Connecticut 2024 Regular Session

Connecticut Senate Bill SB00440 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3		-	LCO 1 of 20
	3	+	LCO No. 2995 1 of 20
4	4
5		-	General Assembly ~~Substitute~~ Bill No. 440
	5	+	General Assembly Raised Bill No. 440
6	6		February Session, 2024
	7	+	LCO No. 2995
	8	+
	9	+
	10	+	Referred to Committee on PUBLIC HEALTH
	11	+
	12	+
	13	+	Introduced by:
	14	+	(PH)
	15	+
7	16
8	17
9	18
10	19		AN ACT CONCERNING CERTIFICATES OF NEED.
11	20		Be it enacted by the Senate and House of Representatives in General
12	21		Assembly convened:
13	22
14	23		Section 1. Section 19a-638 of the 2024 supplement to the general 1
15	24		statutes is repealed and the following is substituted in lieu thereof 2
16	25		(Effective October 1, 2024): 3
17	26		(a) A certificate of need issued by the unit shall be required for: 4
18	27		(1) The establishment of a new health care facility; 5
19	28		(2) A transfer of ownership of a health care facility; 6
20	29		(3) A transfer of ownership of a large group practice to any entity 7
21	30		other than a (A) physician, or (B) group of two or more physicians, 8
22	31		legally organized in a partnership, professional corporation or limited 9
23	32		liability company formed to render professional services and not 10
24	33		employed by or an affiliate of any hospital, medical foundation, 11
25	34		insurance company or other similar entity; 12
26		-	(4) The establishment of a freestanding emergency department; 13
	35	+	(4) The establishment of a freestanding emergency department; 13 Raised Bill No. 440
	36	+
	37	+
	38	+
	39	+	LCO No. 2995 2 of 20
	40	+
27	41		(5) The termination of inpatient or outpatient services offered by a 14
28	42		hospital, including, but not limited to, the termination by a short-term 15
29	43		acute care general hospital or children's hospital of inpatient and 16
30		-	outpatient mental health and substance abuse services; 17 Substitute Bill No. 440
31		-
32		-
33		-	LCO 2 of 20
34		-
	44	+	outpatient mental health and substance abuse services; 17
35	45		(6) The establishment of an outpatient surgical facility, as defined in 18
36	46		section 19a-493b, or as established by a short-term acute care general 19
37	47		hospital; 20
38	48		(7) The termination of surgical services by an outpatient surgical 21
39	49		facility, as defined in section 19a-493b, or a facility that provides 22
40	50		outpatient surgical services as part of the outpatient surgery department 23
41	51		of a short-term acute care general hospital, provided termination of 24
42	52		outpatient surgical services due to (A) insufficient patient volume, or (B) 25
43	53		the termination of any subspecialty surgical service, shall not require 26
44	54		certificate of need approval; 27
45	55		(8) The termination of an emergency department by a short-term 28
46	56		acute care general hospital; 29
47	57		(9) The establishment of cardiac services, including inpatient and 30
48	58		outpatient cardiac catheterization, interventional cardiology and 31
49	59		cardiovascular surgery; 32
50	60		(10) The acquisition of computed tomography scanners, magnetic 33
51	61		resonance imaging scanners, positron emission tomography scanners or 34
52	62		positron emission tomography-computed tomography scanners, by any 35
53	63		person, physician, provider, short-term acute care general hospital or 36
54	64		children's hospital, except (A) as provided for in subdivision (22) of 37
55	65		subsection (b) of this section, and (B) a certificate of need issued by the 38
56	66		unit shall not be required where such scanner is a replacement for a 39
57	67		scanner that was previously acquired through certificate of need 40
58	68		approval or a certificate of need determination, including a replacement 41
59	69		scanner that has dual modalities or functionalities if the applicant 42
60	70		already offers similar imaging services for each of the scanner's 43
61		-	modalities or functionalities that will be utilized; 44
	71	+	modalities or functionalities that will be utilized; 44 Raised Bill No. 440
	72	+
	73	+
	74	+
	75	+	LCO No. 2995 3 of 20
	76	+
62	77		(11) The acquisition of nonhospital based linear accelerators, except a 45
63	78		certificate of need issued by the unit shall not be required where such 46
64	79		accelerator is a replacement for an accelerator that was previously 47
65	80		acquired through certificate of need approval or a certificate of need 48
66		-	determination; 49 Substitute Bill No. 440
67		-
68		-
69		-	LCO 3 of 20
70		-
	81	+	determination; 49
71	82		(12) An increase in the licensed bed capacity of a health care facility, 50
72	83		except as provided in subdivision (23), subparagraph (C) of subdivision 51
73	84		(26) and subdivision (28) of subsection (b) of this section; 52
74	85		(13) The acquisition of equipment utilizing technology that has not 53
75	86		previously been utilized in the state; 54
76	87		(14) An increase of two or more operating rooms within any three-55
77	88		year period, commencing on and after October 1, 2010, by an outpatient 56
78	89		surgical facility, as defined in section 19a-493b, or by a short-term acute 57
79	90		care general hospital; [and] 58
80	91		(15) The termination of inpatient or outpatient services offered by a 59
81	92		hospital or other facility or institution operated by the state that 60
82	93		provides services that are eligible for reimbursement under Title XVIII 61
83	94		or XIX of the federal Social Security Act, 42 USC 301, as amended from 62
84	95		time to time; 63
85	96		(16) The relocation of outpatient, behavioral health care, substance 64
86	97		use disorder, women's health care or emergency medical services 65
87	98		outside of the municipality in which such services are currently 66
88		-	provided, except as provided in subdivision (27) of subsection (b) of this 67
89		-	section; 68
90		-	(17) Any investment in a health care facility by a private equity 69
91		-	company in which the private equity company acquires a controlling 70
92		-	interest, either directly or indirectly, in a health care facility, or 71
93		-	otherwise obtains the ability to exercise operational control, managerial 72
94		-	control or decision-making authority over such facility; 73
95		-	(18) Any transaction in which a private equity company acquires a 74
96		-	controlling interest, either directly or indirectly, in a large group practice 75
97		-	of ten or more full-time equivalent physicians, or otherwise obtains the 76
98		-	ability to exercise operational control, managerial control or decision-77
99		-	making authority over such large group practice; and 78
100		-	(19) Any transaction involving a private equity company in which a 79 Substitute Bill No. 440
	99	+	provided; 67
	100	+	(17) Any investment in a health care facility by a private equity 68
	101	+	company in which the private equity company acquires a controlling 69
	102	+	interest, either directly or indirectly, in a health care facility, or 70
	103	+	otherwise obtains the ability to exercise operational control, managerial 71
	104	+	control or decision-making authority over such facility; 72
	105	+	(18) Any transaction in which a private equity company acquires a 73
	106	+	controlling interest, either directly or indirectly, in a large group practice 74 Raised Bill No. 440
101	107
102	108
103		-	LCO 4 of 20
104	109
105		-	health care facility's assets would be increased or reduced. 80
106		-	(b) A certificate of need shall not be required for: 81
107		-	(1) Health care facilities owned and operated by the federal 82
108		-	government; 83
109		-	(2) The establishment of offices by a licensed private practitioner, 84
110		-	whether for individual or group practice, except when a certificate of 85
111		-	need is required in accordance with the requirements of section 19a-86
112		-	493b or subdivision (3), (10) or (11) of subsection (a) of this section; 87
113		-	(3) A health care facility operated by a religious group that 88
114		-	exclusively relies upon spiritual means through prayer for healing; 89
115		-	(4) Residential care homes, as defined in subsection (c) of section 19a-90
116		-	490, and nursing homes and rest homes, as defined in subsection (o) of 91
117		-	section 19a-490; 92
118		-	(5) An assisted living services agency, as defined in section 19a-490; 93
119		-	(6) Home health agencies, as defined in section 19a-490; 94
120		-	(7) Hospice services, as described in section 19a-122b; 95
121		-	(8) Outpatient rehabilitation facilities; 96
122		-	(9) Outpatient chronic dialysis services; 97
123		-	(10) Transplant services; 98
124		-	(11) Free clinics, as defined in section 19a-630; 99
125		-	(12) School-based health centers and expanded school health sites, as 100
126		-	such terms are defined in section 19a-6r, community health centers, as 101
127		-	defined in section 19a-490a, not-for-profit outpatient clinics licensed in 102
128		-	accordance with the provisions of chapter 368v and federally qualified 103
129		-	health centers; 104
130		-	(13) A program licensed or funded by the Department of Children 105 Substitute Bill No. 440
	110	+	LCO No. 2995 4 of 20
	111	+
	112	+	of ten or more full-time equivalent physicians, or otherwise obtains the 75
	113	+	ability to exercise operational control, managerial control or decision-76
	114	+	making authority over such large group practice; and 77
	115	+	(19) Any transaction involving a private equity company in which a 78
	116	+	health care facility's assets would be increased or reduced. 79
	117	+	(b) A certificate of need shall not be required for: 80
	118	+	(1) Health care facilities owned and operated by the federal 81
	119	+	government; 82
	120	+	(2) The establishment of offices by a licensed private practitioner, 83
	121	+	whether for individual or group practice, except when a certificate of 84
	122	+	need is required in accordance with the requirements of section 19a-85
	123	+	493b or subdivision (3), (10) or (11) of subsection (a) of this section; 86
	124	+	(3) A health care facility operated by a religious group that 87
	125	+	exclusively relies upon spiritual means through prayer for healing; 88
	126	+	(4) Residential care homes, as defined in subsection (c) of section 19a-89
	127	+	490, and nursing homes and rest homes, as defined in subsection (o) of 90
	128	+	section 19a-490; 91
	129	+	(5) An assisted living services agency, as defined in section 19a-490; 92
	130	+	(6) Home health agencies, as defined in section 19a-490; 93
	131	+	(7) Hospice services, as described in section 19a-122b; 94
	132	+	(8) Outpatient rehabilitation facilities; 95
	133	+	(9) Outpatient chronic dialysis services; 96
	134	+	(10) Transplant services; 97
	135	+	(11) Free clinics, as defined in section 19a-630; 98
	136	+	(12) School-based health centers and expanded school health sites, as 99
	137	+	such terms are defined in section 19a-6r, community health centers, as 100 Raised Bill No. 440
131	138
132	139
133		-	LCO 5 of 20
134	140
135		-	and Families, provided such program is not a psychiatric residential 106
136		-	treatment facility; 107
137		-	(14) Any nonprofit facility, institution or provider that has a contract 108
138		-	with, or is certified or licensed to provide a service for, a state agency or 109
139		-	department for a service that would otherwise require a certificate of 110
140		-	need. The provisions of this subdivision shall not apply to a short-term 111
141		-	acute care general hospital or children's hospital, or a hospital or other 112
142		-	facility or institution operated by the state that provides services that are 113
143		-	eligible for reimbursement under Title XVIII or XIX of the federal Social 114
144		-	Security Act, 42 USC 301, as amended; 115
145		-	(15) A health care facility operated by a nonprofit educational 116
146		-	institution exclusively for students, faculty and staff of such institution 117
147		-	and their dependents; 118
148		-	(16) An outpatient clinic or program operated exclusively by or 119
149		-	contracted to be operated exclusively by a municipality, municipal 120
150		-	agency, municipal board of education or a health district, as described 121
151		-	in section 19a-241; 122
152		-	(17) A residential facility for persons with intellectual disability 123
153		-	licensed pursuant to section 17a-227 and certified to participate in the 124
154		-	Title XIX Medicaid program as an intermediate care facility for 125
155		-	individuals with intellectual disabilities; 126
156		-	(18) Replacement of existing computed tomography scanners, 127
157		-	magnetic resonance imaging scanners, positron emission tomography 128
158		-	scanners, positron emission tomography-computed tomography 129
159		-	scanners, or nonhospital based linear accelerators, if such equipment 130
160		-	was acquired through certificate of need approval or a certificate of need 131
161		-	determination, provided a health care facility, provider, physician or 132
162		-	person notifies the unit of the date on which the equipment is replaced 133
163		-	and the disposition of the replaced equipment, including if a 134
164		-	replacement scanner has dual modalities or functionalities and the 135
165		-	applicant already offers similar imaging services for each of the 136
166		-	equipment's modalities or functionalities that will be utilized; 137 Substitute Bill No. 440
	141	+	LCO No. 2995 5 of 20
	142	+
	143	+	defined in section 19a-490a, not-for-profit outpatient clinics licensed in 101
	144	+	accordance with the provisions of chapter 368v and federally qualified 102
	145	+	health centers; 103
	146	+	(13) A program licensed or funded by the Department of Children 104
	147	+	and Families, provided such program is not a psychiatric residential 105
	148	+	treatment facility; 106
	149	+	(14) Any nonprofit facility, institution or provider that has a contract 107
	150	+	with, or is certified or licensed to provide a service for, a state agency or 108
	151	+	department for a service that would otherwise require a certificate of 109
	152	+	need. The provisions of this subdivision shall not apply to a short-term 110
	153	+	acute care general hospital or children's hospital, or a hospital or other 111
	154	+	facility or institution operated by the state that provides services that are 112
	155	+	eligible for reimbursement under Title XVIII or XIX of the federal Social 113
	156	+	Security Act, 42 USC 301, as amended; 114
	157	+	(15) A health care facility operated by a nonprofit educational 115
	158	+	institution exclusively for students, faculty and staff of such institution 116
	159	+	and their dependents; 117
	160	+	(16) An outpatient clinic or program operated exclusively by or 118
	161	+	contracted to be operated exclusively by a municipality, municipal 119
	162	+	agency, municipal board of education or a health district, as described 120
	163	+	in section 19a-241; 121
	164	+	(17) A residential facility for persons with intellectual disability 122
	165	+	licensed pursuant to section 17a-227 and certified to participate in the 123
	166	+	Title XIX Medicaid program as an intermediate care facility for 124
	167	+	individuals with intellectual disabilities; 125
	168	+	(18) Replacement of existing computed tomography scanners, 126
	169	+	magnetic resonance imaging scanners, positron emission tomography 127
	170	+	scanners, positron emission tomography-computed tomography 128
	171	+	scanners, or nonhospital based linear accelerators, if such equipment 129
	172	+	was acquired through certificate of need approval or a certificate of need 130
	173	+	determination, provided a health care facility, provider, physician or 131 Raised Bill No. 440
167	174
168	175
169		-	LCO 6 of 20
170	176
171		-	(19) Acquisition of cone-beam dental imaging equipment that is to be 138
172		-	used exclusively by a dentist licensed pursuant to chapter 379; 139
173		-	(20) The partial or total elimination of services provided by an 140
174		-	outpatient surgical facility, as defined in section 19a-493b, except as 141
175		-	provided in subdivision (6) of subsection (a) of this section and section 142
176		-	19a-639e; 143
177		-	(21) The termination of services for which the Department of Public 144
178		-	Health has requested the facility to relinquish its license; 145
179		-	(22) Acquisition of any equipment by any person that is to be used 146
180		-	exclusively for scientific research that is not conducted on humans; 147
181		-	(23) On or before June 30, 2026, an increase in the licensed bed 148
182		-	capacity of a mental health facility, provided (A) the mental health 149
183		-	facility demonstrates to the unit, in a form and manner prescribed by 150
184		-	the unit, that it accepts reimbursement for any covered benefit provided 151
185		-	to a covered individual under: (i) An individual or group health 152
186		-	insurance policy providing coverage of the type specified in 153
187		-	subdivisions (1), (2), (4), (11) and (12) of section 38a-469; (ii) a self-154
188		-	insured employee welfare benefit plan established pursuant to the 155
189		-	federal Employee Retirement Income Security Act of 1974, as amended 156
190		-	from time to time; or (iii) HUSKY Health, as defined in section 17b-290, 157
191		-	and (B) if the mental health facility does not accept or stops accepting 158
192		-	reimbursement for any covered benefit provided to a covered 159
193		-	individual under a policy, plan or program described in clause (i), (ii) or 160
194		-	(iii) of subparagraph (A) of this subdivision, a certificate of need for such 161
195		-	increase in the licensed bed capacity shall be required. 162
196		-	(24) The establishment at harm reduction centers through the pilot 163
197		-	program established pursuant to section 17a-673c; [or] 164
198		-	(25) On or before June 30, 2028, a birth center, as defined in section 165
199		-	19a-490, that is enrolled as a provider in the Connecticut medical 166
200		-	assistance program, as defined in section 17b-245g; 167 Substitute Bill No. 440
	177	+	LCO No. 2995 6 of 20
	178	+
	179	+	person notifies the unit of the date on which the equipment is replaced 132
	180	+	and the disposition of the replaced equipment, including if a 133
	181	+	replacement scanner has dual modalities or functionalities and the 134
	182	+	applicant already offers similar imaging services for each of the 135
	183	+	equipment's modalities or functionalities that will be utilized; 136
	184	+	(19) Acquisition of cone-beam dental imaging equipment that is to be 137
	185	+	used exclusively by a dentist licensed pursuant to chapter 379; 138
	186	+	(20) The partial or total elimination of services provided by an 139
	187	+	outpatient surgical facility, as defined in section 19a-493b, except as 140
	188	+	provided in subdivision (6) of subsection (a) of this section and section 141
	189	+	19a-639e; 142
	190	+	(21) The termination of services for which the Department of Public 143
	191	+	Health has requested the facility to relinquish its license; 144
	192	+	(22) Acquisition of any equipment by any person that is to be used 145
	193	+	exclusively for scientific research that is not conducted on humans; 146
	194	+	(23) On or before June 30, 2026, an increase in the licensed bed 147
	195	+	capacity of a mental health facility, provided (A) the mental health 148
	196	+	facility demonstrates to the unit, in a form and manner prescribed by 149
	197	+	the unit, that it accepts reimbursement for any covered benefit provided 150
	198	+	to a covered individual under: (i) An individual or group health 151
	199	+	insurance policy providing coverage of the type specified in 152
	200	+	subdivisions (1), (2), (4), (11) and (12) of section 38a-469; (ii) a self-153
	201	+	insured employee welfare benefit plan established pursuant to the 154
	202	+	federal Employee Retirement Income Security Act of 1974, as amended 155
	203	+	from time to time; or (iii) HUSKY Health, as defined in section 17b-290, 156
	204	+	and (B) if the mental health facility does not accept or stops accepting 157
	205	+	reimbursement for any covered benefit provided to a covered 158
	206	+	individual under a policy, plan or program described in clause (i), (ii) or 159
	207	+	(iii) of subparagraph (A) of this subdivision, a certificate of need for such 160
	208	+	increase in the licensed bed capacity shall be required. 161
	209	+	(24) The establishment at harm reduction centers through the pilot 162 Raised Bill No. 440
201	210
202	211
203		-	LCO 7 of 20
204	212
205		-	(26) On or before June 30, 2030, (A) the establishment or expansion of 168
206		-	diagnostic or therapeutic cardiac catheterization or cardiac surgery 169
207		-	units, psychiatric units, substance use disorder units or rural health 170
208		-	services, (B) upgrades to radiologic technology, (C) an increase of 171
209		-	behavioral health beds for children, (D) an increase in capacity for 172
210		-	existing services offered by a health care facility, and (E) an increase in 173
211		-	the number of operating rooms at a health care facility existing on or 174
212		-	before October 1, 2024; 175
213		-	(27) The relocation of outpatient services (A) within the municipality 176
214		-	in which such services are currently provided, or (B) not more than 177
215		-	twenty miles from the current location at which such services are 178
216		-	provided; or 179
217		-	(28) An increase or reduction in the licensed bed capacity of a health 180
218		-	care facility of not more than twelve beds within any two-year period, 181
219		-	commencing on and after October 1, 2024. 182
220		-	(c) (1) Any person, health care facility or institution that is unsure 183
221		-	whether a certificate of need is required under this section, or (2) any 184
222		-	health care facility that proposes to relocate pursuant to section 19a-185
223		-	639c, shall send a letter to the unit that describes the project and requests 186
224		-	that the unit make a determination as to whether a certificate of need is 187
225		-	required. In the case of a relocation of a health care facility, the letter 188
226		-	shall include information described in section 19a-639c. A person, health 189
227		-	care facility or institution making such request shall provide the unit 190
228		-	with any information the unit requests as part of its determination 191
229		-	process. The unit shall provide a determination within thirty days of 192
230		-	receipt of such request. 193
231		-	(d) The executive director of the Office of Health Strategy may 194
232		-	implement policies and procedures necessary to administer the 195
233		-	provisions of this section while in the process of adopting such policies 196
234		-	and procedures as regulation, provided the executive director holds a 197
235		-	public hearing prior to implementing the policies and procedures and 198
236		-	posts notice of intent to adopt regulations on the office's Internet web 199 Substitute Bill No. 440
	213	+	LCO No. 2995 7 of 20
	214	+
	215	+	program established pursuant to section 17a-673c; [or] 163
	216	+	(25) On or before June 30, 2028, a birth center, as defined in section 164
	217	+	19a-490, that is enrolled as a provider in the Connecticut medical 165
	218	+	assistance program, as defined in section 17b-245g; 166
	219	+	(26) On or before June 30, 2030, (A) the establishment or expansion of 167
	220	+	diagnostic or therapeutic cardiac catheterization or cardiac surgery 168
	221	+	units, psychiatric units, substance use disorder units or rural health 169
	222	+	services, (B) upgrades to radiologic technology, (C) an increase of 170
	223	+	behavioral health beds for children, (D) an increase in capacity for 171
	224	+	existing services offered by a health care facility, and (E) an increase in 172
	225	+	the number of operating rooms at a health care facility existing on or 173
	226	+	before October 1, 2024; 174
	227	+	(27) The relocation of outpatient services (A) within the municipality 175
	228	+	in which such services are currently provided, or (B) not more than 176
	229	+	twenty miles from the current location at which such services are 177
	230	+	provided; or 178
	231	+	(28) An increase or reduction in the licensed bed capacity of a health 179
	232	+	care facility of not more than twelve beds within any two-year period, 180
	233	+	commencing on and after October 1, 2024. 181
	234	+	(c) (1) Any person, health care facility or institution that is unsure 182
	235	+	whether a certificate of need is required under this section, or (2) any 183
	236	+	health care facility that proposes to relocate pursuant to section 19a-184
	237	+	639c, shall send a letter to the unit that describes the project and requests 185
	238	+	that the unit make a determination as to whether a certificate of need is 186
	239	+	required. In the case of a relocation of a health care facility, the letter 187
	240	+	shall include information described in section 19a-639c. A person, health 188
	241	+	care facility or institution making such request shall provide the unit 189
	242	+	with any information the unit requests as part of its determination 190
	243	+	process. The unit shall provide a determination within thirty days of 191
	244	+	receipt of such request. 192
	245	+	(d) The executive director of the Office of Health Strategy may 193 Raised Bill No. 440
237	246
238	247
239		-	LCO 8 of 20
240	248
241		-	site and the eRegulations System not later than twenty days after the 200
242		-	date of implementation. Policies and procedures implemented pursuant 201
243		-	to this section shall be valid until the time final regulations are adopted. 202
244		-	(e) On or before June 30, 2026, a mental health facility seeking to 203
245		-	increase licensed bed capacity without applying for a certificate of need, 204
246		-	as permitted pursuant to subdivision (23) of subsection (b) of this 205
247		-	section, shall notify the Office of Health Strategy, in a form and manner 206
248		-	prescribed by the executive director of said office, regarding (1) such 207
249		-	facility's intent to increase licensed bed capacity, (2) the address of such 208
250		-	facility, and (3) a description of all services that are being or will be 209
251		-	provided at such facility. 210
252		-	(f) Not later than January 1, 2025, the executive director of the Office 211
253		-	of Health Strategy shall report to the Governor and, in accordance with 212
254		-	the provisions of section 11-4a, to the joint standing committee of the 213
255		-	General Assembly having cognizance of matters relating to public 214
256		-	health concerning the executive director's recommendations, if any, 215
257		-	regarding the establishment of an expedited certificate of need process 216
258		-	for mental health facilities. 217
259		-	Sec. 2. Section 19a-639a of the 2024 supplement to the general statutes 218
260		-	is repealed and the following is substituted in lieu thereof (Effective 219
261		-	October 1, 2024): 220
262		-	(a) An application for a certificate of need shall be filed with the unit 221
263		-	in accordance with the provisions of this section and any regulations 222
264		-	adopted by the Office of Health Strategy. The application shall address 223
265		-	the guidelines and principles set forth in (1) subsection (a) of section 19a-224
266		-	639, and (2) regulations adopted by the department. The applicant shall 225
267		-	include with the application a nonrefundable application fee based on 226
268		-	the cost of the project. The amount of the fee shall be as follows: (A) One 227
269		-	thousand dollars for a project that will cost not greater than fifty 228
270		-	thousand dollars; (B) two thousand dollars for a project that will cost 229
271		-	greater than fifty thousand dollars but not greater than one hundred 230
272		-	thousand dollars; (C) three thousand dollars for a project that will cost 231 Substitute Bill No. 440
	249	+	LCO No. 2995 8 of 20
	250	+
	251	+	implement policies and procedures necessary to administer the 194
	252	+	provisions of this section while in the process of adopting such policies 195
	253	+	and procedures as regulation, provided the executive director holds a 196
	254	+	public hearing prior to implementing the policies and procedures and 197
	255	+	posts notice of intent to adopt regulations on the office's Internet web 198
	256	+	site and the eRegulations System not later than twenty days after the 199
	257	+	date of implementation. Policies and procedures implemented pursuant 200
	258	+	to this section shall be valid until the time final regulations are adopted. 201
	259	+	(e) On or before June 30, 2026, a mental health facility seeking to 202
	260	+	increase licensed bed capacity without applying for a certificate of need, 203
	261	+	as permitted pursuant to subdivision (23) of subsection (b) of this 204
	262	+	section, shall notify the Office of Health Strategy, in a form and manner 205
	263	+	prescribed by the executive director of said office, regarding (1) such 206
	264	+	facility's intent to increase licensed bed capacity, (2) the address of such 207
	265	+	facility, and (3) a description of all services that are being or will be 208
	266	+	provided at such facility. 209
	267	+	(f) Not later than January 1, 2025, the executive director of the Office 210
	268	+	of Health Strategy shall report to the Governor and, in accordance with 211
	269	+	the provisions of section 11-4a, to the joint standing committee of the 212
	270	+	General Assembly having cognizance of matters relating to public 213
	271	+	health concerning the executive director's recommendations, if any, 214
	272	+	regarding the establishment of an expedited certificate of need process 215
	273	+	for mental health facilities. 216
	274	+	Sec. 2. Section 19a-639a of the 2024 supplement to the general statutes 217
	275	+	is repealed and the following is substituted in lieu thereof (Effective 218
	276	+	October 1, 2024): 219
	277	+	(a) An application for a certificate of need shall be filed with the unit 220
	278	+	in accordance with the provisions of this section and any regulations 221
	279	+	adopted by the Office of Health Strategy. The application shall address 222
	280	+	the guidelines and principles set forth in (1) subsection (a) of section 19a-223
	281	+	639, and (2) regulations adopted by the department. The applicant shall 224
	282	+	include with the application a nonrefundable application fee based on 225 Raised Bill No. 440
273	283
274	284
275		-	LCO 9 of 20
276	285
277		-	greater than one hundred thousand dollars but not greater than five 232
278		-	hundred thousand dollars; (D) four thousand dollars for a project that 233
279		-	will cost greater than five hundred thousand dollars but not greater than 234
280		-	one million dollars; (E) five thousand dollars for a project that will cost 235
281		-	greater than one million dollars but not greater than five million dollars; 236
282		-	(F) eight thousand dollars for a project that will cost greater than five 237
283		-	million dollars but not greater than ten million dollars; and (G) ten 238
284		-	thousand dollars for a project that will cost greater than ten million 239
285		-	dollars. 240
286		-	(b) Prior to the filing of a certificate of need application, the applicant 241
287		-	shall (1) publish notice that an application is to be submitted to the unit 242
288		-	(A) in a newspaper having a substantial circulation in the area where 243
289		-	the project is to be located, and (B) on the applicant's Internet web site 244
290		-	in a clear and conspicuous location that is easily accessible by members 245
291		-	of the public, (2) request the publication of notice (A) in at least two sites 246
292		-	within the affected community that are commonly accessed by the 247
293		-	public, such as a town hall or library, and (B) on any existing Internet 248
294		-	web site of the municipality or local health department, and (3) submit 249
295		-	such notice to the unit for posting on such unit's Internet web site. Such 250
296		-	newspaper notice shall be published for not less than three consecutive 251
297		-	days, with the final date of consecutive publication occurring not later 252
298		-	than twenty days prior to the date of filing of the certificate of need 253
299		-	application, and contain a brief description of the nature of the project 254
300		-	and the street address where the project is to be located. Postings in the 255
301		-	affected community and on the applicant's Internet web site shall 256
302		-	remain until the decision on the application is rendered. The unit shall 257
303		-	not invalidate any notice due to changes or removal of the notice from 258
304		-	a community Internet web site of which the applicant has no control. An 259
305		-	applicant shall file the certificate of need application with the unit not 260
306		-	later than ninety days after publishing notice of the application in a 261
307		-	newspaper in accordance with the provisions of this subsection. The 262
308		-	unit shall not accept the applicant's certificate of need application for 263
309		-	filing unless the application is accompanied by the application fee 264
310		-	prescribed in subsection (a) of this section and proof of compliance with 265 Substitute Bill No. 440
	286	+	LCO No. 2995 9 of 20
	287	+
	288	+	the cost of the project. The amount of the fee shall be as follows: (A) One 226
	289	+	thousand dollars for a project that will cost not greater than fifty 227
	290	+	thousand dollars; (B) two thousand dollars for a project that will cost 228
	291	+	greater than fifty thousand dollars but not greater than one hundred 229
	292	+	thousand dollars; (C) three thousand dollars for a project that will cost 230
	293	+	greater than one hundred thousand dollars but not greater than five 231
	294	+	hundred thousand dollars; (D) four thousand dollars for a project that 232
	295	+	will cost greater than five hundred thousand dollars but not greater than 233
	296	+	one million dollars; (E) five thousand dollars for a project that will cost 234
	297	+	greater than one million dollars but not greater than five million dollars; 235
	298	+	(F) eight thousand dollars for a project that will cost greater than five 236
	299	+	million dollars but not greater than ten million dollars; and (G) ten 237
	300	+	thousand dollars for a project that will cost greater than ten million 238
	301	+	dollars. 239
	302	+	(b) Prior to the filing of a certificate of need application, the applicant 240
	303	+	shall (1) publish notice that an application is to be submitted to the unit 241
	304	+	(A) in a newspaper having a substantial circulation in the area where 242
	305	+	the project is to be located, and (B) on the applicant's Internet web site 243
	306	+	in a clear and conspicuous location that is easily accessible by members 244
	307	+	of the public, (2) request the publication of notice (A) in at least two sites 245
	308	+	within the affected community that are commonly accessed by the 246
	309	+	public, such as a town hall or library, and (B) on any existing Internet 247
	310	+	web site of the municipality or local health department, and (3) submit 248
	311	+	such notice to the unit for posting on such unit's Internet web site. Such 249
	312	+	newspaper notice shall be published for not less than three consecutive 250
	313	+	days, with the final date of consecutive publication occurring not later 251
	314	+	than twenty days prior to the date of filing of the certificate of need 252
	315	+	application, and contain a brief description of the nature of the project 253
	316	+	and the street address where the project is to be located. Postings in the 254
	317	+	affected community and on the applicant's Internet web site shall 255
	318	+	remain until the decision on the application is rendered. The unit shall 256
	319	+	not invalidate any notice due to changes or removal of the notice from 257
	320	+	a community Internet web site of which the applicant has no control. An 258
	321	+	applicant shall file the certificate of need application with the unit not 259 Raised Bill No. 440
311	322
312	323
313		-	LCO 10 of 20
314	324
315		-	the publication requirements prescribed in this subsection. Prior to 266
316		-	submitting the certificate of need application, the applicant may request 267
317		-	an informational meeting with the unit to discuss the requirements of 268
318		-	the application process. The unit shall hold such informational meeting 269
319		-	with the applicant not later than one week after the date it receives the 270
320		-	applicant's request for an informational meeting. 271
321		-	(c) (1) Not later than five business days after receipt of a properly filed 272
322		-	certificate of need application, the unit shall publish notice of the 273
323		-	application on its Internet web site. Not later than thirty days after the 274
324		-	date of filing of the application, the unit may request such additional 275
325		-	information as the unit determines necessary to complete the 276
326		-	application. In addition to any information requested by the unit, if the 277
327		-	application involves the transfer of ownership of a hospital, as defined 278
328		-	in section 19a-639, the applicant shall submit to the unit (A) a plan 279
329		-	demonstrating how health care services will be provided by the new 280
330		-	hospital for the first three years following the transfer of ownership of 281
331		-	the hospital, including any consolidation, reduction, elimination or 282
332		-	expansion of existing services or introduction of new services, and (B) 283
333		-	the names of persons currently holding a position with the hospital to 284
334		-	be purchased or the purchaser, as defined in section 19a-639, as an 285
335		-	officer, director, board member or senior manager, whether or not such 286
336		-	person is expected to hold a position with the hospital after completion 287
337		-	of the transfer of ownership of the hospital and any salary, severance, 288
338		-	stock offering or any financial gain, current or deferred, such person is 289
339		-	expected to receive as a result of, or in relation to, the transfer of 290
340		-	ownership of the hospital. 291
341		-	(2) The applicant shall, not later than sixty days after the date of the 292
342		-	unit's request, submit any requested information and any information 293
343		-	required under this subsection to the unit. If an applicant fails to submit 294
344		-	such information to the unit within the sixty-day period, the unit shall 295
345		-	consider the application to have been withdrawn. 296
346		-	(3) The unit shall make reasonable efforts to limit the requests for 297
347		-	additional information to two such requests and, in all cases, cease all 298 Substitute Bill No. 440
	325	+	LCO No. 2995 10 of 20
	326	+
	327	+	later than ninety days after publishing notice of the application in a 260
	328	+	newspaper in accordance with the provisions of this subsection. The 261
	329	+	unit shall not accept the applicant's certificate of need application for 262
	330	+	filing unless the application is accompanied by the application fee 263
	331	+	prescribed in subsection (a) of this section and proof of compliance with 264
	332	+	the publication requirements prescribed in this subsection. Prior to 265
	333	+	submitting the certificate of need application, the applicant may request 266
	334	+	an informational meeting with the unit to discuss the requirements of 267
	335	+	the application process. The unit shall hold such informational meeting 268
	336	+	with the applicant not later than one week after the date it receives the 269
	337	+	applicant's request for an informational meeting. 270
	338	+	(c) (1) Not later than five business days after receipt of a properly filed 271
	339	+	certificate of need application, the unit shall publish notice of the 272
	340	+	application on its Internet web site. Not later than thirty days after the 273
	341	+	date of filing of the application, the unit may request such additional 274
	342	+	information as the unit determines necessary to complete the 275
	343	+	application. In addition to any information requested by the unit, if the 276
	344	+	application involves the transfer of ownership of a hospital, as defined 277
	345	+	in section 19a-639, the applicant shall submit to the unit (A) a plan 278
	346	+	demonstrating how health care services will be provided by the new 279
	347	+	hospital for the first three years following the transfer of ownership of 280
	348	+	the hospital, including any consolidation, reduction, elimination or 281
	349	+	expansion of existing services or introduction of new services, and (B) 282
	350	+	the names of persons currently holding a position with the hospital to 283
	351	+	be purchased or the purchaser, as defined in section 19a-639, as an 284
	352	+	officer, director, board member or senior manager, whether or not such 285
	353	+	person is expected to hold a position with the hospital after completion 286
	354	+	of the transfer of ownership of the hospital and any salary, severance, 287
	355	+	stock offering or any financial gain, current or deferred, such person is 288
	356	+	expected to receive as a result of, or in relation to, the transfer of 289
	357	+	ownership of the hospital. 290
	358	+	(2) The applicant shall, not later than sixty days after the date of the 291
	359	+	unit's request, submit any requested information and any information 292
	360	+	required under this subsection to the unit. If an applicant fails to submit 293 Raised Bill No. 440
348	361
349	362
350		-	LCO 11 of 20
351	363
352		-	requests for additional information not later than six months after 299
353		-	receiving the application. 300
354		-	(d) Upon deeming an application complete, the unit shall provide 301
355		-	notice of this determination to the applicant and to the public in 302
356		-	accordance with regulations adopted by the department. In addition, 303
357		-	the unit shall post such notice on its Internet web site and notify the 304
358		-	applicant not later than five days after deeming the application 305
359		-	complete. The date on which the unit posts such notice on its Internet 306
360		-	web site shall begin the review period. Except as provided in this 307
361		-	subsection, (1) the review period for an application deemed complete 308
362		-	shall be [ninety] thirty days from the date on which the unit posts such 309
363		-	notice on its Internet web site; and (2) the unit shall issue a decision on 310
364		-	an application deemed complete prior to the expiration of the [ninety-311
365		-	day] thirty-day review period in matters without a public hearing. If the 312
366		-	unit does not issue a decision on an application deemed complete prior 313
367		-	to the expiration of the thirty-day review period in matters without a 314
368		-	public hearing, such application shall be deemed approved. The review 315
369		-	period for an application deemed complete that involves a transfer of a 316
370		-	large group practice, as described in subdivision (3) of subsection (a) of 317
371		-	section 19a-638, when the offer was made in response to a request for 318
372		-	proposal or similar voluntary offer for sale, shall be [sixty] twenty days 319
373		-	from the date on which the unit posts notice on its Internet web site. 320
374		-	Upon request or for good cause shown, the unit may extend the review 321
375		-	period for a period of time not to exceed [sixty] twenty days. If the 322
376		-	review period is extended, the unit shall issue a decision on the 323
377		-	completed application prior to the expiration of the extended review 324
378		-	period. If the unit holds a public hearing concerning a completed 325
379		-	application in accordance with subsection (e) or (f) of this section, the 326
380		-	unit shall issue a decision on the completed application not later than 327
381		-	[sixty] twenty days after the date the unit closes the public hearing 328
382		-	record. If the unit does not issue a decision on the completed 329
383		-	application, not later than twenty days after such date, the application 330
384		-	shall be deemed approved. 331
385		-	(e) Except as provided in this subsection, the unit shall hold a public 332 Substitute Bill No. 440
	364	+	LCO No. 2995 11 of 20
	365	+
	366	+	such information to the unit within the sixty-day period, the unit shall 294
	367	+	consider the application to have been withdrawn. 295
	368	+	(3) The unit shall make reasonable efforts to limit the requests for 296
	369	+	additional information to two such requests and, in all cases, cease all 297
	370	+	requests for additional information not later than six months after 298
	371	+	receiving the application. 299
	372	+	(d) Upon deeming an application complete, the unit shall provide 300
	373	+	notice of this determination to the applicant and to the public in 301
	374	+	accordance with regulations adopted by the department. In addition, 302
	375	+	the unit shall post such notice on its Internet web site and notify the 303
	376	+	applicant not later than five days after deeming the application 304
	377	+	complete. The date on which the unit posts such notice on its Internet 305
	378	+	web site shall begin the review period. Except as provided in this 306
	379	+	subsection, (1) the review period for an application deemed complete 307
	380	+	shall be [ninety] thirty days from the date on which the unit posts such 308
	381	+	notice on its Internet web site; and (2) the unit shall issue a decision on 309
	382	+	an application deemed complete prior to the expiration of the [ninety-310
	383	+	day] thirty-day review period in matters without a public hearing. If the 311
	384	+	unit does not issue a decision on an application deemed complete prior 312
	385	+	to the expiration of the thirty-day review period in matters without a 313
	386	+	public hearing, such application shall be deemed approved. The review 314
	387	+	period for an application deemed complete that involves a transfer of a 315
	388	+	large group practice, as described in subdivision (3) of subsection (a) of 316
	389	+	section 19a-638, when the offer was made in response to a request for 317
	390	+	proposal or similar voluntary offer for sale, shall be [sixty] twenty days 318
	391	+	from the date on which the unit posts notice on its Internet web site. 319
	392	+	Upon request or for good cause shown, the unit may extend the review 320
	393	+	period for a period of time not to exceed [sixty] twenty days. If the 321
	394	+	review period is extended, the unit shall issue a decision on the 322
	395	+	completed application prior to the expiration of the extended review 323
	396	+	period. If the unit holds a public hearing concerning a completed 324
	397	+	application in accordance with subsection (e) or (f) of this section, the 325
	398	+	unit shall issue a decision on the completed application not later than 326
	399	+	[sixty] twenty days after the date the unit closes the public hearing 327 Raised Bill No. 440
386	400
387	401
388		-	LCO 12 of 20
389	402
390		-	hearing on a properly filed and completed certificate of need application 333
391		-	if three or more individuals or an individual representing an entity with 334
392		-	five or more people submits a request, in writing, that a public hearing 335
393		-	be held on the application. For a properly filed and completed certificate 336
394		-	of need application involving a transfer of ownership of a large group 337
395		-	practice, as described in subdivision (3) of subsection (a) of section 19a-338
396		-	638, when an offer was made in response to a request for proposal or 339
397		-	similar voluntary offer for sale, a public hearing shall be held if twenty-340
398		-	five or more individuals or an individual representing twenty-five or 341
399		-	more people submits a request, in writing, that a public hearing be held 342
400		-	on the application. Any request for a public hearing shall be made to the 343
401		-	unit not later than [thirty] ten days after the date the unit deems the 344
402		-	application to be complete. 345
403		-	(f) (1) The unit shall hold a public hearing with respect to each 346
404		-	certificate of need application filed pursuant to section 19a-638, as 347
405		-	amended by this act, after December 1, 2015, that concerns any transfer 348
406		-	of ownership involving a hospital. Such hearing shall be held in the 349
407		-	municipality in which the hospital that is the subject of the application 350
408		-	is located. 351
409		-	(2) The unit may hold a public hearing with respect to any certificate 352
410		-	of need application submitted under this chapter. The unit shall provide 353
411		-	not less than [two weeks'] five days' advance notice to the applicant, in 354
412		-	writing, and to the public by publication in a newspaper having a 355
413		-	substantial circulation in the area served by the health care facility or 356
414		-	provider. In conducting its activities under this chapter, the unit may 357
415		-	hold hearings with respect to applications of a similar nature at the same 358
416		-	time. The applicant shall post a copy of the unit's hearing notice on the 359
417		-	applicant's Internet web site in a clear and conspicuous location that is 360
418		-	easily accessible by members of the public. Such applicant shall request 361
419		-	the publication of notice in at least two sites within the affected 362
420		-	community that are commonly accessed by the public, such as a town 363
421		-	hall or library, as well as on any existing Internet web site of the 364
422		-	municipality or local health department. The unit shall not invalidate 365
423		-	any notice due to changes or removal of the notice from a community 366 Substitute Bill No. 440
	403	+	LCO No. 2995 12 of 20
	404	+
	405	+	record. If the unit does not issue a decision on the completed 328
	406	+	application, not later than twenty days after such date, the application 329
	407	+	shall be deemed approved. 330
	408	+	(e) Except as provided in this subsection, the unit shall hold a public 331
	409	+	hearing on a properly filed and completed certificate of need application 332
	410	+	if three or more individuals or an individual representing an entity with 333
	411	+	five or more people submits a request, in writing, that a public hearing 334
	412	+	be held on the application. For a properly filed and completed certificate 335
	413	+	of need application involving a transfer of ownership of a large group 336
	414	+	practice, as described in subdivision (3) of subsection (a) of section 19a-337
	415	+	638, when an offer was made in response to a request for proposal or 338
	416	+	similar voluntary offer for sale, a public hearing shall be held if twenty-339
	417	+	five or more individuals or an individual representing twenty-five or 340
	418	+	more people submits a request, in writing, that a public hearing be held 341
	419	+	on the application. Any request for a public hearing shall be made to the 342
	420	+	unit not later than [thirty] ten days after the date the unit deems the 343
	421	+	application to be complete. 344
	422	+	(f) (1) The unit shall hold a public hearing with respect to each 345
	423	+	certificate of need application filed pursuant to section 19a-638, as 346
	424	+	amended by this act, after December 1, 2015, that concerns any transfer 347
	425	+	of ownership involving a hospital. Such hearing shall be held in the 348
	426	+	municipality in which the hospital that is the subject of the application 349
	427	+	is located. 350
	428	+	(2) The unit may hold a public hearing with respect to any certificate 351
	429	+	of need application submitted under this chapter. The unit shall provide 352
	430	+	not less than [two weeks'] five days' advance notice to the applicant, in 353
	431	+	writing, and to the public by publication in a newspaper having a 354
	432	+	substantial circulation in the area served by the health care facility or 355
	433	+	provider. In conducting its activities under this chapter, the unit may 356
	434	+	hold hearings with respect to applications of a similar nature at the same 357
	435	+	time. The applicant shall post a copy of the unit's hearing notice on the 358
	436	+	applicant's Internet web site in a clear and conspicuous location that is 359
	437	+	easily accessible by members of the public. Such applicant shall request 360 Raised Bill No. 440
424	438
425	439
426		-	LCO 13 of 20
427	440
428		-	Internet web site of which the applicant has no control. 367
429		-	(g) An applicant may request an expedited timeline for determination 368
430		-	on a certificate of need application in a form and manner prescribed by 369
431		-	the unit. The unit shall develop a process for approving a request for an 370
432		-	expedited timeline. Notwithstanding the provisions of this section, if the 371
433		-	unit accepts a request for an expedited timeline, a determination shall 372
434		-	be made on the application not more than fourteen days after the date 373
435		-	the completed application is submitted to the unit. 374
436		-	[(g)] (h) (1) For applications submitted on or after October 1, 2023, the 375
437		-	unit may retain an independent consultant with expertise in the specific 376
438		-	area of health care that is the subject of the application filed by an 377
439		-	applicant if the review and analysis of an application cannot reasonably 378
440		-	be conducted by the unit without the expertise of an industry analyst or 379
441		-	other actuarial consultant. The unit shall submit bills for independent 380
442		-	consultant services to the applicant. Such applicant shall pay such bills 381
443		-	not later than thirty days after receipt of such bills. Such bills shall be a 382
444		-	reasonable amount per application. The provisions of chapter 57 and 383
445		-	sections 4-212 to 4-219, inclusive, and 4e-19 shall not apply to any 384
446		-	retainer agreement executed pursuant to this subsection. 385
447		-	(2) For applications submitted on or after October 1, 2024, the unit 386
448		-	may contract with independent consultants or other persons, as deemed 387
449		-	necessary by the executive director of the Office of Health Strategy, to 388
450		-	assist in reviewing and issuing decisions on applications submitted 389
451		-	pursuant to the provisions of this section. Not later than July 1, 2025, 390
452		-	and quarterly thereafter, the executive director of the Office of Health 391
453		-	Strategy shall post all costs incurred as a result of contracts entered into 392
454		-	pursuant to the provisions of this subdivision on the Office of Health 393
455		-	Strategy's Internet web site. 394
456		-	[(h)] (i) The executive director of the Office of Health Strategy may 395
457		-	implement policies and procedures necessary to administer the 396
458		-	provisions of this section while in the process of adopting such policies 397
459		-	and procedures as regulation, provided the executive director holds a 398 Substitute Bill No. 440
	441	+	LCO No. 2995 13 of 20
	442	+
	443	+	the publication of notice in at least two sites within the affected 361
	444	+	community that are commonly accessed by the public, such as a town 362
	445	+	hall or library, as well as on any existing Internet web site of the 363
	446	+	municipality or local health department. The unit shall not invalidate 364
	447	+	any notice due to changes or removal of the notice from a community 365
	448	+	Internet web site of which the applicant has no control. 366
	449	+	(g) An applicant may request an expedited timeline for determination 367
	450	+	on a certificate of need application in a form and manner prescribed by 368
	451	+	the unit. The unit shall develop a process for approving a request for an 369
	452	+	expedited timeline. Notwithstanding the provisions of this section, if the 370
	453	+	unit accepts a request for an expedited timeline, a determination shall 371
	454	+	be made on the application not more than fourteen days after the date 372
	455	+	the completed application is submitted to the unit. 373
	456	+	[(g)] (h) (1) For applications submitted on or after October 1, 2023, the 374
	457	+	unit may retain an independent consultant with expertise in the specific 375
	458	+	area of health care that is the subject of the application filed by an 376
	459	+	applicant if the review and analysis of an application cannot reasonably 377
	460	+	be conducted by the unit without the expertise of an industry analyst or 378
	461	+	other actuarial consultant. The unit shall submit bills for independent 379
	462	+	consultant services to the applicant. Such applicant shall pay such bills 380
	463	+	not later than thirty days after receipt of such bills. Such bills shall be a 381
	464	+	reasonable amount per application. The provisions of chapter 57 and 382
	465	+	sections 4-212 to 4-219, inclusive, and 4e-19 shall not apply to any 383
	466	+	retainer agreement executed pursuant to this subsection. 384
	467	+	(2) For applications submitted on or after October 1, 2024, the unit 385
	468	+	may contract with independent consultants or other persons, as deemed 386
	469	+	necessary by the executive director of the Office of Health Strategy, to 387
	470	+	assist in reviewing and issuing decisions on applications submitted 388
	471	+	pursuant to the provisions of this section. Not later than July 1, 2025, 389
	472	+	and quarterly thereafter, the executive director of the Office of Health 390
	473	+	Strategy shall post all costs incurred as a result of contracts entered into 391
	474	+	pursuant to the provisions of this subdivision on the Office of Health 392
	475	+	Strategy's Internet web site. 393 Raised Bill No. 440
460	476
461	477
462		-	LCO 14 of 20
463	478
464		-	public hearing prior to implementing the policies and procedures and 399
465		-	posts notice of intent to adopt regulations on the office's Internet web 400
466		-	site and the eRegulations System not later than twenty days after the 401
467		-	date of implementation. Policies and procedures implemented pursuant 402
468		-	to this section shall be valid until the time final regulations are adopted. 403
469		-	Sec. 3. (Effective from passage) The executive director of the Office of 404
470		-	Health Strategy shall conduct a study regarding the certificate of need 405
471		-	process in the state. Such study shall include, but need not be limited to, 406
472		-	(1) an examination of the cost to health care systems resulting from 407
473		-	delays or inefficiencies in the certificate of need process, (2) not less than 408
474		-	three public hearings convened by the executive director that allow 409
475		-	providers, insurers, the public and other stakeholders to provide 410
476		-	testimony regarding the certificate of need process, and (3) the 411
477		-	development of recommendations to improve the certificate of need 412
478		-	process by reducing delays, streamlining administrative processes and 413
479		-	hiring trained, experienced staff in lieu of contracting with third-party 414
480		-	experts. Not later than January 1, 2025, the executive director shall 415
481		-	report, in accordance with section 11-4a of the general statutes, to the 416
482		-	joint standing committee of the General Assembly having cognizance of 417
483		-	matters relating to public health regarding the results of such study. 418
484		-	Sec. 4. Section 19a-639f of the general statutes is repealed and the 419
485		-	following is substituted in lieu thereof (Effective October 1, 2024): 420
486		-	(a) The [Health Systems Planning Unit of the Office of Health 421
487		-	Strategy] office of the Attorney General shall conduct a cost and market 422
488		-	impact review in each case where (1) an application for a certificate of 423
489		-	need filed pursuant to section 19a-638, as amended by this act, involves 424
490		-	the transfer of ownership of a hospital, as defined in section 19a-639, and 425
491		-	(2) the purchaser is a hospital, as defined in section 19a-490, whether 426
492		-	located within or outside the state, that had net patient revenue for fiscal 427
493		-	year 2013 in an amount greater than one billion five hundred million 428
494		-	dollars, or a hospital system, as defined in section 19a-486i, whether 429
495		-	located within or outside the state, that had net patient revenue for fiscal 430
496		-	year 2013 in an amount greater than one billion five hundred million 431 Substitute Bill No. 440
	479	+	LCO No. 2995 14 of 20
	480	+
	481	+	[(h)] (i) The executive director of the Office of Health Strategy may 394
	482	+	implement policies and procedures necessary to administer the 395
	483	+	provisions of this section while in the process of adopting such policies 396
	484	+	and procedures as regulation, provided the executive director holds a 397
	485	+	public hearing prior to implementing the policies and procedures and 398
	486	+	posts notice of intent to adopt regulations on the office's Internet web 399
	487	+	site and the eRegulations System not later than twenty days after the 400
	488	+	date of implementation. Policies and procedures implemented pursuant 401
	489	+	to this section shall be valid until the time final regulations are adopted. 402
	490	+	Sec. 3. (Effective from passage) The executive director of the Office of 403
	491	+	Health Strategy shall conduct a study regarding the certificate of need 404
	492	+	process in the state. Such study shall include, but need not be limited to, 405
	493	+	(1) an examination of the cost to health care systems resulting from 406
	494	+	delays or inefficiencies in the certificate of need process, (2) not less than 407
	495	+	three public hearings convened by the executive director that allow 408
	496	+	providers, insurers, the public and other stakeholders to provide 409
	497	+	testimony regarding the certificate of need process, and (3) the 410
	498	+	development of recommendations to improve the certificate of need 411
	499	+	process by reducing delays, streamlining administrative processes and 412
	500	+	hiring trained, experienced staff in lieu of contracting with third-party 413
	501	+	experts. Not later than January 1, 2025, the executive director shall 414
	502	+	report, in accordance with section 11-4a of the general statutes, to the 415
	503	+	joint standing committee of the General Assembly having cognizance of 416
	504	+	matters relating to public health regarding the results of such study. 417
	505	+	Sec. 4. Section 19a-639f of the general statutes is repealed and the 418
	506	+	following is substituted in lieu thereof (Effective October 1, 2024): 419
	507	+	(a) The [Health Systems Planning Unit of the Office of Health 420
	508	+	Strategy] office of the Attorney General shall conduct a cost and market 421
	509	+	impact review in each case where (1) an application for a certificate of 422
	510	+	need filed pursuant to section 19a-638, as amended by this act, involves 423
	511	+	the transfer of ownership of a hospital, as defined in section 19a-639, and 424
	512	+	(2) the purchaser is a hospital, as defined in section 19a-490, whether 425
	513	+	located within or outside the state, that had net patient revenue for fiscal 426 Raised Bill No. 440
497	514
498	515
499		-	LCO 15 of 20
500	516
501		-	dollars or any person that is organized or operated for profit. 432
502		-	(b) Not later than twenty-one days after receipt of a properly filed 433
503		-	certificate of need application involving the transfer of ownership of a 434
504		-	hospital filed on or after December 1, 2015, as described in subsection 435
505		-	(a) of this section, the unit shall notify the office of the Attorney General 436
506		-	of the need for the cost and market impact review. The Attorney General 437
507		-	shall initiate such cost and market impact review by sending the 438
508		-	transacting parties a written notice that shall contain a description of the 439
509		-	basis for the cost and market impact review as well as a request for 440
510		-	information and documents. Not later than thirty days after receipt of 441
511		-	such notice, the transacting parties shall submit to the [unit] Attorney 442
512		-	General a written response. Such response shall include, but need not 443
513		-	be limited to, any information or documents requested by the [unit] 444
514		-	Attorney General concerning the transfer of ownership of the hospital. 445
515		-	The [unit] Attorney General shall have the powers with respect to the 446
516		-	cost and market impact review as provided in section 19a-633. 447
517		-	(c) The [unit] Attorney General shall keep confidential all nonpublic 448
518		-	information and documents obtained pursuant to this section and shall 449
519		-	not disclose the information or documents to any person without the 450
520		-	consent of the person that produced the information or documents, 451
521		-	except in a preliminary report or final report issued in accordance with 452
522		-	this section if the [unit] Attorney General believes that such disclosure 453
523		-	should be made in the public interest after taking into account any 454
524		-	privacy, trade secret or anti-competitive considerations. Such 455
525		-	information and documents shall not be deemed a public record, under 456
526		-	section 1-210, and shall be exempt from disclosure. 457
527		-	(d) The cost and market impact review conducted pursuant to this 458
528		-	section shall examine factors relating to the businesses and relative 459
529		-	market positions of the transacting parties as defined in subsection (d) 460
530		-	of section 19a-639 and may include, but need not be limited to: (1) The 461
531		-	transacting parties' size and market share within its primary service 462
532		-	area, by major service category and within its dispersed service areas; 463
533		-	(2) the transacting parties' prices for services, including the transacting 464 Substitute Bill No. 440
	517	+	LCO No. 2995 15 of 20
	518	+
	519	+	year 2013 in an amount greater than one billion five hundred million 427
	520	+	dollars, or a hospital system, as defined in section 19a-486i, whether 428
	521	+	located within or outside the state, that had net patient revenue for fiscal 429
	522	+	year 2013 in an amount greater than one billion five hundred million 430
	523	+	dollars or any person that is organized or operated for profit. 431
	524	+	(b) Not later than twenty-one days after receipt of a properly filed 432
	525	+	certificate of need application involving the transfer of ownership of a 433
	526	+	hospital filed on or after December 1, 2015, as described in subsection 434
	527	+	(a) of this section, the unit shall notify the office of the Attorney General 435
	528	+	of the need for the cost and market impact review. The Attorney General 436
	529	+	shall initiate such cost and market impact review by sending the 437
	530	+	transacting parties a written notice that shall contain a description of the 438
	531	+	basis for the cost and market impact review as well as a request for 439
	532	+	information and documents. Not later than thirty days after receipt of 440
	533	+	such notice, the transacting parties shall submit to the [unit] Attorney 441
	534	+	General a written response. Such response shall include, but need not 442
	535	+	be limited to, any information or documents requested by the [unit] 443
	536	+	Attorney General concerning the transfer of ownership of the hospital. 444
	537	+	The [unit] Attorney General shall have the powers with respect to the 445
	538	+	cost and market impact review as provided in section 19a-633. 446
	539	+	(c) The [unit] Attorney General shall keep confidential all nonpublic 447
	540	+	information and documents obtained pursuant to this section and shall 448
	541	+	not disclose the information or documents to any person without the 449
	542	+	consent of the person that produced the information or documents, 450
	543	+	except in a preliminary report or final report issued in accordance with 451
	544	+	this section if the [unit] Attorney General believes that such disclosure 452
	545	+	should be made in the public interest after taking into account any 453
	546	+	privacy, trade secret or anti-competitive considerations. Such 454
	547	+	information and documents shall not be deemed a public record, under 455
	548	+	section 1-210, and shall be exempt from disclosure. 456
	549	+	(d) The cost and market impact review conducted pursuant to this 457
	550	+	section shall examine factors relating to the businesses and relative 458
	551	+	market positions of the transacting parties as defined in subsection (d) 459 Raised Bill No. 440
534	552
535	553
536		-	LCO 16 of 20
537	554
538		-	parties' relative prices compared to other health care providers for the 465
539		-	same services in the same market; (3) the transacting parties' health 466
540		-	status adjusted total medical expense, including the transacting parties' 467
541		-	health status adjusted total medical expense compared to that of similar 468
542		-	health care providers; (4) the quality of the services provided by the 469
543		-	transacting parties, including patient experience; (5) the transacting 470
544		-	parties' cost and cost trends in comparison to total health care 471
545		-	expenditures state wide; (6) the availability and accessibility of services 472
546		-	similar to those provided by each transacting party, or proposed to be 473
547		-	provided as a result of the transfer of ownership of a hospital within 474
548		-	each transacting party's primary service areas and dispersed service 475
549		-	areas; (7) the impact of the proposed transfer of ownership of the 476
550		-	hospital on competing options for the delivery of health care services 477
551		-	within each transacting party's primary service area and dispersed 478
552		-	service area including the impact on existing service providers; (8) the 479
553		-	methods used by the transacting parties to attract patient volume and to 480
554		-	recruit or acquire health care professionals or facilities; (9) the role of 481
555		-	each transacting party in serving at-risk, underserved and government 482
556		-	payer patient populations, including those with behavioral, substance 483
557		-	use disorder and mental health conditions, within each transacting 484
558		-	party's primary service area and dispersed service area; (10) the role of 485
559		-	each transacting party in providing low margin or negative margin 486
560		-	services within each transacting party's primary service area and 487
561		-	dispersed service area; (11) consumer concerns, including, but not 488
562		-	limited to, complaints or other allegations that a transacting party has 489
563		-	engaged in any unfair method of competition or any unfair or deceptive 490
564		-	act or practice; and (12) any other factors that the [unit] Attorney 491
565		-	General determines to be in the public interest. 492
566		-	(e) Not later than ninety days after the [unit] Attorney General 493
567		-	determines that there is substantial compliance with any request for 494
568		-	documents or information issued by the [unit] Attorney General in 495
569		-	accordance with this section, or a later date set by mutual agreement of 496
570		-	the unit and the transacting parties, the [unit] Attorney General shall 497
571		-	make factual findings and issue a preliminary report on the cost and 498 Substitute Bill No. 440
	555	+	LCO No. 2995 16 of 20
	556	+
	557	+	of section 19a-639 and may include, but need not be limited to: (1) The 460
	558	+	transacting parties' size and market share within its primary service 461
	559	+	area, by major service category and within its dispersed service areas; 462
	560	+	(2) the transacting parties' prices for services, including the transacting 463
	561	+	parties' relative prices compared to other health care providers for the 464
	562	+	same services in the same market; (3) the transacting parties' health 465
	563	+	status adjusted total medical expense, including the transacting parties' 466
	564	+	health status adjusted total medical expense compared to that of similar 467
	565	+	health care providers; (4) the quality of the services provided by the 468
	566	+	transacting parties, including patient experience; (5) the transacting 469
	567	+	parties' cost and cost trends in comparison to total health care 470
	568	+	expenditures state wide; (6) the availability and accessibility of services 471
	569	+	similar to those provided by each transacting party, or proposed to be 472
	570	+	provided as a result of the transfer of ownership of a hospital within 473
	571	+	each transacting party's primary service areas and dispersed service 474
	572	+	areas; (7) the impact of the proposed transfer of ownership of the 475
	573	+	hospital on competing options for the delivery of health care services 476
	574	+	within each transacting party's primary service area and dispersed 477
	575	+	service area including the impact on existing service providers; (8) the 478
	576	+	methods used by the transacting parties to attract patient volume and to 479
	577	+	recruit or acquire health care professionals or facilities; (9) the role of 480
	578	+	each transacting party in serving at-risk, underserved and government 481
	579	+	payer patient populations, including those with behavioral, substance 482
	580	+	use disorder and mental health conditions, within each transacting 483
	581	+	party's primary service area and dispersed service area; (10) the role of 484
	582	+	each transacting party in providing low margin or negative margin 485
	583	+	services within each transacting party's primary service area and 486
	584	+	dispersed service area; (11) consumer concerns, including, but not 487
	585	+	limited to, complaints or other allegations that a transacting party has 488
	586	+	engaged in any unfair method of competition or any unfair or deceptive 489
	587	+	act or practice; and (12) any other factors that the [unit] Attorney 490
	588	+	General determines to be in the public interest. 491
	589	+	(e) Not later than ninety days after the [unit] Attorney General 492
	590	+	determines that there is substantial compliance with any request for 493 Raised Bill No. 440
572	591
573	592
574		-	LCO 17 of 20
575	593
576		-	market impact review. Such preliminary report shall include, but shall 499
577		-	not be limited to, an indication as to whether a transacting party meets 500
578		-	the following criteria: (1) Currently has or, following the proposed 501
579		-	transfer of operations of the hospital, is likely to have a dominant market 502
580		-	share for the services the transacting party provides; and (2) (A) 503
581		-	currently charges or, following the proposed transfer of operations of 504
582		-	the hospital, is likely to charge prices for services that are materially 505
583		-	higher than the median prices charged by all other health care providers 506
584		-	for the same services in the same market, or (B) currently has or, 507
585		-	following the proposed transfer of operations of a hospital, is likely to 508
586		-	have a health status adjusted total medical expense that is materially 509
587		-	higher than the median total medical expense for all other health care 510
588		-	providers for the same service in the same market. 511
589		-	(f) The transacting parties that are the subject of the cost and market 512
590		-	impact review may respond in writing to the findings in the preliminary 513
591		-	report issued in accordance with subsection (e) of this section not later 514
592		-	than thirty days after the issuance of the preliminary report. Not later 515
593		-	than sixty days after the issuance of the preliminary report, the [unit] 516
594		-	Attorney General shall issue a final report of the cost and market impact 517
595		-	review. [The unit shall refer to the Attorney General any final report on 518
596		-	any proposed transfer of ownership that meets the criteria described in 519
597		-	subsection (e) of this section.] 520
598		-	(g) Nothing in this section shall prohibit a transfer of ownership of a 521
599		-	hospital, provided any such proposed transfer shall not be completed 522
600		-	(1) less than thirty days after the [unit] Attorney General has issued a 523
601		-	final report on a cost and market impact review, if such review is 524
602		-	required, or (2) while any action brought by the Attorney General 525
603		-	pursuant to subsection (h) of this section is pending and before a final 526
604		-	judgment on such action is issued by a court of competent jurisdiction. 527
605		-	(h) After the [unit refers a final report on a transfer of ownership of a 528
606		-	hospital to the Attorney General under subsection (f) of this section] 529
607		-	Attorney General has issued a final report on the cost and market impact 530
608		-	review, the Attorney General may: (1) Conduct an investigation to 531 Substitute Bill No. 440
	594	+	LCO No. 2995 17 of 20
	595	+
	596	+	documents or information issued by the [unit] Attorney General in 494
	597	+	accordance with this section, or a later date set by mutual agreement of 495
	598	+	the unit and the transacting parties, the [unit] Attorney General shall 496
	599	+	make factual findings and issue a preliminary report on the cost and 497
	600	+	market impact review. Such preliminary report shall include, but shall 498
	601	+	not be limited to, an indication as to whether a transacting party meets 499
	602	+	the following criteria: (1) Currently has or, following the proposed 500
	603	+	transfer of operations of the hospital, is likely to have a dominant market 501
	604	+	share for the services the transacting party provides; and (2) (A) 502
	605	+	currently charges or, following the proposed transfer of operations of 503
	606	+	the hospital, is likely to charge prices for services that are materially 504
	607	+	higher than the median prices charged by all other health care providers 505
	608	+	for the same services in the same market, or (B) currently has or, 506
	609	+	following the proposed transfer of operations of a hospital, is likely to 507
	610	+	have a health status adjusted total medical expense that is materially 508
	611	+	higher than the median total medical expense for all other health care 509
	612	+	providers for the same service in the same market. 510
	613	+	(f) The transacting parties that are the subject of the cost and market 511
	614	+	impact review may respond in writing to the findings in the preliminary 512
	615	+	report issued in accordance with subsection (e) of this section not later 513
	616	+	than thirty days after the issuance of the preliminary report. Not later 514
	617	+	than sixty days after the issuance of the preliminary report, the [unit] 515
	618	+	Attorney General shall issue a final report of the cost and market impact 516
	619	+	review. [The unit shall refer to the Attorney General any final report on 517
	620	+	any proposed transfer of ownership that meets the criteria described in 518
	621	+	subsection (e) of this section.] 519
	622	+	(g) Nothing in this section shall prohibit a transfer of ownership of a 520
	623	+	hospital, provided any such proposed transfer shall not be completed 521
	624	+	(1) less than thirty days after the [unit] Attorney General has issued a 522
	625	+	final report on a cost and market impact review, if such review is 523
	626	+	required, or (2) while any action brought by the Attorney General 524
	627	+	pursuant to subsection (h) of this section is pending and before a final 525
	628	+	judgment on such action is issued by a court of competent jurisdiction. 526 Raised Bill No. 440
609	629
610	630
611		-	LCO 18 of 20
612	631
613		-	determine whether the transacting parties engaged, or, as a result of 532
614		-	completing the transfer of ownership of the hospital, are expected to 533
615		-	engage in unfair methods of competition, anti-competitive behavior or 534
616		-	other conduct in violation of chapter 624 or 735a or any other state or 535
617		-	federal law; and (2) if appropriate, take action under chapter 624 or 735a 536
618		-	or any other state law to protect consumers in the health care market. 537
619		-	The [unit's] final cost and market impact review report may be evidence 538
620		-	in any such action. 539
621		-	(i) For the purposes of this section, the provisions of chapter 735a may 540
622		-	be directly enforced by the Attorney General. Nothing in this section 541
623		-	shall be construed to modify, impair or supersede the operation of any 542
624		-	state antitrust law or otherwise limit the authority of the Attorney 543
625		-	General to (1) take any action against a transacting party as authorized 544
626		-	by any law, or (2) protect consumers in the health care market under any 545
627		-	law. Notwithstanding subdivision (1) of subsection (a) of section 42-546
628		-	110c, the transacting parties shall be subject to chapter 735a. 547
629		-	(j) The [unit] Attorney General shall retain an independent consultant 548
630		-	with expertise on the economic analysis of the health care market and 549
631		-	health care costs and prices to conduct each cost and market impact 550
632		-	review, as described in this section. The [unit] transacting parties shall 551
633		-	submit three proposed independent consultants to the Attorney 552
634		-	General, who shall select one such independent consultant to conduct 553
635		-	the cost and market impact review. The Attorney General shall submit 554
636		-	bills for such services to the purchaser, as defined in subsection (d) of 555
637		-	section 19a-639. Such purchaser shall pay such bills not later than thirty 556
638		-	days after receipt. Such bills shall not exceed two hundred thousand 557
639		-	dollars per application. The provisions of chapter 57, sections 4-212 to 4-558
640		-	219, inclusive, and section 4e-19 shall not apply to any agreement 559
641		-	executed pursuant to this subsection. 560
642		-	(k) Any employee of the unit who [directly oversees or] assists in 561
643		-	conducting a cost and market impact review shall not take part in factual 562
644		-	deliberations or the issuance of a preliminary or final decision on the 563
645		-	certificate of need application concerning the transfer of ownership of a 564 Substitute Bill No. 440
	632	+	LCO No. 2995 18 of 20
	633	+
	634	+	(h) After the [unit refers a final report on a transfer of ownership of a 527
	635	+	hospital to the Attorney General under subsection (f) of this section] 528
	636	+	Attorney General has issued a final report on the cost and market impact 529
	637	+	review, the Attorney General may: (1) Conduct an investigation to 530
	638	+	determine whether the transacting parties engaged, or, as a result of 531
	639	+	completing the transfer of ownership of the hospital, are expected to 532
	640	+	engage in unfair methods of competition, anti-competitive behavior or 533
	641	+	other conduct in violation of chapter 624 or 735a or any other state or 534
	642	+	federal law; and (2) if appropriate, take action under chapter 624 or 735a 535
	643	+	or any other state law to protect consumers in the health care market. 536
	644	+	The [unit's] final cost and market impact review report may be evidence 537
	645	+	in any such action. 538
	646	+	(i) For the purposes of this section, the provisions of chapter 735a may 539
	647	+	be directly enforced by the Attorney General. Nothing in this section 540
	648	+	shall be construed to modify, impair or supersede the operation of any 541
	649	+	state antitrust law or otherwise limit the authority of the Attorney 542
	650	+	General to (1) take any action against a transacting party as authorized 543
	651	+	by any law, or (2) protect consumers in the health care market under any 544
	652	+	law. Notwithstanding subdivision (1) of subsection (a) of section 42-545
	653	+	110c, the transacting parties shall be subject to chapter 735a. 546
	654	+	(j) The [unit] Attorney General shall retain an independent consultant 547
	655	+	with expertise on the economic analysis of the health care market and 548
	656	+	health care costs and prices to conduct each cost and market impact 549
	657	+	review, as described in this section. The transacting parties shall submit 550
	658	+	three proposed independent consultants to the Attorney General, who 551
	659	+	shall select one such independent consultant to conduct the cost and 552
	660	+	market impact review. The [unit] Attorney General shall submit bills for 553
	661	+	such services to the purchaser, as defined in subsection (d) of section 554
	662	+	19a-639. Such purchaser shall pay such bills not later than thirty days 555
	663	+	after receipt. Such bills shall not exceed two hundred thousand dollars 556
	664	+	per application. The provisions of chapter 57, sections 4-212 to 4-219, 557
	665	+	inclusive, and section 4e-19 shall not apply to any agreement executed 558
	666	+	pursuant to this subsection. 559 Raised Bill No. 440
646	667
647	668
648		-	LCO 19 of 20
649	669
650		-	hospital that is the subject of such cost and market impact review. 565
651		-	(l) The executive director of the Office of Health Strategy shall adopt 566
652		-	regulations, in accordance with the provisions of chapter 54, concerning 567
653		-	cost and market impact reviews and to administer the provisions of this 568
654		-	section. Such regulations shall include definitions of the following 569
655		-	terms: "Dispersed service area", "health status adjusted total medical 570
656		-	expense", "major service category", "relative prices", "total health care 571
657		-	spending" and "health care services". The executive director may 572
658		-	implement policies and procedures necessary to administer the 573
659		-	provisions of this section while in the process of adopting such policies 574
660		-	and procedures in regulation form, provided the executive director 575
661		-	publishes notice of intention to adopt the regulations on the office's 576
662		-	Internet web site and the eRegulations System not later than twenty 577
663		-	days after implementing such policies and procedures. Policies and 578
664		-	procedures implemented pursuant to this subsection shall be valid until 579
665		-	the time such regulations are effective. 580
666		-	Sec. 5. (NEW) (Effective October 1, 2024) On and after October 1, 2024, 581
667		-	an insurance company that invests in any institution, as defined in 582
668		-	section 19a-490 of the general statutes, shall not exercise operational 583
669		-	control, managerial control or decision-making authority relating to the 584
670		-	institution's delivery of health care services. 585
	670	+	LCO No. 2995 19 of 20
	671	+
	672	+	(k) Any employee of the unit who [directly oversees or] assists in 560
	673	+	conducting a cost and market impact review shall not take part in factual 561
	674	+	deliberations or the issuance of a preliminary or final decision on the 562
	675	+	certificate of need application concerning the transfer of ownership of a 563
	676	+	hospital that is the subject of such cost and market impact review. 564
	677	+	(l) The executive director of the Office of Health Strategy shall adopt 565
	678	+	regulations, in accordance with the provisions of chapter 54, concerning 566
	679	+	cost and market impact reviews and to administer the provisions of this 567
	680	+	section. Such regulations shall include definitions of the following 568
	681	+	terms: "Dispersed service area", "health status adjusted total medical 569
	682	+	expense", "major service category", "relative prices", "total health care 570
	683	+	spending" and "health care services". The executive director may 571
	684	+	implement policies and procedures necessary to administer the 572
	685	+	provisions of this section while in the process of adopting such policies 573
	686	+	and procedures in regulation form, provided the executive director 574
	687	+	publishes notice of intention to adopt the regulations on the office's 575
	688	+	Internet web site and the eRegulations System not later than twenty 576
	689	+	days after implementing such policies and procedures. Policies and 577
	690	+	procedures implemented pursuant to this subsection shall be valid until 578
	691	+	the time such regulations are effective. 579
	692	+	Sec. 5. (NEW) (Effective October 1, 2024) On and after October 1, 2024, 580
	693	+	an insurance company that invests in any institution, as defined in 581
	694	+	section 19a-490 of the general statutes, shall not exercise operational 582
	695	+	control, managerial control or decision-making authority relating to the 583
	696	+	institution's delivery of health care services. 584
671	697		This act shall take effect as follows and shall amend the following
672	698		sections:
673	699
674	700		Section 1 October 1, 2024 19a-638
675	701		Sec. 2 October 1, 2024 19a-639a
676	702		Sec. 3 from passage New section
677	703		Sec. 4 October 1, 2024 19a-639f
678	704		Sec. 5 October 1, 2024 New section
679		-
680		-	Statement of Legislative Commissioners:
681		-	In Section 1(a)(16), ", except as provided in subdivision (27) of
682		-	subsection (b) of this section" was added for clarity and consistency with
683		-	other provisions of the section.
684		-	Substitute Bill No. 440
	705	+	Raised Bill No. 440
685	706
686	707
687		-	LCO 20 of 20
688	708
689		-	PH Joint Favorable Subst. -LCO
	709	+	LCO No. 2995 20 of 20
	710	+
	711	+	Statement of Purpose:
	712	+	To make various revisions to the certificate of need process.
	713	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	714	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	715	+	underlined.]
690	716