Missouri

The grounds, as Missouri describes them

19 CSR 30-82.050(2) (Missouri Secretary of State (PDF), rule history line ends amended filed Sept. 1, 2021, effective March 30, 2022, retrieved 2026-09-14): "The facility shall permit each resident to remain in the" "facility unless—"

"(A) The transfer or discharge is appropriate because the" "resident’s welfare and the resident’s needs cannot be met by" "the facility;"

"(B) The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no" "longer needs the services provided by the facility;"

"(C) The safety of individuals in the facility is endangered;"

"(D) The health of individuals in the facility would otherwise" "be endangered;"

"(E) The resident has failed, after reasonable and appropriate notice, to pay for (or have paid under Medicare or Medicaid)" "a stay at the facility. For a resident who becomes eligible for" "Medicaid after admission to a facility, the facility may charge" "that resident only allowable charges under Medicaid; or"

"(F) The facility ceases to operate."

The published process

Requesting the hearing

19 CSR 30-82.050(6): "Any resident of a facility who receives notice of discharge" "from the facility in which he/she resides may file an appeal of" "the notice with the Department of Health and Senior Services" "Appeals Unit, PO Box 570, 912 Wildwood Drive 3rd floor," "Jefferson City, Missouri 65102-0570, by fax to (573) 751-0247, or" "by email to DHSS.Appeals@health.mo.gov within thirty (30)" "days of the date the resident received the discharge notice" "from the facility." The Appeals Unit's own number is "(573)" "522-1699". Who may file: "The resident’s legal guardian, the resident’s" "attorney-in-fact appointed under sections 404.700–404.725," "RSMo (Durable Power of Attorney Law of Missouri) or pursuant" "to sections 404.800–404.865, RSMo (Durable Power of Attorney" "for Health Care Act), or any other individual may file an" "appeal on the resident’s behalf." A form exists but is optional: "A Nursing Facility Transfer or" "Discharge Hearing Request form (MO Form 886-3245) to request" "a hearing may be obtained from the Department of Health and" "Senior Services or the regional ombudsman. However, the use" "of a form is not required in order to file a request for a hearing." The request "shall be verified in writing by the" "resident, his/her legal guardian, attorney-in-fact, or any other" "party requesting a hearing on the resident’s behalf by attesting" "to the truth of the resident’s request for a hearing."

On pendency, subsection (8): "The discharge of the resident shall be stayed at the time" "the request for a hearing was filed unless the facility can" "show good cause why the resident should not remain in the" "facility until a written hearing decision has been issued by the" "designated hearing official." The facility contests the stay by "filing a written Motion to Set" "Aside the Stay with the Department of Health and Senior" "Services Appeals Unit", and subsection (8)(B) requires that "the designated hearing official shall schedule" "a hearing to determine whether the facility has" "good cause to discharge the resident prior to a written hearing" "decision being issued."

On the hearing itself, subsection (12): "The resident may obtain legal counsel, represent him/" "herself or use a relative, a friend or other spokesperson." Subsection (13): "Hearings shall be subject to the hearing procedures found" "in 42 CFR Chapter IV, Part 483, subpart E, and the Missouri" "Administrative Procedures Act, specifically sections 536.070" "through 536.080, RSMo, which include, but are not limited" "to, oral and written evidence, witnesses, objections, official" "notices, affidavits, transcripts, depositions and other discovery" "methods, sanctions, oral arguments and written briefs." Subsection (11) places the burden on the facility: "The burden of showing that the facility has complied with" "all requirements for appropriate discharge of the resident shall" "be upon the facility."

The notice's required contents

19 CSR 30-82.050(4): "Before a facility transfers or discharges a resident, the" "facility shall—" "(A) Send written notice to the resident in a language" "and manner reasonably calculated to be understood by the" "resident. The notice must also be sent to any legally authorized" "representative of the resident and to at least one (1) family" "member. In the event that there is no family member known" "to the facility, the facility shall send a copy of the notice to the" "appropriate regional coordinator of the Missouri State" "Ombudsman’s office;" "(B) Include in the written notice the following information:"

"1. The reason for the transfer or discharge;"

"2. The effective date of transfer or discharge;"

"3. The resident’s right to appeal the transfer or discharge" "notice to the director of the Department of Health and Senior" "Services or his/her designated hearing official within thirty (30)" "days of the receipt of the notice;"

"4. That a request for a hearing should be sent to Department" "of Health and Senior Services Appeals Unit, PO Box 570, 912" "Wildwood Drive 3rd floor, Jefferson City, Missouri 65102-0570," "by fax to (573) 751-0247, or by email to" "DHSS.Appeals@health.mo.gov" "and the phone number for the appeals unit is (573)" "522-1699;"

"5. That filing an appeal will allow a resident to remain in" "the facility until the hearing is held unless a hearing official" "finds otherwise;"

"6. The location to which the resident is being transferred" "or discharged;"

"7. The name, address, and telephone number of the" "designated regional long-term care ombudsman office;"

"8. For Medicare and Medicaid certified facility residents" "with developmental disabilities, the mailing address and" "telephone number of the Missouri Protection and Advocacy" "Agency, 925 South Country Club Drive, Jefferson City, MO" "65109, (573) 893-3333, or the current address and telephone number of the protection advocacy agency if it has changed."

Subsection (4)(C): the facility must "Record and document in detail in each affected resident’s record the reason for the transfer or discharge."

Bed-hold and return

Two publishers answer different halves of this question. 19 CSR 30-82.050(10) states what happens to a resident who wins the appeal after already being moved: "If the resident" "prevails and has already been discharged, the facility shall" "notify the resident, the qualified representative, or any other" "responsible party who will assure that the resident is made" "aware of the decision and that the resident may return to the facility. In the event that there are no beds available, the facility" "shall admit the resident to occupy the first available bed" "without regard to any waiting list maintained by the facility."

The MO HealthNet Division's own Nursing Home Provider Manual, section 2.11, "Program Policies" (running header "Nursing Home Manual – 01/08/2024"), states the Medicaid payment side for an ordinary hospital stay or home visit, independent of any appeal. On a home visit: "MHD reimburses the NF for therapeutic home reserve days provided the attending physician has documented approval in the patient’s plan of care." "The number of days allowed for home leave is 12 days for the first six (6) calendar months and 12 days for the second six (6) calendar months of the year." On a hospital stay, payment for "hospital reserve days is made under the following specific conditions only": among them, "The NF has 97% occupancy of the MHD certified area in the prior calendar quarter in which the first hospital reserve day occurs", "The inpatient hospital stay is three (3) days or less", and "The resident has enough unused therapeutic home reserve days to use two (2) home reserve days when one (1) hospital reserve day is requested". Where those conditions are not met, or a resident does not wish to use them, the manual states two things happen instead: "Under OBRA 1987 the NF is obligated to place the resident in the first available semi-private room with a Medicaid certified bed upon the participant's discharge from the hospital", or "The resident may pay the NF to reserve the bed during the hospitalization period instead of using the participant's therapeutic home reserve days." The manual's own "Bed-Hold Policy" heading states the same choice plainly: "Neither a resident nor the responsible party is required to pay an NF to hold a bed. If the resident or responsible party chooses to, they may pay an NF to reserve the same bed the participant is leaving." And, matching the rule's own readmission floor: "When a resident is transferred to a hospital, the NF is required, both by federal statute and federal regulation, to readmit the resident immediately upon the first availability of a bed in a semi-private room."

The three rows above hoist the questions a facility's counsel answers in the first fifteen minutes. They are quotations from Missouri's published sources, not a determination that any of them applies to any situation.

Notice periods and deadlines, as stated in the sources

All quoted; none calculated.

Thirty days' advance notice — 19 CSR 30-82.050(5): "The notice of transfer or discharge described in this rule" "shall be made by the facility no less than thirty (30) days before" "the resident is to be transferred or discharged."

As-soon-as-practicable exceptions for an emergency discharge — subsection (5): "In the case of an" "emergency discharge, the notice shall be made as soon as" "practicable before the discharge when it is specifically alleged" "in the notice that—" one of five stated circumstances applies, among them that "The resident has not resided in the facility for thirty (30)" "days."

Thirty days to appeal — subsection (6), quoted above in full; the notice's own required contents restate the same period in item 3, "within thirty (30)" "days of the receipt of the notice".

Five days for the department to schedule a good-cause hearing on the stay — subsection (8)(B): "Within five (5) days after a written Motion to Set Aside" "the Stay has been filed with the Department of Health and" "Senior Services Appeals Unit the designated hearing official" "shall schedule a hearing to determine whether the facility has" "good cause to discharge the resident prior to a written hearing" "decision being issued."

Ten days' notice before a good-cause or discharge hearing — subsection (9): "Written notice of a hearing shall contain the date and time" "for the hearing and shall be mailed to the facility, the resident" "or the resident's legally authorized representative, and to any and all parties in interest, including any family members" "who received notice of the discharge, that are known to the" "designated hearing official." "The written notice shall be mailed" "to the parties at least ten (10) days prior to the hearing."

Ten additional days after a decision in the facility's favor — subsection (10): "If the decision is" "in the facility’s favor, the resident shall be granted" "an additional ten (10) days after the decision is received for" "purpose of relocation, and the facility shall assist the resident" "in making suitable arrangements for relocation."

Twelve days per half-year for a home-leave Medicaid reserve day, and a three-day cap on a hospital stay for a Medicaid reserve day — MO HealthNet Nursing Home Provider Manual, section 2.11, quoted above in full.

What any of these periods means for a particular case is for the hearing office to determine.

Source map

Captured: all three, in tools/packets/missouri-packet.txt. Pending: MO Form 886-3245, section 198.088 RSMo, the department's ombudsman transfer-and-discharge handout and know-your-rights page — per the packet's pending list.

Change log

2026-09-14 — Deepened to a full page. Newly captured: the MO HealthNet Nursing Home Provider Manual's section 2.11, "Program Policies" (source 3), the state's Medicaid bed-hold payment statement, found by following the "Section 5" / "Nursing Home Provider Manual" links off the department's own Nursing Home Facility Claims FAQs page to a stable, directly-linked PDF. Added to tools/recipes/missouri.json as a new source (recipe digest 9d0acc95d4b4), sliced to the whole of section 2.11 by heading anchors bounding it on either side, a deliberate superset rather than a tighter cut, because the section is one continuous run of prose with no internal heading marking where the bed-hold material specifically begins. The two standing sources were recaptured unchanged in the same pass and the packet was promoted as a rebuild. Section 01 (the grounds) and section 02 (the published process, including the notice's required contents in full, bed-hold and return, and the notice-periods register) are now written.

Findings, continuing the numbering from 2026-08-30: (7) Two publishers answer the bed-hold question without contradicting each other: the licensing rule (19 CSR 30-82.050(10)) states a resident's right to return to the facility after prevailing on appeal, with a "first available bed" floor if none is open; the Medicaid manual states a separate, ordinary-course payment policy — twelve reserve days per half-year for a home visit, a conditioned allowance for a hospital stay capped at three days unless the resident pays privately to hold the bed longer — and its own readmission floor matching the rule's. Neither publisher states what a facility's own written bed-hold policy must say to a resident before a move, and none was found. (8) The manual's own text mixes the curly and straight apostrophe glyph within the same document (e.g. "participant's discharge" against "resident’s welfare" elsewhere in the same PDF); both are reproduced exactly as the extraction returned them, publisher's typesetting and all. (9) MO Form 886-3245, section 198.088 RSMo, and the department's ombudsman transfer-and-discharge handout and know-your-rights page remain uncaptured, as recorded 2026-08-30. Capture pending: per the source map. Internet Archive: not yet submitted for the new source. Reviewer: Carrie Schluter, reviewed 2026-09-15. Corrections: hello@fieldassembly.net.

2026-08-30 — Baseline page built from the first Missouri packet: docket, lede, source map, change log. Not yet captured or written: section 01 (the grounds, as Missouri describes them) and section 02 (the published process, including the notice's required contents in full, bed-hold and return, and the notice-periods register). Findings: (1) The Secretary of State prints the Code of State Regulations in two columns, so the extractor renders each printed line as one column's text followed by the other's. Quotations on this page are therefore contiguous spans of the capture as rendered, not of the printed column; the capture notes record the layout, and each quoted span was verified against the packet mechanically. (2) Missouri's appeal window is thirty days from receipt of the notice — the same length as the notice period itself — and the rule states the deadline twice, once as a required notice content and once in the filing provision, with the first running from "the receipt of the notice" and the second from "the date the resident received the discharge notice". Both are quoted as published. (3) The rule states a form exists, MO Form 886-3245, and that it is not required; the form itself was not captured. (4) Two of the department's own ombudsman documents — the transfer-and-discharge handout and the know-your-rights page — returned HTTP 404 at the paths found and are capture-pending. (5) The rule provides for the facility to move against the stay by a "Motion to Set Aside the Stay", with its own hearing; that machinery is captured and will be quoted in section 02 when that section is written. (6) No first-party statement of a Missouri Medicaid bed-hold period was captured. Capture pending: per the source map. Internet Archive: not yet submitted. Reviewer: Carrie Schluter, reviewed 2026-08-30. Corrections: hello@fieldassembly.net.