216 R.I. Code R. 216-RICR-40-10-1.7

Current through November 7, 2024

Section 216-RICR-40-10-1.7 - Issuance and Renewal of License

A. The provisions contained in §§ 1.7(G)(1)(c) and 1.7(G)(2)(a)(1) of this Part shall apply to those applicants whose change in effective control applications are submitted for review on and after October 2, 2023; and those applications for a change in effective control review submitted on and before October 2, 2023 that were not deemed to be complete and not accepted for review by the Department.

B. The licensing agency shall issue a license or renewal thereof for a period of no longer than one (1) year. Said license, unless sooner suspended or revoked, shall expire by limitation on the thirty-first (31st) day of December following its issuance and may be renewed from year to year after inspection, and approval by the licensing agency, provided the applicant meets the appropriate requirements of R.I. Gen. Laws Chapter 23-17 and this Part.

C. A license shall be issued to a specific licensee for a specific location and shall not be transferable. The license shall be issued to the individual owner, operator or lessee, or to the corporate entity responsible for its governance.

1. Any initial licensure or change in owner, operator, or lessee of a licensed nursing facility shall require prior review by the Health Services Council and approval of the licensing agency as provided in §§ 1.7(F) and (G) of this Part as a condition precedent to the transfer, assignment or issuance of a new license.

D. A license issued pursuant to this Part 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.

E. A distinct part of a nursing facility which is designed, maintained and primarily devoted to the provision of residential care and assisted living in accordance with R.I. Gen. Laws Chapter 23-17.4 shall obtain a separate license in accordance with the requirements of R.I. Gen. Laws Chapter 23-17.4 and Part 2 of this Subchapter, Licensing Assisted Living Residences.

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

1. Applicants for a change in effective control of a nursing facility shall submit all required information as contained in the application provided by the licensing agency.

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

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

4. 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.

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

G. Except as otherwise provided in R.I. Gen. Laws Chapter 23-17, a review by the Health Services Council of an application for a license in the case of an initial licensure or a proposed change in the owner, operator, or lessee of a licensed nursing facility may not be made subject to any criterion unless the criterion directly relates to the statutory purpose expressed in R.I. Gen. Laws § 23-17-3. 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 nursing facility as evidenced by:

a. In cases where the proposed owners, operators, or directors of the nursing facility currently own, operate, or direct a nursing facility, or in the past five (5) years owned, operated or directed a nursing 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 nursing facility's services;

(2) In encouraging, promoting and effecting quality improvement in all aspects of nursing facility services; and

(3) In providing appropriate access to nursing 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 nursing facility.

2. The extent to which the nursing 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 individuals receiving the nursing 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 nursing 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 nursing facility will continue to provide safe and adequate treatment for individuals receiving the nursing facility's services and the extent to which the nursing facility will encourage quality improvement in all aspects of the operation of the nursing 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 nursing facility will continue to provide appropriate access with respect to traditionally underserved populations and in consideration of the proposed continuance or termination of health care services by the nursing facility as evidenced by:

a. In cases where the proposed owners, operators, or directors of the nursing facility currently own, operate, or direct a nursing facility, or in the past five (5) years owned, operated or directed a nursing 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 nursing 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 nursing facility;

5. In consideration of the proposed continuation or termination of health care services by the nursing 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 (2) 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.

H. Subsequent to reviews conducted under §§ 1.7(F) and (G) 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 § 1.7(G) 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 nursing facility by the licensing agency.

1.7.1Background and Qualifications of the Applicant or Proposed License Holder

A. For purposes of § 1.7 of this Part, applicants must meet a financial threshold that shall include, as a minimum, that the applicant or proposed license holder shall have sufficient resources to operate the nursing facility at licensed capacity for thirty (30) days, evidenced by an unencumbered line of credit, a joint escrow account established with the licensing agency, or a performance bond secured in favor of the State or a similar form of security satisfactory to the licensing agency.

B. The licensing agency may also require background information to be submitted relating to any partner, officer, director, manager or member (if member managed) of the applicant or proposed license holder, or information relating to each person having a beneficial ownership interest of five percent (5%) or more in the applicant or proposed license holder.

C. In reviewing information required by §§1.7.1(A) and (B) of this Part, the licensing agency may require the applicant or proposed license holder to file a sworn affidavit substantiating the validity of any submitted information as required by the licensing agency to substantiate a satisfactory compliance history relating to each State or other jurisdiction in which the applicant, proposed license holder or any other person described by §§1.7.1(A) and (B) of this Part operated a nursing facility at any time during the five (5) year period preceding the date on which the application is made. The licensing agency shall determine what constitutes a satisfactory compliance history.

D. The licensing agency may also require the applicant or proposed license holder to file information relating to the current financial condition of the applicant, proposed license holder or any other person described by §§1.7.1(A) and (B) of this Part and the history of the financial condition of the applicant, proposed license holder or any other person described by §§1.7.1(A) and (B) of this Part with respect to a nursing facility operated in another State or jurisdiction at any time during the five (5) year period preceding the date on which the application is made.

E. In addition to the information required to be provided in §§1.7.1(A) through (D) of this Part, the licensing agency shall gather information from State departments and agencies relating to the background and qualifications of the applicant, proposed license holder, or any person having a five percent (5%) or more beneficial ownership interest.

F. Notwithstanding any other provision of the law to the contrary, a nursing facility may take out of service any or all beds of its licensed capacity without impediment to its right to place back into service such beds at a future date under the same terms and conditions as applied at the time of taking them out of service.

1. "Take out of service," as used in §1.7.1(F) of this Part, shall be referred to as "beds on hold" and means an action by a nursing facility to leave a bed(s) unutilized as a nursing facility bed for a specified period of time. Specified periods of time shall be in six (6) month increments, at a minimum.

2. The nursing facility shall inform the licensing agency in writing no less than ten (10) days prior to placing beds on hold and shall describe the alteration of physical space (if any) resulting from taking such bed(s) out of service.

3. Beds on hold and out of service shall reduce a nursing facility's licensed bed capacity by the number of beds on hold.

4. Bed(s) on hold will not automatically be returned to service at the expiration of the specified time-period. Nursing facilities shall request, in writing, that the beds be re-licensed. The request will be reviewed and must be approved for licensure before the nursing facility beds can be occupied.

5. If applicable, the nursing facility shall attest, as part of annual renewal of the nursing facility's license, to their intent to maintain their current number of bed(s) on hold into the next licensing period.

1.7.2Additional Information Required of all Nursing Facilities

A. Notwithstanding any other provision of the law to the contrary, including any moratorium, any nursing facility applying for initial licensure or renewal of its license that contracts with a management company to assist with the nursing facility's operation shall file a copy of the management contract with the licensing agency including the management fee and, if the management company is a corporation or limited liability company, shall identify every person having an ownership interest of five percent (5%) or more in such corporation or limited liability company and, if the management company is a general partnership or limited partnership, shall identify all general or limited partners of such general partnership or limited partnership.

1. Any nursing facility planning to contract with a management company or change management companies during the license period shall notify the licensing agency in writing thirty (30) days prior to the implementation date of the contract and provide documentation of information as outlined in §1.7.2 of this Part. The Department has authority to reject management agreements for failure to comply with nursing home regulations.

2. Any nursing facility with any significant changes in its management contract shall submit a copy of the revised management contract to the licensing agency within thirty (30) days of the effective date of the new contract provisions.

3. Any nursing facility, that fails to comply with the provisions of §1.7.2 of this Part shall be subject to suspension or revocation of its license or curtailment of its activities in accordance with R.I. Gen. Laws §§ 23-17-8 and 23-17-8.1 and the regulations promulgated pursuant thereto.

4. Any nursing facility, licensee, operator or manager that fails to comply with the provisions of this §1.7.2 of this Part shall be subject to civil penalties in accordance with R.I. Gen. Laws § 23-17-17. Civil penalties may be issued in addition to other disciplinary action provided for under these regulations.

216 R.I. Code R. 216-RICR-40-10-1.7

Amended effective 7/3/2022
Amended effective 8/25/2022
Amended effective 10/2/2023, exp. 1/30/2024(Emergency)
Amended effective 3/7/2024