Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0794 Compare Versions

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

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5	5	2023 -- S 0794
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7	7	LC001454
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9	9	S TATE OF RHODE IS LAND
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
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14	14	A N A C T
15	15	RELATING TO HEALTH AND SAFETY -- ASSISTED LIVING RESIDENCE LICENSING
16	16	ACT
17	17	Introduced By: Senators DiPalma, Miller, Lauria, and Murray
18	18	Date Introduced: March 23, 2023
19	19	Referred To: Senate Health & Human Services
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22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Section 23-17.4-2 of the General Laws in Chapter 23-17.4 entitled "Assisted 1
24	24	Living Residence Licensing Act" is hereby amended to read as follows: 2
25	25	23-17.4-2. Definitions. 3
26	26	As used in this chapter: 4
27	27	(1) “Activities of daily living (ADLs)” means bathing, dressing, eating, toileting, mobility 5
28	28	and transfer. 6
29	29	(2) “Administrator” means any person who has responsibility for day to day administration 7
30	30	or operation of an assisted living residence. 8
31	31	(3) “Alzheimer’s dementia special care unit or program” means a distinct living 9
32	32	environment within an assisted living residence that has been physically adapted to accommodate 10
33	33	the particular needs and behaviors of those with dementia. The unit provides increased staffing, 11
34	34	therapeutic activities designed specifically for those with dementia and trains its staff on an ongoing 12
35	35	basis on the effective management of the physical and behavioral problems of those with dementia. 13
36	36	The residents of the unit or program have had a standard medical diagnostic evaluation and have 14
37	37	been determined to have a diagnosis of Alzheimer’s dementia or another dementia. 15
38	38	(4) “Assisted living residence” means a publicly or privately operated residence that 16
39	39	provides directly or indirectly by means of contracts or arrangements personal assistance and may 17
40	40	include the delivery of limited health services, as defined under subsection (12), to meet the 18
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44	44	resident’s changing needs and preferences, lodging, and meals to six (6) or more adults who are 1
45	45	unrelated to the licensee or administrator, excluding however, any privately operated establishment 2
46	46	or facility licensed pursuant to chapter 17 of this title, and those facilities licensed by or under the 3
47	47	jurisdiction of the department of behavioral healthcare, developmental disabilities and hospitals, 4
48	48	the department of children, youth and families, or any other state agency. The department shall 5
49	49	develop levels of licensure for assisted living residences within this definition as provided in § 23-6
50	50	17.4-6. Assisted living residences include sheltered care homes, and board and care residences or 7
51	51	any other entity by any other name providing the services listed in this subdivision which meet the 8
52	52	definition of assisted living residences. 9
53	53	(5) “Capable of self-preservation” means the physical mobility and judgmental ability of 10
54	54	the individual to take appropriate action in emergency situations. Residents not capable of self-11
55	55	preservation are limited to facilities that meet more stringent life safety code requirements as 12
56	56	provided under § 23-17.4-6(b)(3). 13
57	57	(6) “Director” means the director of the Rhode Island department of health. 14
58	58	(7) “Licensing agency” means the Rhode Island department of health. 15
59	59	(8) “Qualified licensed assisted living staff members” means a certified nursing assistant 16
60	60	as provided under § 23-17.9-2(a)(3), a licensed practical nurse as provided under § 5-34-3(13) 17
61	61	and/or a registered nurse as provided under § 5-34-3(14). 18
62	62	(9) “Personal assistance” means the provision of one or more of the following services, as 19
63	63	required by the resident or as reasonably requested by the resident, on a scheduled or unscheduled 20
64	64	basis, including: 21
65	65	(i) Assisting the resident with personal needs including activities of daily living; 22
66	66	(ii) Assisting the resident with self-administration of medication or administration of 23
67	67	medications by appropriately licensed staff; 24
68	68	(iii) Providing or assisting the resident in arranging for health and supportive services as 25
69	69	may be reasonably required; 26
70	70	(iv) Monitoring the activities of the resident while on the premises of the residence to 27
71	71	ensure his or her health, safety, and well-being; and 28
72	72	(v) Reasonable recreational, social and personal services. 29
73	73	(10) “Resident” means an individual not requiring medical or nursing care as provided in 30
74	74	a healthcare facility but who as a result of choice and/or physical or mental limitation requires 31
75	75	personal assistance, lodging and meals and may require the administration of medication and/or 32
76	76	limited health services. A resident must be capable of self-preservation in emergency situations, 33
77	77	unless the facility meets a more stringent life safety code as required under § 23-17.4-6(b)(3). 34
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81	81	Persons Unless provided herein, persons needing medical or skilled nursing care, including daily 1
82	82	professional observation and evaluation, as provided in a healthcare facility, and/or persons who 2
83	83	are bedbound or in need of the assistance of more than one person for ambulation, are not 3
84	84	appropriate to reside in for initial admission to assisted living residences. However, an established 4
85	85	resident may receive daily medical and/or skilled nursing care or therapy from a licensed healthcare 5
86	86	provider for a condition that results from a temporary illness or injury for up to forty-five (45) days 6
87	87	subject to an extension of additional days as approved by the department as necessary and/or 7
88	88	appropriate for the resident's condition, known as assisted living flex care, or if the resident is under 8
89	89	the care of a Rhode Island licensed hospice agency provided the assisted living residence assumes 9
90	90	responsibility for ensuring that the required care is received. Furthermore, a new resident may 10
91	91	receive daily therapy services and/or limited medical and/or skilled nursing care services, or 11
92	92	therapy as defined through rules and regulations promulgated by the department of health, from a 12
93	93	licensed healthcare provider as defined through rules and regulations promulgated by the 13
94	94	department of health, from a licensed healthcare provider for a condition that results from a 14
95	95	temporary illness or injury for up to forty-five (45) days subject to an extension of additional days 15
96	96	as approved by the department as necessary and/or appropriate for the resident's condition, or if the 16
97	97	resident is under the care of a licensed hospice agency provided that assisted living residence 17
98	98	assumes responsibility for ensuring that the care is received. For the purposes of this chapter, 18
99	99	“resident” shall also mean the resident’s agent as designated in writing or legal guardian. 19
100	100	Notwithstanding the aforementioned, residents who are bed bound or in need of assistance of more 20
101	101	than one staff person for ambulation may reside in a residence if they are receiving hospice care in 21
102	102	accordance with the rules and regulations promulgated by the department of health. For the 22
103	103	purposes of this chapter, “resident” shall also mean the resident’s agent as designated in writing or 23
104	104	legal guardian. 24
105	105	(11) “Supervision” means the supervision requirements of qualified licensed assisted living 25
106	106	staff delivering limited health services in accordance with this chapter, as defined through rules and 26
107	107	regulations promulgated by the department of health. 27
108	108	(12) “Limited health services” means health services, as ordered by the resident’s 28
109	109	physician, provided by qualified licensed assisted living staff members with supervision as required 29
110	110	in rules and regulations promulgated by the department of health. a licensed health care 30
111	111	professional, including, without limitation, stage I and stage II vascular ulcer treatment and 31
112	112	prevention; simple wound care, including post-operative suture care/removal and stasis ulcer care; 32
113	113	ostomy care, including appliance changes for residents who have established stomas; urinary 33
114	114	catheter care; oxygen services, including both oxygen concentrators and portable tanks, monitoring 34
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118	118	pulse oximetry, assistance with respiratory equipment for residents who can no longer manage 1
119	119	equipment on their own, including, without limitation, a bi-level positive airway pressure ventilator 2
120	120	("BIPAP") that helps with breathing, a continuous positive airway pressure machine ("CPAP") that 3
121	121	provides constant airflow, nebulizers and inhalers; and physical, occupational, speech and language 4
122	122	therapy. Nothing in this definition shall be construed to limit the right of assisted living residents 5
123	123	to access home nursing care or hospice provider services. 6
124	124	SECTION 2. This act shall take effect upon passage. 7
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131	131	EXPLANATION
132	132	BY THE LEGISLATIVE COUNCIL
133	133	OF
134	134	A N A C T
135	135	RELATING TO HEALTH AND SAFETY -- ASSISTED LIVING RESIDENCE LICENSING
136	136	ACT
137	137	***
138	138	This act would allow assisted living facilities ("ALFs") the ability to provide assisted living 1
139	139	flex care to better care for individuals whose health care needs progress over time. This act would 2
140	140	allow ALFs to provide more intensive medical and skilled nursing care services to residents in the 3
141	141	assisted living setting, as their care needs change over time, rather than requiring their transition to 4
142	142	a skilled nursing facility when full-time skilled services are required for the resident. It would also 5
143	143	remove the forty-five (45) day limitation on medical or skilled care permitted for a resident of an 6
144	144	ALF, whose condition may require longer daily skilled care, because of that condition or illness. 7
145	145	This act would take effect upon passage. 8
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