It is enacted by the General Assembly as follows:

SECTION 1. Sections 23-15-2, 23-15-4, 23-15-4.1, 23-15-4.2, 23-15-4.4 and 23-15-6 of the General Laws in Chapter 23-15 entitled "Determination of Need for New Health Care Equipment and New Institutional Health Services" are 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 {ADD which are limited to ADD} 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 {ADD inpatient ADD} 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 listed and certified by the first church of Christ, scientist, Boston, Massachusetts.

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:

(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) {ADD (7) ADD} "Health services" means organized program components for preventive, assessment, maintenance, diagnostic, treatment and rehabilitative services, provided in a health care facility.

(9) {ADD (8) ADD} "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) {ADD (9) ADD} "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 {ADD two million dollars ($2,000,000) ADD} 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) {ADD two million dollars ($2,000,000) ADD} .

(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 {ADD seven hundred and fifty thousand dollars ($750,000) ADD} , 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 time.

(11) {ADD (10) ADD} "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 {ADD one million dollars ($1,000,000) ADD} (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 {ADD exempt from review any application which proposes ADD} one for one equipment replacement {ADD as defined in regulation ADD} .

(12) {ADD (11) ADD} "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) {ADD (12) ADD} "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) {ADD (13) ADD} "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) {ADD (14) ADD} "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.

(16) {ADD (15) ADD} "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.

23-15-4. Review and approval of new health care equipment and new institutional health services. -- No health care provider or health care facility 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 state agency; except that review by the health services council may be waived in the case of expeditious reviews conducted in accordance with section 23-15-5 herein, 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 herein upon approval by the state agency of an application for exemption therefrom which contains such information as the state agency may require to determine if the health maintenance organization meets the criteria{ADD . ADD} and except further that any health care facility presently licensed under chapter 24 of title 40.1 of the Rhode Island general laws which wishes to provide a new institutional service to non-Rhode Island residents shall be exempted from the review and approval requirements established herein. In providing the new institutional service to non-Rhode Island residents, said health care facilities shall not increase its charges to Rhode Island residents because of the capital and/or operating costs associated with such new institutional service.

(a) No approval shall be made without an adequate demonstration of need thereof 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 by the people of the state.

(b) 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 section 23-15-6 (b) (6) are made.

(c) Applications for determination of need shall be filed with the state agency on a date fixed by the state agency together with plans and specifications and such other data and information as the state agency shall require by regulation, and shall be considered in relation to each other no less often than once a year. A duplicate copy of each application together with all supporting documentation shall be kept on file by the state agency as a public record.

(d) The health services council shall consider but shall not be limited to the following, in conducting reviews and determining need:

(1) The relationship of the proposal to such state health plans as may be formulated by the state agency;

(2) The relationship of the proposal to the long and short-range development plans (if any) of the applicant, and the {ADD The ADD} impact of approval or denial of the proposal on the future liability {ADD viability ADD} 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 resources (including health manpower, management personnel, and funds for capital and operating needs ) for the provision of the services or equipment proposed to be offered , and the relative priority of alternative uses of the resources for the provision of other health services or equipment ;

(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 such entities 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) The special needs and circumstances of health maintenance organizations;

(14) The special needs and circumstances of biomedical and behavioral research projects which are designed to meet a national need and for which local conditions offer special advantages; and

(15) {ADD (13) ADD} In the case of a construction project --

(A) The costs and methods of the proposed construction, and projected energy costs of operation; and

(B) The probable impact of the construction project reviewed on the costs of providing health services by the person proposing the construction project.

(16) {ADD (14) ADD} Such considerations as may be established in rules and regulations promulgated by the state agency with the advice of the health services council.

(17) {ADD (15) ADD} 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.

(18) {ADD (16) ADD} The relationship of the proposal to the need indicated in any requests for proposals issued by the state agency.

(e) In conducting its review, the health services council shall perform the following:

(1) Within one hundred 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 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 subdivision (d) 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 his or her decision within five (5) days of the determination of the health services council.

(2) Prior to the conclusion of its review in accordance with section 23-15-6(f) {ADD 23-15-6(e) ADD} herein, the health services council shall evaluate each proposal for which a determination of need has been established in relation to other such 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 subdivision (d) of this section and 23-15-6(h) {ADD 23-15-6(f) ADD} herein.

(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

(A) The health services council shall recommend approval of only those proposals found to be affordable in accordance with the provisions of section 23-15-6(h) {ADD 23-15-6(f) ADD} herein; and

(B) If the state agency proposes to render a decision which is contrary to the recommendation of the health services council, the state agency must render its reasons for doing so in writing.

(f) Approval of new institutional health services or new health care equipment by the state agency shall be subject to such conditions as may be prescribed by rules and regulations developed by the state agency with the advice of the health services council, but such conditions must relate to the considerations enumerated in subdivision (d) and to such considerations as may be established in regulations in accordance with subdivision (d) (16) {ADD (14) ADD} .

(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 state agency shall be grounds for imposition of licensure sanctions on the facility including denial, suspension, revocation, or curtailment or for imposition of such monetary fines as may be statutorily permitted by virtue of individual health care facility licensing statutes.

(h) No government agency and no hospital or medical service corporation organized under the laws of the state shall reimburse any 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 health care facility or health care provider has received approval of the 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.

(i) In addition, the state agency shall not make grants to, enter into contracts with, or recommend approval of the use of federal or state funds by any 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 state agency.

23-15-4.1. Exempt for non-clinical 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, telephone systems, shall not require a certificate of need review and approval by the state agency{ADD . ADD} if such capital expenditures, after considering budget savings in other areas, will not result in a net increase to the health care facilitity's annual negotiated budget as provided in section 27-19-14.

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 cerificate of need review and approval by the state agency{ADD . ADD} if financed solely by non-patient care revenues of the health care facility.

23-15-4.4. Exemption for voter approved capital bond issues for state health care facilities. -- {ADD Exemption for voter approved capital bond issues for health care facilities. -- ADD} Notwithstanding the requirement of any other provisions of any general law or public law, voter approved state bond issues authorizing capital expenditures for state health care facilities shall not require a certificate of need review and approval by the state agency{ADD . ADD} if financed solely by state approved bond funds.

23-15-6. Procedures for review. -- (a) The state agency, with the advice of the health services council, and in accordance with the administrative procedures act after public hearing pursuant to reasonable notice, which notice shall include affected persons, shall promulgate such rules and regulations as may be designated to further the accomplishment of the purposes of this chapter including the formulation of such procedures as may be particularly necessary for the conduct on reviews of particular types of new institutional health services or new health care equipment.

(b) Review procedures promulgated in accordance with subsection (a) above shall include at least the following, except that substitute procedures for the conduct of expeditious {ADD and accelterated ADD} reviews may be promulgated by the state agency in accordance with section 23-15-5 herein.

(1) Provision 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 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 twenty (120) days shall elapse between initial notification of affected persons and the final decision of the state agency.

(3) Provision that, if the state agency fails to act upon an application within the applicable period established in subsection (b)(2), the applicant may apply to the superior court of Providence County to require the state agency to act upon the application.

(4) Provision for review and comment by the health services council and any affected person, including but not limited to those parties defined in section 23-15-2(14) and the department of business regulation; the department of mental health, retardation 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)(A) Provision for issuance of a written decision by the state agency which shall be based upon the findings and recommendations of the health services council unless the state agency shall afford written justification for variance therefrom.

(B) 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 as to:

(i) The efficiency and appropriateness of the use of existing inpatient facilities providing inpatient services similar to those proposed; and

(ii) The capital and operating costs (and their potential impact on patient charges), efficiency, and appropriateness of the proposed new institutional health services; and

(iii) 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 have been implemented to the maximum extent practicable;

(III) That patients will experience serious problems in terms of costs, availability, or accessibility, or such other problems as 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) Provision for the distribution of the decision of the state agency, including its findings and recommendations, to the applicant and to affected persons.

(8) Provision that the 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) 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; or

(B) Demonstrates that there have been significant changes in factors or circumstances relied upon by the state agency in reaching its decision; or

(C) Demonstrates that the state agency has materially failed to follow its adopted procedures in reaching its decision; or

(D) Provides such other basis for reconsideration as the state agency may have determined by regulation to constitute good cause.

Procedures for reconsideration shall be established in regulations promulgated by the state agency with the advice of the health services council.

(10) 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 section 42-35-15.

(c) Health care facilities and health care providers shall provide periodic reports in such form or manner as shall be established in rules and regulations promulgated by the state agency with the advice of the health services council, which reports shall detail the long and short range plans of the health care facility or health care provider antecedent to the development of proposals for offering or developing new institutional health services and new health care equipment, which plans may be considered to fulfill the requirement of a letter of intent in the case of construction projects. The long and short range plans individually and collectively so provided shall form the initial basis for determinations by the health services council of the relative priorities of the various proposals to be submitted in the course of the ensuing year, in the context of overall projected budgets, the state health system plan, the annual implementation plan, and such capital and operating budgeting mechanisms as may be formulated to which the state and health care facilities or health care providers may be parties.

(d) {ADD (c) ADD} The 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.

(e) {ADD (d) ADD} All applications reviewed by the state agency and all written materials pertinent to state agency review, including minutes of all health services council meetings, shall be accessible to the public upon request.

(f) {ADD (g) ADD} In the case of review of proposals by health care facilities who by contractual agreement, chapter 27-19 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 and hospital service corporations organized under chapter 27-19 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 section 23-15-4(e)(1) herein:

(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.

(g) {ADD (f) ADD} 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 such other factors as it may deem appropriate.

SECTION 2. Section 23-15-4.3 of the General Laws in Chapter 23-15 entitled "Determination of Need for New Health Care Equipment and New Institutional Health Services" is hereby repealed in its entirety.

23-15-4.3. Exemption for the establishment of a health maintenance organization. -- Notwithstanding the requirements of any other provision of any public law, the establishment of a new health maintenance organization shall not require a certificate of need review and approval by the state agency; provided, however, that no exemption is provided by this section for (a) any action or proposed action by or on behalf of a health maintenance organization related to the construction, renovation, or acquisition of a physical facility for the provision of health services to patients, or (b) any action or proposed action by or on behalf of ahealth maintenance organization to acquire, purchase, or lease new health care equipment.

SECTION 3. Sections 23-17-3, 23-17-14, 23-17-14.3 and 23-17-14.4 of the General Laws in Chapter 23-17 entitled "Licensing of Health Care Facilities" are hereby amended to read as follows:

23-17-3. Purpose of provisions. -- The purpose of this chapter is to provide for the development, establishment, and enforcement of standards:

(1) for the care and treatment of individuals in health care facilities; and

(2) for the maintenance and operation of health care facilities which in the light of advancing knowledge, will promote appropriate access and safe and adequate treatment for individuals receiving health care facility services . {ADD ; and ADD}

{ADD (3) For the encouragement of quality improvement in all aspects of the operations of health care facilities. ADD}

23-17-14. Functions of health services council. -- The health services council shall have the following responsibilities and duties:

(1) To consult and advise with the licensing agency {ADD regarding licensing reviews conducted under sections 23-17-14.3 and 23-17-14.4 and ADD} in matters of policy affecting administration of this chapter, and in the development of rules, regulations, and standards provided for hereunder . {ADD ; ADD} Wherever practicable the health services council and the licensing agency shall consider but not be bound by the advice and recommendations of the appropriate voluntary nonprofit area-wide planning agency before taking official action on any application filed in accordance with chapter 15 of this title;

(2) To review and make recommendations with respect to rules, regulations, and standards authorized hereunder prior to their promulgation by the licensing agency as specified herein;

(3) To consult and advise with the licensing agency with respect to the administration of chapter 15 of this title;

(4) When acting as an advisory council authorized by section 23-16-3, to consult with the director of the state department of health in carrying out the purposes of chapter 16 of this title.

23-17-14.3. Review criteria. -- Except as otherwise provided herein, a review by the health services council of an application for {ADD an initial license or ADD} a license in the case of a proposed change in the owner, operator, or lessee of a {ADD any ADD} licensed health care facility may not be made subject to any criterion unless the criterion directly relates to the statutory purpose expressed in Section 23-17-3. In conducting reviews of the applications, the health services council shall specifically consider: the character, {ADD commitment, ADD} competence, and standing in the community of the proposed owners, operators or directors of the health care facility; {ADD in cases of initial licensure or of proposed change in owner, operator, or lessee, ADD} the extent to which the facility will continue, {ADD provide or will continue to provide, ADD} without material effect on its viability at the time of {ADD initial licensure or ADD} change of owner, operator, or lessee, to provide safe and adequate treatment for individuals receiving the health care facility's services; the extent to which the facility will {ADD provide or will ADD} continue to provide safe and adequate treatment for individuals receiving the health care facility's services; and the extent to which the facility will {ADD provide or will ADD} continue to provide appropriate access with respect to traditionally underserved populations and in consideration of the proposed continuation or termination of health care services by the health care facility.

23-17-14.4. Procedures for review. -- (a) Within ten (10) working days of receipt, in acceptable form, of an application for {ADD an initial license or ADD} a license in connection with a change in the owner, operator, or lessee of an {ADD any ADD} existing health care facility, the licensing agency will notify and afford the public an opportunity to comment on the application.

(b) To the extent practicable, {ADD The recommendations of the health services council and ADD} the decision of the licensing agency will be rendered within sixty (60) {ADD ninety (90) ADD} days of acceptance of the application for license , {ADD . ADD} except that, upon request by the health services council, the licensing agency may extend the period of review to ninety (90) days from acceptance of the application for license.

{ADD (c) The licensing agency shall promulgate in rules and regulations procedures and criteria for expedited review of licensure applications. The criteria for expedited review consideration shall include, but not be limited to, all of the following: (a)that the licensure application is solely for initial licensure; (b) that the legal entity seeking a license currently is the licensee for one or more Rhode Island licensed health care facilities whose records of compliance are deemed by the licensing agency to demonstrate the legal entity's ability and commitment to provide quality health care services; and (c) that the licensure application demonstrates complete and satisfactory compliance with review criteria in section 23-17-14.3. The licensing agency shall exercise its discretion in granting expedited review of license applications and a decision by the licensing agency not to process an application on an expedited review basis shall be final and shall not be subject to appeal. ADD}

(c) {ADD (d) ADD} The decision of the licensing agency shall be based upon the findings and recommendations of the health services council unless the licensing agency shall afford written justification for variance therefrom.

(d) {ADD (e) ADD} All applications reviewed by the licensing agency and all written materials pertinent to licensing agency review, including minutes of all health services council meetings, shall be accessible to the public upon request.

{ADD (f) Any person holding a valid certificate of need issued pursuant to chapter 23-15, shall be exempt from the requirements of sections 23-17-14.3 or 23-17-14.4 of this chapter for initial facility licensure. ADD}

SECTION 4. Chapter 23-17 of the General Laws entitled "Licensing of Health Care Facilities" is hereby amended by adding thereto the following section:

{ADD 23-17-43. Charity care requirements. -- ADD} {ADD Any new hospital licensee shall meet the statewide community standard for the provision of charity care services as a condition of initial and continued licensure. Such standard shall be consistent with guidelines established by the legislature in the charters of the existing hospitals in the state which hold charters from the legislature. ADD}

{ADD 23-17-44. Moratorium on new initial nursing facility licensed beds and on increases to the licensed capacity of existing nursing facility licenses. -- ADD} {ADD (1) The licensing agency shall issue no new initial licenses for nursing facilities prior to January 1, 1998; provided, however, that: (a) any person holding a previously issued and valid certificate of need as of the date of passage of this section shall be permitted to effect such prior certificate from the licensing agency consistent with such other statutory and regulatory provisions which may further apply; (b) any person holding a nursing facility license may undertake activities to construct and operate a replacement nursing facility with the same or lower bed capacity as is presently licensed provided that such replacement facility may only be licensed upon the otherwise unconditional cessation of operation of the previously licensed nursing facility; and (c) any certificate of need application under active review before the state agency as of January 10, 1996 which application seeks approval of a proposal to establish a new nursing facility or seeks to increase the licensed bed capacity of an existing nursing facility shall continue to be reviewed under all the statutory and regulatory requirements in effect at the time such application was accepted for review by the state agency.

(2) The licensing agency shall not increase the licensed bed capacity of any existing licensed nursing facility, including any nursing facility approved for change in ownership pursuant to section 23-17-14 herein, except for the greater of ten (10) beds or ten percent (10%) of the facility's licensed capacity prior to January 1, 1998; provided, however, that any person holding a previously issued and valid certificate of need as of the date of passage of this section or who shall subsequently be granted a certificate of need pursuant to subsection (1) above shall be permitted to effect such prior certificate from the licensing agency consistent with such other statutory and regulatory provisions which may further apply. ADD}

{ADD 23-17-45. Quality standards for volume related tertiary services. -- ADD} {ADD The director is authorized to establish through regulation quality and volume related standards to be achieved and maintained for specific tertiary health care services offered by individual licensed health care facilities where peer reviewed medical and health literature establishes significant relationships between desired quality related outcomes and volume of services provided. The standards shall include time frames for achieving stipulated volumes of services. In developing such standards the director shall seek input from affected providers and the public at large. The director may accept in regulation the standards of and the accreditation from recognized national accrediting entities in lieu of standards and assessments otherwise developed pursuant to this section. ADD}

SECTION 5. This act shall take effect upon passage.