2016 -- H 7500 SUBSTITUTE A

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LC004411/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTH CARE FACILITIES

     Introduced By: Representatives Serpa, McKiernan, Ackerman, O'Brien, and Shekarchi

     Date Introduced: February 05, 2016

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 23-17-2, 23-17-4, 23-17-10, 23-17-10.2, 23-17-26, 23-17-40, 23-

17-43, 23-17-54 and 23-17-58 of the General Laws in Chapter 23-17 entitled "Licensing of

Health Care Facilities" are hereby amended to read as follows:

     23-17-2. Definitions. -- As used in this chapter:

      (1) "Alzheimer's dementia special care unit or program" means a distinct living

environment within a nursing facility that has been physically adapted to accommodate the

particular needs and behaviors of those with dementia. The unit provides increased staffing,

therapeutic activities designed specifically for those with dementia, and trains its staff on an

ongoing basis on the effective management of the physical and behavioral problems of those with

dementia. The residents of the unit/program have had a standard medical diagnostic evaluation

and have been determined to have a diagnosis of Alzheimer's dementia or another dementia.

      (2) (i) "Change in operator" means a transfer by the governing body or operator of a

health care facility to any other person (excluding delegations of authority to the medical or

administrative staff of the facility) of the governing body's authority to:

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

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

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

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

      (ii) This definition is not applicable to circumstances wherein the governing body of a

health care facility retains the immediate authority and jurisdiction over the activities enumerated

in subdivisions (2)(i)(A) -- (2)(i)(D).

      (3) "Change in owner" means:

      (i) In the case of a health care facility which is a partnership, the removal, addition, or

substitution of a partner which results in a new partner acquiring a controlling interest in the

partnership;

      (ii) In the case of a health care facility which is an unincorporated solo proprietorship,

the transfer of the title and property to another person;

      (iii) In the case of a health care facility that is a corporation:

      (A) A sale, lease exchange, or other disposition of all, or substantially all of the property

and assets of the corporation; or

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

      (C) The consolidation or two (2) or more corporations, resulting in the creation of a new

corporation; or

      (D) In the case of a health care facility which is a business corporation, any transfer of

corporate stock which results in a new person acquiring a controlling interest in the corporation;

or

      (E) In the case of a health care facility which is a nonbusiness corporation, any change in

membership which results in a new person acquiring a controlling vote in the corporation.

      (4) "Clinician" means a physician licensed under title 5, chapter 37; a nurse licensed

under title 5, chapter 34; a psychologist licensed under title 5, chapter 44; a social worker licensed

under title 5, chapter 39.1; a physical therapist licensed under title 5, chapter 40; and a speech

language pathologist or audiologist licensed under title 5, chapter 48.

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

      (6) "Health care facility" means any institutional health service provider, facility or

institution, place, building, agency, or portion thereof, whether a partnership or corporation,

whether public or private, whether organized for profit or not, used, operated, or engaged in

providing health care services, including but not limited to hospitals; nursing facilities; home

nursing care provider (which shall include skilled nursing services and may also include activities

allowed as a home care provider or as a nursing service agency); home care provider (which may

include services such as personal care or homemaker services); rehabilitation centers; kidney

disease treatment centers; health maintenance organizations; free-standing emergency care

facilities as defined in this section, and facilities providing surgical treatment to patients not

requiring hospitalization (surgi-centers); hospice care, and physician ambulatory surgery centers

LC004411/SUB A - Page 2 of 17

and podiatry ambulatory surgery centers providing surgical treatment. The term "health care

facility" also includes organized ambulatory care facilities which are not part of a hospital but

which are organized and operated to provide health care services to outpatients such as central

services facilities serving more than one health care facility or health care provider, treatment

centers, diagnostic centers, outpatient clinics, infirmaries and health centers, school based health

centers and neighborhood health centers. The term "health care facility" also includes a mobile

health screening vehicle as defined in this section. The term "health care facility" shall not apply

to organized ambulatory care facilities owned and operated by professional service corporations

as defined in chapter 5.1 of title 7, as amended (the "Professional Service Corporation Law"), or

to a private practitioner's (physician, dentist, or other health care provider) office or group of the

practitioners' offices (whether owned and/or operated by an individual practitioner, alone or as a

member of a partnership, professional service corporation, organization, or association).

Individual categories of health care facilities shall be defined in rules and regulations

promulgated by the licensing agency with the advice of the health services council. Rules and

regulations concerning hospice care shall be promulgated with regard to the "Standards of a

Hospice Program of Care", promulgated by National Hospice Organization. Any provider of

hospice care who provides hospice care without charge shall be exempt from the licensing

provisions of this chapter but shall meet the "Standards of a Hospice Program of Care." Facilities

licensed by the department of mental health, retardation, and hospitals and the department of

human services, and clinical laboratories licensed in accordance with chapter 16.2 of this title, as

well as Christian Science institutions (also known as Christian Science Nursing Facilities) listed

and certified by the Commission for Accreditation of Christian Science Nursing

Organizations/Facilities, Inc. shall not be considered health care facilities for purposes of this

chapter.

      (7) "Homemaker", or however else called, means a trained non-professional worker who

performs related housekeeping services in the home for the sick, disabled, dependent, or infirm,

and as further defined by regulation; the director shall establish criteria for training.

      (8) "Hospital" means a person or governmental entity licensed in accordance with this

chapter to establish, maintain and operate a hospital.

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

      (10) "Medical services" means any professional services and supplies rendered by or

under the direction of persons duly licensed under the laws of this state to practice medicine,

surgery, or podiatry that may be specified by any medical service plan. Medical service shall not

be construed to include hospital services.

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      (11) "Non-English speaker" means a person who cannot speak or understand, or has

difficulty in speaking or understanding, the English language, because he/she uses only or

primarily a spoken language other than English, and/or a person who uses a sign language and

requires the use of a sign language interpreter to facilitate communication.

      (12) "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.

      (13) "Physician ambulatory surgery center" means an office or portion of an office which

is utilized for the purpose of furnishing surgical services to the owner and/or operator's own

patients on an ambulatory basis, and shall include both single-practice physician ambulatory

surgery centers and multi-practice physician ambulatory surgery centers. A "single-practice

physician ambulatory surgery center" is a physician ambulatory center owned and/or operated by

a physician controlled professional service corporation as defined in chapter 5.1 of title 7 (the

"Professional Service Corporation Law"), or a physician controlled limited liability company (as

defined in chapter 16 of title 7 (the "Limited Liability Company Act")) in which no physician is

an officer, shareholder, director, or employee of any other corporation engaged in the practice of

the same profession, or a private physician's office (whether owned and/or operated by an

individual practitioner, alone or as a member of a partnership, professional service corporation,

limited liability company, organization, or association). A "multi-practice physician ambulatory

surgery center" is a physician ambulatory surgery center owned and/or operated by a physician

controlled professional service corporation (as defined in the Professional Service Corporation

Law) or a physician controlled limited liability company (as defined in the Limited Liability

Company Act) in which a physician is also an officer, shareholder, director, or employee of

another corporation engaged in the practice of the same profession, or a group of physicians'

offices (whether owned and/or operated by an individual practitioner, alone or as a member of a

partnership, professional service corporation, limited liability company, organization, or

association).

      (14) "Podiatry ambulatory surgery center" means an office or portion of an office which

is utilized for the purpose of furnishing surgical services to the owner and/or operator's own

patients on an ambulatory basis, and shall include both single-practice podiatry ambulatory

surgery centers and multi-practice podiatry ambulatory surgery centers. A "single-practice

podiatry ambulatory surgery center" is a podiatry ambulatory center owned and/or operated by a

podiatrist controlled professional service corporation as (defined in chapter 5.1 of title 7 (the

"Professional Service Corporation Law")), or a podiatrist controlled limited liability company (as

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defined in chapter 16 of title 7 (the "Limited Liability Company Act")) in which no podiatrist is

an officer, shareholder, director, or employee of any other corporation engaged in the practice of

the same profession, or a private podiatrist's office (whether owned and/or operated by an

individual practitioner, alone or as a member of a partnership, professional service corporation,

limited liability company, organization, or association). A "multi-practice podiatry ambulatory

surgery center" is a podiatry ambulatory surgery center owned and/or operated by a podiatry

controlled professional service corporation (as defined in the Professional Service Corporation

Law) or a podiatry controlled limited liability company (as defined in the Limited Liability

Company Act) in which a podiatrist is also an officer, shareholder, director, or employee of

another corporation engaged in the practice of the same profession, or a group of podiatrists'

offices (whether owned and/or operated by a an individual practitioner, alone or as a member of

a partnership, professional service corporation, limited liability company, organization, or

association).

      (15) "Qualified interpreter" means a person who, through experience and/or training, is

able to translate a particular foreign language into English with the exception of sign language

interpreters who must be licensed in accordance with chapter 71 of title 5.

      (16) "Qualified sign language interpreter" means one who has been licensed in

accordance with the provisions of chapter 71 of title 5.

      (17) "School based health center" means a facility located in an elementary or secondary

school that delivers primary and preventive health care services to students on site.

      (18) "Mobile health screening vehicle" means a mobile vehicle, van, or trailer that

delivers primary and preventive health care screening services, and:

      (i) Does not maintain active contracts or arrangements with any health insurer subject to

regulation under chapters 20 or 42 of title 27;

      (ii) Does not maintain active contracts or arrangements with another licensed health care

facility as that term is defined within this section; and

      (iii) Does not provide medical services free of charge.

     (19) "Freestanding emergency care facility" means an establishment, place or facility

which may be a public or private organization, structurally distinct and separate from a hospital;

staffed, equipped, and operated to provide prompt emergency medical care. For the purposes of

this chapter, "emergency medical care" means services provided for a medical condition or

behavioral health condition that is manifested by symptoms of sufficient severity that, in the

absence of immediate medical attention, could result in harm to the person or others, serious

impairment to bodily functions, serious dysfunction of any bodily organ or part, or development

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or continuance of severe pain.

     23-17-4. License required for health care facility operation. -- (a) No person acting

severally or jointly with any other person shall establish, conduct, or maintain a health care

facility in this state without a license under this chapter; provided, however, that any person, firm,

corporation, or other entity that provides volunteer registered and licensed practical nurses to the

public shall not be required to have a license as a health care facility.

      (b) Each location at which a health care facility provides services shall be licensed;

provided, however, that a hospital or organized ambulatory care facility shall be permitted to

provide, solely on an ambulatory basis, limited physician services, other limited professional

health care services, and/or other limited professional mental health care services in conjunction

with services provided by and at community health centers, community mental health centers,

organized ambulatory care facilities or other licensed health care facilities, physicians' offices,

and facilities operated by the department of corrections without establishing such locations as

additional licensed premises of the hospital or organized ambulatory care facility; provided, that a

health care facility licensed as an organized ambulatory care facility in the state, may provide

services at other locations operated by that licensed organized ambulatory care facility, without

the requirement of a separate organized ambulatory care facility license for such other locations.

For purposes of this section, an organized ambulatory care facility or other licensed health care

facility shall not include a freestanding emergency care facility. The department is further

authorized to adopt rules and regulations to accomplish the purpose of this section, including, but

not limited to, defining "limited physician services, other limited professional health care

services, and/or other limited professional mental health care services."

      (c) The reimbursement rates for the services rendered in the settings listed in subsection

(b) of this chapter shall be subject to negotiations between the hospitals, organized ambulatory

care facilities, and the payors, respectively, as defined in § 23-17.12-2.

     23-17-10. Regulations, inspections, and investigations -- Certain hospitals required

to provide on-premises coverage by physician -- Uniform reports -- Data systems. -- (a) (1)

The licensing agency, with the advice of the health services council, shall after a public hearing

pursuant to reasonable notice adopt, amend, promulgate, and enforce rules, regulations, and

standards with respect to each category of health care facility to be licensed under this chapter

that may be designed to further the accomplishment of the purposes of this chapter in promoting

safe and adequate treatment of individuals in health care facilities in the interest of public health,

safety, and welfare. Provided, further, however, that all licensed medical, surgical, or obstetrical

hospitals (excepting those hospitals as defined in § 23-17-2, as amended, which maintain an on-

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premises emergency room staffed by a licensed physician, resident, or intern at all times) and

freestanding emergency care facilities shall be required to protect their patients by providing on-

premises coverage by a licensed physician, resident or intern at all times.

      (2) In developing regulations for home nursing care providers and home care providers,

the director shall consider and adopt, where appropriate, standards of relevant national accrediting

bodies. The director shall make or cause to be made quality improvement and licensure

inspections of each licensed home nursing care provider and home care provider at a minimum of

once in a twelve (12) month period. These inspections shall include but not be limited to: home

visits; patient surveys; and employee interviews.

      (b) The licensing agency shall make or cause to be made any inspections and

investigations that it deems necessary including medical records. The licensing agency, with the

advice of the health services council, shall also adopt, amend, promulgate, and enforce rules and

regulations to provide for a uniform system of reporting detailed financial and statistical data

pertaining to the operation, services, and facilities of the health care facilities and the periodic

reporting shall, in accordance with the rules and regulations, be concerned with, but not limited

to, unit cost utilization charges of health care facility services, financial condition of health care

facilities, and quality of health care facility care. The uniform reports shall also include

institutional plans that shall be prescribed in accordance with rules and regulations promulgated

by the licensing agency with the advice of the health services council. Each health care facility

shall establish and maintain data systems to meet the requirements of any uniform system of

periodic reporting that may be prescribed in accordance with the provisions of this section. The

data shall be made available and be considered by the state agency concerned with the

reimbursement and/or utilization of health care facility services.

     23-17-10.2. Full financial disclosure by hospitals Full financial disclosure by

hospitals and freestanding emergency care facilities. -- Any hospital or freestanding

emergency care facility licensed under this chapter, other than state-operated hospitals, shall

annually submit to the director of the department of health:

      (a) Public audited financial statements containing information concerning all hospital-

related or freestanding emergency care facility-related corporations, holding corporations and

subsidiary corporations, whether for-profit or not-for-profit. Any hospital corporation, holding

corporation, or subsidiary corporation, whether for-profit or not-for-profit, which is not audited

by an independent public auditor due to limited activity or small size, shall submit a financial

statement certified by the chief executive officer of that corporation.

      (b) Any hospital or freestanding emergency care facility licensed under this chapter,

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other than state operated hospitals shall on or before January 1, 2014 and annually thereafter,

submit a summary of financial information contained in accordance with the following: (1) Not-

for-profit hospitals shall submit a summary of the information contained in section 501(c), 527, or

4947(a)(1) of the internal revenue code 990 form including:

      (i) Its statement of financial position;

      (ii) The verified total costs incurred by the hospital or freestanding emergency care

facility in providing health services;

      (iii) Total payroll including fringe benefits, and any other remuneration of the top five

(5) highest compensated employees and/or contractors, identified by position description and

specialty;

      (iv) The verified net costs of medical education; and

      (v) Administrative expenses; as defined by the director of the department of health.

      (2) For-profit hospitals and freestanding emergency care facilities shall submit the

information listed in (b)(1) of this section in a form approved by the department of health.

      (c) All information provided shall be made available to the healthcare planning and

accountability advisory council, as established in § 23-81-4 and shall be made available to the

public for inspection.

     23-17-26. Emergency health care. -- (a) Every health care facility that has an

emergency medical care unit including freestanding emergency care facilities shall provide to

every person prompt life saving medical care treatment in an emergency, and a sexual assault

examination for victims of sexual assault without discrimination on account of economic status or

source of payment, and without delaying treatment for the purpose of a prior discussion of the

source of payment unless the delay can be imposed without material risk to the health of the

person.

      (b) Violations of this section shall be reported to the director of the state department of

health who shall investigate the violations as the director deems appropriate.

     23-17-40. Hospital events reporting Hospital and freestanding emergency care

facility events reporting. -- (a) Definitions. - As used in this section, the following terms shall

have the following meanings:

      (1) "Adverse event" means injury to a patient resulting from a medical intervention, and

not to the underlying condition of the patient.

      (2) "Checklist of care" means predetermined steps to be followed by a team of healthcare

providers before, during or after a given procedure to decrease the possibility of adverse effects

and other patient harm by articulating standards of care.

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      (b) Reportable events as defined in subsection (c) shall be reported to the department of

health division of facilities regulation on a telephone number maintained for that purpose.

Hospitals and freestanding emergency care facilities shall report incidents as defined in

subsection (c) within twenty-four (24) hours of when the accident occurred or if later, within

twenty-four (24) hours of receipt of information causing the hospital or freestanding emergency

care facility to believe that a reportable event has occurred.

      (c) Reportable events are defined as follows:

      (1) Fires or internal disasters in the facility which disrupt the provisions of patient care

services or cause harm to patients or personnel;

      (2) Poisoning involving patients of the facility;

      (3) Infection outbreaks as defined by the department in regulation;

      (4) Kidnapping and inpatient psychiatric elopements and elopements by minors;

      (5) Strikes by personnel;

      (6) Disasters or other emergency situations external to the hospital or freestanding

emergency care facility environment which adversely affect facility operations; and

      (7) Unscheduled termination of any services vital to the continued safe operation of the

facility or to the health and safety of its patients and personnel.

      (d) Any hospital or freestanding emergency care facility filing a report with the attorney

general's office concerning abuse, neglect and mistreatment of patients as defined in chapter 17.8

of this title shall forward a copy of the report to the department of health. In addition, a copy of

all hospital notifications and reports made in compliance with the federal Safe Medical Devices

Act of 1990, 21 U.S.C. § 301 et seq., shall be forwarded to the department of health within the

time specified in the federal law.

      (e) Any reportable incident in a hospital that results in patient injury as defined in

subsection (f) shall be reported to the department of health with seventy-two (72) hours or when

the hospital has reasonable cause to believe that an incident as defined in subsection (f) has

occurred. The department of health shall promulgate rules and regulations to include the process

whereby health care professionals with knowledge of an incident shall report it to the hospital,

requirements for the hospital to conduct a root cause analysis of the incident or other appropriate

process for incident investigation and to develop and file a performance improvement plan, and

additional incidents to be reported that are in addition to those listed in subsection (f). In its

reports, no personal identifiers shall be included. The hospital shall require the appropriate

committee within the hospital to carry out a peer review process to determine whether the

incident was within the normal range of outcomes, given the patient's condition. The hospital

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shall notify the department of the outcome of the internal review, and if the findings determine

that the incident was within the normal range of patient outcomes no further action is required. If

the findings conclude that the incident was not within the normal range of patient outcomes, the

hospital shall conduct a root cause analysis or other appropriate process for incident investigation

to identify causal factors that may have lead to the incident and develop a performance

improvement plan to prevent similar incidents from occurring in the future. The hospital shall

also provide to the department of health the following information:

      (1) An explanation of the circumstances surrounding the incident;

      (2) An updated assessment of the effect of the incident on the patient;

      (3) A summary of current patient status including follow-up care provided and post-

incident diagnosis;

      (4) A summary of all actions taken to correct identified problems to prevent recurrence

of the incident and/or to improve overall patient care and to comply with other requirements of

this section.

      (f) Incidents to be reported are those causing or involving:

      (1) Brain injury;

      (2) Mental impairment;

      (3) Paraplegia;

      (4) Quadriplegia;

      (5) Any type of paralysis;

      (6) Loss of use of limb or organ;

      (7) Hospital stay extended due to serious or unforeseen complications;

      (8) Birth injury;

      (9) Impairment of sight or hearing;

      (10) Surgery on the wrong patient;

      (11) Subjecting a patient to a procedure other than that ordered or intended by the

patient's attending physician;

      (12) Any other incident that is reported to their malpractice insurance carrier or self-

insurance program;

      (13) Suicide of a patient during treatment or within five (5) days of discharge from an

inpatient or outpatient unit (if known);

      (14) Blood transfusion error; and

      (15) Any serious or unforeseen complication, that is not expected or probable, resulting

in an extended hospital stay or death of the patient.

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      (g) This section does not replace other reporting required by this chapter.

      (h) Nothing in this section shall prohibit the department from investigating any event or

incident.

      (i) All reports to the department under this section shall be subject to the provisions of §

23-17-15. In addition, all reports under this section, together with the peer review records and

proceedings related to events and incidents so reported and the participants in the proceedings

shall be deemed entitled to all the privileges and immunities for peer review records set forth in §

23-17-25.

      (j) The department shall issue an annual report by March 31 each year providing

aggregate summary information on the events and incidents reported by hospitals and

freestanding emergency care facilities as required by this chapter. A copy of the report shall be

forwarded to the governor, the speaker of the house, the senate president and members of the

health care quality steering committee established pursuant to § 23-17.17-6.

      (k) The director shall review the list of incidents to be reported in subsection (f) above at

least biennially to ascertain whether any additions, deletions or modifications to the list are

necessary. In conducting the review, the director shall take into account those adverse events

identified on the National Quality Forum's List of Serious Reportable Events. In the event the

director determines that incidents should be added, deleted or modified, the director shall make

such recommendations for changes to the legislature.

     23-17-43. Charity care requirements. -- Any new hospital or freestanding emergency

care facility licensee shall meet the statewide community standard for the provision of charity

care services as a condition of initial and continued licensure. That 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.

     23-17-54. Provisions of interpreter services. -- (a) Every hospital and freestanding

emergency care facility shall, as a condition of initial or continued licensure, provide a qualified

interpreter, if an appropriate bilingual clinician is not available to translate, in connection with all

services provided to every non-English speaker who is a patient or seeks appropriate care and

treatment and is not accompanied or represented by an appropriate qualified interpreter or a

qualified sign language interpreter who has attained at least sixteen (16) years of age.

      (b) Each hospital and freestanding emergency care facility shall post a multi-lingual

notice in conspicuous places setting forth the requirement in subsection (a) of this section in

English and the, at minimum, three (3) most common foreign languages used by the hospital or

freestanding emergency care facility as determined by the hospital or freestanding emergency

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care facility.

      (c) The receipt by a non-English speaker of interpreter services shall not be deemed the

receipt of a benefit under any provisions of law restricting benefits or assistance on the basis of

immigrant status.

      (d) Nothing in this section shall be construed to affect or limit any rights, remedies or

obligations under chapter 24 of title 11 or under chapters 87 or 112 of title 42.

     23-17-58. Documentation of pre-hospital exposure of emergency medical services

workers Documentation of pre-hospital and pre-freestanding emergency care facility

exposure of emergency medical services workers. -- Hospitals and freestanding emergency

care facilities shall be required to complete the hospital related information requirements of the

pre-hospital exposure form for emergency service workers as required by § 23-4.1-19. Further,

the hospitals and freestanding emergency care facilities shall report to the director of the

department of health the information and data as may be required by regulation.

     SECTION 2. Sections 23-4.1-7.1 and 23-4.1-19 of the General Laws in Chapter 23-4.1

entitled "Emergency Medical Transportation Services" are hereby amended to read as follows:

     23-4.1-7.1. Restocking of municipal ambulance supplies. -- (a) The director of health,

with the cooperation of hospitals and freestanding emergency care facilities licensed in

accordance with chapter 17 of this title, will develop a listing of supplies that are subject to

mandatory restocking in accordance with subsection (b) of this section.

      (b) Every hospital and freestanding emergency care facility licensed in accordance with

chapter 17 of this title is required to restock supplies listed in accordance with subsection (a) of

this section that are used by a licensed emergency medical services provider in transporting

emergency patients to hospitals or freestanding emergency care facilities licensed in accordance

with chapter 17 of this title. Restocking will not be required:

      (1) In the absence of documentation of supply usage on the emergency patient's RI EMS

ambulance run report; or

      (2) If the licensed emergency medical services provider bills any third party payer for the

supplies which were used.

     23-4.1-19. Documentation of pre-hospital exposure of emergency medical services

workers Documentation of pre-health care facility exposure of emergency medical services

workers. -- (a) Any emergency service worker responding on behalf of a licensed

ambulance/rescue service, or a fire department or a law enforcement agency who has sufficient

reason to believe that, in the course of their professional duties, they have been exposed to bodily

fluids or other substances that may result in the worker contracting a serious infection and/or

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illness shall complete a pre-hospital pre-health care facility exposure form. The worker shall file a

copy of the form with the hospital or freestanding emergency care facility receiving the

transported patient believed to be the source of the infectious materials to which the worker

believes he or she has been exposed. The worker shall file the form with the hospital or

freestanding emergency care facility immediately post exposure. The worker shall retain a copy

of the completed form, except for that information protected by applicable confidentiality laws.

The source patient's diagnostic information shall not appear on the pre-hospital pre-health care

facility exposure form.

      (b) The director of the department of health, with the advice of the ambulance services

advisory board, shall develop the pre-hospital pre-health care facility exposure form, and shall

make copies available to all agencies employing emergency medical service workers, and

hospitals and freestanding emergency care facilities.

     SECTION 3. Section 23-15-2 of the General Laws in Chapter 23-15 entitled

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

is hereby amended to read as follows:

     23-15-2. Definitions. -- As used in this chapter:

      (1) "Affected person" means and includes 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, those voluntary nonprofit area-

wide planning agencies that may be established in the state, the state budget office, the office of

health insurance commissioner, 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.

      (2) "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 any detail that may be prescribed by the state agency in

rules and regulations.

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

      (4) (i) "Health care facility" means any institutional health service provider, facility or

institution, place, building, agency, or portion of them, whether a partnership or corporation,

whether public or private, whether organized for profit or not, used, operated, or engaged in

providing health care services, which are limited to hospitals, nursing facilities, home nursing

care provider, home care provider, hospice provider, inpatient rehabilitation centers (including

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drug and/or alcohol abuse treatment centers), freestanding emergency care facilities as defined in

§23-17-2, certain facilities providing surgical treatment to patients not requiring hospitalization

(surgi-centers, multi-practice physician ambulatory surgery centers and multi-practice podiatry

ambulatory surgery centers) and facilities providing inpatient hospice care. Single-practice

physician or podiatry ambulatory surgery centers (as defined in subdivisions 23-17-2(13) and 23-

17-2(14), respectively) are exempt from the requirements of chapter 15 of this title; provided,

however, that such exemption shall not apply if a single-practice physician or podiatry

ambulatory surgery center is established by a medical practice group (as defined in § 5-37-1)

within two (2) years following the formation of such medical practice group, when such medical

practice group is formed by the merger or consolidation of two (2) or more medical practice

groups or the acquisition of one medical practice group by another medical practice group. The

term "health care facility" does not include Christian Science institutions (also known as

Christian Science nursing facilities) listed and certified by the Commission for Accreditation of

Christian Science Nursing Organizations/Facilities, Inc.

      (ii) Any provider of hospice care who provides hospice care without charge shall be

exempt from the provisions of this chapter.

      (5) "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.

      (6) "Health services" means organized program components for preventive, assessment,

maintenance, diagnostic, treatment, and rehabilitative services provided in a health care facility.

      (7) "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 provided to serve as the advisory body to the state agency in its review functions

under this chapter.

      (8) "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.

      (9) "New health care equipment" means any single piece of medical equipment (and any

components which constitute operational components of the piece of medical equipment)

proposed to be utilized in conjunction with the provision of services to patients or the public, the

capital costs of which would exceed two million two hundred fifty thousand dollars ($2,250,000);

provided, however, that the state agency shall exempt from review any application which

proposes one for one equipment replacement as defined in regulation. Further, beginning July 1,

LC004411/SUB A - Page 14 of 17

2012 and each July thereafter the amount shall be adjusted by the percentage of increase in the

consumer price index for all urban consumers (CPI-U) as published by the United States

department of labor statistics as of September 30 of the prior calendar year.

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

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

      (ii) 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 five million two hundred fifty thousand dollars

($5,250,000) which is a capital expenditure including expenditures for predevelopment activities;

provided further, beginning July 1, 2012 and each July thereafter the amount shall be adjusted by

the percentage of increase in the consumer price index for all urban consumers (CPI-U) as

published by the United States department of labor statistics as of September 30 of the prior

calendar year.

      (iii) 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.

      (iv) 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 licensed 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 two million dollars ($2,000,000).

      (v) 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 one million five hundred thousand dollars ($1,500,000), 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.

Further beginning July 1, 2012 and each July thereafter the amount shall be adjusted by the

percentage of increase in the consumer price index for all urban consumers (CPI-U) as published

by the United States department of labor statistics as of September 30 of the prior calendar year.

      (vi) Any new or expanded tertiary or specialty care service, regardless of capital expense

LC004411/SUB A - Page 15 of 17

or operating expense, as defined by and listed in regulation, the list not to exceed a total of twelve

(12) categories of services at any one time and shall include full body magnetic resonance

imaging and computerized axial tomography; provided, however, that the state agency shall

exempt from review any application which proposes one for one equipment replacement as

defined by and listed in regulation. Acquisition of full body magnetic resonance imaging and

computerized axial tomography shall not require a certificate of need review and approval by the

state agency if satisfactory evidence is provided to the state agency that it was acquired for under

one million dollars ($1,000,000) on or before January 1, 2010 and was in operation on or before

July 1, 2010.

      (11) "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.

      (12) "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.

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

      (14) "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 that service.

      (15) "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.

     SECTION 4. 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 -- LICENSING OF HEALTH CARE FACILITIES

***

     This act would define freestanding emergency care facilities subject to health care

facilities licensing requirements, emergency medical transportation regulations and determination

of need for new health care equipment and new institutional health services purposes.

     This act would take effect upon passage.

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