This Rhode Island regulation establishes minimum licensing standards for home nursing care providers and home care providers, covering application and renewal procedures, certificate of need requirements, ownership change notifications, inspections, deficiency and plan of correction processes, and uncompensated care obligations. Operators must obtain a license before establishing or operating such agencies, notify the Department of Health of ownership or operational changes, and meet a 1% uncompensated care standard as a condition of licensure.
View official sourceAn Official Rhode Island State Website.
Rhode Island Department of State
Gregg M. Amore
Secretary of State
Licensing Home Nursing Care Providers and Home Care Providers (216-RICR-40-10-17)
216-RICR-40-10-17
ACTIVE RULE
Regulation Text
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Regulation
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17.1
Authority
A.
These Regulations are promulgated pursuant to the authority conferred under R.I. Gen. Laws §§ 23-17-10 and 23-17-42 and are established for the purpose of adopting minimum standards for licensed home nursing care and home care providers in this State.
17.2
Reserved
17.3
Definitions
A.
Wherever used in these Rules and Regulations the following terms shall be construed to mean:
1.
"Abuse" means:
a.
Any assault as defined in
R.I. Gen. Laws Chapter
11-5
, including, but not limited to, hitting, kicking, pinching, slapping, or the pulling of hair; provided, however, unless it is required as an element of the offense charged, it shall not be necessary to prove that the patient or resident was injured by the assault;
b.
Any assault as defined in
R.I. Gen. Laws Chapter
11-37
;
c.
Any offense under
R.I. Gen. Laws Chapter
11-10
;
d.
Any conduct which harms or is likely to physically harm the patient or resident except where the conduct is a part of the care and treatment, and in furtherance of the health and safety of the patient or resident;
e.
Intentionally engaging in a pattern of harassing conduct which causes or is likely to cause emotional or psychological harm to the patient or resident, including but not limited to, ridiculing or demeaning a patient or resident, making derogatory remarks to a patient or resident or cursing directed towards a patient or resident, or threatening to inflict physical or emotional harm on a patient or resident.
2.
"Administrator" means an individual who:
a.
Is a licensed physician; or
b.
Has training and experience in health service administration and at least one (1) year of supervisory or administrative experience in home nursing care or home care or related health programs; or
c.
Is a registered nurse who meets qualifications of as set forth in 42 C.F.R. Part 484 (2022).
3.
“Advanced practice registered nurse” or “APRN” means the title given to an individual licensed to practice advanced practice registered nursing with one (1) of the following roles: Certified Nurse Practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA) as defined in R.I. Gen. Laws Chapter
5-34.2
, or Certified Clinical Nurse Specialist (CNS) and who functions in a population focus. An APRN may serve as a primary or acute-care provider of record.
4.
"Attending clinician" means a physician, physician assistant, advanced practice registered nurse, certified nurse midwife, certified midwife, or certified clinical nurse specialist identified by the patient/client/family as having a significant role in the determination and delivery of the individual's medical care.
5.
"Branch office" means a location from which a licensed home nursing care provider or licensed home care provider provides services within a portion of the total geographic area served by the licensed central office.
6.
"Change in operator" means a transfer by the governing body or operator of a home nursing care or home care provider 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 home nursing care provider or home care provider;
b.
Maintain and control the books and records of the home nursing care provider or home care provider;
c.
Dispose of assets and incur liabilities on behalf of the home nursing care provider or home care provider; or
d.
Adopt and enforce policies regarding operation of the home nursing care provider or home care provider.
e.
This definition is not applicable to circumstances wherein the governing body of a home nursing care provider or home care provider retains the immediate authority and jurisdiction over the activities enumerated above.
7.
"Change in owner" means:
a.
In the case of a home nursing care provider or home care provider which is a partnership, the removal, addition, or substitution of a partner which results in a new partner acquiring a controlling interest in such partnership.
b.
In the case of a home nursing care provider or home care provider which is an unincorporated solo proprietorship, the transfer of the title and property to another person;
c.
In the case of a home nursing care provider or home care provider which is a corporation:
(1)
A sale, lease, exchange or other disposition of all, or substantially all of the property and assets of the corporation; or
(2)
A merger of the corporation into another corporation; or
(3)
The consolidation of two (2) or more corporations, resulting in the creation of a new corporation; or
(4)
In the case of a home nursing care provider or home care provider which is a business corporation, any transfer of corporate stock which results in a new person acquiring a controlling interest in such corporation; or
(5)
In the case of a home nursing care provider or home care provider which is a non- business corporation, any change in membership which results in a new person acquiring a controlling vote in such corporation.
8.
“Certified clinical nurse specialist” means an advance practice registered nurse who independently provides care to clients; facilitates attainment of health goals; and provides innovation in nursing practice based on clinical expertise, evidence-based decision making, and leadership skills. The Clinical Nurse Specialist practices with individual clients and populations; nurses and other multidisciplinary team members; and organizations to effect system-wide changes to improve programs of care. The practice may include prescriptive privileges.
9.
“Certified nurse midwife” means a person who has successfully completed an accredited education program in midwifery, holds a current certification as a nurse-midwife by the American Midwifery Certification Board (AMCB) and is licensed to practice midwifery in Rhode Island.
10.
“Department” means the Rhode Island Department of Health.
11.
"Director" means the Director of the Rhode Island Department of Health.
12.
“Equity” means non-debt funds contributed towards the capital costs related to an initial licensure or change in owner or change in operator of a home nursing care provider or home care provider which funds are free and clear of any repayment 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.
13.
"Fluency" means the ability to converse freely in a language.
14.
"Health care 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 health care services, including, but not limited to, hospitals; nursing facilities; home nursing care providers (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; free-standing emergency care facilities and facilities providing surgical treatment to patients not requiring hospitalization (surgi-centers); hospice care and physician office settings providing surgical treatment
and podiatry ambulatory-surgery centers providing surgical treatment.
The term "health care facility" also includes organized ambulatory care facilities that are not part of a hospital but that are organized and operated to provide health care services to outpatients such as central services facilities serving more than one (1) health care facility or health care provider, treatment centers, diagnostic centers, rehabilitation centers, outpatient clinics, infirmaries and health centers, school-based health centers, and neighborhood health centers; providing, however, that the term "health care facility" shall not apply to organized ambulatory care facilities owned and operated by professional service corporations as defined in R.I. Gen. Laws Chapter 7-5.1 (the "Professional Service Corporation Law"), or to a private practitioner's (physician, dentist, or other health care provider) office or group of practitioners' offices (whether owned and/or operated by an individual practitioner, alone or as a member of a partnership, professional service corporation organization, or association). Facilities licensed by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals and clinical laboratories licensed in accordance with
R.I. Gen. Laws
Chapter 23-16.2, 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 health care facilities for purposes of this Part.
15.
“Health care provider” means any person licensed by the State of Rhode Island to provide or otherwise lawfully providing health care services, including, but not limited to, a physician, hospital, intermediate care facility or other health care facility, dentist, nurse, APRN, Certified Clinical Nurse Specialist, physician assistant, optometrist, podiatrist, physical therapist, psychiatric social worker, pharmacist, or psychologist, and any officer, employee or agent of that provider acting in the course and scope of his or her employment or agency related to or supportive of health services.
16.
“High managerial agent" means an officer of a licensee, the administrator and assistant administrator of the facility, the Director and Assistant Director of Nursing Services, or any other agent in a position of comparable authority with respect to the formulation of policies of the facility or the supervision in a managerial capacity of subordinate employees.
17.
"Home care provider" means any person that provides, arranges to provide, offers to provide, or in any other way provides for the delivery of any direct health care services in the home requiring supervision by a Registered Nurse (RN), but excludes the delivery of direct nursing care by a Registered (RN) or Licensed Practical (LPN) Nurse on an on-going basis; Also as used in this Part, "home care provider" includes homemaker services as defined in this Part. Nursing service agency services may also be provided under this license provided such services are rendered in accordance with Part
10
of this Subchapter, Licensing Nursing Service Agencies.
18.
"Home nursing care provider" means any person that provides, arranges to provide, offers to provide, or in any other way provides for the delivery of direct nursing services in the home by a Registered (RN) or licensed Practical (LPN) Nurse or therapeutic services provided by an applicable, licensed healthcare provider. As used in this Part, “home nursing care provider” may include home care provider services. Nursing service agency services may also be provided under this license provided such services are rendered in accordance with Part
10
of this Subchapter, Licensing Nursing Service Agencies.
19.
“Home health aide” means “nursing assistant.”
20.
“Homemaker” means a trained non-professional worker who performs related housekeeping services in the home for the sick, disabled, dependent or infirm.
21.
“Homemaker services” means housekeeping services performed in the home for the sick, disabled, dependent, or infirm by a trained non-professional worker who is supervised in accordance with the requirements of § 17.5.3(H)(2) of this Part.
22.
“Licensing agency” means the Rhode Island Department of Health.
23.
“Medical services” means such professional services and supplies rendered by or under the direction of persons duly licensed under the laws of the State of Rhode Island to practice medicine or to provide medical and surgical services in collaboration with physicians, or podiatry, or advanced practice nursing as may be specified by any medical service plan. Medical services shall not be construed to include hospital services.
24.
“Mistreatment” means the inappropriate use of medications, isolation, or use of physical or chemical restraints:
a.
As punishment;
b.
For staff convenience;
c.
As a substitute for treatment or care;
d.
In conflict with a physician’s order; or
e.
In quantities which inhibit effective care or treatment, or which harms or is likely to harm the patient or resident.
25.
“Neglect” means the intentional failure to provide treatment, care, goods, and services necessary to maintain the health and safety of the patient or resident, or the intentional failure to carry out a plan of treatment or care prescribed by the physician of the patient or resident, or the intentional failure to report patient or resident health problems or changes in health problems or changes in health conditions to an immediate supervisor or nurse, or the intentional lack of attention to the physical needs of a patient or resident including, but not limited to toileting, bathing, meals, and safety. No person shall be considered to be neglected for the sole reason that he or she relies on or is being furnished treatment in accordance with the tenets and teachings of a well-recognized church or denomination by a duly-accredited practitioner of a well-recognized church or denomination.
26.
“Nursing assistant” means a nurse’s aide, or home health aide, who is a paraprofessional, registered, pursuant to the provisions of
R.I. Gen. Laws Chapter
23-17.9
, and who is trained to give personal care and related health care and assistance based on his/her level of preparation to individuals who are sick, disabled, dependent or infirm, and who are residents of or receive services from health care facilities licensed pursuant to
R.I. Gen. Laws Chapter
23-17
, or who are receiving services from agencies licensed pursuant to R.I. Gen. Laws Chapter 23-17.7.1.
27.
“Patient” means a person who receives home nursing care or home care provider services or who is judged to need home nursing care or home care provider services based upon the results of an initial screening. The terms “patient” and “client” are synonymous in the context of this Part.
28.
“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.
29.
“Personal care services” means those services provided to a patient that do not require the skills of a licensed nurse. These services may include, but are not limited to: bathing, dressing, grooming, caring for hair/nails, and assistance with ambulation.
30.
“Physician” means any individual licensed to practice medicine in Rhode Island.
31.
“Physician assistant” means a person who is qualified by academic and practical training to provide medical and surgical services in collaboration with physicians and licensed in Rhode Island.
32.
“Plan of care” or “care plan,” means the comprehensive written plan for the patient’s care. The plan shall include attending clinician orders for medications, treatments, procedures, or therapeutic services, where indicated; and shall also encompass patient assessments and treatment goals/objectives, including provisions for personal care and social needs. (For further requirements related to the patient’s plan of care, see §§ 17.4.4(A)(4) and 17.6.2(C) of this Part.
33.
“Supervision” means clinical guidance provided by a qualified person for the assessment and monitoring of patient care management.
a.
Registered Nurses and other appropriate professionals of the health care team, licensed, registered and/or certified as may be required by the laws of Rhode Island, shall supervise (directly or indirectly) Nursing Assistants. A registered nurse shall supervise any acts, functions or tasks performed by a Nursing Assistant that are nursing-related.
34.
“Therapeutic services”, as used in this Part, means those treatments provided by a licensed health care professional that have medicinal or healing properties, such as, but not limited to, infusion, respiratory, occupational, speech, or physical therapy and that are included in the patient’s care plan.
35.
"Uncompensated care" means health care services provided by a home nursing care or home care provider for which the home nursing care or home care provider does not and has not expected payment and which health care services are not recognized as either a receivable or as revenue in the home nursing care or home care provider's financial statements.
17.4
General Requirements for Licensure and Certificate of Need
Requirements
17.4.1
General 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
.
17.4.2
Application
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.
17.4.3
Application, 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.
17.4.4
Statewide 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.
17.4.5
Change 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.
17.4.6
Inspections
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.
17.4.7
Deficiencies 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
e
.
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
.
17.4.8
Denial, 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
23-1-21
.
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.
17.5
Organization and
Management
17.5.1
Governing
Body
A.
Each
home
nursing
care
provider
or
home
care
provider
shall
have
an
organized
governing body or equivalent legal authority ultimately responsible for:
1.
The management, fiscal affairs and operation of the home nursing care provider or home care provider;
2.
The assurance of quality care and services; and
3.
Compliance with all federal, state,
and local laws
and
Regulations
pertaining
to
a
home
nursing
care
provider
or
home
care
provider
and this Part.
B.
The governing body, or equivalent legal authority, shall provide appropriate personnel, physical
resources
and
equipment
to
facilitate
the
delivery
of
prescribed
services
and
shall furthermore:
1.
Appoint an Administrator and/or Director of Nursing Services in accordance with the provisions of § 17.5.2(O) of this Part;
2.
Identify the range of services to be provided which must include no less than those services required in §§ 17.5.2(D) and 17.8.1(B) of this Part as applicable;
3.
Define the geographic areas to be served; and
4.
Carry out such other functions as may be relevant to the organization and operation of the home nursing care provider or home care provider.
C.
The governing body, or equivalent legal authority, shall adopt and maintain by-laws or acceptable equivalent which defines responsibilities for the operation and performance of the organization, and shall identify purposes and means of fulfilling same. In addition, the governing body or equivalent legal authority, shall establish administrative policies pertaining to no less than the following:
1.
Responsibilities of the Administrator and/or Director of Nursing Services;
2.
Acquiring and maintaining employee bonding insurance (theft and damage) (a minimum amount of ten thousand dollars ($10,000.00) per loss) and liability insurance (a minimum amount of five hundred thousand dollars ($500,000.00) per occurrence);
3.
The modalities of services to be provided;
4.
Circumstances under which definitive care cannot be provided and procedures for referral;
5.
Linkages and referrals with other health care facilities, which shall include a mechanism for recording, transmitting and receiving information essential to the continuity of patient care. Such information shall contain no less than the following:
a.
Patient identification data such as: name, address, age, gender, name of next-of-kin, health insurance coverage, etc.
b.
Diagnosis and prognosis, medical status of patient, brief description of current illness, plan of care, including such information as medications, treatments, dietary needs, baseline laboratory data;
c.
Functional status;
d.
Therapeutic services such as: physical therapy, infusion therapy, occupational therapy, or speech therapy;
e.
Psychosocial needs; and
f.
Such other information pertinent to ensure continuity of patient care.
6.
Reports of patient's condition and transmission thereof to the patient's attending clinician;
7.
Policies
and
procedures
regarding
persons
employed
by
the
facility;
Said
policies
shall include, but not be limited to, the
following:
a.
Compliance
with
health
screening
and
in-service
education
requirements
of
§ 17.5.3 of this Part;
b.
Timely completion of the Bureau of Criminal Identification (BCI)
check in accordance with R.I. Gen. Laws § 23-17-34;
c.
Timely judgment regarding continued employment of an employee upon whom disqualifying
information
has
been
found
(see
§ 17.5.3(L) of this Part.
8.
Accreditation by a nationally recognized accrediting body must be achieved within two (2) years of the date on which the home care provider/home nursing care provider is initially licensed. Further, such accreditation must be maintained in order to remain licensed in good standing.
9.
Such other matters as may be relevant to the organization and operation of the home nursing care provider or home care
provider.
D.
The
governing
body
or
other
legal
authority
shall
organize
services
to
ensure
an
integrated continuum of patient care. An organizational chart with written description of the organization, authorities, responsibilities, accountability, and relationships shall be maintained which shall include but not be limited
to:
1.
A description of each service
offered;
2.
Policies and procedures pertaining to each
service;
3.
A description of the system for the maintenance of the patient's clinical record;
and
4.
Standards of clinical
practice.
E.
Quality Improvement
1.
The governing body shall ensure that there is an effective, ongoing, agency-wide quality improvement program to evaluate the provision of patient care. Further, the home nursing care
provider
or
home
care
provider
shall
have
written
policies
and
procedures
establishing
a mechanism
for
the
annual
evaluation
of
professional
standards
of
practice
and
administrative
practices, conducted by professional personnel, including home nursing care provider or home care provider
staff.
a.
Such
evaluation
shall
assess
the
extent
to
which
the
home
nursing
care
provider’s
or home
care
provider’s
programs
and
services
are
appropriate,
adequate,
effective
and efficient based on data such as: number of patients on services, patient visits, reasons for discharge, diagnoses, sources of referral, patients denied services, community
needs,
staff
days
for
each
service
offered
and
such
other
criteria
as
may be deemed
appropriate.
2.
The
organized
agency-wide
quality
improvement
program
shall
be
ongoing
and
shall
have
a written
plan
of
implementation.
The
written
quality
improvement
plan
shall
include
at
least the
following:
a.
Program
objectives;
b.
Organization(s)
involved;
c.
Oversight responsibility (e.g., reports to the governing
body);
d.
Home nursing care provider-wide or home care provider-wide
scope;
e.
Program administration and
coordination;
f.
Involvement of all patient care
disciplines/services;
g.
Methodology for monitoring and evaluating quality of
care;
h.
Priority setting and problem
resolution;
i.
Determination of the effectiveness of action(s)
taken;
j.
Documentation of the quality improvement plan
review.
3.
All patient care services, including services rendered by a contractor, shall be
evaluated.
4.
The
home
nursing
care
provider
or
home
care
provider
shall
take
and
document
appropriate remedial action to address problems identified through the quality improvement program. The
outcome(s)
of
the
remedial
action
shall
be
documented
and
submitted
to
the
governing body for their consideration.
5.
The provisions of § 17.5.1(E)(2) of this Part shall be deemed to have been met if the agency has met similar requirements of a national accrediting body, as approved by the Director.
F.
Uniform Reporting System
1.
Each
home
nursing
care
provider
or
home
care
provider
shall
establish
and
maintain
records and
data
in
such
a
manner
as
to
make
uniform
a
system
of
periodic
reporting.
The
manner
in which the requirements of this Part may be met shall be prescribed from time to time in directives promulgated by the
Director.
2.
Each
home
nursing
care
provider
or
home
care
provider
shall
report
to
the
licensing
agency detailed
statistical
data
pertaining
to
its
operation
and
services.
Such
reports
and
data
shall be made at such intervals and by such dates as determined by the
Director.
3.
The
licensing
agency
is
authorized
to
make
the
reported
data
available
to
any
state
or
federal agency concerned with or exercising jurisdiction over the home nursing care provider or home care
provider.
4.
The directives promulgated by the Director pursuant to this Part shall be sent to each
home
nursing
care
provider
or
home
care
provider
to
which
they
apply.
Such
directives shall
prescribe
the
form
and
manner
in
which
the
statistical
data
required
shall
be
furnished to the licensing
agency.
G.
Disaster/Emergency Planning
1.
Each home nursing care provider or home care provider shall develop and maintain an emergency preparedness plan that is reviewed and updated annually.
a.
At a minimum, the emergency preparedness plan must include all of the provisions contained in 42 C.F.R. § 484.102 that include but are not limited to:
(1)
Emergency preparedness policies and procedures;
(2)
Communications plan that is in conformity with all federal, state, and local laws and regulations;
(3)
Training and testing program.
b.
Any home nursing care provider or home care provider that is part of a healthcare system consisting of multiple separately licensed healthcare facilities may participate in the healthcare system’s coordinated emergency preparedness program, provided that it meets the requirements of 42 C.F.R. § 484.102.
2.
The emergency preparedness plan shall be developed with the assistance of qualified safety, emergency management, and/or other appropriate experts.
3.
Each home nursing care provider or home care provider shall develop back-up or contingency plans to address possible internal systems and/or equipment failures.
H.
Pending and Actual Labor Disputes/Actions
1.
Health
care
facilities
shall
provide
the
licensing
agency
with
prompt
notice
of
pending
and actual
labor
disputes/actions
which
would
impact
delivery
of
patient
care
services
including, but
not
limited
to,
strikes,
walk-outs,
and
strike
notices.
Health
care
facilities
shall
provide
a plan, acceptable to the Director, for continued operation of the facility, suspension of operations, or closure in the event of such actual or potential labor dispute/action.
I.
Latex
1.
Any
home
nursing
care
provider
or
home
care
provider
that
utilizes
latex
gloves
shall
do
so in accordance with the provisions of the rules and regulations pertaining to Part
20-15-3
of this Title, Use of Latex Gloves by Health Care Workers, in Licensed Health Care Facilities, and by Other Persons, Firms, or Corporations Licensed or Registered by the Department.
J.
Reporting of Resident Abuse, Mistreatment, or Neglect
1.
Duty
to
Report resident abuse, mistreatment, or neglect is pursuant to
R.I. Gen. Laws
§
23-17.8
-2
.
The
report
shall
be
on
forms
provided
by
the
licensing
Agency
and
shall
contain
information
as
outlined
in
R.I. Gen. Laws
§
23-17.8-2
.
17.5.2
Service
Accessibility
A.
Accessibility to agency: Each home nursing care provider or home care provider shall establish
a
mechanism
to
enable
patients
to
make
telephone
contact
with
responsible
staff
of the home nursing care provider or home care provider on a twenty-four (24) hour basis, seven (7) days a
week.
B.
Medical
supplies
and
equipment:
Each
home
nursing
care
provider
or
home
care
provider shall
assist
patients
in
arranging
for
the
procurement
of
medical
supplies
and
equipment
as may be prescribed in the plan of
care.
C.
Written Agreements
1.
There shall be written agreements for the provision of service(s) not provided directly by the home nursing care provider or home care provider which clearly delineate the responsibilities of the parties involved and shall include no less than the following provisions:
a.
Designation of service(s) to be provided which must be within the scope and limitations set forth in the plan of care and which must not be altered in type, amount, frequency, or duration (except in case of adverse reaction) by the individual or home nursing care provider or home care provider;
b.
The responsibility of the licensed home nursing care provider or home care provider for the provision of services to the patient;
c.
Assurance of compliance with the patient care policies of the licensed home nursing care provider or home care provider;
d.
Establishment of procedures for and frequency of patient care assessment and attendance at case conferences;
e.
Mechanism for submission of clinical progress notes on patient care;
f.
Documented evidence that personnel and services under contract meet the requirements specified in this Part for home nursing care provider or home care provider personnel and services, including licensure, health screenings, and criminal background checks. In instances where the contracted services are provided by another Department CHFR licensee, said license shall suffice to meet the requirements of § 17.5.2(C) of this Part.
g.
Reimbursement mechanism, charges and terms for renewal or termination of the agreement; and
h.
Such other provisions as may be mutually agreed upon.
D.
Scope of
Services
1.
Each
home
nursing
care/home
care
provider
shall
provide
either
directly,
or
by
written contractual agreement with another Department-licensed agency, homemaker,
nursing assistant services or other therapeutic service(s) (e.g., physical/occupational
therapy).
2.
Additional health services or related services may be provided by agencies as may be deemed appropriate to meet community needs in a manner consistent with professionally-recognized standards of practice and all applicable current laws and Regulations.
17.5.3
Personnel
A.
Each
home
nursing
care
provider
or
home
care
provider
shall
employ
a
sufficient
number
of qualified personnel to provide effective patient care and other related services.
B.
A
job
description
for
each
classification
of
position
shall
be
established,
clearly
delineating qualifications, duties, authority and responsibilities inherent in each position.
C.
Written personnel policies supporting sound patient care and personnel practices shall be made available to all full-time or part-time personnel and shall include provisions
for:
1.
Annual evaluation of employee performance that is reviewed with and signed by the employee within forty-five (45) days of the evaluation;
and
2.
Such other matters as deemed
appropriate.
D.
An inservice educational program shall be conducted on an ongoing basis, which shall include an orientation program for staff personnel employed by the home nursing care provider or home care provider providing direct care and a continuing program for the development
and
improvement
of
skills
of
staff
to
ensure
the
delivery
of
quality
home
care services. The inservice program shall include but not be limited to, infection control measures, Health Insurance Portability and Accountability Act (HIPAA) general provisions, recognition and reporting of abuse, neglect, mistreatment, and
exploitation.
E.
A
mechanism
to
establish
an
audit
trail
of
employees
shall
be
implemented
and
shall
include, at
a
minimum,
for
each
employee:
1.
Date
of
employment
by
the
home
nursing
care
provider
or home care provider agency; and
2.
Date(s), name(s), and address(es) of each assignment.
F.
For
every
person
employed
by
the
home
nursing
care
provider
or
home
care
provider
who
is licensed, certified, or registered by the Department, a mechanism shall be in place to electronically verify such licensure via the Department's licensure
database.
G.
Personnel
files
shall
be
maintained
for
each
employee
and
shall
be
available
at
all
times
for inspection by the licensing agency. Such files shall include no less than the following documentation:
1.
A certified copy of birth certificate or copy of the U.S. Immigration and Naturalization Service Employment Eligibility Verification form (“I-9”); or immigration papers or resident alien card;
2.
Information pertaining to qualifications for employment;
3.
Records of completion of required training and educational programs;
4.
Evidence of current licensure or certification as may be required by law;
5.
Resume of previous employment;
6.
Records of required health examination which shall be kept confidential and in accordance with provisions of § 17.5.3(K) of this Part;
7.
Documentation of complaints and follow-up;
8.
Findings of a criminal records check, if employed after July 26,1993;
9.
Reference check prior to employment;
10.
Employee orientation, evaluation (annual) and documentation of in-service education; and
11.
Such other matters as may be relevant to the organization and operation of the agency.
H.
Supervision of Homemakers
1.
All homemaker services performed by a homemaker shall be in accordance with the provisions of
R.I. Gen. Laws
Chapter
23-17
, and this Part.
2.
Homemaker services shall be rendered in accordance with a plan of care and shall be supervised
by
a
nurse,
licensed
in
Rhode
Island,
or
by
an
individual with
a
bachelor's
degree
in
social
work,
home
economics,
gerontology
or
other
related
field of study, and who shall be responsible for no less than the
following:
a.
Conducting the initial in-home assessment and assessments no less than every three (3) months thereafter or more frequently as the condition of the patient/client may require;
b.
Monitoring the performance of the homemakers and maintaining appropriate clinical records;
c.
Coordinating management of services (inter and intra-agency);
d.
Assigning only delegable duties in accordance with § 17.5.3(J) of this Part;
e.
Maintaining a record for each patient/client with appropriate documentation of services rendered which is signed by the homemaker rendering services;
f.
Such other functions and activities as may be deemed necessary and appropriate.
I.
Training Program for Homemakers
1.
Homemakers shall be required to have successfully completed a basic training program of twenty (20) hours of classroom instruction, and with no less than five (5) hours of practical experience in addition to the required classroom instruction.
2.
The course of instruction shall be designed to provide skill in all the duties listed in § 17.5.3(J) of this Part and to provide homemaker skills, information, and an orientation to basic human needs. The course of instruction curriculum must include, but is not limited to:
a.
Orientation to homemaker agency, including policies and procedures, ethical responsibilities/accountability, confidentiality, and the function of the homemaker as a team member;
b.
Understanding basic human needs, including the needs of children/older persons, physically/disabled people, people with terminal illness, and people with mental illness/dementia;
c.
Infection control, including hand washing, cross contamination, and universal precautions appropriate to the homemaker;
d.
Emergency procedures; and
e.
Care of the home, including planning and serving meals, shopping, food preparation, basic nutrition, cleanliness/general housekeeping, accident prevention, care of food preparation areas/dishes, laundry and ironing, making unoccupied beds, and disposal of trash/medical waste.
3.
Upon completion of the homemaker training program, each homemaker must satisfactorily pass the final examination of the training program in order to be eligible to function as a homemaker.
J.
Duties of Homemakers
1.
A homemaker who has satisfactorily completed a training program approved by the Director, as described in § 17.5.3(I) of this Part, may perform the following duties under an established plan of care and under the supervision of a qualified person in accordance with § 17.5.3(H) of this Part:
a.
Change bed linens (unoccupied);
b.
Grocery shopping;
c.
General housekeeping (washing dishes, cleaning kitchen, bathroom, patient’s/client's room);
d.
Laundry and ironing;
e.
Meal preparation;
f.
Shopping, errand-running;
g.
Recording services rendered.
2.
Notwithstanding the provisions of § 17.5.3(J)(1) of this Part, additional duties may be assigned to homemakers provided such duties do not include the duties of a nursing assistant, as listed in Subchapter 05 Part
22
of this Chapter, Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs.
a.
Such additional duties must be clearly delineated in agency policies and procedures, but may not be in conflict with other state regulations.
3.
A health care facility shall require all persons, including students, who examine, observe, or treat a patient or resident of the facility to wear a photo identification badge which states, in a reasonably legible manner:
a.
The first name;
b.
Licensure registration status, if any;
c.
Fluency in languages other than English, if any; and
d.
Staff position of that person.
4.
A home nursing care provider or home care provider shall be considered for all purposes an employer and those persons that it supplies on a temporary basis shall be considered employees and not independent contractors and home nursing care providers or home care providers shall be subject to all state and federal laws which govern employer/employee relationships.
K.
Health Screening
1.
Upon hire and prior to delivering services, a pre-employment health screening shall be required for each individual who has or may have direct contact with a patient of the home care provider/home care nursing provider. Such health screening shall be conducted in accordance with Immunization, Part
20-15-7
of this Title, Testing, and Health Screening for Health Care Workers, promulgated by the Department of Health.
L.
Criminal Records Check
1.
Criminal records checks shall be in accordance with R.I. Gen. Laws § 23-17-34.
M.
Administrator and/or Director of Nursing Services
1.
A
full-time
administrator
as
defined
in
this Part shall
be
appointed
by
and be
responsible
to
the
governing
body
or
other
legal
authority
for
no
less
than
the
following:
a.
The management and operation of the agency;
b.
The implementation of policies, statutory and regulatory provisions;
c.
Acting as liaison between the governing body and the professional and paraprofessional staff and the community;
d.
The preparation and implementation of an effective budgeting, accounting and reporting system;
e.
The establishment of standards of professional practice developed in cooperation with the governing board and staff;
f.
The establishment of policies and procedures governing the range of health care services provided by the home nursing care provider or home care provider;
g.
The establishment of a quality improvement program which includes a review mechanism for patient care management;
h.
The preparation of an annual report;
i.
The employment of qualified professional and paraprofessional staff; and
j.
For such other related functions as may be delegated by the governing body or other legal authority.
2.
In the event that a non-nurse is appointed administrator of the home nursing care provider or home care provider, the nursing service shall be under the direction of a Registered Nurse who is licensed in Rhode Island and who shall be responsible to the Administrator for the management of professional services, the standards of practice, and other related professional aspects of patient care services.
17.6
Patient Care Management
17.6.1
Rights of
Patients
A.
Each
patient/client
of
a
home
nursing
care
provider
or
home
care
provider
has
the
right
to
be informed of his or her rights under
R.I. Gen. Laws
§
23-17-19.1
and the home nursing care provider or home care provider must protect and promote the exercise of these
rights.
B.
The
home
nursing
care
provider
or
home
care
provider
must
provide
the
patient/client
with
a written notice of the patient/client rights in § 17.6.1(E) of this Part in advance of furnishing
care
to
the
patient/client
or
during
the
initial
evaluation
visit
before
the
initiation of
treatment.
C.
A
copy
of
the
written
notice
of
rights
signed
by
the
patient/client
will
be
maintained
in
the patient/client record by the home nursing care provider or home care provider and in the patient/client's
home.
The
home
nursing
care
provider
or
home
care
provider
must
maintain documentation showing that it has complied with the requirements of this
Section.
D.
The provisions of § 17.6 of this Part shall not apply to nursing services or home health services conducted by and for those who rely exclusively upon spiritual means through prayer alone in accordance with the creed or tenets of a recognized church or religious
denomination.
E.
In addition to the rights stated in R.I. Gen. Laws § 23-17-19.1:
1.
No
charge
shall
be
made
for
furnishing
a
health
record
or
part
thereof
to
a
patient,
his/her attorney or authorized representative if the record or part thereof is necessary for the purpose
of
supporting
an
appeal
under
any
provision
of
the
Social
Security
Act
(42 U.S.C. § 301
et seq.
) and the request is accompanied by documentation of the appeal.
A
provider
shall
furnish
a
health
record
requested
pursuant
to
this
Section
within thirty (30) days of the request.
17.6.2
Confidentiality
A.
Disclosure of any health care information relating to individuals shall be subject to the provisions of the "Confidentiality of Health Care Communication and Information Act",
R.I. Gen. Laws
Chapter
5-37.3
,
and
other
relevant
statutory
and
federal
requirements.
17.6.3
Admission and Discharge
Policies
A.
Providers shall establish policies pertaining to eligibility for admission to and discharge from home nursing care provider or home care provider services. Such policies shall be based on the following criteria:
1.
Pre-admission assessment of patient care needs;
2.
Reasonable expectations of the home nursing care provider’s or home care provider’s capability to respond to the medical and nursing needs of the patient;
3.
Plan of care;
4.
Constraints imposed by limitation of services, family conditions;
5.
Community or other resources to ensure continuity of patient care; and
6.
Such other criteria as may be deemed appropriate.
17.6.4
Alzheimer’s Operational Plan
A.
Every healthcare facility as defined in R.I. Gen. Laws § 23-17-2 shall complete and implement an operational plan for the recognition and management of patients with Alzheimer's disease or dementia.
1.
Such plan shall include a protocol for the following:
a.
Identifying the signs and symptoms of cognitive impairments, including Alzheimer’s disease;
b.
Management of clients/patients with Alzheimer’s disease;
c.
Training of clinical and non-clinical staff; and
d.
Advance care planning and resources for family members.
2.
Such plan shall be maintained by the healthcare facility and made available to the licensing agency upon request.
17.6.5
Clinical
Records
A.
Accurate and complete clinical records maintained in accordance with accepted professional standards shall be kept on each patient and filed in an accessible location within the home nursing care provider or home care provider. Such records shall contain no less than the following information:
1.
Identifying data (name, address, date of birth, gender, date of admission or readmission);
2.
Sources of patient referral;
3.
Name of attending clinician (including address and telephone number);
4.
Original plan of care for services provided;
a.
Personal care objectives;
b.
Homemaker objectives, as appropriate;
5.
Documentation of each patient contact;
6.
Changes in and reviews of the patient's plan of care, signed by responsible professional;
7.
Documentation of an executed advance directive (if any) and a copy of the advance directive, if provided to the facility by the patient; and
8.
Discharge summaries.
B.
Home nursing care provider or home care provider personnel involved in the care of patients shall participate, to the extent possible, in developing care plans. When practical, designated home nursing care provider or home care provider personnel shall complete a “Continuity of Care” form as approved by the Director for each patient who is discharged to another health care facility, such as a hospital or nursing facility, or other facility licensed under the provisions of
R.I. Gen. Laws
Chapter
23-17
. Said form shall be provided to the receiving facility, agency, or provider prior to, upon transfer, or discharge of the patient. (See the Department’s website for the approved form: health.ri.gov).
C.
Records
shall
be
maintained
by
the
home
nursing
care
provider
or
home
care
provider
for
a period of at least seven (7) years following the date of discharge and shall be safeguarded against loss or unauthorized use. This requirement shall also apply to computerized or electronic records.
1.
Records shall be maintained by the home nursing care provider or home care provider for a minimum of seven (7) years after a minor patient turns eighteen (18) years of age.
D.
Each home nursing care provider or home care provider shall have written policies and procedures
to
govern
the
use
and
removal
of
records
and
determine
the
conditions
for
release of information in accordance with statutory provisions pertaining to
confidentiality.
17.6.6
Nursing Assistant
Services
A.
Each home nursing care provider or home care provider that chooses to provide home nursing care and home care as provided in this Part shall be subject to the same training requirements for nursing assistants and the duties of the individuals shall be the same as those prescribed in Subchapter 05 Part
22
of this Chapter, Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs.
B.
Supervision of Nursing Assistants
1.
Supervision of nursing assistants shall be directed to the management of patients’/clients' care and services, the performance of duties, and shall be available at all times during the established hours of operation of the home nursing care provider or home care provider and at such other times as they are providing services to patients/clients.
2.
Supervision of nursing assistants as employees of a home nursing care provider or home care provider:
3.
Nursing assistant services shall be:
a.
Provided in accordance with a plan of care; and
b.
Monitored/supervised
no
less
than
once
every
three
(3)
months
by
a
professional
(registered) nurse or other appropriate health care professional who is licensed in Rhode Island; and
c.
P
rovided in accordance with Subchapter 05 Part
22
of this Chapter, Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs.
d.
Such supervision shall include the following
duties:
(1)
Conducting the initial in-home assessment prior to commencement of service, unless documented
extraordinary
circumstances
prevent
such
timing.
In
these
cases
the
initial in-home assessment must be conducted within forty-eight (48) hours. Subsequent assessments and direct supervision of the Nursing Assistant (at least one supervisory session) must be conducted no less than every three (3) months thereafter or more frequently as the condition of the patient/client may
require;
(2)
Involving other professional disciplines where personal care is provided, as may be deemed necessary to ensure the provision of quality
care;
(3)
Developing,
reviewing
and
revising
the
plan
of
care,
as
the
condition
of
the
patient/client may require but no less than once every three (3)
months;
(4)
Assigning only delegable duties as set forth in Subchapter 05 Part
22
of this Chapter, Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs for Nursing Assistants;
(5)
On-site
monitoring
the
performance
of
Nursing
Assistants
no
less
than
once
every
three (3) months and maintaining appropriate records of such monitoring;
(6)
Coordinating the management of services (inter- and
intra-agency);
(7)
Monitoring the clinical record for each patient/client which includes appropriate recording of the plan of care, services rendered, and which is signed by the person rendering services; and
(8)
Such other functions and activities as may be deemed necessary and
appropriate.
17.6.7
Reporting of Communicable Diseases
A.
Each facility shall report promptly to the Rhode Island Department of Health, Division of Disease Control, cases of communicable diseases designated as "reportable diseases" by the Director, when such cases are diagnosed in accordance with the most current Part
30-05-1
of this Title, Reporting and Testing of Infectious, Environmental, and Occupational Diseases.
17.7
Physical Plant
17.7.1
General
Provisions
A.
Each licensed home nursing care provider or home care provider shall maintain an office(s) located in Rhode Island with adequate space and equipment to accommodate staff personnel to carry out their professional and administrative responsibilities in an efficient manner within a safe environment.
B.
Adequate space shall be provided for the storage and maintenance of equipment, supplies and records necessary for patient care services and for the operation of the home nursing care provider or home care provider.
C.
All equipment and furnishings shall be maintained in good condition, properly functioning and replaced as necessary.
D.
Each home nursing care provider or home care provider shall maintain an effective telephone communication system accessible to patients and personnel on a twenty-four (24) hour basis, seven (7) days a week, in accordance with § 17.5.2(A) of this Part.
E.
Medical Waste Disposal
1.
In accordance with the Medical Waste Regulations,
250-RICR-140-15-1
, medical waste generated by individuals on the premises of a single-family home or single-family dwelling unit or by members of households residing in single and multiple residences, hotels, and motels which serve as a residence for individuals, provided the dwelling is not serving as a commercial or professional office where individuals who are not members of the family residing at such dwelling are receiving medical care by a health care professional is specifically excluded from the definition of regulated medical waste and the requirements of the aforementioned regulations. Medical waste generated by health care providers in private homes where they provide medical services to individuals residing in said homes is also exempt from the requirements of the Medical Waste Regulations,
250-RICR-140-15-1
, promulgated by the Rhode Island Department of Environmental Management.
17.8
Additional
Requirements – Home Nursing
Care
Providers
A.
In addition to meeting the General Requirements as set forth in §§ 17.1 through 17.7.1 of this Part, home nursing care providers shall meet the additional requirements of § 17.8.1 of this Part.
17.8.1
Governing Body & Management Professional Advisory Committee
A.
An
advisory
group
of
professional
personnel
("Professional
Advisory
Committee")
shall
be established by the governing body or other legal authority which shall include at least:
1.
One (1) physician and a registered nurse; and
2.
A representative of each therapeutic service offered by the home nursing care provider or home care provider, which may also include appropriate representation from other professional disciplines.
3.
The administrator of the home nursing care provider or home care provider shall be
ex-officio
member of the committee.
4.
At least one (1) member shall neither be an owner nor an employee of the home nursing care provider or home care provider.
5.
The Professional Advisory Committee shall meet at least twice per year to advise the agency on professional issues and to establish and annually review the home nursing care provider’s or home care provider’s policies pertaining to:
a.
The scope of services offered;
b.
Admission and discharge policies;
c.
Plans of care;
d.
Clinical records;
e.
Personnel qualifications;
f.
Program evaluation; and
g.
Such other matters as may be deemed appropriate by the governing body or other legal authority.
6.
The physician member of the Professional Advisory Committee shall attend at least one (1) meeting per year and show evidence of participation (e.g., review of agenda/minutes) in any other Professional Advisory Committee meetings.
B.
Scope of Services
1.
Each home nursing care provider shall provide direct nursing services in the home, or by contractual
agreement
with
another
Department-licensed
agency,
delivered
by
a
Registered (RN) or Licensed Practical (LPN)
Nurse.
2.
Each home nursing care provider may provide homemaker and Nursing Assistant services, either directly or by contractual agreement with another Department-licensed agency; and may provide other therapeutic service(s), to be provided either directly or by contractual agreement.
3.
Additional health services or related services may be provided by a home nursing care provider as may be deemed appropriate to meet community needs in a manner consistent with acceptable standards of practice.
C.
Medical Services
1.
Patients admitted for medical services shall be under the care of an attending clinician responsible for the development of the plan of care.
a.
A care plan prescribed by the attending clinician, if appropriate, shall contain no less than the following:
(1)
Pertinent diagnosis, including mental status, level of consciousness, ability to communicate including language, speech and hearing;
(2)
Types of services and equipment required, frequency of visits, prognosis, rehabilitative potential, functional limitations, activities permitted, nutritional requirements, medications and treatments, safety measures (if any), instructions for continuing care, referral or discharge; dates/times of any follow-up appointment(s), when known;
(3)
Medical diagnosis and nursing assessment, therapeutic goals, prognosis and all conditions relevant to the plan of care, including any known allergies and reactions; and
(4)
Surgical procedures, surgical complications, infections, prior diagnoses, presence of pressure ulcers, incontinence, disabilities;
2.
The attending clinician’s orders for any services which shall specify the procedures and modalities to be used including the amount, frequency and duration of therapy and/or care, including therapeutic services, such as physical therapy, occupational therapy, speech therapy, clinical social work, nutritional assessment, audiology, intravenous (IV) therapy,
percutaneous endoscopic gastrostomy (
PEG) feeding
, wound/dressing, surgical drains, central line, oxygen, diet, all medications prescribed.
3.
The plan of care shall not be modified without consent of the attending clinician and shall furthermore be reviewed by the attending clinician and home nursing care provider or home care provider staff as often as the severity of the patient's condition requires but no less than once every sixty (60) days beginning with the start of care date.
4.
Direct Nursing Services Direct nursing services shall be provided by Registered and/or Practical Nurses duly licensed in Rhode Island and in accordance with the written plan of care, acceptable standards of nursing practice and Subchapter 05 Part
3
of this Chapter, Licensing of Nurses and Standards for the Approval of Basic Nursing Education Programs.
5.
Copies of the plan of care and the number of service hours scheduled shall be provided to the patient upon admission and as revised.
17.8.2
Supervision of Therapeutic
Services
A.
Therapeutic services may include, but are not limited to, speech pathology/audiology, physical therapy, occupational therapy and respiratory care. Supervision of therapeutic services shall be in accordance with applicable Rules and Regulations for licensing of said therapists.
17.9
Variance Procedure, Practices and Procedures, and Severability
17.9.1
Variance
Procedure
A.
The licensing agency may grant a variance either upon its own motion or upon request of the applicant from the provisions of any rule or regulation in a specific case if it finds that a literal enforcement of such provision will result in unnecessary hardship to the applicant and that such variance will not be contrary to the public interest, public health and/or health and safety of patients.
B.
A request for a variance shall be filed by an applicant in writing setting forth in detail the basis upon which the request is made.
1.
Upon the filing of each request for variance with the licensing agency and within a reasonable time thereafter, the licensing agency shall notify the applicant of its approval, or in the case of a denial, a hearing date, time and place may be scheduled if the home nursing care provider or home care provider appeals the denial.
17.9.2
Rules Governing Practices and
Procedures
A.
All hearings and reviews required under the provisions of
R.I. Gen. Laws
Chapter
23-17
shall be held in accordance with the provisions of Part
10-05-4
of this Title, Practices and Procedures Before the Rhode Island Department of Health.
Title
216
Department of Health
Chapter
40
Professional Licensing and Facility Regulation
Subchapter
10
Facilities Regulation
Part
17
Licensing Home Nursing Care Providers and Home Care Providers (216-RICR-40-10-17)
Type of Filing
Amendment
Regulation Status
Active
Effective
05/06/2024
Additional Information
https://health.ri.gov/regulations/
Regulation Authority:
R.I. Gen. Laws §§ 23-17-10 and 23-17-42
Purpose and Reason:
The Rhode Island Department of Health (“RIDOH”; “The Department”) is proposing to amend “Licensing Home Nursing Care Providers and Home Care Providers” [216-RICR-40-10-17] in order to bring these regulations into conformity with current statutory requirements.
To view the official Final Regulation for accessibility and readability, click Download Regulation:
Download Regulation
ACTIVE RULE
Amendment
- effective from 05/06/2024
to Current
INACTIVE RULE
Amendment
- effective from 03/24/2022
to 05/06/2024
INACTIVE RULE
Periodic Refile
- effective from 01/04/2022
to 03/24/2022
INACTIVE RULE
Technical Revision
- effective from 03/07/2018
to 01/04/2022
INACTIVE RULE
Amendment
- effective from 03/07/2018
to 03/07/2018
INACTIVE RULE
Amendment
- effective from 12/23/2012
to 03/07/2018
INACTIVE RULE
Amendment
- effective from 12/10/2012
to 12/23/2012
INACTIVE RULE
EMERGENCY RULE
Amendment
- effective from 02/06/2012
to 09/03/2012
INACTIVE RULE
Amendment
- effective from 10/18/2007
to 12/10/2012
INACTIVE RULE
Amendment
- effective from 04/07/2005
to 10/18/2007
INACTIVE RULE
Amendment
- effective from 04/02/2003
to 04/07/2005
INACTIVE RULE
Amendment
- effective from 08/04/2002
to 04/02/2003
INACTIVE RULE
Periodic Refile
- effective from 01/02/2002
to 08/04/2002
Rulemaking Documents are organized by document type and are part of this rule’s rulemaking record (R.I. Gen. Laws § 42-35-2.3). If multiple documents of the same type are listed below, each is a unique document.
If there are multiple Public Notice of Proposed Rulemaking documents, view each document to identify the most recently amended version, as it may be amended at any point during the Public Comment Period.
Concise Explanatory Statement
Public Comment
Public Notice of Proposed Rulemaking
Proposed Rule
Additional Documentation
2002-Current Regulations
1950-2001 Regulations
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