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HB 1637

Repeals provisions relating to certificates of need

2026 Regular Session Introduced by Matthew Overcast

Missouri HB 1637 repeals the Certificate of Need program and replaces it with a four-section framework that reshapes facility identification, access for continuing care communities

Referred: Emerging Issues(H)
#healthcare #hospitals
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Bill Summary · HB 1637

Bill overview

  • Bill: HB 1637
  • Session: 2026
  • Jurisdiction: Missouri
  • Sponsor: Representative Overcast
  • Purpose: Repeal the Missouri Certificate of Need (CON) law and replace it with four new sections (197.705, 198.530, 208.169, 208.225) that redefine certain terms and address related health care provisions. The bill effectively eliminates the existing CON framework and replaces it with new statutory language.

Main purpose and intent

  • Eliminate the Missouri Certificate of Need regime (Sections 197.300–197.367 and related sections) and substitute four new sections.
  • Align remaining and newly created provisions around identification, pricing, reimbursement, and ongoing governance in related health care contexts, while removing CON review requirements for new institutional health services.
  • The bill also updates definitions and certain administrative provisions to fit within a CON-repeal framework.

Key provisions and changes

  • Repeal and replacement:

    • Repeals numerous sections of the Missouri CON law (Sections 197.300, 197.305, 197.310, 197.311, 197.312, 197.315, 197.316, 197.318, 197.320, 197.325, 197.326, 197.327, 197.330, 197.335, 197.340, 197.345, 197.355, 197.357, 197.366, 197.367, 197.705, 198.530, 208.169, 208.225, RSMo).
    • Enacts four new sections to read as 197.705, 198.530, 208.169, and 208.225.

  • New Section 197.705 (definition and badge requirement):

    • Defines “health care facilities” to include: facilities licensed under chapter 198, long-term care beds in hospitals (as described in 198.012), and long-term care hospitals/beds meeting 42 CFR 412.23(e).
    • Requires all personnel in hospitals and health care facilities to wear identification badges, displaying licensure status.

  • New Section 198.530 (continuing care retirement communities and access to on-site services):

    • Defines “continuing care retirement community” and outlines that when an enrollee in a managed care organization (MCO) resides in such a facility, the MCO must offer the option to receive covered services at the resident facility.
    • MCOs must reimburse the resident facility per terms that resemble Medicare rules if conditions are met (facility capable to provide services, licensure/training standards met, Medicare-certified, and contract terms aligned with health carrier standards and state/federal protections).
    • Reimbursement rate: not less than Medicare allowable rate.
    • Services covered include skilled nursing, rehab, postacute care, and other needed services, with possible use of contracted providers.
    • Facilities may not charge enrollees for ancillary services when provided by participating providers, and violations are treated as abuse or neglect.

  • New Section 208.169 (MO HealthNet reimbursement and capital cost policy changes):

    • Several provisions relate to MO HealthNet (Medicaid) reimbursements and historical cost controls. Key elements include:
    • Restrictions on adjusting nursing facility reimbursement rates after ownership/management changes (no rate revisions for such transitions).
    • Specific rules for newly built facilities entering MO HealthNet (per diem rates based on estimated operating costs or a calculated ceiling, with multi-year rate dynamics and caps).
    • Detailed methodology for capital-related expenses and how reimbursements for newly built facilities are calculated (building rate, movable equipment, land, working capital, etc.), including percentage returns and bed-day calculations.
    • Acknowledges state-funding implications and cites transition rules for rate determinations and ceilings.
    • Note: The text includes complex historical constructs (as this is a draft of a CON repeal with retained Old MO HealthNet rate concepts). The final bill language would determine how these provisions operate post-repeal.

  • New Section 208.225 (MO HealthNet rate recalculation and capital cost treatment):

    • Requires MO HealthNet to calculate per diem rates for nursing homes based on a cost report (for a specified fiscal year).
    • Recalculates class ceilings and allocates a portion of any increased costs as a rate increase, with a phased approach.
    • Defines “capital expenditures” and outlines when recalculations apply, including for facilities incurring capital costs beyond a per-bed threshold.

  • Other structural provisions (from the CON-era text, as retained or modified in the bill):

    • Fee provisions for CON applications: initial application fee structure (minimum $1,000 or 0.1% of total project cost, whichever is greater), with funds to be deposited to the state treasury.
    • Review process mechanics: notification timelines, public hearings, findings of fact/conclusions of law within set timeframes, and possible extensions.
    • Non-transferability of CON approvals, reporting requirements, and potential forfeiture for failure to complete approved capital expenditures or to file required reports.
    • Limits on considering nearby facilities (within 15 miles) when evaluating CON applications, and safeguards against denial based on refusal to provide abortion services.
    • Provisions regarding transfer of ownership and bed-reallocation rules, including rules for expanding beds and related occupancy criteria.

Who and what would be affected

  • Health facilities: hospitals, long-term care facilities, long-term care hospitals, and other health care facilities would be affected by the CON repeal and the transition to the new framework.
  • Enrollees and residents: patients and residents in continuing care retirement communities and facilities receiving services under MCO arrangements would be impacted by access and reimbursement changes.
  • Managed care organizations and health carriers: would be involved in new reimbursement arrangements and contract requirements for facility-based services.
  • MO HealthNet (Medicaid) recipients and providers: the per diem reimbursement methodology and capital-related reimbursements would be redefined or transitioned, affecting facility rates.
  • State budget and agencies: the repeal implies administrative adjustments, including reallocation of funds and changes in rulemaking and oversight functions.

Procedural and timeline aspects

  • Process for CON repeal:
    • Repeals current CON statutes and replaces with four new sections.
    • Requires ongoing regulatory and administrative transitions, including potential rulemaking under the new framework.
  • Administrative timelines:
    • New and revised processes for hospital/facility identification badges, MCO arrangements, and reimbursement structures would need implementation.
    • The bill contains detailed timeframes for approval decisions (e.g., findings within 100 days for CON decisions, with possible extensions), public notification, and appeals processes (de novo review by administrative hearing commissioner or Cole County circuit court).
  • Financial implications:
    • The bill notes that there could be a loss of federal funds tied to CON programs and contemplates state general assembly appropriations to support MO HealthNet and related activities.
  • Transition notes:
    • Some provisions reflect historical CON concepts but would be subsumed under the broader repeal; specifics would be clarified through the enacted language and any subsequent implementing regulations.

Summary takeaway

HB 1637 proposes to repeal Missouri’s long-standing Certificate of Need law and replace it with a streamlined framework, including four new sections. It introduces identifying badges for health facility staff, broadens access considerations for residents in certain care communities, and restructures MO HealthNet reimbursement and capital cost rules in the context of the CON repeal. The bill would shift regulatory oversight away from CON review toward alternative mechanisms for evaluating and financing health care capacity expansion, while retaining certain funding, reporting, and regulatory processes to manage the transition.

Compiled from official sources — confirm details with the bill’s official record.

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