health services.

(a) No health care provider or health care facility person shall develop or offer new health

care equipment or new institutional health services in Rhode Island, the magnitude of which

exceeds the limits defined by this chapter, without prior review by the health services council and

approval by the state agency department ; except that review by the health services council may be

waived in the case of expeditious reviews conducted in accordance with § 23-15-5 , and except that

health maintenance organizations which fulfill criteria to be established in rules and regulations

promulgated by the state agency with the advice of the health services council shall be exempted

from the review and approval requirement established in this section upon approval by the state

agency of an application for exemption from the review and approval requirement established in

this section which contain any information that the state agency may require to determine if the

health maintenance organization meets the criteria .

(b) No approval shall be made without an adequate demonstration of need by the applicant

at the time and place and under the circumstances proposed , nor shall the approval be made without

a determination that a proposal for which need has been demonstrated is also affordable by the

people of the state.

(c) No approval of new institutional health services for the provision of health services to

inpatients shall be granted unless the written findings required in accordance with § 23-15-6(b)(6)

are made.

(d) (c) Applications for determination of need shall be filed with the state agency on a date

fixed by the state agency department together with plans and specifications and any other

appropriate data and information that the state agency department shall require by regulation , and

shall be considered in relation to each other no less than once a year . A duplicate copy of each

application together with all supporting documentation shall be kept on file by the state agency

department as a public record.

(e) (d) The health services council shall consider, but shall not be limited to, the following

in conducting reviews and determining need: In its recommendations to the department, the health

services council may assess criteria including, but not limited to, affordability, accessibility,

innovation and quality standards, as further defined in regulations adopted by the department.

(1) The relationship of the proposal to state health plans that may be formulated by the state

agency;

(2) The impact of approval or denial of the proposal on the future viability of the applicant

and of the providers of health services to a significant proportion of the population served or

proposed to be served by the applicant;

(3) The need that the population to be served by the proposed equipment or services has

for the equipment or services;

(4) The availability of alternative, less costly, or more effective methods of providing

services or equipment, including economies or improvements in service that could be derived from

feasible cooperative or shared services;

(5) The immediate and long term financial feasibility of the proposal, as well as the

probable impact of the proposal on the cost of, and charges for, health services of the applicant;

(6) The relationship of the services proposed to be provided to the existing health care

system of the state;

(7) The impact of the proposal on the quality of health care in the state and in the population

area to be served by the applicant;

(8) The availability of funds for capital and operating needs for the provision of the services

or equipment proposed to be offered;

(9) The cost of financing the proposal including the reasonableness of the interest rate, the

period of borrowing, and the equity of the applicant in the proposed new institutional health service

or new equipment;

(10) The relationship, including the organizational relationship of the services or

equipment proposed, to ancillary or support services;

(11) Special needs and circumstances of those entities which provide a substantial portion

of their services or resources, or both, to individuals not residing within the state;

(12) Special needs of entities such as medical and other health professional schools,

multidisciplinary clinics, and specialty centers; also, the special needs for and availability of

osteopathic facilities and services 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 reviewed on the costs of providing

health services by the person proposing the construction project; and

(iii) The proposed availability and use of safe patient handling equipment in the new or

renovated space to be constructed.

(14) Those appropriate considerations that may be established in rules and regulations

promulgated by the state agency with the advice of the health services council;

(15) The potential of the proposal to demonstrate or provide one or more innovative

approaches or methods for attaining a more cost effective and/or efficient health care system;

(16) The relationship of the proposal to the need indicated in any requests for proposals

issued by the state agency;

(17) The input of the community to be served by the proposed equipment and services and

the people of the neighborhoods close to the health care facility who are impacted by the proposal;

(18) The relationship of the proposal to any long-range capital improvement plan of the

health care facility applicant.

(19) Cost impact statements forwarded pursuant to subsection 23-15-6(e).

(f) (e) In conducting its review, the health services council shall perform the following:

(1) Within one hundred and fifteen (115) days after initiating its review, which must be

commenced no later than thirty-one (31) days after the filing of an application, the health services

council shall determine as to each proposal whether the applicant has demonstrated need at the time

and place and under the circumstances proposed, and in doing so may apply the criteria and

standards set forth in subsection (e) of this section; provided however, that a determination of need

shall not alone be sufficient to warrant a recommendation to the state agency that a proposal should

be approved. Make recommendations to the department relative to approval or denial of the new

institutional health services or new healthcare equipment proposed. The director shall render , in

writing, his or her decision within five (5) ten (10) days of the 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 for which a determination of need has been established in

relation to other proposals, 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 relative need 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 services council shall make recommendations

to the state agency relative to approval or denial of the new institutional health services or new

health care equipment proposed; provided that:

(i) The health services council shall recommend approval of only those proposals found to

be affordable in accordance with the provisions of § 23-15-6(f); and

(ii) If the state agency proposes to render a decision that is contrary to the recommendation

of the health services council, the state agency must render its reasons for doing so in writing.

(g) (f) Approval of new institutional health services or new health care equipment by the

state agency department shall be subject to conditions that may be prescribed by rules and

regulations developed by the state agency with the advice of the health services council, but those

conditions must relate to the considerations enumerated in subsection (e) and to considerations that

28 may be established in regulations in accordance with subsection (e)(14). may be subject to

conditions as necessary to promote affordability, accessibility, innovation, and quality standards.

(h) (g) The offering or developing of new institutional health services or health care

equipment by a health care facility without prior review by the health services council and approval

by the state agency department shall be grounds for the imposition of licensure sanctions on the

facility, including denial, suspension, revocation, or curtailment or for imposition of any monetary

fines that may be statutorily permitted by virtue of individual health care facility licensing statutes.

(i) (h) No government agency and no hospital or medical service corporation organized

under the laws of the state shall reimburse any health care facility or health care provider person

for the costs associated with offering or developing new institutional health services or new health

care equipment unless the health care facility or health care provider person has received the

approval of the state agency department in accordance with this chapter. Government agencies and

hospital and medical service corporations organized under the laws of the state shall, during budget

negotiations, hold health care facilities and health care providers accountable to operating

efficiencies claimed or projected in proposals which receive the approval of the state agency in

accordance with this chapter.

(j) (i) In addition, the state agency department shall not make grants to, enter into contracts

with, or recommend approval of the use of federal or state funds by any health care facility or health

care provider person which proceeds with the offering or developing of new institutional health

services or new health care equipment after disapproval by the state agency department .