2021 -- H 5844 SUBSTITUTE A | |
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LC002146/SUB A/2 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2021 | |
____________ | |
A N A C T | |
RELATING TO HEALTH AND SAFETY | |
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Introduced By: Representatives Baginski, Casimiro, and Bennett | |
Date Introduced: February 24, 2021 | |
Referred To: House Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby |
2 | amended by adding thereto the following chapter: |
3 | CHAPTER 95 |
4 | MEDICAL SPAS |
5 | 23-95-1. Definitions. |
6 | For purposes of this chapter: |
7 | (1) "Ablative lasers or ablative energy devices" means lasers intended to excise or vaporize |
8 | the outer layer of skin. |
9 | (2) "Advanced Practice Registered Nurse" or "APRN" means a registered nurse who has |
10 | an active, unrestricted advanced practice registered nurse license granted under the authority of |
11 | chapter 34 of title 5. |
12 | (3) "Cosmetic medical procedure" means any procedure that does not require sedation that |
13 | is performed on a person and is directed at improving the person's appearance and does not |
14 | meaningfully promote the proper function of the body or prevent or treat illness or disease. |
15 | Cosmetic medical procedures may include, but are not limited to, cosmetic surgery, microneedling, |
16 | hair transplants, cosmetic injections, cosmetic soft tissue fillers, dermaplaning, dermastamping, |
17 | dermarolling, dermabrasion that removes cells beyond the stratum corneum, chemical peels using |
18 | modification solutions that exceed thirty percent (30%) concentration with a pH value of lower |
19 | than 3.0, laser hair removal, laser skin resurfacing, laser treatment of leg veins, sclerotherapy and |
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1 | other laser procedures, intense pulsed light, injection of cosmetic filling agents and neurotoxins and |
2 | the use of class II medical devices designed to induce deep skin tissue alteration. The performance |
3 | of cosmetic medical services is the practice of medicine and surgery. A cosmetic medical service |
4 | shall be performed only by a qualified licensed or certified non-physician if the services have been |
5 | delegated by a medical director, supervising physician, or APRN who is responsible for on-site |
6 | supervision of the services performed. |
7 | (4) "Delegate" means a non-physician tasked with performing a procedure as defined § 23- |
8 | 95-1(3) by a physician or APRN. |
9 | (5) "Department" means the Rhode Island department of health. |
10 | (6) "Medical director" means a physician who assumes the role of, or holds oneself out as, |
11 | medical director at a medical spa. The medical director shall be: |
12 | (i) Trained in the indications for, and performance of, cosmetic medical procedures, |
13 | including all medical devices or instruments that can alter or cause biological change or damage |
14 | the skin and subcutaneous tissue. Training programs provided by a manufacturer or vendor of a |
15 | medical device or supplies may not be a medical director's, supervising physician's or APRN's only |
16 | education in the cosmetic medical service or the operation of medical devices to be used; |
17 | (ii) Responsible for implementing policies and procedures to ensure quality patient care; |
18 | (iii) Responsible for the delegation and supervision of cosmetic procedures; |
19 | (iv) Responsible for the oversight of all cosmetic medical procedures performed by |
20 | physicians, APRNs, and non-physicians; and |
21 | (v) Responsible for ensuring that all supervising physicians and supervising APRNs, any |
22 | physicians and APRNs performing cosmetic medical procedures, and any non-physicians and non- |
23 | APRNs delegated to perform cosmetic medical procedures, are properly trained in the safe and |
24 | effective performance of all cosmetic medical procedures that they perform at the medical spa. |
25 | (7) "Medical spa" means an establishment in which cosmetic medical procedures are |
26 | performed. |
27 | (8) "Physician" means an allopath or osteopath who has an active license, unrestricted |
28 | medical license granted under the authority of chapter 37 of title 5. |
29 | (9) "Supervision" means an arrangement when a qualified supervising physician or APRN |
30 | is either: |
31 | (i) On site and able to directly observe the treatment being performed, though not |
32 | necessarily in the same room (i.e., direct supervision); or |
33 | (ii) Is off site, but immediately available if needed, either in person or by |
34 | telecommunication (i.e., indirect supervision). |
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1 | 23-95-2. Protection of patients in a medical spa. |
2 | (a) A physician or APRN who performs cosmetic medical procedures, or supervises such |
3 | procedures delegated to and performed by a non-physician or non-APRN, must be trained in the |
4 | indications for and performance of the cosmetic medical procedure. An APRN who performs |
5 | cosmetic medical procedures, or supervises such procedures delegated to and performed by a non- |
6 | physician or non-APRN, must be accredited by the state board of nursing. |
7 | (b) The supervising physician or APRN shall: |
8 | (1) Develop and maintain written office protocols for each cosmetic medical procedure. |
9 | Such protocols shall be kept on site at the medical spa for review and/or inspection by the |
10 | department. |
11 | (2) Perform an initial assessment of the patient. |
12 | (3) Prepare a written treatment plan for each patient, which plan shall include, as |
13 | applicable, diagnoses, course of treatment, and specifications for any device being used. |
14 | (4) Obtain patient consent, if the cosmetic medical procedure(s) are being performed by a |
15 | non-physician or non-APRN and documenting, in the patient’s medical record, the credentials and |
16 | names of the non-physician or non-APRN who will be performing the cosmetic medical procedure. |
17 | (5) Create and maintain medical records in a manner consistent with applicable laws and |
18 | regulations and accepted medical practice. |
19 | (c) Non-physicians and non-APRNs may only perform cosmetic medical procedures: |
20 | (1) For which they have the requisite training; and |
21 | (2) Which have been delegated to them by a supervising physician or APRN. |
22 | (d) At all times in the performance of their duties relative to cosmetic procedures, all |
23 | non-physicians and non-APRNs shall: |
24 | (1) Wear identification that identifies them as not being physicians or APRNs. As |
25 | applicable, such identification must identify the non-physician/non-APRN’s job title and |
26 | credentials, including professional license; |
27 | (2) Review and follow written protocols for each delegated cosmetic medical procedure; |
28 | (3) Verify that the supervising physician or supervising APRN has assessed the patient and |
29 | given written treatment instructions for each procedure performed; |
30 | (4) Review the cosmetic medical procedure with each patient; |
31 | (5) Notify the medical director, as well as the supervising physician or supervising APRN, |
32 | before the patient leaves or as they become aware, of any adverse events or complications, and |
33 | follow up with the patient post-procedure, as appropriate; |
34 | (6) Document all relevant details of the performed cosmetic medical procedure in the |
| LC002146/SUB A/2 - Page 3 of 13 |
1 | patient’s medical record; and |
2 | (7) As applicable, satisfy any requirements imposed upon them by their licensing boards. |
3 | (e) Cosmetic medical procedures using ablative lasers or ablative energy devices shall only |
4 | be performed by physicians. |
5 | 23-95-3. Rules and regulations. |
6 | The department shall, by July 1, 2022, promulgate rules and regulations necessary and not |
7 | inconsistent with law to implement the purpose and intent of this chapter, which rules and |
8 | regulations shall provide for, though not be limited to, the licensing of medical spas as health care |
9 | facilities. |
10 | SECTION 2. Section 23-17-2 of the General Laws in Chapter 23-17 entitled "Licensing of |
11 | Healthcare Facilities" is hereby amended to read as follows: |
12 | 23-17-2. Definitions. |
13 | As used in this chapter: |
14 | (1) "Affiliate" means a legal entity that is in control of, is controlled by, or is in common |
15 | control with another legal entity. |
16 | (2) "Alzheimer's dementia special-care unit or program" means a distinct living |
17 | environment within a nursing facility that has been physically adapted to accommodate the |
18 | particular needs and behaviors of those with dementia. The unit provides increased staffing; |
19 | therapeutic activities designed specifically for those with dementia; and trains its staff on an |
20 | ongoing basis on the effective management of the physical and behavioral problems of those with |
21 | dementia. The residents of the unit/program have had a standard, medical-diagnostic evaluation |
22 | and have been determined to have a diagnosis of Alzheimer's dementia or another dementia. |
23 | (3)(i) "Change in operator" means a transfer by the governing body or operator of a |
24 | healthcare facility to any other person (excluding delegations of authority to the medical or |
25 | administrative staff of the facility) of the governing body's authority to: |
26 | (A) Hire or fire the chief executive officer of the healthcare facility; |
27 | (B) Maintain and control the books and records of the healthcare facility; |
28 | (C) Dispose of assets and incur liabilities on behalf of the healthcare facility; or |
29 | (D) Adopt and enforce policies regarding operation of the healthcare facility. |
30 | (ii) This definition is not applicable to circumstances wherein the governing body of a |
31 | healthcare facility retains the immediate authority and jurisdiction over the activities enumerated |
32 | in subdivisions (3)(i)(A) -- (3)(i)(D). |
33 | (4) "Change in owner" means: |
34 | (i) In the case of a healthcare facility that is a partnership, the removal, addition, or |
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1 | substitution of a partner that results in a new partner acquiring a controlling interest in the |
2 | partnership; |
3 | (ii) In the case of a healthcare facility that is an unincorporated, solo proprietorship, the |
4 | transfer of the title and property to another person; |
5 | (iii) In the case of a healthcare facility that is a corporation: |
6 | (A) A sale, lease exchange, or other disposition of all, or substantially all, of the property |
7 | and assets of the corporation; or |
8 | (B) A merger of the corporation into another corporation; or |
9 | (C) The consolidation or two (2) or more corporations, resulting in the creation of a new |
10 | corporation; or |
11 | (D) In the case of a healthcare facility that is a business corporation, any transfer of |
12 | corporate stock that results in a new person acquiring a controlling interest in the corporation; or |
13 | (E) In the case of a healthcare facility that is a nonbusiness corporation, any change in |
14 | membership that results in a new person acquiring a controlling vote in the corporation. |
15 | (5) "Clinician" means a physician licensed under chapter 37 of title 5; a nurse licensed |
16 | under chapter 34 of title 5; a psychologist licensed under chapter 44 of title 5; a social worker |
17 | licensed under chapter 39.1 of title 5; a physical therapist licensed under chapter 40 of title 5; and |
18 | a speech language pathologist or audiologist licensed under chapter 48 of title 5. |
19 | (6) "Director" means the director of the Rhode Island state department of health. |
20 | (7) "Freestanding emergency-care facility" means an establishment, place, or facility that |
21 | may be a public or private organization, structurally distinct and separate from a hospital; staffed, |
22 | equipped, and operated to provide prompt, emergency medical care. For the purposes of this |
23 | chapter, "emergency medical care" means services provided for a medical condition or behavioral- |
24 | health condition that is manifested by symptoms of sufficient severity that, in the absence of |
25 | immediate medical attention, could result in harm to the person or others; serious impairment to |
26 | bodily functions; serious dysfunction of any bodily organ or part; or development or continuance |
27 | of severe pain. |
28 | (8) "Healthcare facility" means any institutional health-service provider, facility, or |
29 | institution, place, building, agency, or portion thereof, whether a partnership or corporation, |
30 | whether public or private, whether organized for profit or not, used, operated, or engaged in |
31 | providing healthcare services, including, but not limited to: hospitals; nursing facilities; home |
32 | nursing-care provider (which shall include skilled nursing services and may also include activities |
33 | allowed as a home-care provider or as a nursing service agency); home-care provider (which may |
34 | include services such as personal care or homemaker services); rehabilitation centers; kidney |
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1 | disease treatment centers; health maintenance organizations; freestanding emergency-care facilities |
2 | as defined in this section, and facilities providing surgical treatment to patients not requiring |
3 | hospitalization (surgi-centers); hospice care, and physician ambulatory-surgery centers and |
4 | podiatry ambulatory-surgery centers providing surgical treatment. The term "health-care facility" |
5 | also includes organized ambulatory-care facilities that are not part of a hospital but that are |
6 | organized and operated to provide healthcare services to outpatients, such as: central-services |
7 | facilities serving more than one healthcare facility or healthcare provider; treatment centers; |
8 | diagnostic centers; outpatient clinics; medical spas as defined in chapter 95 of title 23; infirmaries |
9 | and health centers; school-based health centers, and neighborhood health centers. The term |
10 | "healthcare facility" also includes a mobile, health-screening vehicle as defined in this section. The |
11 | term "healthcare facility" shall not apply to organized, ambulatory-care facilities owned and |
12 | operated by professional service corporations as defined in chapter 5.1 of title 7, as amended (the |
13 | "professional service corporation law"), or to a practitioner's (physician, dentist, or other healthcare |
14 | provider) office or group of practitioners' offices (whether owned and/or operated by a hospital or |
15 | an affiliate of a hospital or an individual practitioner, alone or as a member of a partnership, |
16 | professional service corporation, organization, or association); provided, however, notwithstanding |
17 | any other provision herein or in the general laws, any hospital or any affiliate of a hospital that |
18 | owns and/or operates a practitioner's office shall ensure that such practitioner's office complies with |
19 | licensing or accreditation requirements that may be applicable to the practitioner's office. Individual |
20 | categories of healthcare facilities shall be defined in rules and regulations promulgated by the |
21 | licensing agency with the advice of the health services council. Rules and regulations concerning |
22 | hospice care shall be promulgated with regard to the "Standards of a Hospice Program of Care," |
23 | promulgated by the National Hospice Organization. Any provider of hospice care who provides |
24 | hospice care without charge shall be exempt from the licensing provisions of this chapter but shall |
25 | meet the "Standards of a Hospice Program of Care." Facilities licensed by the department of |
26 | behavioral healthcare, developmental disabilities and hospitals and the department of human |
27 | services, and clinical laboratories licensed in accordance with chapter 16.2 of this title, as well as |
28 | Christian Science institutions (also known as Christian Science Nursing Facilities) listed and |
29 | certified by the Commission for Accreditation of Christian Science Nursing |
30 | Organizations/Facilities, Inc. shall not be considered health-care facilities for purposes of this |
31 | chapter. |
32 | (9) "Homemaker," or however else called, means a trained, non-professional worker who |
33 | performs related housekeeping services in the home for the sick, disabled, dependent, or infirm, |
34 | and as further defined by regulation; the director shall establish criteria for training. |
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1 | (10) "Hospital" means a person or governmental entity licensed in accordance with this |
2 | chapter to establish, maintain, and operate a hospital. |
3 | (11) "Licensing agency" means the Rhode Island state department of health. |
4 | (12) "Medical services" means any professional services and supplies rendered by, or under |
5 | the direction of, persons duly licensed under the laws of this state to practice medicine, surgery, or |
6 | podiatry that may be specified by any medical service plan. Medical service shall not be construed |
7 | to include hospital services. |
8 | (13) "Mobile, health-screening vehicle" means a mobile vehicle, van, or trailer that delivers |
9 | primary and preventive healthcare screening services, and: |
10 | (i) Does not maintain active contracts or arrangements with any health insurer subject to |
11 | regulation under chapter 20 or 42 of title 27; |
12 | (ii) Does not maintain active contracts or arrangements with another licensed healthcare |
13 | facility as that term is defined within this section; and |
14 | (iii) Does not provide medical services free of charge. |
15 | (14) "Non-English speaker" means a person who cannot speak or understand, or has |
16 | difficulty in speaking or understanding, the English language, because he/she uses only, or |
17 | primarily, a spoken language other than English, and/or a person who uses a sign language and |
18 | requires the use of a sign-language interpreter to facilitate communication. |
19 | (15) "Person" means any individual, trust or estate, partnership, corporation (including |
20 | associations, joint stock companies, and insurance companies), state, or political subdivision or |
21 | instrumentality of a state. |
22 | (16) "Physician ambulatory-surgery center" means an office, or portion of an office, that is |
23 | utilized for the purpose of furnishing surgical services to the owner and/or operator's own patients |
24 | on an ambulatory basis, and shall include both single-practice, physician ambulatory-surgery |
25 | centers and multi-practice, physician ambulatory-surgery centers. A "single-practice, physician |
26 | ambulatory-surgery center" is a physician ambulatory center owned and/or operated by a physician- |
27 | controlled professional service corporation as defined in chapter 5.1 of title 7 (the "professional |
28 | service corporation law"), or a physician-controlled limited-liability company (as defined in chapter |
29 | 16 of title 7 (the "limited liability company act")) in which no physician is an officer, shareholder, |
30 | director, or employee of any other corporation engaged in the practice of the same profession, or |
31 | a private physician's office (whether owned and/or operated by an individual practitioner, alone or |
32 | as a member of a partnership, professional service corporation, limited-liability company, |
33 | organization, or association). A "multi-practice, physician ambulatory-surgery center" is a |
34 | physician ambulatory-surgery center owned and/or operated by a physician-controlled professional |
| LC002146/SUB A/2 - Page 7 of 13 |
1 | service corporation (as defined in the professional service corporation law) or a physician- |
2 | controlled limited-liability company (as defined in the limited liability company act) in which a |
3 | physician is also an officer, shareholder, director, or employee of another corporation engaged in |
4 | the practice of the same profession, or a group of physicians' offices (whether owned and/or |
5 | operated by an individual practitioner, alone or as a member of a partnership, professional service |
6 | corporation, limited-liability company, organization, or association). |
7 | (17) "Podiatry ambulatory-surgery center" means an office or portion of an office that is |
8 | utilized for the purpose of furnishing surgical services to the owner and/or operator's own patients |
9 | on an ambulatory basis, and shall include both single-practice, podiatry ambulatory-surgery centers |
10 | and multi-practice podiatry ambulatory-surgery centers. A "single-practice podiatry ambulatory- |
11 | surgery center" is a podiatry ambulatory center owned and/or operated by a podiatrist-controlled |
12 | professional service corporation (as defined in chapter 5.1 of title 7 (the "professional service |
13 | corporation law")), or a podiatrist-controlled limited-liability company (as defined in chapter 16 of |
14 | title 7 (the "limited liability company act")) in which no podiatrist is an officer, shareholder, |
15 | director, or employee of any other corporation engaged in the practice of the same profession, or |
16 | a private podiatrist's office (whether owned and/or operated by an individual practitioner, alone or |
17 | as a member of a partnership, professional service corporation, limited-liability company, |
18 | organization, or association). A "multi-practice, podiatry ambulatory-surgery center" is a podiatry |
19 | ambulatory-surgery center owned and/or operated by a podiatry-controlled professional service |
20 | corporation (as defined in the professional service corporation law) or a podiatry-controlled, |
21 | limited-liability company (as defined in the limited liability company act) in which a podiatrist is |
22 | also an officer, shareholder, director, or employee of another corporation engaged in the practice |
23 | of the same profession, or a group of podiatrists' offices (whether owned and/or operated by a an |
24 | individual practitioner, alone or as a member of a partnership, professional service corporation, |
25 | limited-liability company, organization, or association). |
26 | (18) "Qualified interpreter" means a person who, through experience and/or training, is |
27 | able to translate a particular foreign language into English, with the exception of sign-language |
28 | interpreters who must be licensed in accordance with chapter 71 of title 5. |
29 | (19) "Qualified sign-language interpreter" means one who has been licensed in accordance |
30 | with the provisions of chapter 71 of title 5. |
31 | (20) "School-based health center" means a facility located in an elementary or secondary |
32 | school that delivers primary and preventive healthcare services to students on site. |
33 | SECTION 3. Section 23-15-2 of the General Laws in Chapter 23-15 entitled |
34 | "Determination of Need for New Healthcare Equipment and New Institutional Health Services" is |
| LC002146/SUB A/2 - Page 8 of 13 |
1 | hereby amended to read as follows: |
2 | 23-15-2. Definitions. |
3 | As used in this chapter: |
4 | (1) "Affected person" means and includes the person whose proposal is being reviewed, or |
5 | the applicant, healthcare facilities located within the state that provide institutional health services, |
6 | the state medical society, the state osteopathic society, those voluntary nonprofit area-wide |
7 | planning agencies that may be established in the state, the state budget office, the office of health |
8 | insurance commissioner, any hospital or medical-service corporation organized under the laws of |
9 | the state, the statewide health coordinating council, contiguous health-systems agencies, and those |
10 | members of the public who are to be served by the proposed, new institutional health services or |
11 | new healthcare equipment. |
12 | (2) "Cost-impact analysis" means a written analysis of the effect that a proposal to offer or |
13 | develop new institutional health services or new healthcare equipment, if approved, will have on |
14 | healthcare costs and shall include any detail that may be prescribed by the state agency in rules and |
15 | regulations. |
16 | (3) "Director" means the director of the Rhode Island state department of health. |
17 | (4)(i) "Healthcare facility" means any institutional health-service provider, facility or |
18 | institution, place, building, agency, or portion of them, whether a partnership or corporation, |
19 | whether public or private, whether organized for profit or not, used, operated, or engaged in |
20 | providing healthcare services that are limited to hospitals, nursing facilities, home nursing-care |
21 | provider, home-care provider, hospice provider, inpatient rehabilitation centers (including drug |
22 | and/or alcohol abuse treatment centers), freestanding emergency-care facilities as defined in § 23- |
23 | 17-2, certain facilities providing surgical treatment to patients not requiring hospitalization (surgi- |
24 | centers, multi-practice, physician ambulatory-surgery centers and multi-practice, podiatry |
25 | ambulatory-surgery centers) and facilities providing inpatient hospice care. Single-practice |
26 | physician or podiatry ambulatory-surgery centers (as defined in subdivisions 23-17-2(16) and 23- |
27 | 17-2(17), respectively) are exempt from the requirements of chapter 15 of this title; provided, |
28 | however, that such exemption shall not apply if a single-practice physician or podiatry ambulatory- |
29 | surgery center is established by a medical practice group (as defined in § 5-37-1) within two (2) |
30 | years following the formation of such medical practice group, when such medical practice group |
31 | is formed by the merger or consolidation of two (2) or more medical practice groups or the |
32 | acquisition of one medical practice group by another medical practice group. Medical spas as |
33 | defined in chapter 95 of title 23 are exempt from the requirements of chapter 15 of this title. The |
34 | term "healthcare facility" does not include Christian Science institutions (also known as Christian |
| LC002146/SUB A/2 - Page 9 of 13 |
1 | Science nursing facilities) listed and certified by the Commission for Accreditation of Christian |
2 | Science Nursing Organizations/Facilities, Inc. |
3 | (ii) Any provider of hospice care who provides hospice care without charge shall be exempt |
4 | from the provisions of this chapter. |
5 | (5) "Healthcare provider" means a person who is a direct provider of healthcare services |
6 | (including but not limited to physicians, dentists, nurses, podiatrists, physician assistants, or nurse |
7 | practitioners) in that the person's primary current activity is the provision of healthcare services for |
8 | persons. |
9 | (6) "Health services" means organized program components for preventive, assessment, |
10 | maintenance, diagnostic, treatment, and rehabilitative services provided in a healthcare facility. |
11 | (7) "Health services council" means the advisory body to the Rhode Island state department |
12 | of health established in accordance with chapter 17 of this title, appointed and empowered as |
13 | provided to serve as the advisory body to the state agency in its review functions under this chapter. |
14 | (8) "Institutional health services" means health services provided in or through healthcare |
15 | facilities and includes the entities in or through that the services are provided. |
16 | (9) "New healthcare equipment" means any single piece of medical equipment (and any |
17 | components that constitute operational components of the piece of medical equipment) proposed |
18 | to be utilized in conjunction with the provision of services to patients or the public, the capital costs |
19 | of which would exceed two million two hundred fifty thousand dollars ($2,250,000); provided, |
20 | however, that the state agency shall exempt from review any application that proposes one-for-one |
21 | equipment replacement as defined in regulation. Further, beginning July 1, 2012, and each July |
22 | thereafter, the amount shall be adjusted by the percentage of increase in the consumer price index |
23 | for all urban consumers (CPI-U) as published by the United States Department of Labor Statistics |
24 | as of September 30 of the prior calendar year. |
25 | (10) "New institutional health services" means and includes: |
26 | (i) Construction, development, or other establishment of a new healthcare facility. |
27 | (ii) Any expenditure, except acquisitions of an existing healthcare facility, that will not |
28 | result in a change in the services or bed capacity of the healthcare facility by, or on behalf of, an |
29 | existing healthcare facility in excess of five million two hundred fifty thousand dollars ($5,250,000) |
30 | which is a capital expenditure including expenditures for predevelopment activities; provided |
31 | further, beginning July 1, 2012, and each July thereafter, the amount shall be adjusted by the |
32 | percentage of increase in the consumer price index for all urban consumers (CPI-U) as published |
33 | by the United States Department of Labor Statistics as of September 30 of the prior calendar year. |
34 | (iii) Where a person makes an acquisition by, or on behalf of, a healthcare facility or health |
| LC002146/SUB A/2 - Page 10 of 13 |
1 | maintenance organization under lease or comparable arrangement or through donation, which |
2 | would have required review if the acquisition had been by purchase, the acquisition shall be deemed |
3 | a capital expenditure subject to review. |
4 | (iv) Any capital expenditure that results in the addition of a health service or that changes |
5 | the bed capacity of a healthcare facility with respect to which the expenditure is made, except that |
6 | the state agency may exempt from review, by rules and regulations promulgated for this chapter, |
7 | any bed reclassifications made to licensed nursing facilities and annual increases in licensed bed |
8 | capacities of nursing facilities that do not exceed the greater of ten (10) beds or ten percent (10%) |
9 | of facility licensed bed capacity and for which the related capital expenditure does not exceed two |
10 | million dollars ($2,000,000). |
11 | (v) Any health service proposed to be offered to patients or the public by a healthcare |
12 | facility that was not offered on a regular basis in or through the facility within the twelve-month |
13 | (12) period prior to the time the service would be offered, and that increases operating expenses by |
14 | more than one million five hundred thousand dollars ($1,500,000), except that the state agency may |
15 | exempt from review, by rules and regulations promulgated for this chapter, any health service |
16 | involving reclassification of bed capacity made to licensed nursing facilities. Further, beginning |
17 | July 1, 2012, and each July thereafter, the amount shall be adjusted by the percentage of increase |
18 | in the consumer price index for all urban consumers (CPI-U) as published by the United States |
19 | Department of Labor Statistics as of September 30 of the prior calendar year. |
20 | (vi) Any new or expanded tertiary or specialty-care service, regardless of capital expense |
21 | or operating expense, as defined by and listed in regulation, the list not to exceed a total of twelve |
22 | (12) categories of services at any one time and shall include full-body magnetic resonance imaging |
23 | and computerized axial tomography; provided, however, that the state agency shall exempt from |
24 | review any application that proposes one-for-one equipment replacement as defined by and listed |
25 | in regulation. Acquisition of full body magnetic resonance imaging and computerized axial |
26 | tomography shall not require a certificate-of-need review and approval by the state agency if |
27 | satisfactory evidence is provided to the state agency that it was acquired for under one million |
28 | dollars ($1,000,000) on or before January 1, 2010, and was in operation on or before July 1, 2010. |
29 | (11) "Person" means any individual, trust or estate, partnership, corporation (including |
30 | associations, joint stock companies, and insurance companies), state or political subdivision, or |
31 | instrumentality of a state. |
32 | (12) "Predevelopment activities" means expenditures for architectural designs, plans, |
33 | working drawings, and specifications, site acquisition, professional consultations, preliminary |
34 | plans, studies, and surveys made in preparation for the offering of a new, institutional health |
| LC002146/SUB A/2 - Page 11 of 13 |
1 | service. |
2 | (13) "State agency" means the Rhode Island state department of health. |
3 | (14) "To develop" means to undertake those activities that, on their completion, will result |
4 | in the offering of a new, institutional health service or new healthcare equipment or the incurring |
5 | of a financial obligation, in relation to the offering of that service. |
6 | (15) "To offer" means to hold oneself out as capable of providing, or as having the means |
7 | for the provision of, specified health services or healthcare equipment. |
8 | SECTION 4. This act shall take effect upon passage. |
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LC002146/SUB A/2 | |
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| LC002146/SUB A/2 - Page 12 of 13 |
EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO HEALTH AND SAFETY | |
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1 | This act would require medical spas to employ or contract for the services of a licensed |
2 | physician, physician assistant, or registered nurse. Additionally, each spa would be required to post |
3 | information about personnel performing cosmetic medical procedures, and provide a written notice |
4 | to a person before said procedure is performed. |
5 | This act would take effect upon passage. |
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LC002146/SUB A/2 | |
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| LC002146/SUB A/2 - Page 13 of 13 |