Section 216-RICR-40-10-17.3 - DefinitionsA. Wherever used in these Rules and Regulations the following terms shall be construed to mean: 1. "Abuse" means: a. Any assault as defined in R.I. Gen. Laws Chapter 11-5, including, but not limited to, hitting, kicking, pinching, slapping, or the pulling of hair; provided, however, unless it is required as an element of the offense charged, it shall not be necessary to prove that the patient or resident was injured by the assault;b. Any assault as defined i n R.I. Gen. Laws Chapter 11-37;c. Any offense unde r R.I. Gen. Laws Chapter 11-10;d. Any conduct which harms or is likely to physically harm the patient or resident except where the conduct is a part of the care and treatment, and in furtherance of the health and safety of the patient or resident;e. Intentionally engaging in a pattern of harassing conduct which causes or is likely to cause emotional or psychological harm to the patient or resident, including but not limited to, ridiculing or demeaning a patient or resident, making derogatory remarks to a patient or resident or cursing directed towards a patient or resident, or threatening to inflict physical or emotional harm on a patient or resident.2. "Administrator" means an individual who:a. Is a licensed physician; or b. Has training and experience in health service administration and at least one (1) year of supervisory or administrative experience in home nursing care or home care or related health programs; orc. Is a registered nurse who meets qualifications of as set forth in 42 C.F.R. Part 484 (2022).3. "Advanced practice registered nurse" or "APRN" means the title given to an individual licensed to practice advanced practice registered nursing with one (1) of the following roles: Certified Nurse Practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA) as defined in R.I. Gen. Laws Chapter 5-34.2, or Certified Clinical Nurse Specialist (CNS) and who functions in a population focus. An APRN may serve as a primary or acute-care provider of record.4. "Attending clinician" means a physician, physician assistant, advanced practice registered nurse, certified nurse midwife, certified midwife, or certified clinical nurse specialist identified by the patient/client/family as having a significant role in the determination and delivery of the individual's medical care.5. "Branch office" means a location from which a licensed home nursing care provider or licensed home care provider provides services within a portion of the total geographic area served by the licensed central office.6. "Change in operator" means a transfer by the governing body or operator of a home nursing care or home care provider to any other person (excluding delegations of authority to the medical or administrative staff of the facility) of the governing body's authority to:a. Hire or fire the Chief Executive Officer of the home nursing care provider or home care provider;b. Maintain and control the books and records of the home nursing care provider or home care provider;c. Dispose of assets and incur liabilities on behalf of the home nursing care provider or home care provider; ord. Adopt and enforce policies regarding operation of the home nursing care provider or home care provider.e. This definition is not applicable to circumstances wherein the governing body of a home nursing care provider or home care provider retains the immediate authority and jurisdiction over the activities enumerated above.7. "Change in owner" means: a. In the case of a home nursing care provider or home care provider which is a partnership, the removal, addition, or substitution of a partner which results in a new partner acquiring a controlling interest in such partnership.b. In the case of a home nursing care provider or home care provider which is an unincorporated solo proprietorship, the transfer of the title and property to another person;c. In the case of a home nursing care provider or home care provider which is a corporation: (1) A sale, lease, exchange or other disposition of all, or substantially all of the property and assets of the corporation; or(2) A merger of the corporation into another corporation; or(3) The consolidation of two (2) or more corporations, resulting in the creation of a new corporation; or(4) In the case of a home nursing care provider or home care provider which is a business corporation, any transfer of corporate stock which results in a new person acquiring a controlling interest in such corporation; or(5) In the case of a home nursing care provider or home care provider which is a non- business corporation, any change in membership which results in a new person acquiring a controlling vote in such corporation.8. "Certified clinical nurse specialist" means an advance practice registered nurse who independently provides care to clients; facilitates attainment of health goals; and provides innovation in nursing practice based on clinical expertise, evidence-based decision making, and leadership skills. The Clinical Nurse Specialist practices with individual clients and populations; nurses and other multidisciplinary team members; and organizations to effect system-wide changes to improve programs of care. The practice may include prescriptive privileges.9. "Certified nurse midwife" means a person who has successfully completed an accredited education program in midwifery, holds a current certification as a nurse-midwife by the American Midwifery Certification Board (AMCB) and is licensed to practice midwifery in Rhode Island.10. "Department" means the Rhode Island Department of Health.11. "Director" means the Director of the Rhode Island Department of Health.12. "Equity" means non-debt funds contributed towards the capital costs related to an initial licensure or change in owner or change in operator of a home nursing care provider or home care provider which funds are free and clear of any repayment or liens against the assets of the proposed owner and/or licensee and that result in a like reduction in the portion of the capital cost that is required to be financed or mortgaged.13. "Fluency" means the ability to converse freely in a language.14. "Health care facility" means any institutional health service provider, facility or institution, place, building, agency, or portion thereof, whether a partnership or corporation, whether public or private, whether organized for profit or not, used, operated, or engaged in providing health care services, including, but not limited to, hospitals; nursing facilities; home nursing care providers (which shall include skilled nursing services and may also include activities allowed as a home care provider or as a nursing service agency); home care provider (which may include services such as personal care or homemaker services); rehabilitation centers; kidney disease treatment centers; health maintenance organizations; free-standing emergency care facilities and facilities providing surgical treatment to patients not requiring hospitalization (surgi-centers); hospice care and physician office settings providing surgical treatment and podiatry ambulatory-surgery centers providing surgical treatment. The term "health care facility" also includes organized ambulatory care facilities that are not part of a hospital but that are organized and operated to provide health care services to outpatients such as central services facilities serving more than one (1) health care facility or health care provider, treatment centers, diagnostic centers, rehabilitation centers, outpatient clinics, infirmaries and health centers, school-based health centers, and neighborhood health centers; providing, however, that the term "health care facility" shall not apply to organized ambulatory care facilities owned and operated by professional service corporations as defined in R.I. Gen. Laws Chapter 7-5.1 (the "Professional Service Corporation Law"), or to a private practitioner's (physician, dentist, or other health care provider) office or group of practitioners' offices (whether owned and/or operated by an individual practitioner, alone or as a member of a partnership, professional service corporation organization, or association). Facilities licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals and clinical laboratories licensed in accordance with R.I. Gen. Laws Chapter 23-16.2, as well as 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. shall not be considered health care facilities for purposes of this Part.15. "Health care provider" means any person licensed by the State of Rhode Island to provide or otherwise lawfully providing health care services, including, but not limited to, a physician, hospital, intermediate care facility or other health care facility, dentist, nurse, APRN, Certified Clinical Nurse Specialist, physician assistant, optometrist, podiatrist, physical therapist, psychiatric social worker, pharmacist, or psychologist, and any officer, employee or agent of that provider acting in the course and scope of his or her employment or agency related to or supportive of health services.16. "High managerial agent" means an officer of a licensee, the administrator and assistant administrator of the facility, the Director and Assistant Director of Nursing Services, or any other agent in a position of comparable authority with respect to the formulation of policies of the facility or the supervision in a managerial capacity of subordinate employees.17. "Home care provider" means any person that provides, arranges to provide, offers to provide, or in any other way provides for the delivery of any direct health care services in the home requiring supervision by a Registered Nurse (RN), but excludes the delivery of direct nursing care by a Registered (RN) or Licensed Practical (LPN) Nurse on an on-going basis; Also as used in this Part, "home care provider" includes homemaker services as defined in this Part. Nursing service agency services may also be provided under this license provided such services are rendered in accordance with Part 10 of this Subchapter, Licensing Nursing Service Agencies.18. "Home nursing care provider" means any person that provides, arranges to provide, offers to provide, or in any other way provides for the delivery of direct nursing services in the home by a Registered (RN) or licensed Practical (LPN) Nurse or therapeutic services provided by an applicable, licensed healthcare provider. As used in this Part, "home nursing care provider" may include home care provider services. Nursing service agency services may also be provided under this license provided such services are rendered in accordance with Part 10 of this Subchapter, Licensing Nursing Service Agencies.19. "Home health aide" means "nursing assistant."20. "Homemaker" means a trained non-professional worker who performs related housekeeping services in the home for the sick, disabled, dependent or infirm.21. "Homemaker services" means housekeeping services performed in the home for the sick, disabled, dependent, or infirm by a trained non-professional worker who is supervised in accordance with the requirements of § 17.5.3(H)(2) of this Part.22. "Licensing agency" means the Rhode Island Department of Health.23. "Medical services" means such professional services and supplies rendered by or under the direction of persons duly licensed under the laws of the State of Rhode Island to practice medicine or to provide medical and surgical services in collaboration with physicians, or podiatry, or advanced practice nursing as may be specified by any medical service plan. Medical services shall not be construed to include hospital services.24. "Mistreatment" means the inappropriate use of medications, isolation, or use of physical or chemical restraints: b. For staff convenience;c. As a substitute for treatment or care;d. In conflict with a physician's order; ore. In quantities which inhibit effective care or treatment, or which harms or is likely to harm the patient or resident.25. "Neglect" means the intentional failure to provide treatment, care, goods, and services necessary to maintain the health and safety of the patient or resident, or the intentional failure to carry out a plan of treatment or care prescribed by the physician of the patient or resident, or the intentional failure to report patient or resident health problems or changes in health problems or changes in health conditions to an immediate supervisor or nurse, or the intentional lack of attention to the physical needs of a patient or resident including, but not limited to toileting, bathing, meals, and safety. No person shall be considered to be neglected for the sole reason that he or she relies on or is being furnished treatment in accordance with the tenets and teachings of a well-recognized church or denomination by a duly-accredited practitioner of a well-recognized church or denomination.26. "Nursing assistant" means a nurse's aide, or home health aide, who is a paraprofessional, registered, pursuant to the provisions of R.I. Gen. Laws Chapter 23-17.9, and who is trained to give personal care and related health care and assistance based on his/her level of preparation to individuals who are sick, disabled, dependent or infirm, and who are residents of or receive services from health care facilities licensed pursuant t o R.I. Gen. Laws Chapter 23-17, or who are receiving services from agencies licensed pursuant to R.I. Gen. Laws Chapter 23-17.7.1.27. "Patient" means a person who receives home nursing care or home care provider services or who is judged to need home nursing care or home care provider services based upon the results of an initial screening. The terms "patient" and "client" are synonymous in the context of this Part.28. "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.29. "Personal care services" means those services provided to a patient that do not require the skills of a licensed nurse. These services may include, but are not limited to: bathing, dressing, grooming, caring for hair/nails, and assistance with ambulation.30. "Physician" means any individual licensed to practice medicine in Rhode Island.31. "Physician assistant" means a person who is qualified by academic and practical training to provide medical and surgical services in collaboration with physicians and licensed in Rhode Island.32. "Plan of care" or "care plan," means the comprehensive written plan for the patient's care. The plan shall include attending clinician orders for medications, treatments, procedures, or therapeutic services, where indicated; and shall also encompass patient assessments and treatment goals/objectives, including provisions for personal care and social needs. (For further requirements related to the patient's plan of care, see §§ 17.4.4(A)(4) and 17.6.2(C) of this Part.33. "Supervision" means clinical guidance provided by a qualified person for the assessment and monitoring of patient care management.a. Registered Nurses and other appropriate professionals of the health care team, licensed, registered and/or certified as may be required by the laws of Rhode Island, shall supervise (directly or indirectly) Nursing Assistants. A registered nurse shall supervise any acts, functions or tasks performed by a Nursing Assistant that are nursing-related.34. "Therapeutic services", as used in this Part, means those treatments provided by a licensed health care professional that have medicinal or healing properties, such as, but not limited to, infusion, respiratory, occupational, speech, or physical therapy and that are included in the patient's care plan.35. "Uncompensated care" means health care services provided by a home nursing care or home care provider for which the home nursing care or home care provider does not and has not expected payment and which health care services are not recognized as either a receivable or as revenue in the home nursing care or home care provider's financial statements.216 R.I. Code R. 216-RICR-40-10-17.3
Amended effective 3/24/2022
Amended effective 5/6/2024