CHAPTER 368z*
OFFICE OF HEALTH CARE ACCESS

      Sec. 19a-610. Short title: Office of Health Care Access Act. Sections 19a-610 to 19a-662, inclusive, shall be known and may be cited as the "Office of Health Care Access Act".

      (May Sp. Sess. 94-3, S. 5, 28.)

      History: May Sp. Sess. P.A. 94-3 effective July 1, 1994.

      Sec. 19a-611. Definitions. As used in sections 19a-610 to 19a-614, inclusive:

      (1) "Certified health plan" means a plan that provides the standard benefits package and meets the requirements established by the Office of Health Care Access;

      (2) "Office" means the Office of Health Care Access;

      (3) "Standard benefits package" means the specified set of health services, as determined by federal law or in the absence of such applicable federal law, as determined by state law, that are the minimum which must be available from each certified health plan;

      (4) "Health care provider" or "provider" means a state licensed or certified person or state-authorized facility, which delivers diagnostic, treatment, inpatient or ambulatory health care services; and

      (5) "Health plan" means any hospital or medical policy or certificate or contract, hospital or medical service plan contract, or health care center contract. The term does not include accident-only, specific disease, individual hospital indemnity, credit, dental-only, vision-only, Medicare supplement, long-term care, or disability income insurance; coverage issued as a supplement to liability insurance; workers' compensation or similar insurance; or automobile medical-payment insurance.

      (May Sp. Sess. P.A. 94-3, S. 6, 28; June 18 Sp. Sess. P.A. 97-8, S. 27, 88.)

      History: May Sp. Sess. P.A. 94-3 effective July 1, 1994; (Revisor's note: In 1997 a reference to Sec. 19a-146 was deleted editorially by the Revisors to reflect the repeal of that section by P.A. 95-257); June 18 Sp. Sess. P.A. 97-8 replaced reference to Sec. 19a-622 with Sec. 19a-614 in the introductory clause and deleted Subdiv. (6) which had defined "institute" as the Health Data Institute, effective July 1, 1997.

      Subdiv. (4):

      Cited. 242 C. 1.

      Sec. 19a-612. Office of Health Care Access: Established. Commissioner: Appointment and qualifications. There is established an Office of Health Care Access. The powers of the office shall be vested in and exercised by a commissioner who shall be appointed by the Governor in accordance with the provisions of sections 4-5 to 4-8, inclusive. Said commissioner shall have (1) a graduate degree and (2) a minimum of ten years' experience in the field of financial management, health insurance, hospital administration or a combination of such experience.

      (May Sp. Sess. P.A. 94-3, S. 7, 28; P.A. 95-257, S. 36, 58.)

      History: May Sp. Sess. P.A. 94-3 effective July 1, 1994; P.A. 95-257 deleted provisions re governing board and how its members are selected, replacing the board with a commissioner and setting forth his appointment and qualifications, effective July 1, 1995.

      See Sec. 1-101aa re provider participation in informal committees, task forces and work groups of office not deemed to be lobbying.

      Sec. 19a-612a. Office within Department of Public Health for administrative purposes only. The Office of Health Care Access, established pursuant to section 19a-612, shall be within the Department of Public Health for administrative purposes only.

      (P.A. 95-257, S. 34, 58.)

      History: P.A. 95-257, S. 34 effective July 1, 1995.

      See Sec. 4-38f for definition of "administrative purposes only".

      Sec. 19a-612b. Office of Health Care Access to be successor agency to the Commission on Hospitals and Health Care. (a) The Office of Health Care Access shall constitute a successor agency to the Commission on Hospitals and Health Care, in accordance with the provisions of sections 4-38d and 4-39.

      (b) Wherever the words "Commission on Hospitals and Health Care" are used in the general statutes, the words "Office of Health Care Access" shall be 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, section 19a-630, subsection (b) of section 19a-631, sections 19a-632 to 19a-634, inclusive, 19a-638 and 19a-639 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.

      (P.A. 95-257, S. 35, 58; P.A. 98-150, S. 14, 17.)

      History: P.A. 95-257, S. 35 effective July 1, 1995; P.A. 98-150 made technical changes re statutory references in Subsec. (c), effective June 5, 1998.

      Sec. 19a-612c. Term "Commission on Hospitals and Health Care" deemed to mean "Office of Health Care Access". Section 19a-612c is repealed, effective October 1, 2002.

      (P.A. 95-257, S. 39, 58; P.A. 02-101, S. 15; S.A. 02-12, S. 1.)

      Sec. 19a-613. Powers and duties. Data collection. (a) The Office of Health Care Access may employ the most effective and practical means necessary to fulfill the purposes of this chapter, which may include, but need not be limited to:

      (1) Collecting patient-level outpatient data from health care facilities or institutions, as defined in section 19a-630;

      (2) Establishing a cooperative data collection effort, across public and private sectors, to assure that adequate health care personnel demographics are readily available; and

      (3) Performing the duties and functions as enumerated in subsection (b) of this section.

      (b) The office shall: (1) Authorize and oversee the collection of data required to carry out the provisions of this chapter; (2) oversee and coordinate health system planning for the state; (3) monitor health care costs; and (4) implement and oversee health care reform as enacted by the General Assembly.

      (c) The Commissioner of Health Care Access or any person the commissioner designates may conduct a hearing and render a final decision in any case when a hearing is required or authorized under the provisions of any statute dealing with the Office of Health Care Access.

      (May Sp. Sess. P.A. 94-3, S. 8, 28; P.A. 95-257, S. 37, 58; June 18 Sp. Sess. P.A. 97-8, S. 28, 88; P.A. 98-36, S. 3; 98-87, S. 2; P.A. 99-172, S. 1, 7; P.A. 05-151, S. 1.)

      History: May Sp. Sess. P.A. 94-3 effective July 1, 1994; P.A. 95-257 deleted former Subsec. (b) re responsibility for a state health regulation and financing plan, and former Subsec. (d) re a working group to study a regional health care plan, relettered the remaining Subsecs. accordingly and amended new Subsec. (b) by requiring coordination with the Health Care Data Institute and by adding new Subdiv. (4) re continuing the functions and duties of chapter 368c and renumbering the remaining Subdiv. and added new Subsec. (c) re hearings and decisions by a designee, effective July 1, 1995; June 18 Sp. Sess. P.A. 97-8 made technical changes in Subsec. (b) reflecting the abolishment of the Connecticut Health Care Data Institute, effective July 1, 1997; P.A. 98-36 made a technical correction, changing reference to sections to "this chapter"; P.A. 98-87 amended Subsec. (a) to add Subdivs. (1) and (2) re collecting data, changed "shall" to "may" and changed section reference to chapter reference; P.A. 99-172 made a technical change in Subsec. (c) and added Subsecs. (d) re graduate medical education and (e) re reports, effective June 23, 1999; P.A. 05-151 deleted Subsecs. (d) and (e) re graduate medical education reporting requirements.

      Sec. 19a-614. Support staff and consultants. Consumer education unit. (a) The Commissioner of Health Care Access may employ and pay professional and support staff subject to the provisions of chapter 67 and contract with and engage consultants and other independent professionals as may be necessary or desirable to carry out the functions of the office.

      (b) The commissioner may establish a consumer education unit within the office to provide information to residents of the state concerning the availability of public and private health care coverage.

      (May Sp. Sess. P.A. 94-3, S. 9, 28; P.A. 95-257, S. 38, 58.)

      History: May Sp. Sess. P.A. 94-3 effective July 1, 1994; P.A. 95-257 eliminated the position of executive director and advisory committee, made establishment of the consumer education unit optional, replaced "board" with "Commissioner of Health Care Access" and relettered the Subsecs., effective July 1, 1995.

      Sec. 19a-615. Health Care Reform Review Board. Reports. Section 19a-615 is repealed, effective July 1, 1995.

      (May Sp. Sess. P.A. 94-3, S. 11, 28; P.A. 95-257, S. 57, 58.)

      Sec. 19a-616. Connecticut Health Care Data Institute. Regulations. Section 19a-616 is repealed, effective July 1, 1997.

      (May Sp. Sess. P.A. 94-3, S. 12, 28; June 18 Sp. Sess. P.A. 97-8, S. 87, 88.)

      Sec. 19a-617. Advisory board. Section 19a-617 is repealed, effective July 1, 1995.

      (May Sp. Sess. P.A. 94-3, S. 13, 28; P.A. 95-257, S. 57, 58.)

      Sec. 19a-617a. Demonstration project converting acute care hospital to provider of other medical services. Certificate of need waiver, property tax abatement. Section 19a-617a is repealed, effective July 1, 2005.

      (P.A. 96-238, S. 22, 23, 25; P.A. 05-151, S. 13.)

      Sec. 19a-617b. Demonstration project for long-term acute care hospitals or satellite facilities. Waiver of licensure requirements. Certificate of need. Report. (a) For purposes of this section:

      (1) "Chronic disease hospital" means a nonprofit facility licensed as a chronic disease hospital by the Department of Public Health on or before January 1, 2003; and

      (2) "Satellite facility" means a long-term acute care facility operated as part of a long-term acute care hospital under the provisions of Title XVIII of the Social Security Act.

      (b) The Office of Health Care Access, in consultation with the Departments of Public Health and Social Services, may authorize up to four demonstration projects allowing chronic disease hospitals to establish and operate new long-term acute care hospitals or satellite facilities. The purpose of such demonstration projects is to study the quality of service, patient outcomes and cost-effectiveness resulting from the use of such hospitals or facilities. Such hospitals or facilities operated pursuant to such demonstration projects shall serve patients who require long-term hospitalization in an acute care setting, need twenty-four-hour on-site physician availability and are not suitable for placement in a skilled nursing facility. New long-term acute care hospitals and satellite facilities may be eligible for operation as such projects if they are (1) located within a licensed short-term acute care general or children's hospital, (2) under the common ownership and control of a chronic disease hospital, and (3) currently are, or become certified for, Medicare participation as a long-term acute care hospital under Title XVIII of the Social Security Act.

      (c) In connection with the demonstration projects authorized under this section, the Commissioner of Public Health may, in the commissioner's discretion, waive licensure and other regulatory requirements otherwise applicable to chronic disease hospitals for new long-term acute care hospitals or satellite facilities. It shall not be necessary for the Department of Public Health to adopt or amend regulations for purposes of the demonstration projects authorized by this section.

      (d) Not later than January 1, 2005, a chronic disease hospital may apply to the office for a certificate of need to conduct a demonstration project. Each demonstration project authorized by the office pursuant to this section shall collect and report on data concerning the demonstration project's impact on the quality of service and patient outcomes and cost-effectiveness. Such data shall be reported in the manner prescribed by said commissioner, and shall include (1) length of stay, (2) number of intensive care days per patient, (3) cost of stay, (4) type of discharge, and (5) any other data requested by the Commissioner of Health Care Access.

      (e) Not later than January 1, 2007, the Office of Health Care Access, in consultation with the Departments of Public Health and Social Services, shall report, in accordance with section 11-4a, to the joint standing committees of the General Assembly having cognizance of matters relating to public health and human services concerning findings and recommendations regarding the demonstration projects authorized pursuant to this section.

      (P.A. 03-275, S. 1.)

      Sec. 19a-617c. Payments for services provided in long-term acute care hospitals or satellite facilities. Payments made to hospitals pursuant to subsection (g) of section 17b-239 shall include any inpatient service days provided in a new long-term acute care hospital or satellite facility established as a demonstration project pursuant to section 19a-617b. For the purposes of rate setting and cost per discharge settlement pursuant to said subsection (g), the inpatient stay of a patient eligible for medical assistance shall include both short-term and long-term acute care hospital days provided in a new long-term acute care hospital or satellite facility established as a demonstration project pursuant to section 19a-617b. Notwithstanding any provision of the general statutes, a short-term acute care hospital may enter into an agreement with a chronic disease hospital that establishes a new long-term acute care hospital or satellite facility as a demonstration project pursuant to section 19a-617b, to distribute payments received under section 17b-239 for services provided by such long-term acute care hospital or satellite facility.

      (P.A. 03-275, S. 2.)

      Secs. 19a-618 to 19a-622. Definitions. Collection; methodology; reporting requirements. Fee schedule; reports, analyses and studies. Confidentiality of data. Filing of data with institute. Sections 19a-618 to 19a-622, inclusive, are repealed, effective July 1, 1997.

      (May Sp. Sess. P.A. 94-3, S. 14-18, 28; P.A. 97-47, S. 22; June 18 Sp. Sess. P.A. 97-2, S. 93, 165; June 18 Sp. Sess. P.A. 97-8, S. 87, 88.)

      Secs. 19a-623 to 19a-629. Reserved for future use.

      Sec. 19a-630. (Formerly Sec. 19a-145). Definitions. 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; outpatient surgical facilities; imaging centers; home health agencies and critical access hospitals, as defined in section 19a-490; clinical laboratory or central service facilities serving one or more health care facilities, practitioners or institutions; hospitals; nursing homes; rest 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 or joint venture, or any combination thereof, of any such facility or institution, but does not include 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 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" means the Office of Health Care Access.

      (4) "Commissioner" means the Commissioner of Health Care Access.

      (5) "Person" has the meaning assigned to it in section 4-166.

      (P.A. 73-117, S. 2, 31; 73-616, S. 59; P.A. 75-562, S. 1, 8; P.A. 77-192, S. 1, 13; 77-601, S. 6, 11; 77-614, S. 323, 610; P.A. 78-109, S. 1, 2, 6; P.A. 86-374, S. 1, 6; P.A. 87-420, S. 13, 14; P.A. 89-72, S. 4, 5; P.A. 93-381, S. 9, 39; P.A. 94-174, S. 4, 12; May Sp. Sess. P.A. 94-3, S. 19, 28; P.A. 95-257, S. 12, 21, 39, 41, 58; P.A. 98-150, S. 1, 17; P.A. 99-172, S. 2, 7; P.A. 00-27, S. 23, 24; June 30 Sp. Sess. P.A. 03-3, S. 30; P.A. 04-249, S. 4; P.A. 05-280, S. 61; P.A. 06-196, S. 213.)

      History: P.A. 73-616 excluded from consideration as health care facility or institution facilities operated by nonprofit educational institution solely for students, faculty and staff and their dependents; P.A. 75-562 defined "commission" and "commissioner" and extended applicability beyond chapter; P.A. 77-192 defined "state health care facility or institution"; P.A. 77-601 included homemaker-home health aide agencies as health care facilities and institutions; P.A. 77-614 replaced commissioner of health with commissioner of health services, effective January 1, 1979; P.A. 78-109 excluded Christian Science sanatoriums from consideration as health care facilities or institutions and specified that state health care facility or institution is one which provides services reimbursable under Title XVIII or XIX of Social Security Act; Sec. 19-73b transferred to Sec. 19a-145 in 1983; P.A. 86-374 deleted coordination, assessment and monitoring agencies from definition of health care facility or institution; P.A. 87-420 deleted an obsolete reference to Sec. 19a-7; P.A. 89-72 changed "diagnosis and treatment" to "diagnosis or treatment"; P.A. 93-381 replaced commissioner of health services with commissioner of public health and addiction services, effective July 1, 1993; P.A. 94-174 made technical changes in Subsec. (a) and added new Subsec. (b) defining "clinical laboratory" for certificate of need purposes, effective June 6, 1994; May Sp. Sess. P.A. 94-3 amended Subsec. (a) to add outpatient clinics, free-standing outpatient surgical facilities and imaging centers to the definition of health care facilities and to specify that such facilities include any parent company, subsidiary affiliate, joint venture or combination of such, effective July 1, 1994; P.A. 95-257 replaced reference to Secs. 17b-238 and 19a-114 with reference to chapter 368z, Commission on Hospitals and Health Care with Office of Health Care Access and Commissioner of Public Health and Addiction Services with Commissioner of Health Care Access, effective July 1, 1995; Sec. 19a-145 transferred to Sec. 19a-630 in 1997; P.A. 98-150 changed Subdiv. designations from letters to numbers, amended Subdiv. (1) to change "home health care agencies" to "home health agencies", delete "homemaker-home health aide agencies", change "personal care homes" to "residential care homes" add "rest homes" and delete reference to municipal outpatient clinics, added new Subdiv. (5) defining "affiliate" and deleted former Subsec. (b) defining "clinical laboratory", effective June 5, 1998; P.A. 99-172 deleted former Subdiv. (5) defining "affiliate" and added new Subdiv. (5) defining "person", effective June 23, 1999; P.A. 00-27 made technical changes in Subdiv. (1), effective May 1, 2000; June 30 Sp. Sess. P.A. 03-3 amended Subdiv. (1) by deleting "residential care homes" from definition of "health care facility or institution", effective August 20, 2003; P.A. 04-249 amended Subdiv. (1) by changing "free standing outpatient surgical facilities" to "outpatient surgical facilities", effective July 1, 2004; P.A. 05-280 amended Subdiv. (1) by including critical access hospital in definition of "health care facility or institution", effective July 1, 2005; P.A. 06-196 made technical changes in Subdiv. (1), effective June 7, 2006.

      See Sec. 19a-507 re New Horizons independent living facility for severely physically disabled adults.

      Annotation to former section 19-73b:

      Cited. 182 C. 314.

      Annotation to former section 19a-145:

      Cited. 214 C. 321.

      Sec. 19a-630a. Certificate of need. Limited definition of "affiliate". As used in sections 19a-638 to 19-639c, inclusive, "affiliate" means a person, entity or organization controlling, controlled by or under common control with another person, entity or organization. In addition to other means of being controlled, a person is deemed controlled by another person if the other person, or one of that other person's affiliates, officers or management employees, acting in such capacity, acts as a general partner of a general or limited partnership or manager of a limited liability company.

      (P.A. 99-172, S. 3, 7; P.A. 05-75, S. 1.)

      History: P.A. 99-172 effective June 23, 1999; P.A. 05-75 redefined "affiliate" and extended the new definition to Secs. 19a-639b and 19a-639c, and deleted the definition of "health-care-related person".

      See Sec. 19a-644 re limited definition of "affiliate".

      Sec. 19a-631. (Formerly Sec. 19a-148a). Assessments of hospitals for expenses of the office. (a) As used in this section and section 19a-632, "hospital" means each hospital subject to the provisions of this chapter and licensed as a short-term acute-care general hospital or a children's hospital or both by the Department of Public Health.

      (b) Each hospital shall annually pay to the Commissioner of Health Care Access, for deposit in the General Fund, an amount equal to its share of the actual expenditures made by the office during each fiscal year including the cost of fringe benefits for office personnel as estimated by the Comptroller, the amount of expenses for central state services attributable to the office for the fiscal year as estimated by the Comptroller, plus the expenditures made on behalf of the office from the Capital Equipment Purchase Fund pursuant to section 4a-9 for such year. Payments shall be made by assessment of all hospitals of the costs calculated and collected in accordance with the provisions of this section and section 19a-632. If for any reason a hospital ceases operation, any unpaid assessment for the operations of the office shall be reapportioned among the remaining hospitals to be paid in addition to any other assessment.

      (P.A. 93-229, S. 18, 21; 93-381, S. 9, 39; 93-435, S. 59, 95; P.A. 95-257, S. 12, 21, 42, 58; P.A. 98-22, S. 1, 3.)

      History: P.A. 93-229 effective June 4, 1993; P.A. 93-381 and 93-435 authorized substitution of commissioner and department of public health and addiction services for commissioner and department of health services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health and "commission" with "office", qualified expenditures made by the office as those which are accountable to the functions of the office transferred from the Commission on Hospitals and Health Care, and deleted reference to a fiscal year 1993 share, effective July 1, 1995; Sec. 19a-148a transferred to Sec. 19a-631 in 1997; P.A. 98-22 amended Subsec. (b) to require payment to the Commissioner of Health Care Access rather than Commissioner of Public Health, deleted reference to expenditures "which are accountable to the functions of the office transferred from the Commission on Hospitals and Health Care" and added provision re reapportionment of payments when a hospital ceases operation, effective July 1, 1998.

      Annotation to former section 19a-148a:

      Cited. 235 C. 128.

      Sec. 19a-632. (Formerly Sec. 19a-148b). Calculation of assessment and costs. (a) On or before September first, annually, the Office of Health Care Access shall determine (1) the total net revenue of each hospital for the most recently completed hospital fiscal year beginning October first; and (2) the proposed assessment on the hospital for the state fiscal year. The assessment on each hospital shall be calculated by multiplying the hospital's percentage share of the total net revenue specified in subdivision (1) of this subsection times the costs of the office, as determined in subsection (b) of this section.

      (b) The costs of the office shall be the total of (1) the amount appropriated for the operation of the office for the fiscal year, (2) the cost of fringe benefits for office personnel for such year, as estimated by the Comptroller, (3) the amount of expenses for central state services attributable to the office for the fiscal year as estimated by the Comptroller, and (4) the estimated expenditures on behalf of the office from the Capital Equipment Purchase Fund pursuant to section 4a-9 for such year, provided for purposes of this calculation the amount so appropriated plus the cost of fringe benefits for personnel, the amount of expenses for said central state services for the fiscal year as estimated by the Comptroller, and said estimated expenditures from the Capital Equipment Purchase Fund pursuant to section 4a-9 shall be deemed to be the actual expenditures of the office.

      (c) On or before December thirty-first, annually, for each fiscal year, each hospital shall pay the office twenty-five per cent of its proposed assessment, adjusted to reflect any credit or amount due under the recalculated assessment for the preceding state fiscal year as determined pursuant to subsection (d) of this section or any reapportioned assessment pursuant to subsection (b) of section 19a-631. The hospital shall pay the remaining seventy-five per cent of its assessment to the office in three equal installments on or before the following March thirty-first, June thirtieth and September thirtieth, annually.

      (d) Immediately following the close of each state fiscal year the commissioner shall recalculate the proposed assessment for each hospital based on the costs of the office in accordance with subsection (b) of this section using the actual expenditures made by the office during that fiscal year and the actual expenditures made on behalf of the office from the Capital Equipment Purchase Fund pursuant to section 4a-9. On or before August thirty-first, annually, the office shall render to each hospital a statement showing the difference between the respective recalculated assessment and the amount previously paid. On or before September thirtieth, the commissioner, after receiving any objections to such statements, shall make such adjustments which in said commissioner's opinion may be indicated and shall render an adjusted assessment, if any, to the affected hospitals. Adjustments to reflect any credit or amount due under the recalculated assessment for the previous state fiscal year shall be made to the proposed assessment due on or before December thirty-first of the following state fiscal year.

      (e) If any assessment is not paid when due, a late fee of ten dollars shall be added thereto and interest at the rate of one and one-fourth per cent per month or fraction thereof shall be paid on such assessment and late fee.

      (f) The office shall deposit all payments received pursuant to this section with the State Treasurer. The moneys so deposited shall be credited to the General Fund and shall be accounted for as expenses recovered from hospitals.

      (P.A. 93-229, S. 19, 21; P.A. 95-257, S. 39, 43, 58; P.A. 98-22, S. 2, 3; P.A. 03-222, S. 1; P.A. 06-64, S. 4.)

      History: P.A. 93-229 effective June 4, 1993; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, "commission" with "office" and "chairman of the commission" with "commissioner" and amended Subdiv. (1) of Subsec. (a) and Subdiv. (4) of Subsec. (b) to qualify expenditures as those accountable or attributable to the functions of the office, effective July 1, 1995; Sec. 19a-148b transferred to Sec. 19a-632 in 1997; P.A. 98-22 deleted, in Subsecs. (a) and (b), reference to expenditures "which are accountable to the functions of the office transferred from the Commission on Hospitals and Health Care," changed "total of that portion of" to "total of" in Subsec. (b), inserted "or any reapportioned assessment pursuant to subsection (b) of section 19a-631" in Subsec. (c) and required the "office" rather than the "commissioner" to render recalculated assessments in Subsec. (d), effective July 1, 1998; P.A. 03-222 amended Subsec. (d) by changing due date of statement from office to hospital from July thirty-first to August thirty-first, changing due date of adjusted assessment from August thirty-first to September thirtieth and making a technical change, effective July 1, 2003; P.A. 06-64 deleted Subsec. (g) re inclusion of assessments in computation of net and gross revenue caps, effective July 1, 2006.

      Annotation to former section 19a-148b:

      Cited. 235 C. 128.

      Sec. 19a-633. (Formerly Sec. 19a-149). Investigative powers. The commissioner or any agent authorized by him to conduct any inquiry, investigation or hearing under the provisions of this chapter, shall have power to administer oaths and take testimony under oath relative to the matter of inquiry or investigation. At any hearing ordered by the office, the commissioner or such agent having authority by law to issue such process may subpoena witnesses and require the production of records, papers and documents pertinent to such inquiry. If any person disobeys such process or, having appeared in obedience thereto, refuses to answer any pertinent question put to him by the commissioner or his authorized agent or to produce any records and papers pursuant thereto, the commissioner or his agent may apply to the superior court for the judicial district of Hartford or for the judicial district wherein the person resides or wherein the business has been conducted, or to any judge of said court if the same is not in session, setting forth such disobedience to process or refusal to answer, and said court or such judge shall cite such person to appear before said court or such judge to answer such question or to produce such records and papers.

      (P.A. 73-117, S. 7, 31; P.A. 78-280, S. 2, 6, 127; P.A. 88-230, S. 1, 12; P.A. 90-98, S. 1, 2; P.A. 93-142, S. 4, 7, 8; P.A. 95-220, S. 4-6; 95-257, S. 44, 58.)

      History: P.A. 78-280 replaced "county" with "judicial district" and "Hartford county" with "judicial district of Hartford-New Britain"; Sec. 19-73g transferred to Sec. 19a-149 in 1983; P.A. 88-230 replaced "judicial district of Hartford-New Britain" with "judicial district of Hartford", effective September 1, 1991; P.A. 90-98 changed the effective date of P.A. 88-230 from September 1, 1991, to September 1, 1993; P.A. 93-142 changed the effective date of P.A. 88-230 from September 1, 1993, to September 1, 1996, effective June 14, 1993; P.A. 95-220 changed the effective date of P.A. 88-230 from September 1, 1996, to September 1, 1998, effective July 1, 1995; P.A. 95-257 replaced variants of "commission" with "commissioner" or "office", effective July 1, 1995; Sec. 19a-149 transferred to Sec. 19a-633 in 1997.

      Annotation to former section 19-73g:

      Cited. 42 CS 413.

      Annotations to former section 19a-149:

      Cited. 226 C. 105. Cited. 235 C. 128.

      Cited. 42 CS 413.

      Sec. 19a-634. (Formerly Sec. 19a-150). State-wide health care facility studies, plans and recommendations. (a) The Office of Health Care Access, in consultation with the Department of Public Health, shall carry out a continuing state-wide health care facility utilization study, including a study of existing health care delivery systems; recommend improvements in health care procedures to the health care facilities and institutions; recommend to the commissioner legislation in the area of health care programs; and report annually to the Governor and the General Assembly its findings, recommendations and proposals, as of January first, for improving efficiency, lowering health care costs, coordinating use of facilities and services and expanding the availability of health care throughout the state.

      (b) The office shall establish and maintain a state-wide health care facilities plan, including provisions for an ongoing evaluation of the facility utilization study conducted pursuant to subsection (a) of this section to: (1) Determine the availability of acute care, long-term care and home health care services in private and public institutional and community-based facilities providing diagnostic or therapeutic services for residents of this state; (2) determine the scope of such services; and (3) anticipate future needs for such facilities and services. The health care facilities plan shall be considered part of the state health plan for purposes of office deliberations pursuant to section 19a-637.

      (P.A. 73-117, S. 8, 31; P.A. 75-562, S. 4, 8; P.A. 77-192, S. 5, 13; June Sp. Sess. P.A. 91-11, S. 14, 25; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 45, 58.)

      History: P.A. 75-562 required that recommendations be made to health commissioner rather than to governor and general assembly; P.A. 77-192 required consultation with state bureau of health planning and development and deleted commission's duty to formulate state-wide health care program for improving delivery of services; Sec. 19-73h transferred to Sec. 19a-150 in 1983; June Sp. Sess. P.A. 91-11 replaced reference to "state bureau of health planning and development" with department of health services, replaced utilization review with utilization study, and added Subsec. (b) requiring the commission to establish and maintain a state-wide health care facilities plan; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced "commission" with "Office of Health Care Access" and "office" and "Department of Public Health and Addiction Services" with "Department of Public Health", effective July 1, 1995; Sec. 19a-150 transferred to Sec. 19a-634 in 1997.

      Annotations to former section 19a-150:

      Cited. 200 C. 489. Cited. 208 C. 663. Cited. 214 C. 321. Cited. 226 C. 105. Cited. 235 C. 128.

      Secs. 19a-635 and 19a-636. (Formerly Secs. 19a-151 and 19a-152). Rate-setting powers. Requests for approval of lesser increases. Sections 19a-635 and 19a-636 are repealed, effective July 1, 2002.

      (P.A. 73-117, S. 9, 10, 11, 31; P.A. 74-78, S. 1, 2; P.A. 75-235; P.A. 78-109, S. 3, 6; 78-264, S. 3, 4; P.A. 79-182, S. 3; P.A. 80-7; P.A. 81-465, S. 3, 18; 81-472, S. 45, 159; P.A. 86-69, S. 1-3; P.A. 87-189, S.1-3; P.A. 88-317, S. 79, 107; P.A. 89-371, S. 14, 15; June Sp. Sess. 91-11, S. 15, 25; P.A. 93-262, S. 16, 87; May 25 Sp. Sess. P.A. 94-1, S. 46, 47, 130; P.A. 95-257, S. 39, 58; P.A. 02-101, S. 20.)

      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-639e, 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 shall not direct or control the use of the following resources of any hospital: 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; P.A. 05-151, S. 3.)

      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; P.A. 05-151 amended Subsecs. (b) and (c) by removing references to repealed Sec. 19a-640 and making technical changes.

      Annotations to former section 19-73k:

      Cited. 177 C. 356. Cited. 182 C. 314.

      Cited. 32 CS 300. Cited. 34 CS 225. Cited. 42 CS 413.

      Annotations to former section 19a-153:

      Cited. 208 C. 663. Cited. 226 C. 105. Cited. 235 C. 128.

      Cited. 42 CS 413.

      Subsec. (a):

      Cited. 200 C. 489. Cited. 219 C. 581.

      Subsec. (c):

      Cited. 200 C. 489.

      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 March thirty-first 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; P.A. 06-64, S. 5.)

      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; P.A. 06-64 changed budget submittal date from February twenty-eighth to March thirty-first, effective July 1, 2006.

      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-487a and 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) Except as provided in sections 19a-639a to 19a-639c, inclusive, each applicant, prior to submitting a certificate of need application under this section or 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 (i) a new, replacement or additional facility, service or function, (ii) the expansion or relocation of an existing facility, service or function, (iii) a change in ownership or control, (iv) a termination of a service or a reduction in total bed capacity and the bed type, (v) any new or additional beds and their type, (vi) a capital expenditure over three million dollars, (vii) the purchase, lease or donation acceptance of major medical equipment costing over three million dollars, (viii) a CT scanner, PET scanner, PET/CT scanner or MRI scanner, cineangiography equipment, a linear accelerator or other similar equipment utilizing technology that is new or being introduced into the state, or (ix) 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 or 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 that 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 not later than five business days from the date the office receives such request 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 maintain continued access to the health care services provided by the facility or institution, or 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 (A) 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, and (B) such request is received by the office not later than twenty-one calendar days after the office deems the certificate of need application complete.

      (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; P.A. 05-75, S. 2; 05-93, S. 1; 05-280, S. 58; P.A. 06-28, S. 1; 06-64, S. 6; 06-196, S. 214.)

      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; P.A. 05-75 amended Subsec. (c)(3) by adding Subpara. (A) designator and new Subpara. (B) establishing a twenty-one calendar day deadline for requesting a public hearing on a completed certificate of need application; P.A. 05-93 amended Subsec. (a)(4) by eliminating, with certain exceptions, the four-hundred-thousand-dollar capital expenditure threshold for certificate of need review of proposals involving the purchase, lease or donation acceptance of various types of scanning equipment and linear accelerators and by making technical changes, effective July 1, 2005; P.A. 05-280 amended Subsec. (a) by adding reference to Sec. 19a-487a, effective July 1, 2005; P.A. 06-28 amended Subsec. (a)(4) by increasing the capital expenditure threshold and major medical equipment acquisition threshold for certificate of need review to three million dollars, effective July 1, 2006; P.A. 06-64 amended Subsec. (b) by allowing waiver of letter of intent requirement when a function, service or termination or change of ownership or control is necessary to maintain continued access to health care services provided by a facility or institution, effective July 1, 2006; P.A. 06-196 made technical changes in Subsec. (a)(4), effective June 7, 2006.

      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. Cited. 208 C. 663. Cited. 214 C. 321. Cited. 226 C. 105. Cited. 235 C. 128. Cited. 238 C. 216.

      Subsec. (a):

      Cited. 200 C. 489.

      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 (1) a capital expenditure exceeding three million dollars, (2) to purchase, lease or accept donation of major medical equipment requiring a capital expenditure, as defined in regulations adopted pursuant to section 19a-643, in excess of three million dollars, or (3) to purchase, lease or accept donation of a CT scanner, PET scanner, PET/CT scanner or MRI scanner, cineangiography equipment, a linear accelerator or other similar equipment utilizing technology that is new or being introduced into this state, including the purchase, lease 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 for at least sixty days. A current letter of intent is a letter of intent that 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 not later than five business days from the date the office receives the extension request 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 maintain continued access to the health care services provided by the facility or institution, or 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 not later than ninety days or not later than ten business days, as the case may be, of receipt of such request, 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 upon such request 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, in accordance with chapter 54, 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; (B) the proposal has associated total capital expenditures per unit or total capital costs per unit that exceed three million dollars for the purchase, lease or donation acceptance of major medical equipment; (C) the proposal is for the purchase, lease or donation acceptance of equipment utilizing technology that is new or being introduced into the state, including scanning equipment, cineangiography equipment, a linear accelerator or other similar equipment; or (D) 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 and such request is received by the office not later than twenty-one calendar days after the office deems the certificate of need application complete. 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) Each person or provider, other than a health care or state health care facility or institution subject to subsection (a) of this section, proposing to purchase, lease, accept donation of or replace (1) major medical equipment with a capital expenditure in excess of three million dollars, or (2) a CT scanner, PET scanner, PET/CT scanner or MRI scanner, cineangiography equipment, a linear accelerator or other similar equipment utilizing technology that is new or being introduced into the state, shall submit a request for approval of any such purchase, lease, donation or replacement 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 (A) 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 (B) 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 three 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) proposes capital expenditures not exceeding three million dollars and does not exceed such amount; (3) once operational, continues to operate and provide services in accordance with the department's licensing standards for comprehensive school-based health centers; and (4) 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; P.A. 05-75, S. 3; 05-93, S. 2-4; 05-151, S. 4; P.A. 06-28, S. 2; 06-64, S. 7; 06-196, S. 243, 244.)

      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 for permission to make certain expenditures, effective July 1, 1993; P.A. 93-381 and P.A. 93-435 authorized substitution of commissioner and department of public health and addiction services for commissioner and department of health 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 references to Department of Public Health and Addiction Services with Department of Public Health and to Commission on Hospitals and Health Care with Office of Health Care Access or Commissioner of Health Care Access, deleted reference to a tie vote of the former commission, deleted reference to 1981 deadline for regulations and required the commissioner to notify the Commissioner of Social Services of impact on the medical assistance program, effective July 1, 1995; P.A. 95-338 inserted new Subsec. (c) exempting certain community health centers and relettered former Subsec. accordingly, effective July 13, 1995; Sec. 19a-155 transferred to Sec. 19a-639 in 1997; P.A. 97-112 replaced "home for the aged" with "residential care home"; P.A. 97-159 added new Subsec. (d) re exemption for school-based health care centers and redesignated former Subsec. (b) as Subsec. (e); P.A. 98-150 replaced specified exemptions with reference to sections containing exemptions, divided Subsec. (a) into two Subsecs. and relettered remaining sections accordingly, amended Subsec. (b) by adding "provider" to institution, added exception re one-time exemption, replaced reference to future budget adjustments with Subdivs. (1), (2) and language re exclusion during review process, amended Subsec. (c) by adding "or replace" to acquire, "linear accelerator" to imaging equipment, "donation" to leasing and adding language re determining capital cost or expenditure, amended Subsec. (d) by adding Subdiv. (2) re primary care or dental services, adding "proposed" to project and adding process for community health center exemption, amended Subsec. (f) 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. (b) by dividing existing provisions into Subdivs. (1) and (2), by deleting provisions re mandatory public hearing, two weeks' notice and place of hearing, by adding Subdiv. (3) providing for public hearings only under certain circumstances and by making conforming changes; P.A. 05-75 amended Subsec. (b) by making technical changes and adding provision in Subdiv. (3) establishing a twenty-one calendar day deadline for requesting a public hearing on a completed certificate of need application; P.A. 05-93 amended Subsec. (a) by adding Subdiv. designators and eliminating, with certain exceptions, the four-hundred-thousand-dollar capital expenditure threshold for certificate of need review of proposals involving the purchase, lease or donation acceptance of various types of scanning equipment and linear accelerators, amended Subsec. (b)(3) by extending the public hearing requirement to certificate of need applications involving the purchase, lease or donation acceptance of various types of scanning equipment and linear accelerators, and amended Subsec. (c) by extending the certificate of need approval process to providers, rather than facilities, proposing to purchase, lease or accept donation of various types of scanning equipment and linear accelerators and by making conforming changes, effective July 1, 2005; P.A. 05-151 amended Subsec. (e) by deleting former Subdiv. (2) re school-based health centers, redesignating existing Subdivs. (3) to (5) as new Subdivs. (2) to (4) and replacing "standard model" with "licensing standards" in redesignated Subdiv. (3); P.A. 06-28 amended Subsecs. (a) to (e), inclusive, by increasing the capital expenditure threshold and major medical equipment acquisition threshold for certificate of need review to three million dollars, effective July 1, 2006; P.A. 06-64 amended Subsec. (b)(2) by allowing waiver of letter of intent requirement when a capital expenditure is necessary to maintain continued access to health care services provided by a facility or institution, effective July 1, 2006; P.A. 06-196 made technical changes in Subsecs. (a) and (c), effective June 7, 2006.

      Annotations to former section 19-73m:

      Cited. 182 C. 314.

      Cited. 34 CS 225.

      Annotations to former section 19a-155:

      Section is compatible and can coexist with Sec. 19a-156. 200 C. 133. Cited. 210 C. 697. Cited. 214 C. 321. Cited. 226 C. 105. Cited. 235 C. 128. Cited. 238 C. 216.

      Cited. 2 CA 68.

      Sec. 19a-639a. Certificate of need. Exemptions. Registration of exempt institutions. (a) Except as provided in subsection (c) of section 19a-639 or as required in subsection (b) of this section, the provisions of section 19a-638 and subsection (a) of section 19a-639 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, or a board of education; (2) a 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; (3) an outpatient rehabilitation service agency that was in operation on January 1, 1998, that is operated exclusively on an outpatient basis and that is eligible to receive reimbursement under section 17b-243; (4) a clinical laboratory; (5) an assisted living services agency; (6) an outpatient service offering chronic dialysis; (7) a program of ambulatory services established and conducted by a health maintenance organization; (8) a home health agency; (9) a clinic operated by the Americares Foundation; (10) a nursing home; or (11) a rest home. The exemptions provided in this section shall not apply when a nursing home or rest home 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 affiliate subject to the provisions of section 19a-638 or subsection (a) of section 19a-639.

      (b) Each health care facility or institution exempted under this section shall register with the office by filing the information required by subdivision (4) of subsection (a) of section 19a-638 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 otherwise covered by section 19a-638 or subsection (a) of section 19a-639 or covered by both sections or subsections, except that, if the facility or institution is in operation on June 5, 1998, 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 acknowledgment 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 section 19a-639 until the next September thirtieth. Each entity exempted under this section shall renew its exemption by filing current information once every two years in September.

      (c) Each health care facility, institution or provider that proposes to purchase, lease or accept donation of a CT scanner, PET scanner, PET/CT scanner, MRI scanner, cineangiography equipment or a linear accelerator shall be exempt from certificate of need review pursuant to sections 19a-638 and 19a-639 if such facility, institution or provider (1) provides to the office satisfactory evidence that it purchased or leased such equipment for under four hundred thousand dollars on or before July 1, 2005, and such equipment was in operation on or before July 1, 2006, or (2) obtained, on or before July 1, 2005, from the office, a certificate of need or a determination that a certificate of need was not required for the purchase, lease or donation acceptance of such equipment.

      (d) The Office of Health Care Access shall, in its discretion, exempt from certificate of need review pursuant to sections 19a-638 and 19a-639 any health care facility or institution that proposes to purchase or operate an electronic medical records system on or after October 1, 2005.

      (P.A. 98-150, S. 4, 17; June 30 Sp. Sess. P.A. 03-3, S. 90; P.A. 05-93, S. 5; 05-151, S. 5; 05-168, S. 4; P.A. 06-28, S. 3.)

      History: P.A. 98-150 effective June 5, 1998 (Revisor's note: In codifying this section the Revisors editorially changed a reference in Subsec. (b) to "... September thirty." to "... September thirtieth."); June 30 Sp. Sess. P.A. 03-3 amended Subsec. (a) to delete references to residential care home and make a technical change, effective August 20, 2003; P.A. 05-93 amended Subsec. (a) by adding exception re Sec. 19a-639(c) and making a technical change, and added Subsec. (c), exempting health care facilities, institutions and providers that purchase, lease or accept donation of certain scanning equipment or linear accelerators on or before July 1, 2005, or that obtain certificate of need approval or a determination that a certificate of need is not required on or before said date, effective July 1, 2005; P.A. 05-151 amended Subsec. (b) by requiring biennial, rather than annual, registration of exempt institutions; P.A. 05-168 added new Subsec. (d) exempting from certificate of need review, at office's discretion, proposals involving the purchase or operation of an electronic medical records system on or after October 1, 2005; P.A. 06-28 amended Subsec. (c)(1) by restricting exemption from certificate of need review to proposals involving certain equipment in operation on or before July 1, 2006, effective May 8, 2006.

      Sec. 19a-639b. Certificate of need. Exemption for nonprofit institutions; application. (a) The Commissioner of the Office of Health Care Access or the commissioner's designee may grant an exemption from the requirements of section 19a-638 or subsection (a) of section 19a-639, or both, for any nonprofit facility, institution or provider that is currently under contract with a state agency or department and is seeking to engage in any activity, other than the termination of a service or a facility, otherwise subject to said section or subsection if:

      (1) The nonprofit facility, institution or provider is proposing a capital expenditure of not more than three million dollars and the expenditure does not in fact exceed three million dollars;

      (2) The activity meets a specific service need identified by a state agency or department with which the nonprofit facility, institution or provider is currently under contract;

      (3) The commissioner, executive director, chairman or chief court administrator of the state agency or department that has identified the specific need confirms, in writing, to the office that (A) the agency or department has identified a specific need with a detailed description of that need and that the agency or department believes that the need continues to exist, (B) the activity in question meets all or part of the identified need and specifies how much of that need the proposal meets, (C) in the case where the activity is the relocation 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 and specifies how that is to be done, (D) in the case where the activity is the transfer of all or part of the ownership or control of a facility or institution, 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; and

      (4) In the case where the activity is the relocation of services, the Commissioner of the Office of Health Care Access or the commissioner's designee determines that the needs of the area previously served will continue to be met in a better or satisfactory manner.

      (b) The Commissioner of the Office of Health Care Access or the commissioner's designee may grant an exemption from the requirements of section 19a-638 or subsection (a) of section 19a-639, or both, for any nonprofit facility, institution or provider that is currently under contract with a state agency or department and is seeking to terminate a service or a facility, provided (1) the commissioner, executive director, chairperson or chief court administrator of the state agency or department with which the nonprofit facility, institution or provider is currently under contract confirms, in writing, to the office that the needs of the area previously served will continue to be met in a better or satisfactory manner and specifies how that is to be done, and (2) the Commissioner of the Office of Health Care Access or the commissioner's designee determines that the needs of the area previously served will continue to be met in a better or satisfactory manner.

      (c) A nonprofit 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 part or all of any services, equipment, expenditures or location directly related to the need or location that the state agency or department has identified.

      (d) The office may revoke or modify the scope of the exemption at any time following a public review that allows the state agency or department and the nonprofit facility, institution or provider to address specific, identified, changed conditions or any problems that the state agency, department or the office has identified. A party to any exemption modification or revocation proceeding and the original requesting agency 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. If the requesting commissioner, executive director, chairman or chief court administrator or the Commissioner of Health Care Access certifies that an emergency condition exists, only forty-eight hours written notice shall be required for such modification or revocation action to proceed.

      (P.A. 98-150, S. 5, 17; P.A. 06-28, S. 4; 06-64, S. 8.)

      History: P.A. 98-150 effective June 5, 1998; P.A. 06-28 amended Subsec. (a)(1) by increasing the capital expenditure threshold from one million to three million dollars, effective July 1, 2006; P.A. 06-64 amended Subsec. (a) to restrict exemption to nonprofits currently under contract with a state agency or department, to make a conforming change and delete current need determination requirement imposed upon Office of Health Care Access in Subdiv. (2), and to add Subdiv. (4) re needs determination requirement with respect to exemptions involving relocation of services, added new Subsec. (b) re criteria for granting exemptions involving termination of a service or facility and redesignated existing Subsecs. (b) and (c) as Subsecs. (c) and (d), effective July 1, 2006.

      Sec. 19a-639c. Certificate of need. Waiver for replacement equipment. Notwithstanding the provisions of section 19a-638 or section 19a-639, the office may waive the requirements of said sections and grant a certificate of need to any health care facility or institution or provider or any state health care facility or institution or provider proposing to replace major medical equipment, a CT scanner, PET scanner, PET/CT scanner or MRI scanner, cineangiography equipment or a linear accelerator if:

      (1) The health care facility or institution or provider has previously obtained a certificate of need for the equipment to be replaced; and

      (2) The replacement value or expenditure is less than three million dollars.

      (P.A. 98-150, S. 7, 17; June Sp. Sess. P.A. 98-1, S. 94, 121; P.A. 05-93, S. 6; P.A. 06-28, S. 5; 06-64, S. 9; 06-196, S. 245.)

      History: P.A. 98-150 effective June 5, 1998; June Sp. Sess. P.A. 98-1 made a technical change by adding the first reference to "provider" to "health care facility, institution"; P.A. 05-93 extended waiver provisions to certain scanning equipment, rather than to "imaging equipment", and made technical and conforming changes, effective July 1, 2005; P.A. 06-28 amended Subdiv. (3) by increasing maximum permissible replacement value of major medical equipment and certain scanners and linear accelerators eligible for waiver from certificate of need review from two million to three million dollars, effective July 1, 2006; P.A. 06-64 deleted former Subdiv. (2) which limited waivers for replacement equipment to equipment or accelerators not exceeding a specific value and redesignated existing Subdiv. (3) as Subdiv. (2), effective July 1, 2006; P.A. 06-196 made technical changes, effective June 7, 2006.

      Sec. 19a-639d. Certificate of need. Waiver for year 2000 computer capability. Section 19a-639d is repealed, effective October 1, 2002.

      (P.A. 98-150, S. 6, 17; P.A. 02-89, S. 90.)

      Sec. 19a-639e. Submission of late or incomplete data. Notwithstanding the provisions of sections 19a-486 to 19a-486h, inclusive, section 19a-638, 19a-639 or any other provision of this chapter, the Office of Health Care Access may refuse to accept as filed or submitted a letter of intent or a certificate of need application from any person or health care facility or institution that failed to submit any required data or information, or has filed any required data or information that is incomplete or not filed in a timely fashion. Prior to any refusal and accompanying moratorium under the provisions of this section, the Commissioner of Health Care Access shall notify the person or health care facility or institution, in writing, and such notice shall identify the data or information that was not received and the data or information that is incomplete in any respect. Such person or health care facility or institution shall have fifteen business days from the date of mailing the notice to provide the commissioner with the required data or information. Such refusal and related moratorium on accepting a letter of intent or a certificate of need application may remain in effect, at the discretion of the Commissioner of Health Care Access, until the office determines that all required data has been submitted. The commissioner shall have fifteen business days to notify the person or health care facility or institution submitting the data and information whether or not the letter of intent or certificate of need application is refused. Nothing in this section shall preclude or limit the office from taking any other action authorized by law concerning late, incomplete or inaccurate data submission in addition to such a refusal and accompanying moratorium.

      (P.A. 02-6, S. 1; P.A. 03-278, S. 75; P.A. 05-151, S. 6.)

      History: P.A. 02-6 effective April 17, 2002; P.A. 03-278 made a technical change, effective July 9, 2003; P.A. 05-151 extended applicability of data submission requirements to non-profit hospitals seeking to convert to for-profit status, extended the deadline for submitting data from ten business days after receiving a notice of defect from office to fifteen business days from the date the notice was mailed by office and clarified that provisions apply to health care facilities or institutions.

      Sec. 19a-640. (Formerly Sec. 19a-156). Submission and review of proposed budget. Hearing. Guidelines. Revisions. Section 19a-640 is repealed, effective July 1, 2005.

      (P.A. 73-117, S. 16, 31; P.A. 74-182, S. 1, 3; P.A. 76-44; P.A. 77-61, S. 2, 3; 77-192, S. 10, 13; P.A. 81-465, S. 7, 18; P.A. 89-371, S. 17; May Sp. Sess. P.A. 92-16, S. 65, 89; May 25 Sp. Sess. P.A. 94-1, S. 50, 130; P.A. 95-257, S. 39, 58; P.A. 05-151, S. 13.)

      Sec. 19a-641. (Formerly Sec. 19a-158). Appeals. Any health care facility or institution and any state health care facility or institution aggrieved by any final decision of said office under the provisions of sections 19a-630 to 19a-639e, inclusive, may appeal from such decision in accordance with the provisions of section 4-183, except venue shall be in the judicial district in which it is located. Such appeal shall have precedence in respect to order of trial over all other cases except writs of habeas corpus, actions brought by or on behalf of the state, including informations on the relation of private individuals, and appeals from awards or decisions of workers' compensation commissioners.

      (P.A. 73-117, S. 17, 31; P.A. 76-436, S. 261, 681; P.A. 77-192, S. 11, 13; 77-603, S. 49, 125; P.A. 78-280, S. 1, 127; P.A. 79-376, S. 21; P.A. 81-465, S. 11, 18; P.A. 84-315, S. 22, 24; P.A. 87-443, S. 1, 17; P.A. 89-371, S. 13; May 25 Sp. Sess. P.A. 94-1, S. 51, 130; P.A. 95-257, S. 39, 58; P.A. 05-151, S. 7; P.A. 06-64, S. 10.)

      History: P.A. 76-436 replaced court of common pleas with superior court, effective July 1, 1978; P.A. 77-192 made provisions applicable to state health care institutions and facilities and replaced provision granting appeals precedence over "nonprivileged cases" with provision granting precedence except as specified; P.A. 77-603 replaced previous appeal provisions with statement that appeals to be in accordance with Sec. 4-183 but retained venue in county or judicial district where facility is located and retained precedence provision; P.A. 78-280 dropped reference to counties; P.A. 79-376 replaced "workmen's compensation" with "workers' compensation"; P.A. 81-465 substituted reference to Sec. 19-73b for reference to Sec. 19-73a, repealed by the same act; Sec. 19-73p transferred to Sec. 19a-158 in 1983; P.A. 84-315 added reference to Secs. 19a-165 to 19a-165q, inclusive; P.A. 87-443 added "final" re the decision of the commission; P.A. 89-371 substituted reference to Secs. 19a-167 to 19a-167g, inclusive, for reference to Secs. 19a-165 to 19a-165g, inclusive; May 25 Sp. Sess. P.A. 94-1 removed obsolete language, effective July 1, 1994; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-158 transferred to Sec. 19a-641 in 1997; P.A. 05-151 removed reference to repealed Sec. 19a-640 and made a technical change; P.A. 06-64 deleted references to repealed Secs. 19a-648 and 19a-650, effective July 1, 2006.

      Annotations to former section 19-73p:

      Cited. 182 C. 314.

      Cited. 32 CS 300. Cited. 34 CS 225. Cited. 35 CS 13.

      Annotations to former section 19a-158:

      Cited. 196 C. 451. Cited. 208 C. 663. Cited. 210 C. 697. Cited. 214 C. 726. Cited. 226 C. 105. Cited. 235 C. 128.

      Cited. 2 CA 68.

      Sec. 19a-642. (Formerly Sec. 19a-159). Judicial enforcement. The Superior Court on application of the office or the Attorney General, may enforce, by appropriate decree or process, any provision of this chapter or any act or any order of the office rendered in pursuance of any statutory provision.

      (P.A. 73-117, S. 18, 31; P.A. 76-436, S. 262, 681; P.A. 95-257, S. 39, 58.)

      History: P.A. 76-436 replaced court of common pleas with superior court, effective July 1, 1978; Sec. 19-73q transferred to Sec. 19a-159 in 1983; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-159 transferred to Sec. 19a-642 in 1997.

      Annotations to former section 19a-159:

      Cited. 208 C. 663, 665. Cited. 214 C. 321.

      Sec. 19a-643. (Formerly Sec. 19a-160). Regulations. (a) The office shall adopt regulations, in accordance with the provisions of chapter 54, to carry out the provisions of sections 19a-630 to 19a-639e, inclusive, and sections 19a-644 and 19a-645 concerning the submission of data by health care facilities and institutions, including data on dealings between health care facilities and institutions and their affiliates, and, with regard to requests or proposals pursuant to sections 19a-638 and 19a-639, by state health care facilities and institutions, the ongoing inspections by the office of operating budgets that have been approved by the health care facilities and institutions, standard reporting forms and standard accounting procedures to be utilized by health care facilities and institutions and the transferability of line items in the approved operating budgets of the health care facilities and institutions, except that any health care facility or institution may transfer any amounts among items in its operating budget. All such transfers shall be reported to the office within thirty days of the transfer or transfers.

      (b) The office may adopt such regulations, in accordance with the provisions of chapter 54, as are necessary to implement this chapter.

      (c) The regulations adopted by the Office of Health Care Access concerning requests or proposals pursuant to section 19a-639 shall include a fee schedule for certificate of need review under section 19a-639. The fee schedule shall (1) contain a minimum filing fee for all applications under said 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 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.

      (P.A. 73-117, S. 19, 31; P.A. 77-192, S. 12, 13; 77-304, S. 3; 77-601, S. 8, 11; P.A. 81-465, S. 10, 18; P.A. 83-3, S. 3, 5; P.A. 84-57, S. 2, 4; P.A. 89-371, S. 18; P.A. 91-48, S. 3, 4; Nov. Sp. Sess. P.A. 91-2, S. 9, 27; May Sp. Sess. P.A. 92-6, S. 8, 117; P.A. 93-262, S. 57, 87; P.A. 95-257, S. 39, 58; P.A. 98-150, S. 9, 17; P.A. 05-151, S. 8; P.A. 06-64, S. 11.)

      History: P.A. 77-192 added reference to regulations re requests and proposals pursuant to Secs. 19-73l to 19-73n; P.A. 77-304 added provisions re regulations concerning disclosure of business interests which may have impact on provision of services; P.A. 77-601 added provision re regulation of home health care, homemaker-home health aide and coordination, assessment and monitoring agencies; P.A. 81-465 made commission's adoption of regulations to carry out its duties mandatory rather than optional; Sec. 19-73r transferred to Sec. 19a-160 in 1983; P.A. 83-3 substituted reference to Sec. 19a-157 for reference to Sec. 19a-156; P.A. 84-57 added the requirement to adopt regulations to carry out the provisions of "sections 19a-161 and 19a-162"; P.A. 89-371 added reference to Sec. 19a-167e, removed an obsolete reference and added language concerning affiliates; P.A. 91-48 removed language directing the commission to adopt regulations requiring full disclosure of business interests which directly or indirectly relate to nursing home operations; Nov. Sp. Sess. P.A. 91-2 added Subsec. (b) giving commission authority to adopt regulations for the chapter and made technical change in Subsec. (a); May Sp. Sess. P.A. 92-6 added new Subsec. (c) providing authority for the commission to adopt regulations concerning fees imposed on requests or proposals pursuant to Secs. 19a-154 and 19a-155 and to specify requirements for the fee schedule; P.A. 93-262 removed provision requiring the commission to adopt regulations concerning approval of coordination, assessment and monitoring agencies and regulations concerning rate review of home health care agencies and information based upon recommendations of the commissioner on aging, effective July 1, 1993; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-160 transferred to Sec. 19a-643 in 1997; P.A. 98-150 amended Subsec. (c) by adding condition that modification request have one hundred thousand dollar limit and deleting references to Sec. 19a-638, effective June 5, 1998; P.A. 05-151 amended Subsec. (a) by removing reference to repealed Sec. 19a-640 and providing that authority to approve operating budgets rests with facilities and institutions, not with Office of Health Care Access; P.A. 06-64 deleted reference to repealed Sec. 19a-648 in Subsec. (a), effective July 1, 2006.

      See chapter 54 re uniform administrative procedure.

      Annotations to former section 19a-160:

      Cited. 200 C. 489. Cited. 208 C. 663.

      Sec. 19a-644. (Formerly Sec. 19a-161). Annual reports of short-term acute care general or children's hospitals. Regulations on affiliation or control of health care facilities and institutions. Required reporting of audited financial statements. (a) On or before February twenty-eighth annually, for the fiscal year ending on September thirtieth of the immediately preceding year, each short-term acute care general or children's hospital shall report to the office with respect to its operations in such fiscal year, in such form as the office may by regulation require. Such report shall include: (1) Salaries and fringe benefits for the ten highest paid positions; (2) the name of each joint venture, partnership, subsidiary and corporation related to the hospital; and (3) the salaries paid to hospital employees by each such joint venture, partnership, subsidiary and related corporation and by the hospital to the employees of related corporations.

      (b) The office shall adopt regulations in accordance with chapter 54 to provide for the collection of data and information in addition to the annual report required in subsection (a) of this section. Such regulations shall provide for the submission of information about the operations of the following entities: Persons or parent corporations that own or control the health care facility, institution or provider; corporations, including limited liability corporations, in which the health care facility, institution, provider, its parent, any type of affiliate or any combination thereof, owns more than an aggregate of fifty per cent of the stock or, in the case of nonstock corporations, is the sole member; and any partnerships in which the person, health care facility, institution, provider, its parent or an affiliate or any combination thereof, or any combination of health care providers or related persons, owns a greater than fifty per cent interest. For purposes of this section, "affiliate" means any person that directly or indirectly through one or more intermediaries, controls or is controlled by or is under common control with any health care facility, institution, provider or person that is regulated in any way under this chapter. A person is deemed controlled by another person if the other person, or one of that other person's affiliates, officers, agents or management employees, acts as a general partner or manager of the person in question.

      (c) Each nonprofit short-term acute care general or children's hospital shall include in the annual report required pursuant to subsection (a) of this section a report of all transfers of assets, transfers of operations or changes of control involving its clinical or nonclinical services or functions from such hospital to a person or entity organized or operated for profit.

      (d) The Office of Health Care Access shall require each hospital licensed by the Department of Public Health, that is not subject to the provisions of subsection (a) of this section, to report to said office on its operations in the preceding fiscal year by filing copies of the hospital's audited financial statements. Such report shall be due at said office on or before the close of business on the last business day of the fifth month following the month in which a hospital's fiscal year ends.

      (P.A. 73-117, S. 28, 31; P.A. 81-465, S. 16, 18; P.A. 83-3, S. 4, 5; P.A. 84-57, S. 3, 4; P.A. 86-61, S. 1, 2; P.A. 89-371, S. 19; P.A. 91-125; May 25 Sp. Sess. P.A. 94-1, S. 119, 130; P.A. 95-257, S. 39, 58; P.A. 98-150, S. 15, 17; P.A. 99-172, S. 4, 7; P.A. 02-101, S. 2, 3; P.A. 03-278, S. 76; P.A. 04-258, S. 22; P.A. 06-64, S. 12.)

      History: P.A. 81-465 changed deadline for initial report from December 31, 1974, to February 28, 1982; Sec. 19-73s transferred to Sec. 19a-161 in 1983; P.A. 83-3 added reference to Sec. 19a-157; P.A. 84-57 specified that reports must be "in such form as the commission may by regulation require"; P.A. 86-61 required facilities issued rate orders to submit reports and made technical changes; P.A. 89-371 made technical changes, added reference to Secs. 19a-167 to 19a-167g, inclusive, and removed obsolete language; P.A. 91-125 added Subdivs. (1) to (5), inclusive, listing five specific items of information to be included in the report; May 25 Sp. Sess. P.A. 94-1 replaced revenue caps with revenue limits and made technical changes, effective July 1, 1994; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-161 transferred to Sec. 19a-644 in 1997; P.A. 98-150 added Subsec. (b) re regulations on affiliation or control, effective June 5, 1998; P.A. 99-172 amended Subsec. (a) to make a technical change and to expand budget reporting and make it in the discretion of the office, and amended Subsec. (b) by changing "parent" to "persons or parent", changing "an affiliate" to "any type of affiliate", changing "fifty per cent" to "an aggregate of fifty per cent", adding references to "person", "provider" and "combination of health care providers or related persons", and adding definition of "affiliate", effective June 23, 1999; P.A. 02-101 amended Subsec. (a) to make the reporting requirements applicable to short-term acute care general or children's hospitals by deleting "each health care facility and institution for which a budget was approved or revenue limits were established under the provisions of section 19a-640 or section 19a-674" and added Subsec. (c) re reporting of hospital's audited financial records, effective July 1, 2002; P.A. 03-278 made technical changes in Subsec. (a), effective July 9, 2003; P.A. 04-258 added new Subsec. (c) requiring nonprofit short-term acute care general or children's hospital to include in annual report required by Subsec. (a) a report of all transfers of assets or operations and changes in control of clinical and nonclinical services to a for-profit entity and redesignated existing Subsec. (c) as Subsec. (d), effective July 1, 2004; P.A. 06-64 amended Subsec. (a) by deleting former Subdiv. (1) to remove information on average salaries by job classification from reporting requirements, redesignating existing Subdivs. (2) to (4) as Subdivs. (1) to (3) and eliminating office's discretionary authority to request breakdown of hospital and department budgets, effective July 1, 2006.

      See Sec. 19a-630a re further definition of "affiliate".

      Sec. 19a-645. (Formerly Sec. 19a-162). Taking of land to enlarge hospitals. A nonprofit hospital, licensed by the Department of Public Health, which provides lodging, care and treatment to members of the public, and which wishes to enlarge its public facilities by adding contiguous land and buildings thereon, if any, the title to which it cannot otherwise acquire, may prefer a complaint for the right to take such land to the superior court for the judicial district in which such land is located, provided such hospital shall have received the approval of the Office of Health Care Access under section 19a-639. Said court shall appoint a committee of three disinterested persons, who, after examining the premises and hearing the parties, shall report to the court as to the necessity and propriety of such enlargement and as to the quantity, boundaries and value of the land and buildings thereon, if any, which they deem proper to be taken for such purpose and the damages resulting from such taking. If such committee reports that such enlargement is necessary and proper and the court accepts such report, the decision of said court thereon shall have the effect of a judgment and execution may be issued thereon accordingly, in favor of the person to whom damages may be assessed, for the amount thereof; and, on payment thereof, the title to the land and buildings thereon, if any, for such purpose shall be vested in the complainant, but such land and buildings thereon, if any, shall not be taken until such damages are paid to such owner or deposited with said court, for such owner's use, within thirty days after such report is accepted. If such application is denied, the owner of the land shall recover costs of the applicant, to be taxed by said court, which may issue execution therefor. Land so taken shall be held by such hospital and used only for the public purpose stated in its complaint to the superior court. No land dedicated or otherwise reserved as open space or park land or for other recreational purposes and no land belonging to any town, city or borough shall be taken under the provisions of this section.

      (P.A. 73-582, S. 1; P.A. 77-614, S. 323, 610; P.A. 81-465, S. 12, 18; P.A. 82-472, S. 63, 183; P.A. 89-371, S. 20; P.A. 93-381, S. 9, 39; May 25 Sp. Sess. P.A. 94-1, S. 52, 130; P.A. 95-257, S. 12, 21, 39, 58; P.A. 05-151, S. 9.)

      History: P.A. 77-614 replaced department of health with department of health services, effective January 1, 1979; P.A. 81-465 deleted reference to Sec. 19-73n, repealed by the same act; P.A. 82-472 deleted obsolete reference to counties; Sec. 19-73t transferred to Sec. 19a-162 in 1983; P.A. 89-371 added reference to Secs. 19a-167 to 19a-167g, inclusive; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; May 25 Sp. Sess. P.A. 94-1 removed obsolete language, effective July 1, 1994; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health and replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-162 transferred to Sec. 19a-645 in 1997; P.A. 05-151 deleted reference to repealed Sec. 19a-640.

      Sec. 19a-646. (Formerly Sec. 19a-166). Negotiation of discounts and different rates and methods of payments with hospitals. Filing with the office. (a) As used in this section:

      (1) "Office" means the Office of Health Care Access;

      (2) "Fiscal year" means the hospital fiscal year as used for purposes of this chapter;

      (3) "Hospital" means any short-term acute care general or children's hospital licensed by the Department of Public Health in the state;

      (4) "Payer" means any person, legal entity, governmental body or eligible organization covered by the provisions of Section 1876 of the Social Security Act, or any combination thereof, except for Medicare and Medicaid which is or may become legally responsible, in whole or in part for the payment of services rendered to or on behalf of a patient by a hospital. Payer also includes any legal entity whose membership includes one or more payers and any third-party payer; and

      (5) "Prompt payment" means payment made for services to a hospital by mail or other means on or before the tenth business day after receipt of the bill by the payer.

      (b) No hospital shall provide a discount or different rate or method of reimbursement from the filed rates or charges to any payer except as provided in this section.

      (c) (1) From April 1, 1994, to June 30, 2002, any payer may directly negotiate for a different rate and method of reimbursement with a hospital provided the charges and payments for the payer are reported in accordance with this subsection. No discount agreement or agreement for a different rate or method of reimbursement shall be effective until filed with the office.

      (2) On and after July 1, 2002, any payer may directly negotiate with a hospital for a different rate or method of reimbursement, or both, provided the charges and payments for the payer are on file at the hospital business office in accordance with this subsection. No discount agreement or agreement for a different rate or method of reimbursement, or both, shall be effective until a complete written agreement between the hospital and the payer is on file at the hospital. Each such agreement shall be available to the office for inspection or submission to the office upon request, for at least three years after the close of the applicable fiscal year.

      (3) On and after April 1, 1994, the charges and payments for each payer receiving a discount shall be accumulated by the hospital for each payer and reported as required by the office. The office may require a review by the hospital's independent auditor, at the hospital's expense, to determine compliance with this subsection.

      (4) From October 2, 1991, to June 30, 2002, a full written copy of each agreement executed pursuant to this subsection shall be filed with the Office of Health Care Access by each hospital executing such an agreement, no later than ten business days after such agreement is executed. On and after July 1, 2002, a full written copy of each agreement executed pursuant to this subsection shall be on file in the hospital business office within twenty-four hours of execution. Each agreement filed shall specify on its face that it was executed and filed pursuant to this subsection. Agreements filed at the Office of Health Care Access, in accordance with this subsection, shall be considered trade secrets pursuant to subdivision (5) of subsection (b) of section 1-210 except that the office may utilize and distribute data derived from such agreements, including the names of the parties to the agreement, the duration and dates of the agreement and the estimated value of any discount or alternate rate of payment.

      (d) A payer may negotiate with a hospital to obtain a discount on rates or charges for prompt payment.

      (e) A payer may also negotiate for and may receive a discount for the provision of the following administrative services: (1) A system which permits the hospital to bill the payer through either a computer-processed or machine-readable or similar billing procedure; (2) a system which enables the hospital to verify coverage of a patient by the payer at the time the service is provided; and (3) a guarantee of payment within the scope of the agreement between the patient and the third-party payer for service to the patient prior to the provision of that service.

      (f) No hospital may require a payer to negotiate for another element or any combination of the above elements of a discount, as established in subsections (d) and (e) of this section, in order to negotiate for or obtain a discount for any single element. No hospital may require a payer to negotiate a discount for all patients covered by such payer in order to negotiate a discount for any patient or group of patients covered by such payer.

      (g) Any hospital which agrees to provide a discount to a payer under subsection (d) or (e) of this section shall file a copy of the agreement in the hospital's business office and shall provide the same discount to any other payer who agrees to make prompt payment or provide administrative services similar to that contained in the agreement. Each agreement filed shall specify on its face that it was executed and filed pursuant to this subsection. The office shall disallow any agreement which gives a discount pursuant to the terms of subsections (d) and (e) of this section which is in excess of the maximum amount set forth in said subsections. No such agreement shall be contingent on volume or drafted in such a manner as to limit the discount to one or more payers by establishing criteria unique to such payers. Any payer aggrieved under this subsection may petition the office for an order directing the hospital to provide a similar discount. The office shall adopt regulations in accordance with the provisions of chapter 54 to carry out the provisions of this subsection.

      (h) (1) Nothing in this section shall be construed to require payment by any payer or purchaser, under any program or contract for payment or reimbursement of expenses for health care services, for: (A) Services not covered under such program or contract; or (B) that portion of any charge for services furnished by a hospital that exceeds the amount covered by such program or contract.

      (2) Nothing in this section shall be construed to supersede or modify any provision of such program or contract that requires payment of a copayment, deductible or enrollment fee or that imposes any similar requirement.

      (i) A hospital which has established a program approved by the office with one or more banks for the purpose of reducing the hospital's bad debt load, may reduce its published charges for that portion of a patient's bill for services which a payer who is a private individual is or may become legally responsible for, after all other insurers or third-party payers have been assessed their full charges provided (1) prior to the rendering of such services, the hospital and the individual payer or parent or guardian or custodian have agreed in writing that after receipt of any insurer or third-party payment paid in accordance with the full hospital charges the remaining payment due from the private individual for such reduced charges shall be made in whole or in part from the balance on deposit in a bank account which has been established by or on behalf of such individual patient, and (2) such payment is made from such account. Nothing in this section shall relieve a patient or legally liable person from being responsible for the full amount of any underpayment of the hospital's authorized charges excluding any discount under this section, by a patient's insurer or any other third-party payer for that insurer's or third-party payer's portion of the bill. Any reduction in charges granted to an individual or parent or guardian or custodian under this subsection shall be reported to the office as a contractual allowance. For purposes of this section "private individual" shall include a patient's parent, legal guardian or legal custodian but shall not include an insurer or third-party payer.

      (P.A. 84-323, S. 2, 6; P.A. 85-613, S. 51, 154; P.A. 91-258, S. 3, 4; June Sp. Sess. P.A. 91-11, S. 22, 25; P.A. 93-229, S. 5, 21; P.A. 93-381, S. 9, 39; P.A. 94-9, S. 34, 41; May Sp. Sess. P.A. 94-3, S. 21, 28; P.A. 95-257, S. 12, 21, 39, 58; June 18 Sp. Sess. P.A. 97-2, S. 94, 165; P.A. 02-101, S. 4.)

      History: P.A. 85-613 made technical change; P.A. 91-258 amended Subsec. (c) to add a requirement that a copy of each agreement reached under Subsec. (c) be filed with the commission on hospitals and health care, amended Subsecs. (c) and (g) to require that agreements specify that they have been executed and filed pursuant to those Subsecs. and made technical changes; June Sp. Sess. P.A. 91-11 amended Subsec. (c) to clarify that required agreements be filed until July 1, 1992, and to exempt the names of the parties to agreements from freedom of information provisions; P.A. 93-229 amended Subsec. (a) to delete definition of "Blue Cross", renumbering Subdivs. as necessary, amended Subsec. (c) to insert Subdiv. indicators, to limit Subdiv. (1) to the time period prior to October 1, 1993, and to add new Subdiv. (2) re negotiation commencing October 1, 1993, to amend Subdiv. (3) re commission not including discount in calculation of authorized gross revenue and addition of discount to actual net revenues for fiscal year and to amend Subdiv. (4) to delete provision exempting names of parties from freedom of information provisions, deleted Subsec. (h) an obsolete provision re Blue Cross discount, added new Subsec. (i) re hospital establishing programs with banks to reduce bad debt load and made technical changes, effective June 4, 1993; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; P.A. 94-9 amended Subsec. (a) to add eligible organizations under 42 USC 1395mm(b) to the definition of payer, Subsec. (c) to add new Subdivs. (3) and (4) re discounts permitted and requirements after April 1, 1994, deleting former Subdiv. (3) re prohibition on cost of discount being borne by patients not covered and relettering former Subdiv. (4) as Subdiv. (5) and added provision re agreements considered trade secrets, and made technical changes, effective April 1, 1994; May Sp. Sess. P.A. 94-3 amended Subsec. (c) of Subdiv. (5) to specifically authorize use of names of parties, duration and dates and estimated value, effective July 1, 1994; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access and replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; Sec. 19a-166 transferred to Sec. 19a-646 in 1997; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (a) to make a technical change, effective July 1, 1997; P.A. 02-101 amended Subsec. (a)(3) to redefine "hospital" to include a "children's" hospital, amended Subsec. (a)(4) to change the cite to federal law from "42 USC Section 1395mm(b)" to "Section 1876 of the Social Security Act", amended Subsec. (b) to add the prohibition against a different rate or method of reimbursement, amended Subsec. (c) to delete obsolete Subdivs. (1) and (2) to renumber existing Subdiv. (3) as Subdiv.(1) and limit it to the period from April 1, 1994, to June 30, 2002, to add a new Subdiv. (2) re payer negotiation, on and after July 1, 2002, for a different rate or method of reimbursement, renumbered Subdivs. (4) and (5) as Subdivs. (3) and (4), in new Subdiv. (4) applied requirement for a written copy to be filed with the Office of Health Care Access to agreements executed during the period from October 2, 1991, to June 30, 2002, and added requirement for agreements executed on and after July 1, 2002, to be filed in hospital business office within forty-eight hours of execution, and amended Subsecs. (f) and (g) to make technical changes, effective July 1, 2002.

      Annotation to former section 19a-166:

      Cited. 214 C. 321.

      Sec. 19a-647. (Formerly Sec. 19a-166b). Preferred provider network. Definitions. Filing requirements. Section 19a-647 is repealed, effective October 1, 2001.

      (P.A. 93-358, S. 1; P.A. 94-235; P.A. 95-79, S. 59, 189; 95-257, S. 39, 58; P.A. 97-99, S. 24; June Sp. Sess. P.A. 01-4, S. 57, 58.)

      Sec. 19a-648. (Formerly Sec. 19a-167e). Performance or billing by affiliates after the base year. Adjustments. Civil penalty. Section 19a-648 is repealed, effective July 1, 2006.

      (P.A. 89-371, S. 6; P.A. 95-257, S. 39, 58; P.A. 06-64, S. 21.)

      Sec. 19a-649. (Formerly Sec. 19a-167f). Uncompensated care. Audits. Annual reports. (a) The office, in consultation with the Commissioner of Social Services, shall review annually the level of uncompensated care including emergency assistance to families provided by each hospital to the indigent. Each hospital shall file annually with the office its policies regarding the provision of free or reduced cost services to the indigent, excluding medical assistance recipients, and its debt collection practices. Each hospital shall obtain an independent audit of the level of charges, payments and discharges by primary payer related to Medicare, medical assistance, CHAMPUS or TriCare and nongovernmental payers as well as the amount of uncompensated care including emergency assistance to families. The results of this audit, including the above information, with an opinion, shall be provided to the office by each hospital by March thirty-first of each year, and the hospital's audited financial statements shall be provided by February twenty-eighth of each year. For purposes of this section, "primary payer" means the final payer responsible for more than fifty per cent of the charges on the case, or, if no payer is responsible for more than fifty per cent of the charges the payer responsible for the highest percentage of charges. The office shall evaluate the audit and may rely on the information contained in the independent audit or may require such additional audit as it deems necessary.

      (b) Each hospital shall annually report, along with data submitted pursuant to subsection (a) of this section, (1) the number of applicants for free and reduced cost services, (2) the number of approved applicants, and (3) the total and average charges and costs of the amount of free and reduced cost care provided.

      (P.A. 89-371, S. 7; Nov. Sp. Sess. P.A. 91-2, S. 12, 27; P.A. 93-44, S. 7, 24; 93-229, S. 7, 21; 93-262, S. 1, 87; P.A. 95-257, S. 39, 58; P.A. 03-266, S. 1; P.A. 06-64, S. 13.)

      History: Nov. Sp. Sess. P.A. 91-2 authorized commission to perform audits as part of its evaluation; P.A. 93-44 included emergency assistance to families in uncompensated care, required hospitals to obtain an independent audit and file results of audit on February twenty-eighth annually, where previously commission conducted audit or contracted for independent audit, effective April 23, 1993; P.A. 93-229 added provision re audit by primary payer designation, deleted reference re February twenty-eighth audited financial statements on a separate and distinct schedule and added new language re providing required information with an opinion with hospitals financial statements filed on February twenty-eighth and included a definition of "primary payer", effective June 4, 1993; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-167f transferred to Sec. 19a-649 in 1997; P.A. 03-266 designated existing provisions as Subsec. (a) and added new Subsec. (b) re annual report; P.A. 06-64 amended Subsec. (a) by adding reference to "TriCare" and requiring audit results and opinions to be filed separately from audited financial statements by March thirty-first of each year, effective July 1, 2006.

      Sec. 19a-650. (Formerly Sec. 19a-167g). Regulations. Section 19a-650 is repealed, effective July 1, 2006.

      (P.A. 89-371, S. 8, 31; May 25 Sp. Sess. P.A. 94-1, S. 53, 130; P.A. 95-257, S. 39, 58; P.A. 06-64, S. 21.)

      Sec. 19a-651. (Formerly Sec. 19a-167h). Data requirement. Rate order compliance. Adjustment. Section 19a-651 is repealed, effective October 1, 2002.

      (P.A. 89-371, S. 24; P.A. 95-257, S. 39, 58; S.A. 02-12, S. 1.)

      Sec. 19a-652. (Formerly Sec. 19a-167i). Termination of prospective payment system. Savings clause. Section 19a-652 is repealed, effective July 1, 2006.

      (P.A. 89-371, S. 27; P.A. 06-64, S. 21.)

      Sec. 19a-653. (Formerly Sec. 19a-167j). Failure to file data or information. Civil penalty. Request for determination of a certificate of need requirement. Notice. Extension. Hearing. Appeal. Deduction from Medicaid payments. (a)(1) Any person or health care facility or institution that owns, operates or is seeking to acquire major medical equipment costing over three million dollars, or scanning equipment, cineangiography equipment, a linear accelerator or other similar equipment utilizing technology that is developed or introduced into the state on or after October 1, 2005, or any person or health care facility or institution that is required to file data or information under any public or special act or under this chapter or sections 19a-486 to 19a-486h, inclusive, or any regulation adopted or order issued under this chapter or said sections, which fails to so file within prescribed time periods, shall be subject to a civil penalty of up to one thousand dollars a day for each day such information is missing, incomplete or inaccurate. Any civil penalty authorized by this section shall be imposed by the Office of Health Care Access in accordance with subsections (b) to (e), inclusive, of this section.

      (2) If a person or health care facility or institution is unsure whether a certificate of need is required under section 19a-638 or section 19a-639, or under both sections, it shall send a letter to the office describing the project and requesting that the office make such a determination. A person making a request for a determination as to whether a certificate of need, waiver or exemption is required shall provide the office with any information the office requests as part of its determination process.

      (b) If the office has reason to believe that a violation has occurred for which a civil penalty is authorized by subsection (a) of this section, it shall notify the person or health care facility or institution by first-class mail or personal service. The notice shall include: (1) A reference to the sections of the statute or regulation involved; (2) a short and plain statement of the matters asserted or charged; (3) a statement of the amount of the civil penalty or penalties to be imposed; (4) the initial date of the imposition of the penalty; and (5) a statement of the party's right to a hearing.

      (c) The person or health care facility or institution to whom the notice is addressed shall have fifteen business days from the date of mailing of the notice to make written application to the office to request (1) a hearing to contest the imposition of the penalty, or (2) an extension of time to file the required data. A failure to make a timely request for a hearing or an extension of time to file the required data or a denial of a request for an extension of time shall result in a final order for the imposition of the penalty. All hearings under this section shall be conducted pursuant to sections 4-176e to 4-184, inclusive. The office may grant an extension of time for filing the required data or mitigate or waive the penalty upon such terms and conditions as, in its discretion, it deems proper or necessary upon consideration of any extenuating factors or circumstances.

      (d) A final order of the office assessing a civil penalty shall be subject to appeal as set forth in section 4-183 after a hearing before the office pursuant to subsection (c) of this section, except that any such appeal shall be taken to the superior court for the judicial district of New Britain. Such final order shall not be subject to appeal under any other provision of the general statutes. No challenge to any such final order shall be allowed as to any issue which could have been raised by an appeal of an earlier order, denial or other final decision by the office.

      (e) If any person or health care facility or institution fails to pay any civil penalty under this section, after the assessment of such penalty has become final the amount of such penalty may be deducted from payments to such person or health care facility or institution from the Medicaid account.

      (P.A. 88-230, S. 1, 12; P.A. 89-371, S. 28, 31; P.A. 90-98, S. 1, 2; P.A. 93-142, S. 4, 7, 8; May 25 Sp. Sess. P.A. 94-1, S. 120, 130; P.A. 95-160, S. 55, 69; 95-220, S. 4-6; 95-257, S. 39, 58; P.A. 96-139, S. 12, 13; P.A. 98-150, S. 8, 17; P.A. 99-172, S. 5, 7; 99-215, S. 24, 29; P.A. 05-151, S. 10; P.A. 06-28, S. 6.)

      History: May 25 Sp. Sess. P.A. 94-1 removed obsolete language and added reference to Secs. 19a-170 to 19a-170g, inclusive, in Subsec. (a), effective July 1, 1994 (Revisor's note: The last sentence of Subsec. (a) which reads "Any civil penalty authorized by this section shall be imposed by the Commission on Hospitals and Health Care in accordance with subsection (b) of this section." was omitted from the amendment to Subsec. (a) but in the absence of any indication that the General Assembly intended to delete this sentence it has been treated as a clerical error and reinstated by the Revisors); P.A. 95-160 amended Subsec. (a) to add health care providers who own, operate, or seek to acquire CAT scan or medical imaging equipment, increase the penalty from two hundred fifty to one thousand dollars, made technical changes, broadened application of section to all of chapter 368c and 368z, deleted Subsecs. (b) to (d) and replaced them with new (b) to (e) re procedure for application of penalty, effective June 1, 1995 (Revisor's note: P.A. 88-230, 90-98, 93-142 and 95-220 authorized substitution of "judicial district of Hartford" for "judicial district of Hartford-New Britain" in 1995 public and special acts, effective September 1, 1998); P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; Sec. 19a-167j transferred to Sec. 19a-653 in 1997; P.A. 98-150 amended Subsec. (a) by deleting "health care facility or institution" concerning owning, operating or seeking to acquire equipment and adding it concerning filing data, added "or information under any public or special act", adding linear accelerators and adding Subdiv. (2) re request as to whether certificate of need is required and made technical changes, effective June 5, 1998; P.A. 99-172 added reference to "person" in Subsecs. (a), (c) and (e) and made technical changes in Subsecs. (b), (c) and (e), effective June 23, 1999; P.A. 99-215 replaced "judicial district of Hartford" with "judicial district of New Britain" in Subsec. (d), effective June 29, 1999; P.A. 05-151 amended Subsec. (a) by extending the civil penalty for failure to file certificate of need data or information with office to non-profit hospitals seeking to become for-profit hospitals and to "any person or health care facility or institution", rather than "any health care provider", and by broadening the type of major medical and scanning equipment that triggers the filing requirement, amended Subsec. (c) by extending the deadline for requesting a public hearing to contest the penalty from ten calendar days to fifteen business days after office mails the notice of violation and penalty to be imposed, and made conforming changes in Subsecs. (b), (c) and (e); P.A. 06-28 amended Subsec. (a)(1) by increasing the major medical equipment acquisition threshold from four hundred thousand to three million dollars, effective July 1, 2006.

      Annotations to former section 19a-167j:

      Cited. 223 C. 450. Cited. 238 C. 216.

      Sec. 19a-654. (Formerly Sec. 19a-167k). Data submission requirements. The Office of Health Care Access shall require short-term acute care general or children's hospitals to submit such data, including discharge data, as it deems necessary to fulfill the responsibilities of the office. Such data shall include data taken from medical record abstracts and hospital bills. The timing and format of such submission shall be specified by the office. The data may be submitted through a contractual arrangement with an intermediary. If the data is submitted through an intermediary, the hospital shall ensure that such submission is timely and that the data is accurate. The office may conduct an audit of the data submitted to such intermediary in order to verify its accuracy. Individual patient and physician data identified by proper name or personal identification code submitted pursuant to this section shall be kept confidential, but aggregate reports from which individual patient and physician data cannot be identified shall be available to the public.

      (P.A. 89-371, S. 29, 31; P.A. 95-257, S. 39, 58; P.A. 02-101, S. 5.)

      History: P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-167k transferred to Sec. 19a-654 in 1997; P.A. 02-101 amended section to make provisions applicable to "short-term acute care general or children's hospitals" and to require the submission of data necessary "to fulfill the responsibilities of the office", rather than for "budget review purpose", effective July 1, 2002.

      Annotation to former section 19a-167k:

      Cited. 223 C. 450.

      Sec. 19a-655. (Formerly Sec. 19a-167l). Hospital budget calculations for the fiscal year commencing October 1, 1993. Section 19a-655 is repealed, effective July 1, 2002.

      (P.A. 93-229, S. 12, 21; P.A. 95-257, S. 39, 58; P.A. 02-89, S. 36; 02-101, S. 20.)

      Secs. 19a-656 to 19a-658. (Formerly Secs. 19a-167m to 19a-167o). Compliance assessment calculation for fiscal year commencing October 1, 1991, to be applied in fiscal year commencing fiscal year October 1, 1993. Request for adjustment to authorized net and gross revenue and authorized equivalent discharges for fiscal year commencing October 1, 1993; limitations; filings. Pricemaster adjustment; request procedure; limitations; data requirement; report. Sections 19a-656 to 19a-658, inclusive, are repealed, effective October 1, 2002.

      (P.A. 93-229, S. 13, 14, 17, 21; P.A. 95-257, S. 39, 58; P.A. 02-89, S. 90; 02-101, S. 17-19.)

      Sec. 19a-659. (Formerly Sec. 19a-170). Definitions. As used in sections 19a-659, 19a-662, 19a-669 to 19a-672, inclusive, and 19a-676:

      (1) "Office" means the Office of Health Care Access;

      (2) "Hospital" means a hospital included within the definition of health care facilities or institutions under section 19a-630 and licensed as a short-term general hospital by the Department of Public Health and including John Dempsey Hospital of The University of Connecticut Health Center;

      (3) "Fiscal year" means the hospital fiscal year;

      (4) "Base year" means the fiscal year prior to the fiscal year for which a budget is being determined;

      (5) "Affiliate" means a person, entity or organization controlling, controlled by, or under common control with another person, entity or organization;

      (6) "Uncompensated care including emergency assistance to families" means the actual cost in the year prior to the base year of care written off as bad debts or provided free under a free care policy approved by the office including emergency assistance to families authorized by the Department of Social Services and not otherwise funded;

      (7) "Medical assistance" means medical assistance provided under the state-administered general assistance program or the Medicaid program;

      (8) "CHAMPUS" means TriCare or the federal Civilian Health and Medical Program of the Uniformed Services, 10 USC 1071 et seq.;

      (9) "Primary payer" means the payer responsible for the highest percentage of the charges on the case;

      (10) "Case mix index" means a hospital's case mix index calculated using the medical record abstract and billing data submitted by the hospital to the office. The case mix index shall be calculated by dividing the total case mix adjusted discharges for the hospital by the actual number of discharges for the hospital for the fiscal year. The total case mix adjusted discharges shall be calculated by multiplying the number of discharges in each diagnosis-related group by the Medicare weights in effect for the same diagnosis-related group in effect for the fiscal year and adding the resultant procedures across all diagnosis-related groups;

      (11) "Contractual allowances" means, for the period October 1, 1992, to March 30, 1994, inclusive, the amount of discounts provided to nongovernmental payers pursuant to subsections (d) and (e) of section 19a-646, for the period beginning April 1, 1994, the amount of discounts provided to nongovernmental payers pursuant to subsections (c), (d) and (e) of section 19a-646 and on and after July 1, 2002, any amount of discounts provided to nongovernmental payers pursuant to a written agreement;

      (12) "Medical assistance underpayment" means the difference between the actual net revenue of a hospital times the ratio of medical assistance charges to total charges and the amount received by the hospital from the Department of Social Services for the year prior to the base year;

      (13) "Other allowances" means the amount of any difference between charges for employee self-insurance and related expenses determined using the hospital's overall relationship of costs to charges;

      (14) "Gross revenue" means the total charges for all patient care services;

      (15) "Net revenue" means total gross revenue less contractual allowance, the difference between government charges and government payments, uncompensated care, and other allowances; plus, for purposes of compliance, net payments from the uncompensated care pool in existence prior to April 1, 1994, and payments from the Department of Social Services;

      (16) "Emergency assistance to families" means assistance to families with children under the age of twenty-one who do not have the resources to independently provide the assistance needed to avoid the destitution of the child and which is authorized by the Department of Social Services pursuant to section 17b-107 and is not otherwise funded.

      (P.A. 94-9, S. 26, 41; P.A. 95-257, S. 12, 21, 39, 58; June 18 Sp. Sess. P.A. 97-2, S. 95, 165; P.A. 02-101, S. 6; P.A. 04-76, S. 29; P.A. 06-64, S. 14.)

      History: P.A. 94-9 effective April 1, 1994; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access and replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995 (Revisor's note: References to Secs. 19a-168k and 19a-168d were changed editorially by the Revisors to Secs. 19a-168j and 19a-168c, respectively, to reflect the repeal of Secs. 19a-168k and 19a-169d by P.A. 95-257); Sec. 19a-170 transferred to Sec. 19a-659 in 1997; June 18 Sp. Sess. P.A. 97-2 amended Subdiv. (7) to make technical changes, effective July 1, 1997; P.A. 02-101 amended section by deleting obsolete references and amended Subdiv. (8) by adding "TriCare" to the definition of "CHAMPUS", and amended Subdiv. (14) by adding "and on and after July 1, 2002, any amount of discounts provided to nongovernmental payers pursuant to a written agreement", effective July 1, 2002; P.A. 04-76 amended Subdiv. (7) by deleting reference to "general assistance program" from definition of "medical assistance"; P.A. 06-64 deleted references to repealed Secs. 19a-661, 19a-677 and 19a-679, deleted definitions of "Medicare shortfall", "medical assistance shortfall", "CHAMPUS shortfall", "Medicare underpayment", and "CHAMPUS underpayment" in former Subdivs. (9) to (11), inclusive, (15) and (17), respectively, and renumbered remaining Subdivs., effective July 1, 2006.

      Sec. 19a-660. (Formerly Sec. 19a-168g). Adjustments to orders. Section 19a-660 is repealed, effective July 1, 2002.

      (Nov. Sp. Sess. P.A. 91-2, S. 21, 27; May Sp. Sess. P.A. 92-16, S. 64, 89; P.A. 93-44, S. 14, 24; P.A. 94-9, S. 8, 41; P.A. 95-257, S. 39, 58; P.A. 02-101, S. 20.)

      Sec. 19a-661. (Formerly Sec. 19a-168i). Penalty. Section 19a-661 is repealed, effective July 1, 2006.

      (Nov. Sp. Sess. P.A. 91-2, S. 8, 27; P.A. 93-44, S. 15, 24; P.A. 94-9, S. 9, 41; P.A. 95-257, S. 39, 58; P.A. 06-64, S. 21.)

      Sec. 19a-662. (Formerly Sec. 19a-168j). Cost reduction plan requirement. Regulations. Effective for fiscal year 1993 and subsequent fiscal years: (1) The office shall require a hospital which engages in inefficient or inappropriate provision of uncompensated care services to submit to the office a cost reduction plan. The Commissioner of Social Services may prospectively reduce the hospital's disproportionate share payments upon notification by the office that the hospital has failed to submit such a plan or to implement a cost reduction plan approved by the office. (2) The office shall adopt regulations on admitting, billing and collection procedures. Each hospital shall submit to the office its admission, billing and collection procedures and protocols for approval by the office. In the event that the office finds that these procedures and protocols are inadequate, the office may instruct that they be modified. If a hospital does not modify its procedures and protocols as soon as practicable upon being instructed to do so by the office, or is found by the office to be failing to follow its approved procedures and protocols, the Commissioner of Social Services may reduce the disproportionate share payments to the hospital until such deficiency is corrected. (3) Effective for fiscal year 1994 and subsequent fiscal years, the office shall not recognize and the Commissioner of Social Services shall not make payments for shortfalls due to unpaid costs associated with admissions which were denied through utilization review or denied due to the hospital's failure to comply with payers' utilization review or claims submission requirements. Nothing in subdivision (3) of this section shall limit the hospital's right to collect from any legally liable person or entity for any services rendered.

      (Nov. Sp. Sess. P.A. 91-2, S. 13, 27; P.A. 94-9, S. 10, 41; P.A. 95-257, S. 39, 58.)

      History: P.A. 94-9 made technical changes related to termination of the pool and changed commission to commissioner of social services re prospective reduction of payments, effective April 1, 1994; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; Sec. 19a-168j transferred to Sec. 19a-662 in 1997.

      Sec. 19a-663. (Formerly Sec. 19a-168p). Bond authorization. Section 19a-663 is repealed, effective July 1, 2006.

      (Nov. Sp. Sess. P.A. 91-2, S. 20, 27; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; P.A. 06-64, S. 21.)

      Secs. 19a-664 and 19a-665. (Formerly Secs. 19a-168s and 19a-168t). Assessment factor for the uncompensated care pool adjustments for the fiscal year commencing October 1, 1993. Authorized governmental shortfall calculation for the fiscal year commencing October 1, 1993. Sections 19a-664 and 19a-665 are repealed, effective July 1, 2002.

      (P.A. 93-229, S. 15, 16, 21; P.A. 95-257, S. 39, 58; P.A. 02-89, S. 90; 02-101, S. 20.)

      Sec. 19a-666. (Formerly Sec. 19a-168u). Uncompensated care pool expenditures. Section 19a-666 is repealed, effective October 1, 2002.

      (P.A. 94-9, S. 37, 41; P.A. 02-89, S. 90.)

      Secs. 19a-667 and 19a-668. (Formerly Secs. 19a-168v and 19a-168w). Uncompensated care pool termination; final settlement. Assistance for termination of uncompensated care pool. Sections 19a-667 and 19a-668 are repealed, effective July 1, 2006.

      (P.A. 94-9, S. 3, 4, 41; P.A. 95-160, S. 56, 69; 95-257, S. 39, 58; P.A. 96-139, S. 12, 13; 96-165, S. 3, 9; P.A. 02-89, S. 37, 38; 02-101, S. 7; 02-103, S. 28; P.A. 06-64, S. 21.)

      Sec. 19a-669. (Formerly Sec. 19a-169). Disproportionate share payments and emergency assistance to families; determination of amount eligible for federal matching payments. Effective October 1, 1993, and October first of each subsequent year, the Secretary of the Office of Policy and Management shall determine and inform the Office of Health Care Access of the maximum amount of disproportionate share payments and emergency assistance to families eligible for federal matching payments under the Medical Assistance Program or the Emergency Assistance to Families Program pursuant to federal statute and regulations and subdivisions (2) and (28) of subsection (a) of section 12-407, subdivision (1) of section 12-408, subdivision (5) of section 12-412, section 12-414, section 19a-649 and this section and the actual and anticipated appropriation to the medical assistance disproportionate share-emergency assistance account authorized pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of subsection (a) of section 12-407, subdivision (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subdivision (1) of section 12-414 and sections 19a-646, 19a-659, 19a-662, 19a-669 to 19a-673, inclusive, and 19a-676, and the amount of emergency assistance to families' payments to eligible hospitals projected for the year, and the anticipated amount of any increase in payments made pursuant to any resolution of any civil action pending on April 1, 1994, in the United States district court for the district of Connecticut. The Department of Social Services shall inform the office of any amount of uncompensated care which the Department of Social Services determines is due to a failure on the part of the hospital to register patients for emergency assistance to families, or a failure to bill properly for emergency assistance to families' patients. If during the course of a fiscal year the Secretary of the Office of Policy and Management determines that these amounts should be revised, said secretary shall so notify the office and the office may modify its calculation pursuant to section 19a-671 to reflect such revision and its orders as it deems appropriate and the Commissioner of Social Services may modify said commissioner's determination pursuant to section 19a-671.

      (P.A. 93-44, S. 16, 24; P.A. 94-9, S. 13, 41; P.A. 95-257, S. 39, 58; P.A. 96-165, S. 4, 9; P.A. 02-89, S. 39; 02-101, S. 8; 02-103, S. 29; P.A. 06-64, S. 15.)

      History: P.A. 93-44 effective April 23, 1993; P.A. 94-9 deleted previously existing provisions re payments for Medicare, medical assistance and CHAMPUS underpayments from uncompensated care pool and substituted new provisions re emergency assistance to families program, effective April 1, 1994 (Revisor's note: In 1995 references to repealed sections were deleted editorially by the Revisors); P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995 (Revisor's note: A reference to Sec. 19a-168k was deleted editorially by the Revisors to reflect the repeal of that section by the same act); P.A. 96-165 made technical changes, effective July 1, 1996; Sec. 19a-169 transferred to Sec. 19a-669 in 1997 (Revisor's note: In 1997 when transferring this section the Revisors editorially omitted reference to repealed Secs. 19a-168b, 19a-168e and 19a-169d); P.A. 02-89 replaced reference to Sec. 19a-666 with Sec. 19a-667, reflecting the repeal of Sec. 19a-666 by the same public act, and made technical changes for purposes of gender neutrality; P.A. 02-101 made technical changes, effective July 1, 2002; P.A. 02-103 made technical changes; P.A. 06-64 deleted references to repealed Secs. 19a-661, 19a-667, 19a-677 and 19a-679, effective July 1, 2006.

      Sec. 19a-670. (Formerly Sec. 19a-169a). Disproportionate share and emergency assistance to families payments to hospitals. (a) Within available appropriations, the Department of Social Services may make semimonthly payments to short-term general hospitals in an amount calculated pursuant to section 19a-671, provided the total amount of payments made to individual hospitals and to hospitals in the aggregate shall maximize the amount qualifying for federal matching payments under the medical assistance program and the emergency assistance to families program as determined by the Department of Social Services in consultation with the Office of Policy and Management. No payments shall be made to any hospital exempt from taxation under chapter 211a. The payments shall be medical assistance disproportionate share payments, including grants provided pursuant to section 19a-168k, to the extent allowable under federal law. In addition, payments may be made for authorized emergency assistance to needy families with dependent children in accordance with Title IV-A of the Social Security Act to the extent allowable under federal law. The payments shall not be part of the routine medical assistance inpatient hospital rate determined pursuant to section 17b-239. Payments shall be made on an interim basis during each year and a final settlement shall be calculated pursuant to section 19a-671 by the office for each hospital after the year end based on audited data for the hospitals. The Commissioner of Social Services may withhold payment to a hospital which is in arrears in remitting its obligations to the state.

      (b) (1) For the hospital fiscal year 1994, and subsequent fiscal years, the commission or its designated representative shall conduct a cash audit of the projected amount of uncompensated care, including emergency assistance to families and underpayments against the actual receipts of the hospital. In addition, the office or its designated intermediary shall conduct an audit of the revenues, deductions from revenue, discharges, days or other measures of patient volume for hospitals for the purposes of termination and final settlement of uncompensated care pool assessments and payments for the period ending March 31, 1994.

      (2) For the six-month period ending September 30, 1994, and for each subsequent fiscal year, the office or its designated intermediary shall conduct an audit of the revenues, deductions from revenue, discharges, days or other measures of patient volume for hospitals for the purposes of determining disproportionate share payments. Included in this audit shall be a comparison of projected and actual levels of medical assistance underpayment and uncompensated care.

      (3) The total payments from the Department of Social Services medical assistance disproportionate share-emergency assistance account established pursuant to section 38 of public act 94-9* and made in accordance with sections 19a-670 to 19a-672, inclusive, during the fiscal year less any payments for emergency assistance to families, and less any payments resulting from the resolution of or court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, shall be reallocated to hospitals based on actual audited levels of medical assistance underpayment, grants pursuant to section 19a-168k and uncompensated care to determine the final payment for the fiscal year.

      (4) If the final payment for a hospital for the hospital fiscal year, as determined as a result of this audit, is less than the total payments the hospital received during the same fiscal year excluding any prior year audit adjustment, then the current hospital fiscal year remaining semimonthly payments shall each be reduced by an amount equal to the total excess payment divided by the number of remaining semimonthly payments for the current hospital fiscal year.

      (5) If the final payment for a hospital for the hospital fiscal year, as determined as a result of this audit, is greater than the total payments the hospital received during the same fiscal year, then the current hospital fiscal year remaining semimonthly payments shall each be increased by an amount equal to the total excess payment divided by the number of remaining semimonthly payments for the current hospital fiscal year.

      (6) The office shall, by June 1, 1995, and June first of each subsequent year, report the results of such audit for the previous hospital fiscal year to the joint standing committee of the General Assembly having cognizance of matters relating to public health. The report shall include information concerning the financial stability of hospitals in a competitive market.

      (7) Notwithstanding the provisions of subdivisions (3) to (5), inclusive, of this subsection, no adjustment of disproportionate share payments to hospitals for purposes of final settlement shall be implemented for the hospital fiscal years commencing October 1, 1997, and October 1, 1998, provided every hospital subject to final settlement for said fiscal years submits documentation in writing of its agreement to forego such final settlement to the Commissioner of Social Services in a form acceptable to the commissioner.

      (8) Notwithstanding the provisions of subdivisions (3) to (5), inclusive, of this subsection, for the hospital fiscal year commencing October 1, 1999, and for each subsequent fiscal year, no adjustment of disproportionate share payments to hospitals for purposes of final settlement shall be determined or implemented.

      (9) For the quarter ending September 30, 2001, no negative adjustment to the disproportionate share payments to hospitals for purposes of implementing the final one-quarter of the disproportionate share final settlement for the hospital fiscal year commencing October 1, 1998, shall be made. Any hospitals with a positive adjustment to the disproportionate share payments for purposes of implementing the remaining one-quarter of the hospital fiscal year 1999 disproportionate share final settlement shall receive payment of the adjustment through funds appropriated for said purpose.

      (10) The Department of Social Services may, within available appropriations and with the approval of the Office of Health Care Access and the Office of Policy and Management, make payment of any final settlement amount determined to represent any and all claims arising out of any incorrect payments to Yale-New Haven Hospital for the fiscal quarter ending September 30, 1998, or the hospital fiscal year ending September 30, 1999, or both. If such incorrect payment, whether an overpayment or an underpayment, has occurred as a result of the hospital's reporting incorrect information and statistics to the Office of Health Care Access, the Office of Health Care Access shall recompute the amount of any payments for the indicated time periods, offsetting any underpaid amount by the amount of any overpayment of funds for the indicated time period. Yale-New Haven Hospital shall submit all information and documentation determined necessary by the Office of Health Care Access to make a final determination of the amounts due. Prior to the release of any funds under this section, the hospital shall submit a written release in a form satisfactory to the Secretary of the Office of Policy and Management. The written release shall provide for settlement of any and all claims which have been or could have been brought challenging the amount of payment for the indicated periods. Nothing in this section shall be construed to relieve the hospital from any settlement or adjustments for any periods other than those identified in this section.

      (c) The Commissioner of Social Services is authorized to determine exceptions, exemptions and adjustments in accordance with 42 CFR 413.40.

      (d) Nothing in section 3-114i, subdivision (2) or (29) of subsection (a) of section 12-407, subdivision (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subdivision (1) of section 12-414, or sections 12-263a to 12-263e, inclusive, section 19a-646, 19a-659, 19a-662 or 19a-669 to 19a-673, inclusive, and section 19a-676, or section 1, 2, or 38 of public act 94-9* shall be construed to require the Department of Social Services to pay out more funds than are appropriated pursuant to said sections.

      (P.A. 94-9, S. 5, 41; P.A. 95-160, S. 57, 69; 95-257, S. 39, 58; 95-306, S. 4, 7; P.A. 96-139, S. 12, 13; 96-165, S. 5, 9; P.A. 97-2, S. 4, 8; P.A. 99-279, S. 27, 45; June Sp. Sess. P.A. 01-3, S. 3, 6; P.A. 02-89, S. 40; 02-101, S. 9; 02-103, S. 30; P.A. 06-64, S. 16.)

      *Note: Sections 1, 2 and 38 of public act 94-9 are special in nature and therefore have not been codified but remain in full force and effect according to their terms.

      History: P.A. 94-9 effective April 1, 1994; P.A. 95-160 amended Subsec. (a) to change shall to may re payments to hospitals and added proviso re aggregate to maximize federal match, effective June 1, 1995; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 95-306 amended Subdiv. (3) of Subsec. (b) by requiring the subtraction of payments from a court order entered in a civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, from the total payments made from the medical assistance disproportionate share-emergency assistance account, effective July 6, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 96-165 amended Subsec. (d) to make a technical change, effective July 1, 1996; Sec. 19a-169a transferred to Sec. 19a-670 in 1997 (Revisor's note: In 1997 when transferring this section the Revisors editorially omitted a reference to repealed section 19a-169d from Subsec. (d)); P.A. 97-2 amended Subsec. (a) to provide that no payment be made to children's general hospitals that are exempt from tax under chapter 211a, effective the later of October 1, 1997, or upon the date of federal approval or federal determination that no approval is required pursuant to Sec. 19a-670a; (Revisor's note: Actual effective date was October 1, 1997); P.A. 99-279 amended Subsec. (a) to exempt John Dempsey Hospital of The University of Connecticut Health Center from the disproportionate share payment system, and amended Subsec. (b) to substitute "determining" for "final settlement of" in Subdiv. (2), and to add Subdivs. (7) and (8) which provide that no retroactive adjustment of disproportionate share payments to hospitals for purposes of final settlement shall be implemented, effective July 1, 1999; June Sp. Sess. P.A. 01-3 amended Subsec. (a) by adding provision re short-term general hospitals, making a technical change and deleting provision re increase of rates to resolve civil action pending on April 1, 1994, and amended Subsec. (b) by adding new Subdivs. (9) and (10) re adjustment to disproportionate share payments and settlement of claims arising out of any incorrect payments to Yale-New Haven Hospital, effective July 1, 2001; P.A. 02-89 amended Subsec. (d) to replace reference to Sec. 19a-666 with Sec. 19a-667, reflecting the repeal of Sec. 19a-666 by the same public act; P.A. 02-101 amended Subsec. (d) to make technical changes, effective July 1, 2002; P.A. 02-103 made technical changes in Subsec. (d); P.A. 06-64 amended Subsec. (d) to delete references to repealed Secs. 19a-661, 19a-667, 19a-668, 19a-677 and 19a-679, effective July 1, 2006.

      Sec. 19a-670a. Application for federal approval by the Department of Social Services. The Department of Social Services shall promptly apply to the federal Centers for Medicare and Medicaid Services for any necessary federal approval or a federal determination that no such approval is needed with respect to the provisions of sections 12-263a and 19a-670.

      (P.A. 97-2, S. 5, 8; P.A. 03-19, S. 49.)

      History: P.A. 97-2 effective January 30, 1997; P.A. 03-19 replaced "Health Care Financing Administration" with "Centers for Medicare and Medicaid Services", effective May 12, 2003.

      Sec. 19a-670b. Construction with respect to children's general hospitals. Section 19a-670b is repealed, effective July 1, 2006.

      (P.A. 97-2, S. 6, 8; June Sp. Sess. P.A. 01-2, S. 67, 69; June Sp. Sess. P.A. 01-9, S. 129-131; P.A. 02-89, S. 41; 02-101, S. 10; P.A. 06-64, S. 21.)

      Sec. 19a-671. (Formerly Sec. 19a-169b). Calculation and determination of payments. The Commissioner of Social Services is authorized to determine the amount of payments pursuant to sections 19a-670 to 19a-672, inclusive, for each hospital. The commissioner's determination shall be based on the advice of the office and the application of the calculation in this section. For each hospital, the Office of Health Care Access shall calculate the amount of payments to be made pursuant to sections 19a-670 to 19a-672, inclusive, as follows:

      (1) For the period April 1, 1994, to June 30, 1994, inclusive, and for the period July 1, 1994, to September 30, 1994, inclusive, the office shall calculate and advise the Commissioner of Social Services of the amount of payments to be made to each hospital as follows:

      (A) Determine the amount of pool payments for the hospital, including grants approved pursuant to section 19a-168k, in the previously authorized budget authorization for the fiscal year commencing October 1, 1993.

      (B) Calculate the sum of the result of subparagraph (A) of this subdivision for all hospitals.

      (C) Divide the result of subparagraph (A) of this subdivision by the result of subparagraph (B) of this subdivision.

      (D) From the anticipated appropriation to the medical assistance disproportionate share-emergency assistance account made pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of subsection (a) of section 12-407, subdivision (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subdivision (1) of section 12-414 and sections 19a-646, 19a-659, 19a-662, 19a-669 to 19a-673, inclusive, and 19a-676, for the quarter subtract the amount of any additional medical assistance payments made to hospitals pursuant to any resolution of or court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, and also subtract the amount of any emergency assistance to families payments projected by the office to be made to hospitals in the quarter.

      (E) The disproportionate share payment shall be the result of subparagraph (D) of this subdivision multiplied by the result of subparagraph (C) of this subdivision.

      (2) For the fiscal year commencing October 1, 1994, and subsequent fiscal years, the interim payment shall be calculated as follows for each hospital:

      (A) For each hospital determine the amount of the medical assistance underpayment determined pursuant to section 19a-659, plus the actual amount of uncompensated care including emergency assistance to families determined pursuant to section 19a-659, less any amount of uncompensated care determined by the Department of Social Services to be due to a failure of the hospital to enroll patients for emergency assistance to families, plus the amount of any grants authorized pursuant to the authority of section 19a-168k.

      (B) Calculate the sum of the result of subparagraph (A) of this subdivision for all hospitals.

      (C) Divide the result of subparagraph (A) of this subdivision by the result of subparagraph (B) of this subdivision.

      (D) From the anticipated appropriation made to the medical assistance disproportionate share-emergency assistance account pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of subsection (a) of section 12-407, subdivision (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subdivision (1) of section 12-414 and sections 19a-646, 19a-659, 19a-662, 19a-669 to 19a-673, inclusive, and 19a-676, for the fiscal year, subtract the amount of any additional medical assistance payments made to hospitals pursuant to any resolution of or court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, and also subtract any emergency assistance to families payments projected by the office to be made to the hospitals for the year.

      (E) The disproportionate share payment shall be the result of subparagraph (D) of this subdivision multiplied by the result of subparagraph (C) of this subdivision.

      (P.A. 94-9, S. 6, 41; P.A. 95-257, S. 39, 58; 95-306, S. 5, 7; P.A. 96-165, S. 6, 9; June Sp. Sess. P.A. 00-2, S. 26, 53; P.A. 02-89, S. 42; 02-101, S. 11; 02-103, S. 31; P.A. 06-64, S. 17.)

      History: P.A. 94-9 effective April 1, 1994; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 95-306 amended Subdiv. (D) of Subdiv. (1) and Subdiv. (D) of Subdiv. (2) by requiring the subtraction of any medical assistance payments made to hospitals pursuant to any court order entered in any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut, from the anticipated appropriation to the medical assistance disproportionate share-emergency assistance account, effective July 6, 1995; P.A. 96-165 amended Subpara. (D) of Subdivs. (1) and (2) to make technical changes, effective July 1, 1996; Sec. 19a-169b transferred to Sec. 19a-671 in 1997 (Revisor's note: In 1997 when transferring this section the Revisors editorially omitted references to repealed sections 19a-168k and 19a-169d from Subdivs. (1)(D) and (2)(D)); June Sp. Sess. P.A. 00-2 amended Subdiv. (2)(A) by changing "authorized" to "actual" amount of uncompensated care, effective July 1, 2000; P.A. 02-89 replaced references to Sec. 19a-666 with Sec. 19a-667, reflecting the repeal of Sec. 19a-666 by the same public act; P.A. 02-101 made technical changes, effective July 1, 2002; P.A. 02-103 made technical changes; P.A. 06-64 amended Subdivs. (1)(D) and (2)(D) to delete references to repealed Secs. 19a-661, 19a-667, 19a-668, 19a-677 and 19a-679, effective July 1, 2006.

      Sec. 19a-671a. Adjustment of overpayments for disproportionate share-medical emergency assistance by reducing Medicaid payments. The Department of Social Services is authorized to adjust the amount of any overpayment for disproportionate share-medical emergency assistance determined pursuant to sections 19a-670 and 19a-671 by reducing the Medicaid payment to such hospital by the amount of such overpayment.

      (P.A. 95-160, S. 51, 69; P.A. 96-139, S. 12, 13.)

      History: P.A. 95-160, S. 51 effective June 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section.

      Sec. 19a-671b. Provisions for waiver of certain penalties and interest assessed pertaining to liability for taxes owed under chapter 211a or 219. Section 19a-671b is repealed, effective July 1, 2006.

      (P.A. 95-160, S. 54, 69; 95-306, S. 3, 7; P.A. 96-139, S. 12, 13; June Sp. Sess. P.A. 01-2, S. 67, 69; June Sp. Sess. P.A. 01-9, S. 129-131; P.A. 06-64, S. 21.)

      Sec. 19a-672. (Formerly Sec. 19a-169c). Use of medical assistance disproportionate share-emergency assistance account funds. The funds appropriated to the medical assistance disproportionate share-emergency assistance account pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of subsection (a) of section 12-407, subdivision (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subdivision (1) of section 12-414 and sections 19a-646, 19a-659, 19a-662, 19a-669 to 19a-673, inclusive, and 19a-676, shall be used by said account to make disproportionate share payments to hospitals, including grants to hospitals pursuant to section 19a-168k, and to make emergency assistance to families payments to hospitals. In addition, the medical assistance disproportionate share-emergency assistance account may utilize a portion of these funds to make outpatient payments as the Department of Social Services determines appropriate or to increase the standard medical assistance payments to hospitals if the Department of Social Services determines it to be appropriate to settle any civil action pending on April 1, 1994, in the United States District Court for the district of Connecticut. Notwithstanding any other provision of the general statutes, the Department of Social Services shall not be required to make any payments pursuant to sections 3-114i and 12-263a to 12-263e, inclusive, subdivisions (2) and (29) of subsection (a) of section 12-407, subdivision (1) of section 12-408, section 12-408a, subdivision (5) of section 12-412, subdivision (1) of section 12-414 and sections 19a-646, 19a-659, 19a-662, 19a-669 to 19a-673, inclusive, and 19a-676, in excess of the funds available in the medical assistance disproportionate share-emergency assistance account.

      (P.A. 94-9, S. 7, 41; P.A. 96-165, S. 7, 9; P.A. 02-89, S. 43; 02-101, S. 12; 02-103, S. 32; P.A. 06-64, S. 18.)

      History: P.A. 94-9 effective April 1, 1994; P.A. 96-165 made technical changes, effective July 1, 1996; Sec. 19a-169c transferred to Sec. 19a-672 in 1997 (Revisor's note: In 1997 when transferring this section the Revisors editorially omitted reference to repealed Secs. 19a-168b, 19a-168e and 19a-169d and replaced a reference to Sec. 19a-168k with a reference to Sec. 19a-168j to reflect the repeal of Sec. 19a-168k by P.A. 95-257); P.A. 02-89 replaced references to Sec. 19a-666 with Sec. 19a-667, reflecting the repeal of Sec. 19a-666 by the same public act; P.A. 02-101 made technical changes, effective July 1, 2002; P.A. 02-103 made technical changes; P.A. 06-64 deleted references to repealed Secs. 19a-661, 19a-667, 19a-668, 19a-677 and 19a-679, effective July 1, 2006.

      Sec. 19a-672a. Payments when short-term general hospital changes ownership during fiscal year. The Commissioner of Social Services may make disproportionate share payments to a short-term general hospital that changes ownership in the middle of a hospital fiscal year for the hospital fiscal year in which such change of ownership occurs notwithstanding the provisions of sections 19a-670 to 19a-672, inclusive.

      (June 30 Sp. Sess. P.A. 03-6, S. 55.)

      History: June 30 Sp. Sess. P.A. 03-6 effective August 20, 2003.

      Sec. 19a-673. (Formerly Sec. 19a-169e). Collections by hospitals from uninsured patients. (a) As used in this section:

      (1) "Cost of providing services" means a hospital's published charges at the time of billing, multiplied by the hospital's most recent relationship of costs to charges as taken from the hospital's most recently available annual financial filing with the Office of Health Care Access.

      (2) "Hospital" means an institution licensed by the Department of Public Health as a short-term general hospital.

      (3) "Poverty income guidelines" means the poverty income guidelines issued from time to time by the United States Department of Health and Human Services.

      (4) "Uninsured patient" means any person who is liable for one or more hospital charges whose income is at or below two hundred fifty per cent of the poverty income guidelines who (A) has applied and been denied eligibility for any medical or health care coverage provided under the state-administered general assistance program or the Medicaid program due to failure to satisfy income or other eligibility requirements, and (B) is not eligible for coverage for hospital services under the Medicare or CHAMPUS programs, or under any Medicaid or health insurance program of any other nation, state, territory or commonwealth, or under any other governmental or privately sponsored health or accident insurance or benefit program including, but not limited to, workers' compensation and awards, settlements or judgments arising from claims, suits or proceedings involving motor vehicle accidents or alleged negligence.

      (b) No hospital that has provided health care services to an uninsured patient may collect from the uninsured patient more than the cost of providing services.

      (c) Each collection agent, as defined in section 19a-509b, engaged in collecting a debt from a patient arising from services provided at a hospital shall provide written notice to such patient as to whether the hospital deems the patient an insured patient or an uninsured patient and the reasons for such determination.

      (P.A. 94-9, S. 36, 41; P.A. 95-257, S. 12, 21, 58; June 18 Sp. Sess. P.A. 97-2, S. 96, 165; P.A. 03-266, S. 5; P.A. 04-76, S. 30; 04-257, S. 39.)

      History: P.A. 94-9 effective April 1, 1994; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; Sec. 19a-169e transferred to Sec. 19a-673 in 1997; June 18 Sp. Sess. P.A. 97-2 made technical changes in Subdiv. (4) of Subsec. (a), effective July 1, 1997; P.A. 03-266 amended Subsec. (a)(1) by deleting "of an uninsured patient" and changing "audited financial statements" to "annual financial filing with the Office of Health Care Access", amended Subsec. (a)(4) by adding "who is liable for one or more hospital charges" and changing income level from two hundred per cent to two hundred fifty per cent, and added Subsec. (c) re written notice from collection agent; P.A. 04-76 amended Subsec. (a)(4)(A) by replacing reference to "general assistance program" with reference to "state-administered general assistance program"; P.A. 04-257 made a technical change in Subsec. (c), effective June 14, 2004.

      Sec. 19a-673a. Regulations re uniform debt collection standards for hospitals. The Commissioner of Health Care Access shall adopt regulations, in accordance with chapter 54, to establish uniform debt collection standards for hospitals.

      (June Sp. Sess. P.A. 01-4, S. 39, 58.)

      History: June Sp. Sess. P.A. 01-4 effective July 1, 2001.

      Sec. 19a-673b. Initiation of debt collection activities. (a) No hospital shall refer to a collection agent, as defined in section 19a-509b, or initiate an action against an individual patient or such patient's estate to collect fees arising from care provided at a hospital on or after October 1, 2003, unless the hospital has made a determination whether such individual is (1) an uninsured patient, as defined in section 19a-673, and (2) not eligible for the hospital bed fund.

      (b) Nothing in this section shall affect a hospital's ability to initiate an action against an individual patient or such patient's estate to collect coinsurance, deductibles or fees arising from care provided at a hospital where such coinsurance, deductibles or fees may be eligible for reimbursement through awards, settlements or judgments arising from claims, suits or proceedings. In addition, nothing in this section shall affect a hospital's ability to initiate an action against an individual patient or such patient's estate where payment or reimbursement has been made, or likely is to be made, directly to the patient.

      (P.A. 03-266, S. 3; P.A. 04-46, S. 1; 04-257, S. 88.)

      History: P.A. 04-46 made technical changes and added Subdiv. (1) and (2) indicators in Subsec. (a), effective July 1, 2004; P.A. 04-257 made technical changes, effective June 14, 2004.

      Sec. 19a-673c. Debt collection report. On or before March 1, 2004, and annually thereafter, each hospital shall file with the Office of Health Care Access a debt collection report that includes (1) whether the hospital uses a collection agent, as defined in section 19a-509b, to assist with debt collection, (2) the name of any collection agent used, (3) the hospital's processes and policies for assigning a debt to a collection agent and for compensating such collection agent for services rendered, and (4) the recovery rate on accounts assigned to collection agents, exclusive of Medicare accounts, in the most recent hospital fiscal year.

      (P.A. 03-266, S. 4.)

      Sec. 19a-673d. Cessation of collection efforts upon debtor's eligibility for bed funds or other services. If, at any point in the debt collection process, whether before or after the entry of judgment, a hospital, a consumer collection agency acting on behalf of the hospital, an attorney representing the hospital or any employee or agent of the hospital becomes aware that a debtor from whom the hospital is seeking payment for services rendered receives information that the debtor is eligible for hospital bed funds, free or reduced price hospital services, or any other program which would result in the elimination of liability for the debt or reduction in the amount of such liability, the hospital, collection agency, attorney, employee or agent shall promptly discontinue collection efforts and refer the collection file to the hospital for determination of such eligibility. The collection effort shall not resume until such determination is made.

      (P.A. 03-266, S. 6.)

      Secs. 19a-674 and 19a-675. (Formerly Secs. 19a-170a and 19a-170b). Net revenue limit. Filings for partial or detailed budget review; hearings. Sections 19a-674 and 19a-675 are repealed, effective July 1, 2002.

      (P.A. 94-9, S. 27, 28, 41; P.A. 95-160, S. 58, 69; 95-257, S. 39, 58; P.A. 96-139, S. 12, 13; P.A. 02-101, S. 20.)

      Sec. 19a-676. (Formerly Sec. 19a-170c). Compliance with authorized revenue limits. On or before March thirty-first of each year, for the preceding fiscal year, each hospital shall submit to the office, in the form and manner prescribed by the office, the data specified in regulations adopted by the commissioner in accordance with chapter 54, the independent audit required under section 19a-649 and any other data required by the office, including hospital budget system data for the hospital's twelve months' actual filing requirements.

      (P.A. 94-9, S. 29, 41; 94-174, S. 11, 12; P.A. 95-160, S. 59, 69; 95-257, S. 39, 58; P.A. 96-139, S. 12, 13; 96-238, S. 1, 2, 25; P.A. 05-151, S. 11; P.A. 06-64, S. 19.)

      History: P.A. 94-9 effective April 1, 1994; P.A. 94-174 amended Subsecs. (a) and (b) to eliminate hospitals' compliance payments for hospital fiscal years 1993 and 1994 and for January 1, 1995, to September 1, 1995, and subsequent fiscal years if a hospital exceeds its authorized net revenue limit, the excess shall be deducted from its net revenue limit in the next fiscal year or may be deducted from the hospital's disproportionate share-emergency assistance payments, effective June 6, 1994; P.A. 95-160 amended Subsecs. (a) and (b) to allow the Department of Social Services, in consultation with the Office of Policy and Management, to determine whether compliance shall be (1) deducted from the subsequent year's net revenue limit, (2) paid into the general fund or (3) deducted from payments to the hospital's Medicaid account, (2) and (3) being new Subdivs., effective June 1, 1995; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 96-238 added Subsec. (b) exemption to making payments on an equal quarterly basis commencing fiscal year October 1, 1995, effective July 1, 1996, and further amended section to eliminate all revenue-limit compliance requirements except for data submission, effective October 1, 1997; Sec. 19a-170c transferred to Sec. 19a-676 in 1997; P.A. 05-151 required hospitals to submit, by February twenty-eighth of each year, audit and other data, including the "twelve months' actual filing requirements" and authorized commissioner to extend the deadline for submission of such audit and other data, effective July 1, 2005; P.A. 06-64 changed submittal date from February twenty-eighth to March thirty-first, changed "audit" to "independent audit" and deleted provision allowing Office of Health Care Access to extend submittal deadline, effective July 1, 2006.

      Sec. 19a-676a. Termination of net revenue compliance payments. Section 19a-676a is repealed, effective July 1, 2002.

      (P.A. 97-2, S. 1, 8; P.A. 02-89, S. 90; 02-101, S. 20.)

      Sec. 19a-677. (Formerly Sec. 19a-170d). Computation of relative cost of hospitals. Section 19a-677 is repealed, effective July 1, 2006.

      (P.A. 94-9, S. 30, 41; P.A. 95-257, S. 39, 58; P.A. 06-64, S. 21.)

      Sec. 19a-678. (Formerly Sec. 19a-170e). Inflation factor. Section 19a-678 is repealed, effective July 1, 2002.

      (P.A. 94-9, S. 31, 41; P.A. 95-257, S. 39, 58; P.A. 02-101, S. 20.)

      Sec. 19a-679. (Formerly Sec. 19a-170f). Computation of equivalent discharges. Inpatient and outpatient gross revenues and units of service. Section 19a-679 is repealed, effective July 1, 2006.

      (P.A. 94-9, S. 33, 41; P.A. 95-257, S. 39, 58; P.A. 06-64, S. 21.)

      Sec. 19a-680. (Formerly Sec. 19a-170g). Net revenue limit interim adjustment. Section 19a-680 is repealed, effective July 1, 2002.

      (P.A. 94-9, S. 32, 41; P.A. 02-101, S. 20.)

      Sec. 19a-681. Filing of current pricemaster. Charges to be in accordance with schedule of charges on file. Penalty. (a) Each hospital shall file with the office its current pricemaster which shall include each charge in its detailed schedule of charges.

      (b) If the billing detail by line item on a patient bill does not agree with the detailed schedule of charges on file with the office for the date of service specified on the bill, the hospital shall be subject to a civil penalty of five hundred dollars per occurrence payable to the state within ten business days of notification. The penalty shall be imposed in accordance with subsections (b) to (e), inclusive, of section 19a-653. The office may issue an order requiring such hospital, within ten business days of notification of an overcharge to a patient, to adjust the bill to be consistent with the schedule of charges on file with the office for the date of service specified on the patient bill.

      (P.A. 95-160, S. 60, 69; 95-257, S. 39, 58; P.A. 96-139, S. 12, 13; P.A. 05-151, S. 12.)

      History: P.A. 95-160, S. 60 effective June 1, 1995; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 05-151 amended Subsec. (a) by eliminating requirement that taxes be included in the price of each item listed on the pricemaster and requiring filing of current pricemaster which shall include a detailed schedule of charges and made technical changes in Subsec. (b), effective July 1, 2005.

      Sec. 19a-682. Additional billing for services rendered from November 1, 1994, through June 1, 1995. Section 19a-682 is repealed, effective July 1, 2005.

      (P.A. 95-160, S. 61, 69; P.A. 96-139, S. 12, 13; 96-238, S. 3, 25; P.A. 05-151, S. 13.)

      Sec. 19a-683. Reconciliation account. There is established a reconciliation account which shall be a separate, nonlapsing account within the General Fund. Any moneys received pursuant to subdivision (3) of subsection (b) of section 19a-670 shall be deposited by the Commissioner of Social Services into the account.

      (P.A. 95-160, S. 62, 69; P.A. 96-139, S. 12, 13; P.A. 02-89, S. 44; P.A. 06-64, S. 20.)

      History: P.A. 95-160, S. 62 effective June 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 02-89 replaced reference to Sec. 19a-667(c)(2) with Sec. 19a-667(b)(2); P.A. 06-64 replaced "subdivision (2) of subsection (b) of section 19a-667" with "subdivision (3) of subsection (b) of section 19a-670", effective July 1, 2006.

      Secs. 19a-684 to 19a-689. Reserved for future use.