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repealed and the following is substituted in lieu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