It is enacted by the General Assembly as follows:

SECTION 1. Section 23-15-2 of the General Laws in Chapter 23-15 entitled "Determination of Need for New Health Care Equipment and New Institutional Health Services" is hereby amended to read as follows:

23-15-2. Definitions. -- As used in this chapter: (1) "Person" means any individual, trust or estate, partnership, corporation (including associations, joint stock companies, and insurance companies), state, or political subdivision or instrumentality of a state.

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

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

(4) "Health services council" means the advisory body to the Rhode Island state department of health established in accordance with chapter 17 of this title, appointed and empowered as hereinafter provided to serve as the advisory body to the state agency in its review functions under this chapter.

(5) "Health care facility" means any institutional health service provider, facility or institution, place, building, agency, or portion thereof, whether a partnership or corporation, whether public or private, whether organized for profit or not, used, operated, or engaged in providing health care services, including, but not limited to hospitals; nursing facilities; home health agencies; inpatient rehabilitation centers (including drug and/or alcohol abuse treatment centers licensed by the department of mental health, retardation and hospitals pursuant to chapter 40.1-24 of the general laws); health maintenance organizations; free-standing emergency care facilities; and facilities providing surgical treatment to patients not requiring hospitalization (surgi-centers) and hospice care. The term "health care facility" also includes organized ambulatory care facilities which are not part of a hospital but which are organized and operated to provide health care services to outpatients such as central service facilities serving more than one health care facility or health care provider, treatment centers, diagnostic centers, outpatient clinics, infirmaries and health centers (including alcohol, drug abuse and mental health treatment centers) and neighborhood health centers; providing, however, that the term "health care facility" shall not apply to rehabilitation centers or organized ambulatory care facilities owned and operated by professional service corporations as defined in chapter 5.1 of title 7, as amended (the "Professional Service Corporation Law"), or to a private practitioner's (physician, dentist, or other health care provider) office or a group of such practitioners' offices (whether owned and/or operated by an individual practitioner, alone or as a member of a partnership, professional service corporation organization, or association). The term "health care facility" does not include Christian science institutions operated or {ADD (also known as Christian Science nursing facilities) ADD} listed and certified by the first church of Christ, scientist, Boston, Massachusetts. {ADD the Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc. ADD}

Any provider of hospice care who provides such hospice care without charge shall be exempt from the provisions of this chapter. A home health agency currently licensed pursuant to chapter 17 of title 23 which complies with the provisions of section 23-17-6 shall be exempt from the provisions of this chapter.

Any organized oupatient department of a hospital licensed by the Rhode Island department of health pursuant to chapter 23-17 providing primary care health services in conjunction with a not-for-profit senior center through a formal affiliation agreement shall, upon submission of an exemption request subsequently approved by the state agency, be exempt from the certificate of need requirement for the provision of such primary care services; provided, however, that no exemption is provided for any other matter which otherwise would require review under this chapter. The state agency shall define primary care health services in rules and regulations.

(6) "Health care provider" means a person who is a direct provider of health care services (including but not limited to physicians, dentists, nurses, podiatrists, physician assistants, or nurse practitioners) in that the person's primary current activity is the provision of health care services for persons.

(7) "Health maintenance organization" means a public or private organization, which:

(A) Provides or otherwise makes available to enrolled participants health care services, including at least the following basic health care services: usual physician services, hospitalization, laboratory, x-ray emergency and preventive services, and out-of-area coverage;

(B) Is compensated (except for co-payments) for the provision of the basic health care services listed in subdivision (7) (A) of this section to enrolled participants by a payment which is paid on a periodic basis without regard to the date the health care services are provided, and which is fixed without regard to the frequency, extent or kind of health service actually provided; and

(C) Provides physicians' services primarily:

(i) Directly through physicians who are either employees or partners of the organization; or

(ii) Through arrangements with individual physicians or one or more groups of physicians (organized on a group practice or individual practice basis).

(D) The term "health maintenance organization" shall not include individual health care providers who contract privately with a health maintenance organization to provide health care services.

(8) "Health services" means organized program components for preventive, assessment, maintenance, diagnostic, treatment and rehabilitative services, provided in a health care facility.

(9) "Institutional health services" means health services provided in or through health care facilities and includes the entities in or through which the services are provided.

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

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

(B)(i) Any expenditure except acquisitions of an existing health care facility which will not result in a change in the services or bed capacity of the health care facility by or on behalf of an existing health care facility in excess of eight hundred thousand ($800,000) dollars which is a capital expenditure including expenditures for predevelopment activities.

(C) Where a person makes an acquisition by or on behalf of a health care facility or health maintenance organization under lease or comparable arrangement or through donation, which would have required review if the acquisition had been by purchase, the acquisition shall be deemed a capital expenditure subject to review.

(D) Any capital expenditure which results in the addition of a health service or which changes the bed capacity of a health care facility with respect to which the expenditure is made; except that the state agency may exempt from review by rules and regulations promulgated for this chapter any bed reclassifications made to license 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 eight hundred thousand dollars ($800,000).

(E) Any health service, proposed to be offered to patients or the public by a health care facility, which was not offered on a regular basis in or through the facility within the twelve (12) month period prior to the time the service would be offered, and which increases operating expenses by more than two hundred and fifty thousand ($250,000) dollars, 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.

(F) Any new or expanded tertiary or specialty care service, regardless of capital expense or operating expense, as defined by and listed in regulation, such list not to exceed a total of twelve (12) categories of services at any one (1) time.

(11) "New health care equipment" shall mean any single piece of medical equipment (and any components which constitute operational components of the piece of medical equipment) proposed to be utilized by a health care provider (whether practicing alone or as a member of a partnership, corporation, organization, or association) in conjunction with the provision of services to patients or the public, the capital costs of which would exceed six hundred thousand ($600,000) dollars (including in the case of health care facilities the costs for installation and any necessary costs of erection or alteration of buildings or facilities directly associated with adding the equipment); provided, however, that the state agency shall establish an accelerated review process and criteria by regulation whereby the state agency may review one (1) for one (1) equipment replacement.

(12) "To offer" means to hold oneself out as capable of providing, or as having the means for the provision of, specified health services or health care equipment.

(13) "To develop" means to undertake those activities which, on their completion, will result in the offering of a new institutional health service or new health care equipment or the incurring of a financial obligation, in relation to the offering of such a service.

(14) "Affected person" for purposes of this chapter means and includes, as a minimum, the person whose proposal is being reviewed, or the applicant, health care facilities located within the state which provide institutional health services; the state medical society; the state osteopathic society; such voluntary nonprofit area-wide planning agencies as may be established in the state; the state budget office; any hospital or medical service corporation organized under the laws of the state; the statewide health coordinating council; contiguous health systems agencies; and those members of the public who are to be served by the proposed new institutional health services or new health care equipment.

(15) "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, exclusive of expenditures for feasibility surveys for health maintenance organizations which are funded under section 1303 of the Public Health Services Act or expenditures for planning of health maintenance organizations funded under section 1304 of the Public Health Services Act ›42 U.S.C. section 300e-3!.

(16) "Cost impact analysis" means a written analysis of the effect that a proposal to offer or develop new institutional health services or new health care equipment, if approved, will have on health care costs and shall include such detail as may be prescribed by the state agency in rules and regulations.

SECTION 2. Sections 23-17-2, 23-17-6, 23-17-10, 23-17-34 and 23-17-38 of the General Laws in Chapter 23-17 entitled "Licensing of Health Care Facilities" are hereby amended to read as follows:

23-17-2. Definitions. -- As used in this chapter: (1) "Health care facility" means any institutional health service provider, facility or institution, place, building, agency, or portion thereof, whether a partnership or corporation, whether public or private, whether organized for profit or not, used, operated, or engaged in providing health care services, including but not limited to hospitals; nursing facilities; home health agencies; {ADD home nursing care provider (which shall include skilled nursing services and may also include activities allowed as a home care provider); home care provider (which may include services such as personal care or homemaker services); ADD} rehabilitation centers; kidney disease treatment centers; health maintenance organizations; free-standing emergency care facilities, and facilities providing surgical treatment to patients not requiring hospitalization (surgi-centers); hospice care, and substance abuse treatment facilities. The term "health care facility" also includes organized ambulatory care facilities which are not part of a hospital but which are organized and operated to provide health care services to outpatients such as central services facilities serving more than one health care facility or health care provider, treatment centers, diagnostic centers, rehabilitation centers, outpatient clinics, infirmaries and health centers, and neighborhood health centers; providing, however, that the term "health care facility" shall not apply to organized ambulatory care facilities owned and operated by professional service corporations as defined in chapter 5.1 of title 7, as amended (the "Professional Service Corporation Law"), or to a private practitioner's (physician, dentist or other health care provider) office or group of the practitioners' offices (whether owned and/or operated by an individual practitioner, alone or as a member of a partnership, professional service corporation organization, or association). Individual categories of health care facilities shall be defined in rules and regulations promulgated by the licensing agency with the advice of the health services council. Rules and regulations concerning hospice care shall be promulgated with regard to the "Standards of a Hospice Program of Care," promulgated by National Hospice Organization. Any provider of hospice care who provides such hospice care without charge shall be exempt from the licensing provisions of this chapter but shall meet the "Standards of a Hospice Program of Care." Facilities licensed by the department of mental health, retardation and hospitals, and the department of human services, and clinical laboratories licensed in accordance with chapter 16.2 of this title, as well as Christian science institutions operated, or {ADD (also known as Christian Science Nursing Facilities) ADD} listed and certified by the first church of Christ, scientist, Boston, Massachusetts {ADD the Commission for Accreditation of Christian Science Nursing Organization/Facilities, Inc. ADD} shall not be considered health care facilities for purposes of this chapter.

(2) "Person" means any individual, trust or estate, partnership, corporation, (including associations, joint stock companies, and insurance companies) state, or political subdivision or instrumentality of a state.

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

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

(5) "Change in owner" means:

(A) In the case of a health care facility which is a partnership, the removal, addition, or substitution of a partner which results in a new partner acquiring a controlling interest in the partnership;

(B) In the case of a health care facility which is an unincorporated solo proprietorship, the transfer of the title and property to another person;

(C) In the case of a health care facility which is a corporation:

(i) A sale, lease exchange, or other disposition of all, or substantially all of the property and assets of the corporation; or

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

(iii) The consolidation of two or more corporations, resulting in the creation of a new corporation; or

(iv) In the case of a health care facility which is a business corporation, any transfer of corporate stock which results in a new person acquiring a controlling interest in the corporation; or

(v) In the case of a health care facility which is a nonbusiness corporation, any change in membership which results in a new person acquiring a controlling vote in the corporation.

(6) "Change in operator" means a transfer by the governing body or operator of a health care facility to any other person (excluding delegations of authority to the medical or administrative staff of the facility) of the governing body's authority to:

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

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

(C) Dispose of assets and incur liabilities on behalf of the health care facility; or

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

This definition is not applicable to circumstances wherein the governing body of a health care facility retains the immediate authority and jurisdiction over the activities enumerated in subdivisions (6)(A) to (6)(D) herein.

(7) "Medical services" means such professional services and supplies rendered by or under the direction of persons duly licensed under the laws of this state to practice medicine, surgery, or podiatry as may be specified by any medical service plan. Medical service shall not be construed to include hospital services.

(8) "Alzheimer's special care unit" means any nursing facility that locks, secures, segregates or provides a special program or special unit for residents with a diagnosis of probable Alzheimer's or a related disorder, to prevent or limit access by a resident outside the designated or separated area; and that advertises or markets the facility as providing specialized Alzheimer/dementia care services.

{ADD (9) "Homemaker", or however else called, means a trained non-professional worker who performs related housekeeping services in the home for the sick, disabled, dependent, or infirmed, and as further defined by regulation; the director shall establish criteria for training. ADD}

23-17-6. Issuance of license -- Posting -- Transfer -- Conditions. -- (a) Upon receipt of an application for a license, the licensing agency shall issue a license if the applicant and health care facility meet the requirements established under this chapter and such rules and regulations as may be established in accordance therewith. A license issued hereunder shall be the property of the state and loaned to the licensee, and it shall be kept posted in a conspicuous place on the licensed premises. Each license shall be issued only for the premises and persons named in the application, and shall not be transferable or assignable except with the written approval of the licensing agency.

(b) Any change in owner, operator, or lessee of a licensed health care facility shall require prior review by the health services council and approval of the licensing agency as a condition precedent to the transfer, assignment, or issuance of a new license. Issuance of the license may be made subject to any condition; provided that no condition may be made unless it directly relates to the statutory purpose expressed in section 23-17-3 or to the review criteria set forth in section 23-17-14.3. This shall not limit the authority of the licensing agency to require correction of conditions or defects which existed prior to the proposed change of owner, operator, or lessee and of which notice had been given to the health care facility by the licensing agency.

(c) Upon application, a currently licensed home health agency shall be allowed to provide hospice care if the program of hospice care provided by the licensee conforms to the licensing agency's rules and regulations concerning hospice care.

23-17-10. Regulations, inspections, and investigations -- Certain hospitals required to provide on-premises coverage by physician -- Uniform reports -- Data systems. -- (a) The licensing agency, with the advice of the health services council, shall after public hearing pursuant to reasonable notice adopt, amend, promulgate, and enforce such rules, regulations, and standards with respect to each category of health care facility to be licensed hereunder as may be designed to further the accomplishment of the purposes of this chapter in promoting safe and adequate treatment of individuals in health care facilities in the interest of public health, safety, and welfare. Provided, further, however, that all licensed medical, surgical, or obstetrical hospitals (excepting those hospitals as defined in section 23-17-2, as amended, which maintain an on-premises emergency room staffed by a licensed physician, resident, or intern at all times) shall be required to protect their patients by providing on-premises coverage by a licensed physician, resident or intern at all times.

{ADD In developing regulations for home nursing care providers and home care providers, the director shall consider and adopt, where appropriate, standards of relevant national accrediting bodies. The director shall make or cause to be made quality improvement and licensure inspections of each licensed home nursing care provider and home care provider at a minimum of once in a twelve month period. Said inspections shall include but not be limited to: home visits; patient surveys; and employee interviews. ADD}

(b) The licensing agency shall make or cause to be made such inspections and investigations as it deems necessary including medical records. The licensing agency, with the advice of the health services council, shall also adopt, amend, promulgate, and enforce rules and regulations to provide for a uniform system of reporting detailed financial and statistical data pertaining to the operation, services, and facilities of the health care facilities and the periodic reporting shall, in accordance with the rules and regulations, be concerned with, but not limited to, unit cost utilization charges of health care facility services, financial condition of health care facilities, and quality of health care facility care. The uniform reports shall also include such institutional plans as shall be prescribed in accordance with rules and regulations promulgated by the licensing agency with the advice of the health services council. Each health care facility shall establish and maintain data systems to meet the requirements of such uniform system of periodic reporting as may be prescribed in accordance with the provisions of this section. The data shall be made available and be considered by the state agency concerned with the reimbursement and/or utilization of health care facility services.

23-17-34. Criminal records review -- Nursing facilities and home health agencies. -- {ADD Criminal records review--Nursing facilities--Home nursing care providers and home care providers. -- ADD} Any person seeking employment in a nursing facility {ADD , a home nursing care provider, or a home care provider ADD} or a home health agency which is or is required to be licensed, registered or certified with the department of health if that employment involves routine contact with a patient or resident without the presence of other employees, shall undergo a criminal background check to be initiated prior to or within one (1) week of employment. All employees hired prior to the enactment of this section shall be exempted from the requirements of this section.

The director of the department of health may by rule identify those positions requiring criminal background checks. Said employee, through the employer, shall apply to the bureau of criminal identification of the state police or local police department for a statewide criminal records check. Fingerprinting shall not be required. Upon the discovery of any disqualifying information as defined in section 23-17-37 and in accordance with the rule promulgated by the director of health, the bureau of criminal identification of the state police or the local police department will inform the applicant in writing of the nature of the disqualifying information; and, without disclosing the nature of the disqualifying information, will notify the employer in writing that disqualifying information has been discovered.

An employee against whom disqualifying information has been found may request that a copy of the criminal background report be sent to the employer who shall make a judgment regarding the continued employment of the employee.

In those situations in which no disqualifying information has been found, the bureau of criminal identification of the state police or the local police shall inform the applicant and the employer in writing of this fact.

The employer shall maintain on file, subject to inspection by the department of health, evidence that criminal records checks have been initiated on all employees seeking employment after October 1, 1991, and the results of the checks. Failure to maintain that evidence would be grounds to revoke the license or registration of the employer.

It shall be the responsibility of the bureau of criminal identification of the state police or the local police department to conduct the criminal records check to the applicant for employment without charge to either the employee or the employer.

23-17-38. Establishment of fees. -- The director shall establish fees for licensure application, licensure renewal, inspection and administrative actions under this chapter. Annual inspection fees for hospitals and rehabilitation hospital centers shall be three thousand dollars ($3,000) per facility plus an additional fee of fifteen dollars ($15.00) per bed. Annual licensure fees for health maintenance organizations and for profit end stage renal dialysis facilities shall be three thousand dollars ($3,000) per facility. Annual licensure fees for home health agencies and hospices shall be three thousand dollars ($3,000) per facility, provided that not for profit entities operating more than one (1) such facility or offering more than one (1) such service shall be subject to a single annual licensure fee for all such licenses. {ADD Annual licensure fees for home nursing care providers and home care providers shall be five hundred dollars ($500) per facility. ADD} Annual licensure fees for organized ambulatory care facilities shall be five hundred dollars ($500), provided that not-for-profit entities operating more than one such facility shall be subject to a single annual licensure fee for all such licenses; provided, further, that non-profit charitable community health centers shall be exempt from said fee. All such fees {ADD not otherwise designated ADD} shall be established in regulation and shall be collected and deposited as general revenues of the state.

SECTION 3. Chapter 23-17 of the general laws entitled "Licensing of Health Care Facilities" is hereby amended by adding thereto the following sections:

{ADD 23-17-41. Employer--employee relationship. -- ADD} {ADD A home nursing care provider and home care provider shall be considered for all purposes, an employer and those persons that it supplies on a temporary basis, shall be considered employees and not independent contractors and home nursing care providers and home care providers, shall be subject to all state and federal laws which govern employer/employee relationships. ADD}

{ADD 23-17-42. Home nursing care providers--Uncompensated care provisions. -- ADD} {ADD The director shall establish minimum level of uncompensated care on an annual basis to be provided by licensed home nursing care providers. Such minimal levels shall be reasonable and shall be based upon historical levels of uncompensated care with the exclusion of bad debt. Failure to meet such standard shall be grounds for action pursuant to sections 23-17-8 and 23-17-8.1. ADD}

SECTION 4. Sections 23-17.7-1, 23-17.7-2, 23-17.7-10, 23-17.7-11, 23-17.7-13, 23-17.7-14 and 23-17.7-15 of the General Laws in Chapter 23-17.7 entitled "Licensing of Nursing Service Agencies" are hereby amended to read as follows:

23-17.7-1. Declaration of purpose. -- The purpose of this chapter is to provide for the development, establishment, and enforcement of standards:

(1) For the licensing of nursing service agencies; and

(2) To ensure unified standards among all agencies providing nursing, nursing assistant and/or homemaker services to promote safe and adequate care for individuals receiving nursing and nursing related services.

23-17.7-2. "Nursing service agency". -- A nursing service agency is defined as any person, firm, partnership or corporation doing business within the state of Rhode Island that supplies, on a temporary basis registered nurses, licensed practical nurses, {ADD or ADD} nursing assistants, or homemakers to a hospital, nursing home, private home or other facility requiring the services of such persons with the exception of home health agencies {ADD nursing care providers, home care providers ADD} and hospices licensed in this state. For all purposes a nursing service agency shall be considered an employer and those persons that it supplies on a temporary basis shall be considered employees and not independent contractors and nursing service agency shall be subject to all state and federal laws which govern employer-employee relations.

(a) "Licensing agency" means the Rhode Island state department of health;

(b) "Director" means the director of the Rhode Island state department of health;

(c) "Service record" means the written entire documenting services rendered by the nursing service agency;

(d) A "nursing assistant" shall be defined as a nursing, or orderly, or home health aide who is a paraprofessional, trained to give personal care and related health care and assistance based on his or her level of preparation to individuals who are sick, disabled, dependent, or infirmed. The director of the department of health, may by regulation, establish different levels of nursing assistants;

(e) "Homemaker", or however else called means a trained nonprofessional worker who performs related housekeeping services in the home for the sick, disabled, dependent, or infirmed, and as further defined by regulation;

(f) {ADD (e) ADD} Nursing service.

23-17.7-10. Regulations, inspections, and investigations. -- The licensing agency, shall after public hearing pursuant to chapter 35 of title 42, give notice, adopt, amend, promulgate, and enforce such rules and regulations and standards with respect to nursing service agencies to be licensed hereunder as may be designed to further the accomplishment of the purposes of this chapter in promoting safe and adequate care of individuals receiving nursing , {ADD and ADD} nursing assistant and/or homemaker services, in the interest of public health, safety and welfare. Provided further, however, that all licensed nursing service agencies shall be required to protect clients by insuring that all persons whom it employs receive training and/or competency evaluation pursuant to the provisions of sections 23-17.9-3 and 23-17.7-11 herein. The licensing agency shall make or cause to be made such inspections and investigations as it deems necessary including service records.

23-17.7-11. Training and/or competency evaluation program for nursing assistants. -- (a) Every individual who is employed to provide nursing assistant services shall be required to comply with the provisions of chapter 23-17.9-3 of the general laws.

(b) Homemaker training program. The standards of the national home caring council, model curriculum, and teaching guide for the instruction of the homemakers, shall serve as the guidelines for the development of regulatory standards for homemaker training program. The regulatory standards shall include but not be limited to the subject matter, the number of hours of classroom training and practical experience, supervision of practical experience, time period for completion of program, and other matters necessary to carry out the provisions of this section.

23-17.7-13. Duties of nursing assistants/homemakers and supervision. -- (a) The duties of nursing assistants and/or homemakers shall be defined by the director by rules and regulations.

(b) Supervision in those nursing service agencies which provide direct care to patients shall be provided according to policies and procedures set forth in regulation which shall include but not be limited to a plan of care and shall be supervised by individuals who meet the following qualifications: {ADD the provision that ADD}

(i) Nursing assistants shall be supervised by a registered nurse ; and {ADD . ADD}

(ii) Homemakers shall be supervised by a registered nurse or a person with a bachelor's degree in social work, home economics, gerontology, or other related fields of study.

(c) Every person, sole proprietor, corporation, partnership, or government agency which provides or arranges for nursing assistant and/or homemaker services, shall have supervision as set forth in subsection (b) above, available either directly from agency staff or written contractual arrangement with a qualified individual and/or licensed agency.

23-17.7-14. Agencies to which inapplicable. -- The provisions of this chapter shall not be construed to apply to home health agencies {ADD nursing care providers and home care providers ADD} licensed in accordance with chapter 17 of this title; however, the agencies shall be subject to the same training requirements for nursing assistants and/or homemakers and the duties of the individuals shall be the same as those prescribed by regulations.

23-17.7-15. Nursing service agencies exempt. -- The provisions of this chapter shall not apply to{ADD : ADD} nursing service agencies, nursing assistant service agencies or homemaker services exempt from regulation by the state {ADD (a) Nursing service agencies and nursing exempt from regulation by the state; or

(b) Visiting nursing services or home health services conducted by and for those who rely exclusively upon spiritual means through prayer alone in accordance with the creed or tenets of a recognized church or religious denomination ADD} .

SECTION 5. Section 1 shall take effect on January 1, 1998. Sections 2, 3, and 4 shall take effect on January 1, 1997.