216 R.I. Code R. § 216-RICR-40-10-4.4 - Licensing Procedures

4.4.1 General Requirements for Licensure

A. No person acting severally or jointly with any other person, shall establish, conduct or maintain a hospital in this state without a license in accordance with the requirements of R.I. Gen. Laws § 23-17-4.

B. A certificate of need is required as a precondition to the establishment of a new hospital, and such other activities in accordance with "Rules and Regulations for Determination of Need for New Health Care Equipment and New Institutional Health Services."

C. Each premises and the related operations of a licensed hospital shall be approved by the Department of Health prior to the inclusion of that premises on the hospital license and commencement of operations at that location.

1. The hospital shall have a written lease, contract, or other legal document in place for use of space on premises not owned by the hospital.

D. The hospital shall maintain current accreditation by any organization granted deeming authority by the federal Centers for Medicare and Medicaid Services (CMS).

E. The hospital shall be subject to the provisions of R.I. Gen. Laws Chapter 23-17.17, and the Rules and Regulations Related to the Health Care Quality Program (Part 10-10-7 of this Title) promulgated by the Department. Nothing in these regulations should be construed to be inconsistent with the Rules and Regulations Related to the Health Care Quality Program.

4.4.2 Application for License or Changes in the Owner, Operator, or Lessee

A. Application for a license to conduct, maintain or operate a hospital shall be made to the licensing agency upon forms provided by it one (1) month prior to expiration date of license 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 these regulations.

1. Each application 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).

B. Application for changes in the owner, operator, or lessee of a hospital 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 §4.4.3(E) of this Part. An application for a proposed conversion pursuant to the provisions of R.I. Gen. Laws §23-17.14 shall contain all information required pursuant to R.I. Gen. Laws §23-17.14 as may be determined by the state agency. Further, when review of a proposed change in owner, operator or lessee of a hospital and review of a proposed conversion are both required pursuant to the provisions of R.I. Gen. Laws Chapters 23-17 and 23-17.14, respectively, a conversion application shall be filed with the Department of Health which contains all information required pursuant to R.I. Gen. Laws Chapter 23-17.14 as may be determined by the state agency; and a separate application for a change in effective control shall be filed containing all information required under the provisions of R.I. Gen. Laws Chapter 23-17 and §4.4.2 of this Part. Twenty-five (25) copies of the change in effective control application 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).

4.4.3 Issuance && Renewal of License

A. Upon receipt of an application for a license, the licensing agency shall issue a license or renewal thereof 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 these regulations. Said license, 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 after inspection and approval by the licensing agency.

1. All renewal applications shall be accompanied by a non-refundable, non-returnable annual inspection 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 license shall be issued to a specific licensee for a specific location(s) and shall not be transferable. The license shall be issued only for the premises and the individual owner, operator or lessee, or to the corporate entity responsible for its governance, as identified in the application.

1. Any change in owner, operator, or lessee of a licensed hospital shall require prior advisory review by the Health Services Council and approval of the licensing agency as provided in §§4.4.3(D) through 4.4.3(E) of this Part as a condition precedent to the transfer, assignment or issuance of a new license.

2. Any conversion of a licensed hospital shall require prior approval of the licensing agency as provided in the "Rules and Regulations Pertaining to Hospital Conversions."

3. Any change or addition in premises shall require prior review and approval by the Department of Health and amendment of the hospital license.

C. A license issued hereunder shall be the property of the State of Rhode Island and loaned to such licensee and it shall be kept posted in a conspicuous place on the licensed premises.

D. Reviews of applications for changes in the owner, operator, or lessee of licensed hospitals shall be conducted according to the following procedures:

1. Within ten (10) working days of receipt, in acceptable form, of an application for a license in connection with a change in the owner, operator or lessee of an existing hospital, the licensing agency will notify and afford the public thirty (30) days to comment on such application.

2. The decision of the licensing agency will be rendered within ninety (90) days from acceptance of the application.

3. The Health Services Council shall transmit its advisory to the state agency in writing. The decision of the licensing agency shall be based upon the findings and recommendations of the Health Services Council unless the licensing agency shall afford written justification for variance therefrom.

4. All applications reviewed by the licensing agency and all written materials pertinent to licensing agency review, including minutes of all Health Services Council meetings, shall be accessible to the public upon request.

E. Except as otherwise provided in these regulations, a review by the Health Services Council of an application for a license, in the case of a proposed change in the owner, operator, or lessee of a licensed hospital, 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 hospital 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 facility 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 individual's receiving the facility's 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;

(5) Such other financial indicators as may be requested by the state agency;

3. The extent to which the facility will continue to provide safe and adequate treatment for individuals receiving the facility's 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 facility 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 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 emergency, primary care and/or other core health care services by the facility:

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.

F. Subsequent to reviews conducted under §§4.4.3(D) through 4.4.3(E) of this Part, the issuance of a license by the licensing agency may be made subject to any condition, 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 §4.4.3(E) 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 had been given to the facility by the licensing agency.

G. Any new hospital licensee shall meet the statewide community standard for the provision of charity care as a condition of initial and continued licensure, pursuant to §4.5.2 of this Part.

H. Those entities engaged in a hospital conversion shall be subject to the provisions of the "Rules and Regulations Pertaining to Hospital Conversions" promulgated by the Department. Nothing in these regulations should be construed to be inconsistent with the "Rules and Regulations Pertaining to Hospital Conversions."

4.4.4 Capacity && Classification

A. Each license shall be issued for the specified licensed bed capacity of the hospital. No hospital shall have more inpatients than the number of beds for which it is licensed, except in cases of short term seasonal fluctuations, local epidemics, or multiple casualty emergencies.

1. The number of women in active labor admitted at any point in time to the birth center service shall be no greater than the number of birth rooms in the center.

4.4.5 Inspections

A. The licensing agency shall make, or cause to be made, such inspections and investigations as it deems necessary in accordance with R.I. Gen. Laws § 23-17-10 and these regulations.

B. Every hospital shall be given prompt notice by the licensing agency of all deficiencies reported as a result of an inspection or investigation.

C. Written reports and recommendations of inspections shall be maintained on file in each hospital for a period of no less than three (3) years.

4.4.6 Denial, Suspension, Revocation of License, Curtailment of Activities or Cessation of Operation

A. The licensing agency is authorized to deny, suspend or revoke the license or curtail activities of any hospital which: has failed to comply with the rules and regulations pertaining to licensing of hospitals; and has failed to comply with the provisions of R.I. Gen. Laws Chapter 23-17.

1. Lists of deficiencies noted in inspections conducted in accordance with §4.4.5 of this Part 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 curtail activities of a hospital.

B. Where the licensing agency deems that operation of a hospital results in undue hardship to patients as a result of deficiencies, the licensing agency is authorized to deny licensure to facilities not previously licensed, or to suspend for a stipulated period of time or revoke the license of a hospital already licensed or curtail activities of the hospital.

C. Whenever an action shall be proposed to deny, suspend or revoke a hospital license, or curtail its activities, the licensing agency shall notify the hospital 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.

1. However, if the licensing agency finds that public health, safety, or welfare imperatively 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 §§ 23-1-21 and 42-35-14(c).

D. The appropriate state and federal placement and reimbursement 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.

E. A license shall immediately become void and shall be returned to the licensing agency whenever the hospital ceases delivering patient care.

Notes

216 R.I. Code R. § 216-RICR-40-10-4.4