2014 -- S 2526 SUBSTITUTE A AS AMENDED

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LC004319/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

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A N   A C T

RELATING TO HEALTH AND SAFETY

     Introduced By: Senators Lynch, and Sosnowski

     Date Introduced: February 27, 2014

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby amended by

adding thereto the following chapter:

CHAPTER 23-93

RHODE ISLAND ACCESS TO

MEDICAL TECHNOLOGY INNOVATION ACT

     23-93-1. Domestic medical tourism. -- For purposes of this chapter, "Domestic Medical

Tourism" means the practice of patients traveling to states other than their residence for the

provision of healthcare services.

     23-93-2. Exemption for domestic medical tourism. -- (a) Any healthcare facility

located in the state of Rhode Island specializing in domestic medical tourism, and having more

than fifty percent (50%) of its patients residing outside of the state; or, until July 1, 2015, any in-

state hospital licensed under chapter 17 of title 23; or in-state health care facility under common

ownership with an in-state hospital licensed under chapter 17 of title 23, shall be exempt from the

provisions of chapter 15 of title 23; provided, however, that such healthcare facility must comply

with all other applicable laws and regulations governing healthcare facilities. Any applicant not

compliant shall have thirty (30) days to comply with this section and any applicable regulations

governing this section.

     (b) Any healthcare facility described in subsection (a) shall, on a biennial basis, certify to

the department that more than fifty percent (50%) of its patients reside outside of the state.

     (c) Any healthcare facility exempt under subsection (a) that fails to certify under

subsection (b), or is otherwise found by the department to have not established that more than

fifty percent (50%) of its patients currently reside outside of the state, shall be required to apply

for a certificate of need during the next review cycle established by the health services council.

     23-93-3. Exemption for multi-practice facilities. -- Notwithstanding the requirements

of any other provisions of any general or public laws, the following circumstances shall not

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

     (1) The merger of an existing, currently licensed multi-practice physician ambulatory

surgery center or multi-practice podiatry ambulatory surgery center (as such terms are defined in

§ 23-17-2) with another such center; or

     (2) An existing, currently licensed multi-practice physician ambulatory surgery center or

multi-practice podiatry ambulatory surgery center (as such terms are defined in § 23-17-2)

expanding its operation to add an additional operating room in excess of two (2) operating rooms.

     23-93-4. Penalties for noncompliance. -- (a) The department, after notice and

opportunity for hearing to the applicant, is authorized to take corrective action in any case in

which it finds that there has been failure by an applicant to comply with the requirements

established under any approval granted pursuant to this chapter, including, without limitation, the

imposition of monetary fines that may be statutorily permitted by virtue of individual healthcare

facility licensing statutes.

     (b) The notice shall be effected by registered or certified mail or by personal service,

setting forth the particular reasons for the proposed action and fixing a date not less than thirty

(30) days from the date of the mailing or service, at which the applicant shall be given an

opportunity for a prompt and fair hearing. On the basis of the hearing, or upon default of the

applicant, the department shall make a determination specifying its findings of fact and

conclusions. A copy of the determination shall be sent by registered or certified mail or served

personally upon the applicant. The decision shall become final thirty (30) days after it is so

mailed or served, unless the applicant, within such thirty-day (30) period, appeals the decision

pursuant to § 42-35-15. The procedure governing hearings authorized by this section shall be in

accordance with §§ 42-35-9 - 42-35-13 as stipulated in § 42-35-14(a). A full and complete record

shall be kept of all proceedings and all testimony shall be reported but need not be transcribed

unless the decision is appealed pursuant to § 42-35-15. A copy or copies of the transcript may be

obtained by any interested party on payment of the cost of preparing the copy or copies.

     (c) Nothing in this section shall limit the director's general or emergency powers under §§

23-1-1, 23-17-8 or any other authority granted to the department under the general laws.

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     23-93-5. Moratorium; State wide health plan; Inventory of healthcare facilities,

equipment, and services. -- (a) The health services council shall not review, and applicable state

licensing agencies shall not issue, any approvals for new healthcare equipment or new

institutional health services prior to July 1, 2015; provided, however, that any review by the

health services council and approval by state agencies may be conducted during the moratorium

period in the case of an emergency circumstance; a certificate of need not previously approved; a

certificate of need request made pursuant to the nursing home culture change beds as defined in §

23-17-44(e); a certificate of need request made by a hospital or by a health care facility under

common ownership with a hospital; a change in ownership with respect to an institutional health

service; a change in the effective control of a hospital or other licensed facility; upgrades or

improvements of services related to prior changes in effective control; or a compelling

circumstance affecting the quality of life with respect to a certain geographic area or

subpopulation such as, but not limited to, pain management delivered to the home.

Notwithstanding the foregoing, any certificate of need application pending at the time of passage

of this chapter shall continue to be reviewed pursuant to the provisions of chapter 15 of title 23;

and shall not be subject to the moratorium provisions of this chapter.

     (b) During the moratorium period provided in subsection (a) above, the department of

health (for purposes of this section referred to as the "department") shall conduct, and shall

conduct on a biennial basis thereafter, a state wide healthcare utilization and capacity study. Such

study may include, but not be limited to, an assessment of:

     (1) The current availability and utilization of acute hospital care, hospital emergency

care, specialty hospital care, outpatient surgical care, home care and hospice agencies, assisted

daily living and nursing homes, long-term care facilities, primary care and specialty and clinic

care, behavioral and mental healthcare, and substance abuse care and services;

     (2) The geographic areas and subpopulations that may be underserved or have reduced

access to specific types of healthcare services; and

     (3) Other factors that the department deems pertinent to healthcare utilization including,

but not limited to, the number of magnetic resonance imaging facilities and physician ambulatory

surgi-centers. Not later than November 1 of the year in which the study is conducted, the

department shall report to the governor, the general assembly, and the healthcare planning and

accountability advisory council ("council") on the findings of the study. Such report may also

include the department's recommendations for addressing identified gaps in the provision of

health services and institutional health services; recommendations concerning a lack of access to

health services and institutional health services; and duplicative and/or redundant services.

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     (c)(1) The department, in consultation with the council and such other state agencies as it

deems appropriate, shall establish and maintain a state wide health plan. Such plan may include,

but not be limited to:

     (i) An assessment of the availability of acute hospital care, hospital emergency care,

specialty hospital care, outpatient surgical care, home care and hospice agencies, primary care

and clinic care, behavioral and mental healthcare, and substance abuse care and services;

     (ii) An evaluation of the unmet needs of persons at risk and vulnerable populations as

determined by the department and the council;

     (iii) A projection of future demand for health services and institutional health services

and the impact that technology may have on the demand, capacity, or need for such services; and

     (iv) Recommendations for the expansion, reduction, or modification of healthcare

facilities, health services, or institutional health services. The department, in consultation with

healthcare providers, healthcare facilities, and the council, shall develop a process that requires as

a condition of licensure, that healthcare providers and healthcare facilities incorporate the state

wide health plan into their long-range planning and shall facilitate communication between

appropriate state agencies concerning innovations or changes that may affect future health

planning. Information needed for the development of the state health plan shall be gathered

through systematic methods designed to include local, regional, and statewide perspectives. The

department, in conjunction with the council, shall update the state wide health plan not less than

once every two (2) years.

     (2) The state health plan shall identify:

     (i) Major statewide health concerns;

     (ii) The availability and use of current health resources of the state, including resources

associated with information technology; capacity provided by existing healthcare physicians, and

providers of service and institutions of higher education; and

     (iii) Future health service, information technology, and facility needs of the state.

     (3) The state health plan shall:

     (i) Propose strategies for the correction of any deficiencies in the state health delivery

system;

     (ii) Propose strategies for incorporating information technology in the health service and

institutional health service delivery system;

     (iii) Propose strategies for involving state-supported institutions of higher education in

providing health services and for coordinating those efforts with health and human services

agencies; and

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     (iv) Provide proposals for the state's legislative and executive decision-making processes

to consider implementing the strategies proposed by the plan.

     (d)(1) For purposes of conducting the state wide healthcare utilization and capacity study

and preparing the state wide health plan, and in order to identify the location, distribution, and

nature of all healthcare resources in the state, the department shall establish and maintain an

inventory of all healthcare facilities, health services, and institutional health services in the state

and the equipment located in such healthcare facilities. The state wide inventory of all healthcare

services and equipment shall also include, without limitation, current stock, anticipated need, and

geographical distribution of health services and institutional health services throughout the state.

The department and the council shall develop an inventory questionnaire to obtain, at a minimum,

the following information:

     (i) The name and location of the healthcare provider and healthcare facility;

     (ii) The type of facility;

     (iii) The hours of operation;

     (iv) The type of services provided at that location including, but not limited to, translation

and transportation services;

     (v) The total number of clients, the race, ethnicity and primary language spoken in the

home of the clients, treatments, patient visits, procedures performed, or scans performed in a

calendar year;

     (vi) The total number of the uninsured population in the state; and

     (vii) Such other information as the department deems appropriate. The inventory shall be

completed biennially by healthcare facilities and healthcare providers and such healthcare

facilities and healthcare providers shall not provide patient-specific data.

     (2) The inventory and all related information shall be maintained in a form usable by the

general public in a designated office of the department, shall constitute a public record, and shall

be coordinated with information collected by the department and the council under other

provisions of law; provided, however, that any item of information that is confidential or

privileged in nature shall not be regarded as a public record under this section or the general laws.

     (e) The department and the council shall publish analyses, reports, and interpretations of

information collected under this section in order to further public knowledge concerning the

distribution and nature of health services and institutional health services in the state. The

department may require healthcare providers and healthcare facilities to provide information for

the purposes of this section and may prescribe, by regulation, uniform reporting requirements. In

prescribing such regulations, the department shall strive to make any reports required under this

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section of mutual benefit to those providing as well as those using, such information and shall

avoid placing any burdens on such providers that are not reasonably necessary to accomplish the

purposes of this section.

     (f) Agencies of the state that collect cost or other data concerning health services and

institutional health services shall cooperate with the department in coordinating such data with

information collected under this section.

     (g) In the performance of its duties under this section, the department, subject to

appropriation, may enter into such contracts with agencies of the federal government, the state or

its political subdivisions, and public or private bodies, as it deems necessary.

     (h) The department shall provide a progress report on health care inventory and statewide

health plan no later than February 2015.

     SECTION 2. Section 23-15-5 of the General Laws in Chapter 23-15 entitled

"Determination of Need for New HealthCare Equipment and New Institutional Health Services"

is hereby amended to read as follows:

     23-15-5. Expeditious review. – (a) Any person who proposes to offer or develop new

institutional health services or new health care 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 in

rules and regulations, may apply for an expeditious review. The state agency may exercise its

discretion in recommending approvals through an expeditious review, except that no new

institutional health service or new health care equipment may be approved through the

expeditious review if provision of the new institutional health service or new health care

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 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

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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.

     SECTION 3. Section 23-17-13 of the General Laws in Chapter 23-17 entitled "Licensing

of HealthCare Facilities" is hereby repealed.

     23-17-13. Health services council. -- There shall be established a health services council

consisting of twenty-four (24) members, eight (8) of whom shall be appointed by the speaker of

the house, one of whose appointments shall represent hospital service corporations, six (6) of

whom shall be appointed by the president of the senate, one of whose appointments shall

represent hospitals and a second of whose appointments shall represent the business community,

and ten (10) of whom shall be appointed by the governor, one of whose appoints shall represent

the state budget office, a second of whose appointment shall represent the department of human

services and two (2) of whom shall be members of the general public that maintain his or her

principal residence within fifteen hundred feet (1500 ft.) of a licensed hospital. The governor

shall appoint members of the council in staggered appointments, three (3) members one year, two

(2) members the next year, and two (2) members the year after that. All members shall serve until

their successors are appointed and qualified. In the month of February in each year, the governor

shall appoint successors to the members of the council whose terms shall expire in that year, to

hold office commencing on the first day of March in the year of appointment until the first day of

March in the third (3rd) year after appointment or until their respective successors are appointed

and qualified. Legislative members shall serve until the end of their legislative term. Any vacancy

of a member appointed which may occur in the commission shall be filled by appointment by the

respective appointing authority for the remainder of the unexpired term. The council may also

serve as an advisory council as authorized by section 23-16-3.

     SECTION 4. Chapter 23-17 of the General Laws entitled "Licensing of HealthCare

Facilities" is hereby amended by adding thereto the following section:

     23-17-13.1. Health services council. -- (a) There shall be established a health services

council consisting of twelve (12) members, four (4) of whom shall be appointed by the speaker of

the house, one who shall be an expert in healthcare economic and policy matters, and a second

who shall represent the insurance business; four (4) of whom shall be appointed by the president

of the senate, one who shall represent the business community, and a second who shall represent

the general public; and four (4) of whom shall be appointed by the governor, one who shall

represent the office of the health insurance commissioner, a second who shall represent the

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executive office of health and human services, a third who shall represent the health insurance

business, and a fourth who shall represent the executive office of commerce. All members shall

serve until the first day of July in the third year after appointment or until their respective

successors are appointed and qualified. Any vacancy of a member appointed that may occur in

the council shall be filled by appointment by the respective appointing authority for the remainder

of the unexpired term. The council may also serve as an advisory council as authorized by § 23-

16-3.

     (b) A person may not be a member of the health services council if the person is required

to register as a lobbyist as defined under chapter 139 of title 42.

     (c) Notwithstanding any laws, rules, or regulations to the contrary, all recommendations

of the health services council shall be by a majority vote of its members present at the time the

vote is taken.

     SECTION 5. Sections 3 and 4 of this act shall take effect nine (9) months after passage.

The remainder of this act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY

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     This act would establish the "Rhode Island Access to Medical Technology Innovation

Act", which would, among other things, establish a moratorium on all new healthcare services

and equipment until July 1, 2015, during which time the department of health in conjunction with

the healthcare planning and accountability advisory council, shall conduct a state-wide healthcare

utilization and capacity study, and prepare a state-wide health plan and inventory of healthcare

facilities, equipment and health services. The act would also, under certain circumstances,

provide an exemption from the certificate of need requirements to the domestic medical tourism

industry and multi-practice health facilities.

     This act would also reduce the composition of the health services council from twenty-

four (24) members to twelve (12) members.

     This act would also provide a process for reconsideration of an expeditious review

request and require that a decision in connection with an expeditious review be rendered within

thirty (30) days.

     Sections 3 and 4 of this act would take effect nine (9) months after passage. The

remainder of this act would take effect upon passage.

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