Missouri Revised Statutes

Chapter 344
Nursing Home Administrators

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Definitions.

344.010. As used in this chapter the following words or phrases mean:

(1) "Board", the Missouri board of nursing home administrators;

(2) "Long-term care facility", any residential care facility, assisted living facility, intermediate care facility or skilled nursing facility, as defined in section 198.006, or similar facility licensed by states other than Missouri;

(3) "Nursing home", any institution or facility defined as an assisted living facility, residential care facility, intermediate care facility, or skilled nursing facility for licensing purposes by section 198.006, whether proprietary or nonprofit;

(4) "Nursing home administrator", a person who administers, manages, supervises, or is in general administrative charge of a nursing home, whether such individual has an ownership interest in the home, and whether his functions and duties are shared with one or more individuals.

(L. 1969 3d Ex. Sess. H.B. 33 § 1, A.L. 1980 H.B. 1530 Revision, A.L. 1984 S.B. 451, A.L. 1987 S.B. 277, A.L. 2010 H.B. 2226, et al. merged with S.B. 754)

License required--separate license for assisted living facilitiesadministrators, limitations of license.

344.020. No person shall act or serve in the capacity of a nursing home administrator without first procuring a license from the Missouri board of nursing home administrators as provided in sections 344.010 to 344.108. The board may issue a separate license to administrators of residential care facilities that were licensed as a residential care facility II on or before August 27, 2006, that continue* to meet the licensure standards for a residential care facility II in effect on August 27, 2006, and assisted living facilities, as defined in section 198.006. Any individual who receives a license to operate a residential care facility or an assisted living facility is not thereby authorized to operate any intermediate care facility or skilled nursing facility as those terms are defined in section 198.006.

(L. 1969 3d Ex. Sess. H.B. 33 § 2, A.L. 1989 S.B. 387, A.L. 2007 H.B. 780, A.L. 2010 H.B. 2226, et al. merged with S.B. 754)

*Word "continues" appears in original rolls of S.B. 754.

License, qualifications, fee, examination,term--reciprocity--emergency license.

344.030. 1. An applicant for an initial license shall file a completed application with the board on a form provided by the board, accompanied by an application fee as provided by rule payable to the department of health and senior services. Information provided in the application attested by signature to be true and correct to the best of the applicant's knowledge and belief.

2. No initial license shall be issued to a person as a nursing home administrator unless:

(1) The applicant provides the board satisfactory proof that the applicant is twenty-one years of age or over, of good moral character and a high school graduate or equivalent;

(2) The applicant provides the board satisfactory proof that the applicant has had a minimum of three years' experience in health care administration or two years of postsecondary education in health care administration or has satisfactorily completed a course of instruction and training prescribed by the board, which includes instruction in the needs properly to be served by nursing homes, the protection of the interests of residents therein, and the elements of good nursing home administration, or has presented evidence satisfactory to the board of sufficient education, training, or experience in the foregoing fields to administer, supervise and manage a nursing home; and

(3) The applicant passes the examinations administered by the board. If an applicant fails to make a passing grade on either of the examinations such applicant may make application for reexamination on a form furnished by the board and may be retested. If an applicant fails either of the examinations a third time, the applicant shall be required to complete a course of instruction prescribed and approved by the board. After completion of the board-prescribed course of instruction, the applicant may reapply for examination. With regard to the national examination required for licensure, no examination scores from other states shall be recognized by the board after the applicant has failed his or her third attempt at the national examination. There shall be a separate, nonrefundable fee for each examination. The board shall set the amount of the fee for examination by rules and regulations promulgated pursuant to section 536.021. The fee shall be set at a level to produce revenue which shall not substantially exceed the cost and expense of administering the examination.

3. The board may issue a license through reciprocity to any person who is regularly licensed as a nursing home administrator in any other state, territory, or the District of Columbia, if the regulations for securing such license are equivalent to those required in the state of Missouri. However, no license by reciprocity shall be issued until the applicant passes a special examination approved by the board, which will examine the applicant's knowledge of specific provisions of Missouri statutes and regulations pertaining to nursing homes. The applicant shall furnish satisfactory evidence that such applicant is of good moral character and has acted in the capacity of a nursing home administrator in such state, territory, or the District of Columbia at least one year after the securing of the license. The board, in its discretion, may enter into written reciprocal agreements pursuant to this section with other states which have equivalent laws and regulations.

4. Nothing in sections 344.010 to 344.108, or the rules or regulations thereunder shall be construed to require an applicant for a license as a nursing home administrator, who is employed by an institution listed and certified by the Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc., to administer institutions certified by such commission for the care and treatment of the sick in accordance with the creed or tenets of a recognized church or religious denomination, to demonstrate proficiency in any techniques or to meet any educational qualifications or standards not in accord with the remedial care and treatment provided in such institutions. The applicant's license shall be endorsed to confine the applicant's practice to such institutions.

5. The board may issue a temporary emergency license for a period not to exceed ninety days to a person twenty-one years of age or over, of good moral character and a high school graduate or equivalent to serve as an acting nursing home administrator, provided such person is replacing a licensed nursing home administrator who has died, has been removed or has vacated the nursing home administrator's position. No temporary emergency license may be issued to a person who has had a nursing home administrator's license denied, suspended or revoked. A temporary emergency license may be renewed for one additional ninety-day period upon a showing that the person seeking the renewal of a temporary emergency license meets the qualifications for licensure and has filed an application for a regular license, accompanied by the application fee, and the applicant has taken the examination or examinations but the results have not been received by the board. No temporary emergency license may be renewed more than one time.

(L. 1969 3d Ex. Sess. H.B. 33 § 3, A.L. 1979 S.B. 145, A.L. 1987 S.B. 277, A.L. 1988 S.B. 602, A.L. 1989 S.B. 387, A.L. 1996 H.B. 905 merged with H.B. 1362, A.L. 2007 H.B. 780)

License renewal, application for, fee--late renewal,effect--additional disciplinary action authorized, when.

344.040. 1. Every license issued under this chapter shall expire on June thirtieth of the year following the year of issuance and every other year thereafter, provided that licenses issued or renewed during the year 2006 may be issued or renewed by the board for a period of either one or two years, as provided by rule. Licensees seeking renewal shall, during the month of May of the year of renewal, file an application for renewal on forms furnished by the board, which shall include evidence satisfactory to the board of completion of the approved continuing education hours required by the board, and shall be accompanied by a renewal fee as provided by rule payable to the department of health and senior services.

2. Upon receipt of an incomplete application for renewal, the board shall grant the applicant a temporary permit which shall be in effect for thirty days. The applicant is required to submit the required documentation or fee within the thirty-day period, or the board may refuse to renew his or her application. The thirty-day period can be extended for good cause shown for an additional thirty days. Upon receipt of the approved continuing education credits or other required documentation or fee within the appropriate time period, the board shall issue a license.

3. The board shall renew the license of an applicant who has met all of the requirements for renewal.

4. As a requirement for renewal of license, the board may require not more than forty-eight clock hours of continuing education a year. The continuing education provided for under this section shall be approved by the board. There shall be a separate, nonrefundable fee for each single offering provider. The board shall set the amount of fee for any single offering provided by rules and regulations promulgated pursuant to section 536.021. The fee shall be set at a level to produce revenue which shall not substantially exceed the cost and expense in administering and reviewing any single offering.

5. By April first of each year, the board shall notify every person whose license shall be renewed during the current year. The applicant must submit such information as will enable the board to determine if the applicant's license should be renewed. Information provided in the application shall be attested by signature to be true and correct to the best of the applicant's knowledge and belief.

6. Any licensee who fails to apply to renew his or her license by June thirtieth of the licensee's year of renewal may be relicensed by the board if he meets the requirements set forth by the board pursuant to sections 344.010 to 344.108 and pays the renewal fee required by rule, plus a penalty of twenty-five dollars. No action shall be taken by the board in addition to a penalty of twenty-five dollars imposed by this section against any such licensee whose license has not expired for a period of more than two months, and who has had no action in the preceding five years taken against them by the board, and who has met all other licensure requirements by June thirtieth of the year of renewal; provided, however, that nothing in this section shall prevent the board from taking any other disciplinary action against a licensee if there shall exist a cause for discipline pursuant to section 344.050. A person whose license has expired for a period of more than twelve months must meet the requirements set out in section 344.030 for initial licensure.

(L. 1969 3d Ex. Sess. H.B. 33 § 4, A.L. 1979 S.B. 145, A.L. 1987 S.B. 277, A.L. 1989 S.B. 387, A.L. 2000 H.B. 1591, A.L. 2005 S.B. 177, A.L. 2007 H.B. 780, A.L. 2013 S.B. 80)

Suspension--revocation--probation--refusal to issue or renewlicense--grounds--procedure--right of review by administrativehearing commission.

344.050. 1. The board may refuse to issue or renew any certificate of registration or authority, permit or license required pursuant to this chapter for one or any combination of causes stated in subsection 2 of this section. The board shall notify the applicant in writing of the reasons for the refusal and shall advise the applicant of his or her right to file a complaint with the administrative hearing commission as provided by chapter 621. As an alternative to refusal to issue or renew any certificate, registration or authority, permit or license, the board may, at its discretion, issue a license which is subject to probation for any one or any combination of causes stated in subsection 2 of this section. The board's order of probation shall contain a statement of the discipline imposed, the basis therefor*, the date such action shall become effective, and a statement that the applicant has thirty days to request in writing a hearing before the administrative hearing commission. If the board issues a probationary license to an applicant for licensure, the applicant may file a written petition with the administrative hearing commission within thirty days of the effective date of the probationary license seeking review of whether cause exists to discipline the licensee under subsection 2 of this section. If no written request for a hearing is received by the administrative hearing commission within the thirty-day period, the right to seek review of the board's decision shall be waived.

2. The board may cause a complaint to be filed with the administrative hearing commission as provided by chapter 621 against any holder of any certificate of registration or authority, permit or license required by this chapter or any person who has failed to renew or has surrendered his or her certificate of registration or authority, permit or license for any one or any combination of the following causes:

(1) Use or unlawful possession of any controlled substance, as defined in chapter 195, or alcoholic beverage to an extent that such use impairs a person's ability to perform the work of any profession licensed or regulated by this chapter;

(2) The person has been finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, pursuant to criminal prosecution under the laws of any state or of the United States, for any offense reasonably related to the qualifications, functions or duties of any profession licensed or regulated under this chapter, for any offense an essential element of which is fraud, dishonesty or an act of violence, or for any offense involving moral turpitude, whether or not sentence is imposed;

(3) Use of fraud, deception, misrepresentation or bribery in securing any certificate of registration or authority, permit or license issued pursuant to this chapter or in obtaining permission to take any examination given or required pursuant to this chapter;

(4) Obtaining or attempting to obtain any fee, charge, tuition or other compensation by fraud, deception or misrepresentation;

(5) Incompetency, misconduct, gross negligence, fraud, misrepresentation or dishonesty in the performance of the functions or duties of any profession licensed or regulated by this chapter;

(6) Violation of, or assisting or enabling any person to violate, any provision of this chapter, or of any lawful rule or regulation adopted pursuant to this chapter;

(7) Violation of, or assisting or enabling any person to violate, any provision of chapter 198 or any lawful rule or regulation promulgated thereunder;

(8) Impersonation of any person holding a certificate of registration or authority, permit or license, or allowing any person to use such person's certificate of registration or authority, permit, license or diploma from any school;

(9) Disciplinary action against the holder of a license or other right to practice any profession regulated by this chapter granted by another state, territory, federal agency or country upon grounds for which revocation or suspension is authorized in this state;

(10) A person is finally adjudged incapacitated or disabled by a court of competent jurisdiction;

(11) Assisting or enabling any person to practice or offer to practice any profession licensed or regulated by this chapter who is not registered and currently eligible to practice under this chapter;

(12) Issuance of a certificate of registration or authority, permit or license based upon a material mistake of fact;

(13) Violation of the drug laws or rules and regulations of this state, any other state or the federal government;

(14) Knowingly failing to report abuse or neglect of a resident in a long-term care facility, as required by section 198.070, of which he or she has actual knowledge that it is abuse or neglect;

(15) Violation of any professional trust or confidence;

(16) Having served as the administrator, operator, or any principal involved in the operation of a facility licensed under chapter 198 and during such time the facility has had its license revoked under section 198.036, has entered into a consent agreement to obtain a probationary license under subsection 5 of section 198.026, has had a license denied under subsection 2 of section 198.022, or has surrendered its license while under investigation.

3. The administrative hearing commission shall have no authority to require issuance of a license, pending a final determination by the commission, in any case in which an applicant is seeking initial licensure.

4. No license may be suspended or revoked and no application for renewal of a license may be denied under this section until the licensee has been afforded an opportunity for hearing after due notice as provided in sections 621.015 to 621.205.

5. Upon a finding by the administrative hearing commission that the grounds, provided in subsection 2 of this section, for disciplinary action are met, the board may, singly or in combination, censure or place the person named in the complaint on probation on such terms as the board deems appropriate, or may suspend or revoke the certificate, permit or license. The board may exclude any application for up to five years for any person who has had his or her license revoked by the board or has surrendered his or her license to the board.

(L. 1969 3d Ex. Sess. H.B. 33 § 5, A.L. 1979 S.B. 145, A.L. 1980 H.B. 1530 Revision, A.L. 1987 S.B. 277, A.L. 1989 S.B. 387, A.L. 2007 H.B. 780)

*Word "therefore" appears in original rolls.

Board created--membership, qualifications, terms, removed how,hearing.

344.060. 1. The governor shall appoint with the advice and consent of the senate ten suitable persons who together with the director of the department of health and senior services or the director's designee shall constitute the "Missouri Board of Nursing Home Administrators" which is hereby created within the department of health and senior services and which shall have the functions, powers and duties prescribed by sections 344.010 to 344.108.

2. In addition to the director of the department of health and senior services or the director's designee the membership of the board shall consist of one licensed physician, two licensed health professionals, one person from the field of health care education, four persons who have been in general administrative charge of a licensed nursing home for a period of at least five years immediately preceding their appointment, and two public members. In addition to these qualifications, the physician, the two licensed health care professionals, and the health care educator shall be citizens of the United States and taxpaying residents of the state of Missouri for one year preceding their appointments. The four appointees who have been in general administrative charge of a licensed nursing home shall be citizens of the United States and either residents of the state of Missouri for one year preceding their appointments or persons who have been licensed by the board and whose five years of employment in a licensed nursing home immediately preceding their appointment have occurred in the state of Missouri. The public members shall be citizens of the United States, residents of the state of Missouri for one year preceding their appointment, and registered voters. The public members shall be persons who are not, or never were, licensed nursing home administrators or the spouse of such persons, or persons who do not have or never have had a material, financial interest in either the providing of licensed nursing home services or in an activity or organization directly related to licensed nursing home administration. Neither the one licensed physician, the two licensed health professionals, nor the person from the health care education field shall have any financial interest in a licensed nursing home.

3. The members of the board shall be appointed for three-year terms or until their successors are appointed and qualified provided that no more than four members' terms shall expire in the same year. The governor shall fill any vacancies on the board as necessary. Appointment to fill an unexpired term shall not be considered an appointment for a full term. Board membership, continued until successors are appointed and qualified, shall not constitute an extension of the three-year term and the successors shall serve only the remainder of the term.

4. Every member shall receive a certificate of appointment; and every appointee, before entering upon his or her duties, shall take the oath of office required by Article VII, Section 11, of the Constitution of Missouri.

5. Any member of the board may be removed by the governor for misconduct, incompetency or neglect of duty after first being given an opportunity to be heard in his or her own behalf.

(L. 1969 3d Ex. Sess. H.B. 33 § 6, A.L. 1979 S.B. 145, A.L. 2002 H.B. 1953, A.L. 2007 H.B. 780, A.L. 2011 H.B. 464)

Board officers, how selected--duties and powers of board--rules andregulations, procedure.

344.070. 1. The board shall annually elect one of its members as president, another as vice president, and another as secretary. It shall adopt an official seal. It shall file and preserve all written applications, petitions, complaints, charges or requests made or presented to it. It shall cause to be kept accurate records and minutes of its proceedings, and shall maintain a register of the names and addresses of all persons holding licenses as nursing home administrators. A copy of any entry in the register, or of any records or minutes of the board, certified by the president or secretary of the board under its seal, shall be received in evidence, to all intents and purposes as the original. The board may employ such part- or full-time clerical assistance, purchase such equipment and supplies, employ legal counsel, employ a part- or full-time investigator, and incur travel and other expense, within the limits of its appropriations.

2. The board shall adopt, amend and repeal rules and regulations necessary to carry out the provisions of sections 344.020 to 344.108. Any rule or regulation under the authority of sections 344.020 to 344.108 shall be promulgated in accordance with chapter 536. The committee on administrative rules may file a complaint in accordance with the provisions of chapter 536 before the commission contesting the validity of any rule purportedly promulgated under the authority of sections 344.020 to 344.108. On filing any complaint in accordance with this section, the administrative hearing commission shall immediately suspend that portion of the rule which is challenged until the commission has determined the matter. The commission shall hold a hearing within ten days of the filing to determine the matter. No rule or portion of a rule promulgated under the authority of this chapter shall become effective unless it has been promulgated pursuant to the provisions of section 536.024.

3. The board shall examine, license, and renew the license of duly qualified applicants, and shall conduct hearings affording due process of law, upon charges calling for discipline of a licensee. The board shall refer to the appropriate prosecuting attorney information regarding any persons violating the provisions of sections 344.010 to 344.108 and may incur necessary expenses therefor.

(L. 1969 3d Ex. Sess. H.B. 33 § 7, A.L. 1979 S.B. 145, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3, A.L. 2007 H.B. 686 merged with H.B. 780)

Compensation of board members, exception.

344.080. The members of the board, other than the director of the department of health and senior services or his designee, shall receive as compensation for their services fifty dollars for each day devoted to the affairs of the board, and shall be entitled to reimbursement for their expenses necessarily incurred in the discharge of their official duties.

(L. 1969 3d Ex. Sess. H.B. 33 § 8, A.L. 1979 S.B. 145, A.L. 1987 S.B. 277, A.L. 2007 H.B. 780)

Acting as nursing home administrator without license, penalty.

344.100. Any person who acts or serves in the capacity of a nursing home administrator without being properly licensed by the Missouri board of nursing home administrators as provided in sections 344.010 to 344.100 is guilty of a misdemeanor and, upon conviction, shall be punished as provided by law. The board shall immediately notify the licensing authority for nursing homes whenever a proceeding has been initiated to suspend or revoke the license of a nursing home administrator and whenever the license of a nursing home administrator is suspended, revoked, or not renewed.

(L. 1969 3d Ex. Sess. H.B. 33 § 10, A.L. 1979 S.B. 145)

Retired licenses permitted, when, procedure.

344.105. 1. Any nursing home administrator possessing a current license to practice as a nursing home administrator in this state who has maintained an active license for at least ten years may retire his or her license by filing an affidavit with the board which states the date on which the licensee retired from such practice and such other facts as tend to verify the retirement as the board may deem necessary. The affidavit shall be accompanied by a fee as provided by rule, made payable to the department of health and senior services. Such request for retired status may also be accomplished by signing the request for retired status that appears on the nursing home administrator's application for license renewal and returning such application to the board prior to June thirtieth of the year of renewal of the administrator's active license, accompanied by a fee as provided by rule, made payable to the department of health and senior services.

2. An individual who requests retired license status shall return his or her original wall license and all other indicia of licensure to the board. Once the board has received the original wall license from the licensee or evidence satisfactory to the board that the license has been lost, stolen, or destroyed, and the other requirements for requesting retired status have been met, the board shall issue a new license to the licensee indicating that the licensee is retired.

3. A retired license may be reactivated within five years of the granting of the retired license by filing with the board evidence satisfactory to the board of the completion of twenty clock hours of continuing education for each calendar year the license was retired accompanied by a fee as provided by rule made payable to the department of health and senior services. All clock hours of continuing education shall be completed prior to the filing of the affidavit or renewal form requesting reactivation of the retired license. If more than five years have passed since the issuance of a retired license to a licensee, the licensee shall follow the procedures for initial licensure stated in section 344.030.

4. No person shall practice as a nursing home administrator in this state or hold himself or herself out as a nursing home administrator if his or her license is retired.

5. Retired licensees shall remain subject to disciplinary action for violations of this chapter and the rules promulgated thereunder.

(L. 2000 H.B. 1591, A.L. 2007 H.B. 780, A.L. 2011 H.B. 464)

Inactive status of license permitted, when--reactivation, procedure.

344.108. 1. Any nursing home administrator possessing a current license to practice as a nursing home administrator in this state may place such license on inactive status by filing a written signed request for inactive status with the board, accompanied by evidence satisfactory to the board of completion of ten clock hours of continuing education in the area of patient care and a fee as provided by rule made payable to the department of health and senior services. This request may also be accomplished by signing the request for inactive status that appears on the nursing home administrator's application for license renewal and returning such application to the board prior to June thirtieth of the year of renewal of the administrator's active license, accompanied by evidence satisfactory to the board of the completion of ten clock hours of continuing education in the area of patient care and a fee as provided by rule made payable to the department of health and senior services.

2. An individual who requests that his or her license be placed on inactive status shall return all indicia of licensure to the board or submit evidence satisfactory to the board that the license has been lost, stolen, or destroyed.

3. An inactive license shall expire on June thirtieth of the second year following the year of issuance and every other year thereafter. Licensees seeking to renew shall, during the month of May of the year of renewal, file an application for renewal on forms furnished by the board that include evidence satisfactory to the board of the completion of ten clock hours of continuing education in the area of patient care and shall be accompanied by a renewal fee as provided by rule, payable to the department of health and senior services.

4. A license may be carried in inactive status for up to six years from the date of issuance. If the licensee does not reactivate the license during the six-year period, the license shall expire on the last day of the six-year period.

5. A holder of an inactive license may reactivate the license by submitting a written request to the board, accompanied by evidence satisfactory to the board of the completion or plan for completion of forty clock hours of continuing education and a fee as provided by rule made payable to the department of health and senior services. The forty clock hours of continuing education shall be earned no earlier than six months prior to the request for reactivation and no later than twelve months after the inactive license has been reactivated. If the holder of an inactive license requests reactivation prior to completing the forty clock hours of continuing education, the board shall issue a six-month interim license to the licensee. The interim license shall expire six months from the date of issuance or at such earlier time as the licensee earns the forty clock hours of continuing education and submits evidence satisfactory to the board of completion of the required hours.

6. A request for reactivation of an inactive license shall show, under oath or affirmation of the nursing home administrator, a statement that the nursing home administrator has not practiced during the inactive period and is not presently practicing in this state.

7. No person shall practice as a nursing home administrator or hold himself or herself out as a nursing home administrator in this state while his or her license is inactive.

8. Inactive licensees shall remain subject to discipline for violations of this chapter and the rules promulgated thereunder.

(L. 2007 H.B. 780, A.L. 2011 H.B. 464)


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