Other senior care options in Missouri:

Page 29 of Best Nursing Homes in Missouri

Why trust this guide? Our editorial team analyzed 282 nursing homes in Missouri using Centers for Medicare & Medicaid Services (CMS) data, inspection records, complaints, amenities, and facility-level details. How we rank nursing homes in MO
Reviewed by
Last updated
Jul 2026
We analyzed
282 homes
Other senior care options in Missouri:
Avg Overall CMS Rating: 2.5/ 5The average Overall CMS Rating for all CMS-certified nursing homes in Missouri. Ratings combine health inspections, staffing, and quality measures, with inspections weighted most. Individual facilities can vary widely from this average.
National Average: 3.2/ 5
Avg Staffing Rating: 2.2/ 5The average Staffing Rating across all CMS-certified nursing homes in Missouri. Reflects nursing staff hours per resident per day (including RNs), adjusted for residents' care needs. Individual facilities can vary widely from this average.
National Average: 3.4/ 5
Avg Health Insp. Rating: 2.8/ 5The average Health Inspection Rating across all CMS-certified nursing homes in Missouri. Based on each facility's recent inspections and complaint investigations, weighing the number, scope, and severity of deficiencies. Individual facilities can vary widely from this average.
National Average: 3.0/ 5

Compare Nursing Homes around Missouri

The information below is reported by the Missouri Department of Health and Senior Services, Division of Regulation and Licensure.

CMS & MO Dept. of Health data

Laclede Groves
NH
AL
IL
MC
St. Louis
251
Facility 251
MO AVG 96
Rank #3 / 452
40.8%
Facility 40.8%
MO AVG 65.1
Rank #368 / 420
-37%
5.27
Facility 5.27
MO AVG 3.74
Rank #19 / 280
+48%+41%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
9
Facility 9
MO AVG 36.5
Rank #10 / 284
4.5
Facility 4.5
MO AVG 5.7
Rank #104 / 284
-103-
35
Facility 35
MO AVG 45
Rank #356 / 563
John Komlos
$24.9MFiscal year ending 12/2023
Facility $24.9MFiscal year ending 12/2023
MO AVG $8.4M
Rank #4 / 290
$27.4MFiscal year ending 12/2023
Facility $27.4MFiscal year ending 12/2023
MO AVG $3.3M
Rank #2 / 290
109.9%Fiscal year ending 12/2023
Facility 109.9%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #196 / 290
265600
Republic Nursing and Rehab
NH
SNF
Republic
127
Facility 127
MO AVG 96
Rank #81 / 452
74.0%
Facility 74.0%
MO AVG 65.1
Rank #156 / 420
+14%
3.82
Facility 3.82
MO AVG 3.74
Rank #125 / 280
+34%+2%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
23
Facility 23
MO AVG 36.5
Rank #95 / 284
4.6
Facility 4.6
MO AVG 5.7
Rank #107 / 284
-94-
48
Facility 48
MO AVG 45
Rank #262 / 563
Darius Love
$7.6MFiscal year ending 12/2023
Facility $7.6MFiscal year ending 12/2023
MO AVG $8.4M
Rank #102 / 290
$3.6MFiscal year ending 12/2023
Facility $3.6MFiscal year ending 12/2023
MO AVG $3.3M
Rank #77 / 290
47.3%Fiscal year ending 12/2023
Facility 47.3%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #77 / 290
265326
Chaffee Nursing Center
NH
HOS
SNF
Chaffee
71
Facility 71
MO AVG 96
Rank #302 / 452
87.3%
Facility 87.3%
MO AVG 65.1
Rank #56 / 420
+34%
3.96
Facility 3.96
MO AVG 3.74
Rank #101 / 280
-3%+6%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
9
Facility 9
MO AVG 36.5
Rank #10 / 284
3.0
Facility 3.0
MO AVG 5.7
Rank #23 / 284
-62-
25
Facility 25
MO AVG 45
Rank #425 / 563
Chaffee Nursing, LLC
$5.6MFiscal year ending 12/2023
Facility $5.6MFiscal year ending 12/2023
MO AVG $8.4M
Rank #182 / 290
$3.0MFiscal year ending 12/2023
Facility $3.0MFiscal year ending 12/2023
MO AVG $3.3M
Rank #188 / 290
53.1%Fiscal year ending 12/2023
Facility 53.1%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #161 / 290
265492
Heisinger Bluffs
NH
AL
IL
MC
RC
SNF
Jefferson City
111
Facility 111
MO AVG 96
Rank #155 / 452
49.5%
Facility 49.5%
MO AVG 65.1
Rank #330 / 420
-24%
3.36
Facility 3.36
MO AVG 3.74
Rank #185 / 280
+42%-10%
$8.1k
Facility $8.1k
MO AVG $76.9k
Rank #163 / 286
17
Facility 17
MO AVG 36.5
Rank #60 / 284
5.7
Facility 5.7
MO AVG 5.7
Rank #169 / 284
-55-
32
Facility 32
MO AVG 45
Rank #376 / 563
Hb Operations Holdco LLC
$4.9MFiscal year ending 12/2023
Facility $4.9MFiscal year ending 12/2023
MO AVG $8.4M
Rank #192 / 290
$3.5MFiscal year ending 12/2023
Facility $3.5MFiscal year ending 12/2023
MO AVG $3.3M
Rank #149 / 290
72.1%Fiscal year ending 12/2023
Facility 72.1%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #47 / 290
265794
Linden Woods Village
NH
AL
IL
SNF
Gladstone
40
Facility 40
MO AVG 96
Rank #417 / 452
85.0%
Facility 85.0%
MO AVG 65.1
Rank #76 / 420
+31%
4.51
Facility 4.51
MO AVG 3.74
Rank #46 / 280
+31%+21%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
12
Facility 12
MO AVG 36.5
Rank #29 / 284
4.0
Facility 4.0
MO AVG 5.7
Rank #76 / 284
-34-
53
Facility 53
MO AVG 45
Rank #217 / 563
Amanda Fizer
$8.5MFiscal year ending 12/2023
Facility $8.5MFiscal year ending 12/2023
MO AVG $8.4M
Rank #72 / 290
$3.8MFiscal year ending 12/2023
Facility $3.8MFiscal year ending 12/2023
MO AVG $3.3M
Rank #100 / 290
44.8%Fiscal year ending 12/2023
Facility 44.8%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #224 / 290
265855
Sunterra Springs Independence
NH
SNF
Independence
38
Facility 38
MO AVG 96
Rank #422 / 452
100.0%
Facility 100.0%
MO AVG 65.1
Rank #1 / 420
+54%
3.37
Facility 3.37
MO AVG 3.74
Rank #185 / 280
+95%-10%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
22
Facility 22
MO AVG 36.5
Rank #88 / 284
4.4
Facility 4.4
MO AVG 5.7
Rank #97 / 284
-38-
30
Facility 30
MO AVG 45
Rank #386 / 563
Johnathan Bangerter
$6.5MFiscal year ending 12/2023
Facility $6.5MFiscal year ending 12/2023
MO AVG $8.4M
Rank #148 / 290
$2.8MFiscal year ending 12/2023
Facility $2.8MFiscal year ending 12/2023
MO AVG $3.3M
Rank #198 / 290
43.8%Fiscal year ending 12/2023
Facility 43.8%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #239 / 290
265864
St Francois Manor
NH
HOS
SNF
Farmington
158
Facility 158
MO AVG 96
Rank #43 / 452
--
5.97
Facility 5.97
MO AVG 3.74
Rank #6 / 280
-34%+60%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
19
Facility 19
MO AVG 36.5
Rank #71 / 284
3.8
Facility 3.8
MO AVG 5.7
Rank #66 / 284
-17A+
77
Facility 77
MO AVG 45
Rank #53 / 563
Jennifer Simpson
$5.2MFiscal year ending 12/2023
Facility $5.2MFiscal year ending 12/2023
MO AVG $8.4M
Rank #193 / 290
$2.6MFiscal year ending 12/2023
Facility $2.6MFiscal year ending 12/2023
MO AVG $3.3M
Rank #151 / 290
50.8%Fiscal year ending 12/2023
Facility 50.8%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #47 / 290
265674
Camelot Nursing & Rehab Center
NH
AL
SNF
Farmington (Sleepy Hollow Run)
97
Facility 97
MO AVG 96
Rank #196 / 452
73.1%
Facility 73.1%
MO AVG 65.1
Rank #161 / 420
+12%
3.29
Facility 3.29
MO AVG 3.74
Rank #204 / 280
-16%-12%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
12
Facility 12
MO AVG 36.5
Rank #29 / 284
4.0
Facility 4.0
MO AVG 5.7
Rank #76 / 284
-71-
55
Facility 55
MO AVG 45
Rank #189 / 563
Camelot Snf Investments, LLC
$7.4MFiscal year ending 12/2023
Facility $7.4MFiscal year ending 12/2023
MO AVG $8.4M
Rank #88 / 290
$3.4MFiscal year ending 12/2023
Facility $3.4MFiscal year ending 12/2023
MO AVG $3.3M
Rank #142 / 290
46.4%Fiscal year ending 12/2023
Facility 46.4%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #243 / 290
265348
Wilson’s Creek Nursing &Amp; Rehab
NH
HOS
MC
SNF
Vernon Springfield (Downtown Springfield)
172
Facility 172
MO AVG 96
Rank #32 / 452
74.4%
Facility 74.4%
MO AVG 65.1
Rank #148 / 420
+14%
3.87
Facility 3.87
MO AVG 3.74
Rank #112 / 280
+46%+3%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
21
Facility 21
MO AVG 36.5
Rank #79 / 284
5.3
Facility 5.3
MO AVG 5.7
Rank #149 / 284
1128A+
94
Facility 94
MO AVG 45
Rank #5 / 563
Michael Huffman
$8.5MFiscal year ending 12/2023
Facility $8.5MFiscal year ending 12/2023
MO AVG $8.4M
Rank #99 / 290
$4.3MFiscal year ending 12/2023
Facility $4.3MFiscal year ending 12/2023
MO AVG $3.3M
Rank #97 / 290
50.8%Fiscal year ending 12/2023
Facility 50.8%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #143 / 290
265161
NHC Healthcare, Kennett
NH
HC
HOS
SNF
Falcon Kennett
170
Facility 170
MO AVG 96
Rank #34 / 452
57.6%
Facility 57.6%
MO AVG 65.1
Rank #290 / 420
-12%
3.75
Facility 3.75
MO AVG 3.74
Rank #125 / 280
+17%0%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
11
Facility 11
MO AVG 36.5
Rank #24 / 284
3.7
Facility 3.7
MO AVG 5.7
Rank #64 / 284
-98-
65
Facility 65
MO AVG 45
Rank #124 / 563
Jessica Bader
$8.6MFiscal year ending 12/2023
Facility $8.6MFiscal year ending 12/2023
MO AVG $8.4M
Rank #91 / 290
$5.0MFiscal year ending 12/2023
Facility $5.0MFiscal year ending 12/2023
MO AVG $3.3M
Rank #84 / 290
57.7%Fiscal year ending 12/2023
Facility 57.7%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #120 / 290
265168
Ignite Medical Resort Blue Springs
NH
PC
SNF
Blue Springs
90
Facility 90
MO AVG 96
Rank #226 / 452
98.9%
Facility 98.9%
MO AVG 65.1
Rank #5 / 420
+52%
3.14
Facility 3.14
MO AVG 3.74
Rank #222 / 280
+136%-16%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
16
Facility 16
MO AVG 36.5
Rank #54 / 284
3.2
Facility 3.2
MO AVG 5.7
Rank #31 / 284
-89-
68
Facility 68
MO AVG 45
Rank #92 / 563
Ignite Ind LLC
$14.2MFiscal year ending 12/2023
Facility $14.2MFiscal year ending 12/2023
MO AVG $8.4M
Rank #19 / 290
$5.1MFiscal year ending 12/2023
Facility $5.1MFiscal year ending 12/2023
MO AVG $3.3M
Rank #44 / 290
36.2%Fiscal year ending 12/2023
Facility 36.2%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #277 / 290
265880
Scenic Wellness and Rehabilitation Center
NH
PC
SNF
Herculaneum
189
Facility 189
MO AVG 96
Rank #19 / 452
85.2%
Facility 85.2%
MO AVG 65.1
Rank #75 / 420
+31%
3.64
Facility 3.64
MO AVG 3.74
Rank #159 / 280
-19%-3%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
15
Facility 15
MO AVG 36.5
Rank #47 / 284
3.8
Facility 3.8
MO AVG 5.7
Rank #66 / 284
1161-
30
Facility 30
MO AVG 45
Rank #386 / 563
Jamiee Allen
$13.2MFiscal year ending 12/2023
Facility $13.2MFiscal year ending 12/2023
MO AVG $8.4M
Rank #50 / 290
$8.5MFiscal year ending 12/2023
Facility $8.5MFiscal year ending 12/2023
MO AVG $3.3M
Rank #19 / 290
64.3%Fiscal year ending 12/2023
Facility 64.3%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #72 / 290
265216
Nixa Nursing &Amp; Rehab
NH
HOS
SNF
Nixa
82
Facility 82
MO AVG 96
Rank #263 / 452
79.3%
Facility 79.3%
MO AVG 65.1
Rank #113 / 420
+22%
3.78
Facility 3.78
MO AVG 3.74
Rank #125 / 280
-32%+1%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
9
Facility 9
MO AVG 36.5
Rank #10 / 284
3.0
Facility 3.0
MO AVG 5.7
Rank #23 / 284
-65-
63
Facility 63
MO AVG 45
Rank #141 / 563
N & R Of Nixa, LLC
$6.0MFiscal year ending 12/2023
Facility $6.0MFiscal year ending 12/2023
MO AVG $8.4M
Rank #146 / 290
$2.8MFiscal year ending 12/2023
Facility $2.8MFiscal year ending 12/2023
MO AVG $3.3M
Rank #139 / 290
47.2%Fiscal year ending 12/2023
Facility 47.2%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #100 / 290
265322
Aberdeen Heights
NH
AL
HOS
IL
MC
SNF
Kirkwood
91
Facility 91
MO AVG 96
Rank #220 / 452
37.4%
Facility 37.4%
MO AVG 65.1
Rank #382 / 420
-43%
5.18
Facility 5.18
MO AVG 3.74
Rank #21 / 280
-52%+39%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
9
Facility 9
MO AVG 36.5
Rank #10 / 284
2.3
Facility 2.3
MO AVG 5.7
Rank #11 / 284
-34-
89
Facility 89
MO AVG 45
Rank #29 / 563
Ashfield Active Living And Wellness Communities, Inc
$23.4MFiscal year ending 06/2024
Facility $23.4MFiscal year ending 06/2024
MO AVG $8.4M
Rank #6 / 290
$8.1MFiscal year ending 06/2024
Facility $8.1MFiscal year ending 06/2024
MO AVG $3.3M
Rank #12 / 290
34.7%Fiscal year ending 06/2024
Facility 34.7%Fiscal year ending 06/2024
MO AVG 45.6%
Rank #281 / 290
265841
Heartland Care and Rehabilitation Center
NH
SNF
Cape Girardeau
102
Facility 102
MO AVG 96
Rank #168 / 452
61.8%
Facility 61.8%
MO AVG 65.1
Rank #249 / 420
-5%
3.26
Facility 3.26
MO AVG 3.74
Rank #204 / 280
+8%-13%
$0
Facility $0
MO AVG $76.9k
Rank #1 / 286
16
Facility 16
MO AVG 36.5
Rank #54 / 284
5.3
Facility 5.3
MO AVG 5.7
Rank #149 / 284
-63A+
66
Facility 66
MO AVG 45
Rank #113 / 563
Melissa Bollinger
$5.5MFiscal year ending 12/2023
Facility $5.5MFiscal year ending 12/2023
MO AVG $8.4M
Rank #115 / 290
$2.4MFiscal year ending 12/2023
Facility $2.4MFiscal year ending 12/2023
MO AVG $3.3M
Rank #189 / 290
44.1%Fiscal year ending 12/2023
Facility 44.1%Fiscal year ending 12/2023
MO AVG 45.6%
Rank #268 / 290
265503
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Nursing Home Explorer
Overview of Seneca Healthcare Center

Seneca Healthcare Center is a 30-bed residential care facility at 2400 South Cherokee Avenue, Seneca, Missouri, operated by Seneca Healthcare Center and administrated by Ms. Debra Williams. The facility provides skilled nursing care and rehabilitation services and maintains Joint Commission accreditation, a significant credential indicating compliance with national standards for healthcare quality and safety.

Twenty-four-hour staffing is available, and meals are prepared by a Registered Dietician. The facility accepts both Medicare and Medicaid, broadening payment options for qualifying residents. Beyond these operational details, publicly available data are limited. The facility’s inspection profile shows zero routine inspections compared to the Missouri state average of seven, which could indicate a recent opening or limited survey activity relative to comparable Missouri residential care facilities.

Without access to the complete inspection record and detailed staffing breakdown, independent evaluation of operational performance is not possible. The zero-inspection finding requires clarification regarding facility age, census history, and regulatory standing before placement.

The walk score of 50 reflects moderately walkable surroundings, though most residents will need transportation for daily needs.

Operating hours are Monday through Sunday, 8:00 AM to 8:00 PM.

Missouri residents may access multiple payment assistance programs, including Medicaid A&D Waiver, Supplemental Nursing Care, Structured Family Caregiving Waiver, MO HealthNet Aged/Blind/Disabled, Medicare Savings Program, Caregiver Program, and Veterans Aid and Attendance. The facility accepts these programs; however, pricing and cost-sharing details are not publicly listed.

Families should request staffing details, occupancy status, license expiration, inspection records, any deficiencies and citations, quality metrics, and staff credentials and training.

Contact Seneca Healthcare Center LLC

Ignite Medical Resort St Peters

5101 Executive Centre Parkway, Saint Peters, MO 63376-3463
Overview of Ignite Medical Resort St Peters

Ignite Medical Resort St. Peters is a 91-bed skilled nursing facility at 5101 Executive Centre Parkway, Saint Peters, St. Charles County, Missouri, operated by Ignite St. Peters LLC under the administration of Andrew Lane.

The facility accepts both Medicaid and Medicare, maintains 24-hour staffing, and positions itself as a luxury rehabilitation center with private rooms, a full-service spa, Starbucks café, on-site restaurant with chef-prepared cuisine, on-site chapel, and concierge services. The walk score is 45, indicating somewhat walkable location where a few services are reachable on foot but most trips require transportation.

The facility’s CMS Certification Number and Missouri License Number both display as “0” in available records. Before considering admission, families must verify directly with the Centers for Medicare & Medicaid Services and Missouri Department of Health and Senior Services that the facility holds current and valid Medicare and Medicaid certifications. This verification step is essential.

Ignite Medical Resort specializes in orthopedic rehabilitation, stroke recovery, cardiac care, pulmonary rehabilitation, infection management, and renal disease treatment including in-house dialysis. These specialized programs indicate clinical capacity to manage complex medical conditions and post-acute rehabilitation needs. Without benchmarked staffing information and quality data, families cannot independently assess whether the facility’s clinical resources adequately support the specialized rehabilitation services offered or how the facility’s outcomes compare to peer institutions.

The facility emphasizes lifestyle and recreational elements alongside medical care, with dining options including outdoor courtyard patio and fire pit settings. Religious services are provided.

The facility accepts Missouri Medicaid programs, including the Aged and Disabled Waiver, Missouri Supplemental Nursing Care, Structured Family Caregiving Waiver, MO HealthNet Aged Blind and Disabled, and Medicare Savings Program. Veterans and spouses may qualify for VA Aid and Attendance benefits. The facility reports no federal penalties in the past three years, which is a positive indicator of regulatory compliance during that period.

Families should verify current Medicare-Medicaid certifications, and request staffing hours per resident per day, CMS ratings, and quality outcome measures for specialized programs

Contact Ignite Medical Resort St Peters

Ranking Methodology

How we rank these nursing homes

Every nursing home above is evaluated across five weighted categories using CMS data including Care Compare, Payroll-Based Journal, and Medicare Cost Reports.

  • CMS data
  • 5 weighted categories
  • Updated quarterly
Full methodology

Weighting overview

  • 35%
    Care Quality
  • 20%
    Staffing
  • 20%
    Regulatory
  • 20%
    Operational
  • 5%
    Environment
01

Care Quality 35%

The largest single share of every ranking. CMS star ratings and quality measures that reflect actual care delivered to residents.

  • Includes
  • Overall Rating
  • Health Inspection
  • QM Rating
  • Long-Stay QM
  • Short-Stay QM
02

Staffing Adequacy 20%

The strongest predictor of resident outcomes. Volume and stability of nursing care, drawn from CMS Payroll-Based Journal.

  • Includes
  • Nurse Hrs/Res/Day
  • RN vs State
  • Total Nurse Staff Hrs vs State
  • RN Turnover
03

Regulatory & Safety Record 20%

Inspection patterns that star ratings can mask. We weight per-inspection rates more heavily than raw counts.

  • Includes
  • Citations
  • Citations/Inspection
  • Severe Citations
  • Fines
  • Accreditations
04

Operational & Financial Stability 20%

Stable operations and sound finances are leading indicators of consistent care over time.

  • Includes
  • Occupancy vs State
  • Avg Length of Stay
  • Revenue
  • Payroll %
  • Years in Operation
  • Admin Tenure
05

Environment & Accessibility 5%

Context that matters to families but doesn't directly measure clinical care. Weighted lower for nursing homes than for assisted or independent living.

  • Includes
  • Walk Score
  • BBB Rating
No paid rankings Facilities cannot pay to influence placement.
How we're paid: If we help you find a home and you move in, that home may pay us a referral fee. This never affects where they rank or what you pay. Learn more
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Frequently Asked Questions about Nursing Homes in Missouri

What's the difference between assisted living and a nursing home in Missouri?

Assisted living in Missouri is a residential model focused on housing, hospitality, and help with daily activities. Nursing homes (skilled nursing facilities) provide 24/7 medical care from licensed nurses for residents with significant health needs, and are regulated more strictly under both state and federal CMS rules.

Does Missouri Medicaid cover nursing home care?

Yes — Missouri Medicaid covers nursing home care for residents who meet income, asset, and medical-need eligibility requirements. Most CMS-certified nursing homes accept Medicaid as a primary payer once long-term-care eligibility is established.

What is nursing home care?

Nursing homes (also called skilled nursing facilities) provide 24/7 medical care from licensed nurses, rehabilitation services, and long-term custodial care for residents with significant health or functional needs.

How many nursing homes are listed on this page?

This page features 282 nursing homes in Missouri. Use the filters and comparison tools above to compare ratings, amenities, and pricing.

How do I choose the right nursing home in Missouri?

Start by matching the level of care offered to the resident's current and anticipated needs, then compare licensing status, staff-to-resident ratios, recent inspection results, and pricing. Tour at least two or three communities in Missouri, talk to current residents and families, and confirm what is included in the base rate versus billed as add-on services.

What should I look for when visiting nursing homes in Missouri?

Pay attention to staff interactions with residents, cleanliness and odor, food quality at meal times, the activity calendar, and how questions about pricing and care plans are answered. Ask to see the most recent state inspection report, the move-out / level-of-care-change policy, and a sample monthly bill that lists every fee.