Licensing of Nursing Facilities (216-RICR-40-10-1)


My Page Title


1.2Incorporated Materials


1.4Certificate of Need Requirements

1.5General Requirements for Licensure

1.6Application for License or for Changes in Owner, Operator, or Lessee

1.7Issuance and Renewal of License

1.8Capacity and Classifications

1.9Change of Ownership, Operation and/or Location


1.11Denial, Suspension, Revocation of License or Curtailment of Activities & Sanctions


1.13Organization and Management


1.15Reporting of Resident Abuse or Neglect, Accidents & Death

1.16Resident Care Services

1.17Special Care Units

1.18Environmental and Maintenance Services

1.19Physical Plant

1.20Confidentiality – Variance and Appeal Procedure

1.21Exception and Severability

1.22Licensing Procedures, Definitions, and Conditions for Resident-Directed Homes

Title 216 Department of Health
Chapter 40 Professional Licensing and Facility Regulation
Subchapter 10 Facilities Regulation
Part 1 Licensing of Nursing Facilities (216-RICR-40-10-1)
Type of Filing Amendment
Regulation Status Inactive
Effective 10/02/2023 to 03/07/2024

Regulation Authority:

R.I. Gen. Laws § 23-17-10
R.I. Gen. Laws § 23-17.5-32
R.I. Gen. Laws § 23-17.5-33

Purpose and Reason:

The Rhode Island Department of Health is proposing the following amendments:

  • § 1.3(A) – Definitions
  • Revised the definition for (6) – "Change in operator"
  • Revised the definition for (7) – "Change in owner"
  • Revised the definition for (9) – "Controlling person"
  • Revised the definition for (18) – "Equity"
  • Added definition for (26) - “Lessee”
  • Added definition for (27) - “Licensee”
  • Added definition for (32) - “Management company”
  • Added definition for (40) - “Nursing facility”
  • Added definition for (45) - “Operator”
  • Added definition for (46) - “Owner”

  • § 1.6 – Added section (D) – “In accordance with R.I. Gen. Laws § 23-17-4(a), a person that owns real property that is being operated by another person as a nursing facility is acting severally or jointly with such other person to conduct or maintain such property as a nursing facility. Accordingly, real property that is being operated as a nursing facility may not be acquired or purchased by a person prior to the Department’s review and approval of such transaction.”
  • § 1.7(F)(1)(c) – added “, including maintenance, throughout the period of licensure, including all subsequent renewals, of the minimum equity position approved by the licensing agency at the time of initial licensure or change in effective control.”
  • § 1.7(F)(2)(a)(1) – added “and the maintenance of same by the licensee throughout the period of licensure, including all renewals thereof”
  • § 1.7.2(A)
  • (1) – added “The Department has authority to reject management agreements for failure to comply with nursing home regulations.”
  • (2) and (3) new sections added

Brief statement of Reason for Finding Imminent Peril:

The Rhode Island Department of Health (RIDOH) is filing this emergency amendment to the Licensure of Nursing Facility regulations (216-RICR-40-10-1) to improve nursing home safety and quality and mitigate any imminent threats to the residents of these facilities.

Since August 2020, six Rhode Island nursing homes have closed and three nursing homes with a total of 472 beds are currently in receivership status, with Court-appointed receivers assuming operational responsibilities.

In RIDOH’s examination into facilities that have closed or are currently under receivership, it has become clear that some of these financial difficulties are a result, in part, of premature transfer of operational and financial control.

RIDOH believes that issuing these amendments will clearly hold operators, licensees, and governing bodies wholly accountable for the care provided to residents.

Specifically, this emergency amendment provides for the following:

  • Equity - requires applicant and licensee to maintain invested interest in the financial viability of the nursing facility from initial licensure through license renewals;
  • Management company - restricts management companies from discharging functions that are reserved to the operator/ licensee/governing body and provide RIDOH with the authority to reject management agreements for failure to comply with nursing home regulations;
  • Operator (a/k/a licensee) - holds the operator accountable  for the day-to-day operation of the nursing facility, including employment and supervision of the nursing facility staff and conducting repairs to the physical plant of the nursing facility;
  • Real Property - requires RIDOH’s review and approval prior to the sale of the nursing facility property; and
  • Penalties - provides for civil monetary penalties and disciplinary actions if a nursing facility, licensee, operator, or manager fails to comply with the Licensure of Nursing Facility regulations (216-RICR-40-10-1) and the enabling statute.

This emergency amendment will take effect upon filing with the Rhode Island Secretary of State.