Table of Contents Sec. 19a-610. Short title: Office of Health Care Access Act. Sections 19a-610
to 19a-662, inclusive, shall be known and may be cited as the "Office of Health Care
Access Act". Sec. 19a-611. Definitions. As used in sections 19a-610 to 19a-614, inclusive: Sec. 19a-612. Office of Health Care Access: Established. Commissioner: Appointment and qualifications. There is established an Office of Health Care Access.
The powers of the office shall be vested in and exercised by a commissioner who shall
be appointed by the Governor in accordance with the provisions of sections 4-5 to 4-8,
inclusive. Said commissioner shall have (1) a graduate degree and (2) a minimum of
ten years' experience in the field of financial management, health insurance, hospital
administration or a combination of such experience. Sec. 19a-612a. Office within Department of Public Health for administrative
purposes only. The Office of Health Care Access, established pursuant to section 19a-
612, shall be within the Department of Public Health for administrative purposes only. Sec. 19a-612b. Office of Health Care Access to be successor agency to the Commission on Hospitals and Health Care. (a) The Office of Health Care Access shall
constitute a successor agency to the Commission on Hospitals and Health Care, in accordance with the provisions of sections 4-38d and 4-39. Sec. 19a-612c. Term "Commission on Hospitals and Health Care" deemed to
mean "Office of Health Care Access". (a) On and after July 1, 1995, wherever the
word "commission" is used or referred to in the following sections of the general statutes,
the word "office" shall be substituted in lieu thereof and whenever the words "Commission on Hospitals and Health Care" are used or referred to in the following sections of
the general statutes, the words "Office of Health Care Access" shall be substituted in
lieu thereof: 1-84, 1-84b, 12-263a, 17a-678, 17b-234, 17b-240, 17b-352, 17b-353, 17b-
356, 19a-499, 19a-507, 19a-509b, 19a-535b, 19a-633, 19a-635, 19a-636, 19a-638 to
19a-650, inclusive, 19a-653, 19a-654, 19a-660 to 19a-662, inclusive, 19a-669 to 19a-
671, inclusive, 19a-674 to 19a-679, inclusive. Sec. 19a-613. Powers and duties. Data collection. Graduate medical education. Reports. (a) The Office of Health Care Access may employ the most effective
and practical means necessary to fulfill the purposes of this chapter, which may include,
but need not be limited to: Sec. 19a-614. Support staff and consultants. Consumer education unit. (a) The
Commissioner of Health Care Access may employ and pay professional and support
staff subject to the provisions of chapter 67 and contract with and engage consultants
and other independent professionals as may be necessary or desirable to carry out the
functions of the office. Sec. 19a-615. Health Care Reform Review Board. Reports. Section 19a-615 is
repealed, effective July 1, 1995. Sec. 19a-616. Connecticut Health Care Data Institute. Regulations. Section
19a-616 is repealed, effective July 1, 1997. Sec. 19a-617. Advisory board. Section 19a-617 is repealed, effective July 1, 1995. Sec. 19a-617a. Demonstration project converting acute care hospital to provider of other medical services. Certificate of need waiver, property tax abatement.
(a) The Department of Public Health and the Office of Health Care Access, in consultation with the Department of Social Services, shall establish a five-year demonstration
project to improve access to health care in an area of the state in which the viability of
traditional acute-care hospitals is in question. The Department of Public Health, the
Office of Health Care Access and the Department of Social Services jointly shall select
not more than one hospital that is willing to terminate its certificate of need as an acute-
care hospital pursuant to sections 19a-638 and 19a-639 and its licensure as an in-patient
hospital pursuant to chapter 368v. Such entity shall provide: (1) An emergency room,
provided the emergency room is affiliated with a hospital and that the emergency room
makes use of paramedics, or (2) an ambulatory surgery center. Such entity may also
provide services that include but are not limited to (A) nursing facility beds, provided
such beds represent a portion of beds currently licensed and occupied as of June 4,
1996, and provided further that such nursing facility beds are relocated from an existing
Medicaid certified nursing facility and such relocation does not result in an increase in
state expenditure and does not result in an increase in the number of nursing facility
beds in the state; and (B) assisted living under a continuing care facility that guarantees
life care for its residents, as defined in section 17b-354. Secs. 19a-618 to 19a-622. Definitions. Collection; methodology; reporting requirements. Fee schedule; reports, analyses and studies. Confidentiality of data.
Filing of data with institute. Sections 19a-618 to 19a-622, inclusive, are repealed,
effective July 1, 1997. Secs. 19a-623 to 19a-629. Reserved for future use. Sec. 19a-630. (Formerly Sec. 19a-145). Certificate of need. Definitions. As used
in this chapter: Sec. 19a-630a. Certificate of need. Limited definitions of "affiliate" and
"health-care-related person". As used in sections 19a-638 to 19a-639a, inclusive,
"affiliate" means any health-care-related person who directly or indirectly through one
or more intermediaries, controls or is controlled by or is under common control with,
another health-care-related person. In addition to other means of being controlled, a
person is deemed controlled by another person if the other person, or one of that other
person's affiliates, officers or management employees, acting in such capacity, acts as
a general partner of a general or limited partnership or manager of a limited liability
company in question. For purposes of this section, "health-care-related person" means
an entity that is licensed by a state agency to provide direct patient care services for
the prevention, diagnosis or treatment of human health conditions. Sec. 19a-631. (Formerly Sec. 19a-148a). Assessments of hospitals for expenses
of the office. (a) As used in this section and section 19a-632, "hospital" means each
hospital subject to the provisions of this chapter and licensed as a short-term acute-care
general hospital or a children's hospital or both by the Department of Public Health. Sec. 19a-632. (Formerly Sec. 19a-148b). Calculation of assessment and costs.
(a) On or before September first, annually, the Office of Health Care Access shall determine (1) the total net revenue of each hospital for the most recently completed hospital
fiscal year beginning October first; and (2) the proposed assessment on the hospital for
the state fiscal year. The assessment on each hospital shall be calculated by multiplying
the hospital's percentage share of the total net revenue specified in subdivision (1) of
this subsection times the costs of the office, as determined in subsection (b) of this
section. Sec. 19a-633. (Formerly Sec. 19a-149). Investigative powers. The commissioner or any agent authorized by him to conduct any inquiry, investigation or hearing
under the provisions of this chapter, shall have power to administer oaths and take
testimony under oath relative to the matter of inquiry or investigation. At any hearing
ordered by the office, the commissioner or such agent having authority by law to issue
such process may subpoena witnesses and require the production of records, papers and
documents pertinent to such inquiry. If any person disobeys such process or, having
appeared in obedience thereto, refuses to answer any pertinent question put to him by
the commissioner or his authorized agent or to produce any records and papers pursuant
thereto, the commissioner or his agent may apply to the superior court for the judicial
district of Hartford or for the judicial district wherein the person resides or wherein the
business has been conducted, or to any judge of said court if the same is not in session,
setting forth such disobedience to process or refusal to answer, and said court or such
judge shall cite such person to appear before said court or such judge to answer such
question or to produce such records and papers. Sec. 19a-634. (Formerly Sec. 19a-150). State-wide health care facility studies,
plans and recommendations. (a) The Office of Health Care Access, in consultation
with the Department of Public Health, shall carry out a continuing state-wide health
care facility utilization study, including a study of existing health care delivery systems;
recommend improvements in health care procedures to the health care facilities and
institutions; recommend to the commissioner legislation in the area of health care programs; and report annually to the Governor and the General Assembly its findings,
recommendations and proposals, as of January first, for improving efficiency, lowering
health care costs, coordinating use of facilities and services and expanding the availability of health care throughout the state. Sec. 19a-635. (Formerly Sec. 19a-151). Rate-setting powers. Except with respect to any increase in rates or charges provided for in a budget approved or revenue
caps established under section 19a-640, whenever a hospital, other than a hospital as
defined in subdivision (2) of section 19a-659, proposes to increase its per diem per
patient room rate or rates or its aggregate special services charges per patient in an
amount which would increase such rate or rates or charges by more than six per cent
over a twelve-month period or ten per cent over a twenty-four-month period such hospital shall file a request for approval of such increase with the office, in the form and
manner prescribed by the office by regulation, at least sixty days prior to the proposed
date of increase. Said office may approve, modify, or deny such rate increase request,
with or without a public hearing thereon not less than ten nor more than thirty days after
receipt of such request. Notice of such decision shall be given immediately to the hospital
by certified mail and to the public by publication in a newspaper having a substantial
circulation in the area affected. If such rate increase request is denied, modified or
approved without a public hearing the applicant or any member of the public may request
such a hearing not later than thirty days after the date of such decision, in which case
the office shall hold a public hearing. Any public hearing provided by this section shall
be held not less than ten nor more than thirty days after receipt of the request for a rate
increase or the request for a hearing by the applicant or a member of the public. Notice
of the hearing shall be given to the hospital by certified mail and to the public, by
publication in a newspaper having a substantial circulation in the area affected, at least
one week prior to such hearing. Such hearing shall be held, at the discretion of the office,
in Hartford or in the area served by such hospital. The office shall require from such
hospital such information, data, records, studies and evaluations as it considers necessary
to determine the need for such increases. Such proposed increases shall take effect thirty
days after such hearing or thirty days after the receipt of any data requested by the office,
whichever is later, unless within such period the office denies the requested increase or
approves such percentage of the increase as the office feels is justified. If no hearing is
held or requested said office's decision shall take effect thirty days after the date of such
decision. Sec. 19a-636. (Formerly Sec. 19a-152). Requests for approval of lesser increases. Except with respect to any increase in rates or charges provided for in a budget
approved under section 19a-640 or a revenue limit established under section 19a-674,
whenever any health care facility or institution subject to subsection (a) of section 19a-
635 proposes to increase its per diem room rate or aggregate special services rate in an
amount which would be at least two per cent over a twelve-month period but less than
the percentages requiring submission under said subsection, such facility or institution
shall file a request for approval of such proposed increase with the office, in the form
and manner prescribed by the office by regulation, for its review at least sixty days prior
to the effective date of such increase and, if the office believes such increase may not
be reasonable under the circumstances, said office shall hold a public hearing on such
increase not later than four weeks after receipt of such request for approval, at least
seven days' notice of which shall be given to the facility or institution by certified mail
and to the public by publication in a newspaper having a circulation in the area served
by such facility or institution. If after the hearing the office believes the rate increase is
not justified, it may, within four weeks of such hearing, deny such rate increase for a
period of six months at which time the facility or institution may resubmit such request
for approval for reconsideration or, with the agreement of the facility or institution,
modify such increase. Sec. 19a-637. (Formerly Sec. 19a-153). Considerations in office deliberations;
written findings. Availability of information. Use of charitable gifts. (a) In any of
its deliberations involving a proposal, request or submission regarding rates or services
by a health care facility or institution, the office shall take into consideration and make
written findings concerning each of the following principles and guidelines: The relationship of the proposal, request or submission to the state health plan; the relationship
of the proposal, request or submission to the applicant's long-range plan; the financial
feasibility of the proposal, request or submission and its impact on the applicant's rates
and financial condition; the impact of such proposal, request or submission on the interests of consumers of health care services and the payers for such services; the contribution of such proposal, request or submission to the quality, accessibility and cost-effectiveness of health care delivery in the region; whether there is a clear public need for
any proposal or request; whether the health care facility or institution is competent to
provide efficient and adequate service to the public in that such health care facility or
institution is technically, financially and managerially expert and efficient; that rates be
sufficient to allow the health care facility or institution to cover its reasonable capital
and operating costs; the relationship of any proposed change to the applicant's current
utilization statistics; the teaching and research responsibilities of the applicant; the special characteristics of the patient-physician mix of the applicant; the voluntary efforts
of the applicant in improving productivity and containing costs; and any other factors
which the office deems relevant, including, in the case of a facility or institution as
defined in subsection (c) of section 19a-490, such factors as, but not limited to, the
business interests of all owners, partners, associates, incorporators, directors, sponsors,
stockholders and operators and the personal backgrounds of such persons. Whenever
the granting, modification or denial of a request is inconsistent with the state health
plan, a written explanation of the reasons for the inconsistency shall be included in the
decision. Sec. 19a-638. (Formerly Sec. 19a-154). Certificate of need. Request for approval of transfer of ownership or control, change in function or service, capital
expenditures and acquisition of equipment; letter of intent; approval process. Moratorium on nursing home beds. (a) Except as provided in sections 19a-639a to 19a-
639d, inclusive: Sec. 19a-639. (Formerly Sec. 19a-155). Certificate of need. Request for approval of capital expenditure; approval process; value of part-time use of equipment; community and school-based health center exemptions. (a) Except as provided in sections 19a-639a to 19a-639d, inclusive, each health care facility or institution,
including, but not limited to, any inpatient rehabilitation facility, any health care facility
or institution or any state health care facility or institution proposing a capital expenditure
exceeding one million dollars, or the acquisition of major medical equipment requiring
a capital expenditure, as defined in regulations adopted pursuant to section 19a-643, in
excess of four hundred thousand dollars, including the leasing or donation of equipment
or a facility, shall submit a request for approval of such expenditure to the office, with
such data, information and plans as the office requires in advance of the proposed initiation date of such project. Sec. 19a-639a. Certificate of need. Exemptions. Registration of exempt institutions. (a) Except as required in subsection (b) of this section, the provisions of section
19a-638 and subsection (a) of section 19a-639 shall not apply to: (1) An outpatient clinic
or program operated exclusively by, or contracted to be operated exclusively for, a
municipality or municipal agency, a health district, as defined in section 19a-240, or a
board of education; (2) a residential facility for the mentally retarded licensed pursuant
to section 17a-227 and certified to participate in the Title XIX Medicaid program as an
intermediate care facility for the mentally retarded; (3) an outpatient rehabilitation service agency that was in operation on January 1, 1998, that is operated exclusively on
an outpatient basis and that is eligible to receive reimbursement under section 17b-243;
(4) a clinical laboratory; (5) an assisted living services agency; (6) an outpatient service
offering chronic dialysis; (7) a program of ambulatory services established and conducted by a health maintenance organization; (8) a home health agency; (9) a clinic
operated by the Americares Foundation; (10) a nursing home; (11) a residential care
home; or (12) a rest home. However, the exemptions provided in this section shall not
apply when a nursing home, residential care home or rest home is, or will be created,
acquired, operated or in any other way related to or affiliated with, or under the complete
or partial ownership or control of a facility or institution or affiliate subject to the provisions of section 19a-638 or subsection (a) of section 19a-639. Sec. 19a-639b. Certificate of need. Exemption for nonprofit institutions; application. (a) The Commissioner of the Office of Health Care Access or the commissioner's designee may grant an exemption from the requirements of section 19a-638 or
subsection (a) of section 19a-639 or both, for any nonprofit facility, institution or provider seeking to engage in any activity, other than the termination of a service or a
facility, otherwise subject to said section or subsection if: Sec. 19a-639c. Certificate of need. Waiver for replacement equipment. Notwithstanding the provisions of section 19a-638 or section 19a-639, the office may waive
the requirements of those sections and grant a certificate of need to any health care
facility, institution or provider or any state health care facility, institution or provider
proposing to replace major medical equipment, imaging equipment or a linear accelerator if: Sec. 19a-639d. Certificate of need. Waiver for year 2000 computer capability.
Notwithstanding the provisions of section 19a-638 or section 19a-639, prior to October
1, 2000, the office may waive the requirements of those sections and grant a certificate
of need to any health care facility or institution or any state health care facility for
purchases necessary for year-2000 computer capability: Sec. 19a-640. (Formerly Sec. 19a-156). Submission and review of proposed
budget. Hearing. Guidelines. Revisions. (a) Upon at least one hundred eighty days'
notice from the office, each hospital included within the definition of health care facilities or institutions, except a hospital as defined in subdivision (2) of section 19a-659,
and any other health care facility or institution requested to do so by the office shall
submit annually to the office its complete proposed operating and capital expenditures
budget for its next fiscal year in the form and manner prescribed by the office, at least
ninety days prior to the proposed adoption date of its budget. The office shall review
such proposed budget and may, with the consent of the facility or institution, informally
discuss such budget with representatives of the facility or institution. The office shall
notify the facility or institution of its approval, denial or modification of such budget
not later than forty-five days before such proposed adoption date. If the office denies
or modifies a budget, it shall hold a hearing not later than thirty days before such proposed
adoption date with representatives of the facility or institution, to consider and evaluate
such data and information as it considers relevant, unless an agreement has been reached
between the facility or institution and the office, and, at least fifteen days before the
proposed budget adoption date, the office shall order the facility or institution to adopt
a budget which the office deems acceptable for the coming fiscal period. Sec. 19a-641. (Formerly Sec. 19a-158). Appeals. Any health care facility or institution and any state health care facility or institution aggrieved by any final decision of
said office under the provisions of sections 19a-630 to 19a-640, inclusive, or section
19a-648 or 19a-650, may appeal therefrom in accordance with the provisions of section
4-183, except venue shall be in the judicial district in which it is located. Such appeal
shall have precedence in respect to order of trial over all other cases except writs of
habeas corpus, actions brought by or on behalf of the state, including informations on
the relation of private individuals, and appeals from awards or decisions of workers'
compensation commissioners.
Sec. 19a-610. Short title: Office of Health Care Access Act.
Sec. 19a-611. Definitions.
Sec. 19a-612. Office of Health Care Access: Established. Commissioner: Appointment and
qualifications.
Sec. 19a-612a. Office within Department of Public Health for administrative purposes
only.
Sec. 19a-612b. Office of Health Care Access to be successor agency to the Commission on
Hospitals and Health Care.
Sec. 19a-612c. Term "Commission on Hospitals and Health Care" deemed to mean "Office of
Health Care Access".
Sec. 19a-613. Powers and duties. Data collection. Graduate medical education. Reports.
Sec. 19a-614. Support staff and consultants. Consumer education unit.
Sec. 19a-615. Health Care Reform Review Board. Reports.
Sec. 19a-616. Connecticut Health Care Data Institute. Regulations.
Sec. 19a-617. Advisory board.
Sec. 19a-617a. Demonstration project converting acute care hospital to provider of other
medical services. Certificate of need waiver, property tax abatement.
Secs. 19a-618 to 19a-622. Definitions. Collection; methodology; reporting requirements.
Fee schedule; reports, analyses and studies. Confidentiality of data. Filing of data with
institute.
Secs. 19a-623 to 19a-629.
Sec. 19a-630. (Formerly Sec. 19a-145). Certificate of need. Definitions.
Sec. 19a-630a. Certificate of need. Limited definitions of "affiliate" and "health-care-
related person".
Sec. 19a-631. (Formerly Sec. 19a-148a). Assessments of hospitals for expenses of the
office.
Sec. 19a-632. (Formerly Sec. 19a-148b). Calculation of assessment and costs.
Sec. 19a-633. (Formerly Sec. 19a-149). Investigative powers.
Sec. 19a-634. (Formerly Sec. 19a-150). State-wide health care facility studies, plans and
recommendations.
Sec. 19a-635. (Formerly Sec. 19a-151). Rate-setting powers.
Sec. 19a-636. (Formerly Sec. 19a-152). Requests for approval of lesser increases.
Sec. 19a-637. (Formerly Sec. 19a-153). Considerations in office deliberations; written
findings. Availability of information. Use of charitable gifts.
Sec. 19a-638. (Formerly Sec. 19a-154). Certificate of need. Request for approval of
transfer of ownership or control, change in function or service, capital expenditures and
acquisition of equipment; letter of intent; approval process. Moratorium on nursing home
beds.
Sec. 19a-639. (Formerly Sec. 19a-155). Certificate of need. Request for approval of capital expenditure; approval process; value of part-time use of equipment; community and
school-based health center exemptions.
Sec. 19a-639a. Certificate of need. Exemptions. Registration of exempt institutions.
Sec. 19a-639b. Certificate of need. Exemption for nonprofit institutions; application.
Sec. 19a-639c. Certificate of need. Waiver for replacement equipment.
Sec. 19a-639d. Certificate of need. Waiver for year 2000 computer capability.
Sec. 19a-640. (Formerly Sec. 19a-156). Submission and review of proposed budget. Hearing.
Guidelines. Revisions.
Sec. 19a-641. (Formerly Sec. 19a-158). Appeals.
Sec. 19a-642. (Formerly Sec. 19a-159). Judicial enforcement.
Sec. 19a-643. (Formerly Sec. 19a-160). Certificate of need regulations.
Sec. 19a-644. (Formerly Sec. 19a-161). Annual reports. Regulations on affiliation or control of health care facilities and institutions.
Sec. 19a-645. (Formerly Sec. 19a-162). Taking of land to enlarge hospitals.
Sec. 19a-646. (Formerly Sec. 19a-166). Negotiation of discounts and different rates and
methods of payment with hospitals. Filings with the office.
Sec. 19a-647. (Formerly Sec. 19a-166b). Preferred provider network. Definitions. Filing
requirements.
Sec. 19a-648. (Formerly Sec. 19a-167e). Performance or billing by affiliates after the
base year. Adjustments. Civil penalty.
Sec. 19a-649. (Formerly Sec. 19a-167f). Uncompensated care including emergency assistance
to families. Audits.
Sec. 19a-650. (Formerly Sec. 19a-167g). Regulations.
Sec. 19a-651. (Formerly Sec. 19a-167h). Data requirement. Rate order compliance. Adjustment.
Sec. 19a-652. (Formerly Sec. 19a-167i). Termination of prospective payment system. Savings clause.
Sec. 19a-653. (Formerly Sec. 19a-167j). Certificate of need. Civil penalty. Request for
determination of a certificate of need requirement.
Sec. 19a-654. (Formerly Sec. 19a-167k). Data required for budget review purposes. Audit.
Sec. 19a-655. (Formerly Sec. 19a-167l). Hospital budget calculations for the fiscal year
commencing October 1, 1993.
Sec. 19a-656. (Formerly Sec. 19a-167m). Compliance assessment calculation for fiscal year
commencing October 1, 1991, to be applied in fiscal year commencing fiscal year October 1,
1993.
Sec. 19a-657. (Formerly Sec. 19a-167n). Request for adjustment to authorized net and
gross revenue and authorized equivalent discharges for fiscal year commencing October 1,
1993. Limitations. Filings.
Sec. 19a-658. (Formerly Sec. 19a-167o). Pricemaster adjustment; request procedure. Limitations. Data requirement. Report.
Sec. 19a-659. (Formerly Sec. 19a-170). Definitions.
Sec. 19a-660. (Formerly Sec. 19a-168g). Adjustments to orders.
Sec. 19a-661. (Formerly Sec. 19a-168i). Penalty.
Sec. 19a-662. (Formerly Sec. 19a-168j). Cost reduction plan requirement. Regulations.
Sec. 19a-663. (Formerly Sec. 19a-168p). Bond authorization.
Sec. 19a-664. (Formerly Sec. 19a-168s). Assessment factor for the uncompensated care pool
adjustments for the fiscal year commencing October 1, 1993.
Sec. 19a-665. (Formerly Sec. 19a-168t). Authorized governmental shortfall calculation for
the fiscal year commencing October 1, 1993.
Sec. 19a-666. (Formerly Sec. 19a-168u). Uncompensated care pool expenditures.
Sec. 19a-667. (Formerly Sec. 19a-168v). Uncompensated care pool termination. Final settlement.
Sec. 19a-668. (Formerly Sec. 19a-168w). Assistance for termination of uncompensated care
pool.
Sec. 19a-669. (Formerly Sec. 19a-169). Disproportionate share payments and emergency assistance to families; determination of amount eligible for federal matching payments.
Sec. 19a-670. (Formerly Sec. 19a-169a). Disproportionate share and emergency assistance
to families payments to hospitals.
Sec. 19a-670a. Application for federal approval by the Department of Social Services.
Sec. 19a-670b. Construction with respect to children's general hospitals.
Sec. 19a-671. (Formerly Sec. 19a-169b). Calculation and determination of payments.
Sec. 19a-671a. Adjustment of overpayments for disproportionate share-medical emergency
assistance by reducing Medicaid payments.
Sec. 19a-671b. Provisions for waiver of certain penalties and interest assessed pertaining to liability for taxes owed under chapter 211a or 219.
Sec. 19a-672. (Formerly Sec. 19a-169c). Use of medical assistance disproportionate share-
emergency assistance account funds.
Sec. 19a-673. (Formerly Sec. 19a-169e). Collections by hospitals from uninsured patients.
Sec. 19a-674. (Formerly Sec. 19a-170a). Net revenue limit.
Sec. 19a-675. (Formerly Sec. 19a-170b). Filings for partial or detailed budget review.
Hearings.
Sec. 19a-676. (Formerly Sec. 19a-170c). Compliance with authorized revenue limits.
Sec. 19a-676a. Termination of net revenue compliance payments.
Sec. 19a-677. (Formerly Sec. 19a-170d). Computation of relative cost of hospitals.
Sec. 19a-678. (Formerly Sec. 19a-170e). Inflation factor.
Sec. 19a-679. (Formerly Sec. 19a-170f). Computation of equivalent discharges. Inpatient
and outpatient gross revenues and units of service.
Sec. 19a-680. (Formerly Sec. 19a-170g). Net revenue limit interim adjustment.
Sec. 19a-681. Inclusion of taxes in pricemaster. Charges to be in accordance with schedule of charges on file. Penalty.
Sec. 19a-682. Additional billing for services rendered from November 1, 1994, through
June 1, 1995.
Sec. 19a-683. Reconciliation account.
(May Sp. Sess. 94-3, S. 5, 28.)
History: May Sp. Sess. P.A. 94-3 effective July 1, 1994.
(Return to TOC) (Return to Chapters) (Return to Titles)
(1) "Certified health plan" means a plan that provides the standard benefits package
and meets the requirements established by the Office of Health Care Access;
(2) "Office" means the Office of Health Care Access;
(3) "Standard benefits package" means the specified set of health services, as determined by federal law or in the absence of such applicable federal law, as determined by
state law, that are the minimum which must be available from each certified health plan;
(4) "Health care provider" or "provider" means a state licensed or certified person or
state-authorized facility, which delivers diagnostic, treatment, inpatient or ambulatory
health care services; and
(5) "Health plan" means any hospital or medical policy or certificate or contract,
hospital or medical service plan contract, or health care center contract. The term does
not include accident-only, specific disease, individual hospital indemnity, credit, dental-
only, vision-only, Medicare supplement, long-term care, or disability income insurance;
coverage issued as a supplement to liability insurance; workers' compensation or similar
insurance; or automobile medical-payment insurance.
(May Sp. Sess. P.A. 94-3, S. 6, 28; June 18 Sp. Sess. P.A. 97-8, S. 27, 88.)
History: May Sp. Sess. P.A. 94-3 effective July 1, 1994; in 1997 a reference to Sec. 19a-146 was deleted editorially
by the Revisors to reflect the repeal of that section by P.A. 95-257; June 18 Sp. Sess. P.A. 97-8 replaced reference to Sec.
19a-622 with Sec. 19a-614 in the introductory clause and deleted Subdiv. (6) which had defined "institute" as the Health
Data Institute, effective July 1, 1997.
Subdiv. (4):
Cited. 242 C. 1.
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(May Sp. Sess. P.A. 94-3, S. 7, 28; P.A. 95-257, S. 36, 58.)
History: May Sp. Sess. P.A. 94-3 effective July 1, 1994; P.A. 95-257 deleted provisions re governing board and how
its members are selected, replacing the board with a commissioner and setting forth his appointment and qualifications,
effective July 1, 1995.
See Sec. 1-101aa re provider participation in informal committees, task forces and work groups of office not deemed
to be lobbying.
(Return to TOC) (Return to Chapters) (Return to Titles)
(P.A. 95-257, S. 34, 58.)
History: P.A. 95-257, S. 34 effective July 1, 1995.
See Sec. 4-38f for definition of "administrative purposes only".
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) Wherever the words "Commission on Hospitals and Health Care" are used in
the general statutes, the words "Office of Health Care Access" shall be substituted in
lieu thereof.
(c) Any order, decision, agreed settlement, or regulation of the Commission on
Hospitals and Health Care which is in force on June 30, 1995, shall continue in force
and effect as an order or regulation of the Office of Health Care Access until amended,
repealed or superseded pursuant to law. The Commissioner of Health Care Access may
implement policies and procedures consistent with the provisions of section 4-5, sections
19a-612 to 19a-614, inclusive, section 19a-630, subsection (b) of section 19a-631, sections 19a-632 to 19a-634, inclusive, 19a-638 and 19a-639 while in the process of adopting the policy or procedure in regulation form, provided notice of intention to adopt the
regulations is printed in the Connecticut Law Journal within twenty days of implementation. The policy or procedure shall be valid until the time final regulations are effective.
(P.A. 95-257, S. 35, 58; P.A. 98-150, S. 14, 17.)
History: P.A. 95-257, S. 35 effective July 1, 1995; P.A. 98-150 made technical changes re statutory references in Subsec.
(c), effective June 5, 1998.
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(b) If the term "Commission on Hospitals and Health Care" is used or referred to
in any public or special act of 1995 or 1996 or in any section of the general statutes
which is amended in 1995 or 1996 it shall be deemed to mean or refer to the Office of
Health Care Access.
(P.A. 95-257, S. 39, 58.)
History: P.A. 95-257, S. 39 effective July 1, 1995.
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(1) Collecting patient-level outpatient data from health care facilities or institutions,
as defined in section 19a-630;
(2) Establishing a cooperative data collection effort, across public and private sectors, to assure that adequate health care personnel demographics are readily available; and
(3) Performing the duties and functions as enumerated in subsection (b) of this
section.
(b) The office shall: (1) Authorize and oversee the collection of data required to carry
out the provisions of this chapter; (2) oversee and coordinate health system planning for
the state; (3) monitor health care costs; and (4) implement and oversee health care reform
as enacted by the General Assembly.
(c) The Commissioner of Health Care Access or any person the commissioner designates may conduct a hearing and render a final decision in any case when a hearing is
required or authorized under the provisions of any statute dealing with the Office of
Health Care Access.
(d) The office shall monitor graduate medical education and its sources of funding
and shall annually (1) review the financial implications of such education for hospitals,
and (2) evaluate the effect of such education on (A) access to health care, and (B) sufficiency of the health care provider workforce. The office shall create an advisory council
to advise the commissioner on graduate medical education. For purposes of this subsection, "graduate medical education" means the formal clinical education and training of
a physician or other health care provider that follows graduation from medical school
and prepares the physician or health care provider for licensure and practice.
(e) Not later than January 1, 2000, and annually thereafter, the office shall submit
a report on its findings and recommendations to the joint standing committee of the
General Assembly having cognizance of matters relating to public health, in accordance
with the provisions of section 11-4a.
(May Sp. Sess. P.A. 94-3, S. 8, 28; P.A. 95-257, S. 37, 58; June 18 Sp. Sess. P.A. 97-8, S. 28, 88; P.A. 98-36, S. 3; 98-
87, S. 2; P.A. 99-172, S. 1, 7.)
History: May Sp. Sess. P.A. 94-3 effective July 1, 1994; P.A. 95-257 deleted former Subsec. (b) re responsibility for
a state health regulation and financing plan, and former Subsec. (d) re a working group to study a regional health care plan,
relettered the remaining Subsecs. accordingly and amended new Subsec. (b) by requiring coordination with the Health
Care Data Institute and by adding new Subdiv. (4) re continuing the functions and duties of chapter 368c and renumbering
the remaining Subdiv. and added new Subsec. (c) re hearings and decisions by a designee, effective July 1, 1995; June 18
Sp. Sess. P.A. 97-8 made technical changes in Subsec. (b) reflecting the abolishment of the Connecticut Health Care Data
Institute, effective July 1, 1997; P.A. 98-36 made a technical correction, changing reference to sections to "this chapter";
P.A. 98-87 amended Subsec. (a) to add Subdivs. (1) and (2) re collecting data, changed "shall" to "may" and changed
section reference to chapter reference; P.A. 99-172 made a technical change in Subsec. (c) and added Subsecs. (d) re
graduate medical education and (e) re reports, effective June 23, 1999.
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(b) The commissioner may establish a consumer education unit within the office
to provide information to residents of the state concerning the availability of public and
private health care coverage.
(May Sp. Sess. P.A. 94-3, S. 9, 28; P.A. 95-257, S. 38, 58.)
History: May Sp. Sess. P.A. 94-3 effective July 1, 1994; P.A. 95-257 eliminated the position of executive director and
advisory committee, made establishment of the consumer education unit optional, replaced "board" with "Commissioner
of Health Care Access" and relettered the Subsecs., effective July 1, 1995.
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(May Sp. Sess. P.A. 94-3, S. 11, 28; P.A. 95-257, S. 57, 58.)
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(May Sp. Sess. P.A. 94-3, S. 12, 28; June 18 Sp. Sess. P.A. 97-8, S. 87, 88.)
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(May Sp. Sess. P.A. 94-3, S. 13, 28; P.A. 95-257, S. 57, 58.)
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(b) Notwithstanding any provision of the general statutes or the regulations of Connecticut state agencies, the Office of Health Care Access, with the approval of the Department of Social Services, in consultation with the Department of Public Health, shall
waive certificate of need requirements and the Department of Social Services, with the
approval of the Department of Public Health, in consultation with the Office of Health
Care Access, shall waive the licensure requirements otherwise required for the provision
of the services enumerated in subsection (a) of this section and any other services deemed
necessary for the demonstration project, provided the Office of Health Care Access, in
consultation with the Department of Public Health and the Department of Social Services, determines that the entity providing such services otherwise meets the requirements for such certificate of need or licensure.
(c) The Office of Health Care Access and the Department of Public Health shall
reach a determination of an application for waiver under subsection (b) of this section
within ninety days of submittal of the complete application.
(d) On or before January 1, 2001, the Department of Public Health, the Department
of Social Services and the Office of Health Care Access shall report to the joint standing
committees of the General Assembly having cognizance of matters relating to public
health and human services on the effect on access to health care in the area of the state
selected.
(e) Any municipality may, upon approval by its legislative body or in any town in
which the legislative body is a town meeting, by the board of selectmen, abate the
property taxes due for any tax year or the interest on delinquent taxes with respect to
any demonstration project established pursuant to this section.
(P.A. 96-238, S. 22, 23, 25.)
History: P.A. 96-238 effective June 4, 1996.
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(May Sp. Sess. P.A. 94-3, S. 14−18, 28; P.A. 97-47, S. 22; June 18 Sp. Sess. P.A. 97-2, S. 93, 165; June 18 Sp. Sess.
P.A. 97-8, S. 87, 88.)
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(1) "Health care facility or institution" means any facility or institution engaged
primarily in providing services for the prevention, diagnosis or treatment of human
health conditions, including, but not limited to: Outpatient clinics; free standing outpatient surgical facilities; imaging centers; home health agencies, as defined in section
19a-490; clinical laboratory or central service facilities serving one or more health care
facilities, practitioners or institutions; hospitals; residential care homes; nursing homes;
rest homes; nonprofit health centers; diagnostic and treatment facilities; rehabilitation
facilities; and mental health facilities. "Health care facility or institution" includes any
parent company, subsidiary, affiliate or joint venture, or any combination thereof, of
any such facility or institution, but does not include any health care facility operated
by a nonprofit educational institution solely for the students, faculty and staff of such
institution and their dependents, or any Christian Science sanatorium operated, or listed
and certified, by the First Church of Christ, Scientist, Boston, Massachusetts.
(2) "State health care facility or institution" means a hospital or other such facility or
institution operated by the state providing services which are eligible for reimbursement
under Title XVIII or XIX of the federal Social Security Act, 42 USC Section 301 et
seq., as amended.
(3) "Office" means the Office of Health Care Access.
(4) "Commissioner" means the Commissioner of Health Care Access.
(5) "Person" has the meaning assigned to it in section 4-166.
(P.A. 73-117, S. 2, 31; 73-616, S. 59; P.A. 75-562, S. 1, 8; P.A. 77-192, S. 1, 13; 77-601, S. 6, 11; 77-614, S. 323, 610;
P.A. 78-109, S. 1, 2, 6; P.A. 86-374, S. 1, 6; P.A. 87-420, S. 13, 14; P.A. 89-72, S. 4, 5; P.A. 93-381, S. 9, 39; P.A. 94-
174, S. 4, 12; May Sp. Sess. P.A. 94-3, S. 19, 28; P.A. 95-257, S. 12, 21, 39, 41, 58; P.A. 98-150, S. 1, 17; P.A. 99-172,
S. 2, 7; P.A. 00-27, S. 23, 24.)
History: P.A. 73-616 excluded from consideration as health care facility or institution facilities operated by nonprofit
educational institution solely for students, faculty and staff and their dependents; P.A. 75-562 defined "commission" and
"commissioner" and extended applicability beyond chapter; P.A. 77-192 defined "state health care facility or institution";
P.A. 77-601 included homemaker-home health aide agencies as health care facilities and institutions; P.A. 77-614 replaced
commissioner of health with commissioner of health services, effective January 1, 1979; P.A. 78-109 excluded Christian
Science sanatoriums from consideration as health care facilities or institutions and specified that state health care facility
or institution is one which provides services reimbursable under Title XVIII or XIX of Social Security Act; Sec. 19-73b
transferred to Sec. 19a-145 in 1983; P.A. 86-374 deleted coordination, assessment and monitoring agencies from definition
of health care facility or institution; P.A. 87-420 deleted an obsolete reference to Sec. 19a-7; P.A. 89-72 changed "diagnosis
and treatment" to "diagnosis or treatment"; P.A. 93-381 replaced commissioner of health services with commissioner of
public health and addiction services, effective July 1, 1993; P.A. 94-174 made technical changes in Subsec. (a) and added
new Subsec. (b) defining "clinical laboratory" for certificate of need purposes, effective June 6, 1994; May Sp. Sess. P.A.
94-3 amended Subsec. (a) to add outpatient clinics, free-standing outpatient surgical facilities and imaging centers to the
definition of health care facilities and to specify that such facilities include any parent company, subsidiary affiliate, joint
venture or combination of such, effective July 1, 1994; P.A. 95-257 replaced reference to Secs. 17b-238 and 19a-114 with
reference to chapter 368z, Commission on Hospitals and Health Care with Office of Health Care Access and Commissioner
of Public Health and Addiction Services with Commissioner of Health Care Access, effective July 1, 1995; Sec. 19a-145
transferred to Sec. 19a-630 in 1997; P.A. 98-150 changed Subdiv. designations from letters to numbers, amended Subdiv.
(1) to change "home health care agencies" to "home health agencies", delete "homemaker-home health aide agencies",
change "personal care homes" to "residential care homes" add "rest homes" and delete reference to municipal outpatient
clinics, added new Subdiv. (5) defining "affiliate" and deleted former Subsec. (b) defining "clinical laboratory", effective
June 5, 1998; P.A. 99-172 deleted former Subdiv. (5) defining "affiliate" and added new Subdiv. (5) defining "person",
effective June 23, 1999; P.A. 00-27 made technical changes in Subdiv. (1), effective May 1, 2000.
See Sec. 19a-507 re New Horizons independent living facility for severely physically disabled adults.
Annotation to former section 19-73b:
Cited. 182 C. 314, 317.
Annotation to former section 19a-145:
Cited. 214 C. 321−323, 325−328, 330−333.
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(P.A. 99-172, S. 3, 7.)
History: P.A. 99-172 effective June 23, 1999.
See Sec. 19a-644 re limited definition of "affiliate".
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(b) Each hospital shall annually pay to the Commissioner of Health Care Access,
for deposit in the General Fund, an amount equal to its share of the actual expenditures
made by the office during each fiscal year including the cost of fringe benefits for office
personnel as estimated by the Comptroller, the amount of expenses for central state
services attributable to the office for the fiscal year as estimated by the Comptroller,
plus the expenditures made on behalf of the office from the Capital Equipment Purchase
Fund pursuant to section 4a-9 for such year. Payments shall be made by assessment of
all hospitals of the costs calculated and collected in accordance with the provisions of
this section and section 19a-632. If for any reason a hospital ceases operation, any unpaid
assessment for the operations of the office shall be reapportioned among the remaining
hospitals to be paid in addition to any other assessment.
(P.A. 93-229, S. 18, 21; 93-381, S. 9, 39; 93-435, S. 59, 95; P.A. 95-257, S. 12, 21, 42, 58; P.A. 98-22, S. 1, 3.)
History: P.A. 93-229 effective June 4, 1993; P.A. 93-381 and 93-435 authorized substitution of commissioner and
department of public health and addiction services for commissioner and department of health services, effective July 1,
1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner
and Department of Public Health and "commission" with "office", qualified expenditures made by the office as those
which are accountable to the functions of the office transferred from the Commission on Hospitals and Health Care, and
deleted reference to a fiscal year 1993 share, effective July 1, 1995; Sec. 19a-148a transferred to Sec. 19a-631 in 1997;
P.A. 98-22 amended Subsec. (b) to require payment to the Commissioner of Health Care Access rather than Commissioner
of Public Health, deleted reference to expenditures "which are accountable to the functions of the office transferred from
the Commission on Hospitals and Health Care" and added provision re reapportionment of payments when a hospital
ceases operation, effective July 1, 1998.
Annotations to former section 19a-148a:
Cited. 235 C. 128, 131, 141.
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(b) The costs of the office shall be the total of (1) the amount appropriated for the
operation of the office for the fiscal year, (2) the cost of fringe benefits for office personnel for such year, as estimated by the Comptroller, (3) the amount of expenses for central
state services attributable to the office for the fiscal year as estimated by the Comptroller,
and (4) the estimated expenditures on behalf of the office from the Capital Equipment
Purchase Fund pursuant to section 4a-9 for such year, provided for purposes of this
calculation the amount so appropriated plus the cost of fringe benefits for personnel,
the amount of expenses for said central state services for the fiscal year as estimated by
the Comptroller, and said estimated expenditures from the Capital Equipment Purchase
Fund pursuant to section 4a-9 shall be deemed to be the actual expenditures of the office.
(c) On or before December thirty-first, annually, for each fiscal year, each hospital
shall pay the office twenty-five per cent of its proposed assessment, adjusted to reflect
any credit or amount due under the recalculated assessment for the preceding state fiscal
year as determined pursuant to subsection (d) of this section or any reapportioned assessment pursuant to subsection (b) of section 19a-631. The hospital shall pay the remaining
seventy-five per cent of its assessment to the office in three equal installments on or
before the following March thirty-first, June thirtieth and September thirtieth, annually.
(d) Immediately following the close of each state fiscal year the commissioner shall
recalculate the proposed assessment for each hospital based on the costs of the office
in accordance with subsection (b) of this section using the actual expenditures made by
the office during that fiscal year and the actual expenditures made on behalf of the office
from the Capital Equipment Purchase Fund pursuant to section 4a-9. On or before July
thirty-first, annually, the office shall render to each hospital a statement showing the
difference between the respective recalculated assessment and the amount previously
paid. On or before August thirty-first, the commissioner, after receiving any objections
to such statements, shall make such adjustments which in his opinion may be indicated
and shall render an adjusted assessment, if any, to the affected hospitals. Adjustments
to reflect any credit or amount due under the recalculated assessment for the previous
state fiscal year shall be made to the proposed assessment due on or before December
thirty-first of the following state fiscal year.
(e) If any assessment is not paid when due, a late fee of ten dollars shall be added
thereto and interest at the rate of one and one-fourth per cent per month or fraction
thereof shall be paid on such assessment and late fee.
(f) The office shall deposit all payments received pursuant to this section with the
State Treasurer. The moneys so deposited shall be credited to the General Fund and
shall be accounted for as expenses recovered from hospitals.
(g) For the hospital fiscal year commencing October 1, 1993, and for subsequent
fiscal years, assessments made under this section, excluding any interest or fee payable
pursuant to subsection (e) of this section, shall be included in the computation of net
and gross revenue caps for each hospital.
(P.A. 93-229, S. 19, 21; P.A. 95-257, S. 39, 43, 58; P.A. 98-22, S. 2, 3.)
History: P.A. 93-229 effective June 4, 1993; P.A. 95-257 replaced Commission on Hospitals and Health Care with
Office of Health Care Access, "commission" with "office" and "chairman of the commission" with "commissioner" and
amended Subdiv. (1) of Subsec. (a) and Subdiv. (4) of Subsec. (b) to qualify expenditures as those accountable or attributable
to the functions of the office, effective July 1, 1995; Sec. 19a-148b transferred to Sec. 19a-632 in 1997; P.A. 98-22 deleted,
in Subsecs. (a) and (b), reference to expenditures "which are accountable to the functions of the office transferred from
the Commission on Hospitals and Health Care," changed "total of that portion of" to "total of" in Subsec. (b), inserted "or
any reapportioned assessment pursuant to subsection (b) of section 19a-631" in Subsec. (c) and required the "office" rather
than the "commissioner" to render recalculated assessments in Subsec. (d), effective July 1, 1998.
Annotations to former section 19a-148b:
Cited. 235 C. 128, 131, 141.
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(P.A. 73-117, S. 7, 31; P.A. 78-280, S. 2, 6, 127; P.A. 88-230, S. 1, 12; P.A. 90-98, S. 1, 2; P.A. 93-142, S. 4, 7, 8; P.A.
95-220, S. 4−6; 95-257, S. 44, 58.)
History: P.A. 78-280 replaced "county" with "judicial district" and "Hartford county" with "judicial district of Hartford-
New Britain"; Sec. 19-73g transferred to Sec. 19a-149 in 1983; P.A. 88-230 replaced "judicial district of Hartford-New
Britain" with "judicial district of Hartford", effective September 1, 1991; P.A. 90-98 changed the effective date of P.A.
88-230 from September 1, 1991, to September 1, 1993; P.A. 93-142 changed the effective date of P.A. 88-230 from
September 1, 1993, to September 1, 1996, effective June 14, 1993; P.A. 95-220 changed the effective date of P.A. 88-230
from September 1, 1996, to September 1, 1998, effective July 1, 1995; P.A. 95-257 replaced variants of "commission"
with "commissioner" or "office", effective July 1, 1995; Sec. 19a-149 transferred to Sec. 19a-633 in 1997.
Annotations to former section 19-73g:
Cited. 42 CS 413, 418, 419.
Annotations to former section 19a-149:
Cited. 226 105−107, 111, 117, 132, 141, 143, 144, 146. Cited. 235 C. 128, 131, 141.
Cited. 42 CS 413, 418, 419.
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(b) The office shall establish and maintain a state-wide health care facilities plan,
including provisions for an ongoing evaluation of the facility utilization study conducted
pursuant to subsection (a) of this section to: (1) Determine the availability of acute care,
long-term care and home health care services in private and public institutional and
community-based facilities providing diagnostic or therapeutic services for residents
of this state; (2) determine the scope of such services; and (3) anticipate future needs
for such facilities and services. The health care facilities plan shall be considered part
of the state health plan for purposes of office deliberations pursuant to section 19a-637.
(P.A. 73-117, S. 8, 31; P.A. 75-562, S. 4, 8; P.A. 77-192, S. 5, 13; June Sp. Sess. P.A. 91-11, S. 14, 25; P.A. 93-381,
S. 9, 39; P.A. 95-257, S. 12, 21, 45, 58.)
History: P.A. 75-562 required that recommendations be made to health commissioner rather than to governor and
general assembly; P.A. 77-192 required consultation with state bureau of health planning and development and deleted
commission's duty to formulate state-wide health care program for improving delivery of services; Sec. 19-73h transferred
to Sec. 19a-150 in 1983; June Sp. Sess. P.A. 91-11 replaced reference to "state bureau of health planning and development"
with department of health services, replaced utilization review with utilization study, and added Subsec. (b) requiring the
commission to establish and maintain a state-wide health care facilities plan; P.A. 93-381 replaced department of health
services with department of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced "commission"
with "Office of Health Care Access" and "office" and "Department of Public Health and Addiction Services" with "Department of Public Health", effective July 1, 1995; Sec. 19a-150 transferred to Sec. 19a-634 in 1997.
Annotations to former section 19a-150:
Cited. 200 C. 489, 498. Cited. 208 C. 663, 668. Cited. 214 C. 321, 331. Cited. 226 C. 105, 140, 141. Cited. 235 C. 128,
131, 140, 141.
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(P.A. 73-117, S. 9, 10, 31; P.A. 78-109, S. 3, 6; 78-264, S. 3, 4; P.A. 79-182, S. 3; P.A. 80-7; P.A. 81-465, S. 3, 18;
81-472, S. 45, 159; P.A. 86-69, S. 1, 3; P.A. 87-189, S. 1, 3; P.A. 88-317, S. 79, 107; P.A. 89-371, S. 14; June Sp. Sess.
91-11, S. 15, 25; P.A. 93-262, S. 16, 87; May 25 Sp. Sess. P.A. 94-1, S. 46, 130; P.A. 95-257, S. 39, 58.)
History: P.A. 78-109 allowed commission to act on rate increase without holding a public hearing, but required notice
of its action, established procedure for holding public hearing upon request after decision and required that decision take
effect thirty days after date made if no hearing held or requested; P.A. 78-264 added Subsec. (c) re rate determination;
P.A. 79-182 deleted provision re increases sought by nursing or personal care homes and deleted references to facilities
or homes in Subsec. (b); P.A. 80-7 added provisions re requests for revised rates submitted by home health care or homemaker-home health aide agencies necessitated by unforeseen and material changes in circumstances; P.A. 81-465 amended
Subsecs. (a) and (b) to provide that public notice be in a newspaper having "substantial" circulation in the area served by
the facility and added Subsec. (d) to require the adoption of regulations by the commission to except certain facilities below
a minimum specified size from rate-setting review; P.A. 81-472 made technical changes; Sec. 19-73i transferred to Sec.
19a-151 in 1983; P.A. 86-69 deleted former Subsec. (a) which contained obsolete provisions re commission's analysis of
rate increases in 1973 and deleted former Subsec. (d) which had authorized commission to adopt regulations exempting
certain facilities from provisions of section, renumbering as necessary; P.A. 87-189 excluded rate orders approved under
Secs. 19a-165 to 19a-165q from the requirements of Subsec. (a); P.A. 88-317 amended references to Ch. 54 and Secs. 4-
177 to 4-181 in Subsec. (b) to include new sections added to Sec. 19a-151, effective July 1, 1989, and applicable to all
agency proceedings commencing on or after that date; P.A. 89-371 amended Subsec. (a) by adding reference to Secs. 19a-
167 to 19a-167g, inclusive, and to revenue caps, deleting reference to rate orders approved under Secs. 19a-165 to 19a-
165g, inclusive; June Sp. Sess. P.A. 91-11 amended Subsec. (a) by adding language excluding hospitals as defined in
Subsec. (b) of Sec. 19a-167 from the provisions of the section, deleting reference to revenue caps under Secs. 19a-167 to
19a-167g, inclusive; P.A. 93-262 deleted former Subsec. (b) concerning rates to be charged by home health care agencies
and homemaker-home aide agencies, effective July 1, 1993; May 25 Sp. Sess. P.A. 94-1 made technical changes, effective
July 1, 1994; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective
July 1, 1995; Sec. 19a-151 transferred to Sec. 19a-635 in 1997.
See chapter 54 re uniform administrative procedure.
Annotations to former section 19-73i:
Cited. 177 C. 356, 361.
Cited. 32 CS 300.
Subsec. (b):
Cited. 177 C. 356−358, 363.
Annotations to former section 19a-151:
Cited. 200 C. 489, 498. Cited. 208 C. 663, 668. Cited. 214 C. 321, 331. Cited. 235 C. 128, 131, 140, 141. Cited. 238
C. 216.
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(P.A. 73-117, S. 11, 31; P.A. 74-78, S. 1, 2; P.A. 75-235; P.A. 86-69, S. 2, 3; P.A. 87-189, S. 2, 3; P.A. 89-371, S. 15;
May 25 Sp. Sess. P.A. 94-1, S. 47, 130; P.A. 95-257, S. 39, 58.)
History: P.A. 74-78 required filing of reports sixty rather than thirty days before effective date of increase, extended
period for hearing from two to four weeks after report received and extended period for decision from two to four weeks
after hearing; P.A. 75-235 replaced "report" with "request for approval", deleted reference to commission majority belief
that increase is unjustified, referring simply to commission belief and required that requests for approval be in the form
and manner prescribed by commission; Sec. 19-73j transferred to Sec. 19a-152 in 1983; P.A. 86-69 made technical change,
substituting reference to Subsec. (a) for reference to Subsec. (b) of Sec. 19a-151; P.A. 87-189 excluded rate orders approved
under Secs. 19a-165 to 19a-165q from the requirements of this section; P.A. 89-371 added references to Secs. 19a-167 to
19a-167g, inclusive, and to revenue caps, deleting references to rate orders approved under Secs. 19a-165 to 19a-167g,
inclusive; May 25 Sp. Sess. P.A. 94-1 made technical changes, effective July 1, 1994; P.A. 95-257 replaced Commission
on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-152 transferred to Sec.
19a-636 in 1997.
Annotations to former section 19a-152:
Cited. 214 C. 321, 331. Cited. 235 C. 128, 131, 141.
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(b) Any data submitted to or obtained or compiled by the office with respect to
its deliberations under sections 19a-635 to 19a-640, inclusive, with respect to nursing
homes, licensed under chapter 368v, shall be made available to the Department of Public
Health.
(c) Notwithstanding the provisions of subsection (a) of this section, the office in its
deliberations under section 19a-635, 19a-636 or 19a-640, shall not direct or control the
use of the following resources of the hospital concerned: The principal and all income
from restricted and unrestricted grants, gifts, contributions, bequests and endowments.
(P.A. 73-117, S. 12, 31; P.A. 77-192, S. 6, 13; 77-304, S. 1; 77-614, S. 323, 587, 610; P.A. 78-303, S. 85, 136; P.A.
80-13; P.A. 81-465, S. 4, 18; 81-472, S. 46, 130, 159; P.A. 82-472, S. 62, 183; P.A. 84-315, S. 21, 24; P.A. 88-8, S. 2;
P.A. 89-371, S. 12; P.A. 93-381, S. 9, 30, 39; May 25 Sp. Sess. P.A. 94-1, S. 48, 130; P.A. 95-257, S. 12, 21, 39, 58.)
History: P.A. 77-192 required consideration of teaching and research expenses, community service programs, comments
from professional standards review organizations re volume, need for preservation of capital and segregation of grants,
patient mix, growth of patient load and accounts receivable experience and made consideration of all specified factors
mandatory rather than optional; P.A. 77-304 included in other factors relevant to facilities and institutions business interests
and personal backgrounds of owners, partners, associates, etc. and added Subsec. (b) re availability of data to health
department and nursing home administrators' licensure board; P.A. 77-614 and P.A. 78-303 replaced department of health
with department of health services, effective January 1, 1979; P.A. 80-13 added Subsec. (c) re freedom of hospital resources
from commission control; P.A. 81-465 amended Subsec. (a) to establish new criteria that the commission may utilize in
its deliberations under Secs. 19-73 to 19-73o, inclusive; P.A. 81-472 deleted requirement in Subsec. (b) that data be made
available to board of licensure of nursing home administrators; P.A. 82-472 made a technical correction; Sec. 19-73k
transferred to Sec. 19a-153 in 1983; P.A. 84-315 amended Subsec. (c) to add references to Secs. 19a-156 and 19a-165 to
19a-165q, inclusive; P.A. 88-8 made a technical change by removing an obsolete reference to "the health systems plan"
from the list of criteria; P.A. 89-371 increased factors to be considered by the commission in its deliberations in Subsec.
(a) and added the reference to Secs. 19a-167 to 19a-167g, inclusive, in Subsec. (c), deleting reference to Secs. 19a-165 to
19a-165g, inclusive, repealed by the same act; P.A. 93-381 amended Subsec. (a) re written explanation for inconsistency
with state health plan and replaced department of health services with department of public health and addiction services,
effective July 1, 1993; May 25 Sp. Sess. P.A. 94-1 removed obsolete language, effective July 1, 1994; P.A. 95-257 replaced
Commission on Hospitals and Health Care with Office of Health Care Access and replaced Commissioner and Department
of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; Sec.
19a-153 transferred to Sec. 19a-637 in 1997.
Annotations to former section 19-73k:
Cited. 177 C. 356, 358, 361. Cited. 182 C. 314, 315, 317, 319.
Cited. 32 CS 300. Cited. 34 CS 225, 231, 236. Cited. 42 CS 413, 418, 425.
Subsec. (a):
Cited. 182 C. 314, 319.
Annotations to former section 19a-153:
Cited. 208 C. 663, 668, 670. Cited. 226 C. 105, 112, 125, 139, 143. Cited. 235 C. 128, 131, 141.
Cited. 42 CS 413, 418, 425.
Subsec. (a):
Cited. 200 C. 489, 498. Cited. 208 C. 663, 668. Cited. 219 C. 581, 589. Cited. 235 C. 128, 140.
Subsec. (c):
Cited. 200 C. 489, 510, 511, 519.
(Return to TOC) (Return to Chapters) (Return to Titles)
(1) Each health care facility or institution, that intends to (A) transfer all or part of
its ownership or control, (B) change the governing powers of the board of a parent
company or an affiliate, whatever its designation, or (C) change or transfer the powers
or control of a governing or controlling body of an affiliate, shall submit to the office,
prior to the proposed date of such transfer or change, a request for permission to undertake such transfer or change.
(2) Each health care facility or institution or state health care facility or institution,
including any inpatient rehabilitation facility, which intends to introduce any additional
function or service into its program of health care shall submit to the office, prior to the
proposed date of the institution of such function or service, a request for permission to
undertake such function or service.
(3) Each health care facility or institution or state health care facility or institution
which intends to terminate a health service offered by such facility or institution or
decrease substantially its total bed capacity, shall submit to the office, prior to the proposed date of such termination or decrease, a request to undertake such termination or
decrease.
(4) Each applicant, prior to submitting a certificate of need application under this
section, section 19a-639 or under both sections, shall submit a request, in writing, for
application forms and instructions to the office. The request shall be known as a letter
of intent. A letter of intent shall include: (A) The name of the applicant or applicants;
(B) a statement indicating whether the application is for a new, replacement or additional
facility, service or function, the expansion or relocation of an existing facility, service
or function, a change in ownership or control, a termination of a service or a reduction
in licensed bed capacity and the bed type, any new or additional beds and their type, a
capital expenditure over one million dollars, the acquisition of major medical equipment,
imaging equipment or a linear accelerator costing over four hundred thousand dollars,
or any combination thereof; (C) the estimated capital cost, value or expenditure; (D)
the town where the project is or will be located; and (E) a brief description of the proposed
project. No certificate of need application will be considered submitted to the office
unless a current letter of intent, specific to the proposal and in compliance with this
subsection, has been on file with the office at least sixty days. A current letter of intent
is a letter of intent which has been on file at the office up to and including one hundred
twenty days, except that an applicant may request a one-time extension of a letter of
intent of up to an additional thirty days for a maximum total of up to one hundred fifty
days if, prior to the expiration of the current letter of intent, the office receives a written
request to so extend the letter of intent's current status. The extension request shall fully
explain why an extension is requested. The office shall accept or reject the extension
request within five business days and shall so notify the applicant.
(b) The office shall make such review of a request made pursuant to subdivision
(1), (2) or (3) of subsection (a) of this section as it deems necessary. In the case of a
proposed transfer of ownership or control, the review shall include, but not be limited
to, the financial responsibility and business interests of the transferee and the ability of
the institution to continue to provide needed services or, in the case of the introduction
of a new or additional function or service expansion or the termination of a service
or function, ascertaining the availability of such service or function at other inpatient
rehabilitation facilities, health care facilities or institutions or state health care facilities
or institutions or other providers within the area to be served, the need for such service
or function within such area and any other factors which the office deems relevant to a
determination of whether the facility or institution is justified in introducing or terminating such functions or services into or from its program. The office shall grant, modify
or deny such request within ninety days of the receipt of a complete application, except
as provided for in this section. Upon the request of the applicant, the review period
may be extended for an additional fifteen days if the office has requested additional
information subsequent to the commencement of the review period. The commissioner
may extend the review period for a maximum of thirty days if the applicant has not filed
in a timely manner information deemed necessary by the office. Failure of the office to
act on such request within such review period shall be deemed approval thereof. The
ninety-day review period, pursuant to this subsection, for an application filed by a hospital, as defined in section 19a-490, and licensed as a short-term acute-care general hospital
or children's hospital by the Department of Public Health or an affiliate of such a hospital
or any combination thereof, shall not apply if, in the certificate of need application or
request, the hospital or applicant projects either (1) that, for the first three years of
operation taken together, the total impact of the proposal on the operating budget of the
hospital or an affiliate of such a hospital or any combination thereof will exceed one
per cent of the actual operating expenses of the hospital for the most recently completed
fiscal year as filed with or determined by the office, or (2) that the total capital expenditure for the project will exceed fifteen million dollars. If the office determines that an
application is not subject to the ninety-day review period pursuant to this subsection, it
shall remain so excluded for the entire review period of that application, even if the
application or circumstances change and the application no longer meets the stated terms
of the exclusion. Upon a showing by such facility or institution that the need for such
function, service or termination or change of ownership or control is of an emergency
nature, in that the function, service or termination or change of ownership or control is
necessary to comply with requirements of any federal, state or local health, fire, building
or life safety code, the commissioner may waive the letter of intent requirement, provided
such request shall be submitted at least ten business days before the proposed date of
institution of the function, service or termination or change of ownership or control.
(c) In conducting its activities under this section, section 19a-639 or under both
sections, the office may hold hearings on applications of a similar nature at the same time.
(d) For the purposes of this section, section 19a-639 or both sections, construction
shall be deemed to have begun if the following have occurred and the office has been
so notified in writing within the thirty days prior to the date by which construction is
to begin: (1) All necessary town, state and federal approvals required to begin construction have been obtained, including all zoning and wetlands approvals; (2) all necessary
town and state permits required to begin construction or site work have been obtained;
(3) financing approval, as defined in subsection (e) of this section, has been obtained;
and (4) construction of a structure approved in the certificate of need has begun. For
the purposes of this subsection, commencement of construction of a structure shall
include, at a minimum, completion of a foundation. Notwithstanding the provisions of
this subsection, upon receipt of an application filed at least thirty days prior to the date
by which construction is to begin, the office may deem construction to have begun if
(A) an owner of a certificate of need has fully complied with the provisions of subdivisions (1), (2) and (3) of this subsection; (B) such owner submits clear and convincing
evidence that he has complied with the provisions of this subsection sufficiently to
demonstrate a high probability that construction shall be completed in time to obtain
licensure by the Department of Public Health on or before the date required in the certificate of need as the office may amend it from time to time; (C) construction of a structure
cannot begin due to unforseeable circumstances beyond the control of the owner; and
(D) at least ten per cent of the approved total capital expenditure or two hundred fifty
thousand dollars, whichever is greater, has been expended.
(e) Financing shall be deemed to have been obtained for the purposes of this section
if the owner of the certificate of need has (1) received a final commitment for financing
in writing from a lender, or (2) provided evidence to the office that the owner has sufficient funds available to construct the project without financing.
(f) The General Assembly finds evidence of insufficient need for all the nursing
home beds approved by the Office of Health Care Access but not yet constructed and
finds allowing unnecessary beds and facilities to be built will result in severely damaging
economic consequences to the state and to consumers. All certificates of need for nursing
home beds granted pursuant to this section shall expire on June 9, 1993, except (1)
beds for which an application for financing was received and deemed complete by the
Connecticut Health and Educational Facilities Authority prior to March 1, 1993; (2)
beds restricted to use by patients with acquired immune deficiency syndrome or traumatic brain injury; (3) beds associated with a continuing care facility which guarantees
life care for its residents as defined in subsection (b) of section 17b-354; (4) beds authorized under a certificate of need for an addition of five beds in a facility which has
undertaken the addition of ten beds pursuant to section 17b-351; and (5) beds for which
twenty-five per cent of project costs have been expended prior to June 9, 1993, as submitted to the Office of Health Care Access in the form of a report prepared by a certified
public accountant having no affiliation with the owner of the certificate of need or
the developer of the project. A certificate of need which has expired pursuant to this
subsection may be reauthorized by the Office of Health Care Access, provided need for
nursing home beds exists and twenty per cent or more of the project costs have been
expended by June 9, 1993. A request for reauthorization shall be submitted to the Office
of Health Care Access no later than July 15, 1993. The office shall issue a decision on
such request within forty-five days of receipt of documentation necessary to determine
expended project costs. Project expenditures shall cease from June 9, 1993, until reauthorization by the office. Evidence of project costs expended shall be submitted in the
form of a report prepared by a certified public accountant having no affiliation with the
owner of the certificate of need or the developer of the project. For the purposes of this
section, "need for nursing home beds" means there is a demonstrated bed need in the
towns within twenty miles of the town in which the facility is proposed to be located,
including the town of the proposed location, as listed in the March 1, 1974, official
mileage table of the Public Utilities Commission. Bed need shall be projected no more
than five years into the future at ninety-seven and one-half per cent occupancy using
the latest official population projections by town and age as published by the Office of
Policy and Management and the latest available nursing home utilization statistics by
age cohort from the Department of Public Health. For the purposes of this subsection,
"project costs" means the capital costs approved by the Office of Health Care Access
in the certificate of need, exclusive of the cost of land acquisition. Owners of certificates
of need for nursing home beds which have expired may apply to the Commissioner of
Social Services for compensation on or after June 29, 1993, but no later than September
1, 1993. Such compensation shall be limited to actual verifiable losses which directly
result from the expiration of the certificate of need pursuant to this subsection and which
cannot be otherwise recouped through the mitigating efforts of the owner, excluding
consequential and incidental losses such as lost profits. Such compensation shall not
exceed an amount approved by the office within the certificate of need unless the commissioner determines it is reasonable or cost-effective to compensate the excess amount.
Notwithstanding any provision of this subsection, no compensation shall be provided
to an owner of a certificate of need whose ability to implement the certificate of need
is contingent on the outcome of a legal action taken against the owner until the owner
obtains a final decision in his favor. An owner aggrieved by the amount of compensation
determined by the commissioner may request a hearing in accordance with the provisions of sections 17b-61 and 17b-104. The commissioner may so compensate an owner
of a certificate of need for nursing home beds who volunteers to relinquish such a certificate, provided the request for compensation is received by the commissioner prior to
July 15, 1993. The commissioner shall notify such an owner as to whether he will be
compensated within forty-five days from receipt of notice of voluntary relinquishment
or forty-five days of June 29, 1993, whichever is later.
(P.A. 73-117, S. 13, 31; P.A. 77-192, S. 7, 13; 77-304, S. 2; 77-601, S. 7, 11; P.A. 79-98, S. 1, 4; P.A. 80-73, S. 4; P.A.
81-211; 81-441, S. 1; 81-465, S. 5, 9, 18; P.A. 82-415, S. 15, 18; P.A. 83-215, S. 1, 3; P.A. 86-374, S. 2, 6; P.A. 87-192,
S. 1, 3; 87-420, S. 11, 14; P.A. 89-72, S. 1, 5; 89-325, S. 12, 26; P.A. 91-48, S. 1, 4; June Sp. Sess. P.A. 91-8, S. 27, 63;
June Sp. Sess. P.A. 91-12, S. 10; P.A. 92-220, S. 1, 2; P.A. 93-229, S. 3, 21; 93-262, S. 1, 17, 87; 93-381, S. 9, 39; 93-
406, S. 1, 6; 93-435, S. 59, 95; P.A. 94-236, S. 9, 10; P.A. 95-257, S. 12, 21, 39, 46, 58; P.A. 97-112, S. 2; P.A. 98-150,
S. 2, 17.)
History: P.A. 77-192 included state health care facilities or institutions in provisions of section; P.A. 77-304 specified
applicability to facilities or institutions which intend to "transfer all or any part of its ownership or control prior to being
initially licensed" and specified factors to be considered in review if transfer of ownership or control is proposed; P.A.
77-601 added provisions concerning applicability of provisions to home health care, homemaker-home health aide, or
coordination assessment and monitoring agencies and added Subsec. (b) re approval of home health care, homemaker-
home health aide or coordination, assessment and monitoring agencies; P.A. 79-98 made provisions applicable to inpatient
rehabilitation facilities affiliated with Easter Seal Society; P.A. 80-73 allowed commission to modify requests as well as
to grant or deny requests in Subsec. (a); P.A. 81-211 mandated commission approval in Subsec. (a) for decreases in services
to medical assistance patients by termination of medicaid provider agreements; P.A. 81-441 amended the commission on
hospitals and health care certificate of need review process by exempting from review outpatient, i.e. "ambulatory", services
provided by a health maintenance organization and by extending review to any facility plan to terminate a health service
or to substantially decrease bed capacity; P.A. 81-465 amended Subsec. (a) to exempt home health care and homemaker-
home health care agencies from commission review relative to transfers of ownership prior to initial licensure or increased
staffing or services, and added provisions, codified by the Revisors as Subsec. (c), re coordination of activities between
commission and health systems agencies; P.A. 82-415 eliminated exception for ambulatory service programs by health
maintenance organizations from provision requiring submission of request for permission to add a function or service or
to increase staff in Subsec. (a); Sec. 19-73l transferred to Sec. 19a-154 in 1983; P.A. 83-215 exempted ambulatory services
established and conducted by a health maintenance organization from certificate of need review, provided for a fifteen
day extension of the ninety day review period if additional information is requested by the commissioner or a motion to
approve, modify or deny a request results in a tie vote and authorized the adoption of regulations to establish a schedule
for the submission of similar requests; P.A. 86-374 deleted references to coordination, assessment and monitoring agencies,
including all of Subsec. (b), relettering Subsec. (c) accordingly; P.A. 87-192 deleted references to "ninety-day" review
period and added the provision re extension of the review period for thirty days; P.A. 87-420 deleted references to health
systems agency and deleted the provision re coordination of activities with health systems agencies; P.A. 89-72 amended
Subsec. (b) to change "shall" to "may" with regard to holding of hearings, adopting of regulations and establishing of a
schedule which provides for completed applications pertaining to similar types of services; P.A. 89-325 deleted provisions
re the decrease in services to recipients of medical assistance benefits in Subsec. (a); P.A. 91-48 restated Subsec. (a)
provision re agencies required to request permission to undertake transfer of ownership or control, to institute additional
functions or services or to terminate functions and services or to reduce bed capacity; June Sp. Sess. P.A. 91-8 added
Subsecs. (d), (e) and (f) re moratorium on certificate of need for additional nursing home beds, on additional requests for
beds from residential facilities for the mentally retarded, and any requests to modify the capital cost or expiration date of
approval; June Sp. Sess. P.A. 91-12 amended Subsec. (c) requiring the commission to adopt regulations requiring that
applications for certificates be submitted in cycles; P.A. 92-220 amended Subsec. (d) by extending moratorium through
June 30, 1994, and adding provision re date by which construction shall begin and date by which nursing home shall be
licensed under certificates of need in effect August 1, 1991, amended Subsec. (e) by deleting provision re expiration of
approval of additional nursing home beds granted on or before July 1, 1991, and substituting definition of "a continuing
care facility which guarantees life care for its residents", added Subsec. (g) re joint request for merger of certificates of
need, added Subsec. (h) re when construction shall be deemed to have begun, added Subsec. (i) re when financing shall
be deemed to have been obtained, and added Subsec. (j) re when financing shall be deemed to have been obtained on and
after March 1, 1993; P.A. 93-229 amended Subsec. (a) to add new Subdiv. (4) re submission of letter of intent, amended
Subsec. (b) re exception to ninety-day review period, adding language explaining that emergency nature to include compliances with fire, building or life safety code and that the letter of intent may be waived and amended Subsec. (c) to change
"shall" to "may" re adoption of regulations, effective June 4, 1993; P.A. 93-262 deleted homemaker-home health aide
agencies and added nursing homes, homes for the aged, rest homes and certain residential facilities for the mentally retarded
as facilities to which section applies, deleted Subsecs. (d) to (g), inclusive, and (i) concerning requests for additional nursing
home beds, continuing care facilities, requests for beds in residential facilities for the mentally retarded, certificates of
need and financing methods, relettering remaining Subsecs. as necessary, effective July 1, 1993; P.A. 93-381 replaced
department of health services with department of public health and addiction services, effective July 1, 1993; P.A. 93-406
added Subsecs. (f) and (g) re expiration of certificates of need for nursing home beds, effective June 29, 1993 (Revisor's
note: Pursuant to P.A. 93-262, 93-381 and 93-435 references to commissioners and departments of health services and
income maintenance were replaced editorially by the Revisors by references to commissioners and departments of public
health and addiction services and social services, respectively); P.A. 94-236 deleted former Subsec. (g) regarding nonexpiration of certificate of need if additional beds are used for a continuing care facility, effective June 7, 1994; P.A. 95-257
replaced Commission on Hospitals and Health Care and "commission" with Office of Health Care Access and "office" or
"commissioner", replaced Department of Public Health and Addiction Services with Department of Public Health and
deleted reference to a tie vote of the former commission, effective July 1, 1995; Sec. 19a-154 transferred to Sec. 19a-638
in 1997; P.A. 97-112 replaced "home for the aged" with "residential care home"; P.A. 98-150 added reference to exceptions
in introductory language of Subsec. (a) and deleted the exceptions throughout section, reworded transfer as Subpara. (A)
in Subsec. (a)(1) and added Subparas. (B) and (C), changed "transfer" to "transfer or change" in Subsec. (a)(1), amended
Subdiv. (a)(4) by adding "replacement or additional", adding "or relocation" to "expansion" adding references to change
in ownership or control, termination of services or reduction in bed capacity or type, capital expenditure over one million
dollars and acquisition of specified equipment over four hundred thousand dollars, added "value or expenditure" to Subdiv.
(a)(4)(C), changed ninety days to sixty in Subdiv. (a)(4)(E) and added exception re one-time extension, amended Subsec.
(b) by adding "new" and "expansion or the termination" to service or function and adding reference to termination or
change of ownership throughout Subsec., added "affiliate of such hospital or any combination thereof", replaced reference
to future budget adjustments with Subdivs. (1), (2) and language re exclusion during review period, amended Subsec. (c)
by deleting obsolete authority to adopt regulations and made technical changes throughout, effective June 5, 1998.
See chapter 54 re uniform administrative procedure.
See Sec. 17b-347 re transfer of Medicaid patients to participating facility by nursing home which terminates its provider
agreement.
Annotation to former section 19-73l:
Cited. 33 CS 86.
Annotations to former section 19a-154:
Cited. 200 C. 133, 135. Cited. 208 C. 663−665, 667, 668, 670. Cited. 214 C. 321, 323−327, 333−335. Cited. 226 C.
105, 108, 113, 134. Cited. 235 C. 128, 130, 131, 141. Cited. 238 C. 216.
Subsec. (a):
Cited. 200 C. 489, 498. Cited. 208 C. 663, 668. Cited. 214 C. 321, 326, 335. Cited. 226 C. 105, 108. Cited. 235 C. 128, 140.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) The office shall hold a public hearing with respect to any complete certificate
of need request under this section, at least two weeks' notice of which shall be given to
the facility, institution or provider by certified mail and to the public by publication in
a newspaper having a substantial circulation in the area served by the facility, institution
or provider. The commissioner shall notify the Commissioner of Social Services of any
application that may impact on expenditures under the state medical assistance program.
Such hearing shall be held at the discretion of the office in Hartford or in the area so
served or to be served. The office shall consider such request in relation to the community
or regional need for such capital program or purchase of land, the possible effect on the
operating costs of the health care facility or institution and such other relevant factors
as the office deems necessary. In approving or modifying such request, the commissioner
may not prescribe any condition, such as but not limited to, any condition or limitation
on the indebtedness of the facility or institution in connection with a bond issue, the
principal amount of any bond issue or any other details or particulars related to the
financing of such capital expenditure, not directly related to the scope of such capital
program and within control of the facility or institution. An applicant, prior to submitting
a certificate of need application, shall submit a request, in writing, for application forms
and instructions to the office. The request shall be known as a letter of intent. A letter
of intent shall conform to the letter of intent requirements of subdivision (4) of subsection
(a) of section 19a-638. No certificate of need application will be considered submitted
to the office unless a current letter of intent, specific to the proposal and in compliance
with this subsection, is on file with the office at least sixty days. A current letter of intent
is a letter of intent which has been on file at the office no more than one hundred twenty
days, except that an applicant may request a one-time extension of a letter of intent of
up to an additional thirty days for a maximum total of up to one hundred fifty days if,
prior to the expiration of the current letter of intent, the office receives a written request
to so extend the letter of intent's current status. The extension request shall fully explain
why an extension is requested. The office shall accept or reject the extension request
within five business days and shall so notify the applicant. Upon a showing by such
facility or institution that the need for such capital program is of an emergency nature,
in that the capital expenditure is necessary to comply with any federal, state or local
health, fire, building or life safety code, the commissioner may waive the letter of intent
requirement and that a public hearing be held, provided such request shall be submitted
at least ten business days before the proposed initiation date of the project. The commissioner shall grant, modify or deny such request within ninety days or within ten business
days, as the case may be, of receipt thereof, except as provided for in this section. Upon
the request of the applicant, the review period may be extended for an additional fifteen
days if the office has requested additional information subsequent to the commencement
of the review period. The commissioner may extend the review period for a maximum
of thirty days if the applicant has not filed, in a timely manner, information deemed
necessary by the office. Failure of the office to act thereon within such review period
shall be deemed approval of such request. The ninety-day review period, pursuant to
this section, for an application filed by a hospital, as defined in section 19a-490, and
licensed as a short-term acute-care general hospital or a children's hospital by the Department of Public Health or an affiliate of such a hospital or any combination thereof, shall
not apply if, in the certificate of need application or request, the hospital or applicant
projects either (1) that, for the first three years of operation taken together, the total
impact of the proposal on the operating budget of the hospital or an affiliate or any
combination thereof will exceed one per cent of the actual operating expenses of the
hospital for the most recently completed fiscal year as filed with the office, or (2) that
the total capital expenditure for the project will exceed fifteen million dollars. If the
office determines that an application is not subject to the ninety-day review period
pursuant to this subsection, it shall remain so excluded for the entire period of that
application, even if the application or circumstances change and the application no
longer meets the stated terms of the exclusion. The office shall adopt regulations to
establish an expedited hearing process to be used to review requests by any facility or
institution for approval of a capital expenditure to establish an energy conservation
program or to comply with requirements of any federal, state or local health, fire, building or life safety code or final court order. The office shall adopt regulations in accordance with the provisions of chapter 54 to provide for the waiver of a hearing, for any
part of a request by a facility or institution for a capital expenditure, provided such
facility or institution and the office agree upon such waiver.
(c) Notwithstanding section 19a-639a or 19a-639b, each person or facility, other
than a health care or state health care facility or institution subject to subsection (a) of
this section, proposing to acquire or replace imaging equipment or a linear accelerator,
requiring a capital expenditure, as defined in regulations adopted pursuant to section
19a-643, in excess of four hundred thousand dollars, including the leasing or donation
of such equipment and facility and including all capital expenditures, as defined in
regulations adopted pursuant to said section, associated with the provision of the imaging
service or operation of a linear accelerator, shall submit a request for approval of any
such imaging equipment or linear accelerator acquisition pursuant to the provisions
of subsection (a) of this section. In determining the capital cost or expenditure for an
application under this section or section 19a-638, the office shall use the greater of (1)
the fair market value of the equipment as if it were to be used for full-time operation,
whether or not the equipment is to be used, shared or rented on a part-time basis, or (2)
the total value or estimated value determined by the office of any capitalized lease
computed for a three-year period. Each method shall include the costs of any service
or financing agreements plus any other cost components or items the office specifies in
regulations, adopted in accordance with chapter 54, or deems appropriate.
(d) Notwithstanding the provisions of section 19a-638 or subsection (a) of this section, no community health center, as defined in section 19a-490a, shall be subject to the
provisions of said section 19a-638 or subsection (a) of this section if the community
health center is: (1) Proposing a capital expenditure not exceeding one million dollars;
(2) exclusively providing primary care or dental services; and (3) either (A) one-third
or more of the cost of the proposed project is financed by the state of Connecticut, (B)
the proposed project is receiving funds from the Department of Public Health, or (C)
the proposed project is located in an area designated by the federal Health Resources and
Services Administration as a health professional shortage area, a medically underserved
area or an area with a medically underserved population. Each community health center
seeking an exemption under this subsection shall provide the office with documentation
verifying to the satisfaction of the office, qualification for this exemption. Each community health center proposing to provide any service other than a primary care or dental
service at any location, including a designated community health center location, shall
first obtain a certificate of need for such additional service in accordance with this section
and section 19a-638. Each satellite, subsidiary or affiliate of a federally qualified health
center, in order to qualify under this exemption, shall: (i) Be part of a federally qualified
health center, that meets the requirements of this subsection; (ii) exclusively provide
primary care or dental services; and (iii) be located in a health professional shortage
area or a medically underserved area. If the subsidiary, satellite or affiliate does not so
qualify, it shall obtain a certificate of need.
(e) Notwithstanding the provisions of section 19a-638, subsection (a) of section
19a-639a or subsection (a) of this section, no school-based health care center shall be
subject to the provisions of section 19a-638 or subsection (a) of this section if the center:
(1) Is or will be licensed by the Department of Public Health as an outpatient clinic; (2)
has been approved by the Department of Public Health as meeting its standard model
for comprehensive school-based health centers; (3) proposes capital expenditures not
exceeding one million dollars and does not exceed such amount; (4) once operational,
continues to operate and provide services in accordance with the department's standard
model for comprehensive school-based health centers; and (5) is or will be located
entirely on the property of a functioning school.
(f) In conducting its activities under this section, section 19a-638 or under both
sections, the office may hold hearings on applications of a similar nature at the same time.
(P.A. 73-117, S. 14, 31; P.A. 77-192, S. 8, 13; P.A. 79-73; 79-98, S. 2, 4; P.A. 80-19, S. 1; 80-72, S. 1; 80-73, S. 2; 80-
74; P.A. 81-159, S. 1, 3; 81-210; 81-441, S. 2; 81-465, S. 6, 9, 18; P.A. 82-415, S. 16, 18; P.A. 83-215, S. 2, 3; P.A. 85-
89, S. 1, 2; P.A. 87-192, S. 2, 3; 87-420, S. 12, 14; P.A. 89-72, S. 2, 3, 5; 89-371, S. 16; P.A. 91-48, S. 2, 4; June Sp. Sess.
P.A. 91-12, S. 11; P.A. 93-229, S. 4, 21; 93-262, S. 18, 87; 93-381, S. 9, 39; 93-435, S. 59, 95; May 25 Sp. Sess. P.A. 94-
1, S. 49, 130; P.A. 95-257, S. 12, 21, 39, 47, 58; 95-338, S. 1, 3; P.A. 97-159; 97-112, S. 2; P.A. 98-150, S. 3, 17.)
History: P.A. 77-192 divided section into Subsecs., made provisions applicable to state health care facilities and institutions, replaced Comprehensive Health Planning Agency with Health Systems Agency and added provisions re thirty-day
extension period; P.A. 79-73 allowed commission to modify requests in Subsec. (b); P.A. 79-98 made provisions applicable
to inpatient rehabilitation facilities affiliated with Easter Seal Society; P.A. 80-19 required adoption of regulations re
expedited hearing process by January 1, 1981, in Subsec. (a); P.A. 80-72 raised applicable capital expenditure in Subsec.
(a) from one hundred to one hundred fifty thousand dollars and included requests relative to "purchase of land"; P.A. 80-
73 deleted reference to commission's option to "make a finding of recommendations" based on request and allowed waiver
of ninety-day advance submission by three-commissioner panel in Subsec. (a) and allowed three-commissioner panel to
take action in Subsec. (b); P.A. 80-74 removed Subsec. indicators, deleted redundant provision re action within ninety
days, deleted thirty-day extension and required that request be submitted to appropriate health systems agency at least
thirty days before submission to commission; P.A. 81-159 required commission to adopt regulations re waiver of a hearing
for any part of a facility's request for a capital expenditure, provided the facility and the commission agree to the waiver;
P.A. 81-210 limited the conditions and restrictions which the commission on hospitals and health care may impose when
approving or modifying a request for a capital expenditure to those that are within the control of the facility; P.A. 81-441
amended the commission on hospitals and health care certificate of need review process by exempting from review outpatient, i.e. "ambulatory" services provided by a health maintenance organization; P.A. 81-465 amended Subsec. (a) to exempt
home health care and homemaker-home health care agencies from commission review relative to capital expenditures or
the acquisition of major medical equipment and changed the threshold for review from expenditures over one hundred
fifty thousand dollars to expenditures exceeding limits set by the secretary of health and human services, deleted provision
allowing three-member panel to act on requests, and Subsec. (b) re coordination of activities between commission and
health systems agencies was added editorially; P.A. 82-415 eliminated exception for ambulatory service programs by
health maintenance organizations from provision requiring submission of a request for approval of expenditures; Sec. 19-
73m transferred to Sec. 19a-155 in 1983; P.A. 83-215 exempted ambulatory services established and conducted by a health
maintenance organization from certificate of need review, changed the threshold for review of capital expenditures from
limits set by the Secretary of Health and Human Services to six hundred thousand dollars and to four hundred thousand
dollars for the acquisition of major medical equipment, provided for a fifteen day extension of the ninety day review period
if additional information is requested by the commissioner or a motion to approve, modify or deny a request results in a
tie vote and authorized the adoption of regulations to establish a schedule for the submission of similar requests; P.A. 85-
89 amended Subsec. (a) to change the threshold for review of capital expenditures from "six hundred" to "seven hundred
fourteen" thousand dollars; P.A. 87-192 substituted one million for seven hundred fourteen thousand dollar expenditure
cap, added the provision re thirty-day extension of the review period upon the vote of the commission and deleted references
to "ninety-day" review period; P.A. 87-420 deleted all references to health systems agency; P.A. 89-72 made technical
changes in Subsecs. (a) and (b) and amended Subsec. (c) to make commission's powers under the Subsec. discretionary
rather than mandatory; P.A. 89-371 added reference to Secs. 19a-167 to 19a-167g, inclusive, and to revenue caps; P.A.
91-48 amended Subsec. (a) to apply exception to outpatient rehabilitation facilities affiliated with Easter Seal Society and
to give the commission ten business days instead of ten calendar days to review emergency requests under the certificate
of need process and made technical changes; June Sp. Sess. P.A. 91-12 amended Subsec. (c) requiring the commission to
adopt regulations providing for the submittal of applications for certificates in cycles; P.A. 93-229 amended Subsec. (a)
re submission of letter of intent, waiver of letter if expenditure necessary to comply with fire, building or life safety code
and exception to ninety-day review period and amended Subsec. (c) to change "shall" to "may" re adoption of regulations,
effective June 4, 1993; P.A. 93-262 removed homemaker-home health aide agencies and added nursing homes, homes for
the aged, rest homes and certain facilities for mentally retarded persons to the list of facilities which do not have to submit
a request for permission to make certain expenditures, effective July 1, 1993; P.A. 93-381 and P.A. 93-435 authorized
substitution of commissioner and department of public health and addiction services for commissioner and department of
health services, effective July 1, 1993; May 25 Sp. Sess. P.A. 94-1 removed obsolete language, effective July 1, 1994;
P.A. 95-257 replaced references to Department of Public Health and Addiction Services with Department of Public Health
and to Commission on Hospitals and Health Care with Office of Health Care Access or Commissioner of Health Care
Access, deleted reference to a tie vote of the former commission, deleted reference to 1981 deadline for regulations and
required the commissioner to notify the Commissioner of Social Services of impact on the medical assistance program,
effective July 1, 1995; P.A. 95-338 inserted new Subsec. (c) exempting certain community health centers and relettered
former Subsec. accordingly, effective July 13, 1995; Sec. 19a-155 transferred to Sec. 19a-639 in 1997; P.A. 97-112 replaced
"home for the aged" with "residential care home"; P.A. 97-159 added new Subsec. (d) re exemption for school-based
health care centers and redesignated former Subsec. (b) as Subsec. (e); P.A. 98-150 replaced specified exemptions with
reference to sections containing exemptions, divided Subsec. (a) into two Subsecs. and relettered remaining sections
accordingly, amended Subsec. (b) by adding "provider" to institution, added exception re one-time exemption, replaced
reference to future budget adjustments with Subdivs. (1), (2) and language re exclusion during review process, amended
Subsec. (c) by adding "or replace" to acquire, "linear accelerator" to imaging equipment, "donation" to leasing and adding
language re determining capital cost or expenditure, amended Subsec. (d) by adding Subdiv. (2) re primary care or dental
services, adding "proposed" to project and adding process for community health center exemption, amended Subsec. (f)
by deleting obsolete authority to adopt regulations and made technical changes throughout, effective June 5, 1998.
Annotations to former section 19-73m:
Cited. 182 C. 314, 315, 317.
Cited. 34 CS 225, 227−229, 231, 235, 237, 241.
Annotations to former section 19a-155:
Section is compatible and can coexist with Sec. 19a-156. 200 C. 133−137, 142−145. Cited. 210 C. 697, 698. Cited. 214
C. 321, 323, 331, 333. Cited. 226 C. 105, 108, 113, 134. Cited. 235 C. 128, 131, 141. Cited. 238 C. 216.
Cited. 2 CA 68, 69, 73, 74, 78, 80.
Subsec. (a):
Cited. 200 C. 133, 143. Cited. 214 C. 321, 325. Cited. 226 C. 105, 110, 142.
Subsec. (b):
Cited. 214 C. 321, 325.
Subsec. (c):
Cited. 226 C. 105, 134.
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(b) Each health care facility or institution exempted under this section shall register
with the office by filing the information required by subdivision (4) of subsection (a)
of section 19a-638 for a letter of intent at least ten business days but not more than
sixty calendar days prior to commencing operations and prior to changing, expanding,
terminating or relocating any facility or service otherwise covered by section 19a-638,
or subsection (a) of section 19a-639 or covered by both sections or subsections, except
that, if the facility or institution is in operation on June 5, 1998, said information shall
be filed not more than sixty days after said date. Not later than ten business days after
the office receives a completed filing required under this subsection, the office shall
provide the health care facility or institution with written acknowledgment of receipt.
Such acknowledgment shall constitute permission to operate or change, expand, terminate or relocate such a facility or institution or to make an expenditure consistent with an
authorization received under subsection (a) of section 19a-639 until the next September
thirtieth. Each entity exempted under this section shall renew its exemption annually
by filing current information each September.
(P.A. 98-150, S. 4, 17.)
History: P.A. 98-150 effective June 5, 1998 (Revisor's note: In codifying this section the Revisors editorially changed
a reference in Subsec. (b) to "... September thirty." to "... September thirtieth.").
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(1) The nonprofit facility, institution or provider is proposing a capital expenditure
of not more than one million dollars and the expenditure does not in fact exceed one
million dollars;
(2) The activity meets a specific service need identified by a state agency or department and confirmed as a current need by the Office of Health Care Access; and
(3) The commissioner, executive director, chairman or Chief Court Administrator
of the state agency or department that has identified the specific need confirms, in writing, to the office that (A) the agency or department has identified a specific need with
a detailed description of that need and that the agency or department believes that the
need continues to exist, (B) the activity in question meets all or part of the identified
need and specifies how much of that need the proposal meets, (C) in the case where the
activity is the relocation of services, the agency or department has determined that the
needs of the area previously served will continue to be met in a better or satisfactory
manner and specifies how that is to be done, (D) in the case where the activity is the
transfer of all or part of the ownership or control of a facility or institution, the agency
or department has investigated the proposed change and the person or entity requesting
the change and has determined that the change would be in the best interests of the state
and the patients or clients, and (E) the activity will be cost-effective and well managed.
(b) A nonprofit facility, institution or provider seeking an exemption under this
section shall provide the office with any information it needs to determine exemption
eligibility. An exemption granted under this section shall be limited to part or all of any
services, equipment, expenditures or location directly related to the need or location
that the state agency or department has identified.
(c) The office may revoke or modify the scope of the exemption at any time following a public review that allows the state agency or department and the nonprofit facility,
institution or provider to address specific, identified, changed conditions or any problems that the state agency, department or the office has identified. A party to any exemption modification or revocation proceeding and the original requesting agency shall be
given at least fourteen calendar days written notice prior to any action by the office and
shall be furnished with a copy, if any, of a revocation or modification request or a
statement by the office of the problems that have been brought to its attention. If the
requesting commissioner, executive director, chairman or Chief Court Administrator
or the Commissioner of Health Care Access certifies that an emergency condition exists,
only forty-eight hours written notice shall be required for such modification or revocation action to proceed.
(P.A. 98-150, S. 5, 17.)
History: P.A. 98-150 effective June 5, 1998.
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(1) The facility, institution or provider has previously obtained a certificate of need
for the equipment or accelerator being replaced;
(2) The replacement value or expenditure for the replacement equipment or accelerator is not more than the original cost plus an increase of ten per cent for each twelve-
month period that has elapsed since the date of the original certificate of need; and
(3) The replacement value or expenditure is less than two million dollars.
(P.A. 98-150, S. 7, 17; June Sp. Sess. P.A. 98-1, S. 94, 121.)
History: P.A. 98-150 effective June 5, 1998; June Sp. Sess. P.A. 98-1 made a technical change by adding the first
reference to "provider" to "health care facility, institution".
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(1) The purchase is for physical plant or nonmedical equipment and the total aggregate cost under this subdivision is less than three million dollars;
(2) The purchase is for computer diagnostic or therapeutic medical equipment components or medical equipment year-2000 capability and the total aggregate cost for all
equipment and components under this subdivision is less than two million dollars; or
(3) The purchase is for computer hardware or software that is used for data collection
or to interface between medical equipment and data equipment and the data equipment
is to be used for medical records, data collection, data storage, business functions or
other similar uses as part of an information system or project and the total aggregate
cost under this subdivision is less than three million dollars.
(P.A. 98-150, S. 6, 17.)
History: P.A. 98-150 effective June 5, 1998.
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(b) On or before April fifteenth of each year the office shall publish the guidelines
which it will apply to such budget review during the forthcoming year.
(c) In the event of unforeseen and material changes in circumstances during any
fiscal year, any hospital or health care facility or institution which has received a budget
from the office pursuant to the provisions of this section may submit a proposed revised
budget to said office pursuant to regulations adopted by the office.
(P.A. 73-117, S. 16, 31; P.A. 74-182, S. 1, 3; P.A. 76-44; P.A. 77-61, S. 2, 3; 77-192, S. 10, 13; P.A. 81-465, S. 7, 18;
P.A. 89-371, S. 17; May Sp. Sess. P.A. 92-16, S. 65, 89; May 25 Sp. Sess. P.A. 94-1, S. 50, 130; P.A. 95-257, S. 39, 58.)
History: P.A. 74-182 required one hundred eighty days' notice for submission of proposed expenditures and added
Subsec. (b) re revised budgets; P.A. 76-44 added Subsec. (c) re proposed budget of Veterans' Memorial Hospital, Meriden;
P.A. 77-61 made conformity of Veterans' Hospital fiscal year to Meriden fiscal year optional rather than mandatory; P.A.
77-192 specified applicability to hospitals "included within the definition of health care facilities or institutions", added
provision re informal budget discussions, changed hearing deadline from "within ten days of such denial or modification"
to "not later than thirty days before such proposed adoption date" and did not require hearing if agreement has been reached,
inserted new Subsec. (b) re publication of guidelines and redesignated former Subsecs. (b) and (c) accordingly; P.A. 81-
465 amended Subsec. (a) to provide an exemption from budget review for hospitals; Sec. 19-73o transferred to Sec. 19a-
156 in 1983; P.A. 89-371 exempted hospitals "for which a budget was approved or revenue caps were established under
sections 19a-167 to 19a-167g, inclusive", from requirement for annual proposed budget submission; May Sp. Sess. P.A.
92-16 made technical changes, deleted a provision in Subsec. (a) which provided a budget shall be deemed approved if
the commission fails to notify the facility or institution of its approval, denial or modification and deleted Subsec. (d) re
World War II Veterans' Memorial Hospital; May 25 Sp. Sess. P.A. 94-1 made technical changes, effective July 1, 1994;
P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995;
Sec. 19a-156 transferred to Sec. 19a-640 in 1997.
See chapter 54 re uniform administrative procedure.
Annotation to former section 19-73o:
Cited. 34 CS 225, 242.
Annotations to former section 19a-156:
Section is compatible and can coexist with Sec. 19a-155. 200 C. 133, 136, 138, 139, 142−144. Cited. 214 C. 321, 331.
Cited. 238 C. 216.
Cited. 2 CA 68, 69, 80.
Subsec. (a):
Cited. 196 C. 451, 452. Cited. 200 C. 133, 135. Cited. Id., 489, 491, 498. Cited. 208 C. 663, 668. Cited. 235 C. 128, 140.
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(P.A. 73-117, S. 17, 31; P.A. 76-436, S. 261, 681; P.A. 77-192, S. 11, 13; 77-603, S. 49, 125; P.A. 78-280, S. 1, 127;
P.A. 79-376, S. 21; P.A. 81-465, S. 11, 18; P.A. 84-315, S. 22, 24; P.A. 87-443, S. 1, 17; P.A. 89-371, S. 13; May 25 Sp.
Sess. P.A. 94-1, S. 51, 130; P.A. 95-257, S. 39, 58.)
History: P.A. 76-436 replaced court of common pleas with superior court, effective July 1, 1978; P.A. 77-192 made
provisions applicable to state health care institutions and facilities and replaced provision granting appeals precedence
over "nonprivileged cases" with provision granting precedence except as specified; P.A. 77-603 replaced previous appeal
provisions with statement that appeals to be in accordance with Sec. 4-183 but retained venue in county or judicial district
where facility is located and retained precedence provision; P.A. 78-280 dropped reference to counties; P.A. 79-376
replaced "workmen's compensation" with "workers' compensation"; P.A. 81-465 substituted reference to Sec. 19-73b for
reference to Sec. 19-73a, repealed by the same act; Sec. 19-73p transferred to Sec. 19a-158 in 1983; P.A. 84-315 added
reference to Secs. 19a-165 to 19a-165q, inclusive; P.A. 87-443 added "final" re the decision of the commission; P.A. 89-
371 substituted reference to Secs. 19a-167 to 19a-167g, inclusive, for reference to Secs. 19a-165 to 19a-165g, inclusive;
May 25 Sp. Sess. P.A. 94-1 removed obsolete language, effective July 1, 1994; P.A. 95-257 replaced Commission on
Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-158 transferred to Sec. 19a-
641 in 1997.
Annotations to former section 19-73p:
Cited. 182 C. 314, 315.
Cited. 32 CS 300. Cited. 34 CS 225, 226, 236. Cited. 35 CS 13, 16.
Annotations to former section 19a-158:
Cited. 196 C. 451, 452, 454. Cited. 208 C. 663, 673. Cited. 210 C. 697, 699. Cited. 214 C. 726, 727, 729. Cited. 226
C. 105, 116, 120, 127. Cited. 235 C. 128, 136.
Cited. 2 CA 68, 74.
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