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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO HEALTH CARE FACILITIES - LICENSING

     Introduced By: Representatives Tanzi, McEntee, and Fogarty

     Date Introduced: March 02, 2017

     Referred To: House Finance

     (by request)

It is enacted by the General Assembly as follows:

     SECTION 1. Section 23-17-2 of the General Laws in Chapter 23-17 entitled "Licensing

of Health-Care Facilities" is hereby amended to read as follows:

     23-17-2. Definitions.

     As used in this chapter:

     (1) "Affiliate" means a legal entity that is in control of, is controlled by or is in common

control with another legal entity.

     (1) (2) "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) (3) (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)(i)(A) – (3)(i)(D).

     (3) (4) "Change in owner" means:

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

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

partnership;

     (ii) In the case of a health-care facility that 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 that is a business corporation, any transfer of

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

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

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

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

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

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

a speech language pathologist or audiologist licensed under chapter 48 of title 5.

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

     (6) (7) "Freestanding, emergency-care facility" means an establishment, place, or facility

that 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

or continuance of severe pain.

     (7) (8) "Health-care facility" means any institutional health-service provider, facility, or

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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; freestanding, 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

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

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

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 a hospital or an affiliate of a hospital or

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

organization, or association); provided, however, notwithstanding any other provision herein or in

the general laws, any hospital or any affiliate of a hospital that owns and/or operates a

practitioner's office shall ensure that such practitioner's office complies with licensing or

accreditation requirements that may be applicable to the practitioner's office. 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 the 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

behavioral healthcare, developmental disabilities, 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

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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.

     (8) (9) "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.

     (9) (10) "Hospital" means a person or governmental entity licensed in accordance with

this chapter to establish, maintain, and operate a hospital.

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

     (11) (12) "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.

     (12) (13) "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.

     (13) (14) "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.

     (14) (15) "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.

     (15) (16) "Physician ambulatory-surgery center" means an office, or portion of an office,

that 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

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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).

     (16) (17) "Podiatry ambulatory-surgery center" means an office or portion of an office

that 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

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).

     (17) (18) "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

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

     (18) (19) "Qualified, sign-language interpreter" means one who has been licensed in

accordance with the provisions of chapter 71 of title 5.

     (19) (20) "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.

     SECTION 2. 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 CARE FACILITIES - LICENSING

***

     This act would amend the definition of health care facility to allow a hospital or an

affiliate of a hospital to own and operate ambulatory-care facilities.

     This act would take effect upon passage.

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