Mr. President:

I hereby move to amend 99 -- H 5762 SUBSTITUTE B, entitled "AN ACT RELATING TO INSURANCE AND BUSINESSES AND PROFESSIONS -- MAGNETIC IMAGING SERVICES QUALITY ASSURANCE", as follows:

By deleting all of the language following the enactment clause and inserting in place thereof the following:

SECTION 1. Chapter 23-17 of the General Laws entitled "Licensing of Health Care Facilities" is hereby amended by adding thereto the following section:

23-17-48. Magnetic Resonance Imaging - Quality assurance standards. -- Any licensed health care facility performing a magnetic resonance imaging examination shall meet state-approved quality assurance standards for taking and processing magnetic resonance imaging examinations. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section. The rules and regulations shall be based upon the most current standards of the American College of Radiology.

SECTION 2. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section:

27-18-53. Magnetic Resonance Imaging - Quality assurance standards. -- A magnetic resonance imaging examination eligible for reimbursement under the provisions of any individual or group health insurance contract, plan or policy delivered in this state shall be reimbursed only if the provider at which the examination has been conducted and processed, and the licensed physician interpreting the results of the magnetic resonance imaging examination, both meet state approved quality assurance standards for taking, processing, and interpreting magnetic resonance imaging examinations. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section. The rules and regulations shall be based upon the most current standards of the American College of Radiology.

SECTION 3. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section:

27-19-45. Magnetic Resonance Imaging - Quality assurance standards. -- A magnetic resonance imaging examination eligible for reimbursement by a nonprofit hospital services corporation licensed pursuant to this chapter shall be reimbursed only if the provider at which the examination has been conducted and processed, and the licensed physician interpreting the results of the magnetic resonance imaging examination, both meet state approved quality assurance standards for taking, processing, and interpreting magnetic resonance imaging examinations. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section. The rules and regulations shall be based upon the most current standards of the American College of Radiology.

SECTION 4. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section:

27-20-40. Magnetic Resonance Imaging - Quality assurance standards. -- A magnetic resonance imaging examination eligible for reimbursement by a nonprofit medical service corporation licensed pursuant to this chapter shall be reimbursed only if the provider at which the examination has been conducted and processed, and the licensed physician interpreting the results of the magnetic resonance imaging examination, both meet state approved quality assurance standards for taking, processing, and interpreting magnetic resonance imaging examinations. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section. The rules and regulations shall be based upon the most current standards of the American College of Radiology.

SECTION 5. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Services Corporations" is hereby amended by adding thereto the following section:

27-20.1-16. Magnetic Resonance Imaging -- Quality assurance standards. -- A magnetic resonance imaging examination eligible for reimbursement by a nonprofit dental services corporation licensed pursuant to this chapter shall be reimbursed only if the provider at which the examination has been conducted and processed, and the licensed physician interpreting the results of the magnetic resonance imaging examination, both meet state approved quality assurance standards for taking, processing, and interpreting magnetic resonance imaging examinations. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section. The rules and regulations shall be based upon the most current standards of the American College of Radiology, and approved by the director.

SECTION 6. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section:

27-41-55. Magnetic Resonance Imaging - Quality assurance standards. -- A magnetic resonance imaging examination eligible for reimbursement by a health maintenance organization licensed pursuant to this chapter shall be reimbursed only if the provider at which the examination has been conducted and processed, and the licensed physician interpreting the results of the magnetic resonance imaging examination, both meet state approved quality assurance standards for taking, processing, and interpreting magnetic resonance imaging examinations. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section. The rules and regulations shall be based upon the most current standards of the American College of Radiology.

SECTION 7. 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" for purposes of this chapter means and includes, as a minimum, 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; such voluntary nonprofit area-wide planning agencies as may be established in the state; the state budget office; 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 such detail as 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 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, which are limited to hospitals; nursing facilities; inpatient rehabilitation centers (including drug and/or alcohol abuse treatment centers) and facilities providing surgical treatment to patients not requiring hospitalization (surgi-centers) and inpatient hospice care. 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 such 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, assessments, 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 hereinafter 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" shall mean any single piece of medical equipment (and any components which constitute operational components of the piece of medical equipment) proposed to be utilized by a health care provider (whether practicing alone or as a member of a partnership, corporation, organization, or association) in conjunction with the provision of services to patients or the public, the capital costs of which would exceed one million dollars ($1,000,000) (including in the case of health care facilities the costs for installation and any necessary costs of erection or alteration of buildings or facilities directly associated with adding the equipment) ; provided, however, that the state agency shall exempt from review any application which proposes one for one equipment replacement as defined in regulation.

(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 two million dollars ($2,000,000) which is a capital expenditure including expenditures for predevelopment activities.

(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 seven hundred and fifty thousand dollars ($750,000), 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.

(vi) Any new or expanded tertiary or specialty care service, regardless of capital expense or operating expense, as defined by and listed in regulation, such list not to exceed a total of twelve (12) categories of services at any one time.

(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 such a 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 8. This act shall take effect on July 1, 1999.