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.
Sec. 19a-646. (Formerly Sec. 19a-166). Negotiation of discounts and different
rates and methods of payments with hospitals. Filing 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 or children's 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 Section 1876 of the Social Security Act, 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 or different rate or method of reimbursement
from the filed rates or charges to any payer except as provided in this section.
(c) (1) From April 1, 1994, to June 30, 2002, 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.
(2) On and after July 1, 2002, any payer may directly negotiate with a hospital for
a different rate or method of reimbursement, or both, provided the charges and payments
for the payer are on file at the hospital business office in accordance with this subsection.
No discount agreement or agreement for a different rate or method of reimbursement,
or both, shall be effective until a complete written agreement between the hospital and
the payer is on file at the hospital. Each such agreement shall be available to the office
for inspection or submission to the office upon request, for at least three years after the
close of the applicable fiscal year.
(3) 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 this subsection.
(4) From October 2, 1991, to June 30, 2002, a full written copy of each agreement
executed pursuant to this subsection 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. On and after July 1, 2002, a full written copy of each agreement
executed pursuant to this subsection shall be on file in the hospital business office within
twenty-four hours of execution. Each agreement filed shall specify on its face that it
was executed and filed pursuant to this subsection. Agreements filed at the Office of
Health Care Access, 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) of this
section, 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) of this section shall file a copy of the agreement in the hospital's business 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) of this section 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; P.A. 02-101, S. 4.)
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; P.A. 02-101 amended Subsec. (a)(3) to redefine "hospital" to include a "children's"
hospital, amended Subsec. (a)(4) to change the cite to federal law from "42 USC Section 1395mm(b)" to "Section 1876
of the Social Security Act", amended Subsec. (b) to add the prohibition against a different rate or method of reimbursement,
amended Subsec. (c) to delete obsolete Subdivs. (1) and (2) to renumber existing Subdiv. (3) as Subdiv.(1) and limit it to
the period from April 1, 1994, to June 30, 2002, to add a new Subdiv. (2) re payer negotiation, on and after July 1, 2002,
for a different rate or method of reimbursement, renumbered Subdivs. (4) and (5) as Subdivs. (3) and (4), in new Subdiv.
(4) applied requirement for a written copy to be filed with the Office of Health Care Access to agreements executed during
the period from October 2, 1991, to June 30, 2002, and added requirement for agreements executed on and after July 1,
2002, to be filed in hospital business office within forty-eight hours of execution, and amended Subsecs. (f) and (g) to
make technical changes, effective July 1, 2002.
Annotation to former section 19a-166:
Cited. 214 C. 321, 331.
Sec. 19a-647. (Formerly Sec. 19a-166b). Preferred provider network. Definitions. Filing requirements. Section 19a-647 is repealed, effective October 1, 2001.
(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; June Sp. Sess. P.A. 01-4, S. 57, 58.)
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.
Sec. 19a-649. (Formerly Sec. 19a-167f). Uncompensated care. Audits. Annual
reports. (a) 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.
(b) Each hospital shall annually report, along with data submitted pursuant to subsection (a) of this section, (1) the number of applicants for free and reduced cost services,
(2) the number of approved applicants, and (3) the total and average charges and costs
of the amount of free and reduced cost care provided.
(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; P.A. 03-266, S. 1.)
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; P.A. 03-266 designated existing provisions as Subsec. (a) and added new Subsec. (b)
re annual report.
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.
Annotation to former section 19a-167g:
Cited. 223 C. 450, 454.
Sec. 19a-651. (Formerly Sec. 19a-167h). Data requirement. Rate order compliance. Adjustment. Section 19a-651 is repealed, effective October 1, 2002.
(P.A. 89-371, S. 24; P.A. 95-257, S. 39, 58; S.A. 02-12, S. 1.)
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.
Annotation to former section 19a-167i:
Cited. 223 C. 450, 454.
Sec. 19a-653. (Formerly Sec. 19a-167j). Failure to file data or information.
Civil penalty. Request for determination of a certificate of need requirement. Notice. Extension. Hearing. Appeal. Deduction from Medicaid payments. (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.
Sec. 19a-654. (Formerly Sec. 19a-167k). Data submission requirements. The
Office of Health Care Access shall require short-term acute care general or children's
hospitals to submit such data, including discharge data, as it deems necessary to fulfill
the responsibilities of the office. 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; P.A. 02-101, S. 5.)
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; P.A. 02-101 amended section to make provisions applicable
to "short-term acute care general or children's hospitals" and to require the submission of data necessary "to fulfill the
responsibilities of the office", rather than for "budget review purpose", effective July 1, 2002.
Annotation to former section 19a-167k:
Cited. 223 C. 450, 454.
Sec. 19a-655. (Formerly Sec. 19a-167l). Hospital budget calculations for the
fiscal year commencing October 1, 1993. Section 19a-655 is repealed, effective July
1, 2002.
(P.A. 93-229, S. 12, 21; P.A. 95-257, S. 39, 58; P.A. 02-89, S. 36; 02-101, S. 20.)
Secs. 19a-656 to 19a-658. (Formerly Secs. 19a-167m to 19a-167o). Compliance
assessment calculation for fiscal year commencing October 1, 1991, to be applied
in fiscal year commencing fiscal year October 1, 1993. Request for adjustment to
authorized net and gross revenue and authorized equivalent discharges for fiscal
year commencing October 1, 1993; limitations; filings. Pricemaster adjustment;
request procedure; limitations; data requirement; report. Sections 19a-656 to 19a-658, inclusive, are repealed, effective October 1, 2002.
(P.A. 93-229, S. 13, 14, 17, 21; P.A. 95-257, S. 39, 58; P.A. 02-89, S. 90; 02-101, S. 17-19.)
Sec. 19a-659. (Formerly Sec. 19a-170). Definitions. As used in sections 19a-659,
19a-661, 19a-662, 19a-669 to 19a-672, inclusive, 19a-676, 19a-677 and 19a-679:
(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 state-administered general assistance program or the Medicaid program;
(8) "CHAMPUS" means TriCare or 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, 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 and on and after July 1, 2002, any amount of discounts
provided to nongovernmental payers pursuant to a written agreement;
(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; P.A. 02-101, S. 6; P.A.
04-76, S. 29.)
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; P.A. 02-101 amended section by deleting
obsolete references and amended Subdiv. (8) by adding "TriCare" to the definition of "CHAMPUS", and amended Subdiv.
(14) by adding "and on and after July 1, 2002, any amount of discounts provided to nongovernmental payers pursuant to
a written agreement", effective July 1, 2002; P.A. 04-76 amended Subdiv. (7) by deleting reference to "general assistance
program" from definition of "medical assistance".
Sec. 19a-660. (Formerly Sec. 19a-168g). Adjustments to orders. Section 19a-660 is repealed, effective July 1, 2002.
(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; P.A. 02-101, S. 20.)
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.