AN ACT RELATING TO HEALTH AND SAFETY -- DETERMINATION OF NEED FOR NEW HEALTHCARE EQUIPMENT AND NEW INSTITUTIONAL HEALTH SERVICES (Requires all major hospitals within the state constructed or substantially renovated or expanded on or after 1/1/2028 to use renewable energy sources for power.)

S2569

2026 -- S 2569
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LC004048
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO HEALTH AND SAFETY -- DETERMINATION OF NEED FOR NEW
HEALTHCARE EQUIPMENT AND NEW INSTITUTIONAL HEALTH SERVICES

Introduced By:
Senators Kallman, Lauria, DiMario, Valverde, Gu, Britto, Euer, Ujifusa,
Vargas, and Bissaillon

Date Introduced:
February 13, 2026

Referred To:
Senate Health & Human Services
It is enacted by the General Assembly as follows:
1
SECTION 1. Section 23-15-2 of the General Laws in Chapter 23-15 entitled
2
"Determination of Need for New Healthcare Equipment and New Institutional Health Services" is
3
hereby amended to read as follows:
4

23-15-2. Definitions.
5
As used in this chapter:
6
(1) “Affected person” means and includes the person whose proposal is being reviewed, or
7
the applicant, healthcare facilities located within the state that provide institutional health services,
8
the state medical society, the state osteopathic society, those voluntary nonprofit area-wide
9
planning agencies that may be established in the state, the state budget office, the office of health
10
insurance commissioner, any hospital or medical service corporation organized under the laws of
11
the state, the statewide health coordinating council, contiguous health-systems agencies, and those
12
members of the public who are to be served by the proposed, new institutional health services or
13
new healthcare equipment.
14
(2) “Cost-impact analysis” means a written analysis of the effect that a proposal to offer or
15
develop new institutional health services or new healthcare equipment, if approved, will have on
16
healthcare costs and shall include any detail that may be prescribed by the state agency in rules and
17
regulations.
18
(3) “Director” means the director of the Rhode Island state department of health.

1
(4)(i) “Healthcare facility” means any institutional health-service provider, facility or
2
institution, place, building, agency, or portion of them, whether a partnership or corporation,
3
whether public or private, whether organized for profit or not, used, operated, or engaged in
4
providing healthcare services that are limited to hospitals, nursing facilities, home nursing-care
5
provider, home-care provider, hospice provider, inpatient rehabilitation centers (including drug
6
and/or alcohol abuse treatment centers), freestanding emergency-care facilities as defined in § 23-
7
17-2, certain facilities providing surgical treatment to patients not requiring hospitalization (surgi-
8
centers, multi-practice, physician ambulatory-surgery centers and multi-practice, podiatry
9
ambulatory-surgery centers), and facilities providing inpatient hospice care. Single-practice
10
physician or podiatry ambulatory-surgery centers (as defined in
§ 23-17-2(17), (18), respectively

§
11
23-17-2
) are exempt from the requirements of chapter 15 of this title; provided, however, that such
12
exemption shall not apply if a single-practice physician or podiatry ambulatory-surgery center is
13
established by a medical practice group (as defined in § 5-37-1) within two (2) years following the
14
formation of such medical practice group, when such medical practice group is formed by the
15
merger or consolidation of two (2) or more medical practice groups or the acquisition of one
16
medical practice group by another medical practice group. Medical spas as defined in chapter 105
17
of this title are exempt from the requirements of this chapter. The term “healthcare facility” does
18
not include Christian Science institutions (also known as Christian Science nursing facilities) listed
19
and certified by the Commission for Accreditation of Christian Science Nursing
20
Organizations/Facilities, Inc.
21
(ii) Any provider of hospice care who provides hospice care without charge shall be exempt
22
from the provisions of this chapter.
23
(5) “Healthcare provider” means a person who is a direct provider of healthcare services
24
(including but not limited to physicians, dentists, nurses, podiatrists, physician assistants, or nurse
25
practitioners) in that the person’s primary current activity is the provision of healthcare services for
26
persons.
27
(6) “Health services” means organized program components for preventive, assessment,
28
maintenance, diagnostic, treatment, and rehabilitative services provided in a healthcare facility.
29
(7) “Health services council” means the advisory body to the Rhode Island state department
30
of health established in accordance with chapter 17 of this title, appointed and empowered as
31
provided to serve as the advisory body to the state agency in its review functions under this chapter.
32
(8) “Institutional health services” means health services provided in or through healthcare
33
facilities and includes the entities in or through that the services are provided.
34
(9) “New healthcare equipment” means any single piece of medical equipment (and any

LC004048 - Page 2 of 12
1
components that constitute operational components of the piece of medical equipment) proposed
2
to be utilized in conjunction with the provision of services to patients or the public, the capital costs
3
of which would exceed two million two hundred fifty thousand dollars ($2,250,000); provided,
4
however, that the state agency shall exempt from review any application that proposes one-for-one
5
equipment replacement as defined in regulation. Further, beginning July 1, 2012, and each July
6
thereafter, the amount shall be adjusted by the percentage of increase in the consumer price index
7
for all urban consumers (CPI-U) as published by the United States Department of Labor Statistics
8
as of September 30 of the prior calendar year.
9
(10) “New institutional health services” means and includes:
10
(i) Construction, development, or other establishment of a new healthcare facility.
11
(ii) Any expenditure, except acquisitions of an existing healthcare facility, that will not
12
result in a change in the services or bed capacity of the healthcare facility by, or on behalf of, an
13
existing healthcare facility in excess of five million two hundred fifty thousand dollars ($5,250,000)
14
which is a capital expenditure including expenditures for predevelopment activities; provided
15
further, beginning July 1, 2012, and each July thereafter, the amount shall be adjusted by the
16
percentage of increase in the consumer price index for all urban consumers (CPI-U) as published
17
by the United States Department of Labor Statistics as of September 30 of the prior calendar year.
18
(iii) Where a person makes an acquisition by, or on behalf of, a healthcare facility or health
19
maintenance organization under lease or comparable arrangement or through donation, which
20
would have required review if the acquisition had been by purchase, the acquisition shall be deemed
21
a capital expenditure subject to review.
22
(iv) Any capital expenditure that results in the addition of a health service or that changes
23
the bed capacity of a healthcare facility with respect to which the expenditure is made, except that
24
the state agency may exempt from review, by rules and regulations promulgated for this chapter,
25
any bed reclassifications made to licensed nursing facilities and annual increases in licensed bed
26
capacities of nursing facilities that do not exceed the greater of ten (10) beds or ten percent (10%)
27
of facility licensed bed capacity and for which the related capital expenditure does not exceed two
28
million dollars ($2,000,000).
29
(v) Any health service proposed to be offered to patients or the public by a healthcare
30
facility that was not offered on a regular basis in or through the facility within the twelve-month
31
(12) period prior to the time the service would be offered, and that increases operating expenses by
32
more than one million five hundred thousand dollars ($1,500,000), except that the state agency may
33
exempt from review, by rules and regulations promulgated for this chapter, any health service
34
involving reclassification of bed capacity made to licensed nursing facilities. Further, beginning

LC004048 - Page 3 of 12
1
July 1, 2012, and each July thereafter, the amount shall be adjusted by the percentage of increase
2
in the consumer price index for all urban consumers (CPI-U) as published by the United States
3
Department of Labor Statistics as of September 30 of the prior calendar year.
4
(vi) Any new or expanded tertiary or specialty-care service, regardless of capital expense
5
or operating expense, as defined by and listed in regulation, the list not to exceed a total of twelve
6
(12) categories of services at any one time and shall include full-body magnetic resonance imaging
7
and computerized axial tomography; provided, however, that the state agency shall exempt from
8
review any application that proposes one-for-one equipment replacement as defined by and listed
9
in regulation. Acquisition of full body magnetic resonance imaging and computerized axial
10
tomography shall not require a certificate-of-need review and approval by the state agency if
11
satisfactory evidence is provided to the state agency that it was acquired for under one million
12
dollars ($1,000,000) on or before January 1, 2010, and was in operation on or before July 1, 2010.
13
(11) “Person” means any individual, trust or estate, partnership, corporation (including
14
associations, joint stock companies, and insurance companies), state or political subdivision, or
15
instrumentality of a state.
16
(12) “Predevelopment activities” means expenditures for architectural designs, plans,
17
working drawings, and specifications, site acquisition, professional consultations, preliminary
18
plans, studies, and surveys made in preparation for the offering of a new, institutional health
19
service.
20
(13) “State agency” means the Rhode Island state department of health.
21
(14) “To develop” means to undertake those activities that, on their completion, will result
22
in the offering of a new, institutional health service or new healthcare equipment or the incurring
23
of a financial obligation, in relation to the offering of that service.
24
(15) “To offer” means to hold oneself out as capable of providing, or as having the means
25
for the provision of, specified health services or healthcare equipment.
26
SECTION 2. Sections 23-17-2, 23-17-50 and 23-17-57 of the General Laws in Chapter 23-
27
17 entitled "Licensing of Healthcare Facilities" are hereby amended to read as follows:
28

23-17-2. Definitions.
29
As used in this chapter:
30
(1) “Affiliate” means a legal entity that is in control of, is controlled by, or is in common
31
control with another legal entity.
32
(2) “Alzheimer’s dementia special-care unit or program” means a distinct living
33
environment within a nursing facility that has been physically adapted to accommodate the
34
particular needs and behaviors of those with dementia. The unit provides increased staffing;

LC004048 - Page 4 of 12
1
therapeutic activities designed specifically for those with dementia; and trains its staff on an
2
ongoing basis on the effective management of the physical and behavioral problems of those with
3
dementia. The residents of the unit/program have had a standard, medical-diagnostic evaluation
4
and have been determined to have a diagnosis of Alzheimer’s dementia or another dementia.
5
(3) “Certified nurse-teacher” means those personnel certified by the department of
6
elementary and secondary education and employed pursuant to the provisions of §§ 16-21-7 and
7
16-21-8.
8
(4)(i) “Change in operator” means a transfer by the governing body or operator of a
9
healthcare facility to any other person (excluding delegations of authority to the medical or
10
administrative staff of the facility) of the governing body’s authority to:
11
(A) Hire or fire the chief executive officer of the healthcare facility;
12
(B) Maintain and control the books and records of the healthcare facility;
13
(C) Dispose of assets and incur liabilities on behalf of the healthcare facility; or
14
(D) Adopt and enforce policies regarding operation of the healthcare facility.
15
(ii) This definition is not applicable to circumstances wherein the governing body of a
16
healthcare facility retains the immediate authority and jurisdiction over the activities enumerated
17
in subsections (4)(i)(A) — (4)(i)(D).
18
(5) “Change in owner” means:
19
(i) In the case of a healthcare facility that is a partnership, the removal, addition, or
20
substitution of a partner that results in a new partner acquiring a controlling interest in the
21
partnership;
22
(ii) In the case of a healthcare facility that is an unincorporated, solo proprietorship, the
23
transfer of the title and property to another person;
24
(iii) In the case of a healthcare facility that is a corporation:
25
(A) A sale, lease exchange, or other disposition of all, or substantially all, of the property
26
and assets of the corporation; or
27
(B) A merger of the corporation into another corporation; or
28
(C) The consolidation or two (2) or more corporations, resulting in the creation of a new
29
corporation; or
30
(D) In the case of a healthcare facility that is a business corporation, any transfer of
31
corporate stock that results in a new person acquiring a controlling interest in the corporation; or
32
(E) In the case of a healthcare facility that is a nonbusiness corporation, any change in
33
membership that results in a new person acquiring a controlling vote in the corporation.
34
(6) “Clinician” means a physician licensed under chapter 37 of title 5; a nurse licensed

LC004048 - Page 5 of 12
1
under chapter 34 of title 5; a psychologist licensed under chapter 44 of title 5; a social worker
2
licensed under chapter 39.1 of title 5; a physical therapist licensed under chapter 40 of title 5; and
3
a speech language pathologist or audiologist licensed under chapter 48 of title 5 or physician
4
assistant licensed under the provisions of chapter 54 of title 5.
5
(7) “Director” means the director of the Rhode Island state department of health.
6
(8) “Freestanding emergency-care facility” means an establishment, place, or facility that
7
may be a public or private organization, structurally distinct and separate from a hospital; staffed,
8
equipped, and operated to provide prompt, emergency medical care. For the purposes of this
9
chapter, “emergency medical care” means services provided for a medical condition or behavioral-
10
health condition that is manifested by symptoms of sufficient severity that, in the absence of
11
immediate medical attention, could result in harm to the person or others; serious impairment to
12
bodily functions; serious dysfunction of any bodily organ or part; or development or continuance
13
of severe pain.
14
(9) “Healthcare facility” means any institutional health-service provider, facility, or
15
institution, place, building, agency, or portion thereof, whether a partnership or corporation,
16
whether public or private, whether organized for profit or not, used, operated, or engaged in
17
providing healthcare services, including, but not limited to: hospitals; nursing facilities; home
18
nursing-care provider (which shall include skilled nursing services and may also include activities
19
allowed as a home-care provider or as a nursing service agency); home-care provider (which may
20
include services such as personal care or homemaker services); rehabilitation centers; kidney
21
disease treatment centers; health maintenance organizations; freestanding emergency-care facilities
22
as defined in this section, and facilities providing surgical treatment to patients not requiring
23
hospitalization (surgi-centers); hospice care; and physician ambulatory-surgery centers and
24
podiatry ambulatory-surgery centers providing surgical treatment. The term “healthcare facility”
25
also includes organized ambulatory-care facilities that are not part of a hospital but that are
26
organized and operated to provide healthcare services to outpatients, such as: central-services
27
facilities serving more than one healthcare facility or healthcare provider; treatment centers;
28
diagnostic centers; outpatient clinics; medical spas as defined in chapter 105 of this title; infirmaries
29
and health centers; school-based health centers, and neighborhood health centers. The term
30
“healthcare facility” also includes a mobile health-screening vehicle as defined in this section. The
31
term “healthcare facility” shall not apply to organized, ambulatory-care facilities owned and
32
operated by professional service corporations as defined in chapter 5.1 of title 7, as amended (the
33
“professional service corporation law”), or to a practitioner’s (physician, dentist, or other healthcare
34
provider) office or group of practitioners’ offices (whether owned and/or operated by a hospital or

LC004048 - Page 6 of 12
1
an affiliate of a hospital or an individual practitioner, alone or as a member of a partnership,
2
professional service corporation, organization, or association); provided, however, notwithstanding
3
any other provision herein or in the general laws, any hospital or any affiliate of a hospital that
4
owns and/or operates a practitioner’s office shall ensure that such practitioner’s office complies
5
with licensing or accreditation requirements that may be applicable to the practitioner’s office.
6
Individual categories of healthcare facilities shall be defined in rules and regulations promulgated
7
by the licensing agency with the advice of the health services council. Rules and regulations
8
concerning hospice care shall be promulgated with regard to the “Standards of a Hospice Program
9
of Care,” promulgated by the National Hospice Organization. Any provider of hospice care who
10
provides hospice care without charge shall be exempt from the licensing provisions of this chapter
11
but shall meet the “Standards of a Hospice Program of Care.” Facilities licensed by the department
12
of behavioral healthcare, developmental disabilities and hospitals and the department of human
13
services, and clinical laboratories licensed in accordance with chapter 16.2 of this title, as well as
14
Christian Science institutions (also known as Christian Science Nursing Facilities) listed and
15
certified by the Commission for Accreditation of Christian Science Nursing
16
Organizations/Facilities, Inc. shall not be considered healthcare facilities for purposes of this
17
chapter.
18
(10) “Homemaker,” or however else called, means a trained, nonprofessional worker who
19
performs related housekeeping services in the home for the sick, disabled, dependent, or infirm,
20
and as further defined by regulation; the director shall establish criteria for training.
21
(11) “Hospital” means a person or governmental entity licensed in accordance with this
22
chapter to establish, maintain, and operate a hospital.
23
(12) “Licensing agency” means the Rhode Island state department of health.
24

(13) “Major hospital” means a large, comprehensive acute care facility, offering extensive
25
specialized services, advanced technology, emergency capabilities, and significant research and
26
teaching roles.
27

(13)
(14)
“Medical services” means any professional services and supplies rendered by, or
28
under the direction of, persons duly licensed under the laws of this state to practice medicine,
29
surgery, or podiatry that may be specified by any medical service plan. Medical service shall not
30
be construed to include hospital services.
31

(14)
(15)
“Mobile health-screening vehicle” means a mobile vehicle, van, or trailer that
32
delivers primary and preventive healthcare screening services, and:
33
(i) Does not maintain active contracts or arrangements with any health insurer subject to
34
regulation under chapter 20 or 42 of title 27;

LC004048 - Page 7 of 12
1
(ii) Does not maintain active contracts or arrangements with another licensed healthcare
2
facility as that term is defined within this section; and
3
(iii) Does not provide medical services free of charge.
4

(15)
(16)
“Non-English speaker” means a person who cannot speak or understand, or has
5
difficulty in speaking or understanding, the English language, because he/she uses only, or
6
primarily, a spoken language other than English, and/or a person who uses a sign language and
7
requires the use of a sign-language interpreter to facilitate communication.
8

(16)
(17)
“Person” means any individual, trust or estate, partnership, corporation (including
9
associations, joint stock companies, and insurance companies), state, or political subdivision or
10
instrumentality of a state.
11

(17)
(18)
“Physician ambulatory-surgery center” means an office, or portion of an office,
12
that is utilized for the purpose of furnishing surgical services to the owner and/or operator’s own
13
patients on an ambulatory basis, and shall include both single-practice, physician ambulatory-
14
surgery centers and multi-practice, physician ambulatory-surgery centers. A “single-practice,
15
physician ambulatory-surgery center” is a physician ambulatory center owned and/or operated by
16
a physician-controlled professional service corporation as defined in chapter 5.1 of title 7 (the
17
“professional service corporation law”), or a physician-controlled limited liability company (as
18
defined in chapter 16 of title 7 (the “limited liability company act”)) in which no physician is an
19
officer, shareholder, director, or employee of any other corporation engaged in the practice of the
20
same profession, or a private physician’s office (whether owned and/or operated by an individual
21
practitioner, alone or as a member of a partnership, professional service corporation, limited
22
liability company, organization, or association). A “multi-practice, physician ambulatory-surgery
23
center” is a physician ambulatory-surgery center owned and/or operated by a physician-controlled
24
professional service corporation (as defined in the professional service corporation law) or a
25
physician-controlled limited liability company (as defined in the limited liability company act) in
26
which a physician is also an officer, shareholder, director, or employee of another corporation
27
engaged in the practice of the same profession, or a group of physicians’ offices (whether owned
28
and/or operated by an individual practitioner, alone or as a member of a partnership, professional
29
service corporation, limited liability company, organization, or association).
30

(18)
(19)
“Podiatry ambulatory-surgery center” means an office or portion of an office that
31
is utilized for the purpose of furnishing surgical services to the owner and/or operator’s own
32
patients on an ambulatory basis, and shall include both single-practice, podiatry ambulatory-
33
surgery centers and multi-practice podiatry ambulatory-surgery centers. A “single-practice podiatry
34
ambulatory-surgery center” is a podiatry ambulatory center owned and/or operated by a podiatrist-

LC004048 - Page 8 of 12
1
controlled professional service corporation (as defined in chapter 5.1 of title 7 (the “professional
2
service corporation law”)), or a podiatrist-controlled limited liability company (as defined in
3
chapter 16 of title 7 (the “limited liability company act”)) in which no podiatrist is an officer,
4
shareholder, director, or employee of any other corporation engaged in the practice of the same
5
profession, or a private podiatrist’s office (whether owned and/or operated by an individual
6
practitioner, alone or as a member of a partnership, professional service corporation, limited
7
liability company, organization, or association). A “multi-practice, podiatry ambulatory-surgery
8
center” is a podiatry ambulatory-surgery center owned and/or operated by a podiatrist-controlled
9
professional service corporation (as defined in the professional service corporation law) or a
10
podiatrist-controlled, limited liability company (as defined in the limited liability company act) in
11
which a podiatrist is also an officer, shareholder, director, or employee of another corporation
12
engaged in the practice of the same profession, or a group of podiatrists’ offices (whether owned
13
and/or operated by an individual practitioner, alone or as a member of a partnership, professional
14
service corporation, limited liability company, organization, or association).
15

(19)
(20)
“Qualified interpreter” means a person who, through experience and/or training,
16
is able to translate a particular foreign language into English, with the exception of sign-language
17
interpreters who must be licensed in accordance with chapter 71 of title 5.
18

(20)
(21)
“Qualified sign-language interpreter” means one who has been licensed in
19
accordance with the provisions of chapter 71 of title 5.
20

(21)
(22)
“School-based health center” means a facility located in an elementary or
21
secondary school licensed as a school-based health center that delivers primary and/or preventive
22
healthcare services to individuals to include, but not be limited to, students on site.
23

23-17-50. Physician ambulatory-surgery center — Accreditation, survey, complaint
24
investigation, and exemptions.
25
(a) Accreditation from a national organization acceptable to the director may be required,
26
at the discretion of the director, in lieu of an annual survey by the department.
27
(b) The provisions of subsection (a) shall not limit in any way the prerogatives of the
28
director to inspect any physician ambulatory-surgery center at any reasonable time, whether for
29
purpose of general survey or for complaint investigation. The director has access to all records of
30
the licensed physician ambulatory-surgery center including medical records.
31
(c) Single practice physician ambulatory-surgery centers as defined in
§ 23-17-2(17)

§ 23-
32
17-2
are exempt from the requirements of chapter 15 of this title.
33
(d) Single practice physician ambulatory-surgery centers as defined in
§ 23-17-2(17)

§ 23-
34
17-2
are exempt from the provisions of §§ 23-17-14.3 and 23-17-14.4 with respect to initial

LC004048 - Page 9 of 12
1
licensure under this chapter.
2

23-17-57. Podiatry ambulatory-surgery center — Accreditation, survey, complaint
3
investigation, and exemptions.
4
(a) Accreditation from a national organization acceptable to the director may be required,
5
at the discretion of the director, in lieu of an annual survey by the department.
6
(b) The provisions of subsection (a) shall not limit in any way the prerogatives of the
7
director to inspect any podiatry ambulatory-surgery center at any reasonable time, whether for
8
purpose of general survey or for complaint investigation. The director has access to all records of
9
the licensed podiatry ambulatory-surgery center including medical records.
10
(c) Single practice podiatry ambulatory-surgery centers as defined in §
23-17-2(18)

§ 23-
11
17-2
are exempt from the requirements of chapter 15 of this title.
12
(d) Single practice podiatry ambulatory-surgery centers as defined in
§ 23-17-2(18)

§ 23-
13
17-2
are exempt from the provisions of §§ 23-17-14.3 and 23-17-14.4 with respect to initial
14
licensure under this chapter.
15
SECTION 3. Chapter 23-17 of the General Laws entitled "Licensing of Healthcare
16
Facilities" is hereby amended by adding thereto the following section:
17

23-17-9.1. Mandatory conversion of major hospitals to renewable energy.

18

(a) On and after January 1, 2028 all new construction of a major hospital as defined in §23-
19
17-2; all renovations and replacements of a value in excess of fifty percent (50%) of a major
20
hospital; and any extension or increase in floor area, number of stories or height of a major hospital
21
within the state, shall not install or use any heating systems that utilizes fossil fuel, natural or
22
propane gas, air or water heating systems, except as provided in subsection (b) of this section.
23

(b) Notwithstanding the provisions of subsection (a) of this section, systems for emergency
24
back-up power at major hospitals within the state, shall be exempt; provided however, those
25
buildings shall seek to minimize emissions and maximize health and safety for non-back-up
26
systems.
27

(c) During any inspection of a major hospital by an inspector, building official, or other
28
local official responsible for code enforcement, the inspector or official may inspect for compliance
29
with this section.
30

(d) The building codes standards committee shall adopt and promulgate all rules and
31
regulations required to implement the purposes of this section.

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1
SECTION 4. This act shall take effect upon passage.
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LC004048
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO HEALTH AND SAFETY -- DETERMINATION OF NEED FOR NEW
HEALTHCARE EQUIPMENT AND NEW INSTITUTIONAL HEALTH SERVICES
***
1
This act would require all major hospitals within the state constructed or substantially
2
renovated or expanded on or after January 1, 2028 to use renewable energy sources for power. The
3
building code standards committee would promulgate rules and regulations to implement the
4
requirements.
5
This act would take effect upon passage.
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LC004048
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