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SB 1143 requires new long-term care facilities (like nursing homes) and expansions of existing facilities to obtain a "certificate of need" from Missouri's health committee before opening or making major changes. This affects developers, healthcare providers, and facilities seeking to add beds or services. Key provisions include: no state funding or licensing without approval, a $1,000 application fee (or 0.1% of project cost), and exemptions for state-operated facilities, research equipment, and transfers of existing facilities. The bill aims to ensure new healthcare projects meet community needs and avoid unnecessary costs, while allowing flexibility for state facilities and medical research.