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| 4 | 4 | | |
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| 5 | 5 | | 2025 -- H 5355 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC001034 |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S T A T E O F R H O D E I S L A N D |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2025 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO HEALTH AND SAFETY -- DETERMINATION OF NEED FOR NEW |
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| 16 | 16 | | HEALTHCARE EQUIPMENT AND NEW INSTITUTIONAL HEALTH SERVICES |
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| 17 | 17 | | Introduced By: Representatives Place, Quattrocchi, Hopkins, J. Brien, Santucci, and |
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| 18 | 18 | | Newberry |
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| 19 | 19 | | Date Introduced: February 07, 2025 |
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| 20 | 20 | | Referred To: House Health & Human Services |
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| 21 | 21 | | |
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| 22 | 22 | | |
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| 23 | 23 | | It is enacted by the General Assembly as follows: |
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| 24 | 24 | | SECTION 1. Chapter 23-15 of the General Laws entitled "Determination of Need for New 1 |
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| 25 | 25 | | Healthcare Equipment and New Institutional Health Services" is hereby repealed in its entirety. 2 |
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| 26 | 26 | | CHAPTER 23-15 3 |
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| 27 | 27 | | Determination of Need for New Healthcare Equipment and New Institutional Health Services 4 |
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| 28 | 28 | | 23-15-1. Short title. 5 |
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| 29 | 29 | | This chapter may be cited as the “Health Care Certificate of Need Act of Rhode Island”. 6 |
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| 30 | 30 | | 23-15-2. Definitions. 7 |
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| 31 | 31 | | As used in this chapter: 8 |
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| 32 | 32 | | (1) “Affected person” means and includes the person whose proposal is being reviewed, or 9 |
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| 33 | 33 | | the applicant, healthcare facilities located within the state that provide institutional health services, 10 |
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| 34 | 34 | | the state medical society, the state osteopathic society, those voluntary nonprofit area-wide 11 |
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| 35 | 35 | | planning agencies that may be established in the state, the state budget office, the office of health 12 |
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| 36 | 36 | | insurance commissioner, any hospital or medical-service corporation organized under the laws of 13 |
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| 37 | 37 | | the state, the statewide health coordinating council, contiguous health-systems agencies, and those 14 |
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| 38 | 38 | | members of the public who are to be served by the proposed, new institutional health services or 15 |
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| 39 | 39 | | new healthcare equipment. 16 |
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| 40 | 40 | | (2) “Cost-impact analysis” means a written analysis of the effect that a proposal to offer or 17 |
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| 41 | 41 | | develop new institutional health services or new healthcare equipment, if approved, will have on 18 |
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| 42 | 42 | | |
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| 43 | 43 | | |
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| 44 | 44 | | LC001034 - Page 2 of 15 |
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| 45 | 45 | | healthcare costs and shall include any detail that may be prescribed by the state agency in rules and 1 |
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| 46 | 46 | | regulations. 2 |
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| 47 | 47 | | (3) “Director” means the director of the Rhode Island state department of health. 3 |
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| 48 | 48 | | (4)(i) “Healthcare facility” means any institutional health-service provider, facility or 4 |
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| 49 | 49 | | institution, place, building, agency, or portion of them, whether a partnership or corporation, 5 |
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| 50 | 50 | | whether public or private, whether organized for profit or not, used, operated, or engaged in 6 |
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| 51 | 51 | | providing healthcare services that are limited to hospitals, nursing facilities, home nursing-care 7 |
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| 52 | 52 | | provider, home-care provider, hospice provider, inpatient rehabilitation centers (including drug 8 |
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| 53 | 53 | | and/or alcohol abuse treatment centers), freestanding emergency-care facilities as defined in § 23-9 |
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| 54 | 54 | | 17-2, certain facilities providing surgical treatment to patients not requiring hospitalization (surgi-10 |
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| 55 | 55 | | centers, multi-practice, physician ambulatory-surgery centers and multi-practice, podiatry 11 |
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| 56 | 56 | | ambulatory-surgery centers) and facilities providing inpatient hospice care. Single-practice 12 |
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| 57 | 57 | | physician or podiatry ambulatory-surgery centers (as defined in § 23-17-2(17), (18), respectively) 13 |
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| 58 | 58 | | are exempt from the requirements of chapter 15 of this title; provided, however, that such 14 |
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| 59 | 59 | | exemption shall not apply if a single-practice physician or podiatry ambulatory-surgery center is 15 |
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| 60 | 60 | | established by a medical practice group (as defined in § 5-37-1) within two (2) years following the 16 |
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| 61 | 61 | | formation of such medical practice group, when such medical practice group is formed by the 17 |
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| 62 | 62 | | merger or consolidation of two (2) or more medical practice groups or the acquisition of one 18 |
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| 63 | 63 | | medical practice group by another medical practice group. The term “healthcare facility” does not 19 |
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| 64 | 64 | | include Christian Science institutions (also known as Christian Science nursing facilities) listed and 20 |
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| 65 | 65 | | certified by the Commission for Accreditation of Christian Science Nursing 21 |
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| 66 | 66 | | Organizations/Facilities, Inc. 22 |
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| 67 | 67 | | (ii) Any provider of hospice care who provides hospice care without charge shall be exempt 23 |
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| 68 | 68 | | from the provisions of this chapter. 24 |
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| 69 | 69 | | (5) “Healthcare provider” means a person who is a direct provider of healthcare services 25 |
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| 70 | 70 | | (including but not limited to physicians, dentists, nurses, podiatrists, physician assistants, or nurse 26 |
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| 71 | 71 | | practitioners) in that the person’s primary current activity is the provision of healthcare services for 27 |
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| 72 | 72 | | persons. 28 |
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| 73 | 73 | | (6) “Health services” means organized program components for preventive, assessment, 29 |
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| 74 | 74 | | maintenance, diagnostic, treatment, and rehabilitative services provided in a healthcare facility. 30 |
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| 75 | 75 | | (7) “Health services council” means the advisory body to the Rhode Island state department 31 |
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| 76 | 76 | | of health established in accordance with chapter 17 of this title, appointed and empowered as 32 |
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| 77 | 77 | | provided to serve as the advisory body to the state agency in its review functions under this chapter. 33 |
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| 78 | 78 | | (8) “Institutional health services” means health services provided in or through healthcare 34 |
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| 79 | 79 | | |
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| 80 | 80 | | |
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| 81 | 81 | | LC001034 - Page 3 of 15 |
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| 82 | 82 | | facilities and includes the entities in or through that the services are provided. 1 |
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| 83 | 83 | | (9) “New healthcare equipment” means any single piece of medical equipment (and any 2 |
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| 84 | 84 | | components that constitute operational components of the piece of medical equipment) proposed 3 |
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| 85 | 85 | | to be utilized in conjunction with the provision of services to patients or the public, the capital costs 4 |
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| 86 | 86 | | of which would exceed two million two hundred fifty thousand dollars ($2,250,000); provided, 5 |
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| 87 | 87 | | however, that the state agency shall exempt from review any application that proposes one-for-one 6 |
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| 88 | 88 | | equipment replacement as defined in regulation. Further, beginning July 1, 2012, and each July 7 |
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| 89 | 89 | | thereafter, the amount shall be adjusted by the percentage of increase in the consumer price index 8 |
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| 90 | 90 | | for all urban consumers (CPI-U) as published by the United States Department of Labor Statistics 9 |
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| 91 | 91 | | as of September 30 of the prior calendar year. 10 |
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| 92 | 92 | | (10) “New institutional health services” means and includes: 11 |
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| 93 | 93 | | (i) Construction, development, or other establishment of a new healthcare facility. 12 |
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| 94 | 94 | | (ii) Any expenditure, except acquisitions of an existing healthcare facility, that will not 13 |
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| 95 | 95 | | result in a change in the services or bed capacity of the healthcare facility by, or on behalf of, an 14 |
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| 96 | 96 | | existing healthcare facility in excess of five million two hundred fifty thousand dollars ($5,250,000) 15 |
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| 97 | 97 | | which is a capital expenditure including expenditures for predevelopment activities; provided 16 |
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| 98 | 98 | | further, beginning July 1, 2012, and each July thereafter, the amount shall be adjusted by the 17 |
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| 99 | 99 | | percentage of increase in the consumer price index for all urban consumers (CPI-U) as published 18 |
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| 100 | 100 | | by the United States Department of Labor Statistics as of September 30 of the prior calendar year. 19 |
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| 101 | 101 | | (iii) Where a person makes an acquisition by, or on behalf of, a healthcare facility or health 20 |
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| 102 | 102 | | maintenance organization under lease or comparable arrangement or through donation, which 21 |
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| 103 | 103 | | would have required review if the acquisition had been by purchase, the acquisition shall be deemed 22 |
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| 104 | 104 | | a capital expenditure subject to review. 23 |
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| 105 | 105 | | (iv) Any capital expenditure that results in the addition of a health service or that changes 24 |
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| 106 | 106 | | the bed capacity of a healthcare facility with respect to which the expenditure is made, except that 25 |
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| 107 | 107 | | the state agency may exempt from review, by rules and regulations promulgated for this chapter, 26 |
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| 108 | 108 | | any bed reclassifications made to licensed nursing facilities and annual increases in licensed bed 27 |
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| 109 | 109 | | capacities of nursing facilities that do not exceed the greater of ten (10) beds or ten percent (10%) 28 |
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| 110 | 110 | | of facility licensed bed capacity and for which the related capital expenditure does not exceed two 29 |
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| 111 | 111 | | million dollars ($2,000,000). 30 |
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| 112 | 112 | | (v) Any health service proposed to be offered to patients or the public by a healthcare 31 |
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| 113 | 113 | | facility that was not offered on a regular basis in or through the facility within the twelve-month 32 |
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| 114 | 114 | | (12) period prior to the time the service would be offered, and that increases operating expenses by 33 |
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| 115 | 115 | | more than one million five hundred thousand dollars ($1,500,000), except that the state agency may 34 |
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| 116 | 116 | | |
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| 117 | 117 | | |
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| 118 | 118 | | LC001034 - Page 4 of 15 |
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| 119 | 119 | | exempt from review, by rules and regulations promulgated for this chapter, any health service 1 |
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| 120 | 120 | | involving reclassification of bed capacity made to licensed nursing facilities. Further, beginning 2 |
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| 121 | 121 | | July 1, 2012, and each July thereafter, the amount shall be adjusted by the percentage of increase 3 |
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| 122 | 122 | | in the consumer price index for all urban consumers (CPI-U) as published by the United States 4 |
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| 123 | 123 | | Department of Labor Statistics as of September 30 of the prior calendar year. 5 |
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| 124 | 124 | | (vi) Any new or expanded tertiary or specialty-care service, regardless of capital expense 6 |
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| 125 | 125 | | or operating expense, as defined by and listed in regulation, the list not to exceed a total of twelve 7 |
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| 126 | 126 | | (12) categories of services at any one time and shall include full-body magnetic resonance imaging 8 |
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| 127 | 127 | | and computerized axial tomography; provided, however, that the state agency shall exempt from 9 |
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| 128 | 128 | | review any application that proposes one-for-one equipment replacement as defined by and listed 10 |
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| 129 | 129 | | in regulation. Acquisition of full body magnetic resonance imaging and computerized axial 11 |
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| 130 | 130 | | tomography shall not require a certificate-of-need review and approval by the state agency if 12 |
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| 131 | 131 | | satisfactory evidence is provided to the state agency that it was acquired for under one million 13 |
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| 132 | 132 | | dollars ($1,000,000) on or before January 1, 2010, and was in operation on or before July 1, 2010. 14 |
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| 133 | 133 | | (11) “Person” means any individual, trust or estate, partnership, corporation (including 15 |
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| 134 | 134 | | associations, joint stock companies, and insurance companies), state or political subdivision, or 16 |
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| 135 | 135 | | instrumentality of a state. 17 |
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| 136 | 136 | | (12) “Predevelopment activities” means expenditures for architectural designs, plans, 18 |
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| 137 | 137 | | working drawings, and specifications, site acquisition, professional consultations, preliminary 19 |
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| 138 | 138 | | plans, studies, and surveys made in preparation for the offering of a new, institutional health 20 |
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| 139 | 139 | | service. 21 |
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| 140 | 140 | | (13) “State agency” means the Rhode Island state department of health. 22 |
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| 141 | 141 | | (14) “To develop” means to undertake those activities that, on their completion, will result 23 |
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| 142 | 142 | | in the offering of a new, institutional health service or new healthcare equipment or the incurring 24 |
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| 143 | 143 | | of a financial obligation, in relation to the offering of that service. 25 |
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| 144 | 144 | | (15) “To offer” means to hold oneself out as capable of providing, or as having the means 26 |
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| 145 | 145 | | for the provision of, specified health services or healthcare equipment. 27 |
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| 146 | 146 | | 23-15-3. Purpose. 28 |
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| 147 | 147 | | The purpose of this chapter is to provide for the development, establishment, and 29 |
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| 148 | 148 | | enforcement of standards for the authorization and allocation of new institutional health services 30 |
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| 149 | 149 | | and new health care equipment. 31 |
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| 150 | 150 | | 23-15-4. Review and approval of new health care equipment and new institutional 32 |
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| 151 | 151 | | health services. 33 |
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| 152 | 152 | | (a) No health care provider or health care facility shall develop or offer new health care 34 |
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| 153 | 153 | | |
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| 154 | 154 | | |
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| 155 | 155 | | LC001034 - Page 5 of 15 |
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| 156 | 156 | | equipment or new institutional health services in Rhode Island, the magnitude of which exceeds 1 |
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| 157 | 157 | | the limits defined by this chapter, without prior review by the health services council and approval 2 |
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| 158 | 158 | | by the state agency; except that review by the health services council may be waived in the case of 3 |
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| 159 | 159 | | expeditious reviews conducted in accordance with § 23-15-5, and except that health maintenance 4 |
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| 160 | 160 | | organizations which fulfill criteria to be established in rules and regulations promulgated by the 5 |
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| 161 | 161 | | state agency with the advice of the health services council shall be exempted from the review and 6 |
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| 162 | 162 | | approval requirement established in this section upon approval by the state agency of an application 7 |
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| 163 | 163 | | for exemption from the review and approval requirement established in this section which contain 8 |
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| 164 | 164 | | any information that the state agency may require to determine if the health maintenance 9 |
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| 165 | 165 | | organization meets the criteria. 10 |
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| 166 | 166 | | (b) No approval shall be made without an adequate demonstration of need by the applicant 11 |
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| 167 | 167 | | at the time and place and under the circumstances proposed, nor shall the approval be made without 12 |
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| 168 | 168 | | a determination that a proposal for which need has been demonstrated is also affordable by the 13 |
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| 169 | 169 | | people of the state. 14 |
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| 170 | 170 | | (c) No approval of new institutional health services for the provision of health services to 15 |
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| 171 | 171 | | inpatients shall be granted unless the written findings required in accordance with § 23-15-6(b)(6) 16 |
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| 172 | 172 | | are made. 17 |
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| 173 | 173 | | (d) Applications for determination of need shall be filed with the state agency on a date 18 |
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| 174 | 174 | | fixed by the state agency together with plans and specifications and any other appropriate data and 19 |
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| 175 | 175 | | information that the state agency shall require by regulation, and shall be considered in relation to 20 |
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| 176 | 176 | | each other no less than once a year. A duplicate copy of each application together with all 21 |
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| 177 | 177 | | supporting documentation shall be kept on file by the state agency as a public record. 22 |
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| 178 | 178 | | (e) The health services council shall consider, but shall not be limited to, the following in 23 |
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| 179 | 179 | | conducting reviews and determining need: 24 |
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| 180 | 180 | | (1) The relationship of the proposal to state health plans that may be formulated by the state 25 |
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| 181 | 181 | | agency; 26 |
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| 182 | 182 | | (2) The impact of approval or denial of the proposal on the future viability of the applicant 27 |
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| 183 | 183 | | and of the providers of health services to a significant proportion of the population served or 28 |
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| 184 | 184 | | proposed to be served by the applicant; 29 |
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| 185 | 185 | | (3) The need that the population to be served by the proposed equipment or services has 30 |
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| 186 | 186 | | for the equipment or services; 31 |
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| 187 | 187 | | (4) The availability of alternative, less costly, or more effective methods of providing 32 |
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| 188 | 188 | | services or equipment, including economies or improvements in service that could be derived from 33 |
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| 189 | 189 | | feasible cooperative or shared services; 34 |
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| 190 | 190 | | |
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| 191 | 191 | | |
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| 192 | 192 | | LC001034 - Page 6 of 15 |
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| 193 | 193 | | (5) The immediate and long term financial feasibility of the proposal, as well as the 1 |
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| 194 | 194 | | probable impact of the proposal on the cost of, and charges for, health services of the applicant; 2 |
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| 195 | 195 | | (6) The relationship of the services proposed to be provided to the existing health care 3 |
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| 196 | 196 | | system of the state; 4 |
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| 197 | 197 | | (7) The impact of the proposal on the quality of health care in the state and in the population 5 |
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| 198 | 198 | | area to be served by the applicant; 6 |
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| 199 | 199 | | (8) The availability of funds for capital and operating needs for the provision of the services 7 |
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| 200 | 200 | | or equipment proposed to be offered; 8 |
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| 201 | 201 | | (9) The cost of financing the proposal including the reasonableness of the interest rate, the 9 |
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| 202 | 202 | | period of borrowing, and the equity of the applicant in the proposed new institutional health service 10 |
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| 203 | 203 | | or new equipment; 11 |
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| 204 | 204 | | (10) The relationship, including the organizational relationship of the services or 12 |
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| 205 | 205 | | equipment proposed, to ancillary or support services; 13 |
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| 206 | 206 | | (11) Special needs and circumstances of those entities which provide a substantial portion 14 |
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| 207 | 207 | | of their services or resources, or both, to individuals not residing within the state; 15 |
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| 208 | 208 | | (12) Special needs of entities such as medical and other health professional schools, 16 |
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| 209 | 209 | | multidisciplinary clinics, and specialty centers; also, the special needs for and availability of 17 |
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| 210 | 210 | | osteopathic facilities and services within the state; 18 |
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| 211 | 211 | | (13) In the case of a construction project: 19 |
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| 212 | 212 | | (i) The costs and methods of the proposed construction, 20 |
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| 213 | 213 | | (ii) The probable impact of the construction project reviewed on the costs of providing 21 |
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| 214 | 214 | | health services by the person proposing the construction project; and 22 |
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| 215 | 215 | | (iii) The proposed availability and use of safe patient handling equipment in the new or 23 |
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| 216 | 216 | | renovated space to be constructed. 24 |
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| 217 | 217 | | (14) Those appropriate considerations that may be established in rules and regulations 25 |
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| 218 | 218 | | promulgated by the state agency with the advice of the health services council; 26 |
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| 219 | 219 | | (15) The potential of the proposal to demonstrate or provide one or more innovative 27 |
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| 220 | 220 | | approaches or methods for attaining a more cost effective and/or efficient health care system; 28 |
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| 221 | 221 | | (16) The relationship of the proposal to the need indicated in any requests for proposals 29 |
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| 222 | 222 | | issued by the state agency; 30 |
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| 223 | 223 | | (17) The input of the community to be served by the proposed equipment and services and 31 |
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| 224 | 224 | | the people of the neighborhoods close to the health care facility who are impacted by the proposal; 32 |
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| 225 | 225 | | (18) The relationship of the proposal to any long-range capital improvement plan of the 33 |
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| 226 | 226 | | health care facility applicant. 34 |
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| 227 | 227 | | |
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| 228 | 228 | | |
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| 229 | 229 | | LC001034 - Page 7 of 15 |
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| 230 | 230 | | (19) Cost impact statements forwarded pursuant to subsection 23-15-6(e). 1 |
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| 231 | 231 | | (f) In conducting its review, the health services council shall perform the following: 2 |
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| 232 | 232 | | (1) Within one hundred and fifteen (115) days after initiating its review, which must be 3 |
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| 233 | 233 | | commenced no later than thirty-one (31) days after the filing of an application, the health services 4 |
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| 234 | 234 | | council shall determine as to each proposal whether the applicant has demonstrated need at the time 5 |
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| 235 | 235 | | and place and under the circumstances proposed, and in doing so may apply the criteria and 6 |
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| 236 | 236 | | standards set forth in subsection (e) of this section; provided however, that a determination of need 7 |
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| 237 | 237 | | shall not alone be sufficient to warrant a recommendation to the state agency that a proposal should 8 |
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| 238 | 238 | | be approved. The director shall render his or her decision within five (5) days of the determination 9 |
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| 239 | 239 | | of the health services council. 10 |
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| 240 | 240 | | (2) Prior to the conclusion of its review in accordance with § 23-15-6(e), the health services 11 |
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| 241 | 241 | | council shall evaluate each proposal for which a determination of need has been established in 12 |
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| 242 | 242 | | relation to other proposals, comparing proposals with each other, whether similar or not, 13 |
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| 243 | 243 | | establishing priorities among the proposals for which need has been determined, and taking into 14 |
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| 244 | 244 | | consideration the criteria and standards relating to relative need and affordability as set forth in 15 |
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| 245 | 245 | | subsection (e) of this section and § 23-15-6(f). 16 |
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| 246 | 246 | | (3) At the conclusion of its review, the health services council shall make recommendations 17 |
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| 247 | 247 | | to the state agency relative to approval or denial of the new institutional health services or new 18 |
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| 248 | 248 | | health care equipment proposed; provided that: 19 |
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| 249 | 249 | | (i) The health services council shall recommend approval of only those proposals found to 20 |
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| 250 | 250 | | be affordable in accordance with the provisions of § 23-15-6(f); and 21 |
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| 251 | 251 | | (ii) If the state agency proposes to render a decision that is contrary to the recommendation 22 |
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| 252 | 252 | | of the health services council, the state agency must render its reasons for doing so in writing. 23 |
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| 253 | 253 | | (g) Approval of new institutional health services or new health care equipment by the state 24 |
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| 254 | 254 | | agency shall be subject to conditions that may be prescribed by rules and regulations developed by 25 |
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| 255 | 255 | | the state agency with the advice of the health services council, but those conditions must relate to 26 |
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| 256 | 256 | | the considerations enumerated in subsection (e) and to considerations that may be established in 27 |
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| 257 | 257 | | regulations in accordance with subsection (e)(14). 28 |
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| 258 | 258 | | (h) The offering or developing of new institutional health services or health care equipment 29 |
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| 259 | 259 | | by a health care facility without prior review by the health services council and approval by the 30 |
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| 260 | 260 | | state agency shall be grounds for the imposition of licensure sanctions on the facility, including 31 |
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| 261 | 261 | | denial, suspension, revocation, or curtailment or for imposition of any monetary fines that may be 32 |
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| 262 | 262 | | statutorily permitted by virtue of individual health care facility licensing statutes. 33 |
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| 263 | 263 | | (i) No government agency and no hospital or medical service corporation organized under 34 |
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| 264 | 264 | | |
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| 265 | 265 | | |
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| 266 | 266 | | LC001034 - Page 8 of 15 |
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| 267 | 267 | | the laws of the state shall reimburse any health care facility or health care provider for the costs 1 |
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| 268 | 268 | | associated with offering or developing new institutional health services or new health care 2 |
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| 269 | 269 | | equipment unless the health care facility or health care provider has received the approval of the 3 |
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| 270 | 270 | | state agency in accordance with this chapter. Government agencies and hospital and medical 4 |
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| 271 | 271 | | service corporations organized under the laws of the state shall, during budget negotiations, hold 5 |
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| 272 | 272 | | health care facilities and health care providers accountable to operating efficiencies claimed or 6 |
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| 273 | 273 | | projected in proposals which receive the approval of the state agency in accordance with this 7 |
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| 274 | 274 | | chapter. 8 |
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| 275 | 275 | | (j) In addition, the state agency shall not make grants to, enter into contracts with, or 9 |
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| 276 | 276 | | recommend approval of the use of federal or state funds by any health care facility or health care 10 |
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| 277 | 277 | | provider which proceeds with the offering or developing of new institutional health services or new 11 |
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| 278 | 278 | | health care equipment after disapproval by the state agency. 12 |
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| 279 | 279 | | 23-15-4.1. Exemption for nonclinical capital expenditures. 13 |
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| 280 | 280 | | Notwithstanding the requirements of any other provisions of any general or public laws, 14 |
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| 281 | 281 | | capital expenditures by a health care facility that are not directly related to the provision of health 15 |
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| 282 | 282 | | services as defined in this chapter, including, but not limited to, capital expenditures for parking 16 |
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| 283 | 283 | | lots, billing computer systems, and telephone systems, shall not require a certificate of need review 17 |
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| 284 | 284 | | and approval by the state agency. 18 |
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| 285 | 285 | | 23-15-4.2. Exemption for research. 19 |
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| 286 | 286 | | Notwithstanding the requirements of any other provisions of any general or public laws, 20 |
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| 287 | 287 | | capital expenditures by a health care facility related to research in basic biomedical or medical 21 |
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| 288 | 288 | | research areas that are not directly related to the provision of clinical or patient care services shall 22 |
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| 289 | 289 | | not require a certificate of need review and approval by the state agency. 23 |
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| 290 | 290 | | 23-15-4.4. Exemption for voter approved capital bond issues for health care facilities. 24 |
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| 291 | 291 | | Notwithstanding the requirements of any other provisions of any general law or public 25 |
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| 292 | 292 | | laws, voter approved state bond issues authorizing capital expenditures for state health care 26 |
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| 293 | 293 | | facilities shall not require a certificate of need review and approval by the state agency. 27 |
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| 294 | 294 | | 23-15-5. Expeditious review. 28 |
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| 295 | 295 | | (a) Any person who proposes to offer or develop new institutional health services or new 29 |
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| 296 | 296 | | healthcare equipment for documented emergency needs; or for the purpose of eliminating or 30 |
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| 297 | 297 | | preventing documented fire or safety hazards affecting the lives and health of patients or staff; or 31 |
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| 298 | 298 | | for compliance with accreditation standards required for receipt of federal or state reimbursement; 32 |
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| 299 | 299 | | or for any other purpose that the state agency may specify in rules and regulations, may apply for 33 |
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| 300 | 300 | | an expeditious review. The state agency may exercise its discretion in recommending approvals 34 |
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| 301 | 301 | | |
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| 302 | 302 | | |
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| 303 | 303 | | LC001034 - Page 9 of 15 |
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| 304 | 304 | | through an expeditious review, except that no new institutional health service or new healthcare 1 |
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| 305 | 305 | | equipment may be approved through the expeditious review if provision of the new institutional 2 |
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| 306 | 306 | | health service or new healthcare equipment is contra-indicated by the state health plan as may be 3 |
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| 307 | 307 | | formulated by the state agency. Specific procedures for the conduct of expeditious reviews shall be 4 |
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| 308 | 308 | | promulgated in rules and regulations adopted by the state agency with the advice of the health 5 |
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| 309 | 309 | | services council. 6 |
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| 310 | 310 | | (b) The decision of the state agency not to conduct an expeditious review shall be 7 |
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| 311 | 311 | | reconsidered upon a written petition to the state agency, and the state agency shall be required to 8 |
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| 312 | 312 | | respond to the written petition within ten (10) days stating whether expeditious review is granted. 9 |
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| 313 | 313 | | If the request for reconsideration is denied, the state agency shall state the reasons in writing why 10 |
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| 314 | 314 | | the expeditious request had been denied. 11 |
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| 315 | 315 | | (c) The decision of the state agency in connection with an expeditious review shall be 12 |
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| 316 | 316 | | rendered within thirty (30) days after the commencement of said review. 13 |
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| 317 | 317 | | (d) Any healthcare facility that provides a service performed in another state and that is not 14 |
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| 318 | 318 | | performed in the state of Rhode Island, or such service is performed in the state on a very limited 15 |
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| 319 | 319 | | basis, shall be granted expeditious review upon request under this section, provided that such 16 |
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| 320 | 320 | | service, among other things, has a clear effect on the timeliness, access, or quality of care and is 17 |
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| 321 | 321 | | able to meet licensing standards. 18 |
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| 322 | 322 | | 23-15-6. Procedures for review. 19 |
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| 323 | 323 | | (a) The state agency, with the advice of the health services council, and in accordance with 20 |
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| 324 | 324 | | the Administrative Procedures Act, chapter 35 of title 42, after public hearing pursuant to 21 |
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| 325 | 325 | | reasonable notice, which notice shall include affected persons, shall promulgate appropriate rules 22 |
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| 326 | 326 | | and regulations that may be designated to further the accomplishment of the purposes of this chapter 23 |
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| 327 | 327 | | including the formulation of procedures that may be particularly necessary for the conduct on 24 |
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| 328 | 328 | | reviews of particular types of new institutional health services or new health care equipment. 25 |
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| 329 | 329 | | (b) Review procedures promulgated in accordance with subsection (a) shall include at least 26 |
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| 330 | 330 | | the following, except that substitute procedures for the conduct of expeditious and accelerated 27 |
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| 331 | 331 | | reviews may be promulgated by the state agency in accordance with § 23-15-5: 28 |
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| 332 | 332 | | (1) Provision that the state agency established a process requiring potential applicants to 29 |
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| 333 | 333 | | file a detailed letter of intent to submit an application at least forty-five (45) days prior to the 30 |
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| 334 | 334 | | submission of an application and that the state agency shall undertake reviews in a timely fashion 31 |
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| 335 | 335 | | no less often than twice a year and give written notification to affected persons of the beginning of 32 |
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| 336 | 336 | | the review including the proposed schedule for the review, the period within which a public meeting 33 |
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| 337 | 337 | | may be held, and the manner by which notification will be provided of the time and place of any 34 |
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| 338 | 338 | | |
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| 339 | 339 | | |
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| 340 | 340 | | LC001034 - Page 10 of 15 |
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| 341 | 341 | | public meeting so held. 1 |
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| 342 | 342 | | (2) Provision that no more than one hundred and twenty (120) days shall elapse between 2 |
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| 343 | 343 | | initial notification of affected persons and the final decision of the state agency. 3 |
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| 344 | 344 | | (3) Provision that, if the state agency fails to act upon an application within the applicable 4 |
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| 345 | 345 | | period established in subsection (b)(2), the applicant may apply to the superior court of Providence 5 |
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| 346 | 346 | | County to require the state agency to act upon the application. 6 |
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| 347 | 347 | | (4) Provision for review and comment by the health services council and any affected 7 |
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| 348 | 348 | | person, including but not limited to those parties defined in § 23-15-2(1) and the department of 8 |
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| 349 | 349 | | business regulation, the department of behavioral healthcare, developmental disabilities and 9 |
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| 350 | 350 | | hospitals, the department of human services, health maintenance organizations, and the state 10 |
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| 351 | 351 | | professional standards review organization, on every application for the determination of need. 11 |
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| 352 | 352 | | (5) Provision that a public meeting may be held during the course of the state agency review 12 |
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| 353 | 353 | | at which any person may have the opportunity to present testimony. Procedures for the conduct of 13 |
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| 354 | 354 | | the public meeting shall be established in rules and regulations promulgated by the state agency 14 |
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| 355 | 355 | | with the advice of the health services council. 15 |
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| 356 | 356 | | (6)(i) Provision for issuance of a written decision by the state agency which shall be based 16 |
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| 357 | 357 | | upon the findings and recommendations of the health services council unless the state agency shall 17 |
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| 358 | 358 | | afford written justification for variance from that decision. 18 |
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| 359 | 359 | | (ii) In the case of any proposed new institutional health service for the provision of health 19 |
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| 360 | 360 | | services to inpatients, a state agency shall not make a finding that the proposed new institutional 20 |
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| 361 | 361 | | health service is needed, unless it makes written findings as to: 21 |
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| 362 | 362 | | (A) The efficiency and appropriateness of the use of existing inpatient facilities providing 22 |
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| 363 | 363 | | inpatient services similar to those proposed; 23 |
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| 364 | 364 | | (B) The capital and operating costs (and their potential impact on patient charges), 24 |
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| 365 | 365 | | efficiency, and appropriateness of the proposed new institutional health services; and 25 |
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| 366 | 366 | | (C) Makes each of the following findings in writing: 26 |
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| 367 | 367 | | (I) That superior alternatives to inpatient services in terms of cost, efficiency, and 27 |
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| 368 | 368 | | appropriateness do not exist and that the development of alternatives is not practicable; 28 |
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| 369 | 369 | | (II) That, in the case of new construction, alternatives to new construction (e.g., 29 |
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| 370 | 370 | | modernization or sharing arrangements) have been considered and implemented to the maximum 30 |
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| 371 | 371 | | extent practicable; 31 |
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| 372 | 372 | | (III) That patients will experience serious problems in terms of costs, availability, or 32 |
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| 373 | 373 | | accessibility, or any other problems that may be identified by the state agency, in obtaining inpatient 33 |
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| 374 | 374 | | care of the type proposed in the absence of the proposed new service; and 34 |
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| 375 | 375 | | |
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| 376 | 376 | | |
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| 377 | 377 | | LC001034 - Page 11 of 15 |
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| 378 | 378 | | (IV) That, in the case of a proposal for the addition of beds for the provision of skilled 1 |
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| 379 | 379 | | nursing or intermediate care, the relationship of the addition to the plans of other agencies of the 2 |
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| 380 | 380 | | state responsible for providing and financing long-term care (including home health services) has 3 |
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| 381 | 381 | | been considered. 4 |
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| 382 | 382 | | (7) Provision for the distribution of the decision of the state agency, including its findings 5 |
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| 383 | 383 | | and recommendations, to the applicant and to affected persons. 6 |
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| 384 | 384 | | (8) Provision that the state agency may approve or disapprove in whole or in part any 7 |
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| 385 | 385 | | application as submitted, but that the parties may mutually agree to a modification of any element 8 |
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| 386 | 386 | | of an application as submitted, without requiring resubmission of the application. 9 |
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| 387 | 387 | | (9)(i) Provision that any person affected may request in writing reconsideration of a state 10 |
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| 388 | 388 | | agency decision if the person: 11 |
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| 389 | 389 | | (A) Presents significant relevant information not previously considered by the state agency; 12 |
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| 390 | 390 | | (B) Demonstrates that there have been significant changes in factors or circumstances 13 |
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| 391 | 391 | | relied upon by the state agency in reaching its decision; 14 |
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| 392 | 392 | | (C) Demonstrates that the state agency has materially failed to follow its adopted 15 |
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| 393 | 393 | | procedures in reaching its decision; or 16 |
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| 394 | 394 | | (D) Provides any other basis for reconsideration that the state agency may have determined 17 |
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| 395 | 395 | | by regulation to constitute good cause. 18 |
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| 396 | 396 | | (ii) Procedures for reconsideration shall be established in regulations promulgated by the 19 |
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| 397 | 397 | | state agency with the advice of the health services council. 20 |
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| 398 | 398 | | (10) Provision that upon the request of any affected person, the decision of the state agency 21 |
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| 399 | 399 | | to issue, deny, or withdraw a certificate of need or to grant or deny an exemption shall be 22 |
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| 400 | 400 | | administratively reviewed under an appeals mechanism provided for in the rules and regulations of 23 |
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| 401 | 401 | | the state agency, with the review to be conducted by a hearing officer appointed by the director of 24 |
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| 402 | 402 | | health. The procedures for judicial review shall be in accordance with the provisions of § 42-35-25 |
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| 403 | 403 | | 15. 26 |
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| 404 | 404 | | (c) The state agency shall publish at least annually a report of reviews of new institutional 27 |
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| 405 | 405 | | health services and new health care equipment conducted, together with the findings and decisions 28 |
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| 406 | 406 | | rendered in the course of the reviews. The reports shall be published on or about February 1 of each 29 |
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| 407 | 407 | | year and shall contain evaluations of the prior year’s statutory changes where feasible. 30 |
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| 408 | 408 | | (d) All applications reviewed by the state agency and all written materials pertinent to state 31 |
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| 409 | 409 | | agency review, including minutes of all health services council meetings, shall be accessible to the 32 |
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| 410 | 410 | | public upon request. 33 |
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| 411 | 411 | | (e) In the case or review of proposals by health care facilities who by contractual 34 |
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| 412 | 412 | | |
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| 413 | 413 | | |
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| 414 | 414 | | LC001034 - Page 12 of 15 |
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| 415 | 415 | | agreement, chapter 19 of title 27, or other statute are required to adhere to an annual schedule of 1 |
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| 416 | 416 | | budget or reimbursement determination to which the state is a party, the state budget office, the 2 |
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| 417 | 417 | | office of the health insurance commissioner, and hospital service corporations organized under 3 |
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| 418 | 418 | | chapter 19 of title 27 shall forward to the health services council within forty-five (45) days of the 4 |
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| 419 | 419 | | initiation of the review of the proposals by the health services council under § 23-15-4(f)(1): 5 |
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| 420 | 420 | | (1) A cost impact analysis of each proposal which analysis shall include, but not be limited 6 |
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| 421 | 421 | | to, consideration of increases in operating expenses, per diem rates, health care insurance 7 |
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| 422 | 422 | | premiums, and public expenditures; and 8 |
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| 423 | 423 | | (2) Comments on acceptable interest rates and minimum equity contributions and/or 9 |
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| 424 | 424 | | maximum debt to be incurred in financing needed proposals. 10 |
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| 425 | 425 | | (f) The health services council shall not make a recommendation to the state agency that a 11 |
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| 426 | 426 | | proposal be approved unless it is found that the proposal is affordable to the people of the state. In 12 |
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| 427 | 427 | | determining whether or not a proposal is affordable, the health service council shall consider the 13 |
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| 428 | 428 | | condition of the state’s economy, the statements of authorities and/or parties affected by the 14 |
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| 429 | 429 | | proposals, and any other factors that it may deem appropriate. 15 |
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| 430 | 430 | | 23-15-6.1. Action subsequent to review. 16 |
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| 431 | 431 | | Development of any new institutional health services or new health care equipment 17 |
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| 432 | 432 | | approved by the state agency must be initiated within one year of the date of the approval and may 18 |
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| 433 | 433 | | not exceed the maximum amount of capital expenditures specified in the decision of the state 19 |
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| 434 | 434 | | agency without prior authorization of the state agency. The state agency, with the advice of the 20 |
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| 435 | 435 | | health services council, shall adopt procedures for the review of the applicant’s failure to develop 21 |
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| 436 | 436 | | new institutional health services or new health care equipment within the timeframe and capital 22 |
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| 437 | 437 | | limitation stipulated in this section, and for the withdrawal of approval in the absence of a good 23 |
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| 438 | 438 | | faith effort to meet the stipulated timeframe. 24 |
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| 439 | 439 | | 23-15-7. Health services council. 25 |
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| 440 | 440 | | The health services council, established in accordance with chapter 17 of this title, shall 26 |
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| 441 | 441 | | function as the advisory body to the state agency in discharging the purpose of this chapter. 27 |
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| 442 | 442 | | 23-15-8. Funds for administration. 28 |
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| 443 | 443 | | There is authorized to be appropriated from the state treasury those sums that may be 29 |
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| 444 | 444 | | necessary for the purposes of administering this chapter. 30 |
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| 445 | 445 | | 23-15-9. Severability. 31 |
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| 446 | 446 | | If any provision of this chapter or the application of any provision of this chapter to any 32 |
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| 447 | 447 | | person or circumstances shall be held invalid, the invalidity shall not affect the provisions or 33 |
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| 448 | 448 | | application of this chapter which can be given effect without the invalid provision or application, 34 |
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| 449 | 449 | | |
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| 450 | 450 | | |
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| 451 | 451 | | LC001034 - Page 13 of 15 |
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| 452 | 452 | | and to this end the provisions of the chapter are declared to be severable. 1 |
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| 453 | 453 | | 23-15-10. Application fees. 2 |
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| 454 | 454 | | The state agency shall require that any applicant for certificate of need submit an 3 |
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| 455 | 455 | | application fee prior to requesting any review of matters pursuant to the requirements of this 4 |
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| 456 | 456 | | chapter; except that health care facilities owned and operated by the state of Rhode Island shall be 5 |
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| 457 | 457 | | exempt from this application fee requirement. The application fee shall be paid by check made 6 |
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| 458 | 458 | | payable to the general treasurer. Except for applications that propose new or expanded tertiary or 7 |
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| 459 | 459 | | specialty care services as defined in subdivision 23-15-2(10)(vi), submission of any application 8 |
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| 460 | 460 | | filed in accordance with § 23-15-4(d) shall include an application fee of five hundred dollars ($500) 9 |
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| 461 | 461 | | per application plus an amount equal to one quarter of one percent (0.25%) of the total capital 10 |
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| 462 | 462 | | expenditure costs associated with the application. For an application filed in accordance with the 11 |
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| 463 | 463 | | requirements of § 23-15-5 (Expeditious review), the application shall include an application 12 |
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| 464 | 464 | | processing fee of seven hundred and fifty dollars ($750) per application plus an amount equal to 13 |
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| 465 | 465 | | one quarter of one percent (0.25%) of the total capital expenditure costs associated with the 14 |
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| 466 | 466 | | application. Applications that propose new or expanded tertiary or specialty care services as defined 15 |
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| 467 | 467 | | in subdivision 23-15-2(10)(vi), shall include an application fee of ten thousand dollars ($10,000) 16 |
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| 468 | 468 | | plus an amount equal to one quarter of one percent (0.25%) of the total capital expenditure costs 17 |
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| 469 | 469 | | associated with the application. Application fees shall be non-refundable. All fees received 18 |
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| 470 | 470 | | pursuant to this chapter shall be deposited in the general fund. 19 |
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| 471 | 471 | | 23-15-11. Reports, use of experts, all costs and expenses. 20 |
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| 472 | 472 | | The state agency may in effectuating the purposes of this chapter engage experts or 21 |
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| 473 | 473 | | consultants including, but not limited to, actuaries, investment bankers, accountants, attorneys, or 22 |
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| 474 | 474 | | industry analysts. Except for privileged or confidential communications between the state agency 23 |
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| 475 | 475 | | and engaged attorneys, all copies of final reports prepared by experts and consultants, and all costs 24 |
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| 476 | 476 | | and expenses associated with the reports, shall be public. All costs and expenses incurred under 25 |
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| 477 | 477 | | this provision shall be the responsibility of the applicant in an amount to be determined by the 26 |
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| 478 | 478 | | director as he or she shall deem appropriate. No application made pursuant to the requirements of 27 |
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| 479 | 479 | | this chapter shall be considered complete unless an agreement has been executed with the director 28 |
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| 480 | 480 | | for the payment of all costs and expenses in accordance with this section. The maximum cost and 29 |
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| 481 | 481 | | expense to an applicant for experts and/or consultants that may be required by the state agency shall 30 |
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| 482 | 482 | | be twenty thousand dollars ($20,000); provided however, that the maximum amount shall be 31 |
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| 483 | 483 | | increased by regulations promulgated by the state agency on or after January 1, 2008 by the most 32 |
|---|
| 484 | 484 | | recently available annual increase in the federal consumer price index as determined by the state 33 |
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| 485 | 485 | | agency. 34 |
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| 486 | 486 | | |
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| 487 | 487 | | |
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| 488 | 488 | | LC001034 - Page 14 of 15 |
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| 489 | 489 | | SECTION 2. This act shall take effect upon passage. 1 |
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| 490 | 490 | | ======== |
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| 491 | 491 | | LC001034 |
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| 492 | 492 | | ======== |
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| 493 | 493 | | |
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| 494 | 494 | | |
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| 495 | 495 | | LC001034 - Page 15 of 15 |
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| 496 | 496 | | EXPLANATION |
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| 497 | 497 | | BY THE LEGISLATIVE COUNCIL |
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| 498 | 498 | | OF |
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| 499 | 499 | | A N A C T |
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| 500 | 500 | | RELATING TO HEALTH AND SAFETY -- DETERMINATION OF NEED FOR NEW |
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| 501 | 501 | | HEALTHCARE EQUIPMENT AND NEW INSTITUTIONAL HEALTH SERVICES |
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| 502 | 502 | | *** |
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| 503 | 503 | | This act would repeal the certificate of need process statutes which are used by the 1 |
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| 504 | 504 | | department of health to determine the need for new health care equipment and new institutional 2 |
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| 505 | 505 | | health services. 3 |
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| 506 | 506 | | This act would take effect upon passage. 4 |
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| 507 | 507 | | ======== |
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| 508 | 508 | | LC001034 |
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| 509 | 509 | | ======== |
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