Connecticut 2024 Regular Session

Connecticut Senate Bill SB00009 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3		-	LCO 1 of 20
	3	+	LCO No. 654 1 of 20
4	4
5		-	General Assembly ~~Substitute~~ Bill No. 9
	5	+	General Assembly Governor's Bill No. 9
6	6		February Session, 2024
	7	+	LCO No. 654
	8	+
	9	+
	10	+	Referred to Committee on PUBLIC HEALTH
	11	+
	12	+
	13	+	Introduced by:
	14	+	Request of the Governor Pursuant
	15	+	to Joint Rule 9
7	16
8	17
9	18
10	19
11	20
12	21		AN ACT PROMOTING HOSPITAL FINANCIAL STABILITY.
13	22		Be it enacted by the Senate and House of Representatives in General
14	23		Assembly convened:
15	24
16	25		Section 1. Subsection (a) of section 19a-494 of the general statutes is 1
17	26		repealed and the following is substituted in lieu thereof (Effective July 1, 2
18	27		2024): 3
19	28		(a) The Commissioner of Public Health, after a hearing held in 4
20	29		accordance with the provisions of chapter 54, may take any of the 5
21	30		following actions, singly or in combination, in any case in which the 6
22	31		commissioner finds that there has been a substantial failure to comply 7
23	32		with the requirements established under this chapter or requirements 8
24	33		established under this title relating to institutions, the Public Health 9
25	34		Code or licensing regulations: 10
26	35		(1) Revoke a license or certificate; 11
27	36		(2) Suspend a license or certificate; 12
28		-	(3) Censure a licensee or certificate holder; 13
	37	+	(3) Censure a licensee or certificate holder; 13 Governor's Bill No. 9
	38	+
	39	+
	40	+
	41	+	LCO No. 654 2 of 20
	42	+
29	43		(4) Issue a letter of reprimand to a licensee or certificate holder; 14
30	44		(5) Place a licensee or certificate holder on probationary status and 15
31		-	require [him] the licensee or certificate holder to report regularly to the 16 Substitute Bill No. 9
32		-
33		-
34		-	LCO 2 of 20
35		-
	45	+	require [him] the licensee or certificate holder to report regularly to the 16
36	46		department on the matters which are the basis of the probation; 17
37	47		(6) Restrict the acquisition of other facilities for a period of time set 18
38	48		by the commissioner; 19
39	49		(7) Issue an order compelling compliance with applicable statutes or 20
40	50		regulations of the department; [or] 21
41	51		(8) Impose a directed plan of correction; or 22
42	52		(9)Assess a civil penalty not to exceed twenty-five thousand dollars. 23
43	53		Sec. 2. (NEW) (Effective July 1, 2024) (a) For the purposes of this 24
44	54		section, (1) "emergency department diversion" means the status of a 25
45	55		hospital licensed pursuant to chapter 368v of the general statutes that 26
46	56		reroutes incoming ambulances to other hospitals due to the diverting 27
47	57		hospital's emergency department saturation or lack of medical 28
48	58		capability, and (2) "emergency department saturation" means a 29
49	59		hospital's emergency department resources are fully committed and are 30
50	60		not available for additional incoming ambulance patients. 31
51	61		(b) The Commissioner of Public Health shall establish (1) emergency 32
52	62		department diversion requirements for hospitals, including, but not 33
53	63		limited to, the requirement that each hospital adopt emergency 34
54	64		department diversion policies and the required content of such policies, 35
55	65		(2) the permissible grounds for, and procedures to be followed by, a 36
56	66		hospital to declare an emergency department diversion and the 37
57	67		procedures to be followed by the hospital after declaring such diversion, 38
58	68		(3) requirements for hospitals to receive diverted patients, and (4) 39
59	69		requirements for emergency medical service organizations licensed or 40
60	70		certified under chapter 368d of the general statutes in the event that a 41
61	71		hospital declares an emergency department diversion. Prior to declaring 42
62		-	an emergency department diversion, a hospital shall provide notice to 43
	72	+	an emergency department diversion, a hospital shall provide notice to 43 Governor's Bill No. 9
	73	+
	74	+
	75	+
	76	+	LCO No. 654 3 of 20
	77	+
63	78		the Department of Public Health in the form and manner prescribed by 44
64	79		the Commissioner of Public Health. 45
65		-	(c) The commissioner shall adopt regulations, in accordance with 46 Substitute Bill No. 9
66		-
67		-
68		-	LCO 3 of 20
69		-
	80	+	(c) The commissioner shall adopt regulations, in accordance with 46
70	81		chapter 54 of the general statutes, to implement the provisions of this 47
71	82		section. The commissioner may implement policies and procedures 48
72	83		necessary to implement the provisions of this section while in the 49
73	84		process of adopting such policies and procedures as regulations, 50
74	85		provided notice of intent to adopt regulations is published on the 51
75	86		eRegulations System not later than twenty days after the date of 52
76	87		implementation. Policies and procedures implemented pursuant to this 53
77	88		section shall be valid until final regulations are adopted in accordance 54
78	89		with the provisions of chapter 54 of the general statutes. 55
79	90		(d) The commissioner may assess a civil penalty not to exceed 56
80	91		twenty-five thousand dollars on a hospital that violates the 57
81	92		requirements established pursuant to the provisions of this section, in 58
82	93		accordance with the provisions of section 19a-494 of the general statutes, 59
83	94		as amended by this act. Failure of an emergency medical service 60
84	95		organization to comply with such requirements shall be grounds for 61
85	96		disciplinary action pursuant to subsection (c) of section 19a-180 of the 62
86	97		general statutes. 63
87	98		Sec. 3. Section 19a-630 of the general statutes is repealed and the 64
88	99		following is substituted in lieu thereof (Effective from passage): 65
89	100		As used in this chapter, unless the context otherwise requires: 66
90	101		(1) "Affiliate" means a person, entity or organization controlling, 67
91	102		controlled by or under common control with another person, entity or 68
92	103		organization. Affiliate does not include a medical foundation organized 69
93	104		under chapter 594b. 70
94	105		(2) "Applicant" means any person or health care facility that applies 71
95	106		for a certificate of need pursuant to section 19a-639a. 72
96		-	(3) "Bed capacity" means the total number of inpatient beds in a 73
	107	+	(3) "Bed capacity" means the total number of inpatient beds in a 73 Governor's Bill No. 9
	108	+
	109	+
	110	+
	111	+	LCO No. 654 4 of 20
	112	+
97	113		facility licensed by the Department of Public Health under sections 19a-74
98	114		490 to 19a-503, inclusive. 75
99		-	(4) "Capital expenditure" means an expenditure that under generally 76 Substitute Bill No. 9
100		-
101		-
102		-	LCO 4 of 20
103		-
	115	+	(4) "Capital expenditure" means an expenditure that under generally 76
104	116		accepted accounting principles consistently applied is not properly 77
105	117		chargeable as an expense of operation or maintenance and includes 78
106	118		acquisition by purchase, transfer, lease or comparable arrangement, or 79
107	119		through donation, if the expenditure would have been considered a 80
108	120		capital expenditure had the acquisition been by purchase. 81
109	121		(5) "Certificate of need" means a certificate issued by the unit. 82
110	122		(6) "Days" means calendar days. 83
111	123		(7) "Executive director" means the executive director of the Office of 84
112	124		Health Strategy. 85
113	125		(8) "Free clinic" means a private, nonprofit community-based 86
114	126		organization that provides medical, dental, pharmaceutical or mental 87
115	127		health services at reduced cost or no cost to low-income, uninsured and 88
116	128		underinsured individuals. 89
117	129		(9) "Large group practice" means eight or more full-time equivalent 90
118	130		physicians, legally organized in a partnership, professional corporation, 91
119	131		limited liability company formed to render professional services, 92
120	132		medical foundation, not-for-profit corporation, faculty practice plan or 93
121	133		other similar entity (A) in which each physician who is a member of the 94
122	134		group provides substantially the full range of services that the physician 95
123	135		routinely provides, including, but not limited to, medical care, 96
124	136		consultation, diagnosis or treatment, through the joint use of shared 97
125	137		office space, facilities, equipment or personnel; (B) for which 98
126	138		substantially all of the services of the physicians who are members of 99
127	139		the group are provided through the group and are billed in the name of 100
128	140		the group practice and amounts so received are treated as receipts of the 101
129	141		group; or (C) in which the overhead expenses of, and the income from, 102
130	142		the group are distributed in accordance with methods previously 103
131		-	determined by members of the group. An entity that otherwise meets 104
	143	+	determined by members of the group. An entity that otherwise meets 104 Governor's Bill No. 9
	144	+
	145	+
	146	+
	147	+	LCO No. 654 5 of 20
	148	+
132	149		the definition of group practice under this section shall be considered a 105
133	150		group practice although its shareholders, partners or owners of the 106
134	151		group practice include single-physician professional corporations, 107
135		-	limited liability companies formed to render professional services or 108 Substitute Bill No. 9
136		-
137		-
138		-	LCO 5 of 20
139		-
	152	+	limited liability companies formed to render professional services or 108
140	153		other entities in which beneficial owners are individual physicians. 109
141	154		(10) "Health care facility" means (A) hospitals licensed by the 110
142	155		Department of Public Health under chapter 368v; (B) specialty hospitals; 111
143	156		(C) freestanding emergency departments; (D) outpatient surgical 112
144	157		facilities, as defined in section 19a-493b and licensed under chapter 113
145	158		368v; (E) a hospital or other facility or institution operated by the state 114
146	159		that provides services that are eligible for reimbursement under Title 115
147	160		XVIII or XIX of the federal Social Security Act, 42 USC 301, as amended; 116
148	161		(F) a central service facility; (G) mental health facilities; (H) substance 117
149	162		abuse treatment facilities; and (I) any other facility requiring certificate 118
150	163		of need review pursuant to subsection (a) of section 19a-638, as 119
151	164		amended by this act. "Health care facility" includes any parent company, 120
152	165		subsidiary, affiliate or joint venture, or any combination thereof, of any 121
153	166		such facility. 122
154	167		(11) "Nonhospital based" means located at a site other than the main 123
155	168		campus of the hospital. 124
156	169		(12) "Office" means the Office of Health Strategy. 125
157	170		(13) "Person" means any individual, partnership, corporation, limited 126
158	171		liability company, association, public company, entity, as defined in 127
159	172		section 33-602, governmental subdivision, agency or public or private 128
160	173		organization of any character, but does not include the agency 129
161	174		conducting the proceeding. 130
162	175		(14) "Physician" has the same meaning as provided in section 20-13a. 131
163	176		(15) "Termination of services" means the cessation of any services for 132
164	177		a period greater than one hundred eighty days. 133
165		-	(16) "Transfer of ownership" means (A) a transfer that impacts or 134
	178	+	(16) "Transfer of ownership" means (A) a transfer that impacts or 134 Governor's Bill No. 9
	179	+
	180	+
	181	+
	182	+	LCO No. 654 6 of 20
	183	+
166	184		changes the governance or controlling body of a health care facility, 135
167	185		institution or large group practice, including, but not limited to, all 136
168	186		affiliations [,] or mergers, [or] (B) any sale or transfer of net assets of a 137
169		-	health care facility, or (C) a transfer of a controlling interest in any entity, 138 Substitute Bill No. 9
170		-
171		-
172		-	LCO 6 of 20
173		-
	187	+	health care facility, or (C) a transfer of a controlling interest in any entity, 138
174	188		as defined in section 33-602, that possesses or controls, directly or 139
175	189		indirectly, an interest of twenty per cent or more of a health care facility, 140
176	190		institution, as defined in section 19a-490, or large group practice. 141
177	191		(17) "Unit" means the Health Systems Planning Unit. 142
178	192		Sec. 4. Section 19a-638 of the 2024 supplement to the general statutes 143
179	193		is repealed and the following is substituted in lieu thereof (Effective 144
180	194		October 1, 2024): 145
181	195		(a) A certificate of need issued by the unit shall be required for: 146
182	196		(1) The establishment of a new health care facility; 147
183	197		(2) A transfer of ownership of a health care facility; 148
184	198		(3) A transfer of ownership of a large group practice to any entity 149
185	199		other than a (A) physician, or (B) group of two or more physicians, 150
186	200		legally organized in a partnership, professional corporation or limited 151
187	201		liability company formed to render professional services and not 152
188	202		employed by or an affiliate of any hospital, medical foundation, 153
189	203		insurance company or other similar entity; 154
190	204		(4) The establishment of a freestanding emergency department; 155
191	205		(5) The termination of inpatient or outpatient services offered by a 156
192	206		hospital, including, but not limited to, the termination by a short-term 157
193	207		acute care general hospital or children's hospital of inpatient and 158
194	208		outpatient mental health and substance abuse services; 159
195	209		(6) The establishment of an outpatient surgical facility, as defined in 160
196	210		section 19a-493b, or as established by a short-term acute care general 161
197		-	hospital; 162
	211	+	hospital; 162 Governor's Bill No. 9
	212	+
	213	+
	214	+
	215	+	LCO No. 654 7 of 20
	216	+
198	217		(7) The termination of surgical services by an outpatient surgical 163
199	218		facility, as defined in section 19a-493b, or a facility that provides 164
200	219		outpatient surgical services as part of the outpatient surgery department 165
201		-	of a short-term acute care general hospital, provided termination of 166 Substitute Bill No. 9
202		-
203		-
204		-	LCO 7 of 20
205		-
	220	+	of a short-term acute care general hospital, provided termination of 166
206	221		outpatient surgical services due to (A) insufficient patient volume, or (B) 167
207	222		the termination of any subspecialty surgical service, shall not require 168
208	223		certificate of need approval; 169
209	224		(8) The termination of an emergency department by a short-term 170
210	225		acute care general hospital; 171
211	226		(9) The establishment of cardiac services, including inpatient and 172
212	227		outpatient cardiac catheterization, interventional cardiology and 173
213	228		cardiovascular surgery; 174
214	229		(10) The acquisition of [computed tomography scanners,] magnetic 175
215	230		resonance imaging scanners, positron emission tomography scanners or 176
216	231		positron emission tomography-computed tomography scanners, by any 177
217	232		person, physician, provider, short-term acute care general hospital or 178
218	233		children's hospital, except (A) as provided for in subdivision (22) of 179
219	234		subsection (b) of this section, and (B) a certificate of need issued by the 180
220	235		unit shall not be required where such scanner is a replacement for a 181
221	236		scanner that was previously acquired through certificate of need 182
222	237		approval or a certificate of need determination, including a replacement 183
223	238		scanner that has dual modalities or functionalities if the applicant 184
224	239		already offers similar imaging services for each of the scanner's 185
225	240		modalities or functionalities that will be utilized; 186
226	241		(11) The acquisition of nonhospital based linear accelerators, except a 187
227	242		certificate of need issued by the unit shall not be required where such 188
228	243		accelerator is a replacement for an accelerator that was previously 189
229	244		acquired through certificate of need approval or a certificate of need 190
230	245		determination; 191
231	246		(12) An increase in the licensed bed capacity of a health care facility, 192
232		-	except as provided in subdivision (23) of subsection (b) of this section; 193
	247	+	except as provided in subdivision (23) of subsection (b) of this section; 193 Governor's Bill No. 9
	248	+
	249	+
	250	+
	251	+	LCO No. 654 8 of 20
	252	+
233	253		(13) The acquisition of equipment utilizing technology that has not 194
234	254		previously been utilized in the state; 195
235		-	(14) An increase of two or more operating rooms within any three-196 Substitute Bill No. 9
236		-
237		-
238		-	LCO 8 of 20
239		-
	255	+	(14) An increase of two or more operating rooms within any three-196
240	256		year period, commencing on and after October 1, 2010, by an outpatient 197
241	257		surgical facility, as defined in section 19a-493b, or by a short-term acute 198
242	258		care general hospital; [and] 199
243	259		(15) The termination of inpatient or outpatient services offered by a 200
244	260		hospital or other facility or institution operated by the state that 201
245	261		provides services that are eligible for reimbursement under Title XVIII 202
246	262		or XIX of the federal Social Security Act, 42 USC 301, as amended; 203
247	263		(16) A transfer of ten per cent or more of the assets owned by a 204
248	264		hospital, including, but not limited to, a transfer of real estate; and 205
249	265		(17) The issuance of dividends over the course of any three-year 206
250	266		period in excess of twenty per cent of the net worth of a hospital. 207
251	267		(b) A certificate of need shall not be required for: 208
252	268		(1) Health care facilities owned and operated by the federal 209
253	269		government; 210
254	270		(2) The establishment of offices by a licensed private practitioner, 211
255	271		whether for individual or group practice, except when a certificate of 212
256	272		need is required in accordance with the requirements of section 19a-213
257	273		493b or subdivision (3), (10) or (11) of subsection (a) of this section; 214
258	274		(3) A health care facility operated by a religious group that 215
259	275		exclusively relies upon spiritual means through prayer for healing; 216
260	276		(4) Residential care homes, as defined in subsection (c) of section 19a-217
261	277		490, and nursing homes and rest homes, as defined in subsection (o) of 218
262	278		section 19a-490; 219
263	279		(5) An assisted living services agency, as defined in section 19a-490; 220
264		-	(6) Home health agencies, as defined in section 19a-490; 221
265		-	(7) Hospice services, as described in section 19a-122b; 222
266		-	(8) Outpatient rehabilitation facilities; 223 Substitute Bill No. 9
	280	+	(6) Home health agencies, as defined in section 19a-490; 221 Governor's Bill No. 9
267	281
268	282
269		-	LCO 9 of 20
270	283
	284	+	LCO No. 654 9 of 20
	285	+
	286	+	(7) Hospice services, as described in section 19a-122b; 222
	287	+	(8) Outpatient rehabilitation facilities; 223
271	288		(9) Outpatient chronic dialysis services; 224
272	289		(10) Transplant services; 225
273	290		(11) Free clinics, as defined in section 19a-630, as amended by this act; 226
274	291		(12) School-based health centers and expanded school health sites, as 227
275	292		such terms are defined in section 19a-6r, community health centers, as 228
276	293		defined in section 19a-490a, not-for-profit outpatient clinics licensed in 229
277	294		accordance with the provisions of chapter 368v and federally qualified 230
278	295		health centers; 231
279	296		(13) A program licensed or funded by the Department of Children 232
280	297		and Families, provided such program is not a psychiatric residential 233
281	298		treatment facility; 234
282	299		(14) Any nonprofit facility, institution or provider that has a contract 235
283	300		with, or is certified or licensed to provide a service for, a state agency or 236
284	301		department for a service that would otherwise require a certificate of 237
285	302		need. The provisions of this subdivision shall not apply to a short-term 238
286	303		acute care general hospital or children's hospital, or a hospital or other 239
287	304		facility or institution operated by the state that provides services that are 240
288	305		eligible for reimbursement under Title XVIII or XIX of the federal Social 241
289	306		Security Act, 42 USC 301, as amended; 242
290	307		(15) A health care facility operated by a nonprofit educational 243
291	308		institution exclusively for students, faculty and staff of such institution 244
292	309		and their dependents; 245
293	310		(16) An outpatient clinic or program operated exclusively by or 246
294	311		contracted to be operated exclusively by a municipality, municipal 247
295	312		agency, municipal board of education or a health district, as described 248
296		-	in section 19a-241; 249
	313	+	in section 19a-241; 249 Governor's Bill No. 9
	314	+
	315	+
	316	+
	317	+	LCO No. 654 10 of 20
	318	+
297	319		(17) A residential facility for persons with intellectual disability 250
298	320		licensed pursuant to section 17a-227 and certified to participate in the 251
299	321		Title XIX Medicaid program as an intermediate care facility for 252
300		-	individuals with intellectual disabilities; 253 Substitute Bill No. 9
301		-
302		-
303		-	LCO 10 of 20
304		-
	322	+	individuals with intellectual disabilities; 253
305	323		(18) Replacement of existing computed tomography scanners, 254
306	324		magnetic resonance imaging scanners, positron emission tomography 255
307	325		scanners, positron emission tomography-computed tomography 256
308	326		scanners, or nonhospital based linear accelerators, if such equipment 257
309	327		was acquired through certificate of need approval or a certificate of need 258
310	328		determination, provided a health care facility, provider, physician or 259
311	329		person notifies the unit of the date on which the equipment is replaced 260
312	330		and the disposition of the replaced equipment, including if a 261
313	331		replacement scanner has dual modalities or functionalities and the 262
314	332		applicant already offers similar imaging services for each of the 263
315	333		equipment's modalities or functionalities that will be utilized; 264
316	334		(19) Acquisition of cone-beam dental imaging equipment that is to be 265
317	335		used exclusively by a dentist licensed pursuant to chapter 379; 266
318	336		(20) The partial or total elimination of services provided by an 267
319	337		outpatient surgical facility, as defined in section 19a-493b, except as 268
320	338		provided in subdivision (6) of subsection (a) of this section and section 269
321	339		19a-639e; 270
322	340		(21) The termination of services for which the Department of Public 271
323	341		Health has requested the facility to relinquish its license; 272
324	342		(22) Acquisition of any equipment by any person that is to be used 273
325	343		exclusively for scientific research that is not conducted on humans; 274
326	344		(23) On or before June 30, 2026, an increase in the licensed bed 275
327	345		capacity of a mental health facility, provided (A) the mental health 276
328	346		facility demonstrates to the unit, in a form and manner prescribed by 277
329	347		the unit, that it accepts reimbursement for any covered benefit provided 278
330	348		to a covered individual under: (i) An individual or group health 279
331		-	insurance policy providing coverage of the type specified in 280
	349	+	insurance policy providing coverage of the type specified in 280 Governor's Bill No. 9
	350	+
	351	+
	352	+
	353	+	LCO No. 654 11 of 20
	354	+
332	355		subdivisions (1), (2), (4), (11) and (12) of section 38a-469; (ii) a self-281
333	356		insured employee welfare benefit plan established pursuant to the 282
334	357		federal Employee Retirement Income Security Act of 1974, as amended 283
335	358		from time to time; or (iii) HUSKY Health, as defined in section 17b-290, 284
336		-	and (B) if the mental health facility does not accept or stops accepting 285 Substitute Bill No. 9
337		-
338		-
339		-	LCO 11 of 20
340		-
	359	+	and (B) if the mental health facility does not accept or stops accepting 285
341	360		reimbursement for any covered benefit provided to a covered 286
342	361		individual under a policy, plan or program described in clause (i), (ii) or 287
343	362		(iii) of subparagraph (A) of this subdivision, a certificate of need for such 288
344	363		increase in the licensed bed capacity shall be required. 289
345	364		(24) The establishment at harm reduction centers through the pilot 290
346	365		program established pursuant to section 17a-673c; or 291
347	366		(25) On or before June 30, 2028, a birth center, as defined in section 292
348	367		19a-490, that is enrolled as a provider in the Connecticut medical 293
349	368		assistance program, as defined in section 17b-245g. 294
350	369		(c) (1) Any person, health care facility or institution that is unsure 295
351	370		whether a certificate of need is required under this section, or (2) any 296
352	371		health care facility that proposes to relocate pursuant to section 19a-297
353	372		639c, shall send a letter to the unit that describes the project and requests 298
354	373		that the unit make a determination as to whether a certificate of need is 299
355	374		required. In the case of a relocation of a health care facility, the letter 300
356	375		shall include information described in section 19a-639c. A person, health 301
357	376		care facility or institution making such request shall provide the unit 302
358	377		with any information the unit requests as part of its determination 303
359	378		process. The unit shall provide a determination within thirty days of 304
360	379		receipt of such request. 305
361	380		(d) The executive director of the Office of Health Strategy may 306
362	381		implement policies and procedures necessary to administer the 307
363	382		provisions of this section while in the process of adopting such policies 308
364	383		and procedures as regulation, provided the executive director holds a 309
365	384		public hearing prior to implementing the policies and procedures and 310
366	385		posts notice of intent to adopt regulations on the office's Internet web 311
367		-	site and the eRegulations System not later than twenty days after the 312
	386	+	site and the eRegulations System not later than twenty days after the 312 Governor's Bill No. 9
	387	+
	388	+
	389	+
	390	+	LCO No. 654 12 of 20
	391	+
368	392		date of implementation. Policies and procedures implemented pursuant 313
369	393		to this section shall be valid until the time final regulations are adopted. 314
370	394		(e) On or before June 30, 2026, a mental health facility seeking to 315
371	395		increase licensed bed capacity without applying for a certificate of need, 316
372		-	as permitted pursuant to subdivision (23) of subsection (b) of this 317 Substitute Bill No. 9
373		-
374		-
375		-	LCO 12 of 20
376		-
	396	+	as permitted pursuant to subdivision (23) of subsection (b) of this 317
377	397		section, shall notify the Office of Health Strategy, in a form and manner 318
378	398		prescribed by the executive director of said office, regarding (1) such 319
379	399		facility's intent to increase licensed bed capacity, (2) the address of such 320
380	400		facility, and (3) a description of all services that are being or will be 321
381	401		provided at such facility. 322
382	402		(f) Notwithstanding the provisions of this section and sections 19a-323
383	403		639, as amended by this act, and 19a-639a, on or before December 31, 324
384	404		2025, the unit shall automatically issue a certificate of need to any large 325
385	405		group practice or health care facility, except a hospital licensed pursuant 326
386	406		to chapter 368v, for a transfer of ownership, as defined in subparagraph 327
387	407		(C) of subdivision (16) of section 19a-630, as amended by this act, upon 328
388	408		such practice or facility's submission of a certificate of need request for 329
389	409		determination to the unit. 330
390	410		[(f)] (g) Not later than January 1, 2025, the executive director of the 331
391	411		Office of Health Strategy shall report to the Governor and, in accordance 332
392	412		with the provisions of section 11-4a, to the joint standing committee of 333
393	413		the General Assembly having cognizance of matters relating to public 334
394	414		health concerning the executive director's recommendations, if any, 335
395	415		regarding the establishment of an expedited certificate of need process 336
396	416		for mental health facilities. 337
397	417		Sec. 5. Section 19a-639 of the general statutes is repealed and the 338
398	418		following is substituted in lieu thereof (Effective October 1, 2024): 339
399	419		(a) In any deliberations involving a certificate of need application 340
400	420		filed pursuant to section 19a-638, as amended by this act, the unit shall 341
401	421		take into consideration and make written findings concerning each of 342
402		-	the following guidelines and principles: 343
	422	+	the following guidelines and principles: 343 Governor's Bill No. 9
	423	+
	424	+
	425	+
	426	+	LCO No. 654 13 of 20
	427	+
403	428		(1) Whether the proposed project is consistent with any applicable 344
404	429		policies and standards adopted in regulations by the Office of Health 345
405	430		Strategy; 346
406	431		(2) [The relationship of the] Whether the proposed project [to] is 347
407		-	consistent with any applicable policies and standards as set forth in the 348 Substitute Bill No. 9
408		-
409		-
410		-	LCO 13 of 20
411		-
	432	+	consistent with any applicable policies and standards as set forth in the 348
412	433		state-wide health care facilities and services plan; 349
413	434		(3) Whether [there is a clear] the applicant has satisfactorily 350
414	435		demonstrated that the proposed project is consistent with a public need, 351
415	436		[for the health care facility or services proposed by the applicant] 352
416	437		including, but not limited to, a public health or community health need 353
417	438		identified in a community health needs assessment, community service 354
418	439		plan, community health improvement plan, community profile, the 355
419	440		applicant's long-term plan or other similar report characterizing the 356
420	441		health needs of the community; 357
421	442		(4) Whether the applicant has satisfactorily demonstrated [how] that 358
422	443		the proposal will not negatively impact the financial strength of the 359
423	444		health care system in the region and state; [or that the proposal is 360
424	445		financially feasible for the applicant;] 361
425	446		(5) Whether the applicant has satisfactorily demonstrated how the 362
426	447		proposal will improve the quality [, accessibility and cost effectiveness] 363
427	448		of health care delivery in the region; [, including, but not limited to, 364
428	449		provision of or any change in the access to services for Medicaid 365
429	450		recipients and indigent persons;] 366
430	451		(6) Whether the applicant has satisfactorily demonstrated how the 367
431	452		proposal will improve access to health care in the region, including the 368
432	453		provision of or any change in the access to services for Medicaid and 369
433	454		Medicare recipients and indigent persons; 370
434	455		(7) Whether the applicant has satisfactorily demonstrated how the 371
435	456		proposal will increase cost effectiveness of health care delivery in the 372
436		-	region; 373
	457	+	region; 373 Governor's Bill No. 9
	458	+
	459	+
	460	+
	461	+	LCO No. 654 14 of 20
	462	+
437	463		[(6) The] (8) Whether the applicant has satisfactorily demonstrated 374
438	464		that the proposal will not negatively affect the applicant's [past and 375
439	465		proposed] provision of health care services to relevant patient 376
440	466		populations [and] or alter the applicant's payer mix, including, but not 377
441	467		limited to, [access to] a decrease in the provision of services [by] to 378
442		-	Medicaid and Medicare recipients and indigent persons; 379 Substitute Bill No. 9
443		-
444		-
445		-	LCO 14 of 20
446		-
	468	+	Medicaid and Medicare recipients and indigent persons; 379
447	469		[(7) Whether the applicant has satisfactorily identified the population 380
448	470		to be served by the proposed project and satisfactorily demonstrated 381
449	471		that the identified population has a need for the proposed services; 382
450	472		(8) The utilization of existing health care facilities and health care 383
451	473		services in the service area of the applicant;] 384
452	474		(9) Whether the applicant has satisfactorily demonstrated that the 385
453	475		proposed project shall not result in an unnecessary duplication of 386
454	476		existing or approved health care services or facilities; 387
455	477		(10) Whether an applicant, who has failed to provide or reduced 388
456	478		access to services by Medicaid or Medicare recipients or indigent 389
457	479		persons, has demonstrated good cause for doing so, which shall not be 390
458	480		demonstrated solely on the basis of differences in reimbursement rates 391
459	481		between [Medicaid and other] public and private health care payers; 392
460	482		(11) Whether the applicant has satisfactorily demonstrated that the 393
461	483		proposal will not negatively impact the diversity of health care 394
462	484		providers and patient choice in the geographic region; [and] 395
463	485		(12) Whether the applicant has satisfactorily demonstrated that any 396
464	486		consolidation resulting from the proposal will not adversely affect 397
465	487		health care costs or [accessibility] access to care; 398
466	488		(13) If the application is for the termination of services, whether and 399
467	489		to what extent the applicant's actions or inactions caused or contributed 400
468	490		to the conditions that resulted in the filing of the application; and 401
469	491		(14) Whether the applicant has satisfactorily demonstrated that the 402
470		-	proposal will not negatively impact the finances of the health care 403
	492	+	proposal will not negatively impact the finances of the health care 403 Governor's Bill No. 9
	493	+
	494	+
	495	+
	496	+	LCO No. 654 15 of 20
	497	+
471	498		facility so as to jeopardize or substantially impair the facility's future 404
472	499		operations. 405
473	500		(b) In deliberations as described in subsection (a) of this section, there 406
474	501		shall be a presumption in favor of approving the certificate of need 407
475	502		application for a transfer of ownership of a large group practice, as 408
476		-	described in subdivision (3) of subsection (a) of section 19a-638, as 409 Substitute Bill No. 9
477		-
478		-
479		-	LCO 15 of 20
480		-
	503	+	described in subdivision (3) of subsection (a) of section 19a-638, as 409
481	504		amended by this act, when an offer was made in response to a request 410
482	505		for proposal or similar voluntary offer for sale. 411
483	506		(c) The unit, as it deems necessary, may revise or supplement the 412
484	507		guidelines and principles, set forth in subsection (a) of this section, 413
485	508		through regulation. The executive director may implement policies and 414
486	509		procedures necessary to implement the provisions of this section while 415
487	510		in the process of adopting such policies and procedures as regulations, 416
488	511		provided the executive director holds a public hearing at least thirty 417
489	512		days prior to implementing such policies and procedures and publishes 418
490	513		notice of intent to adopt the regulations on the Office of Health 419
491	514		Strategy's Internet web site and the eRegulations System not later than 420
492	515		twenty days after implementing such policies and procedures. Policies 421
493	516		and procedures implemented pursuant to this subsection shall be valid 422
494	517		until final regulations are adopted in accordance with the provisions of 423
495	518		chapter 54. 424
496	519		(d) (1) For purposes of this subsection and subsection (e) of this 425
497	520		section: 426
498	521		(A) "Affected community" means a municipality where a hospital is 427
499	522		physically located or a municipality whose inhabitants are regularly 428
500	523		served by a hospital; 429
501	524		(B) "Hospital" has the same meaning as provided in section 19a-490; 430
502	525		(C) "New hospital" means a hospital as it exists after the approval of 431
503	526		an agreement pursuant to section 19a-486b, or a certificate of need 432
504		-	application for a transfer of ownership of a hospital; 433
	527	+	application for a transfer of ownership of a hospital; 433 Governor's Bill No. 9
	528	+
	529	+
	530	+
	531	+	LCO No. 654 16 of 20
	532	+
505	533		(D) "Purchaser" means a person who is acquiring, or has acquired, 434
506	534		any assets of a hospital through a transfer of ownership of a hospital; 435
507	535		(E) "Transacting party" means a purchaser and any person who is a 436
508	536		party to a proposed agreement for transfer of ownership of a hospital; 437
509	537		(F) "Transfer" means to sell, transfer, lease, exchange, option, convey, 438
510		-	give or otherwise dispose of or transfer control over, including, but not 439 Substitute Bill No. 9
511		-
512		-
513		-	LCO 16 of 20
514		-
	538	+	give or otherwise dispose of or transfer control over, including, but not 439
515	539		limited to, transfer by way of merger or joint venture not in the ordinary 440
516	540		course of business; and 441
517	541		(G) "Transfer of ownership of a hospital" means a transfer that 442
518	542		impacts or changes the governance or controlling body of a hospital, 443
519	543		including, but not limited to, all affiliations, mergers or any sale or 444
520	544		transfer of net assets of a hospital and for which a certificate of need 445
521	545		application or a certificate of need determination letter is filed on or after 446
522	546		December 1, 2015. 447
523	547		(2) In any deliberations involving a certificate of need application 448
524	548		filed pursuant to section 19a-638, as amended by this act, that involves 449
525	549		the transfer of ownership of a hospital, the unit shall, in addition to the 450
526	550		guidelines and principles set forth in subsection (a) of this section and 451
527	551		those prescribed through regulation pursuant to subsection (c) of this 452
528	552		section, take into consideration and make written findings concerning 453
529	553		each of the following guidelines and principles: 454
530	554		(A) Whether the applicant fairly considered alternative proposals or 455
531	555		offers in light of the purpose of maintaining health care provider 456
532	556		diversity and consumer choice in the health care market and access to 457
533	557		affordable quality health care for the affected community; and 458
534	558		(B) Whether the plan submitted pursuant to section 19a-639a 459
535	559		demonstrates, in a manner consistent with this chapter, how health care 460
536	560		services will be provided by the new hospital for the first three years 461
537	561		following the transfer of ownership of the hospital, including any 462
538	562		consolidation, reduction, elimination or expansion of existing services 463
539		-	or introduction of new services. 464
	563	+	or introduction of new services. 464 Governor's Bill No. 9
	564	+
	565	+
	566	+
	567	+	LCO No. 654 17 of 20
	568	+
540	569		(3) The unit shall deny any certificate of need application involving a 465
541	570		transfer of ownership of a hospital unless the executive director finds 466
542	571		that the affected community will be assured of continued access to high 467
543	572		quality and affordable health care after accounting for any proposed 468
544	573		change impacting hospital staffing. 469
545		-	(4) The unit may deny any certificate of need application involving a 470 Substitute Bill No. 9
546		-
547		-
548		-	LCO 17 of 20
549		-
	574	+	(4) The unit may deny any certificate of need application involving a 470
550	575		transfer of ownership of a hospital subject to a cost and market impact 471
551	576		review pursuant to section 19a-639f, if the executive director finds that 472
552	577		(A) the affected community will not be assured of continued access to 473
553	578		high quality and affordable health care after accounting for any 474
554	579		consolidation in the hospital and health care market that may lessen 475
555	580		health care provider diversity, consumer choice and access to care, and 476
556	581		(B) any likely increases in the prices for health care services or total 477
557	582		health care spending in the state may negatively impact the affordability 478
558	583		of care. 479
559	584		(5) The unit may place any conditions on the approval of a certificate 480
560	585		of need application involving a transfer of ownership of a hospital 481
561	586		consistent with the provisions of this chapter. Before placing any such 482
562	587		conditions, the unit shall weigh the value of such conditions in 483
563	588		promoting the purposes of this chapter against the individual and 484
564	589		cumulative burden of such conditions on the transacting parties and the 485
565	590		new hospital. For each condition imposed, the unit shall include a 486
566	591		concise statement of the legal and factual basis for such condition and 487
567	592		the provision or provisions of this chapter that it is intended to promote. 488
568	593		Each condition shall be reasonably tailored in time and scope. The 489
569	594		transacting parties or the new hospital shall have the right to make a 490
570	595		request to the unit for an amendment to, or relief from, any condition 491
571	596		based on changed circumstances, hardship or for other good cause. 492
572	597		(6) In any deliberations involving a certificate of need application 493
573	598		filed pursuant to section 19a-638, as amended by this act, that involves 494
574	599		the transfer of ownership of a hospital and that is subject to a cost and 495
575	600		market impact review, the unit shall be permitted to consider the 496
576		-	preliminary report, response to the preliminary report, final report and 497
	601	+	preliminary report, response to the preliminary report, final report and 497 Governor's Bill No. 9
	602	+
	603	+
	604	+
	605	+	LCO No. 654 18 of 20
	606	+
577	607		any written comments from the parties regarding the reports issued or 498
578	608		submitted as part of the review, provided the unit has determined that 499
579	609		the disclosure of any such reports is appropriate in light of the 500
580	610		considerations set forth in subsection (c) of section 19a-639f and each 501
581	611		party in the certificate of need proceeding was provided an opportunity 502
582	612		of not less than fourteen days after the date of issuance of the final report 503
583		-	to provide written comments on the reports issued as part of the review 504 Substitute Bill No. 9
584		-
585		-
586		-	LCO 18 of 20
587		-
	613	+	to provide written comments on the reports issued as part of the review 504
588	614		process. 505
589	615		(e) (1) If the certificate of need application (A) involves the transfer of 506
590	616		ownership of a hospital, (B) the purchaser is a hospital, as defined in 507
591	617		section 19a-490, whether located within or outside the state, that had net 508
592	618		patient revenue for fiscal year 2013 in an amount greater than one billion 509
593	619		five hundred million dollars or a hospital system, as defined in section 510
594	620		19a-486i, whether located within or outside the state, that had net 511
595	621		patient revenue for fiscal year 2013 in an amount greater than one billion 512
596	622		five hundred million dollars, or any person that is organized or operated 513
597	623		for profit, and (C) such application is approved, the unit shall hire an 514
598	624		independent consultant to serve as a post-transfer compliance reporter 515
599	625		for a period of not less than three years after completion of the transfer 516
600	626		of ownership of the hospital. Such reporter shall, at a minimum: (i) Meet 517
601	627		with representatives of the purchaser, the new hospital and members of 518
602	628		the affected community served by the new hospital not less than 519
603	629		quarterly; and (ii) report to the unit not less than quarterly concerning 520
604	630		(I) efforts the purchaser and representatives of the new hospital have 521
605	631		taken to comply with any conditions the unit placed on the approval of 522
606	632		the certificate of need application and plans for future compliance, and 523
607	633		(II) community benefits and uncompensated care provided by the new 524
608	634		hospital. The purchaser shall give the reporter access to its records and 525
609	635		facilities for the purposes of carrying out the reporter's duties. The 526
610	636		purchaser shall hold a public hearing in the municipality in which the 527
611	637		new hospital is located not less than annually during the reporting 528
612	638		period to provide for public review and comment on the reporter's 529
613	639		reports and findings. 530
614		-	(2) If the reporter finds that the purchaser has breached a condition 531
	640	+	(2) If the reporter finds that the purchaser has breached a condition 531 Governor's Bill No. 9
	641	+
	642	+
	643	+
	644	+	LCO No. 654 19 of 20
	645	+
615	646		of the approval of the certificate of need application, the unit may, in 532
616	647		consultation with the purchaser, the reporter and any other interested 533
617	648		parties it deems appropriate, implement a performance improvement 534
618	649		plan designed to remedy the conditions identified by the reporter and 535
619	650		continue the [reporting] compliance monitoring period for up to one 536
620	651		year following a determination by the unit that [such] all conditions 537
621		-	have been [resolved] satisfied. 538 Substitute Bill No. 9
622		-
623		-
624		-	LCO 19 of 20
625		-
	652	+	have been [resolved] met. 538
626	653		(3) The purchaser shall provide funds, in an amount determined by 539
627	654		the unit not to exceed two hundred thousand dollars annually, for the 540
628	655		hiring of the post-transfer compliance reporter. 541
629	656		(f) Nothing in subsection (d) or (e) of this section shall apply to a 542
630	657		transfer of ownership of a hospital in which either a certificate of need 543
631	658		application is filed on or before December 1, 2015, or where a certificate 544
632	659		of need determination letter is filed on or before December 1, 2015. 545
633	660		Sec. 6. (NEW) (Effective July 1, 2024) (a) On or before October 31, 2024, 546
634	661		and quarterly thereafter, each hospital, as defined in section 12-263p of 547
635	662		the general statutes, shall submit a report to the executive director of the 548
636		-	Office of Health Strategy that identifies, for the prior calendar quarter, 549
637		-	(1) any vendor invoices that remained unpaid for more than ninety days 550
638		-	after receipt, regardless of whether the hospital disputes such invoice, 551
639		-	(2) the outstanding balances on such invoices, (3) the number of days of 552
640		-	cash on hand, (4) the operating margin, (5) the total margin, (6) unpaid 553
641		-	rent, (7) unpaid utilities, (8) fees, taxes or assessments owed to public 554
642		-	utilities, and (9) unpaid employee health insurance premiums, 555
643		-	including unpaid contributions, claims or other obligations supporting 556
644		-	employees under a self-funded insurance plan. The executive director 557
645		-	shall develop a uniform template, including definitions of terms used in 558
646		-	such template, to be used by hospitals for the purposes of complying 559
647		-	with the provisions of this subsection and post such template on the 560
648		-	Office of Health Strategy's Internet web site. Such template shall allow 561
649		-	for an explanation of any disputed charges. A hospital may request an 562
650		-	extension of not more than fifteen days to comply with the requirements 563
651		-	of this subsection in a form and manner prescribed by the executive 564
652		-	director. The executive director may grant such request for good cause, 565
653		-	as determined by the executive director. 566
654		-	(b) Any hospital that violates or fails to comply with the provisions 567
655		-	of this section shall be subject to a civil penalty not to exceed ten 568
656		-	thousand dollars for each incident of noncompliance. Prior to imposing 569
657		-	any penalty pursuant to this subsection, the executive director shall 570
658		-	notify the hospital of the alleged violation and the accompanying 571 Substitute Bill No. 9
	663	+	Office of Health Strategy that identifies (1) any vendor invoices that 549
	664	+	remained unpaid for more than ninety days after receipt, regardless of 550
	665	+	whether the hospital disputes such invoice, at the end of the prior 551
	666	+	calendar quarter, (2) the outstanding balances on such invoices at the 552
	667	+	end of the prior calendar quarter, (3) the number of days of cash on hand 553
	668	+	at the end of the prior calendar quarter, (4) the operating margin for the 554
	669	+	prior calendar quarter, and (5) the total margin for the prior calendar 555
	670	+	quarter. The executive director shall develop a uniform template, 556
	671	+	including definitions of terms used in such template, to be used by 557
	672	+	hospitals for the purposes of complying with the provisions of this 558
	673	+	subsection and post such template on the Office of Health Strategy's 559
	674	+	Internet web site. Such template shall allow for an explanation of any 560
	675	+	disputed charges. A hospital may request an extension of not more than 561
	676	+	fifteen days to comply with the requirements of this subsection in a form 562
	677	+	and manner prescribed by the executive director. The executive director 563
	678	+	may grant such request for good cause, as determined by the executive 564 Governor's Bill No. 9
659	679
660	680
661		-	LCO 20 of 20
662	681
663		-	penalty and shall permit such hospital to request that the office review 572
664		-	its findings. A hospital shall request such review not later than fifteen 573
665		-	days after the date of receipt of the notice of violation. The executive 574
666		-	director shall stay the imposition of any penalty pending the outcome 575
667		-	of the review. Payments of penalties received pursuant to this 576
668		-	subsection shall be deposited in the General Fund. 577
669		-	(c) On or before November 30, 2024, and quarterly thereafter, the 578
670		-	executive director shall provide to the Secretary of the Office of Policy 579
671		-	and Management a summary of the reports received in accordance with 580
672		-	subsection (a) of this section for the prior calendar quarter. 581
	682	+	LCO No. 654 20 of 20
	683	+
	684	+	director. 565
	685	+	(b) Any hospital that violates or fails to comply with the provisions 566
	686	+	of this section shall be subject to a civil penalty not to exceed ten 567
	687	+	thousand dollars for each incident of noncompliance. Prior to imposing 568
	688	+	any penalty pursuant to this subsection, the executive director shall 569
	689	+	notify the hospital of the alleged violation and the accompanying 570
	690	+	penalty and shall permit such hospital to request that the office review 571
	691	+	its findings. A hospital shall request such review not later than fifteen 572
	692	+	days after the date of receipt of the notice of violation. The executive 573
	693	+	director shall stay the imposition of any penalty pending the outcome 574
	694	+	of the review. Payments of penalties received pursuant to this 575
	695	+	subsection shall be deposited in the General Fund. 576
	696	+	(c) On or before November 30, 2024, and quarterly thereafter, the 577
	697	+	executive director shall provide to the Secretary of the Office of Policy 578
	698	+	and Management a summary of the reports received in accordance with 579
	699	+	subsection (a) of this section for the prior calendar quarter. 580
673	700		This act shall take effect as follows and shall amend the following
674	701		sections:
675	702
676	703		Section 1 July 1, 2024 19a-494(a)
677	704		Sec. 2 July 1, 2024 New section
678	705		Sec. 3 from passage 19a-630
679	706		Sec. 4 October 1, 2024 19a-638
680	707		Sec. 5 October 1, 2024 19a-639
681	708		Sec. 6 July 1, 2024 New section
682	709
683		-	Statement of Legislative Commissioners:
684		-	In Section 5(e)(2), "met" was changed to "satisfied" for clarity.
685		-
686		-	PH Joint Favorable Subst.
	710	+	Statement of Purpose:
	711	+	To implement the Governor's budget recommendations.
	712	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	713	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	714	+	underlined.]
687	715