Rhode Island 2023 2023 Regular Session

Rhode Island House Bill H5877 Introduced / Bill

Filed 03/01/2023

                     
 
 
 
2023 -- H 5877 
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LC001692 
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S TATE  OF RHODE IS LAND 
IN GENERAL ASSEMBLY 
JANUARY SESSION, A.D. 2023 
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A N   A C T 
RELATING TO HEALTH AND SAFETY -- MEDICAL SPAS SAFETY ACT 
Introduced By: Representatives Baginski, and Casey 
Date Introduced: March 01, 2023 
Referred To: House Health & Human Services 
 
 
It is enacted by the General Assembly as follows: 
SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby 1 
amended by adding thereto the following chapter: 2 
CHAPTER 99 3 
MEDICAL SPAS SAFETY ACT 4 
23-99-1. Definitions. 5 
For purposes of this chapter: 6 
(1) "Ablative lasers or ablative energy devices" means lasers intended to excise or vaporize 7 
the outer layer of skin.  8 
(2) "Advanced practice registered nurse" or "APRN" means a registered nurse who has an 9 
active, unrestricted advanced practice registered nurse license granted under the authority of 10 
chapter 34 of title 5. 11 
(3) "Cosmetic medical procedure" means any procedure that does not require sedation that 12 
is performed on a person and is directed at improving the person's appearance and does not 13 
meaningfully promote the proper function of the body or prevent or treat illness or disease. 14 
Cosmetic medical procedures may include, but are not limited to, cosmetic surgery, microneedling, 15 
hair transplants, cosmetic injections, cosmetic soft tissue fillers, dermaplaning, dermastamping, 16 
dermarolling, dermabrasion that removes cells beyond the stratum corneum, chemical peels using 17 
modification solutions that exceed thirty percent (30%) concentration with a pH value of lower 18 
than 3.0, laser hair removal, laser restricting, laser treatment of veins, sclerotherapy, other laser 19   
 
 
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procedures, intense pulsed light, injection of cosmetic filling agents and neurotoxins and the use of 1 
class II medical devices designed to induce deep skin tissue alteration. The performance of cosmetic 2 
medical services is the practice of medicine and surgery. A cosmetic medical service shall be 3 
performed by a qualified licensed or certified non-physician only if the services have been 4 
delegated by a medical director, supervising physician, supervising PA, or supervising APRN who 5 
is responsible for on-site supervision of the services performed. 6 
(4) "Delegate" means a non-physician tasked with performing a procedure as defined in § 7 
23-99-1 by a physician, PA or APRN.  8 
(5) "Department" means the Rhode Island department of health. 9 
(6) "Medical director" means a physician or advanced practice registered nurse who 10 
assumes the role of, or holds oneself out as, medical director at a medical spa. The medical director 11 
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 shall not be a medical director's, supervising physician's, PA's or 16 
APRN's only education in the cosmetic medical service or the operation of medical devices to be 17 
used;  18 
(ii) Responsible for implementing policies and procedures to ensure quality patient care;  19 
(iii) Responsible for the delegation and supervision of cosmetic procedures;  20 
(iv) Responsible for the oversight of all cosmetic medical procedures performed by 21 
physicians, PAs, APRNs, and non-physicians; and 22 
(v) Responsible for ensuring that all supervising physicians, supervising PAs and 23 
supervising APRNs, any physicians, PAs and APRNs performing cosmetic medical procedures, 24 
and any non-physicians, non-PAs and non-APRNs delegated to perform cosmetic medical 25 
procedures, are properly trained in the safe and effective performance of all cosmetic medical 26 
procedures that they perform at the medical spa. 27 
(7) "Medical spa" means an establishment in which cosmetic medical procedures are 28 
performed. 29 
(8) "Physician" means an allopath or osteopath who has an active license, unrestricted 30 
medical license granted under the provisions of chapter 37 of title 5. 31 
(9) "Physician assistant" or "PA" means a person who is qualified by academic and 32 
practical training to provide medical and surgical services in collaboration with physicians. 33 
(10) "Supervision" means an arrangement when a qualified supervising physician, 34   
 
 
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physician assistant or APRN is either: 1 
(i) On site and able to directly observe the treatment being performed, though not 2 
necessarily in the same room (i.e., direct supervision); or 3 
(ii) Is off site, but immediately available if needed, either in person or by 4 
telecommunication (i.e., indirect supervision). 5 
23-99-2. Protection of patients in a medical spa. 6 
(a) Each medical spa shall appoint a medical director who shall be:  7 
(1) Trained in the indications for, and performance of, cosmetic medical procedures, 8 
including all medical devices or instruments that can alter or cause biological change or damage to 9 
the skin or subcutaneous tissue. Training programs provided by a manufacturer or vendor of a 10 
medical device or supplies shall not be a medical director's, supervising physician's, supervising 11 
PA's or APRN's only education in the cosmetic medical service or the operation of medical devices 12 
to be used;  13 
(2) Responsible for implementing policies and procedures to ensure quality patient care;  14 
(3) Responsible for the delegation and supervision of cosmetic procedures;  15 
(4) Responsible for developing and maintaining written office protocols for each cosmetic 16 
medical procedure. Such protocols shall be kept on site at the medical spa for review and/or 17 
inspection by the department;  18 
(5) Responsible for the oversight of all cosmetic medical procedures performed by 19 
physicians, PAs, APRNs, and non-physicians; and  20 
(6) Responsible for ensuring that all supervisory physicians, supervising PAs and 21 
supervising APRNs, any physicians, PAs and APRNs performing cosmetic medical procedures, 22 
and any non-physicians and non-APRNs delegated to perform cosmetic medical procedures, are 23 
properly trained in the safe and effective performance of all cosmetic medical procedures that they 24 
perform at the medical spa.  25 
(b) A physician, PA or APRN who performs cosmetic medical procedures, or supervises 26 
such procedures delegated to and performed by a non-physician, non-PA or non-APRN, shall be 27 
trained in the indications for and performance of the cosmetic medical procedure. An APRN who 28 
performs cosmetic medical procedures, or supervises such procedures delegated to and performed 29 
by a non-physician, non-PA or non-APRN, shall be accredited by the state board of nursing. 30 
(c) The supervising physician, PA or APRN shall: 31 
(1) Perform an initial assessment of the patient; 32 
(2) Prepare a written treatment plan for each patient, which plan shall include, as 33 
applicable, diagnoses, course of treatment, and specifications for any device being used;  34   
 
 
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(3) Obtain patient consent, if the cosmetic medical procedure(s) are being performed by a 1 
non-physician, non-PA or non-APRN and documenting, in the patient’s medical record, the 2 
credentials and names of the non-physician, non-PA or non-APRN who will be performing the 3 
cosmetic medical procedure; and  4 
(4) Create and maintain medical records in a manner consistent with applicable laws and 5 
regulations and accepted medical practice.  6 
(d) Non-physicians, non-PAs and non-APRNs shall only perform cosmetic medical 7 
procedures: 8 
(1) For which they have the requisite training; and  9 
(2) Which have been delegated to them by a supervising physician, supervising PA or 10 
supervising APRN.  11 
(e) At all times in the performance of their duties relative to cosmetic procedures, all 12 
providers shall:  13 
(1) Review and follow written protocols for each delegated cosmetic medical procedure; 14 
(2) Verify that the supervising physician, supervising PA or supervising APRN has 15 
assessed the patient and given written treatment instructions for each procedure performed;  16 
(3) Review the cosmetic medical procedure with each patient; 17 
(4) Notify the medical director, as well as the supervising physician, supervising PA or 18 
supervising APRN, before the patient leaves or as they become aware, of any adverse events or 19 
complications, and follow up with the patient post-procedure, as appropriate;  20 
(5) Document all relevant details of the performed cosmetic medical procedure in the 21 
patient’s medical record; and 22 
(6) As applicable, satisfy any requirements imposed upon them by their licensing boards. 23 
(f) Cosmetic medical procedures using ablative lasers or ablative energy devices shall only 24 
be performed by physicians. 25 
23-99-3. Rules and regulations. 26 
The department shall, by July 1, 2024, promulgate rules and regulations necessary and not 27 
inconsistent with law to implement the purpose and intent of this chapter, which rules and 28 
regulations shall provide for, though not be limited to, the licensing of medical spas as health care 29 
facilities. 30 
SECTION 2. Section 23-17-2 of the General Laws in Chapter 23-17 entitled "Licensing of 31 
Healthcare Facilities" is hereby amended to read as follows: 32 
23-17-2. Definitions. 33 
As used in this chapter: 34   
 
 
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(1) “Affiliate” means a legal entity that is in control of, is controlled by, or is in common 1 
control with another legal entity. 2 
(2) “Alzheimer’s dementia special-care unit or program” means a distinct living 3 
environment within a nursing facility that has been physically adapted to accommodate the 4 
particular needs and behaviors of those with dementia. The unit provides increased staffing; 5 
therapeutic activities designed specifically for those with dementia; and trains its staff on an 6 
ongoing basis on the effective management of the physical and behavioral problems of those with 7 
dementia. The residents of the unit/program have had a standard, medical-diagnostic evaluation 8 
and have been determined to have a diagnosis of Alzheimer’s dementia or another dementia. 9 
(3) “Certified nurse-teacher” means those personnel certified by the department of 10 
elementary and secondary education and employed pursuant to the provisions of §§ 16-21-7 and 11 
16-21-8. 12 
(4)(i) “Change in operator” means a transfer by the governing body or operator of a 13 
healthcare facility to any other person (excluding delegations of authority to the medical or 14 
administrative staff of the facility) of the governing body’s authority to: 15 
(A) Hire or fire the chief executive officer of the healthcare facility; 16 
(B) Maintain and control the books and records of the healthcare facility; 17 
(C) Dispose of assets and incur liabilities on behalf of the healthcare facility; or 18 
(D) Adopt and enforce policies regarding operation of the healthcare facility. 19 
(ii) This definition is not applicable to circumstances wherein the governing body of a 20 
healthcare facility retains the immediate authority and jurisdiction over the activities enumerated 21 
in subsections (4)(i)(A) — (4)(i)(D). 22 
(5) “Change in owner” means: 23 
(i) In the case of a healthcare facility that is a partnership, the removal, addition, or 24 
substitution of a partner that results in a new partner acquiring a controlling interest in the 25 
partnership; 26 
(ii) In the case of a healthcare facility that is an unincorporated, solo proprietorship, the 27 
transfer of the title and property to another person; 28 
(iii) In the case of a healthcare facility that is a corporation: 29 
(A) A sale, lease exchange, or other disposition of all, or substantially all, of the property 30 
and assets of the corporation; or 31 
(B) A merger of the corporation into another corporation; or 32 
(C) The consolidation or two (2) or more corporations, resulting in the creation of a new 33 
corporation; or 34   
 
 
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(D) In the case of a healthcare facility that is a business corporation, any transfer of 1 
corporate stock that results in a new person acquiring a controlling interest in the corporation; or 2 
(E) In the case of a healthcare facility that is a nonbusiness corporation, any change in 3 
membership that results in a new person acquiring a controlling vote in the corporation. 4 
(6) “Clinician” means a physician licensed under chapter 37 of title 5; a nurse licensed 5 
under chapter 34 of title 5; a psychologist licensed under chapter 44 of title 5; a social worker 6 
licensed under chapter 39.1 of title 5; a physical therapist licensed under chapter 40 of title 5; and 7 
a speech language pathologist or audiologist licensed under chapter 48 of title 5 or physician 8 
assistant licensed under the provisions of chapter 54 of title 5. 9 
(7) “Director” means the director of the Rhode Island state department of health. 10 
(8) “Freestanding emergency-care facility” means an establishment, place, or facility that 11 
may be a public or private organization, structurally distinct and separate from a hospital; staffed, 12 
equipped, and operated to provide prompt, emergency medical care. For the purposes of this 13 
chapter, “emergency medical care” means services provided for a medical condition or behavioral-14 
health condition that is manifested by symptoms of sufficient severity that, in the absence of 15 
immediate medical attention, could result in harm to the person or others; serious impairment to 16 
bodily functions; serious dysfunction of any bodily organ or part; or development or continuance 17 
of severe pain. 18 
(9) “Healthcare facility” means any institutional health-service provider, facility, or 19 
institution, place, building, agency, or portion thereof, whether a partnership or corporation, 20 
whether public or private, whether organized for profit or not, used, operated, or engaged in 21 
providing healthcare services, including, but not limited to: hospitals; nursing facilities; home 22 
nursing-care provider (which shall include skilled nursing services and may also include activities 23 
allowed as a home-care provider or as a nursing service agency); home-care provider (which may 24 
include services such as personal care or homemaker services); rehabilitation centers; kidney 25 
disease treatment centers; health maintenance organizations; freestanding emergency-care facilities 26 
as defined in this section, and facilities providing surgical treatment to patients not requiring 27 
hospitalization (surgi-centers); hospice care, and physician ambulatory-surgery centers and 28 
podiatry ambulatory-surgery centers providing surgical treatment. The term “healthcare facility” 29 
also includes organized ambulatory-care facilities that are not part of a hospital but that are 30 
organized and operated to provide healthcare services to outpatients, such as: central-services 31 
facilities serving more than one healthcare facility or healthcare provider; treatment centers; 32 
diagnostic centers; outpatient clinics; medical spas as defined in chapter 99 of title 23; infirmaries 33 
and health centers; school-based health centers, and neighborhood health centers. The term 34   
 
 
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“healthcare facility” also includes a mobile health-screening vehicle as defined in this section. The 1 
term “healthcare facility” shall not apply to organized, ambulatory-care facilities owned and 2 
operated by professional service corporations as defined in chapter 5.1 of title 7, as amended (the 3 
“professional service corporation law”), or to a practitioner’s (physician, dentist, or other healthcare 4 
provider) office or group of practitioners’ offices (whether owned and/or operated by a hospital or 5 
an affiliate of a hospital or an individual practitioner, alone or as a member of a partnership, 6 
professional service corporation, organization, or association); provided, however, notwithstanding 7 
any other provision herein or in the general laws, any hospital or any affiliate of a hospital that 8 
owns and/or operates a practitioner’s office shall ensure that such practitioner’s office complies 9 
with licensing or accreditation requirements that may be applicable to the practitioner’s office. 10 
Individual categories of healthcare facilities shall be defined in rules and regulations promulgated 11 
by the licensing agency with the advice of the health services council. Rules and regulations 12 
concerning hospice care shall be promulgated with regard to the “Standards of a Hospice Program 13 
of Care,” promulgated by the National Hospice Organization. Any provider of hospice care who 14 
provides hospice care without charge shall be exempt from the licensing provisions of this chapter 15 
but shall meet the “Standards of a Hospice Program of Care.” Facilities licensed by the department 16 
of behavioral healthcare, developmental disabilities and hospitals and the department of human 17 
services, and clinical laboratories licensed in accordance with chapter 16.2 of this title, as well as 18 
Christian Science institutions (also known as Christian Science Nursing Facilities) listed and 19 
certified by the Commission for Accreditation of Christian Science Nursing 20 
Organizations/Facilities, Inc. shall not be considered healthcare facilities for purposes of this 21 
chapter. 22 
(10) “Homemaker,” or however else called, means a trained, nonprofessional worker who 23 
performs related housekeeping services in the home for the sick, disabled, dependent, or infirm, 24 
and as further defined by regulation; the director shall establish criteria for training. 25 
(11) “Hospital” means a person or governmental entity licensed in accordance with this 26 
chapter to establish, maintain, and operate a hospital. 27 
(12) “Licensing agency” means the Rhode Island state department of health. 28 
(13) “Medical services” means any professional services and supplies rendered by, or under 29 
the direction of, persons duly licensed under the laws of this state to practice medicine, surgery, or 30 
podiatry that may be specified by any medical service plan. Medical service shall not be construed 31 
to include hospital services. 32 
(14) “Mobile health-screening vehicle” means a mobile vehicle, van, or trailer that delivers 33 
primary and preventive healthcare screening services, and: 34   
 
 
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(i) Does not maintain active contracts or arrangements with any health insurer subject to 1 
regulation under chapter 20 or 42 of title 27; 2 
(ii) Does not maintain active contracts or arrangements with another licensed healthcare 3 
facility as that term is defined within this section; and 4 
(iii) Does not provide medical services free of charge. 5 
(15) “Non-English speaker” means a person who cannot speak or understand, or has 6 
difficulty in speaking or understanding, the English language, because he/she uses only, or 7 
primarily, a spoken language other than English, and/or a person who uses a sign language and 8 
requires the use of a sign-language interpreter to facilitate communication. 9 
(16) “Person” means any individual, trust or estate, partnership, corporation (including 10 
associations, joint stock companies, and insurance companies), state, or political subdivision or 11 
instrumentality of a state. 12 
(17) “Physician ambulatory-surgery center” means an office, or portion of an office, that 13 
is utilized for the purpose of furnishing surgical services to the owner and/or operator’s own 14 
patients on an ambulatory basis, and shall include both single-practice, physician ambulatory-15 
surgery centers and multi-practice, physician ambulatory-surgery centers. A “single-practice, 16 
physician ambulatory-surgery center” is a physician ambulatory center owned and/or operated by 17 
a physician-controlled professional service corporation as defined in chapter 5.1 of title 7 (the 18 
“professional service corporation law”), or a physician-controlled limited-liability company (as 19 
defined in chapter 16 of title 7 (the “limited liability company act”)) in which no physician is an 20 
officer, shareholder, director, or employee of any other corporation engaged in the practice of the 21 
same profession, or a private physician’s office (whether owned and/or operated by an individual 22 
practitioner, alone or as a member of a partnership, professional service corporation, limited-23 
liability company, organization, or association). A “multi-practice, physician ambulatory-surgery 24 
center” is a physician ambulatory-surgery center owned and/or operated by a physician-controlled 25 
professional service corporation (as defined in the professional service corporation law) or a 26 
physician-controlled limited-liability company (as defined in the limited liability company act) in 27 
which a physician is also an officer, shareholder, director, or employee of another corporation 28 
engaged in the practice of the same profession, or a group of physicians’ offices (whether owned 29 
and/or operated by an individual practitioner, alone or as a member of a partnership, professional 30 
service corporation, limited-liability company, organization, or association). 31 
(18) “Podiatry ambulatory-surgery center” means an office or portion of an office that is 32 
utilized for the purpose of furnishing surgical services to the owner and/or operator’s own patients 33 
on an ambulatory basis, and shall include both single-practice, podiatry ambulatory-surgery centers 34   
 
 
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and multi-practice podiatry ambulatory-surgery centers. A “single-practice podiatry ambulatory-1 
surgery center” is a podiatry ambulatory center owned and/or operated by a podiatrist-controlled 2 
professional service corporation (as defined in chapter 5.1 of title 7 (the “professional service 3 
corporation law”)), or a podiatrist-controlled limited-liability company (as defined in chapter 16 of 4 
title 7 (the “limited liability company act”)) in which no podiatrist is an officer, shareholder, 5 
director, or employee of any other corporation engaged in the practice of the same profession, or a 6 
private podiatrist’s office (whether owned and/or operated by an individual practitioner, alone or 7 
as a member of a partnership, professional service corporation, limited-liability company, 8 
organization, or association). A “multi-practice, podiatry ambulatory-surgery center” is a podiatry 9 
ambulatory-surgery center owned and/or operated by a podiatrist-controlled professional service 10 
corporation (as defined in the professional service corporation law) or a podiatrist-controlled, 11 
limited-liability company (as defined in the limited liability company act) in which a podiatrist is 12 
also an officer, shareholder, director, or employee of another corporation engaged in the practice 13 
of the same profession, or a group of podiatrists’ offices (whether owned and/or operated by an 14 
individual practitioner, alone or as a member of a partnership, professional service corporation, 15 
limited-liability company, organization, or association). 16 
(19) “Qualified interpreter” means a person who, through experience and/or training, is 17 
able to translate a particular foreign language into English, with the exception of sign-language 18 
interpreters who must be licensed in accordance with chapter 71 of title 5. 19 
(20) “Qualified sign-language interpreter” means one who has been licensed in accordance 20 
with the provisions of chapter 71 of title 5. 21 
(21) “School-based health center” means a facility located in an elementary or secondary 22 
school licensed as a school-based health center that delivers primary and/or preventive healthcare 23 
services to individuals to include, but not be limited to, students on site. 24 
SECTION 3. Section 23-15-2 of the General Laws in Chapter 23-15 entitled 25 
"Determination of Need for New Healthcare Equipment and New Institutional Health Services" is 26 
hereby amended to read as follows: 27 
23-15-2. Definitions. 28 
As used in this chapter: 29 
(1) “Affected person” means and includes the person whose proposal is being reviewed, or 30 
the applicant, healthcare facilities located within the state that provide institutional health services, 31 
the state medical society, the state osteopathic society, those voluntary nonprofit area-wide 32 
planning agencies that may be established in the state, the state budget office, the office of health 33 
insurance commissioner, any hospital or medical-service corporation organized under the laws of 34   
 
 
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the state, the statewide health coordinating council, contiguous health-systems agencies, and those 1 
members of the public who are to be served by the proposed, new institutional health services or 2 
new healthcare equipment. 3 
(2) “Cost-impact analysis” means a written analysis of the effect that a proposal to offer or 4 
develop new institutional health services or new healthcare equipment, if approved, will have on 5 
healthcare costs and shall include any detail that may be prescribed by the state agency in rules and 6 
regulations. 7 
(3) “Director” means the director of the Rhode Island state department of health. 8 
(4)(i) “Healthcare facility” means any institutional health-service provider, facility or 9 
institution, place, building, agency, or portion of them, whether a partnership or corporation, 10 
whether public or private, whether organized for profit or not, used, operated, or engaged in 11 
providing healthcare services that are limited to hospitals, nursing facilities, home nursing-care 12 
provider, home-care provider, hospice provider, inpatient rehabilitation centers (including drug 13 
and/or alcohol abuse treatment centers), freestanding emergency-care facilities as defined in § 23-14 
17-2, certain facilities providing surgical treatment to patients not requiring hospitalization (surgi-15 
centers, multi-practice, physician ambulatory-surgery centers and multi-practice, podiatry 16 
ambulatory-surgery centers) and facilities providing inpatient hospice care. Single-practice 17 
physician or podiatry ambulatory-surgery centers (as defined in § 23-17-2(17), (18), respectively) 18 
are exempt from the requirements of chapter 15 of this title; provided, however, that such 19 
exemption shall not apply if a single-practice physician or podiatry ambulatory-surgery center is 20 
established by a medical practice group (as defined in § 5-37-1) within two (2) years following the 21 
formation of such medical practice group, when such medical practice group is formed by the 22 
merger or consolidation of two (2) or more medical practice groups or the acquisition of one 23 
medical practice group by another medical practice group. Medical spas as defined in chapter 99 24 
of title 23 are exempt from the requirements of chapter 15 of this title. The term “healthcare facility” 25 
does not include Christian Science institutions (also known as Christian Science nursing facilities) 26 
listed and certified by the Commission for Accreditation of Christian Science Nursing 27 
Organizations/Facilities, Inc. 28 
(ii) Any provider of hospice care who provides hospice care without charge shall be exempt 29 
from the provisions of this chapter. 30 
(5) “Healthcare provider” means a person who is a direct provider of healthcare services 31 
(including but not limited to physicians, dentists, nurses, podiatrists, physician assistants, or nurse 32 
practitioners) in that the person’s primary current activity is the provision of healthcare services for 33 
persons. 34   
 
 
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(6) “Health services” means organized program components for preventive, assessment, 1 
maintenance, diagnostic, treatment, and rehabilitative services provided in a healthcare facility. 2 
(7) “Health services council” means the advisory body to the Rhode Island state department 3 
of health established in accordance with chapter 17 of this title, appointed and empowered as 4 
provided to serve as the advisory body to the state agency in its review functions under this chapter. 5 
(8) “Institutional health services” means health services provided in or through healthcare 6 
facilities and includes the entities in or through that the services are provided. 7 
(9) “New healthcare equipment” means any single piece of medical equipment (and any 8 
components that constitute operational components of the piece of medical equipment) proposed 9 
to be utilized in conjunction with the provision of services to patients or the public, the capital costs 10 
of which would exceed two million two hundred fifty thousand dollars ($2,250,000); provided, 11 
however, that the state agency shall exempt from review any application that proposes one-for-one 12 
equipment replacement as defined in regulation. Further, beginning July 1, 2012, and each July 13 
thereafter, the amount shall be adjusted by the percentage of increase in the consumer price index 14 
for all urban consumers (CPI-U) as published by the United States Department of Labor Statistics 15 
as of September 30 of the prior calendar year. 16 
(10) “New institutional health services” means and includes: 17 
(i) Construction, development, or other establishment of a new healthcare facility. 18 
(ii) Any expenditure, except acquisitions of an existing healthcare facility, that will not 19 
result in a change in the services or bed capacity of the healthcare facility by, or on behalf of, an 20 
existing healthcare facility in excess of five million two hundred fifty thousand dollars ($5,250,000) 21 
which is a capital expenditure including expenditures for predevelopment activities; provided 22 
further, beginning July 1, 2012, and each July thereafter, the amount shall be adjusted by the 23 
percentage of increase in the consumer price index for all urban consumers (CPI-U) as published 24 
by the United States Department of Labor Statistics as of September 30 of the prior calendar year. 25 
(iii) Where a person makes an acquisition by, or on behalf of, a healthcare facility or health 26 
maintenance organization under lease or comparable arrangement or through donation, which 27 
would have required review if the acquisition had been by purchase, the acquisition shall be deemed 28 
a capital expenditure subject to review. 29 
(iv) Any capital expenditure that results in the addition of a health service or that changes 30 
the bed capacity of a healthcare facility with respect to which the expenditure is made, except that 31 
the state agency may exempt from review, by rules and regulations promulgated for this chapter, 32 
any bed reclassifications made to licensed nursing facilities and annual increases in licensed bed 33 
capacities of nursing facilities that do not exceed the greater of ten (10) beds or ten percent (10%) 34   
 
 
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of facility licensed bed capacity and for which the related capital expenditure does not exceed two 1 
million dollars ($2,000,000). 2 
(v) Any health service proposed to be offered to patients or the public by a healthcare 3 
facility that was not offered on a regular basis in or through the facility within the twelve-month 4 
(12) period prior to the time the service would be offered, and that increases operating expenses by 5 
more than one million five hundred thousand dollars ($1,500,000), except that the state agency may 6 
exempt from review, by rules and regulations promulgated for this chapter, any health service 7 
involving reclassification of bed capacity made to licensed nursing facilities. Further, beginning 8 
July 1, 2012, and each July thereafter, the amount shall be adjusted by the percentage of increase 9 
in the consumer price index for all urban consumers (CPI-U) as published by the United States 10 
Department of Labor Statistics as of September 30 of the prior calendar year. 11 
(vi) Any new or expanded tertiary or specialty-care service, regardless of capital expense 12 
or operating expense, as defined by and listed in regulation, the list not to exceed a total of twelve 13 
(12) categories of services at any one time and shall include full-body magnetic resonance imaging 14 
and computerized axial tomography; provided, however, that the state agency shall exempt from 15 
review any application that proposes one-for-one equipment replacement as defined by and listed 16 
in regulation. Acquisition of full body magnetic resonance imaging and computerized axial 17 
tomography shall not require a certificate-of-need review and approval by the state agency if 18 
satisfactory evidence is provided to the state agency that it was acquired for under one million 19 
dollars ($1,000,000) on or before January 1, 2010, and was in operation on or before July 1, 2010. 20 
(11) “Person” means any individual, trust or estate, partnership, corporation (including 21 
associations, joint stock companies, and insurance companies), state or political subdivision, or 22 
instrumentality of a state. 23 
(12) “Predevelopment activities” means expenditures for architectural designs, plans, 24 
working drawings, and specifications, site acquisition, professional consultations, preliminary 25 
plans, studies, and surveys made in preparation for the offering of a new, institutional health 26 
service. 27 
(13) “State agency” means the Rhode Island state department of health. 28 
(14) “To develop” means to undertake those activities that, on their completion, will result 29 
in the offering of a new, institutional health service or new healthcare equipment or the incurring 30 
of a financial obligation, in relation to the offering of that service. 31 
(15) “To offer” means to hold oneself out as capable of providing, or as having the means 32 
for the provision of, specified health services or healthcare equipment. 33   
 
 
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SECTION 4. This act shall take effect upon passage. 1 
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LC001692 
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EXPLANATION 
BY THE LEGISLATIVE COUNCIL 
OF 
A N   A C T 
RELATING TO HEALTH AND SAFETY -- MEDICAL SPAS SAFETY ACT 
***
This act would provide that the performance of cosmetic medical services is the practice 1 
of medicine and surgery. This act would also provide that a cosmetic medical service would be 2 
performed by a qualified licensed or certified non-physician only if the services have been 3 
delegated by a medical director, supervising physician, supervising physician assistant, or 4 
supervising APRN who is responsible for on-site supervision of the services performed. 5 
This act would take effect upon passage. 6 
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LC001692 
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