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-637 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-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; P.A.
02-101, S. 16.)
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; P.A. 02-101 made technical changes, effective July 1, 2002.
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.
Sec. 19a-637a. Short-term acute care general or children's hospitals to submit
budgets for next hospital fiscal year. On or before February 28, 2004, and each February twenty-eighth thereafter, each short-term acute care general or children's hospital
licensed by the Department of Public Health, shall submit to the Office of Health Care
Access, in the form and manner prescribed by the office, the hospital's budget for the
hospital fiscal year that commenced on October first of the previous calendar year. Said
budget shall have been approved by the hospital's governing body and shall contain the
hospital's budgeted revenue and expenses and utilization amounts for such fiscal year
and any other type of data previously reported pursuant to section 19a-637 and any
regulations adopted pursuant to said section which the office may require.
(P.A. 02-101, S. 1; P.A. 03-12, S. 1.)
History: P.A. 02-101 effective July 1, 2002; P.A. 03-12 changed budget submittal dates from September first to February
twenty-eighth, added provision re fiscal year that commenced on October first of the previous calendar year and made
conforming changes.
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-639c, 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
reduce 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 total 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. The office shall provide public notice of any complete letter of intent submitted
under this section, section 19a-639, or both, by publication in a newspaper having a
substantial circulation in the area served or to be served by the applicant. Such notice
shall be submitted for publication not later than fifteen business days after a determination that a letter of intent is complete. 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 no later than ninety days after the date of 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) (1) The office may hold a public hearing with respect to any complete certificate
of need application submitted under this section. At least two weeks' notice of such
public hearing shall be given to the applicant, in writing, and to the public by publication
in a newspaper having a substantial circulation in the area served by the facility, institution or provider. At the discretion of the office, such hearing may be held in Hartford
or in the area so served or to be served. 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.
(2) The office may hold a public hearing after consideration of criteria that include,
but need not be limited to, whether the proposal involves: (A) The provision of a new
or additional health care function or service through the use of technology that is new
or being introduced into the state; (B) the provision of a new or additional health care
function or service that is not provided in either a region designated by the applicant or
in the applicant's existing primary service area as defined by the office; or (C) the
termination of an existing health care function or service, the reduction of total beds or
the closing of a health care facility.
(3) The office shall hold a public hearing with respect to any complete certificate
of need application submitted to the office under this section if three individuals or an
individual representing an entity with five or more people submit a request, in writing,
that a public hearing be held on the proposal after the office has published notice of a
complete letter of intent.
(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; P.A. 02-89, S. 34; P.A. 03-17, S. 1.)
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; P.A.
02-89 amended Subsec. (a) to replace reference to Sec. 19a-639d with Sec. 19a-639c, reflecting repeal of Sec. 19a-639d
by the same public act; P.A. 03-17 amended Subsec. (a) by replacing "decrease" with "reduce" in Subdiv. (3) and by
changing licensed bed capacity to total bed capacity and requiring notice when letter of intent received in Subdiv. (4),
made technical changes in Subsec. (b) and amended Subsec. (c) by adding Subdivs. (1) to (3) re public hearings on complete
certificate of need applications under certain circumstances.
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.
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-639c, 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) (1) The commissioner shall notify the Commissioner of Social Services of any
certificate of need request that may impact on expenditures under the state medical
assistance program. 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.
(2) 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, 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 (A) 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 (B) 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.
(3) The office shall comply with the public notice provisions of subdivision (4) of
subsection (a) of section 19a-638, and shall hold a public hearing with respect to any
complete certificate of need application filed under this section, if: (A) The proposal
has associated total capital expenditures or total capital costs that exceed twenty million
dollars for land, building or nonclinical equipment acquisition, new building construction or building renovation; or (B) the proposal has associated total capital expenditures
per unit or total capital costs per unit that exceed one million dollars for major medical
equipment, imaging equipment or a linear accelerator, utilizing technology that is new
or being introduced into the state; or (C) three individuals or an individual representing
an entity comprised of five or more people submit a request, in writing, that a public
hearing be held on the proposal. At least two weeks' notice of such public hearing shall
be given to the applicant, in writing, and to the public by publication in a newspaper
having a substantial circulation in the area served by the applicant. At the discretion of
the office, such hearing shall be held in Hartford or in the area so served or to be served.
(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; P.A. 02-89, S. 35; P.A. 03-17, S. 2.)
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 by the Revisors; 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 fo