Substitute House Bill No. 6947
Substitute House Bill No. 6947
PUBLIC ACT NO. 97-204
AN ACT CONCERNING CERTIFICATES OF NEED.
Be it enacted by the Senate and House of
Representatives in General Assembly convened:
Section 1. Section 19a-630 of the general
statutes is repealed and the following is
substituted in lieu thereof:
[(a)] As used in this chapter:
(1) "Health care facility or institution"
means any facility or institution engaged
primarily in providing services for the
prevention, diagnosis or treatment of human health
conditions, including, but not limited to,
outpatient clinics, free standing outpatient
surgical facilities, imaging centers, home health
[care] agencies, [homemaker-home health aide
agencies,] as defined in section 19a-490; clinical
laboratory or central service facilities serving
one or more health care facilities, practitioners
or institutions; hospitals; personal care homes;
nursing homes; nonprofit health centers;
diagnostic and treatment facilities;
rehabilitation facilities, and mental health
facilities; health care facility or institution
includes any parent company, subsidiary,
affiliate, RELATED ENTITY or joint venture or any
combination thereof of a health care facility or
institution; but not including [any outpatient
clinic operated by a town, city or borough or any
state-operated hospital or any rehabilitation
center referred to in section 17b-243, or] any
health care facility operated by a nonprofit
educational institution solely for the students,
faculty and staff of such institution and their
dependents, or any Christian Science sanatorium
operated, or listed and certified, by the First
Church of Christ, Scientist, Boston,
Massachusetts. [;]
(2) ["state] "STATE health care facility or
institution" means a hospital or other such
facility or institution operated by the state
providing services which are eligible for
reimbursement under Title XVIII or XIX of the
federal Social Security Act, 42 USC Section 301 et
seq., as amended. [;]
(3) ["office"] "OFFICE" means the Office of
Health Care Access. [; and]
(4) ["commissioner"] "COMMISSIONER" means the
Commissioner of Health Care Access.
[(b) As used in this chapter for the purpose
of certificate of need, "clinical laboratory"
includes any clinical laboratory as defined in
section 19a-30, requiring a separate clinical
laboratory license from the Department of Public
Health, except laboratories designated as
laboratories performing waived tests, as defined
in 42 CFR 493.15 as from time to time amended, and
laboratories performing tests of moderate
complexity, as defined in 42 CFR 493.20 as from
time to time amended.]
(5) "RELATED ENTITY" MEANS AN AFFILIATE
CORPORATION, HEALTH CARE CORPORATION OR HEALTH
CARE PROVIDER AND INCLUDES A PARENT-SUBSIDIARY,
PARENT-PARENT-SUBSIDIARY, BROTHER-SISTER
CORPORATION OR SIMILAR ARRANGEMENTS INVOLVING
OWNERSHIP OR CONTROL.
Sec. 2. Section 19a-638 of the general
statutes is repealed and the following is
substituted in lieu thereof:
(a) EXCEPT AS PROVIDED IN SECTION 5 OF THIS
ACT:
(1) [Any] EACH health care facility or
institution, [as defined in subsection (a) of
section 19a-490, which intends to transfer all or
part of its ownership or control prior to being
initially licensed, except a home health agency,
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] THAT INTENDS TO (A) TRANSFER ALL OR PART
OF ITS OWNERSHIP OR CONTROL, (B) CHANGE THE POWERS
OF THE BOARD OF A PARENT OR RELATED ENTITY,
WHATEVER ITS DESIGNATION, OR (C) CHANGE OR
TRANSFER THE POWERS OR CONTROL OF A GOVERNING OR
CONTROLLING BODY OF A RELATED ENTITY, shall submit
to the office, prior to the proposed date of such
transfer [and in accordance with any schedule
established by the office pursuant to subsection
(c) of this section] OR CHANGE, a request for
permission to undertake such transfer OR CHANGE.
(2) [Any] EACH health care facility or
institution or [any] state health care facility or
institution, including any inpatient
rehabilitation facility, [affiliated with the
Easter Seal Society of Connecticut, Inc., but
excluding a home health agency, 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,] which
intends to introduce any additional function or
service into its program of health care [, except
a program of ambulatory services established and
conducted by a health maintenance organization or
any outpatient rehabilitation facility affiliated
with the Easter Seal Society of Connecticut,
Inc.,] shall submit to the office, prior to the
proposed date of the institution of such function
or service, [or increase in staff and in
accordance with any schedule established by the
office pursuant to subsection (c) of this
section,] a request for permission to undertake
such function or service. [or increase its staff.]
(3) [Any] EACH health care facility or
institution or [any] state health care facility or
institution [except a home health agency, 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,] which intends to terminate a health
service offered by such facility or institution or
decrease substantially its total bed capacity,
shall submit to the office, prior to the proposed
date of such termination or decrease, [and in
accordance with any schedule established by the
office pursuant to subsection (c) of this
section,] a request to undertake such termination
or decrease.
(4) [An] EACH applicant, prior to submitting a
certificate of need application UNDER THIS SECTION
OR SECTION 19a-639, AS AMENDED BY THIS ACT, shall
SUBMIT A request, in writing, FOR application
forms and instructions [from] 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 LICENSED BED CAPACITY
AND THE BED TYPE, [and] 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 OR EXPENDITURE; (D) the
town where the project IS OR will be located; and
(E) a brief description of the proposed project.
No certificate of need application will be
considered [filed with] SUBMITTED TO the office
unless a current letter of intent, specific to the
proposal and in [accordance] COMPLIANCE with this
subsection, has been on file with the office at
least [ninety] 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.
(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. [, including, in] IN the case of a
proposed transfer of ownership or control, [prior
to initial licensure, such factors as, but not
limited to] 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 [an] A NEW OR additional function
or service 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 [additional]
functions or services into OR FROM its program.
[or increasing its staff.] The office shall grant,
modify or deny such request within ninety days of
the receipt [thereof] 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, 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] 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 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 (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, [or]
service or [increase in staff] TERMINATION OR
CHANGE OF OWNERSHIP OR CONTROL is of an emergency
nature, in that the function, [or] service or
[increase in staff] 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, [and the requirement that the request
for such permission be submitted, in accordance
with any schedule established by the office
pursuant to subsection (c) of this section,]
provided such request shall be submitted at least
ten business days before the proposed date of
institution of the function, [or] service OR
TERMINATION OR CHANGE OF OWNERSHIP OR CONTROL.
(c) In conducting its activities under this
section [and] OR section 19a-639, AS AMENDED BY
THIS ACT, 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.]
(d) For the purposes of this section OR
SECTION 19a-639, AS AMENDED BY THIS ACT,
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 [(i)] (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 [pursuant to subsection (d) of this
section] 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) [On and after March 1, 1993, financing]
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 (e) of this section; (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.
Sec. 3. 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] EXCEPT AS
PROVIDED IN SECTION 4 OF THIS ACT, EACH HEALTH
CARE FACILITY OR INSTITUTION, INCLUDING, BUT NOT
LIMITED TO, 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, AS AMENDED BY THIS
ACT, 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. [and in accordance with any schedule
established by the office pursuant to subsection
(c) of this section.]
(b) The office shall [thereupon] hold a public
hearing with respect to [such request] ANY
COMPLETE CERTIFICATE OF NEED REQUEST UNDER THIS
SECTION, at least two weeks' notice of which shall
be given to the facility, [or] institution OR
PROVIDER 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 OR PROVIDER. 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 OR TO
BE 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 SUBMIT A request, in writing,
FOR application forms and instructions [from] 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 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] CONFORM TO
THE LETTER OF INTENT REQUIREMENTS OF SUBDIVISION
(4) OF SUBSECTION (a) OF SECTION 19a-638, AS
AMENDED BY THIS ACT. No certificate of need
application will be considered [filed with]
SUBMITTED TO the office unless a current letter of
intent, specific to the proposal and in
[accordance] COMPLIANCE with this subsection, has
been on file with the office at least [ninety]
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. 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] EITHER (1) THAT, FOR THE FIRST
THREE YEARS OF OPERATION TAKEN TOGETHER, THE TOTAL
IMPACT OF THE PROPOSAL ON THE HOSPITAL'S OPERATING
BUDGET 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 (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 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.
[(b) Except as provided for in subsection (a)
of this section, any person]
(c) NOTWITHSTANDING SECTION 4 OR 5 OF THIS
ACT, 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, AS AMENDED BY THIS
ACT, 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, [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 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,
AS AMENDED BY THIS ACT, 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 REGULATION, ADOPTED IN ACCORDANCE
WITH CHAPTER 54, OR DEEMS APPROPRIATE.
[(c)] (d) Notwithstanding the provisions of
section 19a-638, AS AMENDED BY THIS ACT, or
subsection (a) of this section, [any] NO community
health center, as defined in section 19a-490a,
shall [not] be subject to the provisions of said
SECTION 19a-638 OR SAID subsection (a) if the
community health center is: (1) Proposing a
capital expenditure not exceeding one million
dollars, [and] (2) EXCLUSIVELY PROVIDING PRIMARY
CARE OR DENTAL SERVICES AND (3) EITHER (A)
one-third or more of the cost of [such] THE
PROPOSED project is financed by the state of
Connecticut, [or] (B) THE PROPOSED PROJECT IS
receiving funds from the Department of Public
Health, [and] 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, AS AMENDED
BY THIS ACT. EACH SATELLITE OR SUBSIDIARY OR
RELATED ENTITY 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 OR SATELLITE
DOES NOT SO QUALIFY, IT SHALL OBTAIN A CERTIFICATE
OF NEED OR, IF APPLICABLE, A WAIVER UNDER SECTION
5 OF THIS ACT.
[(d)] (e) In conducting its activities under
this section [and] OR section 19a-638, AS AMENDED
BY THIS ACT, 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.]
Sec. 4. (NEW) (a) The provisions of section
19a-638 of the general statutes, as amended by
this act, and subsection (a) of section 19a-639 of
the general statutes, as amended by this act,
shall not apply to: (1) An outpatient clinic or
program operated exclusively by, or contracted to
be operated exclusively for, a municipality or
municipal agency, a health district, as defined in
section 19a-240 of the general statutes, or a
board of education; (2) a nursing home; (3) a home
for the aged; (4) a rest home; (5) a residential
facility for the mentally retarded licensed
pursuant to section 17a-227 of the general
statutes and certified to participate in the Title
XIX Medicaid program as an intermediate care
facility for the mentally retarded; or (6) a home
health agency. When a facility or institution
otherwise exempt under this subsection is, or will
be, created, acquired, operated or in any other
way related to or affiliated with, or under the
complete or partial ownership or control of a
facility or institution or related entity subject
to the provisions of section 19a-638 of the
general statutes, as amended by this act, or
subsection (a) of section 19a-639 of the general
statutes, as amended by this act, the exemptions
in this section shall not apply.
(b) (1) The provisions of section 19a-638 of
the general statutes, as amended by this act, and
subsection (a) of section 19a-639 of the general
statutes, as amended by this act, shall not apply
to: (A) An outpatient rehabilitation service
agency operated exclusively on an outpatient basis
and eligible, or whenever operational will be
eligible, to receive reimbursement under section
17b-243 of the general statutes; (B) a clinical
laboratory; (C) an assisted living services
agency; (D) a primary care clinic owned or
operated by a nonprofit corporation that does not
charge for any service at that clinic; (E) a
satellite clinic that is (i) operated for not more
than sixteen hours per week by an existing
facility licensed on or before July 1, 1997, by
the Department of Public Health or the Department
of Children and Families, and (ii) offering only
outpatient primary, preventive, dental, mental
health or substance abuse services, or some
combination thereof; (F) an outpatient service
offering chronic dialysis; or (G) a program of
ambulatory services established and conducted by a
health maintenance organization. (2) Each health
care facility or institution exempted under this
subsection shall register with the office by
filing the information required by subdivision (4)
of subsection (a) of section 19a-638 of the
general statutes, as amended by this act, for a
letter of intent at least ten business days but
not more than sixty calendar days prior to
commencing operations and prior to changing,
expanding, terminating or relocating any facility
or service covered by section 19a-638 of the
general statutes, as amended by this act, or
subsection (a) of section 19a-639 of the general
statutes, as amended by this act, except that, if
the facility or institution is in operation on the
effective date of this act, said information shall
be filed not more than sixty days after said date.
Not later than ten business days after the office
receives a completed filing required under this
subsection, the office shall provide the health
care facility or institution with written
acknowledgement of receipt. Such acknowledgment
shall constitute permission to operate or change,
expand, terminate or relocate such a facility or
institution or to make an expenditure consistent
with an authorization received under subsection
(a) of said section 19a-639.
Sec. 5. (NEW) The Commissioner of the Office
of Health Care Access or his designee may waive or
grant an exemption from the requirements of
section 19a-638 of the general statutes, as
amended by this act, or subsection (a) of section
19a-639 of the general statutes, as amended by
this act, for any facility, institution or
provider seeking to engage in any activity
otherwise subject to said section or subsection
if: (1) The facility, institution or provider is
proposing a capital expenditure of not more than
one million dollars and the expenditure does not
in fact exceed one million dollars; (2) the
activity meets a specific service need identified
by a state agency or the Judicial Department; and
(3) the commissioner of the state agency or the
Chief Court Administrator that has identified the
specific need, confirms, in writing, to the office
that (A) the agency or department has identified a
specific need and the need continues to exist, (B)
the activity in question meets all or part of the
identified need, (C) in the case where the
activity is the relocation or termination of
services, the agency or department has determined
that the needs of the area previously served will
continue to be met in a better or satisfactory
manner, (D) in the case where the activity is the
transfer of all or part of the ownership or
control of a facility or institution or to change
the powers of the members of a board of trustees,
the agency or department has investigated the
proposed change and the person or entity
requesting the change and has determined that the
change would be in the best interests of the state
and the patients or clients, and (E) the activity
will be cost-effective and well managed. A
facility, institution or provider seeking an
exemption under this section shall provide the
office with any information it needs to determine
exemption eligibility. An exemption granted under
this section shall be limited to any services,
equipment, expenditures or location directly
related to the need or location that the state
agency or Judicial Department has identified. The
office may revoke or modify the scope of the
exemption, at any time, to address specific,
identified, changed conditions or any problems the
state agency, Judicial Department or the office
has identified. A party to any exemption
modification or revocation shall be given at least
fourteen calendar days written notice prior to any
action by the office, and shall be furnished with
a copy, if any, of a revocation or modification
request or a statement by the office of the
problems that have been brought to its attention,
unless the requesting commissioner or the Chief
Court Administrator certifies that an emergency
condition exists, in which case only forty-eight
hours written notice is required.
Sec. 6. Subsection (a) of section 19a-653 of
the general statutes is repealed and the following
is substituted in lieu thereof:
(a) (1) Any [health care facility or
institution, or] health care provider which owns,
operates or is seeking to acquire a [CAT] COMPUTER
AXIAL TOMOGRAPHY (CT) scanner, [or] medical
imaging equipment, OR A LINEAR ACCELERATOR OR ANY
HEALTH CARE FACILITY, INSTITUTION OR PROVIDER THAT
IS required to file data under chapter 368z, 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) FAILURE TO COMPLY WITH THE PROVISIONS OF
SECTION 19a-638, AS AMENDED BY THIS ACT, 19a-639,
AS AMENDED BY THIS ACT, SECTION 4 OR 5 OF THIS ACT
OR ANY REGULATIONS ADOPTED OR ORDERS ISSUED BY THE
OFFICE IN ACCORDANCE WITH ANY PROVISION OF CHAPTER
54 OR 368z, SHALL SUBJECT EACH OFFENDER TO A CIVIL
PENALTY OF UP TO TWO HUNDRED FIFTY DOLLARS PER
DAY. ANY CIVIL PENALTY AUTHORIZED BY THIS
SUBDIVISION SHALL BE IMPOSED IN ACCORDANCE WITH
SUBSECTIONS (b) TO (e), INCLUSIVE, OF THIS
SECTION. IF A VIOLATION IS ONGOING, A CIVIL
PENALTY OR SERIES OF CIVIL PENALTIES MAY BE
IMPOSED PERIODICALLY SO LONG AS THE VIOLATION
EXISTS OR CONTINUES, WITHOUT FURTHER PROCEEDINGS
UNDER SUBSECTIONS (b) TO (e), INCLUSIVE, OF THIS
SECTION, PROVIDED THE ORIGINAL CIVIL PENALTY
IMPOSITION PROCESS WAS IN ACCORDANCE WITH SAID
SUBSECTIONS (b) TO (e), INCLUSIVE. IF AN APPLICANT
OR PROVIDER IS UNSURE WHETHER A CERTIFICATE OF
NEED IS REQUIRED UNDER SECTION 19a-638, AS AMENDED
BY THIS ACT, OR 19a-639, AS AMENDED BY THIS ACT,
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.
Sec. 7. Subsection (c) of section 19a-643 of
the general statutes is repealed and the following
is substituted in lieu thereof:
(c) The regulations adopted by the Office of
Health Care Access concerning requests or
proposals pursuant to [sections 19a-638 and]
SECTION 19a-639, AS AMENDED BY THIS ACT, shall
include a fee schedule for certificate of need
review under section [19a-638 or] 19a-639, AS
AMENDED BY THIS ACT. The fee schedule shall (1)
contain a minimum filing fee for all applications
under said [sections] SECTION 19a-639, (2) be
based on a percentage of the requested
authorization in addition to the minimum filing
fee, and (3) apply to new requests and requests
for modification of prior decisions [under said
sections] IF THE MODIFICATION REQUEST HAS A
PROPOSED ADDITIONAL COST OF ONE HUNDRED THOUSAND
DOLLARS OR MORE BEYOND THE ORIGINAL AUTHORIZATION
AMOUNT, OR IF THE MODIFICATION REQUEST AGGREGATED
WITH ANY OTHER PRIOR MODIFICATION REQUESTS TOTALS
ONE HUNDRED THOUSAND DOLLARS OR MORE. The fee
schedule shall be reviewed annually and adjusted
as necessary.
Sec. 8. Subsection (b) of section 17a-451b of
the general statutes is repealed and the following
is substituted in lieu thereof:
(b) Notwithstanding the provisions of the
general statutes or any special act, the
consolidation program, each project, each closure
and each contract entered into in connection with
a project shall be exempt from the provisions of
sections 4b-58 and 4b-91 and from the requirements
for approval of a request or application provided
for in [subsections (a) to (d), inclusive, of]
section 19a-638, AS AMENDED BY THIS ACT, and in
subsection (a) of section 19a-639, AS AMENDED BY
THIS ACT, provided (1) the project begins no later
than June 30, 1998; (2) the project is completed
no later than June 30, 2000; (3) the cost of the
project does not exceed twenty million dollars;
and (4) the Commissioner of Mental Health and
Addiction Services certifies in writing to the
Secretary of the Office of Policy and Management
that the project meets the criteria of public act
95-257* and upon such certification the Secretary
of the Office of Policy and Management shall
authorize the Commissioner of Public Works to
implement such project.
Sec. 9. Subsection (b) of section 17a-451c of
the general statutes is repealed and the following
is substituted in lieu thereof:
(b) Notwithstanding any provision of the
general statutes or any special act, a priority
mental health facility project and each contract
entered into in connection with a project shall be
exempt from the provisions of sections 4b-58 and
4b-91 and from the requirements for approval of a
request or application provided for in
[subsections (a) to (d), inclusive, of] section
19a-638, AS AMENDED BY THIS ACT, and in subsection
(a) of section 19a-639, AS AMENDED BY THIS ACT,
and [sections] 22a-1 to 22a-1h, inclusive,
provided: (1) The project begins no later than
October 1, 1996; (2) the project is completed no
later than July 1, 1998; (3) the cost of the
project does not exceed twenty million dollars;
and (4) the Commissioner of Mental Health and
Addiction Services certifies in writing to the
Secretary of the Office of Policy and Management
that the project meets the criteria of this
section and upon such certification the Secretary
of the Office of Policy and Management authorizes
the Commissioner of Public Works to implement such
project.
Sec. 10. Subsection (b) of section 17b-351 of
the general statutes is repealed and the following
is substituted in lieu thereof:
(b) The General Assembly finds evidence of
insufficient need for all the nursing home beds
permitted pursuant to subsection (a) of this
section, but not licensed by the Department of
Public Health and finds allowing unnecessary beds
to be licensed will result in severely damaging
economic consequences to the state and to
consumers. An addition of beds initiated pursuant
to this section shall be licensed no later than
June 9, 1993. A facility which has initiated the
addition of beds but has not obtained licensure of
such beds, may, no later than July 15, 1993, apply
to the Office of Health Care Access for
authorization to proceed with completion of the
additional beds and application for licensure,
provided (A) plans for the additional beds have
been approved by the Department of Public Health
pursuant to section 19-13-D-8t(v)(4) of the Public
Health Code no later than June 1, 1993, and (B)
twenty-five per cent of estimated project costs
have been expended no later than June 9, 1993,
provided project costs may not exceed thirty-one
thousand two hundred eleven dollars per bed. The
office shall issue a decision on such application
within forty-five days of receipt of documentation
necessary to determine expended project costs.
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 facility or the developer of
the project. The owner of a facility for which
completion of additional beds is not so authorized
may apply to the Commissioner of Social Services
for compensation on or after June 29, 1993, but no
later than September 1, 1993, provided plans for
the additional beds have been approved by the
Department of Public Health no later than June 1,
1993. Such compensation shall be limited to actual
verifiable losses which directly result from the
failure to gain authorization 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. In no event may such compensation
exceed project costs. An owner aggrieved by the
amount of compensation determined by the
commissioner may request a hearing in accordance
with the provisions of sections 17b-60 and 17b-61.
[This subsection shall not apply to any addition
of beds pursuant to this section which is part of
a construction project that also includes an
addition of beds authorized pursuant to
subdivision (4) of subsection (k) of section
19a-638.]
Sec. 11. Subsection (a) of section 17b-353 of
the general statutes is repealed and the following
is substituted in lieu thereof:
(a) Any facility, as defined in subsection (a)
of section 17b-352, which proposes a capital
expenditure exceeding one million dollars or the
acquisition of major medical equipment requiring a
capital expenditure in excess of four hundred
thousand dollars, including the leasing of
equipment or space, shall submit a request for
approval of such expenditure, with such
information as the department requires, to the
Department of Social Services. Any such facility
which proposes to acquire imaging equipment
requiring a capital expenditure in excess of four
hundred thousand dollars, including the leasing of
such equipment, shall obtain the approval of the
Office of Health Care Access in accordance with
[subsection (b) of] section 19a-639, AS AMENDED BY
THIS ACT, subsequent to obtaining the approval of
the Commissioner of Social Services.
Sec. 12. Subsection (c) of section 19a-612b of
the general statutes is repealed and the following
is substituted in lieu thereof:
(c) Any order, decision, agreed settlement, or
regulation of the Commission on Hospitals and
Health Care which is in force on June 30, 1995,
shall continue in force and effect as an order or
regulation of the Office of Health Care Access
until amended, repealed or superseded pursuant to
law. The Commissioner of Health Care Access may
implement policies and procedures consistent with
the provisions of section 4-5, sections 19a-612 to
19a-614, inclusive, AS AMENDED BY THIS ACT,
[subsection (a) of] section 19a-630, AS AMENDED BY
THIS ACT, subsection (b) of section 19a-631,
sections 19a-632 [, 19a-633 and] TO 19a-634,
[subsection (b) of section] INCLUSIVE, 19a-638, AS
AMENDED BY THIS ACT, and [subsection (a) of
section] 19a-639, AS AMENDED BY THIS ACT, while in
the process of adopting the policy or procedure in
regulation form, provided notice of intention to
adopt the regulations is printed in the
Connecticut Law Journal within twenty days of
implementation. The policy or procedure shall be
valid until the time final regulations are
effective.
Sec. 13. This act shall take effect from its
passage.
Vetoed June 26, 1997