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Substitute Senate Bill No. 1148

Public Act No. 03-274

AN ACT CONCERNING OUTPATIENT SURGICAL FACILITIES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective July 1, 2003) (a) As used in this section and subsection (a) of section 19a-490 of the general statutes, as amended by this act, "outpatient surgical facility" means any entity, individual, firm, partnership, corporation, limited liability company or association, other than a hospital, engaged in providing surgical services for human health conditions that include the use of moderate or deep sedation, moderate or deep analgesia or general anesthesia, as such levels of anesthesia are defined from time to time by the American Society of Anesthesiologists, or by such other professional or accrediting entity as recognized by the Department of Public Health.

(b) No entity, individual, firm, partnership, corporation, limited liability company or association, other than a hospital, shall individually or jointly establish or operate an outpatient surgical facility in this state without complying with chapter 368z of the general statutes and obtaining a license from the Department of Public Health for such facility pursuant to the provisions of chapter 368v of the general statutes, unless such entity, individual, firm, partnership, corporation, limited liability company or association meets any of the following exceptions: (1) Provides to the Office of Health Care Access satisfactory evidence that it was in operation on or before July 1, 2003; (2) obtains, on or before July 1, 2003, from the Office of Health Care Access, a determination that a certificate of need is not required and provides the office with satisfactory evidence that it has commenced development of an outpatient surgical facility prior to July 1, 2003; or (3) obtains, between July 1, 2003, and June 30, 2004, inclusive, a certificate of need from the office in accordance with the policies and procedures utilized by the office in approving certificates of need as of July 1, 2003. If an entity, individual, firm, partnership, corporation, limited liability company or association satisfies any of the exceptions in this subsection, it may operate an outpatient surgical facility without a license through March 30, 2007, and shall have until March 30, 2007, to obtain a license from the Department of Public Health. No outpatient surgical facility may be established between July 1, 2003, and July 1, 2004, unless it satisfies one of the exceptions in this subsection.

(c) The factors to be considered by the Commissioner of Health Care Access in making a determination pursuant to subdivision (2) of subsection (b) of this section as to whether development of an outpatient surgical facility has been commenced shall include, but need not be limited to, whether the applicant for such determination has (1) contractually committed to a site for a facility, (2) expended significant funds for predevelopment expenses for the facility, such as consultation and equipment purchases, or (3) entered into contractual arrangements with third-party payors for services related to the operation of the facility. If any application for a determination pursuant to subdivision (2) of subsection (b) of this section is denied, the applicant may request that such denial be reviewed and reconsidered by the commissioner. The commissioner shall give notice of the grounds for such denial and shall conduct a hearing concerning such denial in accordance with the provisions of chapter 54 of the general statutes concerning contested cases.

(d) Notwithstanding the provisions of this section, each outpatient surgical facility shall continue to be subject to the obligations and requirements applicable to such facility, including, but not limited to, any applicable provision of chapter 368v or 368z of the general statutes.

(e) The provisions of this section shall not apply to persons licensed to practice dentistry or dental medicine pursuant to chapter 379 of the general statutes or to outpatient clinics licensed pursuant to chapter 368v of the general statutes.

(f) Any outpatient surgical facility that is accredited as provided in section 19a-691 of the general statutes, shall continue to be subject to the requirements of section 19a-691 of the general statutes.

(g) On and after July 1, 2004, any entity, individual, firm, partnership, corporation, limited liability company or association that meets the definition of outpatient surgical facility pursuant to subsection (a) of this section, shall be subject to the rights and obligations that exist under statutes in effect as of June 30, 2003, and nothing in this section shall be used or introduced in any proceeding to suggest or infer or otherwise indicate or imply that such entity, individual, firm, partnership, corporation, limited liability company or association is or is not a free standing outpatient surgical facility under section 19a-630 of the general statutes. No implication shall be created by this section, or used in any manner in any proceeding of any kind, as to whether or not a certificate of need is required on or after July 1, 2004.

(h) The Commissioner of Public Health may provide a waiver for outpatient surgical facilities from the physical plant and staffing requirements of the licensing regulations adopted pursuant to chapter 368v of the general statutes, provided no waiver may be granted unless the health, safety and welfare of patients is ensured.

Sec. 2. Subsection (a) of section 19a-490 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2003):

(a) "Institution" means a hospital, residential care home, health care facility for the handicapped, nursing home, rest home, home health care agency, homemaker-home health aide agency, mental health facility, substance abuse treatment facility, outpatient surgical facility, an infirmary operated by an educational institution for the care of students enrolled in, and faculty and employees of, such institution; a facility engaged in providing services for the prevention, diagnosis, treatment or care of human health conditions, including facilities operated and maintained by any state agency, except facilities for the care or treatment of mentally ill persons or persons with substance abuse problems; and 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.

Sec. 3. (Effective from passage) The Commissioners of Health Care Access and Public Health shall develop an advisory committee for the purpose of reviewing laws, regulations, standards, policies and practices, analyzing alternatives and formulating recommendations with regard to the issues surrounding the licensure and regulation of outpatient surgical facilities in order to ensure continuation of patient access to and safe operation of such facilities. Such committee shall include the presidents of the Connecticut Hospital Association and the Connecticut State Medical Society, or their designees, and may include representatives from hospitals, physicians, patients, and such other members as the commissioners shall deem necessary. On or before January 1, 2004, the commissioners shall submit a report, in accordance with section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to public health containing the findings and recommendations of the committee, if any.

Approved June 26, 2003