216 R.I. Code R. § 216-RICR-40-10-11.4 - Licensure Procedures
11.4.1
General Requirements for Licensure
A. No person acting alone or jointly with any
other person, shall establish, conduct, or maintain a hospice program in this
state without a license in accordance with the requirements of R.I. Gen. Laws
§
23-17-4 and in accordance with the
rules and regulations of this Part.
1.
However, pursuant to R.I. Gen. Laws §
23-17-2(7), any
provider of hospice care who provides hospice care without charge shall be
exempt from the licensing provisions above, but shall meet applicable standards
of the National Hospice and Palliative Care Organization.
B. A certificate of need is required as a
precondition to licensure of any hospice program, unless exempt under R.I. Gen.
Laws §
23-15-2(4)(ii),
in accordance with the Rules and Regulations Pertaining to Determination of
Need for New Health Care Equipment and New Institutional Health Care
Services.
C. Any change in owner,
operator, or lessee of a licensed hospice program shall require prior review by
the Health Services Council and approval of the licensing agency as provided in
§§11.4.5(A) and (B) of this Part, as a condition precedent to the
transfer, assignment or issuance of a new license.
D. No facility shall hold itself or represent
itself as a hospice program or use the term "hospice" or other similar term in
its advertising, publicity or any other form of communication, unless licensed
as a hospice program in accordance with the provisions herein.
E. A hospice program shall organize, manage,
and administer its hospice care services to attain and maintain the highest
obtainable quality of life for each patient and address issues related to care
at the end of life in a manner consistent with acceptable standards of
practice.
F. Upon notification by
the Department, any licensed hospice program that holds a nursing facility
license shall be issued a new license as a hospice inpatient facility and shall
surrender its nursing facility license to the Department.
G. Each hospice program that maintains a
branch office shall disclose to the licensing agency the location of agency
records (i.e., central office or branch office). At a minimum, all clinical
records shall be maintained at the branch office for those patients served by
the branch office.
11.4.2
Application for License
A.
Application for a license to conduct, maintain or operate a hospice program
shall be made to the licensing agency upon forms provided by the licensing
agency and shall contain such information as the licensing agency reasonably
requires which may include affirmative evidence of ability to comply with the
provisions of R.I. Gen. Laws Chapter
23-17 and the rules and
regulations of this Part.
1. Each application
shall be accompanied by an application fee as set forth in the Rules and
Regulations Pertaining to the Fee Structure for Licensing, Laboratory and
Administrative Services Provided by the Department of Health (Part
10-05-2 of this
Title).
B. A notarized
listing of names and addresses of direct and indirect owners whether
individual, partnership, or corporation with percentages of ownership
designated shall be provided with the application for licensure and shall be
updated annually. The list shall include each owner (in whole or in part) of
any mortgage, deed or trust, note or other obligation secured (in whole or in
part) by the hospice care program or any of the property or assets of the
hospice program.
C. The list shall
also include all officers, directors, and other persons of any subsidiary
corporation owning stock, if the hospice program is organized as a corporation
and all partners if organized as a partnership.
11.4.3
Issuance and Renewal of
License
A. Upon receipt of an
application for a license, the licensing agency shall issue a license for a
period of no more than one (1) year, if the applicant meets the requirements of
R.I. Gen. Laws Chapter
23-17 and the rules and
regulations of this Part. The license issued, unless sooner suspended or
revoked, shall expire by limitation on the 31st day of December following its
issuance and may be renewed from year to year subject to inspection and
approval by the licensing agency.
1. All
renewal applications shall be accompanied by a renewal fee as set forth in the
Rules and Regulations Pertaining to the Fee Structure for Licensing, Laboratory
and Administrative Services Provided by the Department of Health (Part
10-05-2 of this Title).
2. In accordance with R.I. Gen. Laws §
23-17-38, nonprofit hospice
programs with current home nursing care provider licenses shall be exempt from
the annual licensure fee stated herein.
3. Each hospice program that maintains a
branch office shall indicate on the application the location of the central
office as well as the location(s) of the branch office(s).
B. Hospice programs operating under a single
license may establish branch offices under that same single license and such
license shall be maintained and posted in the central office.
C. A license issued shall not be transferable
or assignable except with the written approval of the licensing
agency.
11.4.4
Application for Changes in Owner, Operator, or Lessee
A. Application for review for changes in the
owner, operator, or lessee of a hospice program shall be made on forms provided
by the licensing agency and shall contain but not be limited to information
pertinent to the statutory purpose expressed in R.I. Gen. Laws §
23-17-3 or to the considerations
enumerated in §11.4.5(B) of this Part. Three (3) paper copies and an
electronic copy of such applications are required to be provided.
1. Each application filed pursuant the
provisions of this section shall be accompanied by a non-refundable,
non-returnable application fee, as set forth in the Rules and Regulations
Pertaining to the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health (Part
10-05-2 of this
Title).
11.4.5
Change in Owner, Operator, or Lessee Review
A. Reviews of applications for changes in the
owner, operator, or lessee of a licensed hospice program shall be conducted
according to the procedures stated in R.I. Gen. Laws §
23-17-14.4. The licensing agency
will notify and afford the public thirty (30) days to comment on such
applications.
B. The limits on
licensing criteria are stated in R.I. Gen. Laws §
23-17-14.3. In conducting reviews
of such applications, the Health Services Council shall specifically consider
and it shall be the applicant's burden of proof to demonstrate:
1. The character, commitment, competence, and
standing in the community of the proposed owners, operators or directors of the
hospice program as evidenced by:
a. In cases
where the proposed owners, operators, or directors of the health care facility
currently own, operate, or direct a health care facility, or in the past five
years owned, operated, or directed a health care facility, whether within or
outside Rhode Island, the demonstrated commitment and record of that (those)
person(s):
(1) In providing safe and adequate
treatment to the individuals receiving the health care facility's
services;
(2) In encouraging,
promoting, and effecting quality improvement in all aspects of health care
facility services; and
(3) In
providing appropriate access to health care facility
services;
b. A complete
disclosure of all individuals and entities comprising the applicant;
and
c. The applicant's proposed and
demonstrated financial commitment to the health care
facility.
2. The extent
to which the program will provide or will continue, without material effect on
its viability at the time of change of owner, operator, or lessee, to provide
safe and adequate treatment for individuals receiving the hospice services as
evidenced by:
a. The immediate and long-term
financial feasibility of the proposed financing plan;
(1) The proposed amount and sources of
owner's equity to be provided by the applicant;
(2) The proposed financial plan for operating
and capital expenses and income for the period immediately prior to, during and
after the implementation of the change in owner, operator, or lessee of the
health care facility,
(3) The
relative availability of funds for capital and operating needs,
(4) The applicant's demonstrated financial
capability, and
(5) Such other
financial indicators as may be requested by the state agency.
3. The extent to which
the program will provide or will continue to provide safe and adequate
treatment for individuals receiving the hospice services and the extent to
which the facility will encourage quality improvement in all aspects of the
operation of the health care facility as evidenced by:
a. The applicant's demonstrated record in
providing safe and adequate treatment to individuals receiving services at
facilities owned, operated, or directed by the applicant; and
b. The credibility and demonstrated or
potential effectiveness of the applicant's proposed quality assurance
programs.
4. The extent
to which the program will provide or will continue to provide appropriate
access with respect to traditionally underserved populations as evidenced by:
a. In cases where the proposed owners,
operators, or directors of the health care facility currently own, operate, or
direct a health care facility, or in the past five (5) years owned, operated,
or directed a health care facility, both within and outside of Rhode Island,
the demonstrated record of that person(s) with respect to access of
traditionally underserved populations to its health care facilities;
and
b. The proposed immediate and
long-term plans of the applicant to ensure adequate and appropriate access to
the programs and health care services to be provided by the health care
facility.
5. In
consideration of the proposed continuation or termination of health care
services by the hospice program:
a. The
effect(s) of such continuation or termination on access to safe and adequate
treatment of individuals, including but not limited to traditionally
underserved populations.
6. And, in cases where the application
involves a merger, consolidation or otherwise legal affiliation of two or more
health care facilities, the proposed immediate and long-term plans of such
health care facilities with respect to the health care programs to be offered
and health care services to be provided by such health care facilities as a
result of the merger, consolidation or otherwise legal affiliation.
C. Subsequent to reviews conducted
under §§11.4.5(A), (B), (E), and (F) of this Part, the issuance of a
license by the licensing agency may be made subject to any consideration,
provided that no condition may be made unless it directly relates to the
statutory purpose expressed in R.I. Gen. Laws §
23-17-3 or to the review criteria
set forth in §11.4.5(B) of this Part. This shall not limit the authority
of the licensing agency to require correction of conditions or defects which
existed prior to the proposed change of owner, operator, or lessee and of which
notice has been given to the hospice program by the licensing agency.
D. A license issued hereunder shall be the
property of the state and loaned to such licensee, and it shall be kept posted
in a conspicuous place.
11.4.6
Change of Ownership, Operation
and/or Location
A. When a change of
ownership or operation or location of a hospice program or when discontinuation
or addition of a service(s) is contemplated, the licensing agency shall be
notified in writing.
B. The
Department shall be notified immediately when a licensee/owner determines to
cease operations and close a hospice agency.
1. A meeting shall be conducted between the
Department and the licensee/owner prior to issuance of any closure notification
to patients and the public to ensure there is a formal and comprehensive plan
for an orderly closure.
C. At least sixty (60) days prior to the
proposed closure date the hospice agency shall provide the Department a plan
for orderly closure. This Closure Plan must include, but is not limited to, the
following:
1. Letter of intent and/or
determining factors/justification for the closure (i.e., voluntary, financial),
which must include:
a. Proposed closure
date;
b. Contact information for
the staff member(s) responsible for implementing the closure plan;
and
c. Last day new patients will
be accepted.
2. Detailed
plan and proposed timeline for patient discharge or transition of care to
another licensed agency, including:
a. List of
patients, including patient name, address, phone number, insurer/guarantor, and
contact information for guardian and/or emergency contact;
b. Appointment schedule and acuity/level of
care of each patient receiving services; and
c. Staff scale-down process as appropriate,
given planned transition/reduction of patients/residents.
3. Plan for the retention, storage, and
access to medical records in accordance with R.I. Gen. Laws Chapter
5-37.3 and applicable federal laws,
including:
a. Name and contact information of
agency/company or legally authorized person who will be storing the records and
address where records will be stored.
4. Detailed plan for providing notification
and estimated implementation of notices to the following:
a. Patients, Staff/union, and Public
(1) Patients, their guardians, or relatives
so appointed or elected to be their decision makers must be provided at least
thirty (30) days' notice prior to closure;
b. Medicaid, Medicare, and other third-party
insurers;
c. Accreditation entities
(if applicable); and
d. Other
agencies as required by law.
5. Plan for the removal and/or disposal of
any controlled or non-controlled substances (if applicable).
6. Plan for removal, transfer, or disposal of
clinical/medical equipment and/or oxygen tanks (if applicable).
7. Projected fiscal management plan covering
payroll, benefits, and operations during the closure period, including but not
limited to:
a. Employee retirement plans
currently in effect or under the control of the agency.
D. No implementation of any
discontinuation of the operation of a hospice program shall be in effect
without prior approval of the Department.
E. A license shall immediately become void
and shall be returned to the licensing agency when operation of a hospice
program is discontinued or when any changes in ownership occur in accordance
with the rules and regulations of this Part and R.I. Gen. Laws §
23-17-6.
1. When there is a change in ownership or in
the operation or control of the hospice program, the licensing agency reserves
the right to extend the expiration date of such license, allowing the program
to operate under the same license which applied to the prior license for such
time as shall be required for the processing of a new application or
reassignment of patients, not to exceed six (6) weeks.
11.4.7
Inspections
A. The licensing agency shall make, or cause
to be made, such inspections and investigations, as deemed necessary in
accordance with R.I. Gen. Laws §
23-17-10 and the Rules and
Regulations of this Part.
1. Such inspections
and investigations may include on-site visits to patients, either in their
homes, in the hospital, hospice inpatient facility, or nursing facilities,
provided however, that a signed statement of approval for home visitation has
been obtained by the licensing agency from the
patient/family.
B.
Refusal to permit inspections, other than in-home visits referred to in
§11.4.7(A)(1) of this Part, shall constitute a valid ground for license
denial, suspension, or revocation.
C. Every hospice program shall be given
notice by the licensing agency of all deficiencies reported as a result of an
inspection or investigation.
11.4.8
Denial, Suspension, Revocation
of License or Curtailment of Activities
A. The licensing agency is authorized to
deny, suspend, or revoke the license or curtail activities of any hospice
program which:
1. Has failed to comply with
the Rules and Regulations Pertaining to the Licensing of Hospice Care Programs;
or
2. Has failed to comply with the
provisions of R.I. Gen. Laws Chapter
23-17.
3. Reports of deficiencies shall be
maintained on file in the licensing agency and shall be considered by the
licensing agency in rendering determinations to deny, suspend or revoke the
license or to curtail activities of a hospice program.
B. Whenever an action shall be proposed to
deny, suspend or revoke a license for any hospice program or to curtail its
activities, the licensing agency shall notify the hospice program by certified
mail, setting forth reasons for the proposed action, and the applicant or
licensee shall be given an opportunity for a prompt and fair hearing in
accordance with R.I. Gen. Laws §§
23-17-8 and
42-35-9, and in accordance with
the provisions of §11.8.4 of this Part.
1. However, if the licensing agency finds
that public health, safety or welfare of patients requires emergency action and
incorporates a finding to that effect in its order, the licensing agency may
order summary suspension of license or curtailment of activities pending
proceedings for revocation or other action in accordance with R.I. Gen. Laws
§§
42-35-14(c) and
23-1-21.
C. The appropriate state and federal agencies
shall be notified of any action taken by the licensing agency pertaining to
either denial, suspension, or revocation of license, or curtailment of
activities.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.