Long-Term Care Facility COVID-19 Procedures
216-RICR-40-10-27 INACTIVE RULE EMERGENCY RULE
These regulations are promulgated pursuant to the authority conferred under R.I. Gen. Laws §§ 23-1-1, 23-17-10 and 23-17.4-10 and are established for the purpose of establishing COVID-19 procedures for long-term care facility personnel, residents, visitors and essential caregivers.
A.Wherever used in this Part the following terms shall be construed as follows:
1."COVID-19" means the disease caused by novel coronavirus SARS-CoV-2 and its variants.
2."Declaration of disaster emergency" means a disaster emergency declared by the Governor pursuant to R.I. Gen. Laws § 30-15-9.
3."Department" or "RIDOH" means the Rhode Island Department of Health.
4."Direct resident contact" means, as used herein, any routinely anticipated face-to-face interaction with a resident of a long-term care facility.
5."Essential caregiver" means an individual whether family member or friend of a resident of a long-term care facility, who is designated by the resident or appointed by an individual with decision-making authority for the resident, to provide physical or emotional support to the resident during a declaration of disaster emergency.
6."Long-term care facility" or "facility" means and includes assisted living residences licensed under R.I. Gen. Laws Chapter 23-17.4 and nursing facilities licensed under the provisions of R.I. Gen. Laws Chapter 23-17.
7."Mask" or "Masking" means the wearing of a cloth or paper mask. At a minimum, masks shall:
a. Cover nose and mouth and be secured under the chin;
b. Fit snugly against the side of one's face with no gaps; and
c. Not have exhalation valves or vents.
8."Personnel" means employees as well as volunteers, students, trainees, and any individuals, whether paid or unpaid, directly employed by or under contract with the long-term care facility on a part time or full-time basis.
9."Proof of Vaccination" means an official immunization card, health record, and/or paper/electronic documentation of receiving all doses as recommended by the Center for Disease Control and Prevention (CDC) and authorized by the U.S. Food and Drug Administration (FDA) or World Health Organization (WHO) or all recommended dose(s) of another COVID-19 vaccine approved by the Department (e.g., Novavax).
10."Vaccinated" means a person has received all dose(s) of a COVID-19 vaccine recommended by the CDC and authorized by the FDA or WHO or all recommended dose(s) of another COVID-19 vaccine approved by the Department (e.g., Novavax).
11."Visitor" means and includes family members, friends, or other persons who visit or otherwise assisted the care of a resident in a long-term care facility. "Visitors” also includes persons who enter the long-term care facility and have direct resident contact.
27.3COVID-19 Practices and Procedures
A.Nursing facilities must test personnel and residents in accordance with § 1.13.7 of this Subchapter.
B.Assisted living residences must test personnel and residents in accordance with § 2.4.31 of this Subchapter.
27.4COVID-19 Vaccination Monitoring and Reporting
Each long-term care facility shall ensure their personnel are vaccinated for COVID-19 in accordance with Part 20-15-8 of this Title and § 2.4.31(C) of this Subchapter.
27.5Proof of Vaccination or Testing for Visitors
A.Prior to entering a long-term care facility, a visitor/essential caregiver must either:
1.Provide proof of vaccination against COVID-19; or
a.With permission of visitors/essential caregivers, the long-term care facility may maintain the visitor/essential caregiver's proof of COVID-19 vaccination such that visitors/essential caregivers do not have to provide proof of vaccination against COVID-19 upon successive visits. The facility must take reasonable efforts to maintain the confidentiality of this information for the benefit of visitors/essential caregivers.
2.Provide paper or electronic proof of a negative COVID-19 test result from either:
a.A rapid antigen test (e.g., BinaxNOW) completed within the previous forty-eight (48) hours; or
b.A polymerase chain reaction (PCR) test completed within the previous seventy-two (72) hours.
B.Long term care facilities shall deny entrance to any visitors/essential caregivers who do not show proof of vaccination or a negative test result against COVID-19, as set forth in § 27.5 of this Part.
C.Prior to entering a long-term care facility and at all times until exiting the premises, a visitor/essential caregiver must be masked, regardless of vaccination status, and must keep the mask on throughout the duration of the visit with the resident. The facility shall deny entrance to any visitor/essential caregiver who refuses to do so, subject to the following exceptions:
1.Visitors under two (2) years of age; or
2.Visitors/essential caregivers having a medical condition, mental health condition, or a disability that prevents wearing a mask.
D.Each long-term care facility must post signage for masking and either negative test, and/or proof of visitor/essential caregiver vaccination at all entrances to the residence. Examples of such signage are available here:
E.If a long-term care facility posts its own signage, at a minimum, such a signage must state in bold-print, one of the following
1.MASKS ARE REQUIRED IN THIS FACILITY; and
2.PROOF OF COVID-19 VACCINATION OR A NEGATIVE COVID-19 TEST RESULT IS REQUIRED IN THIS FACILITY.
|Title||216||Department of Health|
|Chapter||40||Professional Licensing and Facility Regulation|
|Part||27||Long-Term Care Facility COVID-19 Procedures|
|Type of Filing||Adoption|
|Effective||01/10/2022 to 05/10/2022|
R.I. Gen. Laws § 23-1-1
R.I. Gen. Laws § 23-17-10
R.I. Gen. Laws § 23-17.4-10
Purpose and Reason:
To provide COVID-19 procedures for long-term care facilities regarding testing of residents and personnel; collecting vaccination status of personnel; and provide requirements for visitors and essential caregivers to enter the facility.
Brief statement of Reason for Finding Imminent Peril:
The Rhode Island Department of Health (RIDOH) is filing a new emergency regulation, effective upon filing with the Rhode Island Secretary of State, entitled “Long-Term Care Facility COVID-19 Procedures” (216-RICR-40-10-27), that requires long-term care facilities, specifically nursing facilities and assisted living residences, to deny entrance to any visitors, including essential caregivers, who do not provide proof of vaccination against COVID-19. For those who are not vaccinated against COVID-19, proof of a negative polymerase chain reaction (PCR) COVID-19 test completed within the previous 72 hours or proof of a negative test result from a point-of-care rapid antigen test (e.g., Binax NOW) completed within the previous 48 hours must be provided to long-term care facility staff prior to entry.
Additionally, a visitor must keep a mask on throughout the duration of a visit with a resident.
RIDOH anticipates that these mandatory requirements will be time-limited. Rhode Island is experiencing a sharp increase in COVID-19 cases. The uptick in cases may be driven by the speed at which the new Omicron variant is spreading. Omicron arrived in the United States around Thanksgiving and during the week of December 12 – December 18, 2021, Omicron accounted for 73 percent of all new infections, according to the Centers for Disease Control and Prevention.
Rhode Island is in a period of high COVID-19 transmission. As of December 23, 2021, there were 728.5 new cases per 100,000 persons in the last seven days in Rhode Island, with a test positivity rate of 6.1 percent. Of approximately 1.1 million residents, 794,940 (72%) are fully vaccinated against COVID-19. 
According to a report from the United Kingdom (UK), which may be predictive for the United States, Omicron cases were multiplying at a pace of 35 percent per day. “There are legitimate concerns about the trajectory of the newest variant, Omicron, and public health experts are paying close attention to the exponentially mounting cases, particularly in the United Kingdom, which in the past has functioned a canary in the Covid-19 coal mine for the U.S.”
The relationship between case fatality rates and the Omicron variant is still emerging: “With Omicron, however, we not only don’t see the rise in death rates that were associated with the first waves, but we actually see a continuing decline in death rates, despite a radical increase in cases. Whether or not this breakdown of the relationship between Omicron cases and deaths will play out in other countries, like the U.S., is hard to say,” according to STAT NEWS reporter Duane Schulthess. 
It is important to point out that earlier in the pandemic (2020), Kaiser Family Foundation reported that Rhode Island was one of two states that had the highest percentage (78%) of long-term care deaths as a share of total state deaths. COVID-19’s impact on the vulnerable long-term care population has been dramatic and disproportionate to the general population. RIDOH’s goal is to mitigate COVID’s effects on this population by requiring long-term care facilities to screen visitors for proof of COVID-19 vaccination and to have visitors mask up while in the facility.
The COVID-19 pandemic continues to have a profoundly disruptive effect on the lives of Rhode Island’s nursing home and assisted living residents and their families, particularly as the second year of the pandemic draws to a close.
These emergency regulations are intended to protect nursing home and assisted living residents’ lives; maintain safety in Rhode Island long-term care facilities; and avoid imminent peril during this challenging time by requiring proof of vaccination against COVID-19 and mask-wearing throughout the duration of a visit with a long-term care resident.
 See: Rhode Island Department of Health, COVID-19 Data Tracker, Available here: RI Department of Health COVID-19 Response Data Hub (arcgis.com) Accessed December 23, 2021.
 See: UK Health Security Agency, SARS-CoV-2 variants of concern and variants under investigation (publishing.service.gov.uk), Technical Briefing #31, December 10, 2021.
 See: Schulthess, Duane, “An Omicron oddity: The number of cases doesn’t predict the number of deaths.” STAT NEWS, December 22, 2021 and available here: An Omicron oddity: unlinking case rates and death rates - STAT (statnews.com) Accessed December 23, 2021.
 Ibid at page 3.
 See: Kaiser Family Foundation, State Data and Policy Actions to Address Coronavirus, November 2020. Available online at: https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-coronavirus/