ARTICLE 10

RELATING TO HEALTH AND HUMAN SERVICES

     SECTION 1. Sections 23-15-2, 23-15-4, 23-15-4.1, 23-15-4.2, 23-15-4.4, 23-15-5, 23-15-

6, 23-15-6.1, 23-15-10, and 23-15-11 of the General Laws in Chapter 23-15 entitled "Determination

of Need for New Healthcare Equipment and New Institutional Health Services” are hereby

amended to read as follows:

     23-15-2. Definitions.

     As used in this chapter:

     (1) “Accessible” or “accessibility” means the ability of underserved populations to access

healthcare and as may be further defined in rules and regulations promulgated by the department.

     (1) (2) “Affected person” means and includes the person whose proposal is being reviewed,

or the applicant, healthcare facilities located within the state that provide institutionaal 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 healthcare equipment.

     (3) “Affordable” means the relative ability of the people of the state to pay for, or incur the

cost, resulting from the proposed determination of need and as may be further defined in rules and

regulations promulgated by the department.

     (4) “Applicant” means the person who has submitted a request for a certificate of need

review and approval in accordance with this chapter.

     (5) “Capital expenditure” means the total non-recurring expenditures for physical

improvements, acquisition of existing buildings, land, and/or interests in land, including costs

associated therewith in excess of fifty million dollars ($50,000,000) and as may be further defined

in rules and regulations promulgated by the department. Further, beginning on July 1, 2026 and

each July thereafter, the amount of the threshold 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

Department of Labor Statistics as of September 30 of the prior calendar year. Expenditures related

to electronic health and management information systems shall not be considered capital

expenditures for the purposes of this chapter.

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

develop new institutional health services or new healthcare equipment, if approved, will have on

healthcare costs and shall include any detail that may be prescribed by the state agency in rules and

regulations.

     (6) “Department” means the Rhode Island department of health.

     (3) (7) “Director” means the director of the Rhode Island state department of health.

     (4)(i) (8) “Healthcare 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 healthcare services that are limited to hospitals, nursing facilities, home nursing-care

provider, home-care provider, hospice provider, inpatient rehabilitation hospital centers (including

drug and/or alcohol abuse treatment centers), and 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 § 23-17-2(17), (18), 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 “healthcare 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) (9) “Healthcare provider” means a person who is a direct provider of health services

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

or nurse practitioners) in that where the person’s primary current activity is the provision of

healthcare services for persons.

     (6) (10) “Health services” means organized program components for preventive,

assessment, maintenance, diagnostic, treatment, and rehabilitative services provided in a healthcare

facility.

     (7) (11) “Health services council” means the advisory body to the Rhode Island state

department of health established in accordance with chapter 17-13.1 of this title, appointed and

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

functions under this chapter.

     (12) “Innovation” means 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

healthcare system as may be further defined in rules and regulations promulgated by the

department.

     (8) (13) “Institutional health services” means health services provided in or through

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

     (9) (14) “New healthcare equipment” means linear accelerators and positron emission

tomography (PET). , any single piece of medical equipment (and any components 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 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 Department of Labor Statistics as of September 30 of the prior

calendar year.

     (10) (15) “New institutional health services” means and includes:

     (i) Construction, development, or other establishment of a new healthcare facility.

     (ii) Any capital expenditure as defined herein. , except acquisitions of an existing

healthcare facility, that will not result in a change in the services or bed capacity of the healthcare

facility by, or on behalf of, an existing healthcare 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 Department of Labor Statistics as of

September 30 of the prior calendar year.

     (iii) Where a person makes an acquisition by, or on behalf of, a healthcare 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 increase in capital expenditure that results in the addition of a health service or

that changes the bed capacity of a licensed hospital. healthcare 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 healthcare

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

(12) period prior to the time the service would be offered, and 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

Department of Labor Statistics as of September 30 of the prior calendar year.

     (vi) (v) Any new or expanded tertiary or specialty-care service in the following areas:

cardiac catheterization, obstetrics, open heart surgery, organ transplantation, and neonatal intensive

care services. , 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 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) (16) “Person” means any individual, trust or estate, partnership, corporation (including

associations, joint stock companies, limited liability corporations, 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) (17) “To develop” means to undertake those activities that, on their completion, will

result in the offering of a new, institutional health service or new healthcare equipment or the

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

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

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

     23-15-4. Review and approval of new health care equipment and new institutional

     health services.

     (a) No health care healthcare provider or health care healthcare facility person 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 department state agency; except that review by the

health services council may be waived in the case of expeditious reviews conducted in accordance

with § 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 and

accessible 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 § 23-15-6(b)(6)

are made.

     (d) (c) Applications for determination of need shall be filed with the department state

agency on a date fixed by the state agency together with plans and specifications and any other

appropriate data and information that the department 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 department state

agency as a public record.

     (e) (d) The health services council shall may consider, but shall not be limited to, the

following in conducting reviews and determining need: In its recommendations to the department,

the health services council may assess criteria, including but not limited to, affordability,

accessibility, innovation and quality standards, as further defined in regulations adopted by the

department.

     (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,

     (ii) The probable impact of the construction project reviewed on the costs of providing

health services by the person proposing the construction project; and

     (iii) The proposed availability and use of safe patient handling equipment in the new or

renovated space to be constructed.

     (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.

     (19) Cost impact statements forwarded pursuant to subsection 23-15-6(e).

     (f) (e) 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 make recommendations to the department relative to approval or denial of the new

institutional health services or new health care equipment proposed. 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,

in writing, his or her decision within five (5) ten (10) days of the determination of the health services

council.

     (2) Prior to the conclusion of its review in accordance with § 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 § 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 § 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) (f) Approval of new institutional health services or new health care equipment by the

department state agency shall may be subject to conditions as necessary to promote affordability,

accessibility, innovation, and quality standards. 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) (g) 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 department 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) (h) No government agency and no hospital or medical service corporation organized

under the laws of the state shall reimburse any person 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 person health care facility or health care provider has received the

approval of the department 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) (i) In addition, the department state agency shall not make grants to, enter into contracts

with, or recommend approval of the use of federal or state funds by any person 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 department state agency.

     (j) The department may promulgate regulations as are necessary to effectuate the purposes

of this chapter.

     23-15-4.1. Exemption for nonclinical capital expenditures.

     Notwithstanding the requirements of any other provisions of any general or public laws,

capital expenditures by a health care facility that are not directly related to the provision of health

services as defined in this chapter, including, but not limited to, capital expenditures for parking

lots, billing computer systems, and telephone, shall not require a certificate of need review and

approval by the department state agency.

     23-15-4.2. Exemption for Research

     Notwithstanding the requirements of any other provisions of any general or public laws,

capital expenditures by a health care facility related to research in basic biomedical or medical

research areas that are not directly related to the provision of clinical or patient care services shall

not require a certificate of need review and approval by the department state agency.

     23-15-4.4. Exemption for voter approved capital bond issues and other state capital

     funds for health care facilities.

     Notwithstanding the requirements of any other provisions of any general law or public

laws, voter approved state bond issues authorizing capital expenditures and any appropriations or

authorization of state capital funds by the General Assembly for state health care facilities shall not

require a certificate of need review and approval by the department state agency.

     23-15-5. Expeditious review.

     (a) Any person who proposes to offer or develop new institutional health services or new

healthcare equipment for documented emergency needs; or for the purpose of eliminating or

preventing documented fire or safety hazards affecting the lives and health of patients or staff; or

for compliance with accreditation standards required for receipt of federal or state reimbursement;

or for any other purpose that the state agency may specify as may be further defined in rules and

regulations promulgated by the department, may apply for an expeditious review. The department

state agency may exercise its discretion in recommending approvals through an expeditious review,

except that no new institutional health service or new healthcare equipment may be approved

through the expeditious review if provision of the new institutional health service or new healthcare

equipment is contra-indicated by the state health plan as may be formulated by the state agency.

Specific procedures for the conduct of expeditious reviews shall be promulgated in rules and

regulations adopted by the department state agency with the advice of the health services council.

     (b) The decision of the state agency not to conduct an expeditious review shall be

reconsidered upon a written petition to the state agency, and the state agency shall be required to

respond to the written petition within ten (10) days stating whether expeditious review is granted.

If the request for reconsideration is denied, the state agency shall state the reasons in writing why

the expeditious request had been denied.

     (c) The decision of the state agency in connection with an expeditious review shall be

rendered within thirty (30) days after the commencement of said review.

     (d) Any healthcare facility that provides a service performed in another state and that is not

performed in the state of Rhode Island, or such service is performed in the state on a very limited

basis, shall be granted expeditious review upon request under this section, provided that such

service, among other things, has a clear effect on the timeliness, access, or quality of care and is

able to meet licensing standards.

     23-15-6. Procedures for review.

     (a) The department state agency, with the advice of the health services council, and in

accordance with the Administrative Procedures Act, chapter 35 of title 42, after public hearing

pursuant to reasonable notice, which notice shall include affected persons, shall promulgate

appropriate rules and regulations that may be designated to further the accomplishment of the

purposes of this chapter including the formulation of procedures that may be particularly necessary

for the conduct on of reviews of particular types of new institutional health services or new health

care equipment.

     (b) Review procedures promulgated in accordance with subsection (a) shall include at least

the following, except that substitute procedures for the conduct of expeditious and accelerated

reviews may be promulgated by the department state agency in accordance with § 23-15-5:

     (1) Provision that the department state agency established a process requiring potential

applicants to file a detailed letter of intent to submit an application at least forty-five (45) days prior

to the submission of an application and that the state agency shall undertake reviews in a timely

fashion no less often than twice a year and give written notification to affected persons of the

beginning of the review. including the proposed schedule for the review, the period within which

a public meeting may be held, and the manner by which notification will be provided of the time

and place of any public meeting so held.

     (2) Provision that no more than one hundred and twenty (120) days shall elapse between

initial notification of affected persons and the final decision of the state agency.

     (3) (2) Provision that, if the department state agency fails to act upon an application within

the applicable period established in subsection (b)(2) § 23-15-4(e)(1), the applicant may apply to

the superior court of Providence County to require the department state agency to act upon the

application.

     (4) (3) Provision for review and comment by the health services council and comment by

any affected person, including but not limited to those parties defined in § 23-15-2(1) and the

department of business regulation, the department of behavioral healthcare, developmental

disabilities and hospitals, the department of human services, health maintenance organizations, and

the state professional standards review organization, on every application for the determination of

need.

     (5) Provision that a public meeting may be held during the course of the state agency review

at which any person may have the opportunity to present testimony. Procedures for the conduct of

the public meeting shall be established in rules and regulations promulgated by the state agency

with the advice of the health services council.

     (6) (4)(i) Provision for issuance of a written decision by the department state agency which

shall be based upon address and consider the findings and recommendations of the health services

council unless the department state agency shall afford written justification for variance from that

decision.

     (ii) In the case of any proposed new institutional health service for the provision of health

services to inpatients, a state agency shall not make a finding that the proposed new institutional

health service is needed, unless it makes written findings recommendations as to:

     (A) The efficiency and appropriateness of the use of existing inpatient facilities providing

inpatient services similar to those proposed;

     (B) The capital and operating costs (and their potential impact on patient charges),

efficiency, and appropriateness of the proposed new institutional health services; and

     (C) Makes each of the following findings in writing:

     (I) That superior alternatives to inpatient services in terms of cost, efficiency, and

appropriateness do not exist and that the development of alternatives is not practicable;

     (II) That, in the case of new construction, alternatives to new construction (e.g.,

modernization or sharing arrangements) have been considered and implemented to the maximum

extent practicable;

     (III) That patients will experience serious problems in terms of costs, availability, or

accessibility, or any other problems that may be identified by the state agency, in obtaining inpatient

care of the type proposed in the absence of the proposed new service; and

     (IV) That, in the case of a proposal for the addition of beds for the provision of skilled

nursing or intermediate care, the relationship of the addition to the plans of other agencies of the

state responsible for providing and financing long-term care (including home health services) has

been considered.

     (7) (5) Provision for the distribution of the decision of the department state agency,

including its findings and recommendations, to the applicant and to affected persons.

     (8) (6) Provision that the department state agency may approve or disapprove in whole or

in part any application as submitted, but that the parties may mutually agree to a modification of

any element of an application as submitted, without requiring resubmission of the application.

     (9) (7)(i) Provision that any person affected may request in writing reconsideration of a

state agency decision if the person:

     (A) Presents significant relevant information not previously considered by the state

agency;

     (B) Demonstrates that there have been significant changes in factors or circumstances

relied upon by the state agency in reaching its decision;

     (C) Demonstrates that the state agency has materially failed to follow its adopted

procedures in reaching its decision; or

     (D) Provides any other basis for reconsideration that the state agency may have determined

by regulation to constitute good cause.

     (ii) Procedures for reconsideration upon request of the applicant shall be established in

regulations promulgated by the department state agency with the advice of the health services

council.

     (10) (8) Provision that upon the request of any affected person, the decision of the state

agency to issue, deny, or withdraw a certificate of need or to grant or deny an exemption shall be

administratively reviewed under an appeals mechanism provided for in the rules and regulations of

the state agency, with the review to be conducted by a hearing officer appointed by the director of

health. The procedures for judicial review shall be in accordance with the provisions of § 42-35-

15. Provision for appeal by the applicant of the department's decision in accordance with § 42-35-

15.1(a).

     (c) The department state agency shall publish, at least annually, a report of reviews of new

institutional health services and new health care equipment conducted, together with the findings

and decisions rendered in the course of the reviews. The reports shall be published on or about

February 1 of each year and shall contain evaluations of the prior year’s statutory changes where

feasible.

     (d) All applications reviewed by the department state agency and all written materials

pertinent to the department’s state agency review, including minutes of all health services council

meetings, shall be accessible to the public upon request.

     (e) In the case or review of proposals by health care facilities who by contractual

agreement, chapter 19 of title 27, or other statute are required to adhere to an annual schedule of

budget or reimbursement determination to which the state is a party, the state budget office, the

office of the health insurance commissioner, and hospital service corporations organized under

chapter 19 of title 27 shall forward to the health services council within forty-five (45) days of the

initiation of the review of the proposals by the health services council under § 23-15-4(f)(1):

     (1) A cost impact analysis of each proposal which analysis shall include, but not be limited

to, consideration of increases in operating expenses, per diem rates, health care insurance

premiums, and public expenditures; and

     (2) Comments on acceptable interest rates and minimum equity contributions and/or

maximum debt to be incurred in financing needed proposals.

     (f) The health services council shall not make a recommendation to the state agency that a

proposal be approved unless it is found that the proposal is affordable to the people of the state. In

determining whether or not a proposal is affordable, the health service council shall consider the

condition of the state’s economy, the statements of authorities and/or parties affected by the

proposals, and any other factors that it may deem appropriate.

     23-15-6.1. Action subsequent to review.

     Development of any new institutional health services or new health care equipment

approved by the department state agency must be initiated within one two years of the date of the

approval and may not exceed the maximum amount of capital expenditures specified in the decision

of the state agency without prior authorization of the state agency. The department state agency,

with the advice of the health services council, shall adopt procedures promulgate rules and

regulations for the review of the applicant’s failure to develop new institutional health services or

new health care equipment within the timeframe and capital limitation stipulated in this section,

and for the withdrawal of approval in the absence of a good faith effort to meet the stipulated

timeframe.

     23-15-10. Application fees.

     The department state agency shall require that any applicant for certificate of need submit

an application fee prior to requesting any review of matters pursuant to the requirements of this

chapter; except that health care facilities and equipment owned and operated by the state of Rhode

Island shall be exempt from this application fee requirement. The application fee shall be paid by

check made payable to the general treasurer. Except for applications that propose new or expanded

tertiary or specialty care services as defined in subdivision 23-15-2(10)(vi) 23-15-2(15)(v),

submission of any application filed in accordance with § 23-15-4(d) shall include an application

fee of five hundred dollars ($500) per application plus an amount equal to one quarter of one percent

(0.25%) of the total capital expenditure costs associated with the application. For an application

filed in accordance with the requirements of § 23-15-5 (Expeditious review), the application shall

include an application processing fee of seven hundred and fifty dollars ($750) per application plus

an amount equal to one quarter of one percent (0.25%) of the total capital expenditure costs

associated with the application. Applications that propose new or expanded tertiary or specialty

care services as defined in subdivision 23-15-2(10)(vi) 23-15-2(15)(v), shall include an application

fee of ten thousand dollars ($10,000) plus an amount equal to one quarter of one percent (0.25%)

of the total capital expenditure costs associated with the application. Application fees shall be non-

refundable once the formal review of the application has commenced. All fees received pursuant

to this chapter shall be deposited in the general fund.

     23-15-11. Reports, use of experts, and all costs and expenses.

     The department state agency may in effectuating the purposes of this chapter engage

experts or consultants including, but not limited to, actuaries, investment bankers, accountants,

attorneys, or industry analysts. Except for privileged or confidential communications between the

department state agency and engaged attorneys, all copies of final reports prepared by experts and

consultants, and all costs and expenses associated with the reports, shall be public. All costs and

expenses incurred under this provision shall be the responsibility of the applicant in an amount to

be determined by the director as he or she shall deem appropriate. No application made pursuant to

the requirements of this chapter shall be considered complete unless an agreement has been

executed with the director for the payment of all costs and expenses in accordance with this section.

The maximum cost and expense to an applicant for experts and/or consultants that may be required

by the department state agency shall be fifty twenty thousand dollars ($20,000 $50,000); provided

however, that the maximum amount shall be increased by regulations promulgated by the state

agency on or after January 1, 2008 annually by the most recently available annual increase in the

federal consumer price index as determined by the department state agency.

     SECTION 2. Sections 23-17.5-32, 23-17.5-33, and 23-17.5-34 of the General Laws in

Chapter 23-17.5 entitled "Rights of Nursing Home Patients” are hereby amended to read as follows:

     23-17.5-32 Minimum staffing levels.

     (a) Each facility shall have the necessary nursing service personnel (licensed and non-

licensed) in sufficient numbers on a twenty-four (24) hour basis, to assess the needs of residents,

to develop and implement resident care plans, to provide direct resident care services, and to

perform other related activities to maintain the health, safety, and welfare of residents. The

facility shall have a registered nurse on the premises twenty-four (24) hours a day.

     (b) For purposes of this section, the following definitions shall apply:

     (1) “Direct caregiver” means a person who receives monetary compensation as an

employee of the nursing facility or a subcontractor as a director of nursing services, a nurse

(RNs/LPNs) with administrative duties, a registered nurse, a licensed practical nurse, a

medication technician, a certified nurse assistant, a licensed physical therapist, a physical therapy

assistant, a licensed occupational therapist, a certified occupational therapy assistant, a licensed

speech-language pathologist, a licensed respiratory care practitioner, a mental health worker who

is also a certified nurse assistant, a nurse aide in training, a social worker, or an activities

director/aide.

     (2) “Hours of direct nursing care” means the actual hours of work performed per patient

day by a direct caregiver.

     (c)(i) Commencing on January 1, 2022, nursing facilities shall provide a quarterly

minimum average of three and fifty-eight hundredths (3.58) hours of direct nursing care per

resident, per day, of which at least two and forty-four hundredths (2.44) hours shall be provided

by certified nurse assistants.

     (ii) Commencing on January 1, 2023, nursing facilities shall provide a quarterly

minimum of three and eighty-one hundredths (3.81) hours of direct nursing care per resident, per

day, of which at least two and six tenths (2.6) hours shall be provided by certified nurse assistants

     (iii) Commencing on July 1, 2025, nursing facilities shall provide a quarterly minimum

of three and eighty-one hundredths (3.81) hours of direct nursing care per resident per day of

which at least two and two tenths (2.2) hours shall be provided by certified nursing assistants

(CNAs), certified nursing assistants (CNAs) who are specially trained and licensed as medication

aides, and nurse aides in training.

     (d) Director of nursing hours and nursing staff hours spent on administrative duties or

non-direct caregiving tasks are excluded and may not be counted toward compliance with the

minimum staffing hours requirement in this section.

     (e)(d) The minimum hours of direct nursing care requirements shall be minimum

standards only. Nursing facilities shall employ and schedule additional staff as needed to ensure

quality resident care based on the needs of individual residents and to ensure compliance with all

relevant state and federal staffing requirements.

     (f)(e) The department shall promulgate rules and regulations to amend the Rhode Island

code of regulations in consultation with stakeholders to implement these minimum staffing

requirements on or before October 15, 2021.

     (g)On or before January 1, 2024, and every five (5) years thereafter, the department shall

consult with consumers, consumer advocates, recognized collective bargaining agents, and

providers to determine the sufficiency of the staffing standards provided in this section and may

promulgate rules and regulations to increase the minimum staffing ratios to adequate levels.

     23-17.5-33. Minimum staffing level compliance and enforcement program.

     (a) Compliance determination.

     (1) The department shall submit proposed rules and regulations for adoption by October

15, 2021, establishing a system for determining compliance with minimum staffing requirements

set forth in § 23-17.5-32.

     (2) Compliance shall be determined quarterly by comparing the number of hours

provided per resident, per day using the Centers for Medicare and Medicaid Services’ payroll-

based journal and the facility’s daily census, as self-reported by the facility to the department on a

quarterly basis.

     (3) The department shall use the quarterly payroll-based journal and the self-reported

census to calculate the number of hours provided per resident, per day and compare this ratio to

the minimum staffing standards required under § 23-17.5-32. Discrepancies between job titles

contained in § 23-17.5-32 and the payroll-based journal shall be addressed by rules and

regulations.

     (b) Monetary penalties.

     (1) The department shall submit proposed rules and regulations for adoption on or before

October 15, 2021, implementing monetary penalty provisions for facilities not in compliance with

minimum staffing requirements set forth in § 23-17.5-32.

     (2) Monetary penalties shall be imposed quarterly and shall be based on the latest quarter

for which the department has data.

     (3) No monetary penalty may be issued for noncompliance with the increase in the

standard set forth in § 23-17.5-32(c)(ii) from January 1, 2023, to March 31, 2023. If a facility is

found to be noncompliant with the increase in the standard during the period that extends from

January 1, 2023, to March 31, 2023, the department shall provide a written notice identifying the

staffing deficiencies and require the facility to provide a sufficiently detailed correction plan to

meet the statutory minimum staffing levels.

     (4) Monetary penalties shall be established based on a formula that calculates on a daily

basis the cost of wages and benefits for the missing staffing hours.

     (5) All notices of noncompliance shall include the computations used to determine

noncompliance and establishing the variance between minimum staffing ratios and the

department’s computations.

     (6) The penalty for the first offense shall be two hundred percent (200%) of the cost of

wages and benefits for the missing staffing hours. The penalty shall increase to two hundred fifty

percent (250%) of the cost of wages and benefits for the missing staffing hours for the second

offense and three hundred percent (300%) of the cost of wages and benefits for the missing

staffing hours for the third and all subsequent offenses.

     (7) For facilities that have an offense in three (3) consecutive quarters, EOHHS shall

deny any further Medicaid Assistance payments with respect to all individuals entitled to benefits

who are admitted to the facility on or after January 1, 2022, or shall freeze admissions of new

residents.

     (c)(1) The penalty shall be imposed regardless of whether the facility has committed

other violations of this chapter during the same period that the staffing offense occurred.

     (2) The penalty may not be waived except as provided in subsection (c)(3) of this section,

but the department shall have the discretion to determine the gravity of the violation in situations

where there is no more than a ten percent (10%) deviation from the staffing requirements and

make appropriate adjustments to the penalty.

     (2) Beginning July 1, 2025, the Department shall impose a fine of up to one thousand

dollars ($1,000.00) per day for each day in a quarter in which a facility fails to comply with the

minimum nursing staff requirements for the quarterly average, unless mitigating factors exist.

The department may reduce penalties, to an amount no lower than two hundred and fifty dollars

($250.00) per day in a quarter that a facility is non-compliant, if the department determines, in its

sole discretion, that any of the following mitigating circumstances existed during the period of

non-compliance:

(a) (i) Extraordinary circumstances faced the facility. For the purposes of this clause,

     extraordinary circumstances shall mean that the facility experienced a natural disaster; a

     national emergency affecting the facility has been officially declared; a State or

     municipal emergency affecting the facility has been declared; or the facility experienced

     a catastrophic event that caused physical damage to the facility or impaired the ability of

     facility personnel to access the facility. Provided, however, that the facility must first

     demonstrate, to the satisfaction of the department that such extraordinary circumstances

     could not have been prevented or mitigated through effective implementation of any of

     the facility’s emergency plans, or

(b) (ii) An acute labor supply shortage of nurse aides, certified nurse aides, licensed

     practical nurses, or registered nurses exists in the metropolitan and nonmetropolitan area

     in which the facility is located, as such areas are defined by the federal Bureau of Labor

     Statistics.

     (3) The department is granted discretion to waive the penalty when unforeseen

circumstances have occurred that resulted in call-offs of scheduled staff. This provision shall be

applied no more than two (2) times per calendar year.

     (3) A nursing facility may seek from the Department a waiver of the minimum direct care

staffing requirements required hereunder. In deciding on the waiver request, the Director’s

determination shall be based on one or more of the following:

     (i) the acuity levels of residents and how stable those levels are based on the case mix of

residents;

     (ii) documented evidence of the facility’s inability to meet minimum staffing

requirements, despite best efforts, such as offering wages at competitive rates for nursing facility

staff in the community;

     (iii) whether the facility has undergone a system-wide culture change as described in §

23-17-44(d) and the impact the facility asserts that such change has had on resident care; and

     (iv) the quality performance of the nursing facility, as evidenced by a four- or five-star

overall rating from the Centers for Medicare or Medicaid Services (“CMS”), or a four- or five-

star overall rating in the areas of quality or staffing, or consistent survey performance with no

deficiencies at the substandard level of care scope and severity or higher.

     Waivers may be granted for periods up to one year, after which a renewal must be

requested by the facility. The Department may seek input from the Rhode Island Department of

Labor and Training concerning labor availability in connection with any waiver request under this

section.

     (4) Nothing in this section diminishes a facility’s right to appeal pursuant to the

provisions of chapter 35 of title 42 (“administrative procedures”).

     (d)(1) Pursuant to rules and regulations established by the department, funds that are

received from financial penalties shall be used for technical assistance or specialized direct care

staff training.

     (2) The assessment of a penalty does not supplant the state’s investigation process or

issuance of deficiencies or citations under this title.

     (3) A notice of noncompliance, whether or not the penalty is waived, and the penalty

assessment shall be prominently posted in the nursing facility and included on the department’s

website.

     (4) Fines for periods prior to the third quarter of 2025 shall be waived and forgiven.

     23-17.5-34. Nursing staff posting requirements.

     (a) Each nursing facility shall post its daily direct care nurse staff levels by shift in a

public place within the nursing facility that is readily accessible to and visible by residents,

employees, and visitors. The posting shall be accurate to the actual number of direct care nursing

staff on duty for each shift per day. The posting shall be in a format prescribed by the director, to

include:

     (1) The number of registered nurses, licensed practical nurses, certified nursing assistants,

medication technicians, licensed physical therapists, licensed occupational therapists, licensed

speech-language pathologists, mental health workers who are also certified nurse assistants, and

physical therapist assistants;

     (2) The number of temporary, outside agency nursing staff;

     (3) The resident census as of twelve o’clock (12:00) a.m.; and

     (4) Documentation of the use of unpaid eating assistants (if utilized by the nursing facility

on that date).

     (b) The posting information shall be maintained on file by the nursing facility for no less

than three (3) years and shall be made available to the public upon request.

     (c) Each nursing facility shall report the information compiled pursuant to section (a) of

this section and in accordance with department of health regulations to the department of health

on a quarterly basis in an electronic format prescribed by the director. The director shall make

this information available to the public on a quarterly basis on the department of health website,

accompanied by a written explanation to assist members of the public in interpreting the

information reported pursuant to this section.

     (d) In addition to the daily direct nurse staffing level reports, each nursing facility shall

post the following information in a legible format and in a conspicuous place readily accessible to

and visible by residents, employees, and visitors of the nursing facility:

     (1) The minimum number of nursing facility direct care staff per shift that is required to

comply with the minimum staffing level requirements in § 23-17.5-32; and

     (2) The telephone number or internet website that a resident, employee, or visitor of the

nursing facility may use to report a suspected violation by the nursing facility of a regulatory

requirement concerning staffing levels and direct patient care.

     (e) No nursing facility shall discharge or in any manner discriminate or retaliate against

any resident of any nursing facility, or any relative, guardian, conservator, or sponsoring agency

thereof or against any employee of any nursing facility or against any other person because the

resident, relative, guardian, conservator, sponsoring agency, employee, or other person has filed

any complaint or instituted or caused to be instituted any proceeding under this chapter, or has

testified or is about to testify in any such proceeding or because of the exercise by the resident,

relative, guardian, conservator, sponsoring agency, employee, or other person on behalf of

himself, herself, or others of any right afforded by §§ 23-17.5-32, 23-17.5-33, and 23-17.5-34.

Notwithstanding any other provision of law to the contrary, any nursing facility that violates any

provision of this section shall:

     (1) Be liable to the injured party for treble damages; and

     (2)(i) Reinstate the employee, if the employee was terminated from employment in

violation of any provision of this section; or

     (ii) Restore the resident to the resident’s living situation prior to such discrimination or

retaliation, including the resident’s housing arrangement or other living conditions within the

nursing facility, as appropriate, if the resident’s living situation was changed in violation of any

provision of this section. For purposes of this section, “discriminate or retaliate” includes, but is

not limited to, the discharge, demotion, suspension, or any other detrimental change in terms or

conditions of employment or residency, or the threat of any such action.

     (f)(1) The nursing facility shall prepare an annual report showing the average daily direct

care nurse staffing level for the nursing facility by shift and by category of nurse to include:

     (i) Registered nurses;

     (ii) Licensed practical nurses;

     (iii) Certified nursing assistants;

     (iv) Medication technicians;

     (v) Licensed physical therapists;

     (vi) Licensed occupational therapists;

     (vii) Licensed speech-language pathologists;

     (viii) Mental health workers who are also certified nurse assistants;

     (ix) Physical therapist assistants;

     (x) The use of registered and licensed practical nurses and certified nursing assistant staff

     from temporary placement agencies; and Director of nursing services;

     (xi) The nurse and certified nurse assistant turnover rates. Nurse (RNs/LPNs) with

     administrative duties,

     (xii) Certified Occupational Therapy Assistants;

     (xiii) Licensed Respiratory Care Practitioner:

     (xiv) Social Workers;

     (xv) Activities Director/aides;

     (xvi) nurse aide in training;

     (xvii) The use of registered and licensed practical nurses and certified nursing assistant

     staff from temporary placement agencies; and

     (xviii) The nurse and certified nurse assistant turnover rates.

     (2) The annual report shall be submitted with the nursing facility’s renewal application

and provide data for the previous twelve (12) months and ending on or after September 30, for the

year preceding the license renewal year. Annual reports shall be submitted in a format prescribed

by the director.

     (g) The information on nurse staffing shall be reviewed as part of the nursing facility’s

annual licensing survey and shall be available to the public, both in printed form and on the

department’s website, by nursing facility.

     (h) The director of nurses may act as a charge nurse only when the nursing facility is

licensed for thirty (30) beds or less.

     (i) Whenever the licensing agency determines, in the course of inspecting a nursing

facility, that additional staffing is necessary on any residential area to provide adequate nursing

care and treatment or to ensure the safety of residents, the licensing agency may require the

nursing facility to provide such additional staffing and any or all of the following actions shall be

taken to enforce compliance with the determination of the licensing agency:

     (1) The nursing facility shall be cited for a deficiency and shall be required to augment its

staff within ten (10) days in accordance with the determination of the licensing agency;

     (2) If failure to augment staffing is cited, the nursing facility shall be required to curtail

admission to the nursing facility;

     (3) If a continued failure to augment staffing is cited, the nursing facility shall be

subjected to an immediate compliance order to increase the staffing, in accordance with § 23-1-

21; or

     (4) The sequence and inclusion or non-inclusion of the specific sanctions may be

modified in accordance with the severity of the deficiency in terms of its impact on the quality of

resident care.

     (j) No nursing staff of any nursing facility shall be regularly scheduled for double shifts.

     (k) A nursing facility that fails to comply with the provisions of this chapter, or any rules

or regulations adopted pursuant thereto, shall be subject to a penalty as determined by the

department.

     SECTION 3. Section 33-21.1-23 of the General Laws Chapter 33-21.1 entitled “Deposit

of funds” is hereby amended to read as follows:

     33-21.1-23. Deposit of funds.

     (a) Except as otherwise provided by this section, the administrator shall promptly deposit

in the general fund of this state all funds received under this chapter, Rhode Island Baby Bond

Trust a one-time $3,000 allocation for each designated beneficiary as defined in § 35-24-1 born in

the preceding calendar year, including the proceeds from the sale of abandoned property under § 33-21.1-22

§ 33-21.1-22. The administrator shall promptly deposit all remaining funds into the general fund of

this state, including the proceeds from the sale of abandoned property under § 33-21.1-22. The

administrator shall retain in a separate bank account an amount not less than one hundred thousand

dollars ($100,000) from which prompt payment of claims duly allowed must be made by him or

her. Before making the deposit, the administrator shall record the name and last known address of

each person appearing from the holders’ reports to be entitled to the property and the name and last

known address of each insured person or annuitant and beneficiary and with respect to each policy

or contract listed in the report of an insurance company its number and the name of the company.

The record with the exception of the amount due must be available for public inspection at all

reasonable business hours.

     (b) Before making any transfer from the account surplus pursuant to subsection (a) to the

credit of the general fund, the administrator may deduct:

     (1) Any costs in connection with the sale of abandoned property;

     (2) Costs of mailing and publication in connection with any abandoned property;

     (3) Reasonable service charges;

     (4) Costs incurred in examining records of holders of property and in collecting the

property from those holders; and

     (5) Any other charges, costs or expenses incurred in the administration of this chapter.

     SECTION 4. Title 35 of the General Laws entitled “Public Finance” is hereby amended by

adding thereto the following chapter:

CHAPTER 24

RHODE ISLAND BABY BOND TRUST

     35-24-1. Definitions.

     As used in this chapter:

     (1) “Designated beneficiary” means an individual who is: (i) born on or after January 1,

2026; and (ii) whose parent or guardian is enrolled in the Rhode Island Works Program pursuant

to R.I. Gen. Laws § 40-5.2-1, et seq. within the first twelve (12) months of their life.

     (2) “Eligible expenditure” means an expenditure associated with any of the following:

     (i) Continuing education of a designated beneficiary at an institution of higher learning,

trade school, vocational school, or professional apprenticeship program in Rhode Island;

     (ii) Ownership of a home in Rhode Island by a designated beneficiary;

     (iii) Ownership of a business with a principal place of business in Rhode Island by a

designated beneficiary; or

     (iv) Any investment in financial assets or personal capital that provides long-term gains to

wages or wealth, as defined by regulation promulgated by the general treasurer.

     (3) “Trust” means the Rhode Island Baby Bond Trust, which consists of:

     (i) All money from public or private sources appropriated or made available to the state for

the benefit of the Trust; and

     (ii) All earnings on the money in the trust.

     35-24-2. Establishment.

     (a) There is hereby established the Rhode Island Baby Bond Trust. The trust shall constitute

an instrumentality of the state and shall perform essential governmental functions as provided under

the provisions of this chapter. The trust shall receive and hold all payments and deposits or

contributions intended for the trust, as well as gifts, bequests, endowments or federal, state or local

grants and any other funds from any public or private source and all earnings until disbursed in

accordance with § 35-24-7.

     (b) The amounts on deposit in the trust shall not constitute property of the state and the

trust shall not be construed to be a department, institution or agency of the state. Amounts on

deposit in the trust shall not be commingled with state funds and the state shall have no claim to or

against, or interest in, such funds. Any contract entered into by, or any obligation of, the trust shall

not constitute a debt or obligation of the state and the state shall have no obligation to any

designated beneficiary or any other person on account of the trust and all amounts obligated to be

paid from the trust shall be limited to amounts available for such obligation on deposit in the trust.

The amounts on deposit in the trust may only be disbursed in accordance with the provisions of this

chapter. The trust shall continue in existence as long as it holds any deposits or has any obligations

and until its existence is terminated by law. Upon termination, any unclaimed assets shall return to

the state.

     (c) The general treasurer shall be responsible for the receipt, maintenance, administration,

investigation, and disbursements from the trust. The trust shall not receive deposits in any form

other than cash.

     35-24-3. Powers of the general treasurer.

     (a) The general treasurer, on behalf of the trust and for purposes of the trust, may:

     (1) Receive and invest moneys in the trust in any instruments, obligations, securities or

property in accordance with the provisions of this chapter;

     (2) Enter into one or more contractual agreements, including contracts for legal, actuarial,

accounting, custodial, advisory, management, administrative, advertising, marketing and

consulting services from the trust and pay for such services from the gains and earnings of the trust;

     (3) Procure insurance in connection with the trust’s property, assets, activities or deposits

to the trust;

     (4) Apply for, accept and expend gifts, grants or donations from public or private sources

to enable the trust to carry out its objectives;

     (5) Adopt rules and regulations it deems necessary to effectuate the purposes of this

chapter;

     (6) Sue and be sued;

     (7) Establish one or more funds within the trust and maintain separate accounts for each

designated beneficiary; and

     (8) Take any other action necessary to effectuate the purposes of this chapter, and incidental

to the duties imposed on the general treasurer pursuant to this chapter.

     (b) The general treasurer shall create a process within the office of the general treasurer to

determine whether an expenditure proposed by a designated beneficiary is an eligible expenditure

before the designated beneficiary is to receive any distribution under § 35-24-7.

     35-24-4. Investment of funds in the trust.

     Notwithstanding the provisions of § 35-10-12 to § 35-10-14, inclusive, the general

treasurer shall invest the amounts on deposit in the trust in a manner reasonable and appropriate to

achieve the objectives of the trust, exercising the discretion and care of a prudent person in similar

circumstances with similar objectives. The general treasurer shall give due consideration to rate of

return, risk, term or maturity, diversification of the portfolio within the trust, liquidity, the projected

disbursements of the total portfolio within the trust, liquidity, the projected disbursements and

expenditures and the expected payments, deposits, contributions and gifts to be received. The

general treasurer shall not require the trust to invest directly in obligations of the state or any

political subdivision of the state or in any investment or other fund administered by the general

treasurer. The assets of the trust shall be continuously invested and reinvested in a manner

consistent with the objectives of the trust until disbursed for eligible expenditures as defined by this

act or expended on expenses incurred by the operations of the trust.

     35-24-5. Exemption from taxation.

     (a) The property of the trust and the earnings on the trust shall be exempt from all taxation

by the state and all political subdivisions of the state. Distributions made pursuant to § 35-24-7

shall be considered income subject to taxation in accordance with chapter 30 title 44 and shall be

subject to federal and state withholdings.

     (b) The tax administrator may adopt rules and regulations necessary to monitor, implement,

and administer the Rhode Island personal income tax provisions referred to in subsection (a) of this

section.

     35-24-6. Moneys invested in trust not considered assets or income.

     Except as otherwise required by federal law, any money deposited into the trust and

credited to a designated beneficiary, and any increase in the values thereof, shall not be used to

calculate the personal assets of a designated beneficiary for purposes of determining income

eligibility of the designated beneficiary for state or local assistance programs including:

     (1) Any disability, medical or other health benefits administered by the state; and

     (2) Any student loan program, student grant program or other student financial program

administered by the state.

     35-24-7. Accounting for designated beneficiary. Claim for accounting.

     (a) The general treasurer shall establish in the Rhode Island Baby Bond Trust an accounting

for each designated beneficiary. Each such account shall include the amount transferred to the trust

pursuant to § 35-24-8, plus the designated beneficiary’s pro rata share of total net earnings from

investments of sums as determined by the general treasurer and held in the trust.

     (b) The Department of Human Services shall notify the office of the general treasurer of

the birth or enrollment of each designated beneficiary.

     (c) Upon a designated beneficiary’s eighteenth birthday, if such a beneficiary is a resident

of the state and has been for the two (2) years immediately preceding receipt of any distribution

under this section, such beneficiary shall become eligible to receive the total sum of the accounting

under subsection (a) of this section to be used for eligible expenditures.

     (d) A designated beneficiary must submit a claim that meets the requirements set forth in

this chapter before the designated beneficiary reaches thirty five (35) years of age.

     (e) If a designated beneficiary is deceased before their eighteenth birthday, does not submit

a timely claim, or is no longer a resident of the state upon reaching thirty five (35) years of age,

such accounting shall be credited back to the general fund of the state.

     (f) The general treasurer shall furnish each eligible beneficiary with an annual statement

relating to the individual’s accounting, which shall include:

     (1) A statement of the balance attributable to the individual;

     (2) A projection of the balance’s growth by the time the individual attains the age of

eighteen (18);

     (3) Resources and information to promote financial wellness and literacy of the designated

beneficiary; and

     (4) Such other information as the general treasurer deems relevant.

     35-24-8. Transfer to trust upon birth of designated beneficiary.

     (a) Upon the birth of a designated beneficiary, the general treasurer shall allocate three

thousand dollars ($3,000) from the trust to be credited toward the accounting of such designated

beneficiary pursuant to § 35-24-7.

     SECTION 5. This article shall take effect upon passage, except for section 3 and section 4,

which shall take effect on July 1, 2026.