SECTION 1. Section 23-15-2 of the General Laws in Chapter 23-15 entitled "Determination of Need for New Healthcare Equipment and New Institutional Health Services" is hereby amended to read as follows:
23-15-2. Definitions.
As used in this chapter:
(1) “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.
(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.
(3) “Director” means the director of the Rhode Island state department of health.
(4)(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, nursing facilities, home nursing-care provider, home-care provider, hospice provider, inpatient rehabilitation 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 § 23-17-2) 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) “Healthcare provider” means a person who is a direct provider of healthcare services (including but not limited to physicians, dentists, nurses, podiatrists, physician assistants, or nurse practitioners) in that the person’s primary current activity is the provision of healthcare services for persons.
(6) “Health services” means organized program components for preventive, assessment, maintenance, diagnostic, treatment, and rehabilitative services provided in a healthcare facility.
(7) “Health services council” means the advisory body to the Rhode Island state department of health established in accordance with chapter 17 of this title, appointed and empowered as provided to serve as the advisory body to the state agency in its review functions under this chapter.
(8) “Institutional health services” means health services provided in or through healthcare facilities and includes the entities in or through that the services are provided.
(9) “New healthcare equipment” means any single piece of medical equipment (and any LC004048 - Page 2 of 12 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) “New institutional health services” means and includes:
(i) Construction, development, or other establishment of a new healthcare facility.
(ii) Any expenditure, 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 LC004048 - Page 3 of 12 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) Any new or expanded tertiary or specialty-care service, 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) “Person” means any individual, trust or estate, partnership, corporation (including associations, joint stock companies, 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) “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) “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.

SECTION 2. Sections 23-17-2, 23-17-50 and 23-17-57 of the General Laws in Chapter 23- 17 entitled "Licensing of Healthcare Facilities" are hereby amended to read as follows:
23-17-2. Definitions.
As used in this chapter:
(1) “Affiliate” means a legal entity that is in control of, is controlled by, or is in common control with another legal entity.
(2) “Alzheimer’s dementia special-care unit or program” means a distinct living environment within a nursing facility that has been physically adapted to accommodate the particular needs and behaviors of those with dementia. The unit provides increased staffing; LC004048 - Page 4 of 12 therapeutic activities designed specifically for those with dementia; and trains its staff on an ongoing basis on the effective management of the physical and behavioral problems of those with dementia. The residents of the unit/program have had a standard, medical-diagnostic evaluation and have been determined to have a diagnosis of Alzheimer’s dementia or another dementia.
(3) “Certified nurse-teacher” means those personnel certified by the department of elementary and secondary education and employed pursuant to the provisions of §§ 16-21-7 and 16-21-8.
(4)(i) “Change in operator” means a transfer by the governing body or operator of a healthcare facility to any other person (excluding delegations of authority to the medical or administrative staff of the facility) of the governing body’s authority to:
(A) Hire or fire the chief executive officer of the healthcare facility;
(B) Maintain and control the books and records of the healthcare facility;
(C) Dispose of assets and incur liabilities on behalf of the healthcare facility; or
(D) Adopt and enforce policies regarding operation of the healthcare facility.
(ii) This definition is not applicable to circumstances wherein the governing body of a healthcare facility retains the immediate authority and jurisdiction over the activities enumerated in subsections (4)(i)(A) — (4)(i)(D).
(5) “Change in owner” means:
(i) In the case of a healthcare facility that is a partnership, the removal, addition, or substitution of a partner that results in a new partner acquiring a controlling interest in the partnership;
(ii) In the case of a healthcare facility that is an unincorporated, solo proprietorship, the transfer of the title and property to another person;
(iii) In the case of a healthcare facility that is a corporation:
(A) A sale, lease exchange, or other disposition of all, or substantially all, of the property and assets of the corporation; or
(B) A merger of the corporation into another corporation; or
(C) The consolidation or two (2) or more corporations, resulting in the creation of a new corporation; or
(D) In the case of a healthcare facility that is a business corporation, any transfer of corporate stock that results in a new person acquiring a controlling interest in the corporation; or
(E) In the case of a healthcare facility that is a nonbusiness corporation, any change in membership that results in a new person acquiring a controlling vote in the corporation.
(6) “Clinician” means a physician licensed under chapter 37 of title 5; a nurse licensed LC004048 - Page 5 of 12 under chapter 34 of title 5; a psychologist licensed under chapter 44 of title 5; a social worker licensed under chapter 39.1 of title 5; a physical therapist licensed under chapter 40 of title 5; and a speech language pathologist or audiologist licensed under chapter 48 of title 5 or physician assistant licensed under the provisions of chapter 54 of title 5.
(7) “Director” means the director of the Rhode Island state department of health.
(8) “Freestanding emergency-care facility” means an establishment, place, or facility that may be a public or private organization, structurally distinct and separate from a hospital; staffed, equipped, and operated to provide prompt, emergency medical care. For the purposes of this chapter, “emergency medical care” means services provided for a medical condition or behavioral- health condition that is manifested by symptoms of sufficient severity that, in the absence of immediate medical attention, could result in harm to the person or others; serious impairment to bodily functions; serious dysfunction of any bodily organ or part; or development or continuance of severe pain.
(9) “Healthcare facility” means any institutional health-service provider, facility, or institution, place, building, agency, or portion thereof, whether a partnership or corporation, whether public or private, whether organized for profit or not, used, operated, or engaged in providing healthcare services, including, but not limited to: hospitals; nursing facilities; home nursing-care provider (which shall include skilled nursing services and may also include activities allowed as a home-care provider or as a nursing service agency); home-care provider (which may include services such as personal care or homemaker services); rehabilitation centers; kidney disease treatment centers; health maintenance organizations; freestanding emergency-care facilities as defined in this section, and facilities providing surgical treatment to patients not requiring hospitalization (surgi-centers); hospice care; and physician ambulatory-surgery centers and podiatry ambulatory-surgery centers providing surgical treatment. The term “healthcare facility” also includes organized ambulatory-care facilities that are not part of a hospital but that are organized and operated to provide healthcare services to outpatients, such as: central-services facilities serving more than one healthcare facility or healthcare provider; treatment centers; diagnostic centers; outpatient clinics; medical spas as defined in chapter 105 of this title; infirmaries and health centers; school-based health centers, and neighborhood health centers. The term “healthcare facility” also includes a mobile health-screening vehicle as defined in this section. The term “healthcare facility” shall not apply to organized, ambulatory-care facilities owned and operated by professional service corporations as defined in chapter 5.1 of title 7, as amended (the “professional service corporation law”), or to a practitioner’s (physician, dentist, or other healthcare provider) office or group of practitioners’ offices (whether owned and/or operated by a hospital or LC004048 - Page 6 of 12 an affiliate of a hospital or an individual practitioner, alone or as a member of a partnership, professional service corporation, organization, or association); provided, however, notwithstanding any other provision herein or in the general laws, any hospital or any affiliate of a hospital that owns and/or operates a practitioner’s office shall ensure that such practitioner’s office complies with licensing or accreditation requirements that may be applicable to the practitioner’s office. Individual categories of healthcare facilities shall be defined in rules and regulations promulgated by the licensing agency with the advice of the health services council. Rules and regulations concerning hospice care shall be promulgated with regard to the “Standards of a Hospice Program of Care,” promulgated by the National Hospice Organization. Any provider of hospice care who provides hospice care without charge shall be exempt from the licensing provisions of this chapter but shall meet the “Standards of a Hospice Program of Care.” Facilities licensed by the department of behavioral healthcare, developmental disabilities and hospitals and the department of human services, and clinical laboratories licensed in accordance with chapter 16.2 of this title, as well as 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. shall not be considered healthcare facilities for purposes of this chapter.
(10) “Homemaker,” or however else called, means a trained, nonprofessional worker who performs related housekeeping services in the home for the sick, disabled, dependent, or infirm, and as further defined by regulation; the director shall establish criteria for training.
(11) “Hospital” means a person or governmental entity licensed in accordance with this chapter to establish, maintain, and operate a hospital.
(12) “Licensing agency” means the Rhode Island state department of health.
(13) “Major hospital” means a large, comprehensive acute care facility, offering extensive specialized services, advanced technology, emergency capabilities, and significant research and teaching roles.
(13)(14) “Medical services” means any professional services and supplies rendered by, or under the direction of, persons duly licensed under the laws of this state to practice medicine, surgery, or podiatry that may be specified by any medical service plan. Medical service shall not be construed to include hospital services.
(14)(15) “Mobile health-screening vehicle” means a mobile vehicle, van, or trailer that delivers primary and preventive healthcare screening services, and:
(i) Does not maintain active contracts or arrangements with any health insurer subject to regulation under chapter 20 or 42 of title 27; LC004048 - Page 7 of 12
(ii) Does not maintain active contracts or arrangements with another licensed healthcare facility as that term is defined within this section; and
(iii) Does not provide medical services free of charge.
(15)(16) “Non-English speaker” means a person who cannot speak or understand, or has difficulty in speaking or understanding, the English language, because he/she uses only, or primarily, a spoken language other than English, and/or a person who uses a sign language and requires the use of a sign-language interpreter to facilitate communication.
(16)(17) “Person” means any individual, trust or estate, partnership, corporation (including associations, joint stock companies, and insurance companies), state, or political subdivision or instrumentality of a state.
(17)(18) “Physician ambulatory-surgery center” means an office, or portion of an office, that is utilized for the purpose of furnishing surgical services to the owner and/or operator’s own patients on an ambulatory basis, and shall include both single-practice, physician ambulatory- surgery centers and multi-practice, physician ambulatory-surgery centers. A “single-practice, physician ambulatory-surgery center” is a physician ambulatory center owned and/or operated by a physician-controlled professional service corporation as defined in chapter 5.1 of title 7 (the “professional service corporation law”), or a physician-controlled limited liability company (as defined in chapter 16 of title 7 (the “limited liability company act”)) in which no physician is an officer, shareholder, director, or employee of any other corporation engaged in the practice of the same profession, or a private physician’s office (whether owned and/or operated by an individual practitioner, alone or as a member of a partnership, professional service corporation, limited liability company, organization, or association). A “multi-practice, physician ambulatory-surgery center” is a physician ambulatory-surgery center owned and/or operated by a physician-controlled professional service corporation (as defined in the professional service corporation law) or a physician-controlled limited liability company (as defined in the limited liability company act) in which a physician is also an officer, shareholder, director, or employee of another corporation engaged in the practice of the same profession, or a group of physicians’ offices (whether owned and/or operated by an individual practitioner, alone or as a member of a partnership, professional service corporation, limited liability company, organization, or association).
(18)(19) “Podiatry ambulatory-surgery center” means an office or portion of an office that is utilized for the purpose of furnishing surgical services to the owner and/or operator’s own patients on an ambulatory basis, and shall include both single-practice, podiatry ambulatory- surgery centers and multi-practice podiatry ambulatory-surgery centers. A “single-practice podiatry ambulatory-surgery center” is a podiatry ambulatory center owned and/or operated by a podiatrist- LC004048 - Page 8 of 12 controlled professional service corporation (as defined in chapter 5.1 of title 7 (the “professional service corporation law”)), or a podiatrist-controlled limited liability company (as defined in chapter 16 of title 7 (the “limited liability company act”)) in which no podiatrist is an officer, shareholder, director, or employee of any other corporation engaged in the practice of the same profession, or a private podiatrist’s office (whether owned and/or operated by an individual practitioner, alone or as a member of a partnership, professional service corporation, limited liability company, organization, or association). A “multi-practice, podiatry ambulatory-surgery center” is a podiatry ambulatory-surgery center owned and/or operated by a podiatrist-controlled professional service corporation (as defined in the professional service corporation law) or a podiatrist-controlled, limited liability company (as defined in the limited liability company act) in which a podiatrist is also an officer, shareholder, director, or employee of another corporation engaged in the practice of the same profession, or a group of podiatrists’ offices (whether owned and/or operated by an individual practitioner, alone or as a member of a partnership, professional service corporation, limited liability company, organization, or association).
(19)(20) “Qualified interpreter” means a person who, through experience and/or training, is able to translate a particular foreign language into English, with the exception of sign-language interpreters who must be licensed in accordance with chapter 71 of title 5.
(20)(21) “Qualified sign-language interpreter” means one who has been licensed in accordance with the provisions of chapter 71 of title 5.
(21)(22) “School-based health center” means a facility located in an elementary or secondary school licensed as a school-based health center that delivers primary and/or preventive healthcare services to individuals to include, but not be limited to, students on site.
23-17-50. Physician ambulatory-surgery center — Accreditation, survey, complaint investigation, and exemptions.
(a) Accreditation from a national organization acceptable to the director may be required, at the discretion of the director, in lieu of an annual survey by the department.
(b) The provisions of subsection (a) shall not limit in any way the prerogatives of the director to inspect any physician ambulatory-surgery center at any reasonable time, whether for purpose of general survey or for complaint investigation. The director has access to all records of the licensed physician ambulatory-surgery center including medical records.
(c) Single practice physician ambulatory-surgery centers as defined in § 23-17-2(17) § 23- 17-2 are exempt from the requirements of chapter 15 of this title.
(d) Single practice physician ambulatory-surgery centers as defined in § 23-17-2(17) § 23- 17-2 are exempt from the provisions of §§ 23-17-14.3 and 23-17-14.4 with respect to initial LC004048 - Page 9 of 12 licensure under this chapter.
23-17-57. Podiatry ambulatory-surgery center — Accreditation, survey, complaint investigation, and exemptions.
(a) Accreditation from a national organization acceptable to the director may be required, at the discretion of the director, in lieu of an annual survey by the department.
(b) The provisions of subsection (a) shall not limit in any way the prerogatives of the director to inspect any podiatry ambulatory-surgery center at any reasonable time, whether for purpose of general survey or for complaint investigation. The director has access to all records of the licensed podiatry ambulatory-surgery center including medical records.
(c) Single practice podiatry ambulatory-surgery centers as defined in § 23-17-2(18) § 23- 17-2 are exempt from the requirements of chapter 15 of this title.
(d) Single practice podiatry ambulatory-surgery centers as defined in § 23-17-2(18) § 23- 17-2 are exempt from the provisions of §§ 23-17-14.3 and 23-17-14.4 with respect to initial licensure under this chapter.

SECTION 3. Chapter 23-17 of the General Laws entitled "Licensing of Healthcare Facilities" is hereby amended by adding thereto the following section:
23-17-9.1. Mandatory conversion of major hospitals to renewable energy.
(a) On and after January 1, 2028 all new construction of a major hospital as defined in §23- 17-2; all renovations and replacements of a value in excess of fifty percent (50%) of a major hospital; and any extension or increase in floor area, number of stories or height of a major hospital within the state, shall not install or use any heating systems that utilizes fossil fuel, natural or propane gas, air or water heating systems, except as provided in subsection (b) of this section.
(b) Notwithstanding the provisions of subsection (a) of this section, systems for emergency back-up power at major hospitals within the state, shall be exempt; provided however, those buildings shall seek to minimize emissions and maximize health and safety for non-back-up systems.
(c) During any inspection of a major hospital by an inspector, building official, or other local official responsible for code enforcement, the inspector or official may inspect for compliance with this section.
(d) The building codes standards committee shall adopt and promulgate all rules and regulations required to implement the purposes of this section. LC004048 - Page 10 of 12

SECTION 4. This act shall take effect upon passage.