Section 216-RICR-40-10-22.4 - Review RequirementA. No health care facility or health care provider shall develop or offer new health care equipment as defined in this Part without prior review by the Health Services Council and approval by the state agency.B. No health care facility or health care provider shall develop or offer new institutional health services as defined in this Part without prior review by the Health Services Council and approval by the state agency unless an exemption has been granted under § 22.4(G) of this Part.C. Only proposals for new health care equipment or new institutional health services as defined in this Part which are found by the state agency to be both needed and affordable shall be granted approval by the state agency.D. No health care facility shall develop or offer new institutional health services as defined in this Part if approval for such services has been withdrawn by the state agency in accordance with § 22.16 of this Part.E. No person may incur an obligation for a capital expenditure for a new institutional health service or new health care equipment without obtaining approval for the capital expenditure. An obligation for a capital expenditure is considered to be incurred by or on behalf of a health care facility or health care provider: 1. When a contract, enforceable under Rhode Island law, is entered into by or on behalf of the health care facility or health care provider for the construction, acquisition, lease or financing of a capital asset; or2. When the governing board of a health care facility takes formal action to commit its own funds for a construction project undertaken by the health care facility as its own contractor; or3. In the case of donated property, on the date on which the gift is completed in accordance with Rhode Island law.4. For the purposes of § 22.4(E) of this Part, an obligation for a capital expenditure which is contingent upon issuance of a certificate of need is not incurred until the certificate of need is issued.F. A certificate of need is required as a precondition to licensure of any new health care facility or to the establishment of any additional inpatient health care facility or a surgi-center premises of a health care facility.G. Any provider of hospice care who provides such hospice care without charge shall be exempt from the provisions of the Act.H. When satisfactory evidence is provided to the state agency, certificate of need review and approval shall not be required upon the purchase, sale, transfer or other types of acquisitions of MRI and CT that were in existence in Rhode Island on or before January 1, 2010 and that were in operation in Rhode Island as of July 1, 2010.I. The state agency, upon prior receipt of written notification on the state agency's form, shall exempt from review any application which proposes "one for one equipment replacement" as defined in this Part. An exemption for one for one equipment replacement for MRI and CT shall not require that the MRI or CT had been the subject of a prior certificate of need approval; provided that a request for an exemption must be in writing and contain evidence satisfactory to the state agency that the MRI or CT equipment to be replaced was in existence in Rhode Island on or before January 1, 2010 and in operation in Rhode Island as of July 1, 2010 or had been the subject of a previous one for one equipment exemption.J. Exemptions for domestic medical tourism are pursuant to R.I. Gen. Laws § 23-93-2.K. Exemptions for multi-practice facilities are pursuant to R.I. Gen. Laws § 23-93-3.216 R.I. Code R. § 216-RICR-40-10-22.4