Sec. 19a-493. (Formerly Sec. 19-578). Issuance and renewal of license. Provisional license. Scheduled and unscheduled inspections. Annual report. Change of
ownership. (a) Upon receipt of an application for an initial license, the Department of
Public Health, subject to the provisions of section 19a-491a, shall issue such license if,
upon conducting a scheduled inspection and investigation, it finds that the applicant
and facilities meet the requirements established under section 19a-495, provided a license shall be issued to or renewed for an institution, as defined in subsection (d), (e)
or (f) of section 19a-490, only if such institution is not otherwise required to be licensed
by the state. Upon receipt of an application for an initial license to establish, conduct,
operate or maintain an institution, as defined in subsection (d), (e) or (f) of section 19a-490, and prior to the issuance of such license, the commissioner may issue a provisional
license for a term not to exceed twelve months upon such terms and conditions as the
commissioner may require. If an institution, as defined in subsections (b), (c), (d), (e)
and (f) of section 19a-490, applies for license renewal and has been certified as a provider
of services by the United States Department of Health and Human Resources under
Medicare or Medicaid programs within the immediately preceding twelve-month period, or if an institution, as defined in subsection (b) of section 19a-490, is currently
certified, the commissioner or the commissioner's designee may waive the inspection
and investigation of such facility required by this section and, in such event, any such
facility shall be deemed to have satisfied the requirements of section 19a-495 for the
purposes of licensure. Such license shall be valid for two years or a fraction thereof and
shall terminate on March thirty-first, June thirtieth, September thirtieth or December
thirty-first of the appropriate year. A license issued pursuant to this chapter, other than
a provisional license or a nursing home license, unless sooner suspended or revoked,
shall be renewable biennially, without charge, after an unscheduled inspection is conducted by the department, and upon the filing by the licensee, and approval by the
department, of a report upon such date and containing such information in such form
as the department prescribes and satisfactory evidence of continuing compliance with
requirements, and in the case of an institution, as defined in subsection (d), (e) or (f) of
section 19a-490, after inspection of such institution by the department. Each license
shall be issued only for the premises and persons named in the application and shall not
be transferable or assignable. Licenses shall be posted in a conspicuous place in the
licensed premises.
(b) (1) A nursing home license may be renewed biennially after (A) an unscheduled
inspection conducted by the department, (B) submission of the information required by
subsections (a) and (c) of section 19a-491a and any other information required by the
commissioner pursuant to subsection (b) of said section, and (C) submission of evidence
satisfactory to the department that the nursing home is in compliance with the provisions
of this chapter, the Public Health Code and licensing regulations.
(2) Any change in the ownership of a facility or institution, as defined in subsection
(c) of section 19a-490, owned by an individual, partnership or association or the change
in ownership or beneficial ownership of ten per cent or more of the stock of a corporation
which owns, conducts, operates or maintains such facility or institution, shall be subject
to prior approval of the department after a scheduled inspection of such facility or institution is conducted by the department, provided such approval shall be conditioned upon
a showing by such facility or institution to the commissioner that it has complied with
all requirements of this chapter, the regulations relating to licensure and all applicable
requirements of the Public Health Code. Any such change in ownership or beneficial
ownership resulting in a transfer to a person related by blood or marriage to such an
owner or beneficial owner shall not be subject to prior approval of the department unless:
(A) Ownership or beneficial ownership of ten per cent or more of the stock of a corporation, partnership or association which owns, conducts, operates or maintains more than
one facility or institution is transferred; (B) ownership or beneficial ownership is transferred in more than one facility or institution; or (C) the facility or institution is the subject
of a pending complaint, investigation or licensure action. If the facility or institution is
not in compliance, the commissioner may require the new owner to sign a consent order
providing reasonable assurances that the violations shall be corrected within a specified
period of time. Notice of any such proposed change of ownership shall be given to the
department at least ninety days prior to the effective date of such proposed change. For
the purposes of this subdivision, "a person related by blood or marriage" means a parent,
spouse, child, brother, sister, aunt, uncle, niece or nephew. For the purposes of this
subdivision, a change in the legal form of the ownership entity, including, but not limited
to, changes from a corporation to a limited liability company, a partnership to a limited
liability partnership, a sole proprietorship to a corporation and similar changes, shall
not be considered a change of ownership if the beneficial ownership remains unchanged
and the owner provides such information regarding the change to the department as may
be required by the department in order to properly identify the current status of ownership
and beneficial ownership of the facility or institution. For the purposes of this subdivision, a public offering of the stock of any corporation that owns, conducts, operates or
maintains any such facility or institution shall not be considered a change in ownership
or beneficial ownership of such facility or institution if the licensee and the officers and
directors of such corporation remain unchanged, such public offering cannot result in
an individual or entity owning ten per cent or more of the stock of such corporation,
and the owner provides such information to the department as may be required by the
department in order to properly identify the current status of ownership and beneficial
ownership of the facility or institution.
(1953, 1955, S. 2053d; P.A. 77-304, S. 4; 77-601, S. 3, 11; 77-614, S. 323, 587, 610; P.A. 78-303, S. 85, 136; P.A. 79-46, S. 2, 3; P.A. 80-17; 80-199; P.A. 81-135; 81-201, S. 1; P.A. 84-546, S. 168, 173; P.A. 85-146, S. 2, 4; P.A. 89-350, S.
7; P.A. 90-13, S. 7; June Sp. Sess. P.A. 91-8, S. 28, 63; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; June Sp. Sess.
P.A. 99-2, S. 15, 72; P.A. 00-10.)
History: Sec. 19-34 transferred to Sec. 19-578 in 1977; P.A. 77-304 added provisions re report of portions of federal
income tax information as condition for license renewal and re notice and approval of proposed changes in ownership;
P.A. 77-601 added provisions re approval and inspection of institutions required for issuance and renewal, respectively,
of licenses; P.A. 77-614 and P.A. 78-303 replaced commissioner and department of health commissioner and department
of health services, effective January 1, 1979; P.A. 79-46 rephrased proviso re license issuance or renewal and allowed
issuance or renewal only if institution not otherwise required to be licensed by state; P.A. 80-17 allowed waiver of inspection
and investigation if currently certified as provider of services by U.S. Department of Health and Human Resources or
certified within last twelve months; P.A. 80-199 rephrased provision re prior approval of change in ownership; P.A. 81-135 specified that inspections conducted by the department of health services prior to the initial licensure of a facility or
prior to the transfer of ownership of a nursing home shall be "scheduled" inspections and that inspections conducted for
purposes of license renewal shall be "unscheduled"; P.A. 81-201 replaced requirement that a nursing home owner submit
pertinent portions of his personal Federal Income Tax for purposes of annual license renewal with authorization for the
department of health services to require the submission of "information related to the character and financial condition"
of the owner; Sec. 19-578 transferred to Sec. 19a-493 in 1983; P.A. 84-546 made technical changes; P.A. 85-146 authorized
the issuance of provisional licenses; P.A. 89-350 divided the existing section into Subsecs. (a) and (b), provided for biennial
licensure, added the language in Subsec. (b) on requirements for the renewal of a nursing home license and on consent
orders and made technical changes; P.A. 90-13 made technical change in Subsec. (a); June Sp. Sess. P.A. 91-8 amended
Subsec. (b) to specify when changes re transfer or change of ownership to relatives are not subject to department approval
and defined "a person related by blood or marriage"; 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; June
Sp. Sess. P.A. 99-2 amended Subsec. (b) by expanding definition of "a person related by blood or marriage" to include a
"brother, sister, aunt, uncle, niece or nephew" and by adding provision re change in legal form of ownership entity, effective
June 29, 1999; P.A. 00-10 made technical changes and added provisions re a public offering of stock that shall not be
considered a change in ownership or beneficial ownership.
Annotation to former section 19-578:
Department did not act illegally, arbitrarily or in abuse of its discretion in refusing a license to plaintiffs for more beds
than it had nurses as required by regulations. 26 CS 452.
Sec. 19a-493a. Evaluation of certain new licensees. If a person who has no record
of operating a nursing home in this state acquires one or more nursing homes and is
issued a license or licenses pursuant to section 19a-493, the Commissioner of Public
Health may prescribe a period of time to evaluate the standard of care rendered by the
licensee as prescribed by the Public Health Code, not to exceed five years from the
date of issuance of the license or licenses, during which such person or corporation is
prohibited from acquiring any other nursing home in this state.
(P.A. 89-350, S. 3; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58.)
History: P.A. 93-381 replaced commissioner of health services with commissioner 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-493b. Definition of outpatient surgical facility. Licensure and exceptions. Compliance with certificate of need requirements. Dental clinics not subject
to section. Waiver of certain licensure regulation requirements. (a) As used in this
section and subsection (a) of section 19a-490, "outpatient surgical facility" means any
entity, individual, firm, partnership, corporation, limited liability company or association, other than a hospital, engaged in providing surgical services or diagnostic procedures 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 recognized by the Department of Public Health. An outpatient
surgical facility shall not include a medical office owned and operated exclusively by
a person or persons licensed pursuant to section 20-13, provided such medical office:
(1) Has no operating room or designated surgical area; (2) bills no facility fees to third
party payers; (3) administers no deep sedation or general anesthesia; (4) performs only
minor surgical procedures incidental to the work performed in said medical office of
the physician or physicians that own and operate such medical office; and (5) uses only
light or moderate sedation or analgesia in connection with such incidental minor surgical
procedures. Nothing in this subsection shall be construed to affect any obligation to
comply with the provisions of section 19a-691.
(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, except as
otherwise provided by this section, and obtaining a license within the time specified in
this subsection from the Department of Public Health for such facility pursuant to the
provisions of this chapter, unless such entity, individual, firm, partnership, corporation,
limited liability company or association: (1) Provides to the Office of Health Care Access
satisfactory evidence that it was in operation on or before July 1, 2003, and (2) obtained,
on or before July 1, 2003, from the Office of Health Care Access, a determination that
a certificate of need is not required. An entity, individual, firm, partnership, corporation,
limited liability company or association otherwise in compliance with this section 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.
(c) Notwithstanding the provisions of this section, no outpatient surgical facility
shall be required to comply with section 19a-617a, 19a-631, 19a-632, 19a-637a, 19a-644, 19a-645, 19a-646, 19a-648, 19a-649, 19a-650, 19a-652, or 19a-654 to 19a-683,
inclusive. 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 this chapter and those provisions of chapter 368z not specified in this subsection, except that a request for permission to undertake a transfer or change of ownership or control shall not be required pursuant to subsection (a) of section 19a-638 if the
Office of Health Care Access determines that the following conditions are satisfied: (1)
Prior to any such transfer or change of ownership or control, the outpatient surgical
facility shall be owned and controlled exclusively by persons licensed pursuant to section
20-13, either directly or through a limited liability company, formed pursuant to chapter
613, a corporation, formed pursuant to chapters 601 and 602, or a limited liability partnership, formed pursuant to chapter 614, that is exclusively owned by persons licensed
pursuant to section 20-13, or is under the interim control of an estate executor or conservator pending transfer of an ownership interest or control to a person licensed under
section 20-13, and (2) after any such transfer or change of ownership or control, persons
licensed pursuant to section 20-13, a limited liability company, formed pursuant to
chapter 613, a corporation, formed pursuant to chapters 601 and 602, or a limited liability
partnership, formed pursuant to chapter 614, that is exclusively owned by persons licensed pursuant to section 20-13, shall own and control no less than a sixty per cent
interest in the outpatient surgical facility.
(d) The provisions of this section shall not apply to persons licensed to practice
dentistry or dental medicine pursuant to chapter 379 or to outpatient clinics licensed
pursuant to this chapter.
(e) Any outpatient surgical facility that is accredited as provided in section 19a-691
shall continue to be subject to the requirements of section 19a-691.
(f) 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 this chapter, provided no waiver may be granted unless the health,
safety and welfare of patients is ensured.
(P.A. 03-274, S. 1; P.A. 04-249, S. 1.)
History: P.A. 03-274 effective July 1, 2003; P.A. 04-249 amended Subsec. (a) by adding provision of diagnostic
procedures to definition and including list of facilities not included in definition, amended Subsec. (b) by deleting provisions
re exception for outpatient surgical facilities under development, deleting moratorium on new facilities and making technical and conforming changes, deleted former Subsec. (c) re determination of commencement of development, redesignated
existing Subsecs. (d) to (f) and (h) as new Subsecs. (c) to (e) and (f), respectively, amended new Subsec. (c) by listing
sections from which facilities are exempt, providing factors under which request for permission to change control or
ownership of facility not required and imposing limitations on ownership and control of facilities, and deleted former
Subsec. (g) re rights and obligations of such facilities, effective July 1, 2004.
Sec. 19a-494. (Formerly Sec. 19-579). Disciplinary action. (a) The Commissioner of Public Health, after a hearing held in accordance with the provisions of chapter
54, may take any of the following actions, singly or in combination, in any case in
which he finds that there has been a substantial failure to comply with the requirements
established under this chapter, the Public Health Code and licensing regulations:
(1) Revoke a license or certificate;
(2) Suspend a license or certificate;
(3) Censure a licensee or certificate holder;
(4) Issue a letter of reprimand to a licensee or certificate holder;
(5) Place a licensee or certificate holder on probationary status and require him to
report regularly to the department on the matters which are the basis of the probation;
(6) Restrict the acquisition of other facilities for a period of time set by the commissioner; and
(7) Issue an order compelling compliance with applicable statutes or regulations of
the department.
(b) Notice of the hearing to the holder of a license or certificate shall be effected
by registered or certified mail or by personal service, setting forth the particular reasons
for the proposed action and fixing a date, not less than thirty days from the date of such
mailing or service, at which the holder of such license or certificate shall be given an
opportunity for a prompt and fair hearing, and witnesses may be subpoenaed by either
party for such hearing. Such hearing may be conducted by the Commissioner of Public
Health, a deputy commissioner, or by a member of the Department of Public Health,
designated by said commissioner. On the basis of such hearing, or upon default of the
holder of such license or certificate, the person conducting such hearing shall specify
his findings and conclusions, and said department may, upon the basis of such findings
and conclusions take any action authorized by this section that it deems necessary. A
copy of such decision shall be sent by registered or certified mail or served personally
upon the holder of such license or certificate.
(1953, 1955, S. 2054d; 1969, P.A. 399; P.A. 77-614, S. 323, 610; P.A. 78-303, S. 70, 136; P.A. 80-127, S. 2; P.A. 83-103, S. 1; P.A. 89-350, S. 8; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58.)
History: 1969 act replaced department of health with public health council, included deputy commissioner or member
of department or public health council as eligible for hearing panel and made slight language changes; Sec. 19-35 transferred
to Sec. 19-579 in 1977; P.A. 77-614 replaced commissioner and department of health with commissioner and department
of health services, effective January 1, 1979; P.A. 78-303 replaced public health council with commissioner of health
services; P.A. 80-127 included references to certificates and holders of certificates; Sec. 19-579 transferred to Sec. 19a-494 in 1983; P.A. 83-103 deleted requirement making suspension or revocation of a license or certificate final thirty days
after it is mailed or served; P.A. 89-350 divided the existing section into Subsecs. (a) and (b), substituted the reference to
chapter 54 for language specifying hearing requirements and specified other actions besides suspension and revocation;
P.A. 93-381 replaced department and commissioner of health services with department and commissioner 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.
Annotation to former section 19-579:
Cited. 26 CS 452, 453.
Sec. 19a-494a. Emergency summary orders. If the Commissioner of Public
Health finds that the health, safety or welfare of any patient or patients served by an
institution, as defined in subsections (d) and (e) of section 19a-490, imperatively requires
emergency action and he incorporates a finding to that effect in his order, he may issue
a summary order to the holder of a license issued pursuant to section 19a-493 pending
completion of any proceedings conducted pursuant to section 19a-494. These proceedings shall be promptly instituted and determined. The orders which the commissioner
may issue shall include, but not be limited to: (1) Revoking or suspending the license;
(2) prohibiting such institution from contracting with new patients or terminating its
relationship with current patients; (3) limiting the license of such institution in any
respect, including reducing the patient capacity or services which may be provided by
such institution; and (4) compelling compliance with the applicable statutes or regulations of the department.
(P.A. 85-146, S. 3, 4; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58.)
History: P.A. 93-381 replaced commissioner of health services with commissioner 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-495. (Formerly Sec. 19-580). Regulations. (a) The Department of Public Health shall, after consultation with the appropriate public and voluntary hospital
planning agencies, establish classifications of institutions. The department shall, in the
Public Health Code, adopt, amend, promulgate and enforce such regulations based upon
reasonable standards of health, safety and comfort of patients and demonstrable need
for such institutions, with respect to each classification of institutions to be licensed
under sections 19a-490 to 19a-503, inclusive, including their special facilities, as will
further the accomplishment of the purposes of said sections in promoting safe, humane
and adequate care and treatment of individuals in institutions. The department shall
adopt such regulations, in accordance with chapter 54, concerning home health care
agencies and homemaker-home health aide agencies.
(b) The Department of Public Health, with the advice of the Department of Mental
Health and Addiction Services, shall include in the regulations adopted pursuant to
subsection (a) of this section, additional standards for community residences, as defined
in section 19a-507a, which shall include, but not be limited to, standards for: (1) Safety,
maintenance and administration; (2) protection of human rights; (3) staffing requirements; (4) administration of medication; (5) program goals and objectives; (6) services
to be offered; and (7) population to be served.
(c) The commissioner may waive any provisions of the regulations affecting the
physical plant requirements of residential care homes if the commissioner determines
that such waiver would not endanger the health, safety or welfare of any resident. The
commissioner may impose conditions, upon granting the waiver, that assure the health,
safety and welfare of residents, and may revoke the waiver upon a finding that the health,
safety or welfare of any resident has been jeopardized. The commissioner shall not grant
a waiver that would result in a violation of the State Fire Safety Code or State Building
Code. The commissioner may adopt regulations, in accordance with chapter 54, establishing procedures for an application for a waiver pursuant to this subsection.
(1953, 1955, S. 2055d; 1969, P.A. 693, S. 3; P.A. 77-61, S. 1, 3; 77-601, S. 4, 11; 77-614, S. 323, 610; P.A. 79-610,
S. 24; P.A. 84-341, S. 7, 8; P.A. 86-371, S. 31, 45; 86-374, S. 3, 6; P.A. 93-262, S. 58, 87; 93-381, S. 33, 39; P.A. 95-160,
S. 13, 69; 95-257, S. 11, 12, 21, 58; P.A. 96-139, S. 12, 13; P.A. 97-112, S. 1; P.A. 01-195, S. 151, 181.)
History: 1969 act replaced "advisory committee", i.e. committee on hospital licensing, with "council", i.e. council on
hospitals, required consultation with public and voluntary hospital planning agencies and included reference to regulations
based on standards of "demonstrable need for such institutions"; Sec. 19-36 transferred to Sec. 19-580 in 1977; P.A. 77-61 deleted reference to council on hospitals; P.A. 77-601 added provision re regulations concerning home health care,
homemaker-home health aide and coordination, assessment and monitoring agencies; P.A. 77-614 replaced department
of health with department of health services, effective January 1, 1979; P.A. 79-610 added Subsec. (b); Sec. 19-580
transferred to Sec. 19a-495 in 1983; P.A. 84-341 added Subsec. (c) concerning additional regulations for community
residences for mentally ill adults; P.A. 86-371 amended Subsec. (b) to require the advice of the Connecticut alcohol and
drug abuse commission rather than the department of mental health; P.A. 86-374 added provision in Subsec. (a) specifying
when a coordination, assessment and monitoring agency may be a service provider; P.A. 93-262 amended Subsec. (a) to
delete the reference to the recommendations of the commissioner on aging, effective July 1, 1993; P.A. 93-381 replaced
department of health services with department of public health and addiction services and deleted Subsec. (b) re licensing
regulations prior to October 1, 1979, effective July 1, 1993; P.A. 95-160 amended Subsec. (a) by deleting references to
coordination, assessment and monitoring agencies and made a technical change, effective July 1, 1995; P.A. 95-257 replaced
Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public
Health and replaced Commissioner and Department of Mental Health with Commissioner and Department of Mental
Health and Addiction Services, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without
affecting this section; P.A. 97-112 added new Subsec. (c) re waiver of physical plant regulations; P.A. 01-195 made
technical changes in Subsecs. (a) and (c), effective July 11, 2001.
Annotation to former section 19-580:
Cited. 26 CS 452, 453, 456.
Annotation to present section:
Subsec. (a):
Cited. 206 C. 316, 319.
Sec. 19a-495a. Regulations re administration of medication by unlicensed assistive personnel in residential care homes. On or before July 1, 2000, the Commissioner of Public Health shall adopt regulations, in accordance with the provisions of
chapter 54, to allow unlicensed personnel in residential care homes, as defined in section
19a-490, to obtain certification for the administration of medication. The regulations
shall establish training requirements, including on-going training requirements, that
include but are not limited to: Initial orientation, resident rights, behavioral management,
personal care, nutrition and food safety, and health and safety in general.
(P.A. 99-80, S. 1.)
Sec. 19a-496. (Formerly Sec. 19-581). Compliance with regulations. An institution which is in operation at the time of the adoption of any regulations under section
19a-495, shall be given a reasonable time, not to exceed one year from the date of such
adoption, within which to comply with such regulations. The provisions of this section
shall not be construed to require the issuance of a license, or to prevent the suspension
or revocation thereof, to an institution which does not comply with minimum requirements of health, safety and comfort designated by the Department of Public Health
through regulation adopted under the provisions of section 19a-495.
(1953, 1955, S. 2056d; P.A. 77-614, S. 323, 610; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; P.A. 01-195, S.
152, 181.)
History: Sec. 19-37 transferred to Sec. 19-581 in 1977; P.A. 77-614 replaced department of health with department of
health services, effective January 1, 1979; Sec. 19-581 transferred to Sec. 19a-496 in 1983; 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; P.A. 01-195 made technical changes, effective July 11, 2001.
Annotation to former section 19-581:
Cited. 26 CS 452, 456.