Substitute Senate Bill No. 1373

Public Act No. 99-172

An Act Concerning Oversight and Evaluation of Graduate Medical Education, Alcohol Screening and Certificates of Need.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 19a-613 of the general statutes is repealed and the following is substituted in lieu thereof:

(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 [designated by him] 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.

(d) The office shall monitor graduate medical education and its sources of funding and shall annually (1) review the financial implications of such education for hospitals, and (2) evaluate the effect of such education on (A) access to health care, and (B) sufficiency of the health care provider workforce. The office shall create an advisory council to advise the commissioner on graduate medical education. For purposes of this subsection, "graduate medical education" means the formal clinical education and training of a physician or other health care provider that follows graduation from medical school and prepares the physician or health care provider for licensure and practice.

(e) Not later than January 1, 2000, and annually thereafter, the office shall submit a report on its findings and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to public health, in accordance with the provisions of section 11-4a.

Sec. 2. Section 19a-630 of the general statutes is repealed and the following is substituted in lieu thereof:

As used in this chapter:

(1) "Health care facility or institution" means any facility or institution engaged primarily in providing services for the prevention, diagnosis or treatment of human health conditions, including, but not limited to, outpatient clinics, free standing outpatient surgical facilities, imaging centers, home health agencies, as defined in section 19a-490; clinical laboratory or central service facilities serving one or more health care facilities, practitioners or institutions; hospitals; residential care homes; 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 a health care facility or institution; but not including 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) "Affiliate" means any health-care-related person that directly or indirectly through one or more intermediaries, controls or is controlled by or is under common control with, another health-care-related person. For purposes of this subdivision, "person" means a corporation, general or limited partnership or limited liability company controlled, directly or indirectly, by such other person or the corporation, provided, in addition to other means of being controlled, a general or limited partnership or limited liability company shall be deemed to be controlled by the corporation if the corporation or one of its affiliates acts as a general partner or a manager of such general or limited partnership or limited liability company.]

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

Sec. 3. (NEW) As used in sections 19a-638 to 19a-639a, inclusive, of the general statutes "affiliate" means any health-care-related person who directly or indirectly through one or more intermediaries, controls or is controlled by or is under common control with, another health-care-related person. 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 in question. For purposes of this section, "health-care-related person" means an entity that is licensed by a state agency to provide direct patient care services for the prevention, diagnosis or treatment of human health conditions.

Sec. 4. Section 19a-644 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) On or before February twenty-eighth annually, 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, for the fiscal year ending on September thirtieth of the immediately preceding year, shall report to the office with respect to its operations in such fiscal year, in such form as the office may by regulation require. Said report shall include: (1) Average salaries in each department of administrative personnel, supervisory personnel, and direct service personnel by job classification; (2) salaries and fringe benefits for the ten highest paid positions; (3) the name of each joint venture, partnership, subsidiary and corporation related to the hospital; and (4) 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. [; and (5)] In addition, said report may, at the discretion of the office, include a breakdown of hospital and department budgets by administrative, supervisory and direct service categories, by total dollars, [and] by full-time equivalent staff or any combination thereof, which the office may request at any time of the year, provided the office gives the hospital at least thirty days from the date of the request to provide the information.

(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: [Parent] 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, [an] 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.

Sec. 5. Section 19a-653 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) (1) Any health care provider which owns, operates or is seeking to acquire a computer axial tomography (CT) scanner, medical imaging equipment, or a linear accelerator or any health care facility, institution, person or provider that is required to file data or information under any public or special act or under chapter 368z or any regulation adopted or order issued thereunder, which fails to so file within prescribed time periods, shall be subject to a civil penalty of up to one thousand dollars a day for each day such information is missing, incomplete or inaccurate. Any civil penalty authorized by this section shall be imposed by the Office of Health Care Access in accordance with subsections (b) to (e), inclusive, of this section.

(2) If an applicant or provider 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 health care facility, [or] institution or provider, 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 facility, institution, person or provider to whom the notice is addressed shall have ten calendar 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 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 Hartford. 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 facility, institution, person or provider 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 facility, [or] institution, person or provider from the Medicaid account.

Sec. 6. Subsection (a) of section 19a-490h of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Each hospital licensed by the Department of Public Health as a short-term general hospital, outpatient surgical facility or outpatient clinic shall include in the record of each trauma patient a notation indicating the extent and outcome of screening for alcohol and substance abuse. For purposes of this section, "trauma patient" means a patient of sufficient age to be at risk of alcohol and substance abuse with a traumatic injury, as defined in the most recent edition of the International Classification of Disease, who is admitted to the hospital on an inpatient basis, is transferred to or from an acute care setting, dies or requires emergent trauma team activation.

Sec. 7. This act shall take effect from its passage.

Approved June 23, 1999

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