law16417

Chapter 417

2016 -- H 7500 SUBSTITUTE A
Enacted 07/12/2016

A N A C T

RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTH-CARE FACILITIES

Introduced By: Representatives Serpa, McKiernan, Ackerman, O'Brien, and Shekarchi

Date Introduced: February 05, 2016

It is enacted by the General Assembly as follows:

SECTION 1. Sections 23-17-2, 23-17-4, 23-17-10, 23-17-10.2, 23-17-26, 23-17-40, 23-

17-43, 23-17-54 and 23-17-58 of the General Laws in Chapter 23-17 entitled "Licensing of

Health-Care Facilities" are hereby amended to read as follows:

23-17-2. Definitions. -- As used in this chapter:

(1) "Alzheimer's dementia special-care unit or program" means a distinct living

environment within a nursing facility that has been physically adapted to accommodate the

particular needs and behaviors of those with dementia. The unit provides increased staffing,;

therapeutic activities designed specifically for those with dementia,; and trains its staff on an

ongoing basis on the effective management of the physical and behavioral problems of those with

dementia. The residents of the unit/program have had a standard, medical-diagnostic evaluation

and have been determined to have a diagnosis of Alzheimer's dementia or another dementia.

(2) (i) "Change in operator" means a transfer by the governing body or operator of a

health-care facility to any other person (excluding delegations of authority to the medical or

administrative staff of the facility) of the governing body's authority to:

(A) Hire or fire the chief executive officer of the health-care facility;

(B) Maintain and control the books and records of the health-care facility;

(D) Adopt and enforce policies regarding operation of the health-care facility.

(ii) This definition is not applicable to circumstances wherein the governing body of a

health-care facility retains the immediate authority and jurisdiction over the activities enumerated

in subdivisions (2)(i)(A) -- (2)(i)(D).

(3) "Change in owner" means:

(i) In the case of a health-care facility which that is a partnership, the removal, addition,

or substitution of a partner which that results in a new partner acquiring a controlling interest in

the partnership;

(ii) In the case of a health-care facility which that is an unincorporated, solo

proprietorship, the transfer of the title and property to another person;

(iii) In the case of a health-care facility that is a corporation:

(A) A sale, lease exchange, or other disposition of all, or substantially all, of the property

and assets of the corporation; or

(B) A merger of the corporation into another corporation; or

corporation; or

(D) In the case of a health-care facility which that is a business corporation, any transfer

of corporate stock which that results in a new person acquiring a controlling interest in the

corporation; or

(E) In the case of a health-care facility which that is a nonbusiness corporation, any

change in membership which that results in a new person acquiring a controlling vote in the

corporation.

(4) "Clinician" means a physician licensed under title 5, chapter 37 of title 5; a nurse

licensed under title 5, chapter 34 of title 5; a psychologist licensed under title 5, chapter 44 of

title 5; a social worker licensed under title 5, chapter 39.1 of title 5; a physical therapist licensed

under title 5, chapter 40 of title 5; and a speech language pathologist or audiologist licensed

under title 5, chapter 48 of title 5.

(5) "Director" means the director of the Rhode Island state department of health.

(6) "Freestanding, emergency-care facility" means an establishment, place, or facility

that may be a public or private organization, structurally distinct and separate from a hospital;

staffed, equipped, and operated to provide prompt, emergency medical care. For the purposes of

this chapter, "emergency medical care" means services provided for a medical condition or

behavioral-health condition that is manifested by symptoms of sufficient severity that, in the

absence of immediate medical attention, could result in harm to the person or others; serious

impairment to bodily functions; serious dysfunction of any bodily organ or part; or development

or continuance of severe pain.

(6)(7) "Health-care facility" means any institutional health-service provider, facility, or

institution, place, building, agency, or portion thereof, whether a partnership or corporation,

whether public or private, whether organized for profit or not, used, operated, or engaged in

providing health-care services, including, but not limited to: hospitals; nursing facilities; home

nursing-care provider (which shall include skilled nursing services and may also include activities

allowed as a home-care provider or as a nursing service agency); home-care provider (which may

include services such as personal care or homemaker services); rehabilitation centers; kidney

disease treatment centers; health maintenance organizations; free-standing freestanding,

emergency-care facilities as defined in this section, and facilities providing surgical treatment to

patients not requiring hospitalization (surgi-centers); hospice care, and physician ambulatory-

surgery centers and podiatry ambulatory-surgery centers providing surgical treatment. The term

"health-care facility" also includes organized ambulatory-care facilities which that are not part of

a hospital but which that are organized and operated to provide health-care services to

outpatients, such as: central-services facilities serving more than one health-care facility or

health-care provider,; treatment centers,; diagnostic centers,; outpatient clinics,; infirmaries and

health centers,; school-based health centers, and neighborhood health centers. The term "health-

care facility" also includes a mobile, health-screening vehicle as defined in this section. The term

"health-care facility" shall not apply to organized, ambulatory-care facilities owned and operated

by professional service corporations as defined in chapter 5.1 of title 7, as amended (the

"Pprofessional Sservice Ccorporation Llaw"), or to a private practitioner's (physician, dentist, or

other health-care provider) office or group of the practitioners' offices (whether owned and/or

operated by an individual practitioner, alone or as a member of a partnership, professional service

corporation, organization, or association). Individual categories of health-care facilities shall be

defined in rules and regulations promulgated by the licensing agency with the advice of the health

services council. Rules and regulations concerning hospice care shall be promulgated with regard

to the "Standards of a Hospice Program of Care", promulgated by the National Hospice

Organization. Any provider of hospice care who provides hospice care without charge shall be

exempt from the licensing provisions of this chapter but shall meet the "Standards of a Hospice

Program of Care." Facilities licensed by the department of mental health, retardation, and

hospitals behavioral healthcare, developmental disabilities, and hospitals and the department

of human services, and clinical laboratories licensed in accordance with chapter 16.2 of this title,

as well as Christian Science institutions (also known as Christian Science Nursing Facilities)

listed and certified by the Commission for Accreditation of Christian Science Nursing

Organizations/Facilities, Inc. shall not be considered health-care facilities for purposes of this

chapter.

(7)(8) "Homemaker", or however else called, means a trained, non-professional worker

who performs related housekeeping services in the home for the sick, disabled, dependent, or

infirm, and as further defined by regulation; the director shall establish criteria for training.

(8)(9) "Hospital" means a person or governmental entity licensed in accordance with this

chapter to establish, maintain, and operate a hospital.

(9)(10) "Licensing agency" means the Rhode Island state department of health.

(10)(11) "Medical services" means any professional services and supplies rendered by,

or under the direction of, persons duly licensed under the laws of this state to practice medicine,

surgery, or podiatry that may be specified by any medical service plan. Medical service shall not

be construed to include hospital services.

(18)(12) "Mobile, health-screening vehicle" means a mobile vehicle, van, or trailer that

delivers primary and preventive health-care screening services, and:

(i) Does not maintain active contracts or arrangements with any health insurer subject to

regulation under chapters 20 or 42 of title 27;

(ii) Does not maintain active contracts or arrangements with another licensed health care

facility as that term is defined within this section; and

(iii) Does not provide medical services free of charge.

(11)(13) "Non-English speaker" means a person who cannot speak or understand, or has

difficulty in speaking or understanding, the English language, because he/she uses only, or

primarily, a spoken language other than English, and/or a person who uses a sign language and

requires the use of a sign-language interpreter to facilitate communication.

(12)(14) "Person" means any individual, trust or estate, partnership, corporation,

(including associations, joint stock companies, and insurance companies) state, or political

subdivision or instrumentality of a state.

(13)(15) "Physician ambulatory-surgery center" means an office, or portion of an office,

which that is utilized for the purpose of furnishing surgical services to the owner and/or

operator's own patients on an ambulatory basis, and shall include both single-practice, physician

ambulatory-surgery centers and multi-practice, physician ambulatory-surgery centers. A "single-

practice, physician ambulatory-surgery center" is a physician ambulatory center owned and/or

operated by a physician-controlled professional service corporation as defined in chapter 5.1 of

title 7 (the "Pprofessional Sservice Ccorporation Llaw"), or a physician-controlled limited

liability company (as defined in chapter 16 of title 7 (the "Llimited Lliability Ccompany Aact"))

in which no physician is an officer, shareholder, director, or employee of any other corporation

engaged in the practice of the same profession, or a private physician's office (whether owned

and/or operated by an individual practitioner, alone or as a member of a partnership, professional

service corporation, limited liability company, organization, or association). A "multi-practice,

physician ambulatory-surgery center" is a physician ambulatory-surgery center owned and/or

operated by a physician-controlled professional service corporation (as defined in the

Pprofessional Sservice Ccorporation Llaw) or a physician-controlled limited, liability company

(as defined in the Llimited Lliability Ccompany Aact) in which a physician is also an officer,

shareholder, director, or employee of another corporation engaged in the practice of the same

profession, or a group of physicians' offices (whether owned and/or operated by an individual

practitioner, alone or as a member of a partnership, professional service corporation, limited

liability company, organization, or association).

(14)(16) "Podiatry ambulatory-surgery center" means an office or portion of an office

which that is utilized for the purpose of furnishing surgical services to the owner and/or

operator's own patients on an ambulatory basis, and shall include both single-practice, podiatry

ambulatory-surgery centers and multi-practice podiatry ambulatory-surgery centers. A "single-

practice podiatry ambulatory-surgery center" is a podiatry ambulatory center owned and/or

operated by a podiatrist-controlled professional service corporation as (defined in chapter 5.1 of

title 7 (the "Pprofessional Sservice Ccorporation Llaw")), or a podiatrist-controlled limited

liability company (as defined in chapter 16 of title 7 (the "Llimited Lliability Ccompany Aact"))

in which no podiatrist is an officer, shareholder, director, or employee of any other corporation

engaged in the practice of the same profession, or a private podiatrist's office (whether owned

and/or operated by an individual practitioner, alone or as a member of a partnership, professional

service corporation, limited liability company, organization, or association). A "multi-practice,

podiatry ambulatory-surgery center" is a podiatry ambulatory-surgery center owned and/or

operated by a podiatry-controlled professional service corporation (as defined in the

Pprofessional Sservice Ccorporation Llaw) or a podiatry-controlled, limited liability company (as

defined in the Llimited Lliability Ccompany Aact) in which a podiatrist is also an officer,

shareholder, director, or employee of another corporation engaged in the practice of the same

profession, or a group of podiatrists' offices (whether owned and/or operated by a an individual

practitioner, alone or as a member of a partnership, professional service corporation, limited

liability company, organization, or association).

(15)(17) "Qualified interpreter" means a person who, through experience and/or training,

is able to translate a particular foreign language into English, with the exception of sign-language

interpreters who must be licensed in accordance with chapter 71 of title 5.

(16)(18) "Qualified, sign-language interpreter" means one who has been licensed in

accordance with the provisions of chapter 71 of title 5.

(17)(19) "School-based health center" means a facility located in an elementary or

secondary school that delivers primary and preventive health-care services to students on site.

(18) "Mobile, health-screening vehicle" means a mobile vehicle, van, or trailer that

delivers primary and preventive health-care screening services, and:

(i) Does not maintain active contracts or arrangements with any health insurer

subject to regulation under chapters 20 or 42 of title 27;

(ii) Does not maintain active contracts or arrangements with another licensed

health care facility as that term is defined within this section; and

(iii) Does not provide medical services free of charge.

23-17-4. License required for health-care facility operation. -- (a) No person acting

severally or jointly with any other person shall establish, conduct, or maintain a health-care

facility in this state without a license under this chapter; provided, however, that any person, firm,

corporation, or other entity that provides volunteer, registered and licensed practical nurses to the

public shall not be required to have a license as a health-care facility.

(b) Each location at which a health-care facility provides services shall be licensed;

provided, however, that a hospital or organized ambulatory-care facility shall be permitted to

provide, solely on an ambulatory basis, limited physician services, other limited, professional

health-care services, and/or other limited, professional mental-health-care services in conjunction

with services provided by and at community health centers, community mental-health centers,

organized ambulatory-care facilities or other licensed health-care facilities, physicians' offices,

and facilities operated by the department of corrections without establishing such locations as

additional licensed premises of the hospital or organized ambulatory-care facility; provided, that a

health-care facility licensed as an organized ambulatory-care facility in the state, may provide

services at other locations operated by that licensed organized ambulatory-care facility, without

the requirement of a separate, organized ambulatory-care facility license for such other locations.

For purposes of this section, an organized ambulatory-care facility or other licensed health-care

facility shall not include a freestanding, emergency-care facility. The department is further

authorized to adopt rules and regulations to accomplish the purpose of this section, including, but

not limited to, defining "limited physician services, other limited, professional health-care

services, and/or other limited, professional mental-health-care services."

(b) of this chapter shall be subject to negotiations between the hospitals, organized, ambulatory-

care facilities, and the payors, respectively, as defined in § 23-17.12-2.

23-17-10. Regulations, inspections, and investigations -- Certain hospitals required

to provide on-premises coverage by physician -- Uniform reports -- Data systems. -- (a) (1)

The licensing agency, with the advice of the health services council, shall, after a public hearing

pursuant to reasonable notice, adopt, amend, promulgate, and enforce rules, regulations, and

standards with respect to each category of health-care facility to be licensed under this chapter

that may be designed to further the accomplishment of the purposes of this chapter in promoting

safe and adequate treatment of individuals in health-care facilities in the interest of public health,

safety, and welfare. Provided, further, however, that all licensed medical, surgical, or obstetrical

hospitals (excepting those hospitals as defined in § 23-17-2, as amended, which maintain an on-

premises emergency room staffed by a licensed physician, resident, or intern at all times) and

freestanding, emergency-care facilities shall be required to protect their patients by providing on-

premises coverage by a licensed physician, resident, or intern at all times.

(2) In developing regulations for home nursing-care providers and home-care providers,

the director shall consider and adopt, where appropriate, standards of relevant, national

accrediting bodies. The director shall make, or cause to be made, quality improvement and

licensure inspections of each licensed, home nursing-care provider and home-care provider at a

minimum of once in a twelve- (12) month (12) period. These inspections shall include, but not be

limited to: home visits;, patient surveys;, and employee interviews.

(b) The licensing agency shall make, or cause to be made, any inspections and

investigations that it deems necessary, including medical records. The licensing agency, with the

advice of the health services council, shall also adopt, amend, promulgate, and enforce rules and

regulations to provide for a uniform system of reporting detailed financial and statistical data

pertaining to the operation, services, and facilities of the health-care facilities and the periodic

reporting shall, in accordance with the rules and regulations, be concerned with, but not limited

to, unit cost utilization charges of health-care facility services, financial condition of health-care

facilities, and quality of health-care facility care. The uniform reports shall also include

institutional plans that shall be prescribed in accordance with rules and regulations promulgated

by the licensing agency with the advice of the health services council. Each health-care facility

shall establish and maintain data systems to meet the requirements of any uniform system of

periodic reporting that may be prescribed in accordance with the provisions of this section. The

data shall be made available and be considered by the state agency concerned with the

reimbursement and/or utilization of health-care facility services.

23-17-10.2. Full financial disclosure by hospitals Full financial disclosure by

hospitals and freestanding, emergency-care facilities. -- Any hospital or freestanding,

emergency-care facility licensed under this chapter, other than state-operated hospitals, shall

annually submit to the director of the department of health:

(a) Public audited financial statements containing information concerning all hospital-

related or freestanding, emergency-care facility-related corporations, holding corporations, and

subsidiary corporations, whether for-profit or not-for-profit. Any hospital corporation, holding

corporation, or subsidiary corporation, whether for-profit or not-for-profit, which is not audited

by an independent public auditor due to limited activity or small size, shall submit a financial

statement certified by the chief executive officer of that corporation.

(b) Any hospital or freestanding, emergency-care facility licensed under this chapter,

other than state-operated hospitals, shall on or before January 1, 2014, and annually thereafter,

submit a summary of financial information contained in accordance with the following:

(1) Not-for-profit hospitals shall submit a summary of the information contained in

section 501(c), 527, or 4947(a)(1) of the internal revenue code 990 form, including:

(i) Its statement of financial position;

(ii) The verified total costs incurred by the hospital or freestanding, emergency-care

facility in providing health services;

(iii) Total payroll including fringe benefits, and any other remuneration of the top five

(5) highest compensated employees and/or contractors, identified by position description and

specialty;

(iv) The verified net costs of medical education; and

(v) Administrative expenses; as defined by the director of the department of health.

(2) For-profit hospitals and freestanding, emergency-care facilities shall submit the

information listed in (b)(1) of this section in a form approved by the department of health.

accountability advisory council, as established in § 23-81-4, and shall be made available to the

public for inspection.

23-17-26. Emergency health care. -- (a) Every health-care facility that has an

emergency medical-care unit, including freestanding, emergency-care facilities, shall provide to

every person prompt, life-saving, medical-care treatment in an emergency, and a sexual-assault

examination for victims of sexual assault, without discrimination on account of economic status

or source of payment, and without delaying treatment for the purpose of a prior discussion of the

source of payment unless the delay can be imposed without material risk to the health of the

person.

(b) Violations of this section shall be reported to the director of the state department of

health who shall investigate the violations as the director deems appropriate.

23-17-40. Hospital events reporting Hospital and freestanding, emergency-care

facility events reporting. -- (a) Definitions. - As used in this section, the following terms shall

have the following meanings:

(1) "Adverse event" means injury to a patient resulting from a medical intervention, and

not to the underlying condition of the patient.

(2) "Checklist of care" means predetermined steps to be followed by a team of health-

care providers before, during, or after a given procedure to decrease the possibility of adverse

effects and other patient harm by articulating standards of care.

(b) Reportable events as defined in subsection (c) shall be reported to the department of

health division of facilities regulation on a telephone number maintained for that purpose.

Hospitals and freestanding, emergency-care facilities shall report incidents as defined in

subsection (c) within twenty-four (24) hours of when the accident occurred or, if later, within

twenty-four (24) hours of receipt of information causing the hospital or freestanding, emergency-

care facility to believe that a reportable event has occurred.

(1) Fires or internal disasters in the facility which that disrupt the provisions of patient-

care services or cause harm to patients or personnel;

(2) Poisoning involving patients of the facility;

(3) Infection outbreaks as defined by the department in regulation;

(4) Kidnapping and inpatient psychiatric elopements and elopements by minors;

(5) Strikes by personnel;

(6) Disasters or other emergency situations external to the hospital or freestanding,

emergency-care facility environment which that adversely affect facility operations; and

(7) Unscheduled termination of any services vital to the continued safe operation of the

facility or to the health and safety of its patients and personnel.

(d) Any hospital or freestanding, emergency-care facility filing a report with the attorney

general's office concerning abuse, neglect, and mistreatment of patients, as defined in chapter

17.8 of this title, shall forward a copy of the report to the department of health. In addition, a copy

of all hospital notifications and reports made in compliance with the federal Safe Medical

Devices Act of 1990, 21 U.S.C. § 301 et seq., shall be forwarded to the department of health

within the time specified in the federal law.

(e) Any reportable incident in a hospital that results in patient injury, as defined in

subsection (f), shall be reported to the department of health with seventy-two (72) hours or when

the hospital has reasonable cause to believe that an incident, as defined in subsection (f), has

occurred. The department of health shall promulgate rules and regulations to include the process

whereby health-care professionals with knowledge of an incident shall report it to the hospital,;

requirements for the hospital to conduct a root-cause analysis of the incident or other appropriate

process for incident investigation and to develop and file a performance-improvement plan,; and

additional incidents to be reported that are in addition to those listed in subsection (f). In its

reports, no personal identifiers shall be included. The hospital shall require the appropriate

committee within the hospital to carry out a peer-review process to determine whether the

incident was within the normal range of outcomes, given the patient's condition. The hospital

shall notify the department of the outcome of the internal review, and if the findings determine

that the incident was within the normal range of patient outcomes, no further action is required. If

the findings conclude that the incident was not within the normal range of patient outcomes, the

hospital shall conduct a root-cause analysis or other appropriate process for incident investigation

to identify causal factors that may have lead to the incident and develop a performance-

improvement plan to prevent similar incidents from occurring in the future. The hospital shall

also provide to the department of health the following information:

(1) An explanation of the circumstances surrounding the incident;

(2) An updated assessment of the effect of the incident on the patient;

(3) A summary of current patient status, including follow-up care provided and post-

incident diagnosis;

(4) A summary of all actions taken to correct identified problems to prevent recurrence

of the incident and/or to improve overall patient care and to comply with other requirements of

this section.

(f) Incidents to be reported are those causing or involving:

(1) Brain injury;

(2) Mental impairment;

(3) Paraplegia;

(4) Quadriplegia;

(5) Any type of paralysis;

(6) Loss of use of limb or organ;

(7) Hospital stay extended due to serious or unforeseen complications;

(8) Birth injury;

(9) Impairment of sight or hearing;

(10) Surgery on the wrong patient;

(11) Subjecting a patient to a procedure other than that ordered or intended by the

patient's attending physician;

(12) Any other incident that is reported to their malpractice insurance carrier or self-

insurance program;

(13) Suicide of a patient during treatment or within five (5) days of discharge from an

inpatient or outpatient unit (if known);

(14) Blood transfusion error; and

(15) Any serious or unforeseen complication, that is not expected or probable, resulting

in an extended hospital stay or death of the patient.

(g) This section does not replace other reporting required by this chapter.

(h) Nothing in this section shall prohibit the department from investigating any event or

incident.

(i) All reports to the department under this section shall be subject to the provisions of §

23-17-15. In addition, all reports under this section, together with the peer-review records and

proceedings related to events and incidents so reported and the participants in the proceedings,

shall be deemed entitled to all the privileges and immunities for peer-review records set forth in §

23-17-25.

(j) The department shall issue an annual report by March 31 each year providing

aggregate, summary information on the events and incidents reported by hospitals and

freestanding, emergency-care facilities as required by this chapter. A copy of the report shall be

forwarded to the governor, the speaker of the house, the senate president, and members of the

health care quality steering committee established pursuant to § 23-17.17-6.

(k) The director shall review the list of incidents to be reported in subsection (f) above at

least biennially to ascertain whether any additions, deletions, or modifications to the list are

necessary. In conducting the review, the director shall take into account those adverse events

identified on the National Quality Forum's List of Serious Reportable Events. In the event the

director determines that incidents should be added, deleted, or modified, the director shall make

such recommendations for changes to the legislature.

23-17-43. Charity care requirements. -- Any new hospital or freestanding, emergency-

care facility licensee shall meet the statewide community standard for the provision of charity-

care services as a condition of initial and continued licensure. That standard shall be consistent

with guidelines established by the legislature in the charters of the existing hospitals in the state

which that hold charters from the legislature.

23-17-54. Provisions of interpreter services. -- (a) Every hospital and freestanding,

emergency-care facility shall, as a condition of initial or continued licensure, provide a qualified

interpreter, if an appropriate bilingual clinician is not available to translate, in connection with all

services provided to every non-English speaker who is a patient or seeks appropriate care and

treatment and is not accompanied or represented by an appropriate, qualified interpreter or a

qualified sign-language interpreter who has attained at least sixteen (16) years of age.

(b) Each hospital and freestanding, emergency-care facility shall post a multi-lingual

notice in conspicuous places setting forth the requirement in subsection (a) of this section in

English and the, at minimum, three (3) most-common foreign languages used by the hospital or

freestanding, emergency-care facility as determined by the hospital or freestanding, emergency-

care facility.

receipt of a benefit under any provisions of law restricting benefits or assistance on the basis of

immigrant status.

(d) Nothing in this section shall be construed to affect or limit any rights, remedies, or

obligations under chapter 24 of title 11 or under chapters 87 or 112 of title 42.

23-17-58. Documentation of pre-hospital exposure of emergency medical services

workers Documentation of pre-hospital and pre-freestanding, emergency-care facility

exposure of emergency medical services workers. -- Hospitals and freestanding, emergency-

care facilities shall be required to complete the hospital-related information requirements of the

pre-hospital exposure form for emergency service workers as required by § 23-4.1-19. Further,

the hospitals and freestanding, emergency-care facilities shall report to the director of the

department of health the information and data as may be required by regulation.

SECTION 2. Sections 23-4.1-7.1 and 23-4.1-19 of the General Laws in Chapter 23-4.1

entitled "Emergency Medical Transportation Services" are hereby amended to read as follows:

23-4.1-7.1. Restocking of municipal ambulance supplies. -- (a) The director of health,

with the cooperation of hospitals and freestanding, emergency-care facilities licensed in

accordance with chapter 17 of this title, will develop a listing of supplies that are subject to

mandatory restocking in accordance with subsection (b) of this section.

(b) Every hospital and freestanding, emergency-care facility licensed in accordance with

chapter 17 of this title is required to restock supplies listed in accordance with subsection (a) of

this section that are used by a licensed, emergency-medical-services provider in transporting

emergency patients to hospitals or freestanding, emergency-care facilities licensed in accordance

with chapter 17 of this title. Restocking will not be required:

(1) In the absence of documentation of supply usage on the emergency patient's RI EMS

ambulance run report; or

(2) If the licensed, emergency-medical-services provider bills any third-party payer for

the supplies which that were used.

23-4.1-19. Documentation of pre-hospital exposure of emergency medical services

workers Documentation of pre-health-care facility exposure of emergency medical services

workers. -- (a) Any emergency-service worker responding on behalf of a licensed

ambulance/rescue service, or a fire department or a law-enforcement agency who has sufficient

reason to believe that, in the course of their professional duties, they have been exposed to bodily

fluids or other substances that may result in the worker contracting a serious infection and/or

illness shall complete a pre-hospital pre-health-care facility exposure form. The worker shall file

a copy of the form with the hospital or freestanding, emergency-care facility receiving the

transported patient believed to be the source of the infectious materials to which the worker

believes he or she has been exposed. The worker shall file the form with the hospital or

freestanding, emergency-care facility immediately post exposure. The worker shall retain a copy

of the completed form, except for that information protected by applicable confidentiality laws.

The source patient's diagnostic information shall not appear on the pre-hospital pre-health-care

facility exposure form.

(b) The director of the department of health, with the advice of the ambulance services

advisory board, shall develop the pre-hospital pre-health-care facility exposure form, and shall

make copies available to all agencies employing emergency medical service workers, and

hospitals and freestanding, emergency-care facilities.

SECTION 3. Section 23-15-2 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:

23-15-2. Definitions. -- As used in this chapter:

(1) "Affected person" means and includes the person whose proposal is being reviewed,

or the applicant, health-care facilities located within the state which that provide institutional

health services, the state medical society, the state osteopathic society, those voluntary nonprofit

area-wide planning agencies that may be established in the state, the state budget office, the office

of health insurance commissioner, any hospital or medical-service corporation organized under

the laws of the state, the statewide health coordinating council, contiguous health-systems

agencies, and those members of the public who are to be served by the proposed, new,

institutional health services or new health-care equipment.

(2) "Cost-impact analysis" means a written analysis of the effect that a proposal to offer

or develop new, institutional health services or new health-care equipment, if approved, will have

on health-care costs and shall include any detail that may be prescribed by the state agency in

rules and regulations.

(3) "Director" means the director of the Rhode Island state department of health.

(4) (i) "Health-care facility" means any institutional health-service provider, facility or

institution, place, building, agency, or portion of them, whether a partnership or corporation,

whether public or private, whether organized for profit or not, used, operated, or engaged in

providing health-care services, which that are limited to hospitals, nursing facilities, home

nursing-care provider, home-care provider, hospice provider, inpatient rehabilitation centers

(including drug and/or alcohol abuse treatment centers), freestanding, emergency-care facilities as

defined in §23-17-2, certain facilities providing surgical treatment to patients not requiring

hospitalization (surgi-centers, multi-practice, physician ambulatory-surgery centers and multi-

practice, podiatry ambulatory-surgery centers) and facilities providing inpatient hospice care.

Single-practice physician or podiatry ambulatory-surgery centers (as defined in subdivisions 23-

17-2(13) and 23-17-2(14), respectively) are exempt from the requirements of chapter 15 of this

title; provided, however, that such exemption shall not apply if a single-practice physician or

podiatry ambulatory-surgery center is established by a medical practice group (as defined in § 5-

37-1) within two (2) years following the formation of such medical practice group, when such

medical practice group is formed by the merger or consolidation of two (2) or more medical

practice groups or the acquisition of one medical practice group by another medical practice

group. The term "health-care facility" does not include Christian Science institutions (also known

as Christian Science nursing facilities) listed and certified by the Commission for Accreditation

of Christian Science Nursing Organizations/Facilities, Inc.

(ii) Any provider of hospice care who provides hospice care without charge shall be

exempt from the provisions of this chapter.

(5) "Health-care provider" means a person who is a direct provider of health-care

services (including but not limited to physicians, dentists, nurses, podiatrists, physician assistants,

or nurse practitioners) in that the person's primary current activity is the provision of health-care

services for persons.

(6) "Health services" means organized program components for preventive, assessment,

maintenance, diagnostic, treatment, and rehabilitative services provided in a health-care facility.

(7) "Health services council" means the advisory body to the Rhode Island state

department of health established in accordance with chapter 17 of this title, appointed and

empowered as provided to serve as the advisory body to the state agency in its review functions

under this chapter.

(8) "Institutional health services" means health services provided in or through health-

care facilities and includes the entities in or through which that the services are provided.

(9) "New health-care equipment" means any single piece of medical equipment (and any

components which that constitute operational components of the piece of medical equipment)

proposed to be utilized in conjunction with the provision of services to patients or the public, the

capital costs of which would exceed two million two hundred fifty thousand dollars ($2,250,000);

provided, however, that the state agency shall exempt from review any application which that

proposes one-for-one equipment replacement as defined in regulation. Further, beginning July 1,

2012, and each July thereafter, the amount shall be adjusted by the percentage of increase in the

consumer price index for all urban consumers (CPI-U) as published by the United States

dDepartment of lLabor sStatistics as of September 30 of the prior calendar year.

(10) "New institutional health services" means and includes:

(i) Construction, development, or other establishment of a new health-care facility.

(ii) Any expenditure, except acquisitions of an existing health-care facility, which that

will not result in a change in the services or bed capacity of the health-care facility by, or on

behalf of, an existing health-care facility in excess of five million two hundred fifty thousand

dollars ($5,250,000) which is a capital expenditure including expenditures for predevelopment

activities; provided further, beginning July 1, 2012, and each July thereafter, the amount shall be

adjusted by the percentage of increase in the consumer price index for all urban consumers (CPI-

U) as published by the United States dDepartment of lLabor sStatistics as of September 30 of the

prior calendar year.

(iii) Where a person makes an acquisition by, or on behalf of, a health-care facility or

health maintenance organization under lease or comparable arrangement or through donation,

which would have required review if the acquisition had been by purchase, the acquisition shall

be deemed a capital expenditure subject to review.

(iv) Any capital expenditure which that results in the addition of a health service or

which that changes the bed capacity of a health-care facility with respect to which the

expenditure is made, except that the state agency may exempt from review, by rules and

regulations promulgated for this chapter, any bed reclassifications made to licensed, nursing

facilities and annual increases in licensed bed capacities of nursing facilities that do not exceed

the greater of ten (10) beds or ten percent (10%) of facility licensed bed capacity and for which

the related capital expenditure does not exceed two million dollars ($2,000,000).

(v) Any health service proposed to be offered to patients or the public by a health-care

facility which that was not offered on a regular basis in or through the facility within the twelve-

(12) month (12) period prior to the time the service would be offered, and which that increases

operating expenses by more than one million five hundred thousand dollars ($1,500,000), except

that the state agency may exempt from review, by rules and regulations promulgated for this

chapter, any health service involving reclassification of bed capacity made to licensed nursing

facilities. Further, beginning July 1, 2012, and each July thereafter, the amount shall be adjusted

by the percentage of increase in the consumer price index for all urban consumers (CPI-U) as

published by the United States dDepartment of lLabor sStatistics as of September 30 of the prior

calendar year.

(vi) Any new or expanded tertiary or specialty-care service, regardless of capital expense

or operating expense, as defined by and listed in regulation, the list not to exceed a total of twelve

(12) categories of services at any one time and shall include full-body magnetic resonance

imaging and computerized axial tomography; provided, however, that the state agency shall

exempt from review any application which that proposes one-for-one equipment replacement as

defined by and listed in regulation. Acquisition of full body magnetic resonance imaging and

computerized axial tomography shall not require a certificate-of-need review and approval by the

state agency if satisfactory evidence is provided to the state agency that it was acquired for under

one million dollars ($1,000,000) on or before January 1, 2010, and was in operation on or before

July 1, 2010.

(11) "Person" means any individual, trust or estate, partnership, corporation (including

associations, joint stock companies, and insurance companies), state or political subdivision, or

instrumentality of a state.

(12) "Predevelopment activities" means expenditures for architectural designs, plans,

working drawings, and specifications, site acquisition, professional consultations, preliminary

plans, studies, and surveys made in preparation for the offering of a new, institutional health

service.

(13) "State agency" means the Rhode Island state department of health.

(14) "To develop" means to undertake those activities which that, on their completion,

will result in the offering of a new, institutional health service or new health-care equipment or

the incurring of a financial obligation, in relation to the offering of that service.

(15) "To offer" means to hold oneself out as capable of providing, or as having the

means for the provision of, specified health services or health-care equipment.

SECTION 4. This act shall take effect upon passage.

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LC004411/SUB A

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