AN ACT RELATING TO HEALTH AND SAFETY -- THE HOSPITAL CONVERSIONS ACT (Prohibits the closure or significant reduction of services of a birthing center without notice, application, financial disclosure, public hearing, and approval by the department of health.)

H7272

2026 -- H 7272
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LC003208
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
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A N A C T
RELATING TO HEALTH AND SAFETY -- THE HOSPITAL CONVERSIONS ACT

Introduced By:
Representatives Carson, Cortvriend, Fogarty, McGaw, Edwards,
Finkelman, Alzate, Donovan, Shallcross Smith, and Boylan

Date Introduced:
January 23, 2026

Referred To:
House Health & Human Services
It is enacted by the General Assembly as follows:
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SECTION 1. Legislative findings. The general assembly finds and declares that:
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(1) Birthing centers, including freestanding centers and hospital-operated birthing units,
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play a critical role in ensuring safe, timely, and equitable access to maternal, perinatal, and newborn
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care across Rhode Island.
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(2) The closure or reduction of birthing centers has significant consequences for maternal
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morbidity and mortality, newborn outcomes, emergency transport times, and regional healthcare
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capacity.
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(3) Rhode Island law does not require sufficient advance notice, public transparency, or
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rigorous financial review before a birthing center is closed or its operations are significantly
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reduced.
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(4) Given ongoing consolidation within regional healthcare systems, it is essential that the
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state receive complete and accurate financial information, including system-level data, to determine
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whether a birthing center's closure is truly unavoidable.
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(5) It is in the public interest to establish a strong review process requiring advance notice,
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robust financial disclosure, community engagement, and independent analysis to protect Rhode
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Island families, particularly in underserved and high-risk communities.
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SECTION 2. Chapter 23-17.14 of the General Laws entitled "The Hospital Conversions
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Act" is hereby amended by adding thereto the following section:
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23-17.14-18.1. The Rhode Island birthing center access, transparency, and financial

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accountability act of 2026.
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(a) For purposes of this section:
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(1) "Applicant" means the birthing center submitting an application pursuant to subsection
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(d) of this section.
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(2) "Birthing center" means any freestanding birthing center licensed under chapter 17 of
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title 23, and any birthing unit, maternity unit, perinatal unit, or labor-and-delivery service operated
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by a hospital or healthcare facility.
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(3) "Closure" means the permanent cessation of all birthing services at a birthing center.
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(4) "Closure application" means the application required by subsection (d) of this section.
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(5) "Discontinuation of services" means the cessation of any prenatal, perinatal,
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postpartum, or birthing-related service or program offered by a birthing center without complete
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closure of the facility.
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(6) "Significant reduction" or "significantly reduced" means:
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(i) A reduction of twenty-five percent (25%) or more in capacity or annual volume;
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(ii) A reduction in operating hours by twenty-five percent (25%) or more;
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(iii) Elimination of labor, delivery, or postpartum services; or
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(iv) Any relocation of birthing-related services outside the municipality in which the
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service is currently located.
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(b) No birthing center shall be closed, terminated, relocated, or significantly reduced
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without the prior written approval of the director of the department of health.
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(c) A facility proposing closure or significant reduction of a birthing center shall file a
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closure application with the director of the department of health no fewer than one hundred eighty
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(180) days prior to the proposed effective closure date. Notice shall also be provided to:
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(1) The city or town council within the municipality in which the birthing center is located;
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(2) The birthing center's patients and personnel;
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(3) The patient advocacy groups within the state that support maternal and child health;
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(4) All local EMS agencies;
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(5) Local and state media outlets by written publication; and
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(6) The speaker of the house and the president of the senate.
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(d) Prior to the discontinuation or significant reduction of services at a birthing center, its
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controlling officers shall provide a closure application to the director of the department of health,
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the contents of which shall be a considered public record and posted on the department of health's
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website. The closure application shall include:
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(1) An access impact assessment that details:

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(i) The number of beds within the impacted birthing unit;
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(ii) The number of existing patients within the impacted birthing unit;
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(iii) The number of employees and staff within the impacted birthing unit;
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(iv) Affected healthcare services for traditionally underserved populations;
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(v) Affected healthcare services for the affected community; and
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(vi) Other licensed birthing centers in the affected community and the distance of those
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facilities to the applicant's birthing center.
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(2) A detailed evaluation of:
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(i) Annual deliveries, prenatal visits, postpartum care, and newborn services;
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(ii) Impact on high-risk pregnancies, low-income families, and Medicaid members;
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(iii) EMS transport impacts; and
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(iv) Projected changes in maternal morbidity and newborn outcomes.
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(3) A patient transition plan, including:
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(i) Protocols for laboring patient transfers;
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(ii) EMS and hospital coordination;
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(iii) Continuity plans for prenatal patients beyond twenty (20) weeks gestation;
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(iv) Transfer agreements with receiving hospitals or birthing centers; and
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(v) Protocols for the storage of and access to medical records.
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(4) Workforce plan, including detailed descriptions of:
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(i) Staffing levels;
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(ii) Proposed layoff or reassignment plans; and
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(iii) Transition plans for licensed midwives, doulas, nurses, and obstetric clinicians.
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(5) Financial justification, certified by a certified public accountant, including:
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(i) Five (5) years of audited financial statements for the birthing center and operating
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hospital, if applicable, parent health system, and all controlled affiliates, subsidiaries, and
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management entities;
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(ii) Detailed service-level financials, including, revenues, expenses, and margins, volume
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trends, overhead allocation methodology, and documentation of any staffing cuts, resource
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reductions, or underinvestment contributing to financial decline;
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(iii) Five (5) year forward projection, including, break-even analyses, capital investment
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needs, labor costs, and sensitivity analyses for multiple scenarios; and
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(iv) Parent system financial capacity review, including, reserves and unrestricted funds,
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cash on hand, investments and endowment holdings, executive compensation, and intercompany
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transfers or management fees.

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(6) Comparative analysis of at least three (3) alternatives to closure including, but not
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limited to, shared staffing models, partnerships with community providers or regional systems,
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cross-subsidization by the parent system, and/or redesign or modernization; and
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(7) The applicant's controlling officers shall certify that neither the birthing center nor
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parent system engaged in actions that materially contributed to financial instability including, but
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not limited to, understaffing, reduction of capital investment, curtailment of marketing or referral
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pathways, diversion of patients, and/or failure to pursue available external funding.
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(e) The director of the department of health shall deny a closure application that fails to
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satisfy the requirements of this section.
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(f) An independent expert, selected by the department of health and paid for by the
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applicant, shall evaluate sustainability, feasible restructuring alternatives, and pathways to avoid
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closure or significant reduction of services.
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(g)(1) Within sixty (60) days of receiving the notice required by subsection (c) of this
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section, the director of the department of health shall hold a public hearing. The applicant's
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controlling officers shall attend the public hearing and members of the public shall be permitted to
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participate and offer testimony; the director of the department of health shall provide twenty-one
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(21) days written notice on the department of health's website of the date, time, and location of the
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public hearing.
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(2) Within thirty (30) days of receiving a closure application that satisfies the requirements
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of subsection (d) of this section, the director of the department of health shall hold a public hearing.
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The applicant's controlling officers shall attend the public hearing and members of the public shall
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be permitted to participate and offer testimony; the director of the department of health shall
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provide twenty-one (21) days written notice on the department of health's website of the date, time,
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and location of the public hearing.
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(h) The director of the department of health shall not approve an application submitted
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pursuant to subsection (d) of this section unless the applicant demonstrates, by clear and convincing
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evidence, that:
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(1) The birthing center cannot reasonably be sustained through restructuring, alternative
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staffing models, or system-level financial support;
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(2) No feasible alternatives exist that would maintain safe and accessible birthing services;
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(3) Closure shall not exacerbate maternal, newborn, racial, economic, or geographic
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disparities; and
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(4) Adequate, timely, and safe birthing access shall remain for the affected population.
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(i) Notwithstanding any other provision in the general laws, the director of the department

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of health shall have the sole authority to review all applications submitted under this section and
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shall issue a written decision within ninety (90) days of the public hearing that follows the
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applicant's submission of the completed closure application. The decision of the director of the
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department of health shall approve, deny, or approve with conditions, the closure application.
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(j) The department of health shall not amend a facility license issued pursuant to chapter
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17 of title 23 to remove a birthing center unless the requirements of this section have been fulfilled.
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(k) Failure to comply with the requirements of this section shall subject the entity required
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to comply with the provisions of this section to civil penalties not to exceed twenty-five thousand
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dollars ($25,000) per violation. Each day of noncompliance shall constitute a separate violation.
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(l) The department of health shall adopt rules and regulations to implement and enforce the
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provisions of this section.
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SECTION 3. This act shall take effect upon passage.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO HEALTH AND SAFETY -- THE HOSPITAL CONVERSIONS ACT
***
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This act would prohibit the closure or significant reduction of services of a birthing center
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without notice, application, financial disclosure, public hearing, and approval by the department of
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health.
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This act would take effect upon passage.
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