216-40-10 R.I. Code R. § 3.4

Current through June 12, 2024

Section 216-RICR-40-10-3.4 - Licensing Procedures

3.4.1General Requirements for Licensure

A. No person or governmental unit acting severally or jointly with any other person or governmental unit shall conduct, maintain or operate or hold itself out as an OACF in Rhode Island without a license in accordance with the requirements of R.I. Gen. Laws § 23-17-4, and shall meet the requirements of this Part.

1. Notwithstanding the requirements of §3.4.1 of this Part, a health care facility licensed as an OACF in Rhode Island, may provide services at other locations (premises) operated by that licensed OACF, without the requirement of a separate OACF license for such other locations.

2. Each premises proposed for addition to an OACF license pursuant to §3.4.1(A)(1) of this Part shall be approved by the Department prior to the inclusion of that premises on the OACF license and commencement of operations at that location.

B. Each premise of a licensed OACF shall comply with all pertinent provisions of this Part consistent with the scope of services provided at such premise.

C. Any initial licensure or any change in owner, operator, or lessee of a licensed OACF shall require prior review by the Health Services Council and approval of the Department as provided in §§3.4.5(A) and (B) of this Part, or for expedited reviews conducted pursuant to §§3.4.5(E) and (F) of this Part, as a condition precedent to the transfer, assignment or issuance of a new license.

D. Any OACF that utilizes latex gloves shall do so in accordance with the provisions of rules and regulations pertaining to the Use of Latex Gloves by Health Care Workers, in Licensed Health Care Facilities, and by Other Persons, Firms, or Corporations Licensed or Registered by the Department (Part 20-15-3 of this Title).

E. Each OACF shall establish and maintain a health care facility specific electronic mail address (i.e., e-mail address) to be provided to the Department for the purposes of contacting the OACF with both routine communications and emergency notices. The OACF shall be responsible for providing notice to the Department at any time that the OACF's specific electronic mail address is changed or updated.

3.4.2Application for License

A. Application for Initial License

1. Application for an initial license to conduct, maintain or operate an OACF shall be made to the Department upon forms provided by it, and shall contain such information as the Department reasonably requires, including but not limited to, evidence of ability to comply with the provisions of R.I. Gen. Laws Chapter 23-17 and this Part.

2. Application to add a premises to an existing OACF license, pursuant to §3.4.1(A)(1) of this Part, shall be made to the Department upon forms provided by it, and shall contain such information as the Department reasonably requires, including but not limited to, evidence of ability to comply with the provisions of the Act and this Part.

3. Licenses will expire at the end of each calendar year unless a renewal application is completed prior to the expiration date. Renewal applications are completed electronically on the Department web site and will be available for on-line renewal sixty (60) days prior to the expiration date.

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) by the OACF or any of the property or assets of the OACF. The list shall also include all officers, directors and other persons or any subsidiary corporation owning stock, if the OACF is organized as a corporation, and all partners if the OACF is organized as a partnership.

3.4.3Issuance and Renewal of License

A. Upon receipt of an application for a license, the Department shall issue a license of renewal thereof 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 this Part. Said license, 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 after inspection, approval and payment of all fees.

1. All applications for licenses shall be accompanied by a non-refundable, non-returnable fee as set forth in the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health (Part 10-05-2 of this Title) provided that not-for-profit entities operating more than one (1) such facility shall be subject to a single annual licensure fee for all such licenses; provided, further, that non-profit charitable community health centers shall be exempt from said fee.

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

C. At least thirty (30) days prior to voluntary cessation of any OACF license, the Department shall be notified and provided with an acceptable plan for orderly closure, which shall include but is not limited to, notification and transfer of patients, transfer, storage or proper disposal of medical records, and notification of the public.

D. A license shall become void and shall be returned to the Department when the OACF ceases delivering patient care.

3.4.4Application for Initial Licensure or Changes in Owner, Operator, or Lessee

A. Application for review for initial licensure or changes in the owner, operator, or lessee of an OACF shall be made on forms provided by the Department 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 §3.4.5(B) of this Part. Three (3) paper copies and one electronic copy (as a single pdf file) 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 the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health (Part 10-05-2 of this Title).

3.4.5Initial Licensure and Change in Owner, Operator, or Lessee Review

A. Except for expedited reviews conducted pursuant to §§3.4.5(E) and (F) of this Part, reviews of applications for initial licensure or for changes in the owner, operator, or lessee of licensed OACF's shall be conducted according to the following procedures:

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

2. The decision of the Department will be rendered within ninety (90) days from acceptance of the application.

3. The decision of the Department shall be based upon the findings and recommendations of the Health Services Council unless the Department shall afford written justification for variance therefrom.

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

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

a. In cases where the proposed owners, operators, or directors of the OACF 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 for traditionally underserved populations, which include but are not limited to Medical Assistance beneficiaries and uninsured and underinsured populations;

b. A complete disclosure of all individuals and entities comprising the applicant; and

c. The applicant's proposed and demonstrated financial commitment to the OACF.

2. The extent to which the OACF 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 OACF'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 OACF;

(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 facility will provide or will continue to provide safe and adequate treatment for individuals receiving the OACF's services and the extent to which the OACF will encourage quality improvement in all aspects of the operation of the OACF 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 facility 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 OACF 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, which include but are not limited to Medical Assistance beneficiaries and uninsured and underinsured 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 OACF for traditionally underserved populations, which include but are not limited to Medical Assistance beneficiaries and uninsured and underinsured populations.

5. In consideration of the proposed continuation or termination of primary care and/or other core health care services by the OACF:

a. The effect(s) of such continuation or termination on the provision of access to safe and adequate treatment of individuals, including but not limited 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 §§3.4.5(A), (B), (E), and (F) of this Part, the issuance of a license by the Department 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 §3.4.5(B) of this Part. This shall not limit the authority of the Department to require correction of conditions or defects which existed prior to the proposed change in owner, operator, or lessee and of which notice had been given to the OACF by the Department.

D. A license issued under 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. Applicants for initial licensure may, at the sole discretion of the Department, be reviewed under expedited review procedures established in §3.4.5(F) of this Part if the Department determines:

1. That the legal entity seeking licensure is the licensee for one or more health care facilities licensed in Rhode Island pursuant to the provisions of R.I. Gen. Laws Chapter 23-17 whose records of compliance with licensure standards and requirements are deemed by the Department to demonstrate the legal entity's ability and commitment to provide quality health services; and

2. That the licensure application demonstrates complete and satisfactory compliance with the review criteria set forth in §3.4.5(B) of this Part.

F. Expedited reviews of applications for initial licensure of OACFs shall be conducted according to the following procedures:

1. Within ten (10) working days of receipt, in acceptable form, of an application for initial licensure the Department will determine if such application will be granted expedited review and the Department will notify the public of the Department's initial assessment of the application materials with respect to the review criteria in §3.4.5(B) of this Part as well as the Department's intent to afford the application expedited review. At the same time the Department will afford the public a twenty (20) day period during which the public may review and comment on the application and the Department's initial assessment of the application materials and the proposal to afford the application expedited review.

2. Written objections from affected parties directed to the processing under the expedited procedures and/or the satisfaction of the review criteria shall be accepted during the twenty (20) day comment period. Objections must provide clear, substantial and unequivocal rationale as to why the application does not satisfy the review criteria and/or why the application ought not to be processed under the expedited review mechanism. The Department may propose a preliminary report on such application provided such proposed report incorporates findings relative to the review criteria set forth in §3.4.5(B) of this Part. The Health Services Council may consider such proposed report and may provide its advisory to the Director by adopting such report in amended or unamended form. The Health Services Council, however, is not bound to recommend to the Director that the application be process under the provisions for expedited review as delineated in §§3.4.5(E) and (F) of this Part. The Health Services Council shall take under advisement all objections both to the merits of the application and to the proposed expedited processing of the proposed application and shall make a recommendation to the Director regarding each. Should the Health Services Council not recommend to the Director that the application be processed under expedited review procedures as initially proposed, such application may continue to be processed consistent with the time frames and procedures for applications not recommended for expedited review. If expedited review is not granted, then the comment period may be forthwith extended consistent with the time frames in §3.4.5(A) of this Part for applications not proposed for expedited review. The Director, with the advice of the Health Services Council, shall make the final decision either to grant or to deny expedited review and shall make the final decision to grant or to deny the application on the merits within the expedited review mechanism and time frames. The final decision either to grant or to deny expedited review cannot be appealed.

3.4.6Inspections

A. The Department shall make or cause to be made such inspections and investigations as it deems necessary, including health care records, in accordance with R.I. Gen. Laws § 23-17-10 and this Part.

B. A duly authorized representative of the Department shall have the right to enter at any time without prior notice to inspect the entire premises and services, including all records of any OACF for which an application has been received or for which a license has been issued. Any application shall constitute permission for and willingness to comply with such inspections.

C. Refusal to permit inspections shall constitute a valid ground for license revocation.

D. Every OACF shall be given notice within fifteen (15) business days by the Department of any deficiencies reported as a result of an inspection or investigation.

E. Written reports and recommendations of inspections and inspection logs or journals shall be maintained on file in each OACF for a period of no less than three (3) years.

3.4.7Denial, Suspension, Revocation of License or Curtailment of Activities

A. The Department is authorized to deny, suspend or revoke the license of or to curtail the activities of any OACF which:

1. Has failed to comply with this Part; and

2. Has failed to comply with the provisions of R.I. Gen Laws Chapter 23-17.

3. Reports of deficiencies noted in inspections conducted in accordance with §3.4.6 of this Part shall be maintained on file in the Department, and shall be considered by the Department in rendering determinations to deny, suspend or revoke the license or to curtail activities of an OACF.

B. Whenever an action shall be proposed to deny, suspend or revoke the license of or to curtail the activities of an OACF, the Department shall notify the OACF 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 pursuant to the provisions of §3.8.1 of this Part.

1. However, if the Department finds that public health, safety or welfare imperatively requires emergency action and incorporates a finding to that effect in its order, the Department may order summary suspension of license or curtailment of activities pending proceedings for revocation or other action in accordance with R.I. Gen. Laws §§ 23-1-21 and 42-35-14(c).

C. The appropriate state and federal agencies shall be notified of any action taken by the Department pertaining to either denial, suspension, or revocation of license or curtailment of activities of any OACF.

216 R.I. Code R. § 216-RICR-40-10-3.4