Rhode Island 2023 Regular Session

Rhode Island House Bill H5877 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3
4	4
5	5	2023 -- H 5877
6	6	========
7	7	LC001692
8	8	========
9	9	S TATE OF RHODE IS LAND
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO HEALTH AND SAFETY -- MEDICAL SPAS SAFETY ACT
16	16	Introduced By: Representatives Baginski, and Casey
17	17	Date Introduced: March 01, 2023
18	18	Referred To: House Health & Human Services
19	19
20	20
21	21	It is enacted by the General Assembly as follows:
22	22	SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby 1
23	23	amended by adding thereto the following chapter: 2
24	24	CHAPTER 99 3
25	25	MEDICAL SPAS SAFETY ACT 4
26	26	23-99-1. Definitions. 5
27	27	For purposes of this chapter: 6
28	28	(1) "Ablative lasers or ablative energy devices" means lasers intended to excise or vaporize 7
29	29	the outer layer of skin. 8
30	30	(2) "Advanced practice registered nurse" or "APRN" means a registered nurse who has an 9
31	31	active, unrestricted advanced practice registered nurse license granted under the authority of 10
32	32	chapter 34 of title 5. 11
33	33	(3) "Cosmetic medical procedure" means any procedure that does not require sedation that 12
34	34	is performed on a person and is directed at improving the person's appearance and does not 13
35	35	meaningfully promote the proper function of the body or prevent or treat illness or disease. 14
36	36	Cosmetic medical procedures may include, but are not limited to, cosmetic surgery, microneedling, 15
37	37	hair transplants, cosmetic injections, cosmetic soft tissue fillers, dermaplaning, dermastamping, 16
38	38	dermarolling, dermabrasion that removes cells beyond the stratum corneum, chemical peels using 17
39	39	modification solutions that exceed thirty percent (30%) concentration with a pH value of lower 18
40	40	than 3.0, laser hair removal, laser restricting, laser treatment of veins, sclerotherapy, other laser 19
41	41
42	42
43	43	LC001692 - Page 2 of 14
44	44	procedures, intense pulsed light, injection of cosmetic filling agents and neurotoxins and the use of 1
45	45	class II medical devices designed to induce deep skin tissue alteration. The performance of cosmetic 2
46	46	medical services is the practice of medicine and surgery. A cosmetic medical service shall be 3
47	47	performed by a qualified licensed or certified non-physician only if the services have been 4
48	48	delegated by a medical director, supervising physician, supervising PA, or supervising APRN who 5
49	49	is responsible for on-site supervision of the services performed. 6
50	50	(4) "Delegate" means a non-physician tasked with performing a procedure as defined in § 7
51	51	23-99-1 by a physician, PA or APRN. 8
52	52	(5) "Department" means the Rhode Island department of health. 9
53	53	(6) "Medical director" means a physician or advanced practice registered nurse who 10
54	54	assumes the role of, or holds oneself out as, medical director at a medical spa. The medical director 11
55	55	shall be: 12
56	56	(i) Trained in the indications for, and performance of, cosmetic medical procedures, 13
57	57	including all medical devices or instruments that can alter or cause biological change or damage 14
58	58	the skin and subcutaneous tissue. Training programs provided by a manufacturer or vendor of a 15
59	59	medical device or supplies shall not be a medical director's, supervising physician's, PA's or 16
60	60	APRN's only education in the cosmetic medical service or the operation of medical devices to be 17
61	61	used; 18
62	62	(ii) Responsible for implementing policies and procedures to ensure quality patient care; 19
63	63	(iii) Responsible for the delegation and supervision of cosmetic procedures; 20
64	64	(iv) Responsible for the oversight of all cosmetic medical procedures performed by 21
65	65	physicians, PAs, APRNs, and non-physicians; and 22
66	66	(v) Responsible for ensuring that all supervising physicians, supervising PAs and 23
67	67	supervising APRNs, any physicians, PAs and APRNs performing cosmetic medical procedures, 24
68	68	and any non-physicians, non-PAs and non-APRNs delegated to perform cosmetic medical 25
69	69	procedures, are properly trained in the safe and effective performance of all cosmetic medical 26
70	70	procedures that they perform at the medical spa. 27
71	71	(7) "Medical spa" means an establishment in which cosmetic medical procedures are 28
72	72	performed. 29
73	73	(8) "Physician" means an allopath or osteopath who has an active license, unrestricted 30
74	74	medical license granted under the provisions of chapter 37 of title 5. 31
75	75	(9) "Physician assistant" or "PA" means a person who is qualified by academic and 32
76	76	practical training to provide medical and surgical services in collaboration with physicians. 33
77	77	(10) "Supervision" means an arrangement when a qualified supervising physician, 34
78	78
79	79
80	80	LC001692 - Page 3 of 14
81	81	physician assistant or APRN is either: 1
82	82	(i) On site and able to directly observe the treatment being performed, though not 2
83	83	necessarily in the same room (i.e., direct supervision); or 3
84	84	(ii) Is off site, but immediately available if needed, either in person or by 4
85	85	telecommunication (i.e., indirect supervision). 5
86	86	23-99-2. Protection of patients in a medical spa. 6
87	87	(a) Each medical spa shall appoint a medical director who shall be: 7
88	88	(1) Trained in the indications for, and performance of, cosmetic medical procedures, 8
89	89	including all medical devices or instruments that can alter or cause biological change or damage to 9
90	90	the skin or subcutaneous tissue. Training programs provided by a manufacturer or vendor of a 10
91	91	medical device or supplies shall not be a medical director's, supervising physician's, supervising 11
92	92	PA's or APRN's only education in the cosmetic medical service or the operation of medical devices 12
93	93	to be used; 13
94	94	(2) Responsible for implementing policies and procedures to ensure quality patient care; 14
95	95	(3) Responsible for the delegation and supervision of cosmetic procedures; 15
96	96	(4) Responsible for developing and maintaining written office protocols for each cosmetic 16
97	97	medical procedure. Such protocols shall be kept on site at the medical spa for review and/or 17
98	98	inspection by the department; 18
99	99	(5) Responsible for the oversight of all cosmetic medical procedures performed by 19
100	100	physicians, PAs, APRNs, and non-physicians; and 20
101	101	(6) Responsible for ensuring that all supervisory physicians, supervising PAs and 21
102	102	supervising APRNs, any physicians, PAs and APRNs performing cosmetic medical procedures, 22
103	103	and any non-physicians and non-APRNs delegated to perform cosmetic medical procedures, are 23
104	104	properly trained in the safe and effective performance of all cosmetic medical procedures that they 24
105	105	perform at the medical spa. 25
106	106	(b) A physician, PA or APRN who performs cosmetic medical procedures, or supervises 26
107	107	such procedures delegated to and performed by a non-physician, non-PA or non-APRN, shall be 27
108	108	trained in the indications for and performance of the cosmetic medical procedure. An APRN who 28
109	109	performs cosmetic medical procedures, or supervises such procedures delegated to and performed 29
110	110	by a non-physician, non-PA or non-APRN, shall be accredited by the state board of nursing. 30
111	111	(c) The supervising physician, PA or APRN shall: 31
112	112	(1) Perform an initial assessment of the patient; 32
113	113	(2) Prepare a written treatment plan for each patient, which plan shall include, as 33
114	114	applicable, diagnoses, course of treatment, and specifications for any device being used; 34
115	115
116	116
117	117	LC001692 - Page 4 of 14
118	118	(3) Obtain patient consent, if the cosmetic medical procedure(s) are being performed by a 1
119	119	non-physician, non-PA or non-APRN and documenting, in the patient’s medical record, the 2
120	120	credentials and names of the non-physician, non-PA or non-APRN who will be performing the 3
121	121	cosmetic medical procedure; and 4
122	122	(4) Create and maintain medical records in a manner consistent with applicable laws and 5
123	123	regulations and accepted medical practice. 6
124	124	(d) Non-physicians, non-PAs and non-APRNs shall only perform cosmetic medical 7
125	125	procedures: 8
126	126	(1) For which they have the requisite training; and 9
127	127	(2) Which have been delegated to them by a supervising physician, supervising PA or 10
128	128	supervising APRN. 11
129	129	(e) At all times in the performance of their duties relative to cosmetic procedures, all 12
130	130	providers shall: 13
131	131	(1) Review and follow written protocols for each delegated cosmetic medical procedure; 14
132	132	(2) Verify that the supervising physician, supervising PA or supervising APRN has 15
133	133	assessed the patient and given written treatment instructions for each procedure performed; 16
134	134	(3) Review the cosmetic medical procedure with each patient; 17
135	135	(4) Notify the medical director, as well as the supervising physician, supervising PA or 18
136	136	supervising APRN, before the patient leaves or as they become aware, of any adverse events or 19
137	137	complications, and follow up with the patient post-procedure, as appropriate; 20
138	138	(5) Document all relevant details of the performed cosmetic medical procedure in the 21
139	139	patient’s medical record; and 22
140	140	(6) As applicable, satisfy any requirements imposed upon them by their licensing boards. 23
141	141	(f) Cosmetic medical procedures using ablative lasers or ablative energy devices shall only 24
142	142	be performed by physicians. 25
143	143	23-99-3. Rules and regulations. 26
144	144	The department shall, by July 1, 2024, promulgate rules and regulations necessary and not 27
145	145	inconsistent with law to implement the purpose and intent of this chapter, which rules and 28
146	146	regulations shall provide for, though not be limited to, the licensing of medical spas as health care 29
147	147	facilities. 30
148	148	SECTION 2. Section 23-17-2 of the General Laws in Chapter 23-17 entitled "Licensing of 31
149	149	Healthcare Facilities" is hereby amended to read as follows: 32
150	150	23-17-2. Definitions. 33
151	151	As used in this chapter: 34
152	152
153	153
154	154	LC001692 - Page 5 of 14
155	155	(1) “Affiliate” means a legal entity that is in control of, is controlled by, or is in common 1
156	156	control with another legal entity. 2
157	157	(2) “Alzheimer’s dementia special-care unit or program” means a distinct living 3
158	158	environment within a nursing facility that has been physically adapted to accommodate the 4
159	159	particular needs and behaviors of those with dementia. The unit provides increased staffing; 5
160	160	therapeutic activities designed specifically for those with dementia; and trains its staff on an 6
161	161	ongoing basis on the effective management of the physical and behavioral problems of those with 7
162	162	dementia. The residents of the unit/program have had a standard, medical-diagnostic evaluation 8
163	163	and have been determined to have a diagnosis of Alzheimer’s dementia or another dementia. 9
164	164	(3) “Certified nurse-teacher” means those personnel certified by the department of 10
165	165	elementary and secondary education and employed pursuant to the provisions of §§ 16-21-7 and 11
166	166	16-21-8. 12
167	167	(4)(i) “Change in operator” means a transfer by the governing body or operator of a 13
168	168	healthcare facility to any other person (excluding delegations of authority to the medical or 14
169	169	administrative staff of the facility) of the governing body’s authority to: 15
170	170	(A) Hire or fire the chief executive officer of the healthcare facility; 16
171	171	(B) Maintain and control the books and records of the healthcare facility; 17
172	172	(C) Dispose of assets and incur liabilities on behalf of the healthcare facility; or 18
173	173	(D) Adopt and enforce policies regarding operation of the healthcare facility. 19
174	174	(ii) This definition is not applicable to circumstances wherein the governing body of a 20
175	175	healthcare facility retains the immediate authority and jurisdiction over the activities enumerated 21
176	176	in subsections (4)(i)(A) — (4)(i)(D). 22
177	177	(5) “Change in owner” means: 23
178	178	(i) In the case of a healthcare facility that is a partnership, the removal, addition, or 24
179	179	substitution of a partner that results in a new partner acquiring a controlling interest in the 25
180	180	partnership; 26
181	181	(ii) In the case of a healthcare facility that is an unincorporated, solo proprietorship, the 27
182	182	transfer of the title and property to another person; 28
183	183	(iii) In the case of a healthcare facility that is a corporation: 29
184	184	(A) A sale, lease exchange, or other disposition of all, or substantially all, of the property 30
185	185	and assets of the corporation; or 31
186	186	(B) A merger of the corporation into another corporation; or 32
187	187	(C) The consolidation or two (2) or more corporations, resulting in the creation of a new 33
188	188	corporation; or 34
189	189
190	190
191	191	LC001692 - Page 6 of 14
192	192	(D) In the case of a healthcare facility that is a business corporation, any transfer of 1
193	193	corporate stock that results in a new person acquiring a controlling interest in the corporation; or 2
194	194	(E) In the case of a healthcare facility that is a nonbusiness corporation, any change in 3
195	195	membership that results in a new person acquiring a controlling vote in the corporation. 4
196	196	(6) “Clinician” means a physician licensed under chapter 37 of title 5; a nurse licensed 5
197	197	under chapter 34 of title 5; a psychologist licensed under chapter 44 of title 5; a social worker 6
198	198	licensed under chapter 39.1 of title 5; a physical therapist licensed under chapter 40 of title 5; and 7
199	199	a speech language pathologist or audiologist licensed under chapter 48 of title 5 or physician 8
200	200	assistant licensed under the provisions of chapter 54 of title 5. 9
201	201	(7) “Director” means the director of the Rhode Island state department of health. 10
202	202	(8) “Freestanding emergency-care facility” means an establishment, place, or facility that 11
203	203	may be a public or private organization, structurally distinct and separate from a hospital; staffed, 12
204	204	equipped, and operated to provide prompt, emergency medical care. For the purposes of this 13
205	205	chapter, “emergency medical care” means services provided for a medical condition or behavioral-14
206	206	health condition that is manifested by symptoms of sufficient severity that, in the absence of 15
207	207	immediate medical attention, could result in harm to the person or others; serious impairment to 16
208	208	bodily functions; serious dysfunction of any bodily organ or part; or development or continuance 17
209	209	of severe pain. 18
210	210	(9) “Healthcare facility” means any institutional health-service provider, facility, or 19
211	211	institution, place, building, agency, or portion thereof, whether a partnership or corporation, 20
212	212	whether public or private, whether organized for profit or not, used, operated, or engaged in 21
213	213	providing healthcare services, including, but not limited to: hospitals; nursing facilities; home 22
214	214	nursing-care provider (which shall include skilled nursing services and may also include activities 23
215	215	allowed as a home-care provider or as a nursing service agency); home-care provider (which may 24
216	216	include services such as personal care or homemaker services); rehabilitation centers; kidney 25
217	217	disease treatment centers; health maintenance organizations; freestanding emergency-care facilities 26
218	218	as defined in this section, and facilities providing surgical treatment to patients not requiring 27
219	219	hospitalization (surgi-centers); hospice care, and physician ambulatory-surgery centers and 28
220	220	podiatry ambulatory-surgery centers providing surgical treatment. The term “healthcare facility” 29
221	221	also includes organized ambulatory-care facilities that are not part of a hospital but that are 30
222	222	organized and operated to provide healthcare services to outpatients, such as: central-services 31
223	223	facilities serving more than one healthcare facility or healthcare provider; treatment centers; 32
224	224	diagnostic centers; outpatient clinics; medical spas as defined in chapter 99 of title 23; infirmaries 33
225	225	and health centers; school-based health centers, and neighborhood health centers. The term 34
226	226
227	227
228	228	LC001692 - Page 7 of 14
229	229	“healthcare facility” also includes a mobile health-screening vehicle as defined in this section. The 1
230	230	term “healthcare facility” shall not apply to organized, ambulatory-care facilities owned and 2
231	231	operated by professional service corporations as defined in chapter 5.1 of title 7, as amended (the 3
232	232	“professional service corporation law”), or to a practitioner’s (physician, dentist, or other healthcare 4
233	233	provider) office or group of practitioners’ offices (whether owned and/or operated by a hospital or 5
234	234	an affiliate of a hospital or an individual practitioner, alone or as a member of a partnership, 6
235	235	professional service corporation, organization, or association); provided, however, notwithstanding 7
236	236	any other provision herein or in the general laws, any hospital or any affiliate of a hospital that 8
237	237	owns and/or operates a practitioner’s office shall ensure that such practitioner’s office complies 9
238	238	with licensing or accreditation requirements that may be applicable to the practitioner’s office. 10
239	239	Individual categories of healthcare facilities shall be defined in rules and regulations promulgated 11
240	240	by the licensing agency with the advice of the health services council. Rules and regulations 12
241	241	concerning hospice care shall be promulgated with regard to the “Standards of a Hospice Program 13
242	242	of Care,” promulgated by the National Hospice Organization. Any provider of hospice care who 14
243	243	provides hospice care without charge shall be exempt from the licensing provisions of this chapter 15
244	244	but shall meet the “Standards of a Hospice Program of Care.” Facilities licensed by the department 16
245	245	of behavioral healthcare, developmental disabilities and hospitals and the department of human 17
246	246	services, and clinical laboratories licensed in accordance with chapter 16.2 of this title, as well as 18
247	247	Christian Science institutions (also known as Christian Science Nursing Facilities) listed and 19
248	248	certified by the Commission for Accreditation of Christian Science Nursing 20
249	249	Organizations/Facilities, Inc. shall not be considered healthcare facilities for purposes of this 21
250	250	chapter. 22
251	251	(10) “Homemaker,” or however else called, means a trained, nonprofessional worker who 23
252	252	performs related housekeeping services in the home for the sick, disabled, dependent, or infirm, 24
253	253	and as further defined by regulation; the director shall establish criteria for training. 25
254	254	(11) “Hospital” means a person or governmental entity licensed in accordance with this 26
255	255	chapter to establish, maintain, and operate a hospital. 27
256	256	(12) “Licensing agency” means the Rhode Island state department of health. 28
257	257	(13) “Medical services” means any professional services and supplies rendered by, or under 29
258	258	the direction of, persons duly licensed under the laws of this state to practice medicine, surgery, or 30
259	259	podiatry that may be specified by any medical service plan. Medical service shall not be construed 31
260	260	to include hospital services. 32
261	261	(14) “Mobile health-screening vehicle” means a mobile vehicle, van, or trailer that delivers 33
262	262	primary and preventive healthcare screening services, and: 34
263	263
264	264
265	265	LC001692 - Page 8 of 14
266	266	(i) Does not maintain active contracts or arrangements with any health insurer subject to 1
267	267	regulation under chapter 20 or 42 of title 27; 2
268	268	(ii) Does not maintain active contracts or arrangements with another licensed healthcare 3
269	269	facility as that term is defined within this section; and 4
270	270	(iii) Does not provide medical services free of charge. 5
271	271	(15) “Non-English speaker” means a person who cannot speak or understand, or has 6
272	272	difficulty in speaking or understanding, the English language, because he/she uses only, or 7
273	273	primarily, a spoken language other than English, and/or a person who uses a sign language and 8
274	274	requires the use of a sign-language interpreter to facilitate communication. 9
275	275	(16) “Person” means any individual, trust or estate, partnership, corporation (including 10
276	276	associations, joint stock companies, and insurance companies), state, or political subdivision or 11
277	277	instrumentality of a state. 12
278	278	(17) “Physician ambulatory-surgery center” means an office, or portion of an office, that 13
279	279	is utilized for the purpose of furnishing surgical services to the owner and/or operator’s own 14
280	280	patients on an ambulatory basis, and shall include both single-practice, physician ambulatory-15
281	281	surgery centers and multi-practice, physician ambulatory-surgery centers. A “single-practice, 16
282	282	physician ambulatory-surgery center” is a physician ambulatory center owned and/or operated by 17
283	283	a physician-controlled professional service corporation as defined in chapter 5.1 of title 7 (the 18
284	284	“professional service corporation law”), or a physician-controlled limited-liability company (as 19
285	285	defined in chapter 16 of title 7 (the “limited liability company act”)) in which no physician is an 20
286	286	officer, shareholder, director, or employee of any other corporation engaged in the practice of the 21
287	287	same profession, or a private physician’s office (whether owned and/or operated by an individual 22
288	288	practitioner, alone or as a member of a partnership, professional service corporation, limited-23
289	289	liability company, organization, or association). A “multi-practice, physician ambulatory-surgery 24
290	290	center” is a physician ambulatory-surgery center owned and/or operated by a physician-controlled 25
291	291	professional service corporation (as defined in the professional service corporation law) or a 26
292	292	physician-controlled limited-liability company (as defined in the limited liability company act) in 27
293	293	which a physician is also an officer, shareholder, director, or employee of another corporation 28
294	294	engaged in the practice of the same profession, or a group of physicians’ offices (whether owned 29
295	295	and/or operated by an individual practitioner, alone or as a member of a partnership, professional 30
296	296	service corporation, limited-liability company, organization, or association). 31
297	297	(18) “Podiatry ambulatory-surgery center” means an office or portion of an office that is 32
298	298	utilized for the purpose of furnishing surgical services to the owner and/or operator’s own patients 33
299	299	on an ambulatory basis, and shall include both single-practice, podiatry ambulatory-surgery centers 34
300	300
301	301
302	302	LC001692 - Page 9 of 14
303	303	and multi-practice podiatry ambulatory-surgery centers. A “single-practice podiatry ambulatory-1
304	304	surgery center” is a podiatry ambulatory center owned and/or operated by a podiatrist-controlled 2
305	305	professional service corporation (as defined in chapter 5.1 of title 7 (the “professional service 3
306	306	corporation law”)), or a podiatrist-controlled limited-liability company (as defined in chapter 16 of 4
307	307	title 7 (the “limited liability company act”)) in which no podiatrist is an officer, shareholder, 5
308	308	director, or employee of any other corporation engaged in the practice of the same profession, or a 6
309	309	private podiatrist’s office (whether owned and/or operated by an individual practitioner, alone or 7
310	310	as a member of a partnership, professional service corporation, limited-liability company, 8
311	311	organization, or association). A “multi-practice, podiatry ambulatory-surgery center” is a podiatry 9
312	312	ambulatory-surgery center owned and/or operated by a podiatrist-controlled professional service 10
313	313	corporation (as defined in the professional service corporation law) or a podiatrist-controlled, 11
314	314	limited-liability company (as defined in the limited liability company act) in which a podiatrist is 12
315	315	also an officer, shareholder, director, or employee of another corporation engaged in the practice 13
316	316	of the same profession, or a group of podiatrists’ offices (whether owned and/or operated by an 14
317	317	individual practitioner, alone or as a member of a partnership, professional service corporation, 15
318	318	limited-liability company, organization, or association). 16
319	319	(19) “Qualified interpreter” means a person who, through experience and/or training, is 17
320	320	able to translate a particular foreign language into English, with the exception of sign-language 18
321	321	interpreters who must be licensed in accordance with chapter 71 of title 5. 19
322	322	(20) “Qualified sign-language interpreter” means one who has been licensed in accordance 20
323	323	with the provisions of chapter 71 of title 5. 21
324	324	(21) “School-based health center” means a facility located in an elementary or secondary 22
325	325	school licensed as a school-based health center that delivers primary and/or preventive healthcare 23
326	326	services to individuals to include, but not be limited to, students on site. 24
327	327	SECTION 3. Section 23-15-2 of the General Laws in Chapter 23-15 entitled 25
328	328	"Determination of Need for New Healthcare Equipment and New Institutional Health Services" is 26
329	329	hereby amended to read as follows: 27
330	330	23-15-2. Definitions. 28
331	331	As used in this chapter: 29
332	332	(1) “Affected person” means and includes the person whose proposal is being reviewed, or 30
333	333	the applicant, healthcare facilities located within the state that provide institutional health services, 31
334	334	the state medical society, the state osteopathic society, those voluntary nonprofit area-wide 32
335	335	planning agencies that may be established in the state, the state budget office, the office of health 33
336	336	insurance commissioner, any hospital or medical-service corporation organized under the laws of 34
337	337
338	338
339	339	LC001692 - Page 10 of 14
340	340	the state, the statewide health coordinating council, contiguous health-systems agencies, and those 1
341	341	members of the public who are to be served by the proposed, new institutional health services or 2
342	342	new healthcare equipment. 3
343	343	(2) “Cost-impact analysis” means a written analysis of the effect that a proposal to offer or 4
344	344	develop new institutional health services or new healthcare equipment, if approved, will have on 5
345	345	healthcare costs and shall include any detail that may be prescribed by the state agency in rules and 6
346	346	regulations. 7
347	347	(3) “Director” means the director of the Rhode Island state department of health. 8
348	348	(4)(i) “Healthcare facility” means any institutional health-service provider, facility or 9
349	349	institution, place, building, agency, or portion of them, whether a partnership or corporation, 10
350	350	whether public or private, whether organized for profit or not, used, operated, or engaged in 11
351	351	providing healthcare services that are limited to hospitals, nursing facilities, home nursing-care 12
352	352	provider, home-care provider, hospice provider, inpatient rehabilitation centers (including drug 13
353	353	and/or alcohol abuse treatment centers), freestanding emergency-care facilities as defined in § 23-14
354	354	17-2, certain facilities providing surgical treatment to patients not requiring hospitalization (surgi-15
355	355	centers, multi-practice, physician ambulatory-surgery centers and multi-practice, podiatry 16
356	356	ambulatory-surgery centers) and facilities providing inpatient hospice care. Single-practice 17
357	357	physician or podiatry ambulatory-surgery centers (as defined in § 23-17-2(17), (18), respectively) 18
358	358	are exempt from the requirements of chapter 15 of this title; provided, however, that such 19
359	359	exemption shall not apply if a single-practice physician or podiatry ambulatory-surgery center is 20
360	360	established by a medical practice group (as defined in § 5-37-1) within two (2) years following the 21
361	361	formation of such medical practice group, when such medical practice group is formed by the 22
362	362	merger or consolidation of two (2) or more medical practice groups or the acquisition of one 23
363	363	medical practice group by another medical practice group. Medical spas as defined in chapter 99 24
364	364	of title 23 are exempt from the requirements of chapter 15 of this title. The term “healthcare facility” 25
365	365	does not include Christian Science institutions (also known as Christian Science nursing facilities) 26
366	366	listed and certified by the Commission for Accreditation of Christian Science Nursing 27
367	367	Organizations/Facilities, Inc. 28
368	368	(ii) Any provider of hospice care who provides hospice care without charge shall be exempt 29
369	369	from the provisions of this chapter. 30
370	370	(5) “Healthcare provider” means a person who is a direct provider of healthcare services 31
371	371	(including but not limited to physicians, dentists, nurses, podiatrists, physician assistants, or nurse 32
372	372	practitioners) in that the person’s primary current activity is the provision of healthcare services for 33
373	373	persons. 34
374	374
375	375
376	376	LC001692 - Page 11 of 14
377	377	(6) “Health services” means organized program components for preventive, assessment, 1
378	378	maintenance, diagnostic, treatment, and rehabilitative services provided in a healthcare facility. 2
379	379	(7) “Health services council” means the advisory body to the Rhode Island state department 3
380	380	of health established in accordance with chapter 17 of this title, appointed and empowered as 4
381	381	provided to serve as the advisory body to the state agency in its review functions under this chapter. 5
382	382	(8) “Institutional health services” means health services provided in or through healthcare 6
383	383	facilities and includes the entities in or through that the services are provided. 7
384	384	(9) “New healthcare equipment” means any single piece of medical equipment (and any 8
385	385	components that constitute operational components of the piece of medical equipment) proposed 9
386	386	to be utilized in conjunction with the provision of services to patients or the public, the capital costs 10
387	387	of which would exceed two million two hundred fifty thousand dollars ($2,250,000); provided, 11
388	388	however, that the state agency shall exempt from review any application that proposes one-for-one 12
389	389	equipment replacement as defined in regulation. Further, beginning July 1, 2012, and each July 13
390	390	thereafter, the amount shall be adjusted by the percentage of increase in the consumer price index 14
391	391	for all urban consumers (CPI-U) as published by the United States Department of Labor Statistics 15
392	392	as of September 30 of the prior calendar year. 16
393	393	(10) “New institutional health services” means and includes: 17
394	394	(i) Construction, development, or other establishment of a new healthcare facility. 18
395	395	(ii) Any expenditure, except acquisitions of an existing healthcare facility, that will not 19
396	396	result in a change in the services or bed capacity of the healthcare facility by, or on behalf of, an 20
397	397	existing healthcare facility in excess of five million two hundred fifty thousand dollars ($5,250,000) 21
398	398	which is a capital expenditure including expenditures for predevelopment activities; provided 22
399	399	further, beginning July 1, 2012, and each July thereafter, the amount shall be adjusted by the 23
400	400	percentage of increase in the consumer price index for all urban consumers (CPI-U) as published 24
401	401	by the United States Department of Labor Statistics as of September 30 of the prior calendar year. 25
402	402	(iii) Where a person makes an acquisition by, or on behalf of, a healthcare facility or health 26
403	403	maintenance organization under lease or comparable arrangement or through donation, which 27
404	404	would have required review if the acquisition had been by purchase, the acquisition shall be deemed 28
405	405	a capital expenditure subject to review. 29
406	406	(iv) Any capital expenditure that results in the addition of a health service or that changes 30
407	407	the bed capacity of a healthcare facility with respect to which the expenditure is made, except that 31
408	408	the state agency may exempt from review, by rules and regulations promulgated for this chapter, 32
409	409	any bed reclassifications made to licensed nursing facilities and annual increases in licensed bed 33
410	410	capacities of nursing facilities that do not exceed the greater of ten (10) beds or ten percent (10%) 34
411	411
412	412
413	413	LC001692 - Page 12 of 14
414	414	of facility licensed bed capacity and for which the related capital expenditure does not exceed two 1
415	415	million dollars ($2,000,000). 2
416	416	(v) Any health service proposed to be offered to patients or the public by a healthcare 3
417	417	facility that was not offered on a regular basis in or through the facility within the twelve-month 4
418	418	(12) period prior to the time the service would be offered, and that increases operating expenses by 5
419	419	more than one million five hundred thousand dollars ($1,500,000), except that the state agency may 6
420	420	exempt from review, by rules and regulations promulgated for this chapter, any health service 7
421	421	involving reclassification of bed capacity made to licensed nursing facilities. Further, beginning 8
422	422	July 1, 2012, and each July thereafter, the amount shall be adjusted by the percentage of increase 9
423	423	in the consumer price index for all urban consumers (CPI-U) as published by the United States 10
424	424	Department of Labor Statistics as of September 30 of the prior calendar year. 11
425	425	(vi) Any new or expanded tertiary or specialty-care service, regardless of capital expense 12
426	426	or operating expense, as defined by and listed in regulation, the list not to exceed a total of twelve 13
427	427	(12) categories of services at any one time and shall include full-body magnetic resonance imaging 14
428	428	and computerized axial tomography; provided, however, that the state agency shall exempt from 15
429	429	review any application that proposes one-for-one equipment replacement as defined by and listed 16
430	430	in regulation. Acquisition of full body magnetic resonance imaging and computerized axial 17
431	431	tomography shall not require a certificate-of-need review and approval by the state agency if 18
432	432	satisfactory evidence is provided to the state agency that it was acquired for under one million 19
433	433	dollars ($1,000,000) on or before January 1, 2010, and was in operation on or before July 1, 2010. 20
434	434	(11) “Person” means any individual, trust or estate, partnership, corporation (including 21
435	435	associations, joint stock companies, and insurance companies), state or political subdivision, or 22
436	436	instrumentality of a state. 23
437	437	(12) “Predevelopment activities” means expenditures for architectural designs, plans, 24
438	438	working drawings, and specifications, site acquisition, professional consultations, preliminary 25
439	439	plans, studies, and surveys made in preparation for the offering of a new, institutional health 26
440	440	service. 27
441	441	(13) “State agency” means the Rhode Island state department of health. 28
442	442	(14) “To develop” means to undertake those activities that, on their completion, will result 29
443	443	in the offering of a new, institutional health service or new healthcare equipment or the incurring 30
444	444	of a financial obligation, in relation to the offering of that service. 31
445	445	(15) “To offer” means to hold oneself out as capable of providing, or as having the means 32
446	446	for the provision of, specified health services or healthcare equipment. 33
447	447
448	448
449	449	LC001692 - Page 13 of 14
450	450	SECTION 4. This act shall take effect upon passage. 1
451	451	========
452	452	LC001692
453	453	========
454	454
455	455
456	456	LC001692 - Page 14 of 14
457	457	EXPLANATION
458	458	BY THE LEGISLATIVE COUNCIL
459	459	OF
460	460	A N A C T
461	461	RELATING TO HEALTH AND SAFETY -- MEDICAL SPAS SAFETY ACT
462	462	***
463	463	This act would provide that the performance of cosmetic medical services is the practice 1
464	464	of medicine and surgery. This act would also provide that a cosmetic medical service would be 2
465	465	performed by a qualified licensed or certified non-physician only if the services have been 3
466	466	delegated by a medical director, supervising physician, supervising physician assistant, or 4
467	467	supervising APRN who is responsible for on-site supervision of the services performed. 5
468	468	This act would take effect upon passage. 6
469	469	========
470	470	LC001692
471	471	========