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
____________
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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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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