216-40-10 R.I. Code R. § 11.4

Current through June 12, 2024

Section 216-RICR-40-10-11.4 - Licensure Procedures

11.4.1General 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.

11.4.2Application 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.

11.4.3Issuance 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.

11.4.4Application 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).

11.4.5Change 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.

11.4.6Change 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.

11.4.7Inspections

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.

11.4.8Denial, 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.

216 R.I. Code R. § 216-RICR-40-10-11.4

Amended effective 3/21/2023