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As used in this chapter:
(1) “Accessible or accessibility” means the ability of underserved populations to access
healthcare and as may be further defined in rules and regulations promulgated by the Rhode Island
state department of health
(1) (2) “Affected person” means and includes the person whose proposal is being reviewed,
or the applicant, healthcare facilities located within the state that provide institutional health
services, the state medical society, the state osteopathic society, those voluntary nonprofit area-
wide planning agencies that may be established in the state, the state budget office, the office of
health insurance commissioner, any hospital or medical service corporation organized under the
laws of the state, the statewide health coordinating council, contiguous health-systems agencies,
and those members of the public who are to be served by the proposed, new institutional health
services or new healthcare equipment.
(3) “Affordable” means the relative ability of the people of the state to pay for, or incur,
the cost, resulting from the proposed determination of need and as may be further defined in rules
and regulations promulgated by the Rhode Island state department of health.
(4) “Applicant” means the person who has submitted a request for a certificate of need
review and approval in accordance with this chapter.
(5) “Capital expenditure” means the total non-recurring expenditures for physical
improvements and the acquisition of existing buildings, land, and/or interests in land, including
costs associated therewith in excess of fifty million dollars ($50,000,000) and as may be further
defined in rules and regulations promulgated by the department. Further, beginning on July 1, 2026,
and each July 1 thereafter, the amount of the threshold shall be adjusted by the percentage increase
in the consumer price index for all urban consumers (CPI-U) as published by the United States
Department of Labor Statistics as of September 30 of the prior calendar year. Expenditures related
to electronic health and management information systems shall not be considered capital
expenditures for the purposes of this chapter.
(2) “Cost-impact analysis” means a written analysis of the effect that a proposal to offer or
develop new institutional health services or new healthcare equipment, if approved, will have on
healthcare costs and shall include any detail that may be prescribed by the state agency in rules and
regulations.
(6) "Department" means the Rhode Island department of health.
(3) (7) “Director” means the director of the Rhode Island state department of health.
(4) (8) (i) “Healthcare facility” means any institutional health-service provider, facility or
institution, place, building, agency, or portion of them, whether a partnership or corporation,
whether public or private, whether organized for profit or not, used, operated, or engaged in
providing healthcare services that are limited to hospitals (except with respect to hospitals whose
services are limited exclusively to behavioral health) , nursing facilities, home nursing-care
provider, home-care provider, hospice provider, inpatient rehabilitation hospital centers (including
drug and/or alcohol abuse treatment centers) , freestanding emergency-care facilities as defined in
§ 23-17-2 , certain facilities providing surgical treatment to patients not requiring hospitalization
(surgi-centers, multi-practice, physician ambulatory-surgery centers and multi-practice, podiatry
ambulatory-surgery centers), and facilities providing inpatient hospice care. Single-practice
physician or podiatry ambulatory-surgery centers (as defined in § 23-17-2(17), (18), respectively)
are exempt from the requirements of chapter 15 of this title; provided, however, that such
exemption shall not apply if a single-practice physician or podiatry ambulatory-surgery center is
established by a medical practice group (as defined in § 5-37-1) within two (2) years following the
formation of such medical practice group, when such medical practice group is formed by the
merger or consolidation of two (2) or more medical practice groups or the acquisition of one
medical practice group by another medical practice group. Medical spas as defined in chapter 105
of this title are exempt from the requirements of this chapter. The term “healthcare facility” does
not include Christian Science institutions (also known as Christian Science nursing facilities) listed
and certified by the Commission for Accreditation of Christian Science Nursing
Organizations/Facilities, Inc.
(ii) Any provider of hospice care who provides hospice care without charge shall be exempt
from the provisions of this chapter.
(5) (9) “Healthcare provider” means a person who is a direct provider of healthcare services
(including but not limited to licensed physicians, dentists, nurses, podiatrists, physician assistants,
or nurse practitioners) in that where the person’s primary current activity is the provision of
healthcare services for persons.
(6) (10) “Health services” means organized program components for preventive,
assessment, maintenance, diagnostic, treatment, and rehabilitative services provided in a healthcare
facility.
(7) (11) “Health services council” means the advisory body to the Rhode Island state
department of health established in accordance with chapter 17 of this title 13.1 of title 17 ,
appointed and empowered as provided to serve as the advisory body to the state agency department
in its review functions under this chapter.
(12) "Innovation" means the potential of the proposal to demonstrate or provide one or
more innovative approaches of methods for attaining a more cost effective and/or efficient
healthcare system as may be further defined in rules and regulations promulgated by the
department.
(8) (13) "Institutional health services" means health services provided in or through
healthcare facilities and includes the entities in or through that the which such services are provided.
(9) “New healthcare equipment” means any single piece of medical equipment (and any
components that constitute operational components of the piece of medical equipment) proposed
to be utilized in conjunction with the provision of services to patients or the public, the capital costs
of which would exceed two million two hundred fifty thousand dollars ($2,250,000); provided,
however, that the state agency shall exempt from review any application that proposes one-for-one
equipment replacement as defined in regulation. Further, beginning July 1, 2012, and each July
thereafter, the amount shall be adjusted by the percentage of increase in the consumer price index
for all urban consumers (CPI-U) as published by the United States Department of Labor Statistics
as of September 30 of the prior calendar year.
(10) (14) “New institutional health services” means and includes:
(i) Construction, development, or other establishment of a new healthcare facility.
(ii) Any capital expenditure as defined herein , except acquisitions of an existing healthcare
facility, that will not result in a change in the services or bed capacity of the healthcare facility by,
or on behalf of, an existing healthcare facility in excess of five million two hundred fifty thousand
dollars ($5,250,000) which is a capital expenditure including expenditures for predevelopment
activities; provided further, beginning July 1, 2012, and each July thereafter, the amount shall be
adjusted by the percentage of increase in the consumer price index for all urban consumers (CPI-
U) as published by the United States Department of Labor Statistics as of September 30 of the prior
calendar year .
(iii) Where a person makes an acquisition by, or on behalf of, a healthcare facility or health
maintenance organization under lease or comparable arrangement or through donation, which
would have required review if the acquisition had been by purchase, the acquisition shall be deemed
a capital expenditure subject to review.
(iv) Any capital expenditure that results in the addition of a health service or that changes
the bed capacity of a healthcare facility with respect to which the expenditure is made, except that
the state agency may exempt from review, by rules and regulations promulgated for this chapter,
any bed reclassifications made to licensed nursing facilities and annual increases in licensed bed
capacities of nursing facilities that do not exceed the greater of ten (10) beds or ten percent (10%)
of facility licensed bed capacity and for which the related capital expenditure does not exceed two
million dollars ($2,000,000).
(v) Any health service proposed to be offered to patients or the public by a healthcare
facility that was not offered on a regular basis in or through the facility within the twelve-month
(12) period prior to the time the service would be offered, and that increases operating expenses by
more than one million five hundred thousand dollars ($1,500,000), except that the state agency may
exempt from review, by rules and regulations promulgated for this chapter, any health service
involving reclassification of bed capacity made to licensed nursing facilities. Further, beginning
July 1, 2012, and each July thereafter, the amount shall be adjusted by the percentage of increase
in the consumer price index for all urban consumers (CPI-U) as published by the United States
Department of Labor Statistics as of September 30 of the prior calendar year.
(vi) (iv) Any new or expanded tertiary or specialty-care service in the following areas:
cardiac catheterization, open heart surgery, organ transplantation, particle accelerator-based
radiation therapy, and neonatal intensive care services. , regardless of capital expense or operating
expense, as defined by and listed in regulation, the list not to exceed a total of twelve (12) categories
of services at any one time and shall include full-body magnetic resonance imaging and
computerized axial tomography; provided, however, that the state agency shall exempt from review
any application that proposes one-for-one equipment replacement as defined by and listed in
regulation. Acquisition of full body magnetic resonance imaging and computerized axial
tomography shall not require a certificate-of-need review and approval by the state agency if
satisfactory evidence is provided to the state agency that it was acquired for under one million
dollars ($1,000,000) on or before January 1, 2010, and was in operation on or before July 1, 2010.
(11) (15) “Person” means any individual, trust or estate, partnership, corporation (including
associations, joint stock companies, limited liability corporations, and insurance companies), state
or political subdivision, or instrumentality of a state.
(12) “Predevelopment activities” means expenditures for architectural designs, plans,
working drawings, and specifications, site acquisition, professional consultations, preliminary
plans, studies, and surveys made in preparation for the offering of a new, institutional health
service.
(13) “State agency” means the Rhode Island state department of health.
(14) (16) “To develop” means to undertake those activities that, on their completion, will
result in the offering of a new, institutional health service or new healthcare equipment or the
incurring of a financial obligation, in relation to the offering of that service.
(15) (17) “To offer” means to hold oneself out as capable of providing, or as having the
means for the provision of, specified health services or healthcare equipment.