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repealed and the following is substituted in lieu thereof (Effective July 1, 2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