Missouri requires CONs within five broad categories—hospital beds, beds outside hospitals, equipment, facilities and services. Missouri maintains 91 CON requirements which are primarily focused on nursing facilities, long-term care facilities and hospitals, and the construction of new hospitals. For example, a private physician’s office can purchase an MRI scanner without obtaining a CON, but a skilled nursing facility or a long-term care hospital must obtain a CON before purchasing the same MRI scanner. Missouri further maintains many specific expenditure minimums, although they are not always standardized. If an intermediate care facility wants to acquire a CT scanner, the CON requirement is not triggered unless the scanner will cost more than $400,000. In comparison, if a long-term hospital wants to purchase the same CT scanner, it must apply for a CON regardless of cost.

COVID-19 Response

As of May 15, 2020, Missouri had not suspended any CON requirements in response to COVID-19.

Application Process

In Missouri, the CON application review process takes up to four months. Mo. Rev. Stat. § 197.330(1)(1), (4)–(5). Applications for full review must be submitted at least 71 days prior to each Missouri Health Facilities Review Committee meeting, and expedited applications must be submitted by the 10th day of each month. Mo. Code Regs. tit. 19, § 60-50.420(1). Expedited applications only apply to limited circumstances, such as renovation of long-term care facilities or replacement of specific types of equipment. See Mo. Code Regs. tit. 19, § 60-50.300(5). The fee for a CON application is $1,000 or 0.1% of the total cost of the proposed project. Mo. Rev. Stat. § 197.315(10). Competitors can intervene in the application process and offer evidence or argument as to why an application should be denied. Mo. Stat. § 197.330(1), (3)–(5).

CON? Number of CONs Moratoria Temporary COVID-19 response:
Hospital Beds Yes 5 No action
Beds Outside Hospitals Yes 16 No action
Equipment Yes 40 No action
Facilities/ Buildings Yes 25 No action
Services Yes 5 No action
Emergency Medical Transport No