2013 -- S 0538

=======

LC00994

=======

STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

____________

A N A C T

RELATING TO HEALTH AND SAFETY - LICENSING OF HEALTHCARE FACILITIES

     Introduced By: Senator Maryellen Goodwin

     Date Introduced: February 28, 2013

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

1-1

     SECTION 1. Section 23-17-44 of the General Laws in Chapter 23-17 entitled "Licensing

1-2

of Health Care Facilities" is hereby amended to read as follows:

1-3

     23-17-44. Moratorium on new initial nursing facility licensed beds and on increases

1-4

to the licensed capacity of existing nursing facility licenses. -- (a) The licensing agency shall

1-5

issue no new initial licenses for nursing facilities prior to July 1, 2013 July 1, 2016; provided,

1-6

however, that: any

1-7

      (1) Any person holding a previously issued and valid certificate of need as of August 21,

1-8

1996 shall be permitted to effect a prior certificate from the licensing agency consistent with any

1-9

other statutory and regulatory provisions which may further apply;

1-10

      (2) Any person holding a nursing facility license may undertake activities to construct

1-11

and operate a replacement nursing facility with the same or lower bed capacity as is presently

1-12

licensed provided that the replacement facility may only be licensed upon the otherwise

1-13

unconditional cessation of operation of the previously licensed nursing facility;

1-14

      (b) Prior to July 1, 2013 July 1, 2016 and with the exception of the culture initiative

1-15

pursuant to section 23-17-44(3), the licensing agency shall not increase the licensed bed capacity

1-16

of any existing licensed nursing facility, including any nursing facility approved for change in

1-17

ownership pursuant to sections 23-17-14.3 and 23-17-14.4, to greater than the level of the

1-18

facility's licensed bed capacity as of August 21, 1996 plus the greater of ten (10) beds or ten

1-19

percent (10%) of the licensed bed capacity. Any person holding a previously issued and valid

1-20

certificate of need as of the date of passage of this section or who shall subsequently be granted a

2-1

certificate of need pursuant to subsection (a) shall be permitted to effect a prior certificate from

2-2

the licensing agency consistent with any other statutory and regulatory provisions which may

2-3

further apply.

2-4

      (c) Notwithstanding any other provision of the law to the contrary, including any

2-5

moratorium on increasing bed capacity in nursing facilities that may otherwise apply, a nursing

2-6

facility may take out of service any or all beds of its licensed capacity without impediment to its

2-7

right to place back into service those beds at a future date under the same terms and conditions as

2-8

applied at the time of taking them out of service.

2-9

      (d) From July 1 of 2009 through December 31, 2010, notwithstanding any other

2-10

provision herein to the contrary, including any moratorium on increasing bed capacity in nursing

2-11

facilities that may otherwise apply, a nursing home member of a multi-facility group may transfer

2-12

its entitlement to add up to ten (10) beds through the "ten (10) beds or ten percent (10%) of

2-13

capacity" exception provided for and in accordance with subsection (b) hereof to another nursing

2-14

facility in the same multi-facility group, provided that:

2-15

      (1) The beds thereby added are, in the discretion of the director of the department of

2-16

health, designed to provide enhanced quality of life to nursing facility residents through the

2-17

adoption of principles and building designs established by the "Eden alternative" or "Green house

2-18

" programs or other like means;

2-19

      (2) The nursing facility applying to receive the transferred beds has fewer than fifty (50)

2-20

licensed beds and has at least a ninety-four percent (94%) bed occupancy rate at the time of

2-21

application to obtain said additional bed licenses;

2-22

      (3) The transferred beds provided for in this subsection (d) shall be limited to a

2-23

maximum total of ten (10) beds per multi-facility group;

2-24

      (4) The transfer of beds results in a reduction in the number of nursing facility beds in

2-25

the state, including the beds transferred under this authority; and

2-26

      (5) For purposes of this subsection (d), the term "multi-facility group" shall mean two (2)

2-27

or more nursing facilities that are affiliated, which for purposes of this subsection shall mean two

2-28

(2) or more nursing facilities that are controlled by, in control of, or in common control with, each

2-29

other.

2-30

      (e) (d) Culture change initiative. - Notwithstanding any other provision of the law to the

2-31

contrary, including any moratorium on increasing bed capacity in nursing facilities that may

2-32

otherwise apply, the licensing agency may increase the licensed bed capacity of any existing

2-33

licensed nursing facility, including any nursing facility approved for change in ownership

2-34

pursuant to sections 23-17-14.3 and 23-17-14.4, for the purposes of nursing facility culture

3-1

change, in accordance with the following criteria and procedures:

3-2

      (i) Culture change definitions and criteria shall be established through regulation, to

3-3

restrict beds added under this initiative only to beds that are designed to provide enhanced quality

3-4

of life to nursing facility residents through the adoption of principles and building designs

3-5

established by the "Eden alternative," "Green house," or "small house" programs or other like

3-6

means;

3-7

      (ii) Only beds taken out-of-service due to facility closure after January 1, 2010 shall be

3-8

available for facility expansion under this culture change initiative subsection. The total number

3-9

of beds that may be licensed to increase capacity under this culture change initiative shall be

3-10

limited to ninety percent (90%) of the first fifty (50) beds that are taken out-of-service, to seventy

3-11

percent (70%) of the next fifty (50) beds that are taken out-of-service, and to fifty percent (50%)

3-12

of any additional beds taken out-of-service;

3-13

      (iii) Only nursing facilities licensed in the state are eligible to expand under the culture

3-14

change initiative;

3-15

      (iv) The department shall promulgate regulations to govern an open and competitive

3-16

process to determine the licensure of expansion beds under this culture change initiative, and

3-17

shall consider the impact on the regional distribution of, and access to, nursing facility beds in the

3-18

state;

3-19

      (v) Any facility seeking to expand their licensed bed capacity under this initiative, that

3-20

will result in an expenditure that meets or exceeds the criteria for determination of need review

3-21

under chapter 23-15, shall be required to receive approval under chapter 23-15.

3-22

      (vi) On or before March 15, 2012, the department shall gather information from the

3-23

department of human services and shall report to the president of the senate and the speaker of the

3-24

house of representatives on the costs and benefits to the state of this culture change initiative,

3-25

including recommendations for revision or termination of the initiative.

3-26

     SECTION 2. This act shall take effect upon passage.

=======

LC00994

=======

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH AND SAFETY - LICENSING OF HEALTHCARE FACILITIES

***

4-1

     This act would extend until July 1, 2016 the moratorium on new initial licenses for

4-2

nursing facilities as well as increases the bed capacity of any existing licensed nursing facility and

4-3

would eliminate the exception allowing certain nursing facilities to transfer beds to other nursing

4-4

facilities.

4-5

     This act would take effect upon passage.

=======

LC00994

=======