Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 40 - Professional licensing and facility regulation › Subchapter 10 - Facility regulation › Part 23 - Hospital Conversions (216-RICR-40-10-23) › Section 216-RICR-40-10-23.3 - Definitions

Current through June 14, 2024
A. Wherever used in these rules and
				  regulations, the terms listed below shall be construed as follows:
1. "Acquiree" means the person or persons
				  which lose(s) any ownership or control in the new hospital, as the terms "new
				  hospital" and "person(s)" are defined within the Act.
2. "Acquiror" means the person or persons
				  which gain(s) an ownership or control in the new hospital, as the terms "new
				  hospital" and "person(s)" are defined within the Act.
3. "Act" means R.I. Gen. Laws Chapter
				  23-17.14, entitled "The Hospital Conversions Act."
4. "Affected community" means any city or
				  town within the state of Rhode Island wherein an existing hospital is
				  physically located and/or those cities and towns whose inhabitants are
				  regularly served by the existing hospital.
5. "Affiliate" means a legal entity as
				  defined in R.I. Gen. Laws §
											23-17-2(1).
6. "Assets" means cash, cash-equivalents and
				  other hard assets that can be converted into cash, including: cash on hand,
				  savings accounts, checking accounts, Certificates of Deposit (CDs), money
				  market accounts, stocks (common and preferred), bonds, mutual funds, IRAs,
				  401(k)s, 403(b)s, 457s, cash-in-value of life insurance policies, personal
				  property, motor vehicles other than for personal use, second homes and rental
				  properties. Excluded from assets are a primary residence and a motor vehicle
				  for personal use.
7. "Assets
				  protection threshold" means the maximum amount of assets that may be held and
				  still allow the patient/guarantor to be eligible for full charity care. The
				  assets protection threshold shall be $8,000 for singles and $12,000 for family
				  units for 2006 and thereafter increased annually by the most current Consumer
				  Price Index. Provided, however, that in instances in which an individual may be
				  eligible for the state's Medical Assistance Program, a hospital may apply a
				  lower threshold consistent with a threshold utilized by the state's Medical
				  Assistance Program for the purpose of that individual qualifying for the
				  state's Medical Assistance Program(s).
8. "Bad debt" means services provided and
				  billed, but reported to be uncollectible, and demonstrated as such in the
				  audited financial statements. Bad debt shall be cost-adjusted by applying a
				  ratio of cost to charges from the hospital's Medicare Cost Reports to the
				  "Provision for Bad Debts" (or equivalent) in the "Statements of Operations" (or
				  equivalent) in the hospital's Audited Financial Statements.
9. "Charity care" means health care services
				  provided by a hospital without charge to a patient and for which the hospital
				  does not and has not expected payment. Said health care services shall be
				  rendered to patients determined to be uninsured, underinsured or otherwise
				  deemed to be eligible at the time of delivery of services. Charity care
				  services are those health care services that are not recognized as either a
				  receivable or as revenue in the hospital's financial statements. Charity care
				  shall not include health care services provided to individuals for the purpose
				  of professional courtesy without charge or for reduced charge. Under no
				  circumstances shall bad debt be deemed to be charity care. Charity care shall
				  be cost-adjusted by applying a ratio of cost to charges from the hospital's
				  Medicare Cost Reports to charity care charges-foregone.
10. "Community benefit" means the provision
				  of hospital services that meet the ongoing needs of the community for primary
				  and emergency care in a manner that enables families and members of the
				  community to maintain relationships with persons who are hospitalized or are
				  receiving hospital services, and shall also include, but not be limited to,
				  charity care and uncompensated care. Community benefit activities may also
				  include the following:
a. Programs,
				  procedures, and protocols that meet the needs of the medically
				  indigent;
b. Linkages with
				  community partners that focus on improving the health and well-being of
				  community residents;
c.
				  Contribution of non-revenue producing services made available to the community,
				  such as fitness programs, health screenings, or transportation
				  services;
d. Public advocacy on
				  behalf of community health needs;
e. Scientific, medical research, or
				  educational activities.
11. "Conversion" means any transfer by a
				  person or persons of an ownership or membership interest or authority in a
				  hospital, or the assets thereof, whether by purchase, merger, consolidation,
				  lease, gift, joint venture, sale, or other disposition which results in a
				  change of ownership or control or possession of twenty percent (20%) or greater
				  of the members or voting rights or interests of the hospital or of the assets
				  of the hospital or pursuant to which, by virtue of such transfer, a person,
				  together with all persons affiliated with such person, holds or owns, in the
				  aggregate, twenty percent (20%) or greater of the membership or voting rights
				  or interests of the hospital or of the assets of the hospital, or the removal,
				  addition or substitution of a partner which results in a new partner gaining or
				  acquiring a controlling interest in the hospital, or any change in membership
				  which results in a new person gaining or acquiring a controlling vote in the
				  hospital.
12. "Department" means
				  the Department of Health.
13.
				  "Director" means the Director of the Rhode Island Department of
				  Health.
14. "Emergency care" means
				  care provided in situations or circumstances involving the sudden onset of a
				  medical, dental, mental or substance abuse condition manifesting itself by
				  acute symptoms of sufficient severity (e.g., severe pain) where the absence of
				  immediate medical attention could reasonably be expected to result in placing
				  the patient's health in serious jeopardy, serious impairment to bodily or
				  mental functions, or serious dysfunction of any body organ or part.
15. "Equity" means non-debt funds contributed
				  towards the capital costs related to a change in owner or change in operator of
				  a hospital which funds are free and clear of any repayment obligation or liens
				  against the assets of the proposed owner and/or licensee and that result in a
				  like reduction in the portion of the capital cost that is required to be
				  financed or mortgaged.
16.
				  "Essential services" means hospital services that are reasonably required to
				  diagnosis, correct, cure, alleviate, or prevent the worsening of conditions
				  that endanger life or cause suffering or pain, or result in illness or
				  infirmity, or threaten to cause or aggravate a handicap, or cause physical
				  deformity or malfunction, and there is no other equally effective more
				  conservative or substantially less costly course of treatment available or
				  suitable for the person requesting the service.
17. "Existing hospital" means the hospital as
				  it exists prior to the acquisition.
18. "Family unit" means a group of two or
				  more persons related by birth, adoption, marriage, or other legal means who
				  either live together or who live apart and are claimed as dependents.
19. "Federal poverty levels" or "FPL" mean
				  the poverty guidelines updated periodically in the Federal Register by the U.S.
				  Department of Health and Human Services under the authority of
				   42 U.S.C. §
												9902(2).
20. "For-profit corporation" means a legal
				  entity formed for the purpose of transacting business which has as any one of
				  its purposes pecuniary profit.
21.
				  "Free care" and "no cost care" means charity care.
22. "Guarantor" means a person or persons who
				  has accepted or is required to accept responsibility for the patient's hospital
				  bills.
23. "Hospital" means a
				  person or governmental entity licensed in accordance with R.I. Gen. Laws
				  Chapter 23-17 to establish, maintain and operate a hospital, for-profit and
				  not-for-profit.
24. "Income" means
				  the actual or estimated total annual cash receipts before taxes from: salaries,
				  wages, self-employment income, child care income, rental income, unemployment
				  compensation, temporary disability insurance, child support, alimony, workers'
				  compensation, veterans' benefits, social security payments, dividend and
				  interest income, royalties, private and public pensions, and public assistance.
				  Also included in income are: strike benefits, net lottery and gambling winnings
				  and one-time insurance payments or injury compensation received in the calendar
				  year in which the financial aid is sought for the hospital services.
25. "Incumbent" or "Recently incumbent" means
				  those individuals holding the position at the time the application is submitted
				  and any individual who held a similar position within one (1) year prior to the
				  application's acceptance.
26. "New
				  hospital" means the hospital as it exists after the completion of a
				  conversion.
27. "Not-for-profit
				  corporation" means a legal entity formed for some charitable or benevolent
				  purpose and not-for-profit which has been exempted from taxation pursuant to
				  Internal Revenue Code Section 501(C)(3) [
				26 U.S.C. §
												501(c)(3)].
28. "Outpatient care areas"
				  means outpatient clinical space and/or programs for which the hospital charges
				  a facility fee or other hospital billing.
29. "Person" means any individual, trust or
				  estate, partnership, corporation (including associations, joint stock
				  companies, and insurance companies), state or political subdivision or
				  instrumentality of the state.
30.
				  "Primary care services" means the provision of integrated, accessible health
				  care services by clinicians who are accountable for addressing a large majority
				  of personal health care needs, developing a sustained partnership with
				  patients, and practicing in the context of family and community. In most
				  instances, primary care is focused on the point at which a patient first seeks
				  assistance from the health care system for non-emergency services. Primary care
				  services include, but are not limited to, such services as family practice,
				  pediatrics, internal medicine, obstetrics/gynecology, and mental health
				  services.
31. "Rhode Island
				  resident" means an individual whose primary permanent residence is within the
				  State of Rhode Island, regardless of citizenship or immigration
				  status.
32. "State agency" means
				  the Rhode Island Department of Health.
33. "Transacting parties" means any person or
				  persons who seeks either to transfer or acquire ownership or a controlling
				  interest or controlling authority in a hospital which would result in a change
				  of ownership, control, or authority of twenty percent (20%) or
				  greater.
34. "Uncompensated care"
				  means a combination of free care, which the hospital provides at no cost to the
				  patient, bad debt, which the hospital bills for but does not collect, and less
				  than full Medicaid reimbursement amounts.
35. "Uninsured" means those individuals who
				  do not have coverage under private or employer-sponsored health insurance or
				  another government health plan, and who continue to lack such
				  coverage.