district or board to      should be sold, the board may sell and con-
(5) To borrow money and to issue bonds,            establish or enforce any regulation or rule in       vey the property in the manner provided in
notes, certificates, or other evidences of         respect to the operation or maintenance of the       subsection 2 of this section, provided that all
indebtedness for the purpose of accomplish-        nursing home within its jurisdiction which           outstanding bonds of the district constituting
ing any of its corporate purposes, subject to      is in conflict with any federal or state law         a lien on the property to be sold have been
compliance with any condition or limitation        or regulation applicable to the same subject         paid in full; or a sum sufficient to pay all such
set forth in sections 198.200 to 198.350 or        matter.                                              bonds, together with interest accrued or to ac-
otherwise provided by the Constitution of the                                                           crue thereon, together with any other items of
state of Missouri;                                 (L. 1963 p. 368 § 12, A.L. 1991 H.B. 450)            expense provided in such bonds, is deposited
                                                                                                        with the fiscal agent named in the bonds for
(6) To employ or enter into contracts for the                                                           the purpose of full payment; or consent in
employment of any person, firm, or corpora-        Section 198.301                                      writing is obtained from all of the holders of
tion, and for professional services, necessary                                                          the bonds.
or desirable for the accomplishment of the
corporate objects of the district or the proper    Whistleblower protection for                         2. Upon filing with the county clerk of the
administration, management, protection or                                                               county in which the original petition to orga-
control of its property;
                                                   employees--availability of in-                       nize the district was filed of a certified copy
                                                   formation on rights of persons                       of the resolution adopted by the board of
(7) To maintain the nursing home for the ben-      retaliated against.                                  directors of the district setting forth the rea-
efit of the inhabitants of the area comprising                                                          sons for selling the property and the manner
the district regardless of race, creed or color,   198.301 No employee of a nursing home                in which the conditions of the provisions in
and to adopt such reasonable rules and regu-       district who directs or exercises any authority      subsection 1 of this section have been satis-
lations as may be necessary to render the use      in a facility shall evict, harass, dismiss, or re-   fied, the clerk shall present the resolution to
of the nursing home of the greatest benefit to     taliate against a resident or employee because
                                                                                                                                                  130
                                                          Missouri Revised Statutes
Statutes

the county commission. If the commission is        specified on the ballot, and issue the bonds of    edness of the issuing authority.
satisfied that the statements in the resolution    the district for the payment thereof.
are true and valid, it shall by order entered of                                                      198.314 Any bonds issued under and pursu-
record approve the resolution. The board of        4. The loans authorized by this section shall      ant to sections 198.312 to 198.318 shall not
directors of the district may then proceed to      not be contracted for a period longer than         be deemed to be an indebtedness of the state
sell and convey the property. The deed shall       twenty years, and the entire amount of the         of Missouri, or of any city, or of the board of
be executed by the secretary of the board for      loan shall at no time exceed, including the        directors, or of the individual members of the
and on behalf of the district, and shall convey    existing indebtedness of the district, in the      board of directors, and shall not be deemed to
to the purchaser all the right, title, interest,   aggregate, ten percent of the value of tax-        be an indebtedness within the meaning of any
and estate which the nursing home district         able tangible property therein, as shown by        constitutional or statutory limitation upon the
has in the property.                               the last completed assessment for state and        incurring of indebtedness.
                                                   county purposes, the rate of interest to be
3. Any proceeds from the sale of the property      agreed upon by the parties, but in no case         (L. 1978 H.B. 1769)
remaining after the expenses of the sale of        to exceed the highest legal rate allowed by
the property and the purchase price and costs      contract; when effected, it shall be the duty
of purchase of any new site or structure have      of the directors to provide for the collection
                                                                                                      Section 198.316
been paid shall be placed in the treasury of       of an annual tax sufficient to pay the interest
the district and used to carry out the purposes    on the indebtedness as it falls due, and also      Revenue bonds, form of, inter-
for which the district was organized.              to constitute a sinking fund for the payment
                                                   of the principal thereof within the time the       est rate--to be negotiable in-
(L. 1975 H.B. 382, A.L. 1991 H.B. 450)             principal becomes due.                             struments.
Section 198.310                                    (L. 1963 p. 368 § 13, A.L. 1978 H.B. 971)          198.316 1. Revenue bonds issued pursuant to
                                                                                                      the provisions of section 198.312 shall be of
                                 Section 198.312                                                      such denomination, shall bear such rate of in-
Indebtedness for nursing                                                                              terest not to exceed the highest rate permitted
                                                                                                      by law, and shall mature at such times as de-
home--election--ballot--limits--
                                 Revenue bonds authorized,                                            termined by the board of directors. The bonds
tax to pay.                                                                                           may be either serial bonds or term bonds
                                 when.                                                                and may be issued with or without reserva-
198.310 1. For the purpose of purchasing                                                              tion of the right to call them for payment or
                                                   198.312 As an alternative to the authoriza-
nursing home district sites, erecting nursing                                                         redemption in advance of their maturity, upon
                                                   tion for an indebtedness provided by section
homes and related facilities and furnishing                                                           the giving of notice and with or without the
                                                   198.310, for the purpose of providing funds
the same, building additions to and repairing                                                         covenant requiring the payment of a premium
                                                   for the acquisition, construction, erection,
old buildings, the board of directors may bor-                                                        in the event of the call and redemption prior
                                                   equipment and furnishing of nursing homes
row money and issue bonds for the payment                                                             to maturity as the board determines.
                                                   and related facilities, and for providing a site
thereof in the manner provided herein. The         therefor, including offstreet parking space,
question of the loan shall be submitted by an                                                         2. The bonds when issued and sold shall be
                                                   and making from time to time enlargements
order of the board of directors of the district.                                                      negotiable instruments within the meaning of
                                                   or extensions thereof, the board of directors
Notice of the submission of the question, the                                                         the law merchant and the negotiable instru-
                                                   may issue and sell revenue bonds. The rev-
amount and the purpose of the loan shall be                                                           ments law and the interest thereon is exempt
                                                   enue bonds are payable, both as to principal
given as provided in section 198.250.                                                                 from income taxes under the laws of the state
                                                   and interest, solely and only out of the net
                                                                                                      of Missouri.
                                                   income and revenues arising from the opera-
2. The question shall be submitted in substan-     tion of the facility, after providing for the
tially the following form:                                                                            (L. 1978 H.B. 1769)
                                                   costs of operation and maintenance thereof,
                                                   or from other funds made available to the fa-
Shall the ......... Nursing Home District bor-     cility from sources other than from proceeds
row money in the amount of ......... dollars       of taxation.                                       Section 198.318
for the purpose of ....... and issue bonds in
payment thereof?                                   (L. 1978 H.B. 1769)
                                                                                                      Board of directors to pre-
3. If two-thirds of the votes cast are for the
                                                   Section 198.314                                    scribe form, make necessary
loan, the board shall, subject to the restric-
tions of subsection 4, be vested with the                                                             covenants, restrictions--bond-
power to borrow money in the name of the           Revenue bonds not an indebt-                       holders, remedies of--revenue
district, to the amount and for the purposes                                                                                     131
                                                         Missouri Revised Statutes
Statutes

bonds, not to be exclusive                        order the submission of the question to the
                                                  voters to decide whether or not the proposed       198.340 Any person desiring to donate
method of financing.                              annexation shall take place. The question          property for the benefit of a nursing home,
                                                  shall be submitted within the territory by the     constructed or to be constructed under sec-
198.318 1. The board of directors, issu-
                                                  county commission as is provided in section        tions 198.200 to 198.350, may vest title to the
ing bonds under the provisions of section
                                                  198.250.                                           property so donated in the board of directors
198.312, shall prescribe the form, details and
incidents of the bonds, and the board of direc-                                                      created under sections 198.200 to 198.350,
                                                  2. The question shall be submitted in substan-     and the board of directors shall hold and
tors shall make such covenants as in their
                                                  tially the following form:                         control the property so received and accepted
judgment are advisable or necessary properly
to secure the payment thereof; but the form,                                                         according to the terms of the deed, gift,
                                                  Shall (description of territory) be annexed to     devise or bequest of the property, and shall be
details, incidents and covenants shall not be
                                                  the .... Nursing Home District?                    a trustee of the property, and shall take title
inconsistent with any of the provisions of sec-
tions 198.312 to 198.318.                                                                            to all property it may acquire in the name of
                                                  3. If a majority of the votes cast on the          the district and shall control the property for
                                                  question in the district and in the territory      the purposes provided in sections 198.200 to
2. The holder of any bonds issued hereun-
                                                  described in the petition, respectively, are in    198.350.
der or of any coupons representing interest
                                                  favor of the annexation, the commissioners of
accrued thereon may, by civil action either
                                                  the county commission shall by order declare       (L. 1963 p. 368 § 16)
at law or in equity, compel the board of
                                                  the territory annexed and shall describe the
directors issuing such bonds to perform all
                                                  altered boundaries of the district.
duties imposed upon them by the provisions                                                           Section 198.345
of sections 198.312 to 198.318, and also to
enforce the performance of any and all other      (L. 1963 p. 368 § 14, A.L. 1978 H.B. 971)
covenants made by such board of directors in                                                         Apartments for seniors, dis-
the issuance of the bonds.                        Section 198.330                                    tricts may establish (Marion
3. The provisions of sections 198.312 to                                                             and Ralls counties).
198.318 shall not be exclusive of other legal     Records of district--officers
methods of financing the facilities therein
described, but shall furnish an alternative
                                                  and employees to give bond.                        198.345 Nothing in sections 198.200 to
                                                                                                     198.350 shall prohibit a nursing home district
method of finance.                                                                                   from establishing and maintaining apartments
                                                  198.330 The board shall provide for the
                                                  proper and safe keeping of its permanent           for seniors that provide at a minimum hous-
(L. 1978 H.B. 1769)                                                                                  ing, food services, and emergency call but-
                                                  records and for the recording of the corporate
                                                  action of the district. It shall keep a true and   tons to the apartment residents in any county
                                                  accurate account of its receipts and an annual     of the third classification without a township
Section 198.320                                   audit shall be made of its books, records          form of government and with more than
                                                  and accounts. All officers and employees           twenty-eight thousand two hundred but fewer
                                                  authorized to receive or retain the custody of     than twenty-eight thousand three hundred
Annexation of territory to                        money or to sign vouchers, checks, warrants        inhabitants or any county of the third classi-
district--election.                               or evidences of indebtedness binding upon          fication without a township form of govern-
                                                  the district shall furnish surety bond for the     ment and with more than nine thousand five
198.320 1. A petition for annexation of land      faithful performance of their duties and the       hundred fifty but fewer than nine thousand
to a nursing home district shall be signed        faithful accounting for all moneys that may        six hundred fifty inhabitants. Such nursing
by not less than ten percent or fifty voters,     come into their hands in an amount to be           home districts shall not lease such apartments
whichever is fewer, residing within the ter-      fixed and in a form to be approved by the          for less than fair market rent as reported by
ritory therein described proposed for an-         board.                                             the United States Department of Housing and
nexation and shall be filed with the county                                                          Urban Development.
clerk of the county in which the district or      (L. 1963 p. 368 § 15)
the greater portion thereof is situated, and                                                         (L. 2005 H.B. 58 merged with S.B. 210)
shall be addressed to the commissioners of
the county commission. A hearing shall be         Section 198.340
held thereon as nearly as possible as in the                                                         Section 198.350
case of a formation petition. If, upon hearing,
the commissioners of the county commis-           Board as trustee may accept
                                                                                                     Citation of law.
sion find that the petition is in compliance      and hold property donated--
with sections 198.200 to 198.350, they shall
                                                  duties.                                                                                   132
                                                        Missouri Revised Statutes
Statutes

198.350 Sections 198.200 to 198.350 shall           means accepting payment for such services.        Expires 9-30-11
be known and may be referred to as "The
Nursing Home District Law".                         3. For the purpose of this section, the term
                                                    "nursing facility" shall be defined using the     Section 198.409
(L. 1963 p. 368 § 1)                                definition in section 1396r, Title 42 United
                                                    States Code, as amended, and as such quali-
                                                    fies as a class of health care providers recog-   Determination of amount due-
Section 198.360                                     nized in federal Public Law 102-234 Med-          -notification, payments--offset
                                                    icaid Voluntary Contribution and Provider         allowed.
                                                    Specific Tax Amendment of 1991.
Dissolution of district.
                                                    (L. 1994 H.B. 1362 § 1)                           198.409 1. The director of the department
198.360 In any nursing home district created                                                          of social services shall make a determination
                                                    Expires 9-30-11
under the provisions of sections 198.200 to                                                           as to the amount of nursing facility reim-
198.350 which is not operating a nursing                                                              bursement allowance due from each nursing
home, and in which the voters of the district       Section 198.403                                   facility.
have on three separate occasions refused to
approve a bond issue for the construction of                                                          2. The director of the department of social
a nursing home, or in which the voters of the       Formula set forth in rules.                       services shall notify each nursing facility of
district have not approved a bond issue for                                                           the annual amount of its reimbursement al-
the construction of a nursing home within           198.403 Each nursing facility's reimburse-        lowance on or before the first day of Octo-
three years after the establishment of the          ment allowance shall be based on a formula        ber each year. Such amount may be paid in
district, the board of that district shall submit   set forth in rules and regulations promulgated    monthly* increments over the balance of the
to the voters the proposition of the dissolu-       by the department of social services as pro-      reimbursement allowance period.
tion of the district. If a majority of the voters   vided in section 198.436.
approve the dissolution, the district shall be                                                        3. The department of social services may
dissolved and any tax money in the treasury         (L. 1994 H.B. 1362 § 2)                           offset the nursing facility reimbursement al-
shall be paid into the general revenue fund of      Expires 9-30-11                                   lowance owed by the nursing facility against
the county or counties in which the district is                                                       any payment due that nursing facility only if
located, in the same proportion as the propor-                                                        the nursing facility requests such an offset.
tion of the valuation of the district in each       Section 198.406                                   The amounts to be offset shall result, so far as
county is to the total valuation of the district.                                                     practicable, in withholding from the nursing
                                                                                                      facility an amount substantially equivalent
(L. 1969 p. 304 § 1, A.L. 1971 S.B. 158, A.L.       Records required, transmit-                       to the reimbursement allowance owed by the
1973 H.B. 364, A.L. 1978 H.B. 1208)                 tal to department--elements of                    nursing facility. The office of administration
                                                    report, determinations.                           and state treasurer may make any fund trans-
                                                                                                      fers necessary to execute the offset.
Section 198.401
                                                    198.406 1. Each nursing facility shall keep       (L. 1994 H.B. 1362 § 4)
                                                    such records as may be necessary to deter-        Expires 9-30-11
Nursing facility reimburse-                         mine the amount of its reimbursement allow-
ment allowance, definitions.                        ance. On or before the first day of October of
                                                                                                      *Word "month" appears in original rolls.
                                                    each year, every nursing facility shall submit
                                                    to the department of social services a state-
198.401 1. Each nursing facility, except
for state-owned and -operated facilities,
                                                    ment that accurately reflects such informa-       Section 198.412
                                                    tion as is necessary to determine that nursing
shall, in addition to all other fees and taxes
                                                    facility's reimbursement allowance.
now required or paid, pay a nursing facility
reimbursement allowance for the privilege of
                                                                                                      Finality of determination,
                                                    2. If a nursing facility does not have a third    protest--hearing, reconsidera-
engaging in the business of providing nursing
                                                    prior year desk-reviewed cost report, ele-
facility services, other than services in an
                                                    ments of the reimbursement allowance shall        tion, appeal.
institution for mental diseases, in this state.
                                                    be based on determinations by the department
                                                    of social services in accordance with rules       198.412 1. Each nursing facility reimburse-
2. For the purpose of this section, the phrase
                                                    and regulations established under section         ment allowance determination shall be final
"engaging in the business of providing nurs-
                                                    198.436.                                          after receipt of written notice from the depart-
ing facility services, other than services in an
institution for mental diseases, in this state"                                                       ment of social services, unless the nursing
                                                    (L. 1994 H.B. 1362 § 3)                                                                   133
                                                          Missouri Revised Statutes
Statutes

facility files a protest with the director of the   restrictions.                                       the nursing facility reimbursement allowance
department of social services setting forth the                                                         fund from year to year.
grounds on which the protest is based, within       198.418 1. The nursing facility reimburse-
thirty days from the date of receipt of written     ment allowance owed or, if an offset has been       (L. 1994 H.B. 1362 § 7)
notice from the department of social services       requested, the balance, if any, after such off-     Expires 9-30-11
to the nursing facility.                            set, shall be remitted by the nursing facility to
                                                    the department of social services. The remit-
2. If a timely protest is filed, the director       tance shall be made payable to the director of      Section 198.421
of the department of social services shall          the department of revenue. The amount re-
reconsider the determination and, if the nurs-      mitted shall be deposited in the state treasury
ing facility has so requested, the director or      to the credit of the "Nursing Facility Reim-        Allowance period, notification
the director's designee shall grant the nursing     bursement Allowance Fund", which is hereby          by department, delinquent
facility a hearing to be held within forty-five     created for the sole purposes of providing          allowance--lien, enforcement,
days after the protest is filed, unless extended    payment to nursing facilities and disbursing
by agreement between the nursing facility           up to five percent of the federal funds depos-      sanctions--effect upon license.
and the director. The director shall issue a        ited to the nursing facility reimbursement
final decision within forty-five days of the        allowance fund each year, not to exceed one         198.421 1. A nursing facility reimbursement
completion of the hearing. After reconsidera-       million five hundred thousand dollars, to the       allowance period as provided in sections
tion of the reimbursement allowance determi-        credit of the nursing facility quality of care      198.401 to 198.436 shall be from the first day
nation and a final decision by the director of      fund, subject to appropriation. The "Nurs-          of October to the thirtieth day of September.
the department of social services, a nursing        ing Facility Quality of Care Fund" is hereby        The department shall notify each nursing
home's appeal of the director's final decision      created in the state treasury. All investment       facility with a balance due on the thirtieth day
shall be to the administrative hearing com-         earnings of the nursing facility quality of care    of September of each year the amount of such
mission in accordance with sections 208.156         fund shall be credited to the nursing facility      balance due. If any nursing home fails to pay
and 621.055, RSMo.                                  quality of care fund. The unexpended balance        its nursing facility reimbursement allowance
                                                    in the nursing facility quality of care fund at     within thirty days of such notice, the reim-
(L. 1994 H.B. 1362 § 5)                             the end of the biennium is exempt from the          bursement allowance shall be delinquent. The
Expires 9-30-11                                     provisions of section 33.080, RSMo. The             reimbursement allowance may remain unpaid
                                                    unexpended balance shall not revert to the          during an appeal or as allowed in section
                                                    general revenue fund, but shall accumulate          198.412.
Section 198.416                                     in the nursing facility quality of care fund
                                                    from year to year. All investment earnings of       2. Except as otherwise provided in this
                                                    the nursing facility reimbursement allowance        section, if any reimbursement allowance im-
Forms and content set forth in                      fund shall be credited to the nursing facility      posed under the provision of section 198.401
rule.                                               reimbursement allowance fund.                       for a previous reimbursement allowance pe-
                                                                                                        riod is unpaid and delinquent, the department
198.416 The director of the department              2. An offset as authorized by this section or       of social services may proceed to enforce the
of social services shall prescribe by rule the      a payment to the nursing facility reimburse-        state's lien against the property of the nursing
form and content of any document required to        ment allowance fund shall be accepted as            facility and to compel the payment of such
be filed pursuant to the provisions of sections     payment of the nursing facility's obligation        reimbursement allowance in the circuit court
198.401 to 198.436.                                 imposed by section 198.401.                         having jurisdiction in the county where the
                                                                                                        nursing facility is located. In addition, the di-
(L. 1994 H.B. 1362 § 6)                             3. The state treasurer shall maintain records       rector of the department of social services or
                                                    that show the amount of money in the nursing        the director's designee may cancel or refuse
Expires 9-30-11                                     facility reimbursement allowance fund at any        to issue, extend or reinstate a Medicaid pro-
                                                    time and the amount of any investment earn-         vider agreement to any nursing facility which
Section 198.418                                     ings on that amount. The department of social       fails to pay such delinquent reimbursement
                                                    services shall disclose such information to         allowance required by section 198.401 unless
                                                    any interested party upon written request.          under appeal as allowed in section 198.412.
Remittance of amount--nurs-
ing facility reimbursement                          4. The unexpended balance in the nursing            3. Except as otherwise provided in this
                                                    facility reimbursement allowance fund at            section, failure to pay a delinquent reim-
allowance fund, purpose,                            the end of the biennium is exempt from the          bursement allowance imposed under section
restrictions--nursing facility                      provisions of section 33.080, RSMo. The             198.401 shall be grounds for denial, suspen-
                                                    unexpended balance shall not revert to the          sion or revocation of a license granted under
quality of care fund, purpose,                      general revenue fund, but shall accumulate in
                                                                                                                                                  134
                                                            Missouri Revised Statutes
Statutes

this chapter. The director of the department of   supplant, and shall be in addition to, general     nursing facilities in accordance with regula-
social services may deny, suspend or revoke       revenue payments to nursing facilities.            tions promulgated by the department of social
the license of any nursing facility which fails                                                      services, along with a full accounting of
to pay a delinquent reimbursement allowance       (L. 1994 H.B. 1362 § 10)                           such disbursements, within forty-five days of
unless under appeal as allowed in section         Expires 9-30-11                                    receipt of notice thereof by the department of
198.412.                                                                                             social services.

(L. 1994 H.B. 1362 § 8)
                                                  Section 198.428                                    (L. 1994 H.B. 1362 § 11)
Expires 9-30-11                                                                                      Expires 9-30-11
                                                  Medicaid eligibility presumed
Section 198.424                                   pending approval or denial of                      Section 198.433
                                                  application, when.
No effect upon tax-exempt                                                                            Imposition of allowance,
                                                  198.428 If the division of family services
status.                                           is unable to make a determination regard-          when.
                                                  ing Medicaid eligibility for a resident within
198.424 Nothing in sections 198.401 to            sixty days of the submission of a completed        198.433 The nursing home reimbursement
198.436 shall be deemed to affect or in any       application for medical assistance for nursing     allowance provided in section 198.401 shall
way limit the tax-exempt or nonprofit status      facility services, the patient shall be Medicaid   not be imposed prior to the effective date
of any nursing facility granted by state law.     eligible until the application is approved or      of rules and regulations promulgated by the
                                                  denied. However, in no event shall benefits        department of social services, but in no event
(L. 1994 H.B. 1362 § 9)                           be construed to commence prior to the date of      prior to October 1, 1994.
Expires 9-30-11                                   application.
                                                                                                     (L. 1994 H.B. 1362 § 12)
                                                  (L. 2003 S.B. 556 & 311)
Section 198.427                                   Expires 9-30-11
                                                                                                     Expires 9-30-11


Medicaid provider agree-                                                                             Section 198.436
                                          Section 198.431
ments, payments, rate, compu-
tation.                                                                                              Rules, regulations, promulga-
                                          Contingent application of
                                                                                                     tion, procedure.
198.427 The department of social services
                                          requirements--disbursement
shall make payments to those nursing fa-  of fund, when.                                             198.436 No regulations implementing sec-
cilities that have a valid Medicaid provider                                                         tions 198.401 to 198.436 may be filed with
agreement with the department. Any per diem       198.431 The requirements of sections               the secretary of state without first being
rate, or its equivalent, used to compute such     198.401 to 198.433 shall apply only as long        provided to interested parties registered on
payments shall be equal to or greater than        as the revenues generated under section            a list of such parties to be maintained by the
the nursing facility's per diem rate in effect    198.401 are eligible for federal financial         director of the department of social services.
on January 1, 1994, for those facilities with     participation as provided in sections 198.401      Regulations must be provided to all interested
a permanent rate established in accordance        to 198.433 and payments are made pursu-            parties seventy-two hours prior to being filed
with regulations promulgated by the depart-       ant to the provisions of section 198.401. For      with the secretary of state. No rule or portion
ment of social services. Those nursing facili-    the purpose of this section, "federal financial    of a rule promulgated under the authority of
ties without a permanent rate or with an inter-   participation" is the federal government's         sections 198.401 to 198.436 shall become
im rate as of January 1, 1994, will be subject    share of Missouri's expenditures under the         effective unless it has been promulgated
to having their permanent rate established in     Medicaid program. Notwithstanding any-             pursuant to the provisions of section 536.024,
accordance with regulations promulgated by        thing in this section to the contrary, in the      RSMo.
the department of social services in effect on    event federal financial participation is either
January 1, 1994. Once the permanent rate is       denied, discontinued, reduced in excess of         (L. 1994 H.B. 1362 § 13, A.L. 1995 S.B. 3)
established, any per diem rate, or its equiva-    five percent per year or no longer available       Expires 9-30-11
lent, used to compute such payments shall be      for the revenues generated under section
equal to or greater than the permanent rate       198.401, the director of the department of
established according to regulations in effect    social services shall cause disbursement of        Section 198.439
on January 1, 1994. The nursing facility          all funds held in the nursing facility reim-
reimbursement allowance shall not be used to      bursement allowance fund to be made to all                                                 135
                                                        Missouri Revised Statutes
Statutes

                                                  and senior services, duties.
                                                                                                      (6) The frequency and types of resident
Expiration date.                                                                                      activities;
                                                  198.510 1. Any facility which offers to
                                                  provide or provides care for persons with
198.439 Sections 198.401 to 198.436 shall                                                             (7) The involvement of families and the
                                                  Alzheimer's disease by means of an Alzheim-
expire on September 30, 2011.                                                                         availability of family support programs;
                                                  er's special care unit or Alzheimer's special
                                                  care program shall be required to disclose
(L. 1994 H.B. 1362 § 14, A.L. 1996 S.B. 952,                                                          (8) The costs of care and any additional fees;
                                                  the form of care or treatment provided that
A.L. 1999 S.B. 326, A.L. 2002 H.B. 1781                                                               and
                                                  distinguishes that unit or program as being
merged with S.B. 1094, A.L. 2005 S.B. 189,
                                                  especially applicable, or suitable for persons
A.L. 2006 S.B. 822, A.L. 2007 S.B. 4)                                                                 (9) Safety and security measures.
                                                  with Alzheimer's or dementia. The disclo-
Effective 5-31-07                                 sure shall be made to the department which
                                                  licenses the facility, agency or center giving      (L. 1996 H.B. 781 § 3)
Section 198.500                                   the special care. At the time of admission of
                                                  a patient requiring treatment rendered by the
                                                  Alzheimer's special care program, a copy of         Section 198.515
Citation of law.                                  the disclosure made to the department shall
                                                  be delivered by the facility to the patient and     Alzheimer's facilities, in-
198.500 Sections 198.500 to 198.515 shall         the patient's next of kin, designee, or guard-
be known and may be cited as the "Alzheim-        ian. The licensing department shall exam-           formational documents
er's Special Care Disclosure Act".                ine all such disclosures in the department's        required--division of aging,
                                                  records and verify the information on the
                                                  disclosure for accuracy as part of the facility's   duties--licensing department,
(L. 1996 H.B. 781 § 1)
                                                  regular license renewal procedure.                  verification.
Section 198.505                                   2. The department of social services and the        198.515 Any facility which offers to provide
                                                  department of health and senior services shall      or provides care for persons with Alzheimer's
                                                  develop a single disclosure form to be com-         disease by means of an Alzheimer's special
Definitions.                                      pleted by the facility, agency or center giving     care unit or Alzheimer's special care program
                                                  the special care. The information required to       shall be required to provide an informational
198.505 For the purposes of sections              be disclosed by subsection 1 of this section        document developed by or approved by
198.500 to 198.515, "Alzheimer's special care     on this form shall include, if applicable, an       the division of aging. The document shall
unit" or "Alzheimer's special care program"       explanation of how the care is different from       include but is not limited to updated informa-
means any facility as defined in section          the rest of the facility in the following areas:    tion on selecting an Alzheimer's special care
198.006, or any home health agency, adult                                                             unit or Alzheimer's special care program.
day care center, hospice or adult foster home     (1) The Alzheimer's special care unit's or          The document shall be given to any person
that locks, secures, segregates or provides a     program's written statement of its overall phi-     seeking information about or placement in an
special program or special unit for residents     losophy and mission which reflects the need         Alzheimer's special care unit or Alzheimer's
with a diagnosis of probable Alzheimer's dis-     of residents afflicted with dementia;               special care program. The distribution of this
ease or a related disorder, to prevent or limit                                                       document shall be verified by the licensing
access by a resident outside the designated or    (2) The process and criteria for placement          department as part of the facility's regular
separated area; and that advertises, markets      in, transfer or discharge from, the unit or         license renewal procedure.
or otherwise promotes the facility as provid-     program;
ing specialized Alzheimer's or dementia care
                                                                                                      (L. 1996 H.B. 781 § 4)
services.                                         (3) The process used for assessment and es-
                                                  tablishment of the plan of care and its imple-
(L. 1996 H.B. 781 § 2)                            mentation, including the method by which            Section 198.525
                                                  the plan of care evolves and is responsive to
Section 198.510                                   changes in condition;
                                                                                                      Inspection of certain long-
                                                  (4) Staff training and continuing education         term care facilities, when.
Disclosure required, by whom-                     practices;
-licensing department, duties-                    (5) The physical environment and design fea-
                                                                                                      198.525. 1. Except as otherwise provided
                                                                                                      pursuant to section 198.526, in order to com-
-department of social services,                   tures appropriate to support the functioning        ply with sections 198.012 and 198.022, the
duties--department of health                      of cognitively impaired adult residents;
                                                                                                                                                136
                                                        Missouri Revised Statutes
Statutes

department of health and senior services shall     any purpose, shall take steps to verify the in-     class I violations or class II violations, the
inspect residential care facilities, assisted      formation and, if the department has probable       facility does not have a change in ownership,
living facilities, intermediate care facilities,   cause to believe that it is correct, shall not      operator, or, if the department finds it signifi-
and skilled nursing, including those facilities    assign the inspector or surveyor to the facility    cant, a change in director of nursing.
attached to acute care hospitals at least twice    or any facility within its organization so as to
a year.                                            avoid an appearance of prejudice or favor to        4. Information regarding unannounced in-
                                                   the facility or bias on the part of the inspector   spections shall be disclosed to employees of
2. The department shall not assign an indi-        or surveyor.                                        the department on a need-to-know basis only.
vidual to inspect or survey a long-term care                                                           Any employee of the department who know-
facility licensed under this chapter, for any      (L. 1999 S.B. 8 & 173 § 4, A.L. 2003 S.B.           ingly discloses the time of an unannounced
purpose, in which the inspector or surveyor        556 & 311, A.L. 2009 H.B. 395)                      inspection in violation of this section is guilty
was an employee of such facility within the                                                            of a class A misdemeanor and shall have his
preceding two years.                                                                                   or her employment immediately terminated.
                                                   Section 198.526
3. For any inspection or survey of a facility                                                          (L. 1999 S.B. 326 § 4, A.L. 2003 S.B. 556 &
licensed under this chapter, regardless of the                                                         311)
purpose, the department shall require every        Biannual inspections--reevalu-                      CROSS REFERENCE:
newly hired inspector or surveyor at the time      ation of inspection process--re-
of hiring or, with respect to any currently
employed inspector or surveyor as of August
                                                   duction in inspection schedule, Rulemaking authority, RSMo 198.534
28, 2009, to disclose:                             when--disclosure of inspection
                                                   schedule limited, penalty for                    Section 198.527
(1) The name of every Missouri licensed
long-term care facility in which he or she has     violation.
been employed; and                                                                                  Inspectors and surveyors of
                                                   198.526 1. Except as provided in subsection      long-term care facilities--uni-
(2) The name of any member of his or her           3 of this section, the department of health
                                                   and senior services shall inspect all facilities
                                                                                                    formity of application of regu-
immediate family who has been employed or
is currently employed at a Missouri licensed       licensed by the department at least twice each lation standards.
long-term care facility.                           year. Such inspections shall be conducted:
                                                                                                       198.527. To ensure uniformity of applica-
The disclosures under this subsection shall        (1) Without the prior notification of the facil-    tion of regulation standards in long-term care
be disclosed to the department whenever the        ity; and                                            facilities throughout the state, the department
event giving rise to disclosure first occurs.                                                          of health and senior services shall:
                                                   (2) At times of the day, on dates and at inter-
4. For purposes of this section, the phrase        vals which do not permit facilities to antici-      (1) Evaluate the requirements for inspec-
“immediate family member” shall mean hus-          pate such inspections.                              tors or surveyors of facilities, including the
band, wife, natural or adoptive parent, child,                                                         eligibility, training and testing requirements
sibling, stepparent, stepchild, stepbrother,       2. The department shall annually reevaluate         for the position. Based on the evaluation, the
stepsister, father-in-law, mother-in-law, son-     the inspection process to ensure the require-       department shall develop and implement ad-
in-law, daughter-in-law, brother-in-law, sister-   ments of subsection 1 of this section are met.      ditional training and knowledge standards for
in-law, grandparent or grandchild.                                                                     inspectors and surveyors;
                                                   3. The department may reduce the frequency
5. The information called for in this section      of inspections to once a year if a facility is      (2) Periodically evaluate the performance
shall be a public record under the provisions      found to be in substantial compliance. The          of the inspectors or surveyors regionally
of subdivision (6) of section 610.010, RSMo.       basis for such determination shall include, but     and statewide to identify any deviations or
                                                   not be limited to, the following:                   inconsistencies in regulation application. At
6. Any person may notify the department                                                                a minimum, the Missouri on-site surveyor
if facts exist that would lead a reasonable        (1) Previous inspection reports;                    evaluation process, and the number and type
person to conclude that any inspector or                                                               of actions overturned by the informal dispute
surveyor has any personal or business affilia-     (2) The facility's history of compliance with       resolution process under section 198.545
tion that would result in a conflict of interest   rules promulgated pursuant to this chapter;         and formal appeal shall be used as part of
in conducting an inspection or survey for                                                              the evaluation. Based on such evaluation,
a facility. Upon receiving that notice, the        (3) The number and severity of complaints           the department shall develop standards and
department, when assigning an inspector or         received about the facility; and                    a retraining process for the region, state, or
surveyor to inspect or survey a facility, for
                                                   (4) In the year subsequent to a finding of no                                                137
                                                         Missouri Revised Statutes
Statutes

individual inspector or surveyor, as needed;        (L. 2003 S.B. 556 & 311)
                                                                                                       2. The managed care organization shall
(3) In addition to the provisions of subdivi-                                                          reimburse the resident facility at a rate of
sions (1) and (2) of this section, the depart-      Section 198.530                                    reimbursement not less than the Medicare
ment shall develop a single uniform compre-                                                            allowable rate pursuant to Medicare rules and
hensive and mandatory course of instruction                                                            regulations.
for inspectors/surveyors on the practical ap-
                                                    Managed care services provid-
plication of enforcement of statutes, rules and     ed in long-term care facilities,                   3. The services in subsection 1 of this section
regulations. Such course shall also be open         when, conditions--reimburse-                       shall include, but are not limited to, skilled
to attendance by administrators and staff of                                                           nursing care, rehabilitative and other therapy
facilities licensed pursuant to this chapter.       ment rate--services included.                      services, and postacute care, as needed. Noth-
                                                                                                       ing in this section shall limit the managed
(L. 1999 H.B. 316, et al. § 2, A.L. 2009 H.B.       198.530 1. If an enrollee in a managed care        care organization from utilizing contracted
395)                                                organization is also a resident in a long-term     providers to deliver the services in the en-
                                                    care facility licensed pursuant to chapter 198,    rollee's resident facility.
                                                    or a continuing care retirement community,
                                                    as defined in section 197.305, RSMo, such          4. A resident facility shall not prohibit a
Section 198.528                                     enrollee's managed care organization shall         health carrier's participating providers from
                                                    provide the enrollee with the option of receiv-    providing covered benefits to an enrollee
Long-term care facility in-                         ing the covered service in the long-term care      in the resident facility. A resident facility or
                                                    facility which serves as the enrollee's primary    health care professional shall not impose any
formation to be provided on                         residence. For purposes of this section, "man-     charges on an enrollee for any service that is
department Internet web site.                       aged care organization" means any organiza-        ancillary to, a component of, or in support of
                                                    tion that offers any health plan certified by      the services provided under this section when
198.528 1. The department of health and             the department of health and senior services       the services are provided by a health carrier's
senior services shall provide through its Inter-    designed to provide incentives to medical          participating provider, or otherwise create a
net web site:                                       care providers to manage the cost and use of       disincentive for the use of the health car-
                                                    care associated with claims, including, but        rier's participating providers. Any violation
(1) The most recent survey of every long-           not limited to, a health maintenance organiza-     of the requirements of this subsection by the
term care facility licensed in this state and       tion and preferred provider organization. The      resident facility shall be considered abuse or
any such findings of deficiencies and the           resident enrollee's managed care organization      neglect of the resident enrollee.
effect the deficiency would have on such fa-        shall reimburse the resident facility for those
cility. If such survey is in dispute, the survey    services which would otherwise be covered          (L. 1999 H.B. 316, et al. § 3)
shall not be posted on the web site until the       by the managed care organization if the fol-
facility's informal dispute resolution process      lowing conditions apply:
                                                                                                       Section 198.531
resolves the dispute and the department shall,
upon request of the facility, post the facility's   (1) The facility is willing and able to provide
                                                    the services to the resident; and
response;                                                                                              Aging-in-place pilot program
(2) The facility's proposed plan of correction;     (2) The facility and those health care profes-     established--program require-
                                                    sionals delivering services to residents pursu-    ments and monitoring--rule-
(3) A link to the federal web site that provides    ant to this section meet the licensing and
                                                    training standards as prescribed by law; and       making authority.
a summary of facility surveys conducted over
the last three years; and
                                                    (3) The facility is certified through Medicare;    198.531 1. The division of aging, in col-
(4) Information on how to obtain a copy of a        and                                                laboration with qualified Missouri schools
complete facility survey conducted over the                                                            and universities, shall establish an aging-in-
last three years.                                   (4) The facility and those health care profes-     place pilot program at a maximum of four
                                                    sionals delivering services to residents pursu-    selected sites throughout the state which
2. Nothing in this section shall be construed       ant to this section agree to abide by the terms    will provide a continuum of care for elders
as requiring the department to post any             and conditions of the health carrier's contracts   who need long-term care. For purposes of
information on its Internet web site that is        with similar providers, abide by patient pro-      this section, "qualified Missouri schools and
prohibited from disclosure pursuant to the          tection standards and requirements imposed         universities" means any Missouri school or
federal Health Insurance Portability and Ac-        by state or federal law for plan enrollees and     university which has a school of nursing,
countability Act, as amended.                       meet the quality standards established by the      a graduate nursing program, or any other
                                                    health carrier for similar providers.
                                                                                                                                                138
                                                          Missouri Revised Statutes
Statutes

similar program or specialized expertise in         protection and care of all residents of the         198.533. Any rule or portion of a rule, as that
the areas of aging, long-term care or health        facility likely to be affected by the alleged ac-   term is defined in section 536.010, RSMo,
services for the elderly.                           tion or inaction. Such investigation shall be in    that is created under the authority delegated
                                                    addition to the investigation requirements for      in this section and sections 198.080, 198.086,
2. The pilot program shall:                         abuse and neglect reports pursuant to section       198.526, 198.532 and 198.533 shall become
                                                    198.070.                                            effective only if it complies with and is
(1) Deliver a full range of physical and men-                                                           subject to all of the provisions of chapter 536,
tal health services to residents in the least re-   2. The department shall provide the results of      RSMo, and, if applicable, section 536.028,
strictive environment of choice to reduce the       all investigations in accordance with sec-          RSMo. This section and chapter 536, RSMo,
necessity of relocating such residents to other     tion 660.320, RSMo. The department shall            are nonseverable and if any of the powers
locations as their health care needs change;        provide the results of such investigation in        vested with the general assembly pursuant to
                                                    writing to all parties to the complaint, and if     chapter 536, RSMo, to review, to delay the
(2) Base licensure on services provided rather      requested, to any of the facility's residents, or   effective date or to disapprove and annul a
than on facility type; and                          their family members or guardians. Com-             rule are subsequently held unconstitutional,
                                                    plaints and written results will be readily         then the grant of rulemaking authority and
(3) Be established in selected urban, rural and     available for public access and review at           any rule proposed or adopted after August 28,
regional sites throughout the state.                the department of health and senior services        1999, shall be invalid and void.
                                                    and at the long-term care facility. Personal
3. The directors of the division of aging and       information identifying the resident will be        (L. 1999 S.B. 326 § 6)
division of medical services shall apply for        blanked out, except in regard to immediate
all federal waivers necessary to provide Med-       family, the attorney-in-fact or the legal guard-
icaid reimbursement for health care services        ian of the resident in question. This informa-      Section 198.545
received through the aging-in-place pilot           tion will remain readily available for a period
program.                                            of time determined by the department of
                                                    health and senior services.                         Definitions--contracting with
4. The division of aging shall monitor the                                                              third parties--department to
pilot program and report to the general as-         (L. 1999 S.B. 326 § 1, A.L. 2003 S.B. 556 &
sembly on the effectiveness of such program,
                                                                                                        establish IDR process, proce-
                                                    311)
including quality of care, resident satisfaction                                                        dures--rulemaking authority.
and cost-effectiveness to include the cost
equivalent of unpaid or volunteer labor.            Section 198.533                                     198.545. 1. This section shall be known and
                                                                                                        may be cited as the “Missouri Informal Dis-
5. Developments authorized by this section                                                              pute Resolution Act”.
shall be exempt from the provisions of sec-         Conflict of interest, state in-
tions 197.300 to 197.367, RSMo, and shall be        vestigators.                                        2. As used in this section, the following terms
licensed by the division of aging.                                                                      shall mean:
                                                    198.533 The division shall ensure that any
(L. 1999 S.B. 326 § 9, A.L. 2001 S.B. 266)          monitor selected to perform state investi-          (1) “Deficiency”, a facility’s failure to meet
                                                    gations of long-term care facilities has no         a participation requirement or standard,
                                                    conflict of interest, and has no direct or          whether state or federal, supported by evi-
                                                    indirect connection to the facility or its parent   dence gathered from observation, interview,
Section 198.532                                     corporation.                                        or record review;

                                                    (L. 1999 S.B. 326 § 2)                              (2) “Department”, the department of health
Investigation of complaints--                                                                           and senior services;
results provided, when.
                                                    Section 198.534                                     (3) “Facility”, a long-term care facility
198.532 1. Complaints filed with the depart-                                                            licensed under this chapter;
ment of health and senior services against a        Rulemaking authority.
long-term care facility which allege that harm                                                          (4) “IDR”, informal dispute resolution as
has occurred or is likely to occur to a resident                                                        provided for in this section;
or residents of the facility due to actions or      198.534 In consultation with consumers,
the lack of actions taken by the facility shall     providers and others, the division shall pro-       (5) “Independent third party”, the federally
be investigated within thirty days of receipt       mulgate rules and regulations to implement          designated Medicare Quality Improvement
of such complaints. The purpose of such             the provisions of this section and sections         Organization in this state;
investigation shall be to ensure the safety,        198.080, 198.086, 198.526, 198.532 and
                                                                                                                                                    139
                                                          Missouri Revised Statutes
Statutes

                                                    opportunity to provide additional informa-           fication and Reporting System, or report to
(6) “Plan of correction”, a facility’s response     tion or clarification in support of the facility’s   any other agency, any information about the
to deficiencies which explains how correc-          contention that the deficiencies were errone-        deficiencies which are in dispute unless the
tive action will be accomplished, how the           ously cited. The facility may be accompanied         dispute determination is made and the facility
facility will identify other residents who may      by counsel during the IDR conference. The            has responded with a revised plan of correc-
be affected by the deficiency practice, what        type of IDR held shall be at the discretion of       tion, if needed.
measures will be used or systemic changes           the facility, but shall be limited to:
made to ensure that the deficient practice will                                                          10. Any rule or portion of a rule, as that term
not reoccur, and how the facility will monitor      (a) A desk review of written information             is defined in section 536.010, RSMo, that
to ensure that solutions are sustained;             submitted by the facility; or                        is created under the authority delegated in
                                                                                                         this section shall become effective only if
(7) “QIO”, the federally designated Medicare        (b) A telephonic conference; or                      it complies with and is subject to all of the
Quality Improvement Organization in this                                                                 provisions of chapter 536, RSMo, and, if
state.                                              (c) A face-to-face conference held at the            applicable, section 536.028, RSMo. This sec-
                                                    headquarters of the QIO or at the facility at        tion and chapter 536, RSMo, are nonsever-
3. The department of health and senior ser-         the request of the facility.                         able and if any of the powers vested with the
vices shall contract with an independent third                                                           general assembly pursuant to chapter 536,
party to conduct informal dispute resolution                                                             RSMo, to review, to delay the effective date,
(IDR) for facilities licensed under this chap-      If the QIO determines the need for additional        or to disapprove and annul a rule are subse-
ter. The IDR process, including conferences,        information, clarification, or discussion after      quently held unconstitutional, then the grant
shall constitute an informal administrative         conclusion of the IDR conference, the depart-        of rulemaking authority and any rule pro-
process and shall not be construed to be a          ment and the facility shall be present.              posed or adopted after August 28, 2009, shall
formal evidentiary hearing. Use of IDR under                                                             be invalid and void.
this section shall not waive the facility’s right   5. Within ten days of the IDR conference
to pursue further or additional legal actions.      described in subsection 4 of this section,           (L. 2009 H.B. 395)
                                                    the QIO shall make a determination, based
4. The department shall establish an IDR pro-       upon the facts and findings presented, and
cess to determine whether a cited deficiency        shall transmit the decision and rationale for        Section 198.600
as evidenced by a statement of deficiencies         the outcome in writing to the facility and the
against a facility shall be upheld. The depart-     department.                                          Uniform data management
ment shall promulgate rules to incorporate by
reference the provisions of 42 CFR 488.331          6. If the department disagrees with such             pilot program established,
regarding the IDR process and to include the        determination, the department shall transmit         purpose, monitoring.
following minimum requirements for the IDR          the department’s decision and rationale for
process:                                            the reversal of the QIO’s decision to the facil-     1. The department of health and senior
                                                    ity within ten calendar days of receiving the        services shall establish a "Uniform Data
(1) Within ten working days of the end of the       QIO’s decision.                                      Management Pilot Program" at a minimum of
survey, the department shall by certified mail                                                           fifty selected facilities of varying licensure or
transmit to the facility a statement of defi-       7. If the QIO determines that the original           classification throughout the state to improve
ciencies committed by the facility. Notifica-       statement of deficiencies should be changed          patient care and retention of nursing facil-
tion of the availability of an IDR and IDR          as a result of the IDR conference, the depart-       ity staff. The department shall determine the
process shall be included in the transmittal;       ment shall transmit a revised statement of           nature and extent of the pilot program and
                                                    deficiencies to the facility with the notifica-      provide all necessary resources.
(2) Within ten calendar days of receipt of the      tion of the determination within ten calendar
statement of deficiencies, the facility shall       days of the decision to change the statement         2. The pilot program shall be implemented
return a plan of correction to the department.      of deficiencies.                                     no later than six months after funding for the
Within such ten-day period, the facility may                                                             pilot program is made available.
request in writing an IDR conference to             8. Within ten calendar days of receipt of
refute the deficiencies cited in the statement      the determination made by the QIO and the            3. The pilot program shall:
of deficiencies;                                    revised statement of deficiencies, the facil-
                                                    ity shall submit a plan of correction to the         (1) Encourage the utilization of existing or
(3) Within ten working days of receipt for          department.                                          the purchase of new software in an effort to
an IDR conference made by a facility, the                                                                modernize the procedures for compiling and
QIO shall hold an IDR conference unless             9. The department shall not post on its web          disseminating data for long-term care facili-
otherwise requested by the facility. The IDR        site or enter into the Centers for Medicare          ties;
conference shall provide the facility with an       & Medicaid Services Online Survey, Certi-

                                                           Missouri Revised Statutes
Statutes


(2) Enable physicians, licensed nurses, and
facility personnel to devote more quality time
to patient care; and

(3) Be established in selected urban, rural,
and regional sites throughout the state.

4. The department of health and senior
services shall monitor the pilot program and
report to the general assembly by January
first next following the implementation of
the pilot program pursuant to this section on
the effectiveness of such program, including
quality of care, employee satisfaction, and
cost-effectiveness.

(L. 2003 S.B. 556 & 311)




                                                 Missouri Revised Statutes

				
DOCUMENT INFO