Chapter 290
2004 -- S 2317
SUBSTITUTE B AS AMENDED
Enacted 07/02/04
A N A C T
RELATING
TO DETERMINATION OF NEED FOR NEW HEALTH CARE EQUIPMENT AND NEW INSTITUTIONAL
HEALTH SERVICES
Introduced
By: Senators Perry, Goodwin, F Caprio, DaPonte, and Pichardo
Date
Introduced: February 10, 2004
It
is enacted by the General Assembly as follows:
SECTION
1. Section 23-15-4 of the General Laws in Chapter 23-15 entitled
"Determination
of Need for New Health Care Equipment and New Institutional Health
Services"
is
hereby amended to read as follows:
23-15-4.
Review and approval of new health care equipment and new institutional
health
services. --
(a) No health care provider or health care facility shall develop or offer new
health
care equipment or new institutional health services in Rhode Island, the
magnitude of
which
exceeds the limits defined by this chapter, without prior review by the health
services
council
and approval by the state agency; except that review by the health services
council may
be
waived in the case of expeditious reviews conducted in accordance with section
23-15-5, and
except
that health maintenance organizations which fulfill criteria to be established
in rules and
regulations
promulgated by the state agency with the advice of the health services council
shall be
exempted
from the review and approval requirement established in this section upon
approval by
the
state agency of an application for exemption from the review and approval
requirement
established
in this section which contain any information that the state agency may require
to
determine
if the health maintenance organization meets the criteria.
(b) No approval shall be made without an adequate demonstration of need by the
applicant
at the time and place and under the circumstances proposed, nor shall the
approval be
made
without a determination that a proposal for which need has been demonstrated is
also
affordable
by the people of the state.
(c) No approval of new institutional health services for the provision of
health services to
inpatients
shall be granted unless the written findings required in accordance with
section 23-15-
6(b)(6)
are made.
(d) Applications for determination of need shall be filed with the state agency
on a date
fixed
by the state agency together with plans and specifications and any other
appropriate data
and
information that the state agency shall require by regulation, and shall be
considered in
relation
to each other no less than once a year. A duplicate copy of each application
together with
all
supporting documentation shall be kept on file by the state agency as a public
record.
(e) The health services council shall consider, but shall not be limited to,
the following in
conducting
reviews and determining need:
(1) The relationship of the proposal to state health plans that may be
formulated by the
state
agency;
(2) The impact of approval or denial of the proposal on the future viability of
the
applicant
and of the providers of health services to a significant proportion of the
population
served
or proposed to be served by the applicant;
(3) The need that the population to be served by the proposed equipment or
services has
for
the equipment or services;
(4) The availability of alternative, less costly, or more effective methods of
providing
services
or equipment, including economies or improvements in service that could be
derived
from
feasible cooperative or shared services;
(5) The immediate and long term financial feasibility of the proposal, as well
as the
probable
impact of the proposal on the cost of, and charges for, health services of the
applicant;
(6) The relationship of the services proposed to be provided to the existing
health care
system
of the state;
(7) The impact of the proposal on the quality of health care in the state and
in the
population
area to be served by the applicant;
(8) The availability of funds for capital and operating needs for the provision
of the
services
or equipment proposed to be offered;
(9) The cost of financing the proposal including the reasonableness of the
interest rate,
the period
of borrowing, and the equity of the applicant in the proposed new institutional
health
service
or new equipment;
(10) The relationship, including the organizational relationship of the
services or
equipment
proposed, to ancillary or support services;
(11) Special needs and circumstances of those entities which provide a
substantial
portion
of their services or resources, or both, to individuals not residing within the
state;
(12) Special needs of entities such as medical and other health professional
schools,
multidisciplinary
clinics, and specialty centers; also, the special needs for and availability of
osteopathic
facilities and services within the state;
(13) In the case of a construction project:
(i) The costs and methods of the proposed construction, and
(ii) The probable impact of the construction project reviewed on the costs of
providing
health
services by the person proposing the construction project;
(14) Those appropriate considerations that may be established in rules and
regulations
promulgated
by the state agency with the advice of the health services council;
(15) The potential of the proposal to demonstrate or provide one or more
innovative
approaches
or methods for attaining a more cost effective and/or efficient health care
system;
(16) The relationship of the proposal to the need indicated in any requests for
proposals
issued
by the state agency. ;
(17)
The input of the community to be served by the proposed equipment and services
and
the people of the neighborhoods close to the health care facility who are
impacted by the
proposal;
(18)
The relationship of the proposal to any long-range capital improvement plan of
the
health
care facility applicant.
(f) In conducting its review, the health services council shall perform the
following:
(1) Within one hundred and fifteen (115) days after initiating its review,
which must be
commenced
no later than thirty-one (31) days after the filing of an application, the
health services
council
shall determine as to each proposal whether the applicant has demonstrated need
at the
time
and place and under the circumstances proposed, and in doing so may apply the
criteria and
standards
set forth in subsection (e) of this section; provided however, that a
determination of
need
shall not alone be sufficient to warrant a recommendation to the state agency
that a proposal
should
be approved. The director shall render his or her decision within five (5) days
of the
determination
of the health services council.
(2) Prior to the conclusion of its review in accordance with section
23-15-6(e), the health
services
council shall evaluate each proposal for which a determination of need has been
established
in relation to other proposals, comparing proposals with each other, whether
similar
or
not, establishing priorities among the proposals for which need has been
determined, and
taking
into consideration the criteria and standards relating to relative need and
affordability as
set
forth in subsection (e) of this section and section 23-15-6(f).
(3) At the conclusion of its review, the health services council shall make
recommendations
to the state agency relative to approval or denial of the new institutional
health
services
or new health care equipment proposed; provided that:
(i) The health services council shall recommend approval of only those
proposals found
to be
affordable in accordance with the provisions of section 23-15-6(f); and
(ii) If the state agency proposes to render a decision that is contrary to the
recommendation
of the health services council, the state agency must render its reasons for
doing
so in
writing.
(g) Approval of new institutional health services or new health care equipment
by the
state
agency shall be subject to conditions that may be prescribed by rules and
regulations
developed
by the state agency with the advice of the health services council, but those
conditions
must
relate to the considerations enumerated in subsection (e) and to considerations
that may be
established
in regulations in accordance with subsection (e)(14).
(h) The offering or developing of new institutional health services or health
care
equipment
by a health care facility without prior review by the health services council
and
approval
by the state agency shall be grounds for the imposition of licensure sanctions
on the
facility,
including denial, suspension, revocation, or curtailment or for imposition of
any
monetary
fines that may be statutorily permitted by virtue of individual health care
facility
licensing
statutes.
(i) No government agency and no hospital or medical service corporation
organized
under
the laws of the state shall reimburse any health care facility or health care
provider for the
costs
associated with offering or developing new institutional health services or new
health care
equipment
unless the health care facility or health care provider has received the
approval of the
state
agency in accordance with this chapter. Government agencies and hospital and
medical
service
corporations organized under the laws of the state shall, during budget
negotiations, hold
health
care facilities and health care providers accountable to operating efficiencies
claimed or
projected
in proposals which receive the approval of the state agency in accordance with
this
chapter.
(j) In addition, the state agency shall not make grants to, enter into contracts
with, or
recommend
approval of the use of federal or state funds by any health care facility or
health care
provider
which proceeds with the offering or developing of new institutional health
services or
new
health care equipment after disapproval by the state agency.
SECTION
2. Section 23-17-13 of the General Laws in Chapter 23-17 entitled
"Licensing
of
Health Care Facilities" is hereby amended to read as follows:
23-17-13.
Health services council. -- There shall be established a health
services council
consisting
of twenty-two (22) twenty-four (24) members, eight (8) of whom
shall be appointed by
the
speaker of the house, one of whose appointments shall represent hospital
service corporations,
six
(6) of whom shall be appointed by the president of the senate, one of whose
appointments
shall
represent hospitals and a second of whose appointments shall represent the
business
community,
and eight (8) ten (10) of whom shall be appointed by the
governor, one of whose
appoints
shall represent the state budget office, and a second of whose
appointment shall
represent
the department of human services. and two (2) of whom shall be
members of the
general
public that maintain his or her principal residence within fifteen hundred feet
(1500 ft.) of
a
licensed hospital.
The governor shall appoint members of the council in staggered
appointments,
three (3) members one year, two (2) members the next year, and two (2) members
the
year after that. All members shall serve until their successors are appointed
and qualified. In
the
month of February in each year, the governor shall appoint successors to the
members of the
council
whose terms shall expire in that year, to hold office commencing on the first
day of
March
in the year of appointment until the first day of March in the third year after
appointment
or
until their respective successors are appointed and qualified. Legislative
members shall serve
until
the end of their legislative term. Any vacancy of a member appointed which may
occur in
the
commission shall be filled by appointment by the respective appointing
authority for the
remainder
of the unexpired term. The council may also serve as an advisory council as
authorized
by
section 23-16-3.
SECTION
3. This act shall take effect upon passage.
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LC01577/SUB
B
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