Section 216-RICR-40-10-23.3 - DefinitionsA. Wherever used in these rules and regulations, the terms listed below shall be construed as follows: 1. "Acquiree" means the person or persons which lose(s) any ownership or control in the new hospital, as the terms "new hospital" and "person(s)" are defined within the Act.2. "Acquiror" means the person or persons which gain(s) an ownership or control in the new hospital, as the terms "new hospital" and "person(s)" are defined within the Act.3. "Act" means R.I. Gen. Laws Chapter 23-17.14, entitled "The Hospital Conversions Act."4. "Affected community" means any city or town within the state of Rhode Island wherein an existing hospital is physically located and/or those cities and towns whose inhabitants are regularly served by the existing hospital.5. "Affiliate" means a legal entity as defined in R.I. Gen. Laws § 23-17-2(1).6. "Assets" means cash, cash-equivalents and other hard assets that can be converted into cash, including: cash on hand, savings accounts, checking accounts, Certificates of Deposit (CDs), money market accounts, stocks (common and preferred), bonds, mutual funds, IRAs, 401(k)s, 403(b)s, 457s, cash-in-value of life insurance policies, personal property, motor vehicles other than for personal use, second homes and rental properties. Excluded from assets are a primary residence and a motor vehicle for personal use.7. "Assets protection threshold" means the maximum amount of assets that may be held and still allow the patient/guarantor to be eligible for full charity care. The assets protection threshold shall be $8,000 for singles and $12,000 for family units for 2006 and thereafter increased annually by the most current Consumer Price Index. Provided, however, that in instances in which an individual may be eligible for the state's Medical Assistance Program, a hospital may apply a lower threshold consistent with a threshold utilized by the state's Medical Assistance Program for the purpose of that individual qualifying for the state's Medical Assistance Program(s).8. "Bad debt" means services provided and billed, but reported to be uncollectible, and demonstrated as such in the audited financial statements. Bad debt shall be cost-adjusted by applying a ratio of cost to charges from the hospital's Medicare Cost Reports to the "Provision for Bad Debts" (or equivalent) in the "Statements of Operations" (or equivalent) in the hospital's Audited Financial Statements.9. "Charity care" means health care services provided by a hospital without charge to a patient and for which the hospital does not and has not expected payment. Said health care services shall be rendered to patients determined to be uninsured, underinsured or otherwise deemed to be eligible at the time of delivery of services. Charity care services are those health care services that are not recognized as either a receivable or as revenue in the hospital's financial statements. Charity care shall not include health care services provided to individuals for the purpose of professional courtesy without charge or for reduced charge. Under no circumstances shall bad debt be deemed to be charity care. Charity care shall be cost-adjusted by applying a ratio of cost to charges from the hospital's Medicare Cost Reports to charity care charges-foregone.10. "Community benefit" means the provision of hospital services that meet the ongoing needs of the community for primary and emergency care in a manner that enables families and members of the community to maintain relationships with persons who are hospitalized or are receiving hospital services, and shall also include, but not be limited to, charity care and uncompensated care. Community benefit activities may also include the following: a. Programs, procedures, and protocols that meet the needs of the medically indigent;b. Linkages with community partners that focus on improving the health and well-being of community residents;c. Contribution of non-revenue producing services made available to the community, such as fitness programs, health screenings, or transportation services;d. Public advocacy on behalf of community health needs;e. Scientific, medical research, or educational activities.11. "Conversion" means any transfer by a person or persons of an ownership or membership interest or authority in a hospital, or the assets thereof, whether by purchase, merger, consolidation, lease, gift, joint venture, sale, or other disposition which results in a change of ownership or control or possession of twenty percent (20%) or greater of the members or voting rights or interests of the hospital or of the assets of the hospital or pursuant to which, by virtue of such transfer, a person, together with all persons affiliated with such person, holds or owns, in the aggregate, twenty percent (20%) or greater of the membership or voting rights or interests of the hospital or of the assets of the hospital, or the removal, addition or substitution of a partner which results in a new partner gaining or acquiring a controlling interest in the hospital, or any change in membership which results in a new person gaining or acquiring a controlling vote in the hospital.12. "Department" means the Department of Health.13. "Director" means the Director of the Rhode Island Department of Health.14. "Emergency care" means care provided in situations or circumstances involving the sudden onset of a medical, dental, mental or substance abuse condition manifesting itself by acute symptoms of sufficient severity (e.g., severe pain) where the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, serious impairment to bodily or mental functions, or serious dysfunction of any body organ or part.15. "Equity" means non-debt funds contributed towards the capital costs related to a change in owner or change in operator of a hospital which funds are free and clear of any repayment obligation 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.16. "Essential services" means hospital services that are reasonably required to diagnosis, correct, cure, alleviate, or prevent the worsening of conditions that endanger life or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no other equally effective more conservative or substantially less costly course of treatment available or suitable for the person requesting the service.17. "Existing hospital" means the hospital as it exists prior to the acquisition.18. "Family unit" means a group of two or more persons related by birth, adoption, marriage, or other legal means who either live together or who live apart and are claimed as dependents.19. "Federal poverty levels" or "FPL" mean the poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. § 9902(2).20. "For-profit corporation" means a legal entity formed for the purpose of transacting business which has as any one of its purposes pecuniary profit.21. "Free care" and "no cost care" means charity care.22. "Guarantor" means a person or persons who has accepted or is required to accept responsibility for the patient's hospital bills.23. "Hospital" means a person or governmental entity licensed in accordance with R.I. Gen. Laws Chapter 23-17 to establish, maintain and operate a hospital, for-profit and not-for-profit.24. "Income" means the actual or estimated total annual cash receipts before taxes from: salaries, wages, self-employment income, child care income, rental income, unemployment compensation, temporary disability insurance, child support, alimony, workers' compensation, veterans' benefits, social security payments, dividend and interest income, royalties, private and public pensions, and public assistance. Also included in income are: strike benefits, net lottery and gambling winnings and one-time insurance payments or injury compensation received in the calendar year in which the financial aid is sought for the hospital services.25. "Incumbent" or "Recently incumbent" means those individuals holding the position at the time the application is submitted and any individual who held a similar position within one (1) year prior to the application's acceptance.26. "New hospital" means the hospital as it exists after the completion of a conversion.27. "Not-for-profit corporation" means a legal entity formed for some charitable or benevolent purpose and not-for-profit which has been exempted from taxation pursuant to Internal Revenue Code Section 501(C)(3) [ 26 U.S.C. § 501(c)(3) ].28. "Outpatient care areas" means outpatient clinical space and/or programs for which the hospital charges a facility fee or other hospital billing.29. "Person" means any individual, trust or estate, partnership, corporation (including associations, joint stock companies, and insurance companies), state or political subdivision or instrumentality of the state.30. "Primary care services" means the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. In most instances, primary care is focused on the point at which a patient first seeks assistance from the health care system for non-emergency services. Primary care services include, but are not limited to, such services as family practice, pediatrics, internal medicine, obstetrics/gynecology, and mental health services.31. "Rhode Island resident" means an individual whose primary permanent residence is within the State of Rhode Island, regardless of citizenship or immigration status.32. "State agency" means the Rhode Island Department of Health.33. "Transacting parties" means any person or persons who seeks either to transfer or acquire ownership or a controlling interest or controlling authority in a hospital which would result in a change of ownership, control, or authority of twenty percent (20%) or greater.34. "Uncompensated care" means a combination of free care, which the hospital provides at no cost to the patient, bad debt, which the hospital bills for but does not collect, and less than full Medicaid reimbursement amounts.35. "Uninsured" means those individuals who do not have coverage under private or employer-sponsored health insurance or another government health plan, and who continue to lack such coverage.216 R.I. Code R. § 216-RICR-40-10-23.3