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General Assembly Raised Bill No. 7050
January Session, 2025
LCO No. 5120
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT CONCERNING THE OFFICE OF HEALTH STRATEGY'S
RECOMMENDATIONS REGARDING THE CERTIFICATE OF NEED
PROGRAM.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-643 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective October 1, 2025): 2
(a) The Office of Health Strategy shall adopt regulations, in 3
accordance with the provisions of chapter 54, to carry out the provisions 4
of sections 19a-630 to 19a-639e, inclusive, as amended by this act, and 5
sections 19a-644 and 19a-645 concerning the submission of data by 6
health care facilities and institutions, including data on dealings 7
between health care facilities and institutions and their affiliates, and, 8
with regard to requests or proposals pursuant to sections 19a-638 to 19a-9
639e, inclusive, as amended by this act, by state health care facilities and 10
institutions, the ongoing inspections by the unit of operating budgets 11
that have been approved by the health care facilities and institutions, 12
standard reporting forms and standard accounting procedures to be 13
utilized by health care facilities and institutions and the transferability 14 Raised Bill No. 7050
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of line items in the approved operating budgets of the health care 15
facilities and institutions, except that any health care facility or 16
institution may transfer any amounts among items in its operating 17
budget. All such transfers shall be reported to the unit not later than 18
thirty days after the transfer or transfers. 19
(b) The [Office] Commissioner of Health Strategy may adopt such 20
regulations, in accordance with the provisions of chapter 54, as are 21
necessary to implement this chapter. The commissioner may implement 22
policies and procedures necessary to administer the provisions of this 23
section while in the process of adopting such policies and procedures as 24
regulations, provided the commissioner holds a public hearing on such 25
policies and procedures not less than thirty days before implementing 26
such policies and procedures and publishes notice of intention to adopt 27
regulations on the Office of Health Strategy's Internet web site and the 28
eRegulations System not later than twenty days after implementing 29
such policies and procedures. Policies and procedures implemented 30
pursuant to this subsection shall be valid until the time final regulations 31
are adopted in accordance with the provisions of chapter 54. 32
Sec. 2. Subdivision (15) of section 19a-630 of the general statutes is 33
repealed and the following is substituted in lieu thereof (Effective from 34
passage): 35
(15) "Termination of services" means the cessation of any services for 36
(A) a [period] combined total of greater than one hundred eighty days 37
within any consecutive two-year period, or (B) a period of thirty 38
consecutive days or more. 39
Sec. 3. Subdivision (11) of subsection (a) of section 19a-638 of the 40
general statutes is repealed and the following is substituted in lieu 41
thereof (Effective October 1, 2025): 42
(11) The acquisition of a proton radiotherapy machine or nonhospital 43
based linear [accelerators] accelerator, except a certificate of need issued 44
by the unit shall not be required where such machine or accelerator is a 45
replacement for [an] a machine or accelerator that was previously 46 Raised Bill No. 7050
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acquired through certificate of need approval or a certificate of need 47
determination; 48
Sec. 4. Subsection (d) of section 19a-639 of the general statutes is 49
repealed and the following is substituted in lieu thereof (Effective July 1, 50
2025): 51
(d) (1) For purposes of this subsection and subsection (e) of this 52
section: 53
(A) "Affected community" means a municipality where a hospital is 54
physically located or a municipality whose inhabitants are regularly 55
served by a hospital; 56
(B) "Hospital" has the same meaning as provided in section 19a-490; 57
(C) "New hospital" means a hospital as it exists after the approval of 58
an agreement pursuant to section 19a-486b or a certificate of need 59
application for a transfer of ownership of a hospital; 60
(D) "Purchaser" means a person who is acquiring, or has acquired, 61
any assets of a hospital through a transfer of ownership of a hospital; 62
(E) "Transacting party" means a purchaser and any person who is a 63
party to a proposed agreement for transfer of ownership of a hospital; 64
(F) "Transfer" means to sell, transfer, lease, exchange, option, convey, 65
give or otherwise dispose of or transfer control over, including, but not 66
limited to, transfer by way of merger or joint venture not in the ordinary 67
course of business; and 68
(G) "Transfer of ownership of a hospital" means a transfer that 69
impacts or changes the governance or controlling body of a hospital, 70
including, but not limited to, all affiliations, mergers or any sale or 71
transfer of net assets of a hospital and for which a certificate of need 72
application or a certificate of need determination letter is filed on or after 73
December 1, 2015. 74 Raised Bill No. 7050
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(2) In any deliberations involving a certificate of need application 75
filed pursuant to section 19a-638, as amended by this act, that involves 76
the transfer of ownership of a hospital, the unit shall, in addition to the 77
guidelines and principles set forth in subsection (a) of this section and 78
those prescribed through regulation pursuant to subsection (c) of this 79
section, take into consideration and make written findings concerning 80
each of the following guidelines and principles: 81
(A) Whether the applicant fairly considered alternative proposals or 82
offers in light of the purpose of maintaining health care provider 83
diversity and consumer choice in the health care market and access to 84
affordable quality health care for the affected community; and 85
(B) Whether the plan submitted pursuant to section 19a-639a, as 86
amended by this act, demonstrates, in a manner consistent with this 87
chapter, how health care services will be provided by the new hospital 88
for the first three years following the transfer of ownership of the 89
hospital, including any consolidation, reduction, elimination or 90
expansion of existing services or introduction of new services. 91
(3) The unit shall deny any certificate of need application involving a 92
transfer of ownership of a hospital unless the commissioner finds that 93
the affected community will be assured of continued access to high 94
quality and affordable health care after accounting for any proposed 95
change impacting hospital staffing. 96
(4) The unit may deny any certificate of need application involving a 97
transfer of ownership of a hospital subject to a cost and market impact 98
review pursuant to section 19a-639f, as amended by this act, if the 99
commissioner finds that (A) the affected community will not be assured 100
of continued access to high quality and affordable health care after 101
accounting for any consolidation in the hospital and health care market 102
that may lessen health care provider diversity, consumer choice and 103
access to care, and (B) any likely increases in the prices for health care 104
services or total health care spending in the state may negatively impact 105
the affordability of care. 106 Raised Bill No. 7050
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(5) The unit may place any conditions on the approval of a certificate 107
of need application involving a transfer of ownership of a hospital 108
consistent with the provisions of this chapter. Before placing any such 109
conditions, the unit shall weigh the value of such conditions in 110
promoting the purposes of this chapter against the individual and 111
cumulative burden of such conditions on the transacting parties and the 112
new hospital. For each condition imposed, the unit shall include a 113
concise statement of the legal and factual basis for such condition and 114
the provision or provisions of this chapter that it is intended to promote. 115
Each condition shall be reasonably tailored in time and scope. The 116
transacting parties or the new hospital shall have the right to make a 117
request to the unit for an amendment to, or relief from, any condition 118
based on changed circumstances, hardship or for other good cause. 119
(6) In any deliberations involving a certificate of need application 120
filed pursuant to section 19a-638, as amended by this act, that involves 121
the transfer of ownership of a hospital and is subject to a cost and market 122
impact review, the unit may consider the preliminary report, response 123
to the preliminary report, final report and any written comments from 124
the parties regarding the reports issued or submitted as part of the 125
review. 126
Sec. 5. Section 19a-639a of the general statutes is amended by adding 127
subsection (i) as follows (Effective July 1, 2025): 128
(NEW) (i) (1) Notwithstanding the provisions of this section, the unit 129
may develop and implement an expedited certificate of need review 130
process for (A) certificate of need applications for (i) a service, facility or 131
equipment identified as having a significant unmet need in the 132
geographic region of the applicant in the most recently published final 133
version of the state-wide health care facilities and services plan, 134
established pursuant to section 19a-634, (ii) the acquisition of a 135
computed tomography scanner or magnetic resonance imaging scanner, 136
and (B) any other category of certificate of need application under 137
subsection (a) of section 19a-638, as amended by this act, that the unit 138
designates as eligible to request expedited review, provided the 139 Raised Bill No. 7050
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applicant, pursuant to subdivision (2) of this subsection, (i) requests an 140
expedited review of a certificate of need application, and (ii) clearly 141
demonstrates that the subject of the application addresses a significant 142
unmet need in the service area of the applicant. The unit shall issue a 143
decision on any certificate of need application eligible for expedited 144
review pursuant to the provisions of this subdivision not more than 145
thirty days after the unit receives an applicant's complete certificate of 146
need application. 147
(2) An expedited certificate of need applicant may request, in a form 148
and manner prescribed by the Commissioner of Health Strategy, an 149
expedited review of a certificate of need application pursuant to 150
subparagraph (B) of subdivision (1) of this subsection. Such request 151
shall include, but need not be limited to, (A) a description of the target 152
population to be served by the subject of the certificate of need 153
application, (B) a clear demonstration of a significant unmet need for the 154
subject of the certificate of need application in the geographic region of 155
the applicant based on patient demographics, diagnoses, utilization or 156
other recent data, and (C) a description of the availability of the subject 157
of the certificate of need application in the primary service area of the 158
applicant. The unit shall determine whether an applicant who requests 159
an expedited review pursuant to the provisions of this subdivision is 160
eligible for such expedited review not more than thirty days after the 161
date that the unit receives the applicant's request. 162
(3) Notwithstanding the provisions of this section, the expedited 163
certificate of need review process established pursuant to the provisions 164
of this subsection shall (A) allow the unit to resolve an expedited 165
certificate of need application by (i) agreed settlement with the 166
applicant, (ii) making a determination approving the expedited 167
certificate of need application with or without conditions, or (iii) 168
requiring the applicant to submit a certificate of need application 169
pursuant to the provisions of subsections (a) to (f), inclusive, of this 170
section, and (B) not require a public hearing on an expedited certificate 171
of need application. 172 Raised Bill No. 7050
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(4) If the unit requires an applicant to submit a certificate of need 173
application pursuant to subparagraph (A)(iii) of subdivision (3) of this 174
subsection, the unit shall (A) treat the expedited review application as a 175
properly filed certificate of need application, (B) issue any request for 176
additional information not later than thirty days after issuing a notice 177
requiring an applicant to submit a certificate of need application 178
pursuant to said subparagraph, and (C) follow the procedures described 179
in subsections (c) to (g), inclusive, of this section. 180
(5) The expedited certificate of need review process established 181
pursuant to the provisions of this subsection shall not be considered a 182
contested case, as defined in section 4-166. The unit's decision on any 183
expedited certificate of need application submitted pursuant to the 184
provisions of this subsection shall not be considered a final decision, as 185
defined in section 4-166. 186
Sec. 6. Subsection (j) of section 19a-639f of the general statutes is 187
repealed and the following is substituted in lieu thereof (Effective October 188
1, 2025): 189
(j) The unit shall retain an independent consultant with expertise on 190
the economic analysis of the health care market and health care costs 191
and prices to conduct each cost and market impact review, as described 192
in this section. The unit shall submit bills for such services to the 193
purchaser, as defined in subsection (d) of section 19a-639, as amended 194
by this act. Such purchaser shall pay such bills not later than thirty days 195
after receipt. Such bills shall not exceed [two] three hundred thousand 196
dollars per application. The provisions of chapter 57, sections 4-212 to 4-197
219, inclusive, and section 4e-19 shall not apply to any agreement 198
executed pursuant to this subsection. 199
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2025 19a-643
Sec. 2 from passage 19a-630(15)
Sec. 3 October 1, 2025 19a-638(a)(11) Raised Bill No. 7050
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Sec. 4 July 1, 2025 19a-639(d)
Sec. 5 July 1, 2025 19a-639a(i)
Sec. 6 October 1, 2025 19a-639f(j)
PH Joint Favorable