Health Systems Approval Process

The Department of Health has an interest in promoting appropriate access; safe and adequate treatment; and quality improvement in healthcare facilities. As such, initial licensure or a change in ownership, control, or lesse of a healthcare facility in Rhode Island requires approval by the Department of Health, known as a "Change in Effective Control". Healthcare facilities which require this approval include: hospitals, nursing homes, organized ambulatory care facilities, outpatient kidney dialysis facilities, outpatient hospice care facilities, freestanding emergency care facilities, home health care providers

Proposals Subject to Review

Change in Effective Control

Proposed change of owner, operator, or lessee of a healthcare facility: transfer of governance, operational authority, or controlling interest in ownership or governance.

Initial Licensure

Proposed licensure of a: freestanding emergency care facility, kidney disease treatment center, organized abulatory care facility, or birth center.

Criteria for Review and Decision

  1. The character, commitment, competence, and standing in the community of the proposed owner or operator;
  2. The extent to which the facility will continue to provide care without effect on the viability of the facility;
  3. The extent to which the facility will continue to provide safe and adequate treatment for the individuals receiving health care provided by the facility;
  4. The extent to which the facility will continue to provide access to underserved populations, in consideration of proposed continuation or termination of services provided by the facility.


Phase One: Completeness Review

The Department of Health reviews a Change in Effective Control application and determines whether the application is complete. If the application is complete, we will accept it for review within 10 working days of receipt. Otherwise, a deficiency letter will be sent to applicants in cases where the application is deemed incomplete. If the application is determined to be incomplete, we will request the application to be resubmitted with all the additional information incorporated into the resubmitted application.

Phase Two: Criteria Review by the Health Services Council

When the application is determined by the Department of Health to be complete, the Health Services Council reviews the application. The Health Services Council is a statutory advisory council appointed by the Governor, Speaker of the House and President of the Senate that is staffed by the Department of Health.

The public has the opportunity to comment on the application within 30 days public notification and initiation of review, when practicable. All Health Services Council meetings are open to the public.

The entire Initial Licensure application and record is public. The public may request to view the application and the Deparment of Health may post the application on its website.

Based on a review of the application in consideration of the Initial Licensure criteria, the Health Services Council makes an advisory recommendation to the Department of Health to:

  • Approve the application;
  • Reject the application; or
  • Approve the application with conditions.

The process of Health Services Council review and decision may take up to 90 days after initiation of review.

Phase Three: Decision

The Deparment of Health makes a decision on the application considering the Initial Licensure review criteria and the Health Services Council's advisory recommendation.