§ 23-15-4 - Review and approval of new health care equipment and new institutional health services.
SECTION 23-15-4
§ 23-15-4 Review and approval of newhealth care equipment and new institutional health services. – (a) No health care provider or health care facility shall develop or offer newhealth care equipment or new institutional health services in Rhode Island, themagnitude of which exceeds the limits defined by this chapter, without priorreview by the health services council and approval by the state agency; exceptthat review by the health services council may be waived in the case ofexpeditious reviews conducted in accordance with § 23-15-5, and exceptthat health maintenance organizations which fulfill criteria to be establishedin rules and regulations promulgated by the state agency with the advice of thehealth services council shall be exempted from the review and approvalrequirement established in this section upon approval by the state agency of anapplication for exemption from the review and approval requirement establishedin this section which contain any information that the state agency may requireto determine if the health maintenance organization meets the criteria.
(b) No approval shall be made without an adequatedemonstration of need by the applicant at the time and place and under thecircumstances proposed, nor shall the approval be made without a determinationthat a proposal for which need has been demonstrated is also affordable by thepeople of the state.
(c) No approval of new institutional health services for theprovision of health services to inpatients shall be granted unless the writtenfindings required in accordance with § 23-15-6(b)(6) are made.
(d) Applications for determination of need shall be filedwith the state agency on a date fixed by the state agency together with plansand specifications and any other appropriate data and information that thestate agency shall require by regulation, and shall be considered in relationto each other no less than once a year. A duplicate copy of each applicationtogether with all supporting documentation shall be kept on file by the stateagency as a public record.
(e) The health services council shall consider, but shall notbe limited to, the following in conducting reviews and determining need:
(1) The relationship of the proposal to state health plansthat may be formulated by the state agency;
(2) The impact of approval or denial of the proposal on thefuture viability of the applicant and of the providers of health services to asignificant proportion of the population served or proposed to be served by theapplicant;
(3) The need that the population to be served by the proposedequipment or services has for the equipment or services;
(4) The availability of alternative, less costly, or moreeffective methods of providing services or equipment, including economies orimprovements in service that could be derived from feasible cooperative orshared services;
(5) The immediate and long term financial feasibility of theproposal, as well as the probable impact of the proposal on the cost of, andcharges for, health services of the applicant;
(6) The relationship of the services proposed to be providedto the existing health care system of the state;
(7) The impact of the proposal on the quality of health carein the state and in the population area to be served by the applicant;
(8) The availability of funds for capital and operating needsfor the provision of the services or equipment proposed to be offered;
(9) The cost of financing the proposal including thereasonableness of the interest rate, the period of borrowing, and the equity ofthe applicant in the proposed new institutional health service or new equipment;
(10) The relationship, including the organizationalrelationship of the services or equipment proposed, to ancillary or supportservices;
(11) Special needs and circumstances of those entities whichprovide a substantial portion of their services or resources, or both, toindividuals not residing within the state;
(12) Special needs of entities such as medical and otherhealth professional schools, multidisciplinary clinics, and specialty centers;also, the special needs for and availability of osteopathic facilities andservices within the state;
(13) In the case of a construction project:
(i) The costs and methods of the proposed construction,
(ii) The probable impact of the construction project reviewedon the costs of providing health services by the person proposing theconstruction project; and
(iii) The proposed availability and use of safe patienthandling equipment in the new or renovated space to be constructed.
(14) Those appropriate considerations that may be establishedin rules and regulations promulgated by the state agency with the advice of thehealth services council;
(15) The potential of the proposal to demonstrate or provideone or more innovative approaches or methods for attaining a more costeffective and/or efficient health care system;
(16) The relationship of the proposal to the need indicatedin any requests for proposals issued by the state agency;
(17) The input of the community to be served by the proposedequipment and services and the people of the neighborhoods close to the healthcare facility who are impacted by the proposal;
(18) The relationship of the proposal to any long-rangecapital improvement plan of the health care facility applicant.
(19) Cost impact statements forwarded pursuant to subsection23-15-6(e).
(f) In conducting its review, the health services councilshall perform the following:
(1) Within one hundred and fifteen (115) days afterinitiating its review, which must be commenced no later than thirty-one (31)days after the filing of an application, the health services council shalldetermine as to each proposal whether the applicant has demonstrated need atthe time and place and under the circumstances proposed, and in doing so mayapply the criteria and standards set forth in subsection (e) of this section;provided however, that a determination of need shall not alone be sufficient towarrant a recommendation to the state agency that a proposal should beapproved. The director shall render his or her decision within five (5) days ofthe determination of the health services council.
(2) Prior to the conclusion of its review in accordance with§ 23-15-6(e), the health services council shall evaluate each proposal forwhich a determination of need has been established in relation to otherproposals, comparing proposals with each other, whether similar or not,establishing priorities among the proposals for which need has been determined,and taking into consideration the criteria and standards relating to relativeneed and affordability as set forth in subsection (e) of this section and§ 23-15-6(f).
(3) At the conclusion of its review, the health servicescouncil shall make recommendations to the state agency relative to approval ordenial of the new institutional health services or new health care equipmentproposed; provided that:
(i) The health services council shall recommend approval ofonly those proposals found to be affordable in accordance with the provisionsof § 23-15-6(f); and
(ii) If the state agency proposes to render a decision thatis contrary to the recommendation of the health services council, the stateagency must render its reasons for doing so in writing.
(g) Approval of new institutional health services or newhealth care equipment by the state agency shall be subject to conditions thatmay be prescribed by rules and regulations developed by the state agency withthe advice of the health services council, but those conditions must relate tothe considerations enumerated in subsection (e) and to considerations that maybe established in regulations in accordance with subsection (e)(14).
(h) The offering or developing of new institutional healthservices or health care equipment by a health care facility without priorreview by the health services council and approval by the state agency shall begrounds for the imposition of licensure sanctions on the facility, includingdenial, suspension, revocation, or curtailment or for imposition of anymonetary fines that may be statutorily permitted by virtue of individual healthcare facility licensing statutes.
(i) No government agency and no hospital or medical servicecorporation organized under the laws of the state shall reimburse any healthcare facility or health care provider for the costs associated with offering ordeveloping new institutional health services or new health care equipmentunless the health care facility or health care provider has received theapproval of the state agency in accordance with this chapter. Governmentagencies and hospital and medical service corporations organized under the lawsof the state shall, during budget negotiations, hold health care facilities andhealth care providers accountable to operating efficiencies claimed orprojected in proposals which receive the approval of the state agency inaccordance with this chapter.
(j) In addition, the state agency shall not make grants to,enter into contracts with, or recommend approval of the use of federal or statefunds by any health care facility or health care provider which proceeds withthe offering or developing of new institutional health services or new healthcare equipment after disapproval by the state agency.