Substitute House Bill No. 6536
          Substitute House Bill No. 6536

              PUBLIC ACT NO. 97-159


AN   ACT  CONCERNING  SCHOOL-BASED  HEALTH  CENTER
CERTIFICATE OF NEED EXEMPTIONS.


    Be  it  enacted  by  the  Senate  and House of
Representatives in General Assembly convened:
    Section  19a-639  of  the  general statutes is
repealed and the following is substituted in  lieu
thereof:
    (a)  Except  for  (1)  a program of ambulatory
services established and  conducted  by  a  health
maintenance   organization,   (2)  any  outpatient
rehabilitation facility affiliated with the Easter
Seal  Society  of  Connecticut,  Inc.,  (3) a home
health agency or (4) a nursing home, home for  the
aged,  rest  home  or residential facility for the
mentally retarded  licensed  pursuant  to  section
17a-227  and certified to participate in the Title
XIX  Medicaid  program  as  an  intermediate  care
facility  for the mentally retarded, any inpatient
rehabilitation facility affiliated with the Easter
Seal Society of Connecticut, Inc., 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 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 and in accordance
with  any  schedule  established  by  the   office
pursuant  to  subsection  (c) of this section. The
office shall thereupon hold a public hearing  with
respect  to  such  request,  at  least  two weeks'
notice of which shall be given to the facility  or
institution by certified mail and to the public by
publication in a newspaper  having  a  substantial
circulation  in the area served by the facility or
institution. The  commissioner  shall  notify  the
Commissioner of Social Services of any application
that may impact on expenditures  under  the  state
medical  assistance program. Such hearing shall be
held at the discretion of the office  in  Hartford
or  in  the  area  so  served.  The  office  shall
consider such request in relation to the community
or  regional  need  for  such  capital  program or
purchase of  land,  the  possible  effect  on  the
operating  costs  of  the  health care facility or
institution and such other relevant factors as the
office  deems necessary. In approving or modifying
such request, the commissioner may  not  prescribe
any  condition,  such  as  but not limited to, any
condition or limitation on the indebtedness of the
facility  or institution in connection with a bond
issue, the principal amount of any bond  issue  or
any  other  details  or particulars related to the
financing  of  such   capital   expenditure,   not
directly  related  to  the  scope  of such capital
program and within  control  of  the  facility  or
institution.  An  applicant, prior to submitting a
certificate of need application, shall request  in
writing,  application  forms and instructions from
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 facility, service or function, expansion
of  an  existing facility, service or function and
any new or additional beds and their type; (C) the
estimated  capital  cost;  (D)  the town where the
project  will  be  located;  and   (E)   a   brief
description    of   the   proposed   project.   No
certificate of need application will be considered
filed  with  the office unless a current letter of
intent, specific to the proposal and in accordance
with  this  subsection,  has been on file with the
office at least ninety 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.   Upon   a   showing  by  such  facility  or
institution that the need for such capital program
is  of  an  emergency  nature, in that the capital
expenditure  is  necessary  to  comply  with   any
federal,  state or local health, fire, building or
life safety code, the commissioner may  waive  the
letter  of  intent requirement and the requirement
that the request be submitted in  accordance  with
any schedule established by the office pursuant to
subsection (c) of this section and that  a  public
hearing  be  held  thereon,  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  under  section  19a-490  and
licensed   as   a  short-term  acute-care  general
hospital  or  a   children's   hospital   by   the
Department  of  Public Health, shall not apply if,
in the certificate of need application or request,
the  hospital  projects that the implementation of
such application or request  will  require  future
budget   adjustments.   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.   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.
    (b)  Except  as provided for in subsection (a)
of this section, any person proposing  to  acquire
imaging 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  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,  which  imaging
equipment  will  not  be  owned by or located in a
health care  facility  or  institution,  or  state
health  care facility or institution, shall submit
a  request  for  approval  of  any  such   imaging
equipment  acquisition  pursuant to the provisions
of subsection (a) of this section.
    (c)  Notwithstanding the provisions of section
19a-638 or subsection (a)  of  this  section,  any
community  health  center,  as  defined in section
19a-490a, shall not be subject to  the  provisions
of  said subsection if the community health center
is:  (1)  Proposing  a  capital  expenditure   not
exceeding  one  million  dollars  and one-third or
more of the cost of such project  is  financed  by
the  state  of  Connecticut or (2) receiving funds
from  the  Department  of  Public  Health  and  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.
    (d) NOTWITHSTANDING THE  PROVISIONS OF SECTION
19a-638 OR SUBSECTION  (a)  OF  THIS  SECTION,  NO
SCHOOL-BASED HEALTH CARE  CENTER  SHALL BE SUBJECT
TO  THE  PROVISIONS  OF  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.
    [(d)]  (e)  In conducting its activities under
this section and section 19a-638, the  office  may
hold  hearings on applications of a similar nature
at the same time. The office may adopt regulations
in  accordance  with the provisions of chapter 54,
to establish a schedule for the submission of such
applications which (1) requires applications to be
submitted in cycles that allow applications to  be
heard  and  reviewed at times when hospital budget
reviews are not in progress, and (2)  may  provide
for   all  completed  applications  pertaining  to
similar types of services, facilities or equipment
affecting  the  same  health  service  area  to be
considered in relation to each other and  reviewed
at least twice a year.

Approved June 24, 1997