§ 23-15-2. Definitions.
As used in this chapter:
(1) "Affected person� means and includes the person whose proposal is being reviewed,
or the applicant, healthcare facilities located within the state that provide institutional
health services, the state medical society, the state osteopathic society, those voluntary
nonprofit area-wide planning agencies that may be established in the state, the state
budget office, the office of health insurance commissioner, any hospital or medical
service corporation organized under the laws of the state, the statewide health coordinating
council, contiguous health-systems agencies, and those members of the public who are
to be served by the proposed, new institutional health services or new healthcare
equipment.
(2) "Cost-impact analysis� means a written analysis of the effect that a proposal to offer
or develop new institutional health services or new healthcare equipment, if approved,
will have on healthcare costs and shall include any detail that may be prescribed
by the state agency in rules and regulations.
(3) "Director� means the director of the Rhode Island state department of health.
(4)(i) "Healthcare facility� means any institutional health-service provider, facility or
institution, place, building, agency, or portion of them, whether a partnership or
corporation, whether public or private, whether organized for profit or not, used,
operated, or engaged in providing healthcare services that are limited to hospitals,
nursing facilities, home nursing-care provider, home-care provider, hospice provider,
inpatient rehabilitation centers (including drug and/or alcohol abuse treatment centers),
freestanding emergency-care facilities as defined in § 23-17-2, certain facilities providing surgical treatment to patients not requiring hospitalization
(surgi-centers, multi-practice, physician ambulatory-surgery centers and multi-practice,
podiatry ambulatory-surgery centers), and facilities providing inpatient hospice care.
Single-practice physician or podiatry ambulatory-surgery centers (as defined in § 23-17-2(17), (18), respectively) are exempt from the requirements of chapter 15 of this title;
provided, however, that such exemption shall not apply if a single-practice physician
or podiatry ambulatory-surgery center is established by a medical practice group (as
defined in § 5-37-1) within two (2) years following the formation of such medical practice group, when
such medical practice group is formed by the merger or consolidation of two (2) or
more medical practice groups or the acquisition of one medical practice group by another
medical practice group. Medical spas as defined in chapter 105 of this title are exempt
from the requirements of this chapter. The term "healthcare facility� does not include
Christian Science institutions (also known as Christian Science nursing facilities)
listed and certified by the Commission for Accreditation of Christian Science Nursing
Organizations/Facilities, Inc.
(ii) Any provider of hospice care who provides hospice care without charge shall be exempt
from the provisions of this chapter.
(5) "Healthcare provider� means a person who is a direct provider of healthcare services
(including but not limited to physicians, dentists, nurses, podiatrists, physician
assistants, or nurse practitioners) in that the person's primary current activity
is the provision of healthcare services for persons.
(6) "Health services� means organized program components for preventive, assessment, maintenance,
diagnostic, treatment, and rehabilitative services provided in a healthcare facility.
(7) "Health services council� means the advisory body to the Rhode Island state department
of health established in accordance with chapter 17 of this title, appointed and empowered
as provided to serve as the advisory body to the state agency in its review functions
under this chapter.
(8) "Institutional health services� means health services provided in or through healthcare
facilities and includes the entities in or through that the services are provided.
(9) "New healthcare equipment� means any single piece of medical equipment (and any components
that constitute operational components of the piece of medical equipment) proposed
to be utilized in conjunction with the provision of services to patients or the public,
the capital costs of which would exceed two million two hundred fifty thousand dollars
($2,250,000); provided, however, that the state agency shall exempt from review any
application that proposes one-for-one equipment replacement as defined in regulation.
Further, beginning July 1, 2012, and each July thereafter, the amount shall be adjusted
by the percentage of increase in the consumer price index for all urban consumers
(CPI-U) as published by the United States Department of Labor Statistics as of September
30 of the prior calendar year.
(10) "New institutional health services� means and includes:
(i) Construction, development, or other establishment of a new healthcare facility.
(ii) Any expenditure, except acquisitions of an existing healthcare facility, that will
not result in a change in the services or bed capacity of the healthcare facility
by, or on behalf of, an existing healthcare facility in excess of five million two
hundred fifty thousand dollars ($5,250,000) which is a capital expenditure including
expenditures for predevelopment activities; provided further, beginning July 1, 2012,
and each July thereafter, the amount shall be adjusted by the percentage of increase
in the consumer price index for all urban consumers (CPI-U) as published by the United
States Department of Labor Statistics as of September 30 of the prior calendar year.
(iii) Where a person makes an acquisition by, or on behalf of, a healthcare facility or
health maintenance organization under lease or comparable arrangement or through donation,
which would have required review if the acquisition had been by purchase, the acquisition
shall be deemed a capital expenditure subject to review.
(iv) Any capital expenditure that results in the addition of a health service or that changes
the bed capacity of a healthcare facility with respect to which the expenditure is
made, except that the state agency may exempt from review, by rules and regulations
promulgated for this chapter, any bed reclassifications made to licensed nursing facilities
and annual increases in licensed bed capacities of nursing facilities that do not
exceed the greater of ten (10) beds or ten percent (10%) of facility licensed bed
capacity and for which the related capital expenditure does not exceed two million
dollars ($2,000,000).
(v) Any health service proposed to be offered to patients or the public by a healthcare
facility that was not offered on a regular basis in or through the facility within
the twelve-month (12) period prior to the time the service would be offered, and that
increases operating expenses by more than one million five hundred thousand dollars
($1,500,000), except that the state agency may exempt from review, by rules and regulations
promulgated for this chapter, any health service involving reclassification of bed
capacity made to licensed nursing facilities. Further, beginning July 1, 2012, and
each July thereafter, the amount shall be adjusted by the percentage of increase in
the consumer price index for all urban consumers (CPI-U) as published by the United
States Department of Labor Statistics as of September 30 of the prior calendar year.
(vi) Any new or expanded tertiary or specialty-care service, regardless of capital expense
or operating expense, as defined by and listed in regulation, the list not to exceed
a total of twelve (12) categories of services at any one time and shall include full-body
magnetic resonance imaging and computerized axial tomography; provided, however, that
the state agency shall exempt from review any application that proposes one-for-one
equipment replacement as defined by and listed in regulation. Acquisition of full
body magnetic resonance imaging and computerized axial tomography shall not require
a certificate-of-need review and approval by the state agency if satisfactory evidence
is provided to the state agency that it was acquired for under one million dollars
($1,000,000) on or before January 1, 2010, and was in operation on or before July
1, 2010.
(11) "Person� means any individual, trust or estate, partnership, corporation (including
associations, joint stock companies, and insurance companies), state or political
subdivision, or instrumentality of a state.
(12) "Predevelopment activities� means expenditures for architectural designs, plans, working
drawings, and specifications, site acquisition, professional consultations, preliminary
plans, studies, and surveys made in preparation for the offering of a new, institutional
health service.
(13) "State agency� means the Rhode Island state department of health.
(14) "To develop� means to undertake those activities that, on their completion, will result
in the offering of a new, institutional health service or new healthcare equipment
or the incurring of a financial obligation, in relation to the offering of that service.
(15) "To offer� means to hold oneself out as capable of providing, or as having the means
for the provision of, specified health services or healthcare equipment.