2024 -- S 2870 | |
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LC005397 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2024 | |
____________ | |
A N A C T | |
RELATING TO HEALTH AND SAFETY -- MEDICAL SPAS SAFETY ACT | |
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Introduced By: Senator Alana DiMario | |
Date Introduced: March 22, 2024 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby |
2 | amended by adding thereto the following chapter: |
3 | CHAPTER 100 |
4 | MEDICAL SPAS SAFETY ACT |
5 | 23-100-1. Definitions. |
6 | For purposes of this chapter: |
7 | (1) "Ablative lasers or ablative energy devices" means lasers intended to excise or vaporize |
8 | the outer layer of skin. |
9 | (2) "Advanced practice registered nurse" or "APRN" means a registered nurse who has an |
10 | active, unrestricted advanced practice registered nurse license granted under the provisions of § 5- |
11 | 34-45. |
12 | (3) "Cosmetic medical procedure" means a medical procedure or treatment which alters or |
13 | reshapes normal structures of the body or ablates or removes living tissue to improve physical |
14 | appearance. Cosmetic medical procedures shall include, but are not limited to, injection of cosmetic |
15 | filling agents, injection of neuromodulators, use of light or laser devices to affect the skin, hair or |
16 | underlying soft tissue, chemical peels, injection of fat dissolving agents, sclerotherapy, and the use |
17 | of any type of energy sources used to change the structure or function of the skin or underlying soft |
18 | tissue. The performance of cosmetic medical services is the practice of medicine and surgery. A |
19 | cosmetic medical service shall be performed by a qualified licensed or certified non-physician only |
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1 | if the services have been delegated by a medical director, supervising physician, supervising PA, |
2 | or supervising APRN who is responsible for on-site supervision of the services performed. |
3 | (4) "Delegate" means a non-physician tasked with performing a procedure as defined in § |
4 | 23-100-3 by a physician. |
5 | (5) "Department" means the Rhode Island department of health. |
6 | (6) "Medical director" means a physician who assumes the role of, or holds oneself out as, |
7 | medical director at a medical spa. The medical director shall be: |
8 | (i) Trained in the indications for, and performance of, cosmetic medical procedures, |
9 | including all medical devices or instruments that can alter or cause biological change or damage |
10 | the skin and subcutaneous tissue. Training programs provided by a manufacturer or vendor of a |
11 | medical device or supplies shall not be a medical director's, supervising physician's, PA's or |
12 | APRN's only education in the cosmetic medical service or the operation of medical devices to be |
13 | used; |
14 | (ii) Responsible for implementing policies and procedures to ensure quality patient care; |
15 | (iii) Responsible for the delegation and supervision of cosmetic procedures; |
16 | (iv) Responsible for the oversight of all cosmetic medical procedures performed by |
17 | physicians, PAs, APRNs, and non-physicians; |
18 | (v) Responsible for ensuring that all supervising physicians, supervising PAs and |
19 | supervising APRNs, any physicians, PAs and APRNs performing cosmetic medical procedures, |
20 | and any non-physicians, non-PAs and non-APRNs delegated to perform cosmetic medical |
21 | procedures, are properly trained in the safe and effective performance of all cosmetic medical |
22 | procedures that they perform at the medical spa; and |
23 | (vi) Responsible to maintain the required medical malpractice insurance in accordance with |
24 | § 42-14.1-2. The certificate of insurance shall be displayed in a conspicuous location in the facility |
25 | where the cosmetic medical procedure is conducted. |
26 | (7) "Medical spa" means a licensed establishment in which cosmetic medical procedures |
27 | are performed. |
28 | (8) "Physician" means an allopath or osteopath who has an active unrestricted medical |
29 | license granted under the provisions of chapter 37 of title 5. |
30 | (9) "Physician assistant" or "PA" means a person who is qualified by academic and |
31 | practical training to provide medical and surgical services in collaboration with physicians pursuant |
32 | to chapter 54 of title 5, and is licensed pursuant to § 5-54-11. |
33 | (10) "Supervision" means an arrangement when a qualified supervising physician, |
34 | physician assistant or APRN is either: |
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1 | (i) On site and able to directly observe the treatment being performed, though not |
2 | necessarily in the same room (i.e., direct supervision); or |
3 | (ii) Is off site, but immediately available if needed, either in person or by |
4 | telecommunication (i.e., indirect supervision). |
5 | 23-100-2. Protection of patients in a medical spa. |
6 | (a) Each medical spa shall appoint a medical director who shall be: |
7 | (1) Trained in the indications for, and performance of, cosmetic medical procedures, |
8 | including all medical devices or instruments that can alter or cause biological change or damage to |
9 | the skin or subcutaneous tissue. Training programs provided by a manufacturer or vendor of a |
10 | medical device or supplies shall not be a medical director's, supervising physician's, supervising |
11 | PA's or APRN's only education in the cosmetic medical service or the operation of medical devices |
12 | to be used; |
13 | (2) Responsible for implementing policies and procedures to ensure quality patient care; |
14 | (3) Responsible for the delegation and supervision of cosmetic procedures; |
15 | (4) Responsible for developing and maintaining written office protocols for each cosmetic |
16 | medical procedure. The protocols shall be kept on site at the medical spa for review and/or |
17 | inspection by the department; |
18 | (5) Responsible for the oversight of all cosmetic medical procedures performed by |
19 | physicians, PAs, APRNs, and non-physicians; and |
20 | (6) Responsible for ensuring that all supervisory physicians, supervising PAs and |
21 | supervising APRNs, any physicians, PAs and APRNs performing cosmetic medical procedures, |
22 | and any non-physicians and non-APRNs delegated to perform cosmetic medical procedures, are |
23 | properly trained in the safe and effective performance of all cosmetic medical procedures that they |
24 | perform at the medical spa. |
25 | (b) A physician, PA or APRN who performs cosmetic medical procedures, or supervises |
26 | cosmetic medical procedures delegated to and performed by a non-physician, non-PA or non- |
27 | APRN, shall be trained in the indications for and performance of the cosmetic medical procedure. |
28 | An APRN who performs cosmetic medical procedures, or supervises cosmetic medical procedures |
29 | delegated to and performed by a non-physician, non-PA or non-APRN, shall be accredited by the |
30 | state board of nursing. |
31 | (c) The supervising physician, PA or APRN shall: |
32 | (1) Perform an initial assessment of the patient; |
33 | (2) Prepare a written treatment plan for each patient, which plan shall include, as |
34 | applicable, diagnoses, course of treatment, and specifications for any device being used; |
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1 | (3) Obtain patient consent, if the cosmetic medical procedure(s) are being performed by a |
2 | non-physician, non-PA or non-APRN and documenting, in the patient's medical record, the |
3 | credentials and names of the non-physician, non-PA or non-APRN who will be performing the |
4 | cosmetic medical procedure; and |
5 | (4) Create and maintain medical records in a manner consistent with applicable laws and |
6 | regulations and accepted medical practice. |
7 | (d) Non-physicians, non-PAs and non-APRNs shall only perform cosmetic medical |
8 | procedures: |
9 | (1) For which they have the requisite training; and |
10 | (2) Which have been delegated to them by a supervising physician, supervising PA or |
11 | supervising APRN. |
12 | (e) At all times in the performance of their duties relative to cosmetic medical procedures, |
13 | all providers shall: |
14 | (1) Review and follow written protocols for each delegated cosmetic medical procedure; |
15 | (2) Verify that the supervising physician, supervising PA or supervising APRN has |
16 | assessed the patient and given written treatment instructions for each procedure performed; |
17 | (3) Review the cosmetic medical procedure with each patient; |
18 | (4) Notify the medical director, as well as the supervising physician, supervising PA or |
19 | supervising APRN, before the patient leaves or as they become aware, of any adverse events or |
20 | complications, and follow up with the patient post-procedure, as appropriate; |
21 | (5) Document all relevant details of the performed cosmetic medical procedure in the |
22 | patient's medical record; and |
23 | (6) As applicable, satisfy any requirements imposed upon them by their licensing boards. |
24 | (f) The medical director is responsible for reporting all complications as reported by the |
25 | supervising physician, supervising PA or supervising APRN to the department. |
26 | (g) Cosmetic medical procedures using ablative lasers or ablative energy devices, dermal |
27 | fillers, platelet rich plasma injections, and any other energy source that involves the structure or |
28 | function beyond the mid-epidermis (such as medium depth chemical peels or radiofrequency micro |
29 | needling) shall only be performed by physicians, or may be performed by APRNs or PAs under the |
30 | direction of medical director who is on site at the time of the procedure. |
31 | (h) All cosmetic medical procedures as defined in this chapter, shall only be performed at |
32 | a licensed medical spa. |
33 | 23-100-3. Rules and regulations. |
34 | The department shall, by July 1, 2024, promulgate rules and regulations necessary and not |
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1 | inconsistent with law to implement the purpose and intent of this chapter, which rules and |
2 | regulations shall provide for, though not be limited to, the licensing of medical spas as health care |
3 | facilities. |
4 | SECTION 2. Section 23-17-2 of the General Laws in Chapter 23-17 entitled "Licensing of |
5 | Healthcare Facilities" is hereby amended to read as follows: |
6 | 23-17-2. Definitions. |
7 | As used in this chapter: |
8 | (1) “Affiliate” means a legal entity that is in control of, is controlled by, or is in common |
9 | control with another legal entity. |
10 | (2) “Alzheimer’s dementia special-care unit or program” means a distinct living |
11 | environment within a nursing facility that has been physically adapted to accommodate the |
12 | particular needs and behaviors of those with dementia. The unit provides increased staffing; |
13 | therapeutic activities designed specifically for those with dementia; and trains its staff on an |
14 | ongoing basis on the effective management of the physical and behavioral problems of those with |
15 | dementia. The residents of the unit/program have had a standard, medical-diagnostic evaluation |
16 | and have been determined to have a diagnosis of Alzheimer’s dementia or another dementia. |
17 | (3) “Certified nurse-teacher” means those personnel certified by the department of |
18 | elementary and secondary education and employed pursuant to the provisions of §§ 16-21-7 and |
19 | 16-21-8. |
20 | (4)(i) “Change in operator” means a transfer by the governing body or operator of a |
21 | healthcare facility to any other person (excluding delegations of authority to the medical or |
22 | administrative staff of the facility) of the governing body’s authority to: |
23 | (A) Hire or fire the chief executive officer of the healthcare facility; |
24 | (B) Maintain and control the books and records of the healthcare facility; |
25 | (C) Dispose of assets and incur liabilities on behalf of the healthcare facility; or |
26 | (D) Adopt and enforce policies regarding operation of the healthcare facility. |
27 | (ii) This definition is not applicable to circumstances wherein the governing body of a |
28 | healthcare facility retains the immediate authority and jurisdiction over the activities enumerated |
29 | in subsections (4)(i)(A) — (4)(i)(D). |
30 | (5) “Change in owner” means: |
31 | (i) In the case of a healthcare facility that is a partnership, the removal, addition, or |
32 | substitution of a partner that results in a new partner acquiring a controlling interest in the |
33 | partnership; |
34 | (ii) In the case of a healthcare facility that is an unincorporated, solo proprietorship, the |
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1 | transfer of the title and property to another person; |
2 | (iii) In the case of a healthcare facility that is a corporation: |
3 | (A) A sale, lease exchange, or other disposition of all, or substantially all, of the property |
4 | and assets of the corporation; or |
5 | (B) A merger of the corporation into another corporation; or |
6 | (C) The consolidation or two (2) or more corporations, resulting in the creation of a new |
7 | corporation; or |
8 | (D) In the case of a healthcare facility that is a business corporation, any transfer of |
9 | corporate stock that results in a new person acquiring a controlling interest in the corporation; or |
10 | (E) In the case of a healthcare facility that is a nonbusiness corporation, any change in |
11 | membership that results in a new person acquiring a controlling vote in the corporation. |
12 | (6) “Clinician” means a physician licensed under chapter 37 of title 5; a nurse licensed |
13 | under chapter 34 of title 5; a psychologist licensed under chapter 44 of title 5; a social worker |
14 | licensed under chapter 39.1 of title 5; a physical therapist licensed under chapter 40 of title 5; and |
15 | a speech language pathologist or audiologist licensed under chapter 48 of title 5 or physician |
16 | assistant licensed under the provisions of § 5-54-11. |
17 | (7) “Director” means the director of the Rhode Island state department of health. |
18 | (8) “Freestanding emergency-care facility” means an establishment, place, or facility that |
19 | may be a public or private organization, structurally distinct and separate from a hospital; staffed, |
20 | equipped, and operated to provide prompt, emergency medical care. For the purposes of this |
21 | chapter, “emergency medical care” means services provided for a medical condition or behavioral- |
22 | health condition that is manifested by symptoms of sufficient severity that, in the absence of |
23 | immediate medical attention, could result in harm to the person or others; serious impairment to |
24 | bodily functions; serious dysfunction of any bodily organ or part; or development or continuance |
25 | of severe pain. |
26 | (9) “Healthcare facility” means any institutional health-service provider, facility, or |
27 | institution, place, building, agency, or portion thereof, whether a partnership or corporation, |
28 | whether public or private, whether organized for profit or not, used, operated, or engaged in |
29 | providing healthcare services, including, but not limited to: hospitals; nursing facilities; home |
30 | nursing-care provider (which shall include skilled nursing services and may also include activities |
31 | allowed as a home-care provider or as a nursing service agency); home-care provider (which may |
32 | include services such as personal care or homemaker services); rehabilitation centers; kidney |
33 | disease treatment centers; health maintenance organizations; freestanding emergency-care facilities |
34 | as defined in this section, and facilities providing surgical treatment to patients not requiring |
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1 | hospitalization (surgi-centers); hospice care, and physician ambulatory-surgery centers and |
2 | podiatry ambulatory-surgery centers providing surgical treatment. The term “healthcare facility” |
3 | also includes organized ambulatory-care facilities that are not part of a hospital but that are |
4 | organized and operated to provide healthcare services to outpatients, such as: central-services |
5 | facilities serving more than one healthcare facility or healthcare provider; treatment centers; |
6 | diagnostic centers; outpatient clinics; medical spas as defined in § 23-100-1; infirmaries and health |
7 | centers; school-based health centers, and neighborhood health centers. The term “healthcare |
8 | facility” also includes a mobile health-screening vehicle as defined in this section. The term |
9 | “healthcare facility” shall not apply to organized, ambulatory-care facilities owned and operated |
10 | by professional service corporations as defined in chapter 5.1 of title 7, as amended (the |
11 | “professional service corporation law”), or to a practitioner’s (physician, dentist, or other healthcare |
12 | provider) office or group of practitioners’ offices (whether owned and/or operated by a hospital or |
13 | an affiliate of a hospital or an individual practitioner, alone or as a member of a partnership, |
14 | professional service corporation, organization, or association); provided, however, notwithstanding |
15 | any other provision herein or in the general laws, any hospital or any affiliate of a hospital that |
16 | owns and/or operates a practitioner’s office shall ensure that such practitioner’s office complies |
17 | with licensing or accreditation requirements that may be applicable to the practitioner’s office. |
18 | Individual categories of healthcare facilities shall be defined in rules and regulations promulgated |
19 | by the licensing agency with the advice of the health services council. Rules and regulations |
20 | concerning hospice care shall be promulgated with regard to the “Standards of a Hospice Program |
21 | of Care,” promulgated by the National Hospice Organization. Any provider of hospice care who |
22 | provides hospice care without charge shall be exempt from the licensing provisions of this chapter |
23 | but shall meet the “Standards of a Hospice Program of Care.” Facilities licensed by the department |
24 | of behavioral healthcare, developmental disabilities and hospitals and the department of human |
25 | services, and clinical laboratories licensed in accordance with chapter 16.2 of this title, as well as |
26 | Christian Science institutions (also known as Christian Science Nursing Facilities) listed and |
27 | certified by the Commission for Accreditation of Christian Science Nursing |
28 | Organizations/Facilities, Inc. shall not be considered healthcare facilities for purposes of this |
29 | chapter. |
30 | (10) “Homemaker,” or however else called, means a trained, nonprofessional worker who |
31 | performs related housekeeping services in the home for the sick, disabled, dependent, or infirm, |
32 | and as further defined by regulation; the director shall establish criteria for training. |
33 | (11) “Hospital” means a person or governmental entity licensed in accordance with this |
34 | chapter to establish, maintain, and operate a hospital. |
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1 | (12) “Licensing agency” means the Rhode Island state department of health. |
2 | (13) “Medical services” means any professional services and supplies rendered by, or under |
3 | the direction of, persons duly licensed under the laws of this state to practice medicine, surgery, or |
4 | podiatry that may be specified by any medical service plan. Medical service shall not be construed |
5 | to include hospital services. |
6 | (14) “Mobile health-screening vehicle” means a mobile vehicle, van, or trailer that delivers |
7 | primary and preventive healthcare screening services, and: |
8 | (i) Does not maintain active contracts or arrangements with any health insurer subject to |
9 | regulation under chapter 20 or 42 of title 27; |
10 | (ii) Does not maintain active contracts or arrangements with another licensed healthcare |
11 | facility as that term is defined within this section; and |
12 | (iii) Does not provide medical services free of charge. |
13 | (15) “Non-English speaker” means a person who cannot speak or understand, or has |
14 | difficulty in speaking or understanding, the English language, because he/she uses only, or |
15 | primarily, a spoken language other than English, and/or a person who uses a sign language and |
16 | requires the use of a sign-language interpreter to facilitate communication. |
17 | (16) “Person” means any individual, trust or estate, partnership, corporation (including |
18 | associations, joint stock companies, and insurance companies), state, or political subdivision or |
19 | instrumentality of a state. |
20 | (17) “Physician ambulatory-surgery center” means an office, or portion of an office, that |
21 | is utilized for the purpose of furnishing surgical services to the owner and/or operator’s own |
22 | patients on an ambulatory basis, and shall include both single-practice, physician ambulatory- |
23 | surgery centers and multi-practice, physician ambulatory-surgery centers. A “single-practice, |
24 | physician ambulatory-surgery center” is a physician ambulatory center owned and/or operated by |
25 | a physician-controlled professional service corporation as defined in chapter 5.1 of title 7 (the |
26 | “professional service corporation law”), or a physician-controlled limited-liability company (as |
27 | defined in chapter 16 of title 7 (the “limited liability company act”)) in which no physician is an |
28 | officer, shareholder, director, or employee of any other corporation engaged in the practice of the |
29 | same profession, or a private physician’s office (whether owned and/or operated by an individual |
30 | practitioner, alone or as a member of a partnership, professional service corporation, limited- |
31 | liability company, organization, or association). A “multi-practice, physician ambulatory-surgery |
32 | center” is a physician ambulatory-surgery center owned and/or operated by a physician-controlled |
33 | professional service corporation (as defined in the professional service corporation law) or a |
34 | physician-controlled limited-liability company (as defined in the limited liability company act) in |
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1 | which a physician is also an officer, shareholder, director, or employee of another corporation |
2 | engaged in the practice of the same profession, or a group of physicians’ offices (whether owned |
3 | and/or operated by an individual practitioner, alone or as a member of a partnership, professional |
4 | service corporation, limited-liability company, organization, or association). |
5 | (18) “Podiatry ambulatory-surgery center” means an office or portion of an office that is |
6 | utilized for the purpose of furnishing surgical services to the owner and/or operator’s own patients |
7 | on an ambulatory basis, and shall include both single-practice, podiatry ambulatory-surgery centers |
8 | and multi-practice podiatry ambulatory-surgery centers. A “single-practice podiatry ambulatory- |
9 | surgery center” is a podiatry ambulatory center owned and/or operated by a podiatrist-controlled |
10 | professional service corporation (as defined in chapter 5.1 of title 7 (the “professional service |
11 | corporation law”)), or a podiatrist-controlled limited-liability company (as defined in chapter 16 of |
12 | title 7 (the “limited liability company act”)) in which no podiatrist is an officer, shareholder, |
13 | director, or employee of any other corporation engaged in the practice of the same profession, or a |
14 | private podiatrist’s office (whether owned and/or operated by an individual practitioner, alone or |
15 | as a member of a partnership, professional service corporation, limited-liability company, |
16 | organization, or association). A “multi-practice, podiatry ambulatory-surgery center” is a podiatry |
17 | ambulatory-surgery center owned and/or operated by a podiatrist-controlled professional service |
18 | corporation (as defined in the professional service corporation law) or a podiatrist-controlled, |
19 | limited-liability company (as defined in the limited liability company act) in which a podiatrist is |
20 | also an officer, shareholder, director, or employee of another corporation engaged in the practice |
21 | of the same profession, or a group of podiatrists’ offices (whether owned and/or operated by an |
22 | individual practitioner, alone or as a member of a partnership, professional service corporation, |
23 | limited-liability company, organization, or association). |
24 | (19) “Qualified interpreter” means a person who, through experience and/or training, is |
25 | able to translate a particular foreign language into English, with the exception of sign-language |
26 | interpreters who must be licensed in accordance with chapter 71 of title 5. |
27 | (20) “Qualified sign-language interpreter” means one who has been licensed in accordance |
28 | with the provisions of chapter 71 of title 5. |
29 | (21) “School-based health center” means a facility located in an elementary or secondary |
30 | school licensed as a school-based health center that delivers primary and/or preventive healthcare |
31 | services to individuals to include, but not be limited to, students on site. |
32 | SECTION 3. Section 23-15-2 of the General Laws in Chapter 23-15 entitled |
33 | "Determination of Need for New Healthcare Equipment and New Institutional Health Services" is |
34 | hereby amended to read as follows: |
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1 | 23-15-2. Definitions. |
2 | As used in this chapter: |
3 | (1) “Affected person” means and includes the person whose proposal is being reviewed, or |
4 | the applicant, healthcare facilities located within the state that provide institutional health services, |
5 | the state medical society, the state osteopathic society, those voluntary nonprofit area-wide |
6 | planning agencies that may be established in the state, the state budget office, the office of health |
7 | insurance commissioner, any hospital or medical-service corporation organized under the laws of |
8 | the state, the statewide health coordinating council, contiguous health-systems agencies, and those |
9 | members of the public who are to be served by the proposed, new institutional health services or |
10 | new healthcare equipment. |
11 | (2) “Cost-impact analysis” means a written analysis of the effect that a proposal to offer or |
12 | develop new institutional health services or new healthcare equipment, if approved, will have on |
13 | healthcare costs and shall include any detail that may be prescribed by the state agency in rules and |
14 | regulations. |
15 | (3) “Director” means the director of the Rhode Island state department of health. |
16 | (4)(i) “Healthcare facility” means any institutional health-service provider, facility or |
17 | institution, place, building, agency, or portion of them, whether a partnership or corporation, |
18 | whether public or private, whether organized for profit or not, used, operated, or engaged in |
19 | providing healthcare services that are limited to hospitals, nursing facilities, home nursing-care |
20 | provider, home-care provider, hospice provider, inpatient rehabilitation centers (including drug |
21 | and/or alcohol abuse treatment centers), freestanding emergency-care facilities as defined in § 23- |
22 | 17-2, certain facilities providing surgical treatment to patients not requiring hospitalization (surgi- |
23 | centers, multi-practice, physician ambulatory-surgery centers and multi-practice, podiatry |
24 | ambulatory-surgery centers) and facilities providing inpatient hospice care. Single-practice |
25 | physician or podiatry ambulatory-surgery centers (as defined in § 23-17-2(17), (18), respectively) |
26 | are exempt from the requirements of chapter 15 of this title; provided, however, that such |
27 | exemption shall not apply if a single-practice physician or podiatry ambulatory-surgery center is |
28 | established by a medical practice group (as defined in § 5-37-1) within two (2) years following the |
29 | formation of such medical practice group, when such medical practice group is formed by the |
30 | merger or consolidation of two (2) or more medical practice groups or the acquisition of one |
31 | medical practice group by another medical practice group. Medical spas as defined in § 23-100-1 |
32 | are exempt from the requirements of chapter 15 of this title. The term “healthcare facility” does not |
33 | include Christian Science institutions (also known as Christian Science nursing facilities) listed and |
34 | certified by the Commission for Accreditation of Christian Science Nursing |
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1 | Organizations/Facilities, Inc. |
2 | (ii) Any provider of hospice care who provides hospice care without charge shall be exempt |
3 | from the provisions of this chapter. |
4 | (5) “Healthcare provider” means a person who is a direct provider of healthcare services |
5 | (including but not limited to physicians, dentists, nurses, podiatrists, physician assistants, or nurse |
6 | practitioners) in that the person’s primary current activity is the provision of healthcare services for |
7 | persons. |
8 | (6) “Health services” means organized program components for preventive, assessment, |
9 | maintenance, diagnostic, treatment, and rehabilitative services provided in a healthcare facility. |
10 | (7) “Health services council” means the advisory body to the Rhode Island state department |
11 | of health established in accordance with chapter 17 of this title, appointed and empowered as |
12 | provided to serve as the advisory body to the state agency in its review functions under this chapter. |
13 | (8) “Institutional health services” means health services provided in or through healthcare |
14 | facilities and includes the entities in or through that the services are provided. |
15 | (9) “New healthcare equipment” means any single piece of medical equipment (and any |
16 | components that constitute operational components of the piece of medical equipment) proposed |
17 | to be utilized in conjunction with the provision of services to patients or the public, the capital costs |
18 | of which would exceed two million two hundred fifty thousand dollars ($2,250,000); provided, |
19 | however, that the state agency shall exempt from review any application that proposes one-for-one |
20 | equipment replacement as defined in regulation. Further, beginning July 1, 2012, and each July |
21 | thereafter, the amount shall be adjusted by the percentage of increase in the consumer price index |
22 | for all urban consumers (CPI-U) as published by the United States Department of Labor Statistics |
23 | as of September 30 of the prior calendar year. |
24 | (10) “New institutional health services” means and includes: |
25 | (i) Construction, development, or other establishment of a new healthcare facility. |
26 | (ii) Any expenditure, except acquisitions of an existing healthcare facility, that will not |
27 | result in a change in the services or bed capacity of the healthcare facility by, or on behalf of, an |
28 | existing healthcare facility in excess of five million two hundred fifty thousand dollars ($5,250,000) |
29 | which is a capital expenditure including expenditures for predevelopment activities; provided |
30 | further, beginning July 1, 2012, and each July thereafter, the amount shall be adjusted by the |
31 | percentage of increase in the consumer price index for all urban consumers (CPI-U) as published |
32 | by the United States Department of Labor Statistics as of September 30 of the prior calendar year. |
33 | (iii) Where a person makes an acquisition by, or on behalf of, a healthcare facility or health |
34 | maintenance organization under lease or comparable arrangement or through donation, which |
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1 | would have required review if the acquisition had been by purchase, the acquisition shall be deemed |
2 | a capital expenditure subject to review. |
3 | (iv) Any capital expenditure that results in the addition of a health service or that changes |
4 | the bed capacity of a healthcare facility with respect to which the expenditure is made, except that |
5 | the state agency may exempt from review, by rules and regulations promulgated for this chapter, |
6 | any bed reclassifications made to licensed nursing facilities and annual increases in licensed bed |
7 | capacities of nursing facilities that do not exceed the greater of ten (10) beds or ten percent (10%) |
8 | of facility licensed bed capacity and for which the related capital expenditure does not exceed two |
9 | million dollars ($2,000,000). |
10 | (v) Any health service proposed to be offered to patients or the public by a healthcare |
11 | facility that was not offered on a regular basis in or through the facility within the twelve-month |
12 | (12) period prior to the time the service would be offered, and that increases operating expenses by |
13 | more than one million five hundred thousand dollars ($1,500,000), except that the state agency may |
14 | exempt from review, by rules and regulations promulgated for this chapter, any health service |
15 | involving reclassification of bed capacity made to licensed nursing facilities. Further, beginning |
16 | July 1, 2012, and each July thereafter, the amount shall be adjusted by the percentage of increase |
17 | in the consumer price index for all urban consumers (CPI-U) as published by the United States |
18 | Department of Labor Statistics as of September 30 of the prior calendar year. |
19 | (vi) Any new or expanded tertiary or specialty-care service, regardless of capital expense |
20 | or operating expense, as defined by and listed in regulation, the list not to exceed a total of twelve |
21 | (12) categories of services at any one time and shall include full-body magnetic resonance imaging |
22 | and computerized axial tomography; provided, however, that the state agency shall exempt from |
23 | review any application that proposes one-for-one equipment replacement as defined by and listed |
24 | in regulation. Acquisition of full body magnetic resonance imaging and computerized axial |
25 | tomography shall not require a certificate-of-need review and approval by the state agency if |
26 | satisfactory evidence is provided to the state agency that it was acquired for under one million |
27 | dollars ($1,000,000) on or before January 1, 2010, and was in operation on or before July 1, 2010. |
28 | (11) “Person” means any individual, trust or estate, partnership, corporation (including |
29 | associations, joint stock companies, and insurance companies), state or political subdivision, or |
30 | instrumentality of a state. |
31 | (12) “Predevelopment activities” means expenditures for architectural designs, plans, |
32 | working drawings, and specifications, site acquisition, professional consultations, preliminary |
33 | plans, studies, and surveys made in preparation for the offering of a new, institutional health |
34 | service. |
| LC005397 - Page 12 of 14 |
1 | (13) “State agency” means the Rhode Island state department of health. |
2 | (14) “To develop” means to undertake those activities that, on their completion, will result |
3 | in the offering of a new, institutional health service or new healthcare equipment or the incurring |
4 | of a financial obligation, in relation to the offering of that service. |
5 | (15) “To offer” means to hold oneself out as capable of providing, or as having the means |
6 | for the provision of, specified health services or healthcare equipment. |
7 | SECTION 4. This act shall take effect upon passage. |
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| LC005397 - Page 13 of 14 |
EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO HEALTH AND SAFETY -- MEDICAL SPAS SAFETY ACT | |
*** | |
1 | This act would provide that the performance of cosmetic medical services is the practice |
2 | of medicine and surgery. This act would also provide that a cosmetic medical service would be |
3 | performed by a qualified licensed or certified non-physician only if the services have been |
4 | delegated by a medical director, supervising physician, supervising physician assistant, or |
5 | supervising APRN who is responsible for on-site supervision of the services performed. |
6 | This act would take effect upon passage. |
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| LC005397 - Page 14 of 14 |