216 R.I. Code R. 216-RICR-40-10-17.4

Current through December 26, 2024

Section 216-RICR-40-10-17.4 - General Requirements for Licensure and Certificate of Need Requirements

17.4.1General Requirements

A. No person acting alone or jointly with any other person, shall establish, conduct or maintain a home nursing care provider or home care provider in Rhode Island without a license in accordance with the requirements of R.I. Gen. Laws § 23-17-4 and in conformity with this Part. Provided, however, that any person, firm, corporation or other entity which provides volunteer registered and licensed practical nurses to the public shall not be required to have a license as a health care facility.

B. A certificate of need is required as a precondition to the establishment and initial licensure of any home nursing care provider or home care provider and such other activities in accordance with Part 22 of this Subchapter, Determination of Need for New Health Care Equipment and New Institutional Health Care Services.

1. Any certificate of need required as a precondition to the establishment and initial licensure or any change in owner, operator, or lessee of a licensed home nursing care provider or home care provider shall require prior review by the Health Services Council and approval of the licensing agency in accordance with §§ 17.2.2(C) and (E) of this Part, as a condition precedent to the issuance, transfer, or assignment of a new license.

C. No facility shall hold itself or represent itself as a home nursing care provider or home care provider or use the term "home nursing care provider or home care provider", "home health care provider" or other similar term in its advertising, publicity or any other form of communication, unless licensed as a home nursing care provider or home care provider in accordance with the provisions of this Part.

1. Any person establishing, conducting, managing, or operating any home nursing care provider or home care provider without a license shall be fined not more than five thousand dollars ($5,000.00) or imprisoned not more than one (1) year or both, in the discretion of the court, for each offense.

D. Each home nursing care provider or home care provider that maintains a branch office shall disclose to the licensing agency the location of their records (i.e., central office or branch office). At a minimum, all clinical records shall be maintained at the branch office for those patients served by the branch office.

E. Financial Interest Disclosure

1. Any health care facility licensed pursuant to R.I. Gen. Laws Chapter 23-17 which refers clients/patients to another such licensed health care facility or to a residential care/assisted living facility licensed pursuant to R.I. Gen. Laws Chapter 23-17.4, or to a certified adult day care program in which the referring entity has a financial interest shall, at the time a referral is made, disclose in writing the following information to the client/patient:

a. That the referring entity has a financial interest in the facility or provider to which the referral is being made;

b. That the patient/client has the option of seeking care from a different facility or provider which is also licensed and/or certified by the State to provide similar services to the patient/client.

2. The referring entity shall also offer the patient/client a written list prepared by the Department of all such alternative licensed and/or certified facilities or providers. Said written list may be obtained by contacting:

Rhode Island Department of Health Center for Health Facilities Regulation (CHFR)

Capitol Hill, Room 306

Providence, RI 02908

F. Non-compliance with §§ 17.4.1(E)(1) and (2) of this Part shall constitute grounds to revoke, suspend or otherwise discipline the licensee or to deny an application for licensure by the Director, or may result in imposition of an administrative penalty in accordance with R.I. Gen. Laws Chapter 23-17.10.

17.4.2Application for Certificate of Need or Changes in the Owner, Operator, or Lessee

A. Application for a Certificate of Need for a home nursing care provider or home care provider shall be made on forms provided by the licensing agency, and shall contain, but not be limited to. information pertinent to the statutory purpose expressed in R.I. Gen. Laws Chapter 23-15 or to the considerations enumerated in Part 22 of this Subchapter, Determination of Need for New Health Care Equipment and New Institutional Health Care Services.

1. Each application for Certificate of Need filed pursuant the provisions of § 17.4.2 of this Part shall be accompanied by an application fee, made payable to the General Treasurer, State of Rhode Island, in the amount specified in Part 10-05-2 of this Title, Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health.

B. Application for changes in the owner, operator, or lessee of a home nursing care provider or home care provider shall be made on forms provided by the licensing agency 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 § 17.4.3(G) of this Part.

1. Each application for changes in the owner, operator, or lessee filed pursuant the provisions of § 17.4.2 of this Part shall be accompanied by a non-returnable, non-refundable application fee, made payable to the Rhode Island General Treasurer, in Part 10-05-2 of this Title, Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health.

C. Review of an application for Certificate of Need for a home nursing care provider or a home care provider shall be conducted according to the procedures and criteria set forth in Part 22 of this Subchapter, Determination of Need for New Health Care Equipment and New Institutional Health Care Services. Review of an application for changes in the owner, operator, or lessee of licensed home nursing care provider or home care provider 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 home nursing care provider or home care provider, the licensing agency will notify and afford the public thirty (30) days to comment, when practicable, on such application.

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

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

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

D. Except as otherwise provided in R.I. Gen. Laws Chapter 23-17, a review by the Health Services Council on an application for changes in the owner, operator, or lessee of a licensed home nursing care provider or home care provider may not be made subject to any criterion unless the criterion directly relates to the statutory purpose expressed in R.I. Gen. Laws § 23-17-3. In conducting reviews of such an application 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 home nursing care provider or home care provider, including but not limited to the following:

a. In cases where the proposed owners, operators, or directors of the health care facility currently own, operate, or direct a health care facility, or in the past five (5) 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

b. In providing appropriate access to health care facility services;

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

3. The applicant's proposed and demonstrated financial commitment to the health care facility.

4. Any other factors deemed relevant by the Health Services Council and the Director.

E. The extent to which the facility 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 home nursing care provider or home care provider's services, including but not limited to the following:

1. The immediate and long-term financial feasibility of the proposed financing plan;

a. The proposed amount and sources of owner's equity to be provided by the applicant;

b. 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 health care facility;

c. The relative availability of funds for capital and operating needs;

d. The applicant's demonstrated financial capability; and

e. Any other factors deemed relevant by the Health Services Council or the Director.

F. The extent to which the facility will provide or will continue to provide safe and adequate treatment for individuals receiving the home nursing care provider or home care provider's services and the extent to which the facility will encourage quality improvement in all aspects of the operation of the health care facility, including but not limited to the following:

1. The credibility and demonstrated or potential effectiveness of the applicant's proposed quality assurance programs; and

2. Any other factors deemed relevant by the Health Services Council or the Director.

G. The extent to which the facility will provide or will continue to provide appropriate access with respect to traditionally underserved populations, including but not limited to the following:

1. In cases where the proposed owners, operators, or directors of the health care facility 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 to its health care facilities;

a. 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 health care facility; and

b. Any other factors deemed relevant by the Health Services Council or the Director.

H. In consideration of the proposed continuation or termination of emergency, primary care and/or other core health care services by the facility:

1. 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.

2. And in cases where the application involves a merger, consolidation or otherwise legal affiliation of two (2) 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.

17.4.3Application, Issuance and Renewal of License

A. Application for a license to conduct, maintain or operate a home nursing care provider or home care provider shall be made to the licensing agency upon forms provided by it, and shall contain such information as the licensing agency 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.

1. Each application shall be accompanied by a non-returnable, non-refundable application fee, made payable to the Rhode Island General Treasurer, in the amount specified in Part 10-05-2 of this Title, Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health. No additional licensure fee shall be charged when a home nursing care provider or home care provider changes location during any calendar year for which an annual license fee has already been paid for that home nursing care provider or home care provider.

2. Each home nursing care or home care provider that maintains a branch office shall indicate on the application the location of the central office as well as the location(s) of the branch office(s).

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) of any mortgage, deed or trust, note or other obligation secured (in whole or in part) by the home nursing care provider or home care provider or any of the property or assets of the home nursing care provider or home care provider.

1. This list shall also include all officers, directors and other persons of any subsidiary corporation owning stock, if the home nursing care provider or home care provider is organized as a corporation and all partners if the home nursing care provider or home care provider is organized as a partnership.

C. Upon receipt of an application for a home nursing care provider license or a home care provider license, the licensing agency shall issue the applicable license or 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.

1. Home care provider licenses are exempt from the requirements of § 17.8 of this Part.

D. The license issued, unless sooner suspended or revoked, shall expire by limitation on the thirty-first (31st) day of December following its issuance and may be renewed from year to year subject to inspection and approval by the licensing agency.

1. All renewal applications shall be accompanied by a non-returnable, non-refundable renewal fee, made payable to the Rhode Island General Treasurer, in the amount specified in Part 10-05-2 of this Title, Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health.

E. Each license shall be issued only for the premises and persons named in the application and shall not be transferable or assignable except with the written approval of the licensing agency. Home nursing care providers and home care providers operating under a single license may establish branch offices under that same single license and such license shall be maintained and posted in the central office.

F. A license issued pursuant to this Part shall be the property of the State and loaned to such licensee and it shall be kept posted in a conspicuous place on the licensed premises.

G. Subsequent to reviews conducted under §§ 17.4.2(C) and (D) of this Part, the issuance of a license by the licensing agency 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 § 17.4.2(C) of this Part. This shall not limit the authority of the licensing agency to require correction of condition or defects which existed prior to the proposed change of owner, operator, or lessee and of which notice had been given to the facility by the licensing agency.

H. Each home nursing care provider shall meet the statewide community standard for the provision of uncompensated care, established by § 17.4.4 of this Part, as a condition of initial and continued licensure.

17.4.4Statewide Standard for the Provision of Uncompensated Care

A. In accordance with R.I Gen. Laws § 23-17-42, the statewide community standard for uncompensated care shall be one percent (1%) of net patient revenue earned on an annual basis. Uncompensated care shall be cost adjusted by applying a ratio of costs to charges from the licensee's Medicare Cost Report. Licensees not filing Medicare Cost Reports shall submit an audited financial report or such other report as deemed acceptable to the Director.

17.4.5Change of Ownership, Operation and/or Location

A. When a change of ownership or operation or location of a home nursing care provider or home care provider or when discontinuation or addition of a service(s) is contemplated, the licensing agency shall be notified in writing.

B. Sixty (60) days prior to voluntary cessation of any facility license, the Department of Health shall be notified and provided with a plan for orderly closure; notification and transfer of patients; transfer, storage, or proper disposal of medical records; and notification of the public.

C. A license shall immediately become void and shall be returned to the licensing agency when a home nursing care provider or home care provider discontinues services or when any changes in ownership occur in accordance with this Part and R.I. Gen. Laws § 23-17-6.

1. When there is a change in ownership or in the operation or control of the home nursing care provider or home care provider, the licensing agency reserves the right to extend the expiration date of such license, allowing the home nursing care provider or home care provider to operate under the same license which applied to the prior licensee for such time as shall be required for the processing of a new application or reassignment of patients, not to exceed six (6) weeks.

17.4.6Inspections

A. The licensing agency shall make, or cause to be made, such inspections and investigations, including medical records, as deemed necessary in accordance with R.I. Gen. Laws § 23-17-10 and this Part.

B. Refusal to permit inspections shall constitute a valid ground for license denial, suspension or revocation.

C. Every home nursing care provider or home care provider shall be given notice by the licensing agency of all deficiencies reported as a result of an inspection or investigation.

17.4.7Deficiencies and Plans of Correction

A. The licensing agency shall notify the governing body or other legal authority of a facility of violations of individual standards through a notice of deficiencies which shall be forwarded to the facility within fifteen (15) days of inspection of the facility unless the Director determines that immediate action is necessary to protect the health, welfare, or safety of the public or any member thereof through the issuance of an immediate compliance order in accordance with R.I. Gen. Laws § 23-1-21.

B. A facility which received a notice of deficiencies must submit a plan of correction to the licensing agency within fifteen (15) days of the date of the notice of deficiencies. The plan of correction shall detail any requests for variances as well as document the reasons therefor.

C. The licensing agency will be required to approve or reject the plan of correction submitted by a facility in accordance with § 17.4.7(B) of this Part within fifteen (15) days of receipt of the plan of correction.

D. If the licensing agency rejects the plan of correction, or if the facility does not provide a plan of correction within the fifteen (15) day period stipulated in § 17.4.7(C) of this Part, or if a facility whose plan of correction has been approved by the licensing agency fails to execute its plan within a reasonable time, the licensing agency may invoke the sanctions enumerated in § 17.4.8 of this Part. If the facility is aggrieved by the sanctions of the licensing agency, the facility may appeal the decision and request a hearing in accordance with R.I. Gen. Laws Chapter 42-35.

17.4.8Denial, Suspension, Revocation of License or Curtailment of Activities

A. The licensing agency is authorized to deny, suspend or revoke the license or curtail activities of any home nursing care provider or home care provider which:

1. Has failed to comply with the Rules and Regulations pertaining to the licensing of a home nursing care provider or home care provider; or

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

B. Reports of deficiencies shall be maintained on file in the licensing agency and shall be considered by the licensing agency in rendering determinations to deny, suspend or revoke the license or to curtail activities of a home nursing care provider or home care provider.

C. Whenever an action shall be proposed to deny, suspend or revoke a home nursing care provider or home care provider license, or curtail its activities, the licensing agency shall notify the home nursing care provider or home care provider 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 in accordance with the provisions of § 17.9.2 of this Part. However, if the licensing agency finds that public health, safety or welfare of patients requires emergency action and incorporates a finding to that effect in its order, the licensing agency may order summary suspension of license or curtailment of activities pending proceedings for revocation or other action in accordance with R.I. Gen. Laws §§ 42-35-14(c) and 23-1-2.

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

216 R.I. Code R. 216-RICR-40-10-17.4

Amended effective 3/24/2022
Amended effective 5/6/2024