CHAPTER 368z*
OFFICE OF HEALTH CARE ACCESS

*Annotations to former chapter 334a:
A rule or "guideline" having substantial impact on rights and obligations of those regulated must be promulgated in accordance with Uniform Administrative Procedure Act. 177 C. 356, 357, 360, 361.
Cited. 32 CS 300.
Annotations to former chapter 368c:
Cited. 196 C. 451, 454. Cited. 210 C. 697, 698. Cited. 226 C. 105, 140. Commission on Hospitals and Health Care, Secs. 19a-145−19a-168 cited. Id. Cited. 235 C. 128, 139. Cited. 238 C. 216.

Table of Contents

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.


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".
(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)

Sec. 19a-611. Definitions. As used in sections 19a-610 to 19a-614, inclusive:
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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)

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.
(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)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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:
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-615. Health Care Reform Review Board. Reports. Section 19a-615 is repealed, effective July 1, 1995.
(May Sp. Sess. P.A. 94-3, S. 11, 28; P.A. 95-257, S. 57, 58.)

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-616. Connecticut Health Care Data Institute. Regulations. Section 19a-616 is repealed, effective July 1, 1997.
(May Sp. Sess. P.A. 94-3, S. 12, 28; June 18 Sp. Sess. P.A. 97-8, S. 87, 88.)

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-617. Advisory board. Section 19a-617 is repealed, effective July 1, 1995.
(May Sp. Sess. P.A. 94-3, S. 13, 28; P.A. 95-257, S. 57, 58.)

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.)

(Return to TOC) (Return to Chapters) (Return to Titles)

Secs. 19a-623 to 19a-629. Reserved for future use.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-630. (Formerly Sec. 19a-145). Certificate of need. Definitions. As used in this chapter:
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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".

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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)

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:
(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)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.").

(Return to TOC) (Return to Chapters) (Return to Titles)

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:
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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:
(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".

(Return to TOC) (Return to Chapters) (Return to Titles)

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:
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

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.
(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.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-642. (Formerly Sec. 19a-159). Judicial enforcement. The Superior Court on application of the office or the Attorney General, may enforce, by appropriate decree or process, any provision of this chapter or any act or any order of the office rendered in pursuance of any statutory provision.
(P.A. 73-117, S. 18, 31; P.A. 76-436, S. 262, 681; P.A. 95-257, S. 39, 58.)
History: P.A. 76-436 replaced court of common pleas with superior court, effective July 1, 1978; Sec. 19-73q transferred to Sec. 19a-159 in 1983; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-159 transferred to Sec. 19a-642 in 1997.
Annotations to former section 19a-159:
Cited. 208 C. 663, 665. Cited. 214 C. 321, 324.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-643. (Formerly Sec. 19a-160). Certificate of need regulations. (a) The office shall adopt regulations, in accordance with the provisions of chapter 54, to carry out the provisions of sections 19a-630 to 19a-640, inclusive, and sections 19a-644, 19a-645 and 19a-648, concerning the submission of data by health care facilities and institutions, including data on dealings between health care facilities and institutions and their affiliates, and, with regard to requests or proposals pursuant to sections 19a- 638 and 19a-639, by state health care facilities and institutions, the ongoing inspections by the office of operating budgets of health care facilities and institutions after their approval, standard reporting forms and standard accounting procedures to be utilized by health care facilities and institutions and the transferability of line items in the approved operating budgets of the health care facilities and institutions, except that any health care facility or institution may transfer any amounts among items in its operating budget, provided such facility or institution is not exceeding and will not exceed its overall operating budget. All such transfers shall be reported to the office within thirty days of the transfer or transfers.
(b) The office may adopt such regulations, in accordance with the provisions of chapter 54, as are necessary to implement this chapter.
(c) The regulations adopted by the Office of Health Care Access concerning requests or proposals pursuant to section 19a-639 shall include a fee schedule for certificate of need review under section 19a-639. The fee schedule shall (1) contain a minimum filing fee for all applications under said section 19a-639, (2) be based on a percentage of the requested authorization in addition to the minimum filing fee, and (3) apply to new requests and requests for modification of prior decisions if the modification request has a proposed additional cost of one hundred thousand dollars or more beyond the original authorization amount, or if the modification request aggregated with any other prior modification requests totals one hundred thousand dollars or more. The fee schedule shall be reviewed annually and adjusted as necessary.
(P.A. 73-117, S. 19, 31; P.A. 77-192, S. 12, 13; 77-304, S. 3; 77-601, S. 8, 11; P.A. 81-465, S. 10, 18; P.A. 83-3, S. 3, 5; P.A. 84-57, S. 2, 4; P.A. 89-371, S. 18; P.A. 91-48, S. 3, 4; Nov. Sp. Sess. P.A. 91-2, S. 9, 27; May Sp. Sess. P.A. 92- 6, S. 8, 117; P.A. 93-262, S. 57, 87; P.A. 95-257, S. 39, 58; P.A. 98-150, S. 9, 17.)
History: P.A. 77-192 added reference to regulations re requests and proposals pursuant to Secs. 19-73l to 19-73n; P.A. 77-304 added provisions re regulations concerning disclosure of business interests which may have impact on provision of services; P.A. 77-601 added provision re regulation of home health care, homemaker-home health aide and coordination, assessment and monitoring agencies; P.A. 81-465 made commission's adoption of regulations to carry out its duties mandatory rather than optional; Sec. 19-73r transferred to Sec. 19a-160 in 1983; P.A. 83-3 substituted reference to Sec. 19a-157 for reference to Sec. 19a-156; P.A. 84-57 added the requirement to adopt regulations to carry out the provisions of "sections 19a-161 and 19a-162"; P.A. 89-371 added reference to Sec. 19a-167e, removed an obsolete reference and added language concerning affiliates; P.A. 91-48 removed language directing the commission to adopt regulations requiring full disclosure of business interests which directly or indirectly relate to nursing home operations; Nov. Sp. Sess. P.A. 91- 2 added Subsec. (b) giving commission authority to adopt regulations for the chapter and made technical change in Subsec. (a); May Sp. Sess. P.A. 92-6 added new Subsec. (c) providing authority for the commission to adopt regulations concerning fees imposed on requests or proposals pursuant to Secs. 19a-154 and 19a-155 and to specify requirements for the fee schedule; P.A. 93-262 removed provision requiring the commission to adopt regulations concerning approval of coordination, assessment and monitoring agencies and regulations concerning rate review of home health care agencies and information based upon recommendations of the commissioner on aging, effective July 1, 1993; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-160 transferred to Sec. 19a-643 in 1997; P.A. 98-150 amended Subsec. (c) by adding condition that modification request have one hundred thousand dollar limit and deleting references to Sec. 19a-638, effective June 5, 1998.
See chapter 54 re uniform administrative procedure.
Annotations to former section 19a-160:
Cited. 200 C. 489, 497. Cited. 208 C. 663, 668.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-644. (Formerly Sec. 19a-161). Annual reports. Regulations on affiliation or control of health care facilities and institutions. (a) On or before February twenty-eighth annually, each health care facility and institution for which a budget was approved or revenue limits were established under the provisions of section 19a-640 or section 19a-674, for the fiscal year ending on September thirtieth of the immediately preceding year, shall report to the office with respect to its operations in such fiscal year, in such form as the office may by regulation require. Said report shall include: (1) Average salaries in each department of administrative personnel, supervisory personnel, and direct service personnel by job classification; (2) salaries and fringe benefits for the ten highest paid positions; (3) the name of each joint venture, partnership, subsidiary and corporation related to the hospital; and (4) the salaries paid to hospital employees by each such joint venture, partnership, subsidiary and related corporation and by the hospital to the employees of related corporations. In addition, said report may, at the discretion of the office, include a breakdown of hospital and department budgets by administrative, supervisory and direct service categories, by total dollars, by full-time equivalent staff or any combination thereof, which the office may request at any time of the year, provided the office gives the hospital at least thirty days from the date of the request to provide the information.
(b) The office shall adopt regulations in accordance with chapter 54 to provide for the collection of data and information in addition to the annual report required in subsection (a) of this section. Such regulations shall provide for the submission of information about the operations of the following entities: Persons or parent corporations that own or control the health care facility, institution or provider; corporations, including limited liability corporations, in which the health care facility, institution, provider, its parent, any type of affiliate or any combination thereof, owns more than an aggregate of fifty per cent of the stock or, in the case of nonstock corporations, is the sole member; and any partnerships in which the person, health care facility, institution, provider, its parent or an affiliate or any combination thereof, or any combination of health care providers or related persons, owns a greater than fifty per cent interest. For purposes of this section, "affiliate" means any person that directly or indirectly through one or more intermediaries, controls or is controlled by or is under common control with any health care facility, institution, provider or person that is regulated in any way under this chapter. A person is deemed controlled by another person if the other person, or one of that other person's affiliates, officers, agents or management employees, acts as a general partner or manager of the person in question.
(P.A. 73-117, S. 28, 31; P.A. 81-465, S. 16, 18; P.A. 83-3, S. 4, 5; P.A. 84-57, S. 3, 4; P.A. 86-61, S. 1, 2; P.A. 89-371, S. 19; P.A. 91-125; May 25 Sp. Sess. P.A. 94-1, S. 119, 130; P.A. 95-257, S. 39, 58; P.A. 98-150, S. 15, 17; P.A. 99-172, S. 4, 7.)
History: P.A. 81-465 changed deadline for initial report from December 31, 1974, to February 28, 1982; Sec. 19-73s transferred to Sec. 19a-161 in 1983; P.A. 83-3 added reference to Sec. 19a-157; P.A. 84-57 specified that reports must be "in such form as the commission may by regulation require"; P.A. 86-61 required facilities issued rate orders to submit reports and made technical changes; P.A. 89-371 made technical changes, added reference to Secs. 19a-167 to 19a-167g, inclusive, and removed obsolete language; P.A. 91-125 added Subdivs. (1) to (5), inclusive, listing five specific items of information to be included in the report; May 25 Sp. Sess. P.A. 94-1 replaced revenue caps with revenue limits and 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-161 transferred to Sec. 19a-644 in 1997; P.A. 98-150 added Subsec. (b) re regulations on affiliation or control, effective June 5, 1998; P.A. 99-172 amended Subsec. (a) to make a technical change and to expand budget reporting and make it in the discretion of the office, and amended Subsec. (b) by changing "parent" to "persons or parent", changing "an affiliate" to "any type of affiliate", changing "fifty per cent" to "an aggregate of fifty per cent", adding references to "person", "provider" and "combination of health care providers or related persons", and adding definition of "affiliate", effective June 23, 1999.
See Sec. 19a-630a re further definition of "affiliate".

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-645. (Formerly Sec. 19a-162). Taking of land to enlarge hospitals. A nonprofit hospital, licensed by the Department of Public Health, which provides lodging, care and treatment to members of the public, and which wishes to enlarge its public facilities by adding contiguous land and buildings thereon, if any, the title to which it cannot otherwise acquire, may prefer a complaint for the right to take such land to the superior court for the judicial district in which such land is located, provided such hospital shall have received the approval of the Office of Health Care Access under section 19a-639 or 19a-640. Said court shall appoint a committee of three disinterested persons, who, after examining the premises and hearing the parties, shall report to the court as to the necessity and propriety of such enlargement and as to the quantity, boundaries and value of the land and buildings thereon, if any, which they deem proper to be taken for such purpose and the damages resulting from such taking. If such committee reports that such enlargement is necessary and proper and the court accepts such report, the decision of said court thereon shall have the effect of a judgment and execution may be issued thereon accordingly, in favor of the person to whom damages may be assessed, for the amount thereof; and, on payment thereof, the title to the land and buildings thereon, if any, for such purpose shall be vested in the complainant, but such land and buildings thereon, if any, shall not be taken until such damages are paid to such owner or deposited with said court, for such owner's use, within thirty days after such report is accepted. If such application is denied, the owner of the land shall recover costs of the applicant, to be taxed by said court, which may issue execution therefor. Land so taken shall be held by such hospital and used only for the public purpose stated in its complaint to the superior court. No land dedicated or otherwise reserved as open space or park land or for other recreational purposes and no land belonging to any town, city or borough shall be taken under the provisions of this section.
(P.A. 73-582, S. 1; P.A. 77-614, S. 323, 610; P.A. 81-465, S. 12, 18; P.A. 82-472, S. 63, 183; P.A. 89-371, S. 20; P.A. 93-381, S. 9, 39; May 25 Sp. Sess. P.A. 94-1, S. 52, 130; P.A. 95-257, S. 12, 21, 39, 58.)
History: P.A. 77-614 replaced department of health with department of health services, effective January 1, 1979; P.A. 81-465 deleted reference to Sec. 19-73n, repealed by the same act; P.A. 82-472 deleted obsolete reference to counties; Sec. 19-73t transferred to Sec. 19a-162 in 1983; P.A. 89-371 added reference to Secs. 19a-167 to 19a-167g, inclusive; P.A. 93-381 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 Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health and replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-162 transferred to Sec. 19a-645 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-646. (Formerly Sec. 19a-166). Negotiation of discounts and different rates and methods of payment with hospitals. Filings with the office. (a) As used in this section:
(1) "Office" means the Office of Health Care Access;
(2) "Fiscal year" means the hospital fiscal year as used for purposes of this chapter;
(3) "Hospital" means any short-term acute care general hospital licensed by the Department of Public Health in the state;
(4) "Payer" means any person, legal entity, governmental body or eligible organization covered by the provisions of 42 USC Section 1395mm(b), or any combination thereof, except for Medicare and Medicaid which is or may become legally responsible, in whole or in part for the payment of services rendered to or on behalf of a patient by a hospital. Payer also includes any legal entity whose membership includes one or more payers and any third-party payer; and
(5) "Prompt payment" means payment made for services to a hospital by mail or other means on or before the tenth business day after receipt of the bill by the payer.
(b) No hospital shall provide a discount from the filed rates or charges to any payer except as provided in this section.
(c) (1) Until September 30, 1993, in addition to procedures available to other private third-party payers, an eligible organization, as described in 42 USC Section 1395mm(b), may directly negotiate for a different rate and method of reimbursement with a hospital.
(2) Effective October 1, 1993, to March 31, 1994, inclusive, an eligible organization, as described in 42 USC Section 1395mm(b), may directly negotiate for a different rate and method of reimbursement with a hospital provided (A) the cost of such discount is not shifted, in whole or in part, to other payers not so covered by the discount agreement; and (B) the charges and payment for the payer are reported in accordance with this subsection.
(3) On and after April 1, 1994, any payer may directly negotiate for a different rate and method of reimbursement with a hospital provided the charges and payments for the payer are reported in accordance with this subsection. No discount agreement or agreement for a different rate or method of reimbursement shall be effective until filed with the office.
(4) On and after April 1, 1994, the charges and payments for each payer receiving a discount shall be accumulated by the hospital for each payer and reported as required by the office. The office may require a review by the hospital's independent auditor, at the hospital's expense, to determine compliance with subdivision (3) of this subsection.
(5) A full written copy of each agreement executed pursuant to this subsection, on and after October 2, 1991, shall be filed with the Office of Health Care Access by each hospital executing such an agreement, no later than ten business days after such agreement is executed. Each agreement filed shall specify on its face that it was executed and filed pursuant to this subsection. Agreements filed in accordance with this subsection shall be considered trade secrets pursuant to subdivision (5) of subsection (b) of section 1-210 except that the office may utilize and distribute data derived from such agreements, including the names of the parties to the agreement, the duration and dates of the agreement and the estimated value of any discount or alternate rate of payment.
(d) A payer may negotiate with a hospital to obtain a discount on rates or charges for prompt payment.
(e) A payer may also negotiate for and may receive a discount for the provision of the following administrative services: (1) A system which permits the hospital to bill the payer through either a computer-processed or machine-readable or similar billing procedure; (2) a system which enables the hospital to verify coverage of a patient by the payer at the time the service is provided; and (3) a guarantee of payment within the scope of the agreement between the patient and the third-party payer for service to the patient prior to the provision of that service.
(f) No hospital may require a payer to negotiate for another element or any combination of the above elements of a discount, as established in subsections (d) and (e), in order to negotiate for or obtain a discount for any single element. No hospital may require a payer to negotiate a discount for all patients covered by such payer in order to negotiate a discount for any patient or group of patients covered by such payer.
(g) Any hospital which agrees to provide a discount to a payer under subsection (d) or (e) shall file a copy of the agreement with the office and shall provide the same discount to any other payer who agrees to make prompt payment or provide administrative services similar to that contained in the agreement. Each agreement filed shall specify on its face that it was executed and filed pursuant to this subsection. The office shall disallow any agreement which gives a discount pursuant to the terms of subsections (d) and (e) which is in excess of the maximum amount set forth in said subsections. No such agreement shall be contingent on volume or drafted in such a manner as to limit the discount to one or more payers by establishing criteria unique to such payers. Any payer aggrieved under this subsection may petition the office for an order directing the hospital to provide a similar discount. The office shall adopt regulations in accordance with the provisions of chapter 54 to carry out the provisions of this subsection.
(h) (1) Nothing in this section shall be construed to require payment by any payer or purchaser, under any program or contract for payment or reimbursement of expenses for health care services, for: (A) Services not covered under such program or contract; or (B) that portion of any charge for services furnished by a hospital that exceeds the amount covered by such program or contract.
(2) Nothing in this section shall be construed to supersede or modify any provision of such program or contract that requires payment of a copayment, deductible or enrollment fee or that imposes any similar requirement.
(i) A hospital which has established a program approved by the office with one or more banks for the purpose of reducing the hospital's bad debt load, may reduce its published charges for that portion of a patient's bill for services which a payer who is a private individual is or may become legally responsible for, after all other insurers or third-party payers have been assessed their full charges provided (1) prior to the rendering of such services, the hospital and the individual payer or parent or guardian or custodian have agreed in writing that after receipt of any insurer or third-party payment paid in accordance with the full hospital charges the remaining payment due from the private individual for such reduced charges shall be made in whole or in part from the balance on deposit in a bank account which has been established by or on behalf of such individual patient and (2) such payment is made from such account. Nothing in this section shall relieve a patient or legally liable person from being responsible for the full amount of any underpayment of the hospital's authorized charges excluding any discount under this section, by a patient's insurer or any other third-party payer for that insurer's or third-party payer's portion of the bill. Any reduction in charges granted to an individual or parent or guardian or custodian under this subsection shall be reported to the office as a contractual allowance. For purposes of this section "private individual" shall include a patient's parent, legal guardian or legal custodian but shall not include an insurer or third-party payer.
(P.A. 84-323, S. 2, 6; P.A. 85-613, S. 51, 154; P.A. 91-258, S. 3, 4; June Sp. Sess. P.A. 91-11, S. 22, 25; P.A. 93-229, S. 5, 21; P.A. 93-381, S. 9, 39; P.A. 94-9, S. 34, 41; May Sp. Sess. P.A. 94-3, S. 21, 28; P.A. 95-257, S. 12, 21, 39, 58; June 18 Sp. Sess. P.A. 97-2, S. 94, 165.)
History: P.A. 85-613 made technical change; P.A. 91-258 amended Subsec. (c) to add a requirement that a copy of each agreement reached under Subsec. (c) be filed with the commission on hospitals and health care, amended Subsecs. (c) and (g) to require that agreements specify that they have been executed and filed pursuant to those Subsecs. and made technical changes; June Sp. Sess. P.A. 91-11 amended Subsec. (c) to clarify that required agreements be filed until July 1, 1992, and to exempt the names of the parties to agreements from freedom of information provisions; P.A. 93-229 amended Subsec. (a) to delete definition of "Blue Cross", renumbering Subdivs. as necessary, amended Subsec. (c) to insert Subdiv. indicators, to limit Subdiv. (1) to the time period prior to October 1, 1993, and to add new Subdiv. (2) re negotiation commencing October 1, 1993, to amend Subdiv. (3) re commission not including discount in calculation of authorized gross revenue and addition of discount to actual net revenues for fiscal year and to amend Subdiv. (4) to delete provision exempting names of parties from freedom of information provisions, deleted Subsec. (h) an obsolete provision re Blue Cross discount, added new Subsec. (i) re hospital establishing programs with banks to reduce bad debt load and made technical changes, effective June 4, 1993; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; P.A. 94-9 amended Subsec. (a) to add eligible organizations under 42 USC 1395mm(b) to the definition of payer, Subsec. (c) to add new Subdivs. (3) and (4) re discounts permitted and requirements after April 1, 1994, deleting former Subdiv. (3) re prohibition on cost of discount being borne by patients not covered and relettering former Subdiv. (4) as Subdiv. (5) and added provision re agreements considered trade secrets, and made technical changes, effective April 1, 1994; May Sp. Sess. P.A. 94-3 amended Subsec. (c) of Subdiv. (5) to specifically authorize use of names of parties, duration and dates and estimated value, 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-166 transferred to Sec. 19a-646 in 1997; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (a) to make a technical change, effective July 1, 1997.
Annotations to former section 19a-166:
Cited. 214 C. 321, 331.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-647. (Formerly Sec. 19a-166b). Preferred provider network. Definitions. Filing requirements. (a) As used in this section and subsection (b) of section 20-138b:
(1) "Health care services" means health care related services or products rendered or sold by a provider within the scope of the provider's license or legal authorization and includes hospital, medical, surgical, dental, vision and pharmaceutical services or products.
(2) "Person" means an individual, agency, political subdivision, partnership, corporation, limited liability company, association or any other entity.
(3) "Preferred provider network" means an arrangement in which agreements relating to the health care services to be rendered by providers, including the amounts to be paid to the providers for such services, are entered into between such providers and a person who establishes, operates, maintains or underwrites the arrangement, in whole or in part, and shall include any provider-sponsored preferred provider network or independent practice association that offers network services. A preferred provider network shall not include a workers' compensation preferred provider organization established pursuant to section 31-279-10 of the regulations of Connecticut state agencies or an arrangement relating only to health care services offered by providers to individuals covered under self-insured Employee Welfare Benefit Plans established pursuant to the federal Employee Retirement Income Security Act of 1974 as from time to time amended.
(4) "Provider" means an individual or entity duly licensed or legally authorized to provide health care services.
(b) All preferred provider networks shall file with the Office of Health Care Access prior to the start of enrollment and shall annually update said filing by July first of each year thereafter. The filing required by such network shall include the following information: (1) The identity of any company controlling the operation of the preferred provider network, a description of such participation and, where applicable, the following: (A) A certificate from the Secretary of the State or the Insurance Commissioner regarding the company's or organization's good standing to do business in the state of Connecticut; (B) a copy of the company's or organization's balance sheet at the end of its most recently concluded fiscal year, along with the name and address of any public accounting firm or internal accountant which prepared or assisted in the preparation of such balance sheet; (C) a list of the names, official positions and occupations of members of the company's or organization's board of directors or other policy-making body and of those executive officers who are responsible for the company's or organization's activities with respect to the medical care network; (D) a list of the company's or organization's principal owners; (E) in the case of an out-of-state company or organization, a certificate that such company or organization is in good standing in its state of organization; (F) the identity, address and current relationship of any related or predecessor company or organization; "related" for this purpose means that a substantial number of the board or policy-making body members, executive officers or principal owners of both companies are the same; and (G) in the case of a Connecticut or out-of-state company or organization, a report of the details of any suspension, sanction or other disciplinary action relating to such company or organization in this state or in any other state; (2) a general description of the preferred provider network, including: (A) its geographical service area, the names of the hospitals included in the network; and (B) the primary care physicians, the specialty physicians, any other contracting health care providers and the number and percentage of each group's capacity to accept new patients; and (3) the name and address of the person to whom applications may be made for participation. With the exception of the provider network information required in subdivision (2) of this subsection, the information required by this subsection need not be filed with the office if it has already been filed with the Insurance Commissioner.
(c) Any person developing, or expanding into a new county, a preferred provider network pursuant to this section and subsection (b) of section 20-138b shall provide a notice in at least one major newspaper in the service area in which it operates indicating plans to develop, or expand into a new county, a preferred provider network. Such notice shall include the medical specialties included in the network, the name and address of the person to whom applications may be made for participation and a time frame for making application. The preferred provider network shall provide the applicant with written acknowledgment of receipt of the application. Each complete application shall be considered by the network in a timely manner.
(d) The expenses incurred by the Office of Health Care Access pursuant to subsection (b) of this section shall be paid by the office, within existing budgetary resources.
(e) (1) Each preferred provider network shall file with the Office of Health Care Access and make available upon request from a provider, the general criteria for its selection or termination of health care providers. Disclosure shall not be required of criteria deemed by the network to be of a proprietary or competitive nature that would hurt the network's ability to compete or to manage health services. For purposes of this section, disclosure of criteria is proprietary or anticompetitive if it has the tendency to cause health care providers to alter their practice pattern in a manner that would circumvent efforts to contain health care costs and is proprietary if revealing criteria would cause the network's competitors to obtain valuable business information.
(2) If a network uses criteria that have not been filed pursuant to subdivision (1) of this subsection to judge the quality and cost-effectiveness of a health care provider's practice under any specific program within the network, the network may not reject or terminate the provider participating in that program based upon such criteria until the provider has been informed of the criteria that his practice fails to meet.
(f) A preferred provider network which has a limited network and which does not provide any reimbursement when an enrollee obtains service outside that limited network shall inform each applicant of that fact prior to enrolling the applicant for coverage.
(P.A. 93-358, S. 1; P.A. 94-235; P.A. 95-79, S. 59, 189; 95-257, S. 39, 58; P.A. 97-99, S. 24.)
History: P.A. 94-235 amended Subsec. (b) to require that filing contain names and addresses of persons to whom applications for participation made be made, amended Subsec. (c) to apply to expansions into a new county, to require that notice include time frame for making application and to require networks to acknowledge receipt of applications and consider them in timely fashion, added Subsec. (e) regarding filing and disclosure requirements of selection and termination criteria and Subsec. (f) regarding disclosures by limited networks; P.A. 95-79 amended Subsec. (a) to redefine "person" to include a limited liability company, effective May 31, 1995; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-166b transferred to Sec. 19a-647 in 1997; P.A. 97-99 amended Subsec. (b) by requiring filing of capacity to accept new patients, by exempting filing if filed with Insurance Commissioner and by making technical changes and amended Subsec. (c) by making technical changes.
Annotations to former section 19a-166b:
Confers a private cause of action for declaratory relief on plaintiffs. 238 C. 216. P.A. 94-235 cited. Id.
Subsec. (a):
Subdiv. (3) cited. 238 C. 216. P.A. 94-235 (a)(3) cited. Id. Subdiv. (4) cited. Id. P.A. 94-235 (a)(4) cited. Id.
Subsec. (e):
Subdiv. (1) cited. 238 C. 216. P.A. 94-235 (e)(1) cited. Id. Subdiv. (2) cited. Id. P.A. 94-235 (e)(2) cited. Id.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-648. (Formerly Sec. 19a-167e). Performance or billing by affiliates after the base year. Adjustments. Civil penalty. (a) The value of any service (1) performed by a hospital in the base year and performed by an affiliate of a hospital for any portion of the rate year or (2) billed by the hospital in the base year and billed by another health care provider for any portion of the rate year shall be deducted from the revenue caps and the hospital's average charge shall be adjusted accordingly. A hospital which experiences a change in the performance or billing of a service as described in subdivision (1) or (2) of this subsection shall report such change to the office immediately. The office may require a hospital to submit within thirty days such information as the office deems necessary to determine whether a service was performed by an affiliate or billed by another provider.
(b) Any hospital which fails to file any information required pursuant to subsection (a) of this section within the prescribed time shall be subject to a civil penalty in the amount of the excess revenue collected by the hospital due to the failure to file such information as determined by the office plus ten thousand dollars unless such hospital is granted a waiver in accordance with the provisions of subsection (c) of this section. Any civil penalty authorized by this section shall be imposed by the office in accordance with subsection (c) of this section.
(c) The office shall notify any hospital subject to a civil penalty under subsection (b) of this section, of its intention to impose such civil penalty and the amount of such proposed civil penalty, not less than three calendar days prior to the proposed date of imposition of such penalty. Within three calendar days of receipt of such notification, the hospital may object to the imposition of a penalty or request a waiver of the civil penalty or an extension of time to file such required information, by filing a written request with the office which shall contain an explanation and list of any extenuating circumstances. The office shall provide a hospital with the opportunity for a hearing prior to the imposition of a civil penalty pursuant to this section. If any such objection or request is filed, the office shall not impose any civil penalty until it issues a decision on the request. If a waiver is requested, the office may grant the waiver or hold a hearing as soon as possible on the request, or both. The office shall issue a final decision as to whether or not the civil penalty shall be waived, in whole or in part, due to the extenuating circumstances, within ten business days of the close of the hearing or the date of the request if no hearing is held. Unless an objection or a request for a waiver or time extension is filed with the office, any civil penalty imposed under this section shall be effective on the first calendar day after such data is due or after the three-day period, whichever is later. If a waiver is denied, in whole or in part, any civil penalty imposed under this section shall be effective on the first calendar day after such denial. Within ten business days of the office's imposition of a civil penalty, any hospital which had filed an objection, or requested a waiver or time extension, and is aggrieved by a decision under this section may appeal to the Superior Court under section 4-183. An appeal to the Superior Court shall not automatically stay the imposition of any such civil penalty.
(P.A. 89-371, S. 6; P.A. 95-257, S. 39, 58.)
History: P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-167e transferred to Sec. 19a-648 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-649. (Formerly Sec. 19a-167f). Uncompensated care including emergency assistance to families. Audits. The office, in consultation with the Commissioner of Social Services, shall review annually the level of uncompensated care including emergency assistance to families provided by each hospital to the indigent. Each hospital shall file annually with the office its policies regarding the provision of free or reduced cost services to the indigent, excluding medical assistance recipients, and its debt collection practices. Each hospital shall obtain an independent audit of the level of charges, payments and discharges by primary payer related to Medicare, medical assistance, CHAMPUS and nongovernmental payers as well as the amount of uncompensated care including emergency assistance to families. The results of this audit, including the above information, with an opinion, shall be provided to the office by each hospital together with the hospital's financial statements filed on February twenty-eighth of each year. For purposes of this section, "primary payer" means the final payer responsible for more than fifty per cent of the charges on the case, or, if no payer is responsible for more than fifty per cent of the charges the payer responsible for the highest percentage of charges. The office shall evaluate the audit and may rely on the information contained in the independent audit or may require such additional audit as it deems necessary.
(P.A. 89-371, S. 7; Nov. Sp. Sess. P.A. 91-2, S. 12, 27; P.A. 93-44, S. 7, 24; 93-229, S. 7, 21; 93-262, S. 1, 87; P.A. 95-257, S. 39, 58.)
History: Nov. Sp. Sess. P.A. 91-2 authorized commission to perform audits as part of its evaluation; P.A. 93-44 included emergency assistance to families in uncompensated care, required hospitals to obtain an independent audit and file results of audit on February twenty-eighth annually, where previously commission conducted audit or contracted for independent audit, effective April 23, 1993; P.A. 93-229 added provision re audit by primary payer designation, deleted reference re February twenty-eighth audited financial statements on a separate and distinct schedule and added new language re providing required information with an opinion with hospitals financial statements filed on February twenty-eighth and included a definition of "primary payer", effective June 4, 1993; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-167f transferred to Sec. 19a-649 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-650. (Formerly Sec. 19a-167g). Regulations. The office shall adopt regulations, in accordance with the provisions of chapter 54, to implement, administer and ensure compliance with section 19a-648.
(P.A. 89-371, S. 8, 31; May 25 Sp. Sess. P.A. 94-1, S. 53, 130; P.A. 95-257, S. 39, 58.)
History: 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-167g transferred to Sec. 19a-650 in 1997.
Annotations to former section 19a-167g:
Cited. 223 C. 450, 454.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-651. (Formerly Sec. 19a-167h). Data requirement. Rate order compliance. Adjustment. No later than February 28, 1990, each hospital which was subject to the prospective payment system under sections 19a-165 to 19a-165v, inclusive, revision of 1958, revised to 1989, and the regulations adopted pursuant to said sections shall file information deemed necessary by the office in order for the office to determine whether the hospital conformed with its office authorized rate order for the fiscal year commencing October 1, 1988. If the office determines that such rate order has not been complied with, the office shall adjust the revenue caps established pursuant to section 19a-167a or the budget proposed pursuant to section 19a-167c, as appropriate. Any such adjustment shall be consistent with the provisions of sections 19a-648 to 19a-650, inclusive, and shall be made in accordance with regulations adopted pursuant to section 19a-650.
(P.A. 89-371, S. 24; P.A. 95-257, S. 39, 58.)
History: P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-167h transferred to Sec. 19a-651 in 1997; (Revisor's note: In 1997 when transferring Secs. 19a- 167 to 19a-167g, inclusive, to Secs. 19a-648 to 19a-650, inclusive, the Revisors editorially omitted reference to repealed sections 19a-167 to 19a-167d, inclusive).
Annotations to former section 19a-167h:
Cited. 223 C. 450, 454.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-652. (Formerly Sec. 19a-167i). Termination of prospective payment system. Savings clause. The termination of the prospective payment system shall not impair or affect any act done, offense committed or right accruing, accrued or acquired, or an obligation, liability, penalty, forfeiture or punishment incurred prior to October 1, 1989, under chapter 368c of the general statutes, revision of 1958, revised to 1989, and the same may be enjoyed, asserted and enforced, as fully and to the same extent and in the same manner as they might under the laws existing prior to said date, and all matters civil or criminal pending on said date or instituted thereafter for any act done, offense committed, right accruing, accrued, or acquired, or obligation, liability, penalty, forfeiture, or punishment incurred prior to said date may be continued or instituted under and in accordance with the provisions of the law in force at the time of the commission of said act done, offense committed, right accruing, accrued, or acquired, or obligation, liability, penalty, forfeiture or punishment incurred.
(P.A. 89-371, S. 27.)
History: Sec. 19a-167i transferred to Sec. 19a-652 in 1997.
Annotations to former section 19a-167i:
Cited. 223 C. 450, 454.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-653. (Formerly Sec. 19a-167j). Certificate of need. Civil penalty. Request for determination of a certificate of need requirement. (a)(1) Any health care provider which owns, operates or is seeking to acquire a computer axial tomography (CT) scanner, medical imaging equipment, or a linear accelerator or any health care facility, institution, person or provider that is required to file data or information under any public or special act or under this chapter or any regulation adopted or order issued thereunder, which fails to so file within prescribed time periods, shall be subject to a civil penalty of up to one thousand dollars a day for each day such information is missing, incomplete or inaccurate. Any civil penalty authorized by this section shall be imposed by the Office of Health Care Access in accordance with subsections (b) to (e), inclusive, of this section.
(2) If an applicant or provider is unsure whether a certificate of need is required under section 19a-638 or section 19a-639, or under both sections, it shall send a letter to the office describing the project and requesting that the office make such a determination. A person making a request for a determination as to whether a certificate of need, waiver or exemption is required shall provide the office with any information the office requests as part of its determination process.
(b) If the office has reason to believe that a violation has occurred for which a civil penalty is authorized by subsection (a) of this section, it shall notify the health care facility, institution or provider, by first-class mail or personal service. The notice shall include: (1) A reference to the sections of the statute or regulation involved; (2) a short and plain statement of the matters asserted or charged; (3) a statement of the amount of the civil penalty or penalties to be imposed; (4) the initial date of the imposition of the penalty; and (5) a statement of the party's right to a hearing.
(c) The facility, institution, person or provider to whom the notice is addressed shall have ten calendar days from the date of mailing of the notice to make written application to the office to request (1) a hearing to contest the imposition of the penalty, or (2) an extension of time to file the required data. A failure to make a timely request for a hearing or a denial of a request for an extension of time shall result in a final order for the imposition of the penalty. All hearings under this section shall be conducted pursuant to sections 4-176e to 4-184, inclusive. The office may grant an extension of time for filing the required data or mitigate or waive the penalty upon such terms and conditions as, in its discretion, it deems proper or necessary upon consideration of any extenuating factors or circumstances.
(d) A final order of the office assessing a civil penalty shall be subject to appeal as set forth in section 4-183 after a hearing before the office pursuant to subsection (c) of this section, except that any such appeal shall be taken to the superior court for the judicial district of New Britain. Such final order shall not be subject to appeal under any other provision of the general statutes. No challenge to any such final order shall be allowed as to any issue which could have been raised by an appeal of an earlier order, denial or other final decision by the office.
(e) If any facility, institution, person or provider fails to pay any civil penalty under this section, after the assessment of such penalty has become final the amount of such penalty may be deducted from payments to such facility, institution, person or provider from the Medicaid account.
(P.A. 88-230, S. 1, 12; P.A. 89-371, S. 28, 31; P.A. 90-98, S. 1, 2; P.A. 93-142, S. 4, 7, 8; May 25 Sp. Sess. P.A. 94- 1, S. 120, 130; P.A. 95-160, S. 55, 69; 95-220, S. 4−6; 95-257, S. 39, 58; P.A. 96-139, S. 12, 13; P.A. 98-150, S. 8, 17; P.A. 99-172, S. 5, 7; 99-215, S. 24, 29.)
History: May 25 Sp. Sess. P.A. 94-1 removed obsolete language and added reference to Secs. 19a-170 to 19a-170g, inclusive, in Subsec. (a), effective July 1, 1994 (Revisor's note: The last sentence of Subsec. (a) which reads "Any civil penalty authorized by this section shall be imposed by the Commission on Hospitals and Health Care in accordance with subsection (b) of this section." was omitted from the amendment to Subsec. (a) but in the absence of any indication that the General Assembly intended to delete this sentence it has been treated as a clerical error and reinstated by the Revisors); P.A. 95-160 amended Subsec. (a) to add health care providers who own, operate, or seek to acquire CAT scan or medical imaging equipment, increase the penalty from two hundred fifty to one thousand dollars, made technical changes, broadened application of section to all of chapter 368c and 368z, deleted Subsecs. (b) to (d) and replaced them with new (b) to (e) re procedure for application of penalty, effective June 1, 1995 (Revisor's note: P.A. 88-230, 90-98, 93-142 and 95-220 authorized substitution of "judicial district of Hartford" for "judicial district of Hartford-New Britain" in 1995 public and special acts, effective September 1, 1998); P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; Sec. 19a-167j transferred to Sec. 19a-653 in 1997; P.A. 98-150 amended Subsec. (a) by deleting "health care facility or institution" concerning owning, operating or seeking to acquire equipment and adding it concerning filing data, added "or information under any public or special act", adding linear accelerators and adding Subdiv. (2) re request as to whether certificate of need is required and made technical changes, effective June 5, 1998; P.A. 99-172 added reference to "person" in Subsecs. (a), (c) and (e) and made technical changes in Subsecs. (b), (c) and (e), effective June 23, 1999; P.A. 99-215 replaced "judicial district of Hartford" with "judicial district of New Britain" in Subsec. (d), effective June 29, 1999.
Annotations to former section 19a-167j:
Cited. 223 C. 450, 454. Cited. 238 C. 216.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-654. (Formerly Sec. 19a-167k). Data required for budget review purposes. Audit. The Office of Health Care Access shall require hospitals to submit such discharge data as it deems necessary for budget review purposes. Such data shall include data taken from medical record abstracts and hospital bills. The timing and format of such submission shall be specified by the office. The data may be submitted through a contractual arrangement with an intermediary. If the data is submitted through an intermediary, the hospital shall ensure that such submission is timely and that the data is accurate. The office may conduct an audit of the data submitted to such intermediary in order to verify its accuracy. Individual patient and physician data identified by proper name or personal identification code submitted pursuant to this section shall be kept confidential, but aggregate reports from which individual patient and physician data cannot be identified shall be available to the public.
(P.A. 89-371, S. 29, 31; P.A. 95-257, S. 39, 58.)
History: P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-167k transferred to Sec. 19a-654 in 1997.
Annotations to former section 19a-167k:
Cited. 223 C. 450, 454.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-655. (Formerly Sec. 19a-167l). Hospital budget calculations for the fiscal year commencing October 1, 1993. Notwithstanding the provisions of sections 19a-167a to 19a-167d, inclusive, for the fiscal year commencing October 1, 1993, all hospitals shall have their budgets calculated and authorized pursuant to the following method:
(1) The authorized net revenue and expenses per equivalent discharge prior to compliance shall be the authorized net revenue and expenses per equivalent discharge prior to compliance for the year commencing October 1, 1992, adjusted for nonrecurring items and unbundling of services, increased by three and one-fourth per cent, plus any adjustment for certificate of need projects authorized by the office pursuant to sections 19a-638 and 19a-657, or section 19a-639, or both.
(2) The authorized gross revenue per equivalent discharge prior to compliance shall be the authorized gross revenue per equivalent discharge prior to compliance for the year commencing October 1, 1992, adjusted for nonrecurring items and unbundling of services, increased by four and one-fourth per cent, plus any adjustment for certificate of need projects authorized by the office pursuant to sections 19a-638 and 19a-657, or section 19a-639, or both.
(3) The authorized number of equivalent discharges for the fiscal year commencing October 1, 1993, shall be the number of equivalent discharges authorized by the office for the fiscal year commencing October 1, 1992, plus any additional equivalent discharges authorized by the office as a result of authorized certificate of need projects authorized by the office pursuant to sections 19a-638 and 19a-657, or section 19a-639, or both.
(4) The authorized net revenue prior to compliance and the uncompensated care pool adjustments shall be the product of the result of subdivision (1) of this section times the result of subdivision (3) of this section.
(5) The authorized gross revenue prior to compliance and uncompensated care pool adjustments shall be the product of the result of subdivision (2) of this section times subdivision (3) of this section.
(6) The revenue caps established in this section shall not be increased except as provided in accordance with the provisions of sections 19a-657, 19a-658, 19a-660, 19a- 663, 19a-664 and 19a-665.
(P.A. 93-229, S. 12, 21; P.A. 95-257, S. 39, 58.)
History: P.A. 93-229 effective June 4, 1993 (Revisor's note: Reference in Subdiv. (6) to Secs. 19a-168h, 19a-168l and 19a-168m was deleted editorially by the Revisors to reflect the repeal of those sections by P.A. 94-9, S. 39, 41); P.A. 95- 257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995 (Revisor's note: A reference in Subdiv. (6) to Sec. 19a-168k was deleted editorially by the Revisors to reflect the repeal of that section by the same act); Sec. 19a-167l transferred to Sec. 19a-655 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

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. (a) For the fiscal year commencing October 1, 1991, the compliance assessment to be applied in the year commencing October 1, 1993, shall be calculated as follows:
(1) Subtract the authorized net revenue per equivalent discharge for the hospital from the actual net revenue per equivalent discharge for the hospital plus any discounts provided by the hospital pursuant to subsection (c) of section 19a-646.
(2) Multiply the result of subdivision (1) of this subsection by the actual number of equivalent discharges. If the result is positive, it is the net revenue compliance adjustment, otherwise the net revenue compliance adjustment is zero.
(3) Multiply the result of subdivision (2) of this subsection by the ratio of authorized gross revenue prior to any uncompensated care pool adjustment to authorized net revenue for the year commencing October 1, 1991. The result shall be the gross revenue compliance adjustment.
(4) The total amount of the net revenue compliance adjustment calculated in subdivision (2) of this subsection shall be applied in the fiscal year commencing October 1, 1993, except that if the result of subdivision (2) of this subsection is greater than three and one-fourth per cent of the authorized net revenue for the fiscal year commencing October 1, 1992, the amount of net revenue compliance to be taken in the fiscal year commencing October 1, 1993, shall be three and one-fourth per cent of the authorized net revenue for the fiscal year commencing October 1, 1992.
(5) The total amount of the gross revenue compliance adjustment calculated in subdivision (3) of this subsection shall be applied in the fiscal year commencing October 1, 1993, except that if the result of subdivision (3) of this subsection is greater than four and one-fourth per cent of the authorized gross revenue for the fiscal year commencing October 1, 1992, the amount of gross revenue compliance to be taken in the fiscal year commencing October 1, 1993, shall be four and one-fourth per cent of the authorized gross revenue for the fiscal year commencing October 1, 1992.
(b) Any net or gross revenue compliance determined for the year commencing October 1, 1991, pursuant to section 19a-167g-82 of the regulations of Connecticut state agencies, as amended from time to time, which is not assessed pursuant to subdivisions (4) and (5) of subsection (a) of this section shall be forgiven by the office.
(c) The balance of the compliance adjustments calculated by the office for the fiscal year commencing October 1, 1989, but not assessed shall be forgiven by the office.
(d) The compliance adjusted net revenue, prior to the uncompensated care pool adjustments, for the year commencing October 1, 1993, shall be the result of subdivision (4) of section 19a-655 less the net revenue compliance adjustment to be assessed in the fiscal year commencing October 1, 1993, calculated in subdivision (4) of subsection (a) of this section if such compliance adjustment is a positive number. The compliance adjusted net revenue cap for the year commencing October 1, 1993, shall be the compliance adjusted net revenue divided by the authorized equivalent discharges for the fiscal year commencing October 1, 1993.
(e) The compliance adjusted gross revenue, prior to the uncompensated care pool adjustments, for the year commencing October 1, 1993, shall be the result of subdivision (5) of section 19a-655 less the gross revenue compliance adjustment to be assessed in the fiscal year commencing October 1, 1993, calculated in subdivision (5) of subsection (a) of this section if such compliance adjustment is a positive number. The compliance adjusted gross revenue cap prior to the uncompensated care pool adjustments for the year commencing October 1, 1993, shall be the compliance adjusted gross revenue prior to the uncompensated care pool adjustments divided by the authorized equivalent discharges for the fiscal year commencing October 1, 1993.
(P.A. 93-229, S. 13, 21; P.A. 95-257, S. 39, 58.)
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, effective July 1, 1995; Sec. 19a-167m transferred to Sec. 19a-656 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

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. (a) A hospital may request an adjustment to its authorized net and gross revenue and authorized equivalent discharges for the fiscal year commencing October 1, 1993, calculated pursuant to sections 19a-655 and 19a-656 if it has a certificate of need project which was approved on or before April 26, 1993, which has not already been included in the authorized revenue of the hospital and for which the hospital's certificate of need approval decision indicated that the hospital may request such an adjustment. If there is an agreed upon adjustment, that adjustment shall be made. Any request for recognition of incremental expenses or revenues pursuant to this section shall be received in writing within ten business days following the receipt by the hospital of its authorized revenue caps determined pursuant to sections 19a-655 and 19a-656. The hospital shall provide such data and support for its request as shall be required by the office, including, but not limited to, the incremental costs and volumes associated with the project. The office may approve, modify or deny such request.
(b) A hospital may request an adjustment to its authorized gross revenue for the fiscal year commencing October 1, 1993, to recognize additional gross revenue requirements resulting from a change in the wage index due to a Medicare geographic wage index reclassification into urban New York received for the fiscal year commencing October 1, 1992, but not for the fiscal year commencing October 1, 1993, provided:
(1) The failure to obtain a favorable reclassification for the year commencing October 1, 1993, shall not be due to the failure of the hospital to request such reclassification in a timely manner, except where the reclassification was made in error;
(2) The hospital's request has been denied;
(3) The requested incremental gross revenue adjustment for the fiscal year commencing October 1, 1993, shall not exceed the amount of incremental gross revenue the hospital would have received in its authorization for the fiscal year commencing October 1, 1992, after compliance and prior to any uncompensated care pool adjustments, if the hospital had not been granted a change in the Medicare wage index due to geographic reclassification times 1.0425;
(4) Any hospital requesting an adjustment under this subsection shall file at the office documentation and data which demonstrates qualifications under and compliance with subdivisions (1) to (3), inclusive, of this subsection, within ten business days following receipt by the hospital of its authorized revenue caps determined in accordance with sections 19a-655 and 19a-656. The office may approve, modify or deny a hospital's request under this section.
(P.A. 93-229, S. 14, 21; P.A. 95-257, S. 39, 58.)
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, effective July 1, 1995; Sec. 19a-167n transferred to Sec. 19a-657 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-658. (Formerly Sec. 19a-167o). Pricemaster adjustment; request procedure. Limitations. Data requirement. Report. (a) Any hospital may, in accordance with this section and sections 19a-655 to 19a-657, inclusive, 19a-664 and 19a-665, request a one-time adjustment to its pricemaster in its budget request for the fiscal year commencing October 1, 1993. Such hospital shall submit the actual data required by the office for such adjustment on a computer disk in a format to be specified by the office as follows: (1) A description of the applicable units and the number of inpatient and outpatient units for each item on its pricemaster; (2) the price or charges, including a description and item code number, for each item in its pricemaster and the time period or volume for which each price was applicable; (3) the total gross revenue for each item in its pricemaster; (4) the number of discharges; (5) the number of governmental and nongovernmental units for each item in the pricemaster.
(b) The office may approve or deny any request for a pricemaster adjustment in the hospital's fiscal year 1994 budget authorization.
(c) The change in the prices in the pricemaster shall not result in greater actual total gross revenue or nongovernmental gross revenue than actual gross revenue or nongovernmental gross revenue for the twelve-month period commencing October 1, 1991, as measured using the actual units of service for the same period.
(d) By February 28, 1994, each hospital which adjusted its pricemaster in accordance with this section shall provide the data required by the office, as specified in subsection (a) of this section, for the twelve-month period commencing October 1, 1992. If a hospital fails to provide the data required by the office by February 28, 1994, the office shall automatically eliminate for all purposes any increases in charges or prices of the hospital due to the pricemaster adjustment.
(e) By May 1, 1994, each hospital which adjusted its pricemaster in accordance with this section shall provide the data required by the office, as specified for in subsection (a) of this section, for the six-month period commencing October 1, 1993. If after review of such data, the office finds that the hospital is in violation of subsection (c) of this section, it shall require the hospital to readjust its pricemaster in order to comply with the provisions of subsection (c) of this section. If a hospital fails to provide the data required by the office by May 1, 1994, the office shall automatically eliminate for all purposes any increases in charges or prices of the hospital due to the pricemaster adjustment.
(f) The office shall recalculate the number of authorized equivalent discharges and the authorized gross and net revenue caps for the fiscal year commencing October 1, 1993, to ensure that the change in the pricemaster does not result in greater or lesser total net and gross revenue or greater nongovernmental gross revenue for the fiscal year.
(g) The office shall report to the joint standing committee of the General Assembly having cognizance of matters relating to public health on the operation of this section on November 1, 1993, and February 1, 1994.
(P.A. 93-229, S. 17, 21; P.A. 95-257, S. 39, 58.)
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, effective July 1, 1995; Sec. 19a-167o transferred to Sec. 19a-658 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-659. (Formerly Sec. 19a-170). Definitions. As used in sections 19a-659 to 19a-662, inclusive, 19a-669 to 19a-672, inclusive, and 19a-674 to 19a-680, inclusive:
(1) "Office" means the Office of Health Care Access;
(2) "Hospital" means a hospital included within the definition of health care facilities or institutions under section 19a-630 and licensed as a short-term general hospital by the Department of Public Health and including John Dempsey Hospital of The University of Connecticut Health Center;
(3) "Fiscal year" means the hospital fiscal year;
(4) "Base year" means the fiscal year prior to the fiscal year for which a budget is being determined;
(5) "Affiliate" means a person, entity or organization controlling, controlled by, or under common control with another person, entity or organization;
(6) "Uncompensated care including emergency assistance to families" means the actual cost in the year prior to the base year of care written off as bad debts or provided free under a free care policy approved by the office including emergency assistance to families authorized by the Department of Social Services and not otherwise funded;
(7) "Medical assistance" means medical assistance provided under the general assistance program, the state-administered general assistance program or the Medicaid program;
(8) "CHAMPUS" means the federal Civilian Health and Medical Program of the Uniformed Services, 10 USC 1071 et seq.;
(9) "Medicare shortfall" means the Medicare underpayment for the year prior to the base year divided by the proportion of total charges excluding Medicare, medical assistance, CHAMPUS, and uncompensated care including emergency assistance to families and contractual and other allowances for the year prior to the base year;
(10) "Medical assistance shortfall" means the medical assistance underpayment for the year prior to the base year divided by the proportion of total charges excluding Medicare, medical assistance, CHAMPUS, and uncompensated care including emergency assistance to families and contractual and other allowances for the year prior to the base year;
(11) "CHAMPUS shortfall" means the CHAMPUS underpayment for the year prior to the base year divided by the proportion of total charges excluding Medicare, medical assistance, CHAMPUS, and uncompensated care including emergency assistance to families and contractual and other allowances for the year prior to the base year;
(12) "Primary payer" means the payer responsible for the highest percentage of the charges on the case;
(13) "Case mix index" means a hospital's case mix index calculated using the medical record abstract and billing data submitted by the hospital to the office. The case mix index shall be calculated by dividing the total case mix adjusted discharges for the hospital by the actual number of discharges for the hospital for the fiscal year. The total case mix adjusted discharges shall be calculated by multiplying the number of discharges in each diagnosis related group by the Medicare weights in effect for the same diagnosis related group in effect for the fiscal year and adding the resultant procedures across all diagnosis related groups;
(14) "Contractual allowances" means, for the period October 1, 1992, to March 30, 1994, inclusive, the amount of discounts provided to nongovernmental payers pursuant to subsections (d) and (e) of section 19a-646, and for the period beginning April 1, 1994, the amount of discounts provided to nongovernmental payers pursuant to subsections (c), (d) and (e) of section 19a-646;
(15) "Medicare underpayment" means the difference between the actual net revenue of a hospital times the ratio of Medicare charges to total charges and the amount received by the hospital from the federal government for Medicare patients for the year prior to the base year;
(16) "Medical assistance underpayment" means the difference between the actual net revenue of a hospital times the ratio of medical assistance charges to total charges and the amount received by the hospital from the Department of Social Services for the year prior to the base year;
(17) "CHAMPUS underpayment" means the difference between the actual net revenue of a hospital times the ratio of CHAMPUS charges to total charges and the amount received by the hospital from CHAMPUS for the year prior to the base year;
(18) "Other allowances" means the amount of any difference between charges for employee self-insurance and related expenses determined using the hospital's overall relationship of costs to charges;
(19) "Gross revenue" means the total charges for all patient care services;
(20) "Net revenue" means total gross revenue less contractual allowance, the difference between government charges and government payments, uncompensated care, and other allowances; plus, for purposes of compliance, net payments from the uncompensated care pool in existence prior to April 1, 1994, and payments from the Department of Social Services;
(21) "Emergency assistance to families" means assistance to families with children under the age of twenty-one who do not have the resources to independently provide the assistance needed to avoid the destitution of the child and which is authorized by the Department of Social Services pursuant to section 17b-107 and is not otherwise funded.
(P.A. 94-9, S. 26, 41; P.A. 95-257, S. 12, 21, 39, 58; June 18 Sp. Sess. P.A. 97-2, S. 95, 165.)
History: P.A. 94-9 effective April 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 (Revisor's note: References to Secs. 19a-168k and 19a-168d were changed editorially by the Revisors to Secs. 19a-168j and 19a-168c, respectively, to reflect the repeal of Secs. 19a-168k and 19a-169d by P.A. 95-257); Sec. 19a-170 transferred to Sec. 19a-659 in 1997; June 18 Sp. Sess. P.A. 97-2 amended Subdiv. (7) to make technical changes, effective July 1, 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-660. (Formerly Sec. 19a-168g). Adjustments to orders. The office is authorized to adjust its orders in effect for fiscal year 1992 and subsequent fiscal years by order and without a prior hearing as necessary to implement the provisions of sections 19a-643 and 19a-649 and in compliance with the formulas specified herein and as necessary to implement sections 19a-659, 19a-670 to 19a-672, inclusive, and 19a-674 to 19a- 680, inclusive. Any hospital which claims that a formula was improperly calculated or applied may request a hearing in a writing that states the hospital's position with regard to the issues to be heard, within ten days of the notice of the payment factors. Any such hearing shall be limited to the issues of whether the formula was improperly calculated or applied. Any hospital which claims that office action reduces the hospital's authorized revenue other than as necessary for the implementation of said sections and sections 19a-659, 19a-670 to 19a-672, inclusive, and 19a-674 to 19a-680, inclusive, and in compliance with the formulas specified in said sections may request a hearing in a writing that states the hospital's position with regard to the issues to be heard. The office shall hold a hearing on said claim.
(Nov. Sp. Sess. P.A. 91-2, S. 21, 27; May Sp. Sess. P.A. 92-16, S. 64, 89; P.A. 93-44, S. 14, 24; P.A. 94-9, S. 8, 41; P.A. 95-257, S. 39, 58.)
History: May Sp. Sess. P.A. 92-16 provided that the commission may adjust a rate order in effect for any fiscal year in which the pool is modified; P.A. 93-44 deleted provision permitting adjustment in any fiscal year in which the pool is terminated or modified and granted permission for adjustment in fiscal years subsequent to 1992, effective April 1, 1993; P.A. 94-9 added references to Secs. 19a-169a to 19a-169c and 19a-170 to 19a-170g and deleted references to sections repealed by the same act, effective April 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-168g transferred to Sec. 19a-660 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-661. (Formerly Sec. 19a-168i). Penalty. Notwithstanding any other penalty which may be provided by law, if a hospital is delinquent in its payments to the pool in existence prior to April 1, 1994, or in making payments pursuant to section 19a- 676, the office may order that the hospital pay a penalty of up to ten thousand dollars per day to the General Fund for each day for which the payment is delinquent. If not paid by the hospital, the penalty may be recovered in a summary civil proceeding brought in the name of the state in the Superior Court. Said proceeding shall have priority status pursuant to section 52-191. The only issue in said proceeding shall be whether the hospital is delinquent and no counterclaim of any kind shall be filed. No penalty assessed against a hospital shall be recouped by the hospital through the hospital's rates and charges.
(Nov. Sp. Sess. P.A. 91-2, S. 8, 27; P.A. 93-44, S. 15, 24; P.A. 94-9, S. 9, 41; P.A. 95-257, S. 39, 58.)
History: P.A. 93-44 added reference to taxes, effective April 23, 1993; P.A. 94-9 deleted requirement that penalty payments be made to the pool and added that the payments be made to the general fund, effective April 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-168i transferred to Sec. 19a-661 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-662. (Formerly Sec. 19a-168j). Cost reduction plan requirement. Regulations. Effective for fiscal year 1993 and subsequent fiscal years: (1) The office shall require a hospital which engages in inefficient or inappropriate provision of uncompensated care services to submit to the office a cost reduction plan. The Commissioner of Social Services may prospectively reduce the hospital's disproportionate share payments upon notification by the office that the hospital has failed to submit such a plan or to implement a cost reduction plan approved by the office. (2) The office shall adopt regulations on admitting, billing and collection procedures. Each hospital shall submit to the office its admission, billing and collection procedures and protocols for approval by the office. In the event that the office finds that these procedures and protocols are inadequate, the office may instruct that they be modified. If a hospital does not modify its procedures and protocols as soon as practicable upon being instructed to do so by the office, or is found by the office to be failing to follow its approved procedures and protocols, the Commissioner of Social Services may reduce the disproportionate share payments to the hospital until such deficiency is corrected. (3) Effective for fiscal year 1994 and subsequent fiscal years, the office shall not recognize and the Commissioner of Social Services shall not make payments for shortfalls due to unpaid costs associated with admissions which were denied through utilization review or denied due to the hospital's failure to comply with payers' utilization review or claims submission requirements. Nothing in subdivision (3) of this section shall limit the hospital's right to collect from any legally liable person or entity for any services rendered.
(Nov. Sp. Sess. P.A. 91-2, S. 13, 27; P.A. 94-9, S. 10, 41; P.A. 95-257, S. 39, 58.)
History: P.A. 94-9 made technical changes related to termination of the pool and changed commission to commissioner of social services re prospective reduction of payments, effective April 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-168j transferred to Sec. 19a-662 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-663. (Formerly Sec. 19a-168p). Bond authorization. (a) For the purposes described in subsection (b) of this section, the State Bond Commission shall have the power, from time to time to authorize the issuance of bonds of the state in one or more series and in principal amounts not exceeding in the aggregate ten million dollars.
(b) The proceeds of the sale of said bonds, to the extent of the amount stated in subsection (a) of this section, shall be used by the Department of Public Health for the purposes of the uncompensated care pool account.
(c) All provisions of section 3-20, or the exercise of any right or power granted thereby which are not inconsistent with the provisions of this section are hereby adopted and shall apply to all bonds authorized by the State Bond Commission pursuant to this section, and temporary notes in anticipation of the money to be derived from the sale of any such bonds so authorized may be issued in accordance with said section 3-20 and from time to time renewed. Such bonds shall mature at such time or times not exceeding twenty years from their respective dates as may be provided in or pursuant to the resolution or resolutions of the State Bond Commission authorizing such bonds. None of said bonds shall be authorized except upon a finding by the State Bond Commission that there has been filed with it a request for such authorization, which is signed by or on behalf of the Secretary of the Office of Policy and Management and states such terms and conditions as said commission, in its discretion, may require. Said bonds issued pursuant to this section shall be general obligations of the state and the full faith and credit of the state of Connecticut are pledged for the payment of the principal of and interest on said bonds as the same become due, and accordingly and as part of the contract of the state with the holders of said bonds, appropriation of all amounts necessary for punctual payment of such principal and interest is hereby made, and the Treasurer shall pay such principal and interest as the same become due.
(Nov. Sp. Sess. P.A. 91-2, S. 20, 27; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58.)
History: 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 Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; Sec. 19a-168p transferred to Sec. 19a-663 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-664. (Formerly Sec. 19a-168s). Assessment factor for the uncompensated care pool adjustments for the fiscal year commencing October 1, 1993. (a) The assessment factor for uncompensated care pool adjustments shall be calculated as follows for the fiscal year commencing October 1, 1993:
(1) For each hospital, calculate the sum of the uncompensated care determined in subsection (c) of section 19a-665 plus the authorized proportion determined pursuant to section 19a-669 of the governmental underpayment calculated pursuant to subsection (b) of section 19a-665;
(2) Add the results of the calculations in subdivision (1) of this subsection for all hospitals;
(3) Divide the result of subdivision (2) of this subsection by the total of all hospitals' compliance adjusted authorized net revenue from payers other than Medicare, medical assistance and CHAMPUS determined by the commission for the current year less payments from the uncompensated care pool as calculated by the commission in accordance with subsection (d) of section 19a-168b, and subsection (b) of this section, for the current fiscal year;
(4) Subtract six percentage points from the result of subdivision (3) of this subsection.
(b) For the fiscal year commencing October 1, 1993, the interim payment factor shall be calculated as follows for each hospital:
(1) Add the amount of uncompensated care including authorized emergency assistance to families determined pursuant to subsection (c) of section 19a-665 and the authorized proportion determined by the office pursuant to section 19a-669 of the governmental underpayment calculated pursuant to subsection (b) of section 19a-665;
(2) Divide the result of subdivision (1) of this subsection by the estimated gross revenue from payers other than Medicare, medical assistance and CHAMPUS included in the gross revenue authorization determined pursuant to subsection (e) of section 19a-656.
(c) For the fiscal year commencing October 1, 1993, the office shall establish a revised gross revenue cap which shall be the uncompensated care pool gross revenue cap for each hospital computed as follows:
(1) The authorized other allowances for the fiscal year commencing October 1, 1993, shall be the result of other allowances authorized by the office for the fiscal year commencing October 1, 1992, multiplied by the result of the division of subdivision (1) of subsection (a) of section 19a-665 by the result of subdivision (2) of subsection (a) of section 19a-665.
(2) The authorized contractual allowances for the fiscal year commencing October 1, 1993, shall be the result of contractual allowances authorized by the office for the fiscal year commencing October 1, 1992, multiplied by the result of the division of the result of subdivision (1) of subsection (a) of section 19a-665 by the result of subdivision (2) of subsection (a) of section 19a-665.
(3) The uncompensated care pool authorized gross revenue for the fiscal year commencing October 1, 1993, shall be the result of adding the net revenue calculated pursuant to subsection (d) of section 19a-665 plus the result of subdivision (1) of this subsection plus the result of subdivision (2) of this subsection plus one minus the authorized proportion determined pursuant to section 19a-669 of the governmental shortfall determined pursuant to subdivision (4) of subsection (a) of section 19a-665.
(d) No interim adjustment to the rates shall be authorized for the fiscal year commencing October 1, 1993, except in accordance with this section, sections 19a-655 to 19a-657, inclusive, and section 19a-665.
(P.A. 93-229, S. 15, 21; P.A. 95-257, S. 39, 58.)
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, effective July 1, 1995; Sec. 19a-168s transferred to Sec. 19a-664 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-665. (Formerly Sec. 19a-168t). Authorized governmental shortfall calculation for the fiscal year commencing October 1, 1993. (a) For the fiscal year commencing October 1, 1993, the authorized governmental shortfall shall be calculated as follows:
(1) Subtract the authorized net revenue calculated pursuant to section 19a-655 from the authorized gross revenue for the fiscal year commencing October 1, 1993, calculated pursuant to section 19a-655.
(2) Subtract the authorized net revenue prior to compliance for the fiscal year commencing October 1, 1992, from the authorized gross revenue prior to compliance and the uncompensated care pool adjustments for the fiscal year commencing October 1, 1992.
(3) Calculate the sum of the authorized medical assistance shortfall for the fiscal year commencing October 1, 1992, plus the portion of the authorized Medicare and CHAMPUS shortfalls for the fiscal year commencing October 1, 1992, used in calculating the authorized gross revenue for the hospital for the year commencing October 1, 1992.
(4) The authorized governmental shortfall for the fiscal year commencing October 1, 1993, shall be the result of subdivision (3) of this subsection times the result of the division of the result of subdivision (1) of this subsection by the result of subdivision (2) of this subsection.
(b) The authorized governmental underpayment for the fiscal year commencing October 1, 1993, shall be the result of subdivision (4) of subsection (a) of this section times the proportion of total charges excluding Medicare, medical assistance, CHAMPUS and uncompensated care including emergency assistance to families and contractual and other allowances used in establishing the gross revenue authorization for the fiscal year commencing October 1, 1992.
(c) The authorized amount of uncompensated care for the fiscal year commencing October 1, 1993, shall be calculated by multiplying the authorized amount of uncompensated care for the fiscal year commencing October 1, 1992, by the result of dividing the result of subdivision (1) of subsection (a) of this section by the result of subdivision (2) of subsection (a) of this section.
(P.A. 93-229, S. 16, 21.)
History: P.A. 93-229 effective June 4, 1993; Sec. 19a-168t transferred to Sec. 19a-665 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-666. (Formerly Sec. 19a-168u). Uncompensated care pool expenditures. All payments made from the uncompensated care pool during the fiscal years ending June 30, 1992, June 30, 1993, and June 30, 1994, in accordance with the provisions of section 19a-168b, are deemed to be expenditures from appropriated funds authorized by public act of the General Assembly.
(P.A. 94-9, S. 37, 41.)
History: P.A. 94-9 effective April 1, 1994; Sec. 19a-168u transferred to Sec. 19a-666 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-667. (Formerly Sec. 19a-168v). Uncompensated care pool termination. Final settlement. (a) Notwithstanding the provisions of sections 19a-168 to 19a- 168f, inclusive, the uncompensated care pool shall terminate effective 12:00 a.m., April 1, 1994. The termination of the uncompensated care pool shall not impair or affect any act done, offense committed or right accruing, accrued or acquired, or any obligation, liability, penalty, forfeiture or punishment incurred prior to April 1, 1994, under chapter 368c of the general statutes, revision of 1958, revised to 1993, as amended, and the same may be enjoyed, asserted and enforced, as fully and to the same extent and in the same manner as they might under the laws existing prior to said date, and all matters civil or criminal pending on said date or instituted thereafter for any act done, offense committed, right accruing, accrued, or acquired, or obligation, liability, penalty, forfeiture, or punishment incurred prior to said date may be continued or instituted under and in accordance with the provisions of the law in force at the time of the commission of said act done, offense committed, right accruing, accrued, or acquired, or obligation, liability, penalty, forfeiture or punishment incurred.
(b) On April 1, 1994, the Treasurer shall transfer ten million dollars of the funds in said pool representing the proceeds of the sale of bonds issued pursuant to section 19a- 663 for the purpose of providing initial funding for said pool into a separate account of the General Fund to be used to pay debt service on any tax exempt state of Connecticut general obligation bond and shall transfer all remaining funds and assets of said pool to the resources of the General Fund. During the period April 1, 1994, to April 12, 1994, inclusive, revenues received and payments made from said pool, shall be made in accordance with the provisions of section 19a-168b.
(c) (1) Final settlement of all obligations and liabilities of the uncompensated care pool shall be no later than June 15, 1995. All uncompensated care pool assessments and other liabilities of hospitals for the period ending March 31, 1994, based on the assessable accounts receivable as of March 31, 1994, shall be paid and all uncompensated care pool payments to hospitals attributable to the period ending March 31, 1994, shall be made no later than June 15, 1995. The amount, if any, by which assessments and other liabilities exceed payments shall be credited to the resources of the General Fund. (2) Following the final resolution of an action pending in the United States district court for the district of Connecticut entitled New England Health Care Union, District 1199, SEIU, AFL-CIO; et al v. Mt. Sinai Hospital et al, No. 92-CU-1012, any additional amounts owed to the state from hospitals as a result of payments that the hospitals are entitled to receive for patient care services following the resolution of such action shall be due and payable to the state no later than one month following receipt of such payments by the hospital. Such amount shall be deposited into the General Fund and credited to the reconciliation account established pursuant to section 19a-683.
(P.A. 94-9, S. 3, 41; P.A. 95-160, S. 56, 69; P.A. 96-139, S. 12, 13.)
History: P.A. 94-9 effective April 1, 1994; P.A. 95-160 added Subsec. (c) re final settlement of all obligations and liabilities of the uncompensated care pool, effective June 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; Sec. 19a-168v transferred to Sec. 19a-667 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-668. (Formerly Sec. 19a-168w). Assistance for termination of uncompensated care pool. Notwithstanding section 19a-667, the Office of Health Care Access may maintain or enter into any contract or contracts with one or more private entities within available appropriations to deactivate, audit or consult on any rights, duties or obligations owed to the uncompensated care pool prior to April 1, 1994, to assist the Department of Social Services and to assist in the administration of sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of section 12-407, subsection (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subsection (1) of section 12-414, and sections 19a-646, 19a-659 to 19a-662, inclusive, and 19a- 666 to 19a-680, inclusive, on or after April 1, 1994.
(P.A. 94-9, S. 4, 41; P.A. 95-257, S. 39, 58; P.A. 96-165, S. 3, 9.)
History: P.A. 94-9 effective April 1, 1994; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995 (Revisor's note: A reference to Sec. 19a-168k was deleted editorially by the Revisors to reflect the repeal of that section by the same act); P.A. 96-165 made a technical change, effective July 1, 1996; Sec. 19a-168w transferred to Sec. 19a-668 in 1997 (Revisor's note: In 1997 when transferring this section the Revisors editorially omitted the reference to repealed section 19a-168b).

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-669. (Formerly Sec. 19a-169). Disproportionate share payments and emergency assistance to families; determination of amount eligible for federal matching payments. Effective October 1, 1993, and October first of each subsequent year, the Secretary of the Office of Policy and Management shall determine and inform the Office of Health Care Access of the maximum amount of disproportionate share payments and emergency assistance to families eligible for federal matching payments under the Medical Assistance Program or the Emergency Assistance to Families Program pursuant to federal statute and regulations and subdivisions (2) and (28) of section 12-407, subsection (1) of section 12-408, subdivision (5) of section 12-412, section 12-414, sections 19a-649, 19a-660 and 19a-661 and this section and the actual and anticipated appropriation to the medical assistance disproportionate share-emergency assistance account authorized pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of section 12-407, subsection (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subsection (1) of section 12-414 and sections 19a-646, 19a-659 to 19a-662, inclusive, and 19a-666 to 19a-680, inclusive, and the amount of emergency assistance to families' payments to hospitals projected for the year, and the anticipated amount of any increase in payments made pursuant to any resolution of any civil action pending on April 1, 1994, in the United States district court for the district of Connecticut. The Department of Social Services shall inform the office of any amount of uncompensated care which the Department of Social Services determines is due to a failure on the part of the hospital to register patients for emergency assistance to families, or a failure to bill properly for emergency assistance to families' patients. If during the course of a fiscal year the Secretary of the Office of Policy and Management determines that these amounts should be revised, he shall so notify the office and the office may modify its calculation pursuant to section 19a-671 to reflect such revision and its orders in accordance with section 19a-660, as it deems appropriate and the Commissioner of Social Services may modify his determination pursuant to section 19a-671.
(P.A. 93-44, S. 16, 24; P.A. 94-9, S. 13, 41; P.A. 95-257, S. 39, 58; P.A. 96-165, S. 4, 9.)
History: P.A. 93-44 effective April 23, 1993; P.A. 94-9 deleted previously existing provisions re payments for Medicare, medical assistance and CHAMPUS underpayments from uncompensated care pool and substituted new provisions re emergency assistance to families program, effective April 1, 1994 (Revisor's note: References to repealed sections were deleted editorially by the Revisors in 1995); P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995 (Revisor's note: A reference to Sec. 19a-168k was deleted editorially by the Revisors to reflect the repeal of that section by the same act); P.A. 96-165 made technical changes, effective July 1, 1996; Sec. 19a-169 transferred to Sec. 19a-669 in 1997 (Revisor's note: In 1997 when transferring this section the Revisors editorially omitted reference to repealed sections 19a-168b, 19a-168e and 19a-169d).

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-670. (Formerly Sec. 19a-169a). Disproportionate share and emergency assistance to families payments to hospitals. (a) Within available appropriations, the Department of Social Services may make semimonthly payments to hospitals in an amount calculated pursuant to section 19a-671, provided the total amount of payments made to individual hospitals and to hospitals in the aggregate shall maximize the amount qualifying for federal matching payments under the medical assistance program and the emergency assistance to families program as determined by the Department of Social Services in consultation with the Office of Policy and Management. No payments shall be made to any hospital exempt from taxation under chapter 211a. The payments shall be medical assistance disproportionate share payments, including grants provided pursuant to section 19a-168k, to the extent allowable under federal law. In addition payments may be made for authorized emergency assistance to needy families with dependent children in accordance with Title IV-A of the Social Security Act to the extent allowable under federal law. The payments shall not be part of the routine medical assistance inpatient hospital rate determined pursuant to section 17b-239, except to the extent the Commissioner of Social Services determines that increasing those rates would be appropriate to resolve any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut or the court orders such increase. Payments shall be made on an interim basis during each year and a final settlement shall be calculated pursuant to section 19a-671 by the office for each hospital after the year end based on audited data for the hospitals. The Commissioner of Social Services may withhold payment to a hospital which is in arrears in remitting its obligations to the state.
(b) (1) For the hospital fiscal year 1994, and subsequent fiscal years, the commission or its designated representative shall conduct a cash audit of the projected amount of uncompensated care, including emergency assistance to families and underpayments against the actual receipts of the hospital. In addition, the office or its designated intermediary shall conduct an audit of the revenues, deductions from revenue, discharges, days or other measures of patient volume for hospitals for the purposes of termination and final settlement of uncompensated care pool assessments and payments for the period ending March 31, 1994.
(2) For the six-month period ending September 30, 1994, and for each subsequent fiscal year, the office or its designated intermediary shall conduct an audit of the revenues, deductions from revenue, discharges, days or other measures of patient volume for hospitals for the purposes of determining disproportionate share payments. Included in this audit shall be a comparison of projected and actual levels of medical assistance underpayment and uncompensated care.
(3) The total payments from the Department of Social Services medical assistance disproportionate share-emergency assistance account established pursuant to section 38 of public act 94-9* and made in accordance with sections 19a-670 to 19a-672, inclusive, during the fiscal year less any payments for emergency assistance to families, and less any payments resulting from the resolution of or court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, shall be reallocated to hospitals based on actual audited levels of medical assistance underpayment, grants pursuant to section 19a-168k and uncompensated care to determine the final payment for the fiscal year.
(4) If the final payment for a hospital for the hospital fiscal year, as determined as a result of this audit, is less than the total payments the hospital received during the same fiscal year excluding any prior year audit adjustment, then the current hospital fiscal year remaining semimonthly payments shall each be reduced by an amount equal to the total excess payment divided by the number of remaining semimonthly payments for the current hospital fiscal year.
(5) If the final payment for a hospital for the hospital fiscal year, as determined as a result of this audit, is greater than the total payments the hospital received during the same fiscal year, then the current hospital fiscal year remaining semimonthly payments shall each be increased by an amount equal to the total excess payment divided by the number of remaining semimonthly payments for the current hospital fiscal year.
(6) The office shall, by June 1, 1995, and June first of each subsequent year, report the results of such audit for the previous hospital fiscal year to the joint standing committee of the General Assembly having cognizance of matters relating to public health. The report shall include information concerning the financial stability of hospitals in a competitive market.
(7) Notwithstanding the provisions of subdivisions (3) to (5), inclusive, of this subsection, no adjustment of disproportionate share payments to hospitals for purposes of final settlement shall be implemented for the hospital fiscal years commencing October 1, 1997, and October 1, 1998, provided every hospital subject to final settlement for said fiscal years submits documentation in writing of its agreement to forego such final settlement to the Commissioner of Social Services in a form acceptable to the commissioner.
(8) Notwithstanding the provisions of subdivisions (3) to (5), inclusive, of this subsection, for the hospital fiscal year commencing October 1, 1999, and for each subsequent fiscal year, no adjustment of disproportionate share payments to hospitals for purposes of final settlement shall be determined or implemented.
(c) The Commissioner of Social Services is authorized to determine exceptions, exemptions and adjustments in accordance with 42 CFR 413.40.
(d) Nothing in section 3-114i, subdivisions (2) or (29) of section 12-407, subsection (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subsection (1) of section 12-414, sections 12-263a to 12-263e, inclusive, sections 19a-646, 19a- 659 to 19a-662 or 19a-666 to 19a-680, inclusive, or sections 1, 2, or 38 of public act 94-9* shall be construed to require the Department of Social Services to pay out more funds than are appropriated pursuant to said sections.
(P.A. 94-9, S. 5, 41; P.A. 95-160, S. 57, 69; 95-257, S. 39, 58; 95-306, S. 4, 7; P.A. 96-139, S. 12, 13; 96-165, S. 5, 9; P.A. 97-2, S. 4, 8; P.A. 99-279, S. 27, 45.)
*Note: Sections 1, 2 and 38 of public act 94-9 are special in nature and therefore have not been codified but remain in full force and effect according to their terms.
History: P.A. 94-9 effective April 1, 1994; P.A. 95-160 amended Subsec. (a) to change shall to may re payments to hospitals and added proviso re aggregate to maximize federal match, effective June 1, 1995; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 95-306 amended Subdiv. (3) of Subsec. (b) by requiring the subtraction of payments from a court order entered in a civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, from the total payments made from the medical assistance disproportionate share-emergency assistance account, effective July 6, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 96-165 amended Subsec. (d) to make a technical change, effective July 1, 1996; Sec. 19a-169a transferred to Sec. 19a-670 in 1997 (Revisor's note: In 1997 when transferring this section the Revisors editorially omitted a reference to repealed section 19a-169d from Subsec. (d)); P.A. 97-2 amended Subsec. (a) to provide that no payment be made to children's general hospitals that are exempt from tax under chapter 211a, effective the later of October 1, 1997, or upon the date of federal approval or federal determination that no approval is required pursuant to Sec. 19a-670a; (Revisor's note: Actual effective date was October 1, 1997); P.A. 99-279 amended Subsec. (a) to exempt John Dempsey Hospital of The University of Connecticut Health Center from the disproportionate share payment system, and amended Subsec. (b) to substitute "determining" for "final settlement of" in Subdiv. (2), and to add Subdivs. (7) and (8) which provide that no retroactive adjustment of disproportionate share payments to hospitals for purposes of final settlement shall be implemented, effective July 1, 1999.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-670a. Application for federal approval by the Department of Social Services. The Department of Social Services shall promptly apply to the federal Health Care Financing Administration for any necessary federal approval or a federal determination that no such approval is needed with respect to the provisions of sections 12- 263a and 19a-670.
(P.A. 97-2, S. 5, 8.)
History: P.A. 97-2 effective January 30, 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-670b. Construction with respect to children's general hospitals. Nothing in section 12-263a, subsection (28) of section 12-407, section 19a-670, 19a- 670a or 19a-676a shall be construed as relieving any children's general hospital from any prior year's disproportionate share settlements or adjustments.
(P.A. 97-2, S. 6, 8.)
History: P.A. 97-2 effective January 30, 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-671. (Formerly Sec. 19a-169b). Calculation and determination of payments. The Commissioner of Social Services is authorized to determine the amount of payments pursuant to sections 19a-670 to 19a-672, inclusive, for each hospital. The commissioner's determination shall be based on the advice of the office and the application of the calculation in this section. For each hospital the Office of Health Care Access shall calculate the amount of payments to be made pursuant to sections 19a-670 to 19a- 672, inclusive, as follows:
(1) For the period April 1, 1994, to June 30, 1994, inclusive, and for the period July 1, 1994, to September 30, 1994, inclusive, the office shall calculate and advise the Commissioner of Social Services of the amount of payments to be made to each hospital as follows:
(A) Determine the amount of pool payments for the hospital, including grants approved pursuant to section 19a-168k, in the previously authorized budget authorization for the fiscal year commencing October 1, 1993.
(B) Calculate the sum of the result of subparagraph (A) of this subdivision for all hospitals.
(C) Divide the result of subparagraph (A) of this subdivision by the result of subparagraph (B) of this subdivision.
(D) From the anticipated appropriation to the medical assistance disproportionate share-emergency assistance account made pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of section 12-407, subsection (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subsection (1) of section 12-414 and sections 19a-646, 19a-659 to 19a-662, inclusive, and 19a-666 to 19a-680, inclusive, for the quarter subtract the amount of any additional medical assistance payments made to hospitals pursuant to any resolution of or court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, and also subtract the amount of any emergency assistance to families payments projected by the office to be made to hospitals in the quarter.
(E) The disproportionate share payment shall be the result of subparagraph (D) of this subdivision multiplied by the result of subparagraph (C) of this subdivision.
(2) For the fiscal year commencing October 1, 1994, and subsequent fiscal years, the interim payment shall be calculated as follows for each hospital:
(A) For each hospital determine the amount of the medical assistance underpayment determined pursuant to section 19a-659, plus the actual amount of uncompensated care including emergency assistance to families determined pursuant to section 19a-659, less any amount of uncompensated care determined by the Department of Social Services to be due to a failure of the hospital to enroll patients for emergency assistance to families, plus the amount of any grants authorized pursuant to the authority of section 19a-168k.
(B) Calculate the sum of the result of subparagraph (A) of this subdivision for all hospitals.
(C) Divide the result of subparagraph (A) of this subdivision by the result of subparagraph (B) of this subdivision.
(D) From the anticipated appropriation made to the medical assistance disproportionate share-emergency assistance account pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of section 12-407, subsection (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subsection (1) of section 12-414 and sections 19a-646, 19a-659 to 19a-662, inclusive, and 19a-666 to 19a-680, inclusive, for the fiscal year, subtract the amount of any additional medical assistance payments made to hospitals pursuant to any resolution of or court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, and also subtract any emergency assistance to families payments projected by the office to be made to the hospitals for the year.
(E) The disproportionate share payment shall be the result of subparagraph (D) of this subdivision multiplied by the result of subparagraph (C) of this subdivision.
(P.A. 94-9, S. 6, 41; P.A. 95-257, S. 39, 58; 95-306, S. 5, 7; P.A. 96-165, S. 6, 9; June Sp. Sess. P.A. 00-2, S. 26, 53.)
History: P.A. 94-9 effective April 1, 1994; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 95-306 amended Subdiv. (D) of Subdiv. (1) and Subdiv. (D) of Subdiv. (2) by requiring the subtraction of any medical assistance payments made to hospitals pursuant to any court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, from the anticipated appropriation to the medical assistance disproportionate share-emergency assistance account, effective July 6, 1995; P.A. 96-165 amended Subpara. (D) of Subdivs. (1) and (2) to make technical changes, effective July 1, 1996; Sec. 19a-169b transferred to Sec. 19a-671 in 1997 (Revisor's note: In 1997 when transferring this section the Revisors editorially omitted references to repealed sections 19a-168k and 19a-169d from Subdivs. (1)(D) and (2)(D)); June Sp. Sess. P.A. 00- 2 amended Subdiv. (2)(A) by changing "authorized" to "actual" amount of uncompensated care, effective July 1, 2000.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-671a. Adjustment of overpayments for disproportionate share-medical emergency assistance by reducing Medicaid payments. The Department of Social Services is authorized to adjust the amount of any overpayment for disproportionate share-medical emergency assistance determined pursuant to sections 19a-670 and 19a- 671 by reducing the Medicaid payment to such hospital by the amount of such overpayment.
(P.A. 95-160, S. 51, 69; P.A. 96-139, S. 12, 13.)
History: P.A. 95-160, S. 51 effective June 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-671b. Provisions for waiver of certain penalties and interest assessed pertaining to liability for taxes owed under chapter 211a or 219. (a) The Commissioner of Social Services shall calculate for each hospital the sum of (1) the amount of disproportionate share payments for such hospital for the fiscal year ending June 30, 1995, not previously made and (2) payments due to the hospital as the result of final reconciliation of the uncompensated care pool pursuant to section 19a-671.
(b) If (1) the sum of the payments calculated pursuant to subsection (a) is equal to or exceeds the total of (A) the amount of tax liability of such hospital, computed without regard to any order of the United States District Court for the district of Connecticut in the civil case of Connecticut Hospital Association v. Phillips et al, No. 94-CV-1224, under the provisions of chapter 211a and subparagraph (FF) of subdivision (i) of subsection (2) of section 12-407 attributable to any period which commenced on or after April 1, 1994, and as to which the scheduled due date for payment is on or before June 30, 1995, plus (B) all uncompensated care pool assessments and other liabilities due to the state pursuant to section 19a-671, and (2) the tax liability so computed is paid in full to the Commissioner of Revenue Services and pool reconciliation payments are made in full to the Commissioner of Social Services by the hospital on or before June 15, 1995, then the hospital shall receive, not later than the next business day following such payments, the full amount of disproportionate share payments and uncompensated care pool payments due, as determined by the Commissioner of Social Services and no penalty or interest shall be assessed pertaining to such tax liability.
(c) If (1) the sum of the payments computed pursuant to subsection (a) is less than the total of (A) the amount of tax liability of such hospital, computed without regard to any order of the United States District Court for the district of Connecticut in the civil case of Connecticut Hospital Association v. Phillips et al, No. 94-CV-1224, under the provisions of chapter 211a and subparagraph (FF) of subdivision (i) of subsection (2) of section 12-407 attributable to any period which commenced on or after April 1, 1994, and as to which the scheduled due date for payment is on or before June 30, 1995, plus (B) all uncompensated care pool assessments and other liabilities due to the state pursuant to section 19a-671, and (2) the total amount of tax payments made to the Commissioner of Revenue Services and pool reconciliation payments made to the Commissioner of Social Services by the hospital on or before June 15, 1995, is not less than the total amount of disproportionate share payments and pool reconciliation payments due to the hospital, then the hospital shall receive, not later than the next business day following such payments, the full amount of disproportionate share payments and uncompensated care pool payments due, as determined by the Commissioner of Social Services and no penalty or interest shall be assessed pertaining to such tax liability. The unpaid balance due from the hospital shall be due on or before November 30, 1995, and if paid in full to the Commissioner of Revenue Services by such date shall accrue no interest or penalties through November 30, 1995, provided if it is not paid in full by said date any unpaid balance shall be a delinquent tax and shall be subject to chapter 202 and shall be delinquent after said date.
(P.A. 95-160, S. 54, 69; 95-306, S. 3, 7; P.A. 96-139, S. 12, 13.)
History: P.A. 95-160, S. 54 effective June 1, 1995; P.A. 95-306 made technical changes, effective July 6, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-672. (Formerly Sec. 19a-169c). Use of medical assistance disproportionate share-emergency assistance account funds. The funds appropriated to the medical assistance disproportionate share-emergency assistance account pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of section 12-407, subsection (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subsection (1) of section 12-414 and sections 19a-646, 19a-659 to 19a-662, inclusive, and 19a-666 to 19a-680, inclusive, shall be used by said account to make disproportionate share payments to hospitals, including grants to hospitals pursuant to section 19a-168k, and to make emergency assistance to families payments to hospitals. In addition, the medical assistance disproportionate share-emergency assistance account may utilize a portion of these funds to make outpatient payments as the Department of Social Services determines appropriate or to increase the standard medical assistance payments to hospitals if the Department of Social Services determines it to be appropriate to settle any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut. Notwithstanding any other provision of the general statutes, the Department of Social Services shall not be required to make any payments pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of section 12-407, subsection (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subsection (1) of section 12-414 and sections 19a-646, 19a-659 to 19a- 662, inclusive, and 19a-666 to 19a-680, inclusive, in excess of the funds available in the medical assistance disproportionate share-emergency assistance account.
(P.A. 94-9, S. 7, 41; P.A. 96-165, S. 7, 9.)
History: P.A. 94-9 effective April 1, 1994; (Revisor's note: In 1997 a reference to Sec. 19a-168k was replaced editorially by the Revisors with a reference to Sec. 19a-168j to reflect the repeal of Sec. 19a-168k by P.A. 95-257); P.A. 96-165 made technical changes, effective July 1, 1996; Sec. 19a-169c transferred to Sec. 19a-672 in 1997 (Revisor's note: In 1997 when transferring this section the Revisors editorially omitted reference to repealed sections 19a-168b, 19a-168e and 19a-169d).

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-673. (Formerly Sec. 19a-169e). Collections by hospitals from uninsured patients. (a) As used in this section:
(1) "Cost of providing services" means a hospital's published charges at the time of billing of an uninsured patient, multiplied by the hospital's most recent relationship of costs to charges as taken from the hospital's most recently available audited financial statements.
(2) "Hospital" means an institution licensed by the Department of Public Health as a short-term general hospital.
(3) "Poverty income guidelines" means the poverty income guidelines issued from time to time by the United States Department of Health and Human Services.
(4) "Uninsured patient" means any person whose income is at or below two hundred per cent of the poverty income guidelines who (A) has applied and been denied eligibility for any medical or health care coverage provided under the general assistance program or the Medicaid program due to failure to satisfy income or other eligibility requirements, and (B) is not eligible for coverage for hospital services under the Medicare or CHAMPUS programs, or under any Medicaid or health insurance program of any other nation, state, territory or commonwealth, or under any other governmental or privately sponsored health or accident insurance or benefit program including, but not limited to, workers' compensation and awards, settlements or judgments arising from claims, suits or proceedings involving motor vehicle accidents or alleged negligence.
(b) No hospital that has provided health care services to an uninsured patient may collect from the uninsured patient more than the cost of providing services.
(P.A. 94-9, S. 36, 41; P.A. 95-257, S. 12, 21, 58; June 18 Sp. Sess. P.A. 97-2, S. 96, 165.)
History: P.A. 94-9 effective April 1, 1994; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; Sec. 19a-169e transferred to Sec. 19a-673 in 1997; June 18 Sp. Sess. P.A. 97-2 made technical changes in Subdiv. (4) of Subsec. (a), effective July 1, 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-674. (Formerly Sec. 19a-170a). Net revenue limit. (a) For the fiscal year commencing October 1, 1994, and for subsequent fiscal years, the office shall establish an exempt authorized net revenue limit for each hospital provided, for the fiscal year commencing October 1, 1994, said limit shall be effective January 1, 1995. Such limit shall be computed as follows:
(1) For each hospital, except as described in subdivision (2) of this subsection, the hospital's authorized net revenue limit for the base year shall be multiplied by one plus the forecast of reasonable inflation determined in accordance with section 19a-678 less one percentage point; the result shall be adjusted for increases or decreases in equivalent discharges from the authorized base year using a fifty per cent variable cost adjustment factor. The exempt authorized net revenue for the budget year is determined by multiplying the budget year exempt authorized net revenue limit determined in accordance with this subdivision and subdivision (2) of this subsection by the rate year equivalent discharges projected pursuant to section 19a-679.
(2) For the fiscal year commencing October 1, 1994, and the subsequent fiscal year, the base year authorization shall be adjusted to reflect the actual net revenue received by each hospital provided that this adjustment shall not be applied to increase the base above the authorized level. The adjustment shall be as follows: (A) For the fiscal year commencing October first, two years prior to the year for which authorization is being determined, the result of subdivision (2) of subsection (b) of section 19a-676 shall be divided by the result of subdivision (1) of subsection (b) of section 19a-676. If the result is greater than one, then it shall be replaced by one. (B) For the fiscal year commencing October 1, 1994, and the subsequent fiscal year, the result of subparagraph (A) of this subdivision, shall be multiplied by the hospital's authorized net revenue limit for the base year times one plus the forecast of reasonable inflation in accordance with section 19a-678 less one percentage point; the result shall be adjusted for increases or decreases in equivalent discharges from the authorized base year using a fifty per cent variable cost adjustment factor.
(b) Equivalent discharges shall be computed in accordance with section 19a-679.
(c) Each hospital regardless of whether its budget is authorized through the exempt, partial or detailed budget review process shall file with the office copies of all its Medicare cost reports and, on or before June first annually, shall file any other information deemed necessary by the office for purposes of this section and sections 19a-670 to 19a- 672, inclusive.
(d) Each hospital regardless of whether its budget is authorized through the exempt, partial or detailed budget review process shall also file with the office by October first of each fiscal year, or a later date specified by the office, its rates or charges. Said filing shall be for informational purposes only.
(e) On or before July first annually, the office shall set the limit described in this section for each hospital, except as such limit is modified in accordance with sections 19a-674 to 19a-676, inclusive.
(f) Each hospital shall submit a budget request annually under this section.
(P.A. 94-9, S. 27, 41; P.A. 95-160, S. 58, 69; 95-257, S. 39, 58; P.A. 96-139, S. 12, 13.)
History: P.A. 94-9 effective April 1, 1994; P.A. 95-160 amended Subdiv. (2) of Subsec. (a) to add application to fiscal years subsequent to October 1, 1994, and make technical conforming changes, effective June 1, 1995; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; Sec. 19a-170a transferred to Sec. 19a-674 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-675. (Formerly Sec. 19a-170b). Filings for partial or detailed budget review. Hearings. (a) If a hospital qualifies to receive greater revenue than would be allowed under the limit described in section 19a-674, it may file for partial or detailed budget review under this section by July first of the base year or such later date as the office may specify.
(b) A hospital shall be entitled to request partial budget review if it is able to attribute the need for generating revenue greater than such limit to incremental costs associated with certificate of need projects approved under the provisions of sections 19a-638 and 19a-639 for the rate year provided such request is consistent with the office's decision authorizing the project and the certificate of need was approved prior to May first of the base year. Such request shall be made in the form and manner prescribed by the office. The office shall review the information submitted by the hospital and shall approve, modify or deny the request. If the office approves or modifies the request, the net revenue limit shall be computed in the manner specified in subsection (a) of section 19a-674, except that approved incremental costs attributable to an approved certificate of need project or projects shall be included in net revenue and approved incremental volume shall be included in the determination of equivalent discharges.
(c) If a hospital is unable to attribute the need for generating revenue greater than such limit to an authorized certificate of need project it may elect to undergo detailed budget review in accordance with this subsection provided its cost index calculated pursuant to section 19a-677 is less than 0.95 and provided the requested net revenue limit is less than the limit calculated pursuant to subsection (c) of section 19a-677. Such hospital shall submit a detailed budget projection as to its anticipated expenses and projected net revenue requirement to provide for such expenses. The office may require the hospital to submit such information, data, records, studies and evaluations as it considers necessary to determine the need for generating greater net revenue. Submissions made pursuant to this subsection shall be in the form and manner prescribed by the office. The hospital shall bear the burden of demonstrating to the office that the components of its proposed budget are reasonable. The components shall include, but are not limited to: Expenses, incremental volume associated with an approved certificate of need project, if any, operating gain and net revenue. After review of the hospital's filing, the office may issue a proposed final decision regarding the hospital's request. Within ten calendar days of receipt of the proposed final decision, the hospital may request a hearing on its proposed budget. A request for a hearing shall include all evidence the hospital is requesting be included in the record for the hearing. The office shall schedule a public hearing on the proposed final budget within thirty days of its receipt of the required submissions. Any such hearing shall be conducted in accordance with subsection (c) of section 19a-167c. In determining the authorized net revenue limit, the office may modify any budget component which it deems is not fully justified by the hospital. If the office approves or modifies the request, the authorized net revenue limit shall be computed as the net revenue determined to be appropriate by the office, divided by the equivalent discharges determined pursuant to section 19a-679 including any approved adjustments to equivalent discharges attributable to an approved certificate of need project or projects.
(P.A. 94-9, S. 28, 41; P.A. 95-257, S. 39, 58.)
History: P.A. 94-9 effective April 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-170b transferred to Sec. 19a-675 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-676. (Formerly Sec. 19a-170c). Compliance with authorized revenue limits. For the fiscal year commencing October 1, 1992, and subsequent fiscal years, each hospital shall submit to the office, in the form and manner prescribed by the office, the data specified in section 19a-167g-91 of the regulations of Connecticut state agencies, as from time to time amended, the audit required under section 19a-649 and any other data required by the office.
(P.A. 94-9, S. 29, 41; 94-174, S. 11, 12; P.A. 95-160, S. 59, 69; 95-257, S. 39, 58; P.A. 96-139, S. 12, 13; 96-238, S. 1, 2, 25.)
History: P.A. 94-9 effective April 1, 1994; P.A. 94-174 amended Subsecs. (a) and (b) to eliminate hospitals' compliance payments for hospital fiscal years 1993 and 1994 and for January 1, 1995, to September 1, 1995, and subsequent fiscal years if a hospital exceeds its authorized net revenue limit, the excess shall be deducted from its net revenue limit in the next fiscal year or may be deducted from the hospital's disproportionate share-emergency assistance payments, effective June 6, 1994; P.A. 95-160 amended Subsecs. (a) and (b) to allow the Department of Social Services, in consultation with the Office of Policy and Management, to determine whether compliance shall be (1) deducted from the subsequent year's net revenue limit, (2) paid into the general fund or (3) deducted from payments to the hospital's Medicaid account, (2) and (3) being new Subdivs., effective June 1, 1995; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 96-238 added Subsec. (b) exemption to making payments on an equal quarterly basis commencing fiscal year October 1, 1995, effective July 1, 1996, and further amended section to eliminate all revenue-limit compliance requirements except for data submission, effective October 1, 1997; Sec. 19a-170c transferred to Sec. 19a-676 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-676a. Termination of net revenue compliance payments. (a) Notwithstanding the provisions of section 19a-676, for the hospital fiscal year commencing October 1, 1994, no amount due on or after January 31, 1997, for net revenue compliance shall be assessed, collected, or deducted from any hospital which has submitted a written release as specified in this section and such hospital shall not be liable for any such amount. The release required by this section shall be in a form satisfactory to the Secretary of the Office of Policy and Management and shall release any and all claims which have been brought or could have been brought challenging the assessment or collection of any amount of net revenue compliance due prior to January 31, 1997. To be effective for purposes of this section such release must be received by the Secretary on or before January 30, 1997.
(b) Notwithstanding any provision of the general statutes, the Office of Health Care Access shall not assess, collect or deduct net revenue compliance pursuant to said section 19a-676 for hospital fiscal years commencing on or after October 1, 1995.
(P.A. 97-2, S. 1, 8.)
History: P.A. 97-2 effective January 30, 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-677. (Formerly Sec. 19a-170d). Computation of relative cost of hospitals. (a) (1) For the fiscal year commencing October 1, 1994, and subsequent fiscal years, the Office of Health Care Access shall assess the relative cost of hospitals as follows: For each hospital, actual net revenue shall be added to all discounts provided in accordance with subsection (c) of section 19a-646 for the year prior to the base year. The result of this calculation shall be defined as the hospital's adjusted net revenue.
(2) An adjustment shall be made to this adjusted net revenue to remove any costs which are noncomparable between hospitals. Such noncomparable costs may include, but are not limited to: Direct medical education costs, defined pursuant to Medicare principles, and physician expenses.
(3) The office shall adjust the results of subdivision (2) of this subsection to account for the variations in labor markets in which each hospital operates using the Medicare wage indices for the fiscal year, applied to the portion of the hospital's costs associated with wages, salaries and fringe benefits.
(4) The office shall adjust the results of subdivision (3) of this subsection for indirect medical education and disproportionate share using the adjustments for these costs applied by Medicare by dividing the result of subdivision (3) of this subsection by the ratio of the hospital's Medicare prospective payment system nonexempt inpatient operating payment per case after adjustment for indirect medical education and disproportionate share costs to the hospital's Medicare prospective payment system nonexempt inpatient operating payment per case prior to adjustment for indirect medical education and disproportionate share costs. The result shall be the final adjusted net revenue for the hospital.
(5) The office shall calculate the adjusted net revenue for each discharge, the average adjusted net revenue per discharge and the standard adjusted net revenue per discharge by utilizing the medical record abstract and billing data obtained pursuant to section 19a-654 or other information submitted by the hospitals to the office for the year prior to the base year. The adjusted net revenue for each discharge for a hospital shall be computed by multiplying the total charge for each discharge by the ratio of the final adjusted net revenue for the hospital calculated in subdivision (4) of this subsection over the total actual charges of the hospital for the year prior to the base year.
(6) The office may remove discharges which are determined to be outliers from subsequent calculations of the relative cost of hospitals. A discharge shall be defined as an outlier for this purpose if the final adjusted net revenue for a discharge is less than five hundred dollars or more than one hundred thousand dollars.
(7) The office shall calculate the average adjusted net revenue per discharge and the standard adjusted net revenue per discharge for each hospital. The average adjusted net revenue per discharge for a hospital shall be the sum of the adjusted net revenue for all discharges for a hospital divided by the total number of discharges for a hospital. The standard adjusted net revenue per discharge for a hospital shall be calculated as follows: The average adjusted net revenue per discharge for a diagnosis related group shall be the state-wide sum of the adjusted net revenue for each discharge assigned to a diagnosis related group divided by the state-wide total number of discharges assigned to the same diagnosis related group. The average adjusted net revenue per discharge for a diagnosis related group is then multiplied by the number of discharges assigned to the same diagnosis related group at the hospital. This is the expected adjusted hospital net revenue for a diagnosis related group. The total expected adjusted hospital net revenue is the sum of the expected adjusted hospital net revenue per discharge for all diagnosis related groups. The standard adjusted net revenue per discharge for a hospital is the total expected adjusted hospital net revenue divided by the total number of discharges for the hospital. The cost index for the hospital shall be the average adjusted net revenue per discharge for the hospital divided by the standard adjusted net revenue per discharge for the hospital.
(8) The hospitals shall be ranked based on the cost index resulting from subdivision (7) of this subsection.
(b) The office may establish a technical advisory group to advise it on the implementation of this section and on improvements to the methodology to measure the relative cost of hospitals. The office may develop an alternative methodology to measure the relative cost of hospitals which has the following properties: (1) Compares the relative cost of the hospitals in the state; (2) adjusts for case mix and the impact of direct and indirect medical education costs and the costs associated with treating a disproportionate share of poor patients; and (3) adjusts for labor market differences and other factors deemed by the office to result in justifiable differences in the costs of hospitals.
(c) The limit on the net revenue limit that a hospital may request in a detailed budget review shall be calculated as follows: The actual net revenue per equivalent discharge for the year prior to the base year shall be multiplied by the result of dividing 0.95 by the cost index calculated for the hospital pursuant to subdivision (7) of subsection (a) of this section, and the result shall be increased by the increase in the Consumer Price Index (CPI) from the year prior to the base year to the budget year.
(P.A. 94-9, S. 30, 41; P.A. 95-257, S. 39, 58.)
History: P.A. 94-9 effective April 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-170d transferred to Sec. 19a-677 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-678. (Formerly Sec. 19a-170e). Inflation factor. For the fiscal year commencing October 1, 1994, and for subsequent fiscal years, the Office of Health Care Access shall use the inflation factor as specified in section 19a-167g-61 of the regulations of Connecticut state agencies, as from time to time amended, except that the inflation proxy for salaries and wages shall be the Employment Cost Index for Wages and Salaries, All Private Service Industry Workers, Northeast.
(P.A. 94-9, S. 31, 41; P.A. 95-257, S. 39, 58.)
History: P.A. 94-9 effective April 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-170e transferred to Sec. 19a-678 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-679. (Formerly Sec. 19a-170f). Computation of equivalent discharges. Inpatient and outpatient gross revenues and units of service. (a) For purposes of calculating the hospital's net revenue limit for the fiscal year commencing October 1, 1994, and subsequent fiscal years, the authorized number of equivalent discharges shall be:
(1) For a hospital exempt from detailed budget review the authorized equivalent discharges shall be the actual number of equivalent discharges in the year prior to the base year.
(2) For a hospital subject to partial budget review the authorized equivalent discharges shall be the actual number of equivalent discharges in the year prior to the base year plus the authorized number of equivalent discharges associated with the approved certificate of need project or projects for which partial review is requested.
(b) Each hospital shall submit to the Office of Health Care Access inpatient and outpatient gross revenues and units of service separately for each hospital revenue center. For the fiscal years commencing October 1, 1993, and October 1, 1994, the units of service may be determined by the hospital. The office shall specify a standard list of units of service for use by each hospital in the fiscal year commencing October 1, 1995. For the fiscal year commencing October 1, 1995, hospitals shall report units of service based on both the list used in the fiscal year commencing October 1, 1994, and the standard list specified by the office for use in the fiscal year commencing October 1, 1995. For fiscal years commencing on and after October 1, 1996, all hospitals shall report units of service based exclusively on the standard list specified by the office, for use in the fiscal year commencing October 1, 1995. The timing and format of the submissions shall be specified by the office. In addition for the fiscal year commencing October 1, 1994, and subsequent fiscal years, these data shall be submitted on at least a quarterly basis in conjunction with the medical record abstract and billing data specified in subsection (b) of section 19a-654. The revenue centers shall be specified by the office.
(c) (1) For the fiscal year commencing October 1, 1994, "equivalent discharges" shall be defined as follows: The number of discharges for the fiscal year commencing October 1, 1992, times the ratio of the total gross revenue to the inpatient gross revenue for the same year. For compliance purposes for the fiscal year commencing October 1, 1993, the number of equivalent discharges shall be the actual number of discharges in the fiscal year commencing October 1, 1993, multiplied by the actual ratio of the total gross revenue to inpatient gross revenue for the first six months of the fiscal year commencing October 1, 1993. For compliance purposes for the fiscal year commencing October 1, 1994, the number of equivalent discharges shall be the actual number of discharges in the fiscal year commencing October 1, 1994, multiplied by the ratio of the total gross revenue to inpatient gross revenue specified in the budget authorization for the fiscal year commencing October 1, 1994.
(2) For the fiscal years commencing October 1, 1995, and October 1, 1996, "equivalent discharges" shall be defined as follows:
(A) For each revenue center providing services to outpatients, each outpatient unit of service shall be converted into a fraction of a discharge. The fraction shall be the ratio of the revenue per unit of service in the revenue center to the inpatient revenue per inpatient discharge for the fiscal year commencing October 1, 1993.
(B) The number of outpatient equivalent discharges generated by the revenue center for the fiscal year shall be the product of the outpatient units of service for the revenue center for the fiscal year times the fraction calculated in subparagraph (A) of this subdivision for the revenue center for the fiscal year.
(C) The total number of outpatient equivalent discharges for the fiscal year for the hospital shall be the sum of all calculations pursuant to subparagraph (B) of this subdivision across all revenue centers. The total number of equivalent discharges for the hospital shall be defined as the number of outpatient equivalent discharges plus the number of inpatient discharges.
(P.A. 94-9, S. 33, 41; P.A. 95-257, S. 39, 58.)
History: P.A. 94-9 effective April 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-170f transferred to Sec. 19a-679 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-680. (Formerly Sec. 19a-170g). Net revenue limit interim adjustment. Notwithstanding any provision of the general statutes or regulations adopted thereunder, a hospital shall be entitled to receive a net revenue limit increase by means of an interim adjustment, only if it has a cost index calculated pursuant to section 19a-677 of less than 0.9, and the percentage increase in authorized net revenue shall be no greater than one minus the cost index of the hospital.
(P.A. 94-9, S. 32, 41.)
History: P.A. 94-9 effective April 1, 1994; Sec. 19a-170g transferred to Sec. 19a-680 in 1997.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-681. Inclusion of taxes in pricemaster. Charges to be in accordance with schedule of charges on file. Penalty. (a) Each hospital shall include all applicable taxes in the price of each item in its pricemaster for each charge.
(b) If the billing detail by line item does not agree with the detailed schedule of charges on file with the Office of Health Care Access for the date of service specified on the bill, the hospital shall be subject to a civil penalty of five hundred dollars per occurrence payable to the state within ten business days of notification. The penalty shall be imposed in accordance with subsections (b) to (e), inclusive, of section 19a- 653. The office may issue an order requiring such hospital, within ten business days of notification of an overcharge to a patient, to adjust the bill to be consistent with the schedule of charges on file with the office for the date of service specified on the patient bill.
(P.A. 95-160, S. 60, 69; 95-257, S. 39, 58; P.A. 96-139, S. 12, 13.)
History: P.A. 95-160, S. 60 effective June 1, 1995; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-682. Additional billing for services rendered from November 1, 1994, through June 1, 1995. As to any service rendered by a hospital during the period from November 1, 1994, through June 1, 1995, the hospital shall not issue a bill for, or attempt to collect, on a prior bill or otherwise, any amount for or relating to such service in addition to the sums, if any, collected prior to June 1, 1995, whether or not the amount is called a tax, if either (1) the total amount billed or attempted to be collected for or relating to such service is greater than would have been due under the pricemaster in effect on October 31, 1994, or (2) any prior amount billed and collected for or relating to such service included an amount for sales and gross earnings taxes. Nothing in this section shall be construed to alter, impair or interfere with any existing contract between any hospital and any payer. In any civil action involving collection of an amount in addition to the sums, if any, collected prior to June 1, 1995, for or relating to a service rendered during the period from November 1, 1994, the hospital shall have the burden of proof in establishing by clear and convincing evidence that it has complied with this section. Violation of the provisions of this section shall be deemed an unfair or deceptive act or practice as defined by section 42-110b.
(P.A. 95-160, S. 61, 69; P.A. 96-139, S. 12, 13; 96-238, S. 3, 25.)
History: P.A. 95-160, S. 61 effective June 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 96-238 added provisions related to sums "collected" prior to June 1, 1995, effective June 4, 1996.

(Return to TOC) (Return to Chapters) (Return to Titles)

Sec. 19a-683. Reconciliation account. There is established a reconciliation account which shall be a separate, nonlapsing account within the General Fund. Any moneys received pursuant to subdivision (2) of subsection (c) of section 19a-667 shall be deposited by the Commissioner of Social Services into the account.
(P.A. 95-160, S. 62, 69; P.A. 96-139, S. 12, 13.)
History: P.A. 95-160, S. 62 effective June 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section.

(Return to TOC) (Return to Chapters) (Return to Titles)