In a 14-page decision, Alexander Scott said that her “decision aligns with RIDOH’s leading priorities and guiding principles that will move towards improving the population’s overall health, ensuring improved access to diverse and vulnerable populations, including the elderly and those with disabilities, while providing high-quality services and enhancing patient experience of care.”

The proposal approved by the state Health Services Council in March was fiercely opposed by lobbying groups for hospitals and nursing homes, as well as the current providers of rehab services for hip fractures, strokes, traumatic brain injuries, and similar conditions.

They said the Encompass project would cannibalize rehab services at four hospitals -- Rhode Island, Kent, Fatima, Newport, and a freestanding provider -- and predicted it would drive up the cost of care.

Johnston officials, including Mayor Joseph Polisena, championed the proposal, calling it an economic boost and a benefit to existing providers.

A consultant hired by the state found that Rhode Island has a surplus of rehab beds for another 10 years.

But Alexander-Scott said the Encompass facility will benefit Rhode Island.

She wrote that her decision is based in part on how “Rhode Island residents have a disproportionately low rate of utilization of inpatient rehabilitation services compared to regional and national averages, and a significantly higher utilization of skilled nursing facilities compared to the national average. IRFs [independent rehab facilities] are predominantly used by seniors, with specific qualifications required for Medicare coverage, and [state consultant] FCG [Faulkner Consulting Group] projected insufficient IRF beds if utilization were to increase to regional or national rates. Rhode Island’s segment of the population that is over age 65 is only expected to grow.”

With the new facility, “Patients, receiving necessary treatment in an optimal care setting for their conditions, remain in health care institutional settings for shorter periods of time, are then discharged more rapidly into the community, and have improved patient outcomes that are in line with the overall public health vision for Rhode Islanders,” she wrote.

Teresa Paiva Weed, president of the Hospital Association of RI, said HARI "is disappointed in and disagrees with the decision. We are very concerned about the potential impact it will have on our existing rehabilitation facilities and our employees."

In March, the Health Services Council’s support for Encompass proposal took place with a vote by an unusually small group of members, and debate about whether a quorum was met.

As The Public’s Radio reported, a lawyer for the company succeeded in altering the makeup of the panel shortly before the vote.

A series of influential lobbyists argued for and against the proposal.

Alexander-Scott conditioned her approval on 19 factors, including Encompass paying for five years for a monitor to ensure its compliance with the conditions.

Encompass has said it will pay for the $42 million project by itself.

Alexander-Scott took an unusually long time to make her decision, a situation explained in part by the COVID-10 pandemic.

This report has been updated.