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:

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

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adding thereto the following chapter:

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CHAPTER 23-93

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RHODE ISLAND ACCESS TO

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MEDICAL TECHNOLOGY INNOVATION ACT

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

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

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provision of healthcare services.

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

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

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

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

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

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

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

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

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governing this section.

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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facility licensing statutes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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access to specific types of healthcare services; and

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

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

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

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

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

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

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

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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

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

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but not be limited to:

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

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

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

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

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determined by the department and the council;

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

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

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

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

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

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

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

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

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

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

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

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once every two (2) years.

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     (2) The state health plan shall identify:

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     (i) Major statewide health concerns;

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

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

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providers of service and institutions of higher education; and

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

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     (3) The state health plan shall:

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

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system;

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

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institutional health service delivery system;

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

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

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agencies; and

 

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

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to consider implementing the strategies proposed by the plan.

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

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

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

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

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

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

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

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

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the following information:

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

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     (ii) The type of facility;

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     (iii) The hours of operation;

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

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and transportation services;

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

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

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calendar year;

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

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

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completed biennially by healthcare facilities and healthcare providers and such healthcare

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

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

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

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

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

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

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

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

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

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

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

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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

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

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purposes of this section.

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

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

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information collected under this section.

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

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

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

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

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health plan no later than February 2015.

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

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

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is hereby amended to read as follows:

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

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institutional health services or new health care equipment for documented emergency needs,; or

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for the purpose of eliminating or preventing documented fire or safety hazards affecting the lives

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and health of patients or staff,; or for compliance with accreditation standards required for receipt

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of federal or state reimbursement,; or for any other purpose that the state agency may specify in

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

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

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

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

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

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

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

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

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

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

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

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the expeditious request had been denied.

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

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

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     (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

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

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

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is able to meet licensing standards.

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

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of HealthCare Facilities" is hereby repealed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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

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

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

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

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

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

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16-3.

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

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

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

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

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vote is taken.

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

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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

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

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

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

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

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

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

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industry and multi-practice health facilities.

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

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

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

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

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thirty (30) days.

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

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remainder of this act would take effect upon passage.

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