Introduced By: Senators Izzo, Irons and Roberts
Date Introduced : January 28, 1999
It is enacted by the General Assembly as follows:
{ADD SECTION 1. Legislative findings -- The general assembly finds that: ADD}
{ADD (1) the rapid advance of technology increasingly allows health care practitioners to perform surgical procedures with less invasive techniques in physician office settings; ADD}
{ADD (2) anesthesia technology and techniques which facilitate such surgeries are also rapidly evolving; ADD}
{ADD (3) patients and health care practitioners are increasingly finding physician office settings to be appropriate, accessible and available sites for surgical procedures; ADD}
{ADD (4) insurers, health maintenance organizations and other payers are seeking lower cost, high quality alternative sites for the provision of surgical services to their enrollees; ADD}
{ADD (5) at present there is not requirement for and no means for ongoing state oversight of the safety and quality of surgical services in physician office settings providing surgical treatment; and ADD}
{ADD (6) in order to protect the health and safety of the public, it is necessary to establish provisions to regulate the practice of surgery in physician office settings where such surgery may present higher risks of adverse patient outcomes. ADD}
SECTION 2. Sections 23-17-2 and 23-17-6 of the General Laws in Chapter 23-17 entitled "Licensing of Health Care Facilities" are hereby amended to read as follows:
23-17-2. Definitions. -- As used in this chapter:
(1) "Alzheimer's 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 degrees ementia care services.
(2) (i) "Change in operator" means a transfer by the governing body or operator of a health care facility to any other person (excluding delegations of authority to the medical or administrative staff of the facility) of the governing body's authority to:
(A) Hire or fire the chief executive officer of the health care facility;
(B) Maintain and control the books and records of the health care facility;
(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.
(ii) This definition is not applicable to circumstances wherein the governing body of a health care facility retains the immediate authority and jurisdiction over the activities enumerated in subdivisions (2)(i)(A) -- (2)(i)(D).
(3) "Change in owner" means:
(i) In the case of a health care facility which is a partnership, the removal, addition, or substitution of a partner which results in a new partner acquiring a controlling interest in the partnership;
(ii) In the case of a health care facility which is an unincorporated solo proprietorship, the transfer of the title and property to another person;
(iii) In the case of a health care facility which is a corporation:
(A) A sale, lease exchange, or other disposition of all, or substantially all of the property and assets of the corporation; or
(B) A merger of the corporation into another corporation; or
(C) The consolidation or two or more corporations, resulting in the creation of a new corporation; or
(D) 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
(E) 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.
(4) "Director" means the director of the Rhode Island state department of health.
(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 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); 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 {DEL substance abuse treatment facilities. DEL}
{ADD physician office settings providing surgical treatment. ADD}
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 (also known as Christian Science Nursing Facilities)
listed and certified by the Commission for Accreditation of Christian
Science Nursing Organizations/Facilities, Inc. shall not be considered
health care facilities for purposes of this chapter.
(6) "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.
(7) "Licensing agency" means the Rhode Island state department of health.
(8) "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.
(9) "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.
{ADD (10) "Physician office setting providing surgical treatment" means an office or portion thereof owned and/or operated by a physician controlled professional service corporation as defined in chapter 5.1 of title 7, as amended (the "Professional Service Corporation Law"), or a private physician's office or group of the physicians' offices (whether owned and/or operated by an individual practitioner, alone or as a member of a partnership, professional service corporation, organization, or association) which is utilized for the purpose of furnishing surgical services to said owner and/or operator's own patients on an ambulatory basis. 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 {ADD , except for a physician office setting providing surgical treatment, which license shall be transferable or assignable by decision of the licensing agency as shall be provided by regulation, ADD} 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.
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 23-17-49. Surgical procedures. -- General provisions. -- The director shall determine through regulation categories of patients that shall be permitted to receive surgical services in free-standing ambulatory surgical facilities, and physician office settings providing surgical treatment based upon criteria including, but not limited to: ADD}
{ADD (1) risks related to patient characteristics; ADD}
{ADD (2) the type of and risks associated with the anesthesia required; and ADD}
{ADD (3) as appropriate, the complexity of the surgical procedure and the expected duration of the surgical procedure. ADD}
{ADD Further, the director shall determine through regulation categories of patients that shall be prohibited from receiving surgical services in free-standing ambulatory surgical facilities, physician office settings providing surgical treatment, and physician offices not licensed under this chapter based upon criteria including, but not limited to: ADD}
{ADD (1) risks related to patient characteristics; ADD}
{ADD (2) the type of and risks associated with the anesthesia required; and ADD}
{ADD (3) as appropriate, the complexity of the surgical procedure. ADD}
{ADD 23-17-50. Physician office setting providing surgical treatment -- Accreditation, survey, complaint investigation, and exemptions. -- (a) Accreditation from a national organization acceptable to the director may be required, at the discretion of the director, in lieu of an annual survey by the department. ADD}
{ADD (b) The provisions of section 23-17-50(a) shall not limit in any way the prerogatives of the director to inspect any physician office setting providing surgical treatment at any reasonable time, whether for purpose of general survey or for complaint investigation. The director shall have access to all records of the licensed physician office settings providing surgical treatment including medical records. ADD}
{ADD (c) Physician office settings providing surgical treatment shall be exempt from the requirements of chapter 23-15. ADD}
{ADD (d) Physician office settings providing surgical treatment shall be exempt from the provisions of sections 23-17-14.3 and 23-17-14.4 herein with respect to initial licensure under this chapter. ADD}
SECTION 4. This act shall take effect upon passage; provided however, that initial licensure requirements for physician office settings providing surgical treatment shall not take effect until ninety (90) days following the promulgation of regulations for office operatories which regulations shall be filed by the director of health with the secretary of state no later than January 1, 2000. No license as a health care facility shall be required prior to the effective date of the regulations for the conduct of a physician office setting providing surgical treatment.
