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Health care organizations question current CON process

JEFFERSON CITY, Mo. – The Missouri Health Care Association (MHCA) and the Missouri Assisted Living Association (MALA) made a presentation Monday at the Missouri Health Facilities Review Committee’s Certificate of Need Meeting to outline the need for an update to the CON process.

Nikki Strong, the executive vice president of membership and government affairs for MHCA, was one of the presenters. She and those from MALA believe that too many certificates of need are currently being approved by the committee on projects, especially in areas that do not need more assisted living or skilled nursing facilities.

She cited one example of such a project approved in July in Sikeston where there was a surplus of 500-plus beds in the area of the proposed facility and more than half a dozen providers testified against it and used supporting documentation of low occupancy in their facilities to demonstrate that there was no need for this project. However, the MHFRC still voted to approve it.

Strong says approval of these kinds of projects harms existing facilities because it leads to competition over personnel and an inability to pay for a facility’s fixed costs – such as rent, utilities and certain administrative expenditures.

“How can you make ends meet when you’ve got certain fixed costs, but your facility is not full and the state’s Medicaid rate for Skilled Nursing Facilities is significantly underfunded?” she said. “In areas where there is no demonstrated need, the facilities are not full, they can’t retain good quality staff and it is not only the providers who are directly impacted but also the residents in these facilities.  As Missouri becomes more over-bedded, it is having a detrimental impact on the current skilled nursing facilities and assisted living facilities that are out there.”

MALA and MHCA presented statistics showing that the Missouri occupancy rates are well below the national averages at skilled nursing facilities (77 to 88 percent) and assisted living facilities (66 percent to 91 percent), and Since 2013, 44 projects have been approved where no need was shown and this directly correlates to the steady decline of Missouri’s occupancy levels. Low occupancy leads to the problems she described, like staffing and a lower percentage of a given facility’s funds going toward health care, which means quality of care and access to care also decline.

While Strong described the current situation as a crisis, MALA and MHCA asked for a modest and reasonable refinement of the CON process and for the committee to subject each proposal to a more strict level of scrutiny.


Sen. Mike Parson, R-Bolivar, a member of the committee, agreed for the most part that it needed to update its CON meeting rules just due to the massive changes in care for aging populations in the past few decades.

“We’ve got the same rules in place today basically that was there 20 years ago. A lot of things have changed since then, whether it be in the assisted living facility, whether it be in the nursing home facilities, and we need to do a better job on that.”

However, William Krodinger stated during the presentation that, for the most part, the committee did its due diligence, citing an application made today for a, $11.6 million, 75-bed assisted living facility in Kansas City. The committee asked questions of those proposing the project, but no parties spoke in opposition to it.

“I don’t think it was just rubber stamped by this committee,” Krodinger said.

“You have to vote what the facts are in front of you, but there’s probably too many projects that just get approved period,” Parson conceded after the meeting.

Parson said he would like to see a mechanism in place that those who do not qualify for a CON cannot present before the committee and methods of making the process more transparent. In the end, he wants the focus to remain on the citizens that benefit from these facilities.

“How do we serve them best?” he said.