PROVIDENCE — The state Health Department wants every licensed health-care facility to help care for the poor and uninsured, and yesterday morning, draft regulations that would require such spending got their first public airing — and pounding.

Current laws require hospitals and home nursing-care agencies to provide free care for the poor and uninsured. The new rules attempt to “level the playing field” by also mandating charity care by urgent-care centers, outpatient surgical centers, nursing homes, hospice care providers, kidney disease treatment centers and others.

Speakers at yesterday’s informal meeting, which attracted about 50 people, were not happy with the idea. They challenged the Health Department’s authority to require such payments, said the rules imposed impossible administrative and financial burdens, and asserted that these companies already provide free care by accepting patients covered by the state Medicaid program, which pays less than the cost of services.

“Asking us to donate money for charity purposes is ridiculous in my opinion,” said Kathleen M. Lavallee of the Rhode Island Association of Facilities and Services for the Aging, which represents not-for-profit nursing homes. She noted that nearly half of nursing homes lost money 2005, and predicted that soon all will be in the red. “This regulation is going to injure this already fragile industry in Rhode Island.”

Patricia Rocha, lawyer for Blackstone Valley Surgicare and Wayland Square Surgicare, said the surgical centers rely on referrals from doctors and can only do elective surgeries, limiting their ability to attract poor and uninsured patients. “What it is is a tax, a penalty, a fine,” she said. “There is no statutory authority for the department to make this assessment.”

William J. Waters, deputy director of health, said yesterday’s meeting was just the beginning of a discussion on how the state can fairly address the growing problem of uninsured people — who, studies show, get less medical care and have poorer health.

The regulations would require every licensed health-care facility, starting in January 2008, to devote at least 1 percent of its annual net patient revenue to free care for low-income, uninsured Rhode Islanders, or to donate the 1 percent either to a school-based health center or a community health center. The law would affect hospitals by requiring them to reach the 1-percent threshold, which only half of them do now.

People who don’t qualify for health insurance and whose incomes are below 200 percent of the federal poverty level would get free care; those with incomes between 200 and 300 percent of the poverty level would pay on a sliding scale.

Facilities that collect half or more of their revenue from Medicaid would be exempt. The rules would apply equally to for-profit and not-for-profit entities.

Alfred Santos, president of the Rhode Island Health Care Association, which represents for-profit nursing homes, kicked off the discussion with a challenge. “Our attorney says this is unconstitutional,” Santos said. “There is no appearance that the Health Department has the authority to tax without approval of the legislature.”

Waters said later that the statute that empowers the Health Department to license health-care facilities requires it to address patients’ access to care, and he asserted that provision allows the charity-care regulations.

Santos said that 13 nursing homes would be affected by the rules because they have less than 50 percent Medicaid patients. Together, he said, they would owe $887,000 in charity care. “I would suggest they get out of Medicaid,” he said.

Lavallee said that the 15 nonprofit nursing homes in her organization spend $7 million to cover the difference between what Medicaid pays and what the care actually costs. “We provide charity care every day when we accept Medicaid rates,” she said.

Several speakers also questioned the practicality of the regulations, which require patients to fill out forms about their income and assets.

Lavallee said that nursing homes have no ability to verify the accuracy of such information.

With patients moving from emergency room to hospital to home-care agency, Kim Gilbert of Vital Care of Rhode Island asked, “How do we get this information through the pipeline?” Patients could see the same form repeatedly, speakers said.

Alan Tavares, executive director of the Rhode Island Partnership for Home Care, asked whether agencies would be required to check whether an uninsured person was eligible for employer-provided insurance but had declined it. And if someone who looks like charity-care case later turns out to be eligible for Medicaid, would the agency still be able to count the care it provided toward its 1-percent mandate? “We have to clarify, what are we supposed to do here?” he said.

Debra Corey of Assisted Daily Living told of a patient whose insurance ran out, but who delayed applying for Medicare. The patient has no coverage for a month, although technically she was eligible. “I can’t very well right now abandon this patient, but I can’t count that money toward charity care,” she said.

Deborah Griffin of the Hattie Ide Chaffee Home pointed out that UnitedHealthcare of New England has asked the state for permission to send $37 million in profits to its Minnesota parent. She won applause when she said, “Maybe the Health Department should be looking to them to provide charity care.”

The department will accept written comments for two weeks, and will review them before deciding its next step. If the regulations are significantly revised, another community review meeting will be held before taking the regulations to a formal public hearing, Waters said.

“It’s not a panacea, but it’s another way of focusing attention on this issue,” Waters said. “We all want everybody to have good access to high-quality health care on a reasonable basis. … How do we come together as a state and also as a nation … to make that a reality? Obviously the answer has to be a collective decision.”

ffreyer@projo.com