Hospital Merger / Conversion Review Process

The Hospital Conversion / Mergers Program works to assure the viability of a safe, accessible and affordable healthcare system that is available to all Rhode Islanders. more

Proposals Subject to Review

Since 1997, transfers of 20% or more of ownership, assets, membership interest, authority or control of a hospital in Rhode Island require approval by both the Department of Health and the Rhode Island Department of the Attorney General (RIAG) under the authority of the Hospital Conversions Act (HCA).

Review Criteria

The Department of Health reviews completed applications in consideration of nine statutory criteria:

  1. Satisfactory character, commitment, competence, and standing in the community;
  2. Sufficient safeguards to assure the affected community continued access to affordable care;
  3. Satisfactory evidence to provide healthcare and access for traditionally underserved populations in the affected community;
  4. Procedures or safeguards to ensure that ownership interests will not be used as incentives for hospital employees or physicians to refer patients to the hospital;
  5. Commitment to assure the continuation of collective bargaining rights and workplace retention;
  6. Estimated future employment needs under the conversion, and retraining of employees who may be impacted by the proposed restructuring;
  7. Demonstration that public interest will be served, including access to essential medical services needed to provide safe and adequate treatment, and assurance of a balanced healthcare delivery system;
  8. Issues of market share, especially as they affect quality, access, and affordability of services; and
  9. Applicants must meet the Conditions of Approval for any previous Conversion under the Act (For-Profit conversions only)


Upon submission of an application, the Department of Health reviews the submission to determine if it is complete. If the application is determined to be incomplete, the applicants are advised of the additional information required to complete the application.Once the application is complete, the Department of Health reviews the application in consideration of statutory criteria. Public input is sought through written comment and public meetings.


Within 180 days of the determination that an application is complete, the Director of Health issues a decision on the application. The Director’s decision may be to approve the application, to reject the application, or to approve the application with conditions. more

Completed Decisions