Missouri facilities must notify the department within five days after starting construction.

Did you know there’s a built-in countdown for construction projects in Missouri health facilities? If you’re an administrator or a project lead at a nursing home or a related facility, you’ll want to lock this one in your memory: start construction means you must notify the department within five days. Yes, five days. It’s not a suggestion; it’s a requirement designed to keep everyone on the same page—patients, staff, the public, and the regulators.

Let’s unpack why this rule exists, what it covers, and how to handle it without turning your project into a paperwork sprint.

The rule at a glance: five days, full stop

When a facility begins any construction activity that changes the building’s footprint, structure, systems, or the way people move through the space, you’re required to alert the department within five days. That’s the time window. Longer or shorter wouldn’t provide the same balance between oversight and operational continuity, so five days is the sweet spot the rules settled on.

Why five days matters

Think of it as a safety check, not a trap. Here’s what that short notification window helps accomplish:

• Public health and safety: Construction can affect air quality, water systems, waste handling, and patient protection. A quick heads-up lets regulators flag potential issues early.

• Compliance with codes and standards: Zoning considerations, building codes, fire safety, and health regulations often intersect with construction plans. Early notice helps keep everything aligned.

• Oversight without bottlenecks: The department can monitor progress and respond if plans drift from approved scopes. At the same time, the five-day window isn’t meant to slow projects to a crawl.

• Clarity for stakeholders: When the department is in the loop, there’s less guesswork about permit statuses, inspections, or required amendments. That clarity saves time and reduces surprises downstream.

What counts as “starting construction”

This isn’t just about tearing out a wall or laying new flooring. It’s about activities that meaningfully alter the facility’s physical plant or operations. Examples include:

• Structural changes, additions, or major renovations

• Changes to essential systems (HVAC, plumbing, electrical, life-safety)

• Modifications that affect egress, patient flow, or accessibility

• Site work that affects zoning or utility connections

If you’re unsure whether a particular step qualifies as “starting construction,” it’s safer to err on the side of notifying the department. It’s easier to clarify early than to chase compliance after a misstep.

What to include in your notification

A well-prepared notice helps the department respond quickly and smoothly. Here are common elements that typically appear in the submission:

• Facility name and physical address

• Contact person (name, title, phone, email)

• Project name or brief description of the work

• Scope of work and anticipated start date

• Estimated completion date and key milestones

• Any changes to licenses, permits, or enrollment status that might result

• Any anticipated impacts on patient care, access, or daily operations

• Copies of relevant plans or approvals (where the portal or submission method allows)

The exact form or portal can vary, so check your department’s current submission method. Some facilities use a dedicated online portal, others send documentation via email or mail. The important part is including the basics clearly and concisely so the reviewer doesn’t have to hunt for essential details.

How to submit (and what happens next)

Submission processes differ by jurisdiction, but here’s a practical path you can adapt:

• Confirm the required channel: Find the official guidance on the Missouri Department of Health and Senior Services or the appropriate health-regulatory unit. If you’re unsure, contact the department’s liaison for construction activity and ask for the exact form and submission method.

• Gather your materials: Assemble project scope, start/end dates, contact information, and any sketches or diagrams that help explain the work.

• Submit promptly: Do it within five days of starting construction. If you’re mid-project and something changes—scope expands or dates shift—update the department as required.

• Keep a paper trail: Save copies, confirmations, and any correspondence. A dated record helps if questions arise later.

• Expect a response: The department may acknowledge receipt and, depending on the work, may request additional details or schedule inspections. The exchange keeps the project aligned with regulations and expectations.

What happens after the notification is in

After you’ve filed the notice, you’ll likely enter a phase of documentation and periodic oversight. Here’s what that typically looks like:

• Compliance checks: The department reviews the scope to ensure it aligns with licensing rules and health standards.

• Inspections: There may be scheduled or spot inspections to verify that construction adheres to approved plans and safety requirements.

• Amendments or approvals: If plans change significantly, you might need to amend the notification or obtain new approvals before continuing.

• Safety and infection control considerations: Especially in health facilities, regulators keep an eye on how construction affects patient safety, sanitation, and infection control measures.

Common pitfalls and how to avoid them

Like many regulatory steps, the five-day rule is straightforward in principle, but real-world projects don’t always go as planned. Here are some practical tips to stay on track:

• Don’t assume a delay is harmless: If the project starts, the clock starts ticking. Even small mobilization activities count as starting construction and trigger the notification.

• Keep stakeholders aligned: Let the leadership team, facilities manager, and the project lead know about the five-day rule so there’s a shared understanding of timelines.

• Document every change: If the scope shifts, treat it as a new event requiring updated notification or amendments.

• Don’t bury the notification in files: Keep a dedicated folder (digital or physical) for construction notices and related correspondence. Easy access saves time during reviews.

• Build a reminder into project planning: Schedule a five-day alert for the initial notification and for any significant scope change. A little foresight goes a long way.

A quick detour that still matters

Construction oversight isn’t the only regulatory thread in Missouri health facilities. There are fire code checks, OSHA considerations for worker safety, and local zoning rules that can intersect with a construction project. It’s tempting to silo these areas, but the most efficient facilities teams run parallel checks—so a change in one area doesn’t create friction in another. A well-coordinated approach keeps patient care uninterrupted and staff morale steady.

Relating it to everyday leadership

If you’re in charge of a nursing home or related care setting, this five-day notice rule isn’t just a box to check. It’s a signal of responsible leadership—an approach that says, we’ve got systems in place to protect residents’ health, even when we’re upgrading or expanding. It’s about balance: moving forward with improvements while maintaining a safe, compliant environment for the people who call your facility home.

A few practical takeaways

• Start with clarity: Define the scope of work early and communicate that scope clearly in the notification.

• Stay connected: Maintain open lines of communication with the department and your internal teams.

• Be proactive: If plans evolve, update the department promptly; don’t wait for a problem to surface.

• Keep patient safety front and center: Construction activities should never compromise infection control, air quality, or access to essential services.

Wrapping it up

Five days sounds like a tight window, but it’s a thoughtfully chosen timeframe that helps regulators monitor projects without stalling essential improvements. For Missouri nursing home administrators and facilities teams, it’s a reminder that good governance isn’t about red tape—it’s about predictable processes, clear communication, and steady progress that keeps residents safe and cared for.

If you’re involved in a Missouri health facility right now, a quick audit of your construction notification processes can pay big dividends. Do you have a designated point person for regulatory communications? Is your notification checklist ready to go, with all the required details? Take a moment to verify, then breathe a little easier knowing you’ve got the process dialed in.

And if you want a peaceful project trajectory, the simplest rule is this: act early, document clearly, and keep the lines open. The department appreciates it, your team appreciates it, and most importantly, the residents benefit from it. After all, safe, well-run facilities aren’t born from scattered efforts—they’re built from deliberate, coordinated steps like this one.