Connecticut 2025 Regular Session

Connecticut Senate Bill SB01539 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3		-	LCO 6493 1 of 16
	3	+	LCO No. 6493 1 of 16
4	4
5	5		General Assembly Raised Bill No. 1539
6	6		January Session, 2025
7	7		LCO No. 6493
8	8
9	9
10	10		Referred to Committee on PUBLIC HEALTH
11	11
12	12
13	13		Introduced by:
14	14		(PH)
15	15
16	16
17	17
18	18		AN ACT CONCERNING CERTIFICATES OF NEED.
19	19		Be it enacted by the Senate and House of Representatives in General
20	20		Assembly convened:
21	21
22	22		Section 1. Subsection (a) of section 19a-638 of the general statutes is 1
23	23		repealed and the following is substituted in lieu thereof (Effective October 2
24	24		1, 2025): 3
25	25		(a) A certificate of need issued by the unit shall be required for: 4
26	26		(1) The establishment of a new health care facility; 5
27	27		(2) A transfer of ownership of a health care facility; 6
28	28		(3) A transfer of ownership of a large group practice to any entity 7
29	29		other than a (A) physician, or (B) group of two or more physicians, 8
30	30		legally organized in a partnership, professional corporation or limited 9
31	31		liability company formed to render professional services and not 10
32	32		employed by or an affiliate of any hospital, medical foundation, 11
33	33		insurance company or other similar entity; 12
34		-	(4) The establishment of a freestanding emergency department; 13 Raised Bill No. 1539
	34	+	(4) The establishment of a freestanding emergency department; 13
	35	+	(5) The termination of inpatient or outpatient services offered by a 14
	36	+	Raised Bill No. 1539
35	37
36	38
37		-	LCO 6493 2 of 16
38	39
39		-	(5) The termination of inpatient or outpatient services offered by a 14
	40	+	LCO No. 6493 2 of 16
	41	+
40	42		hospital, including, but not limited to, the termination by a short-term 15
41	43		acute care general hospital or children's hospital of inpatient and 16
42	44		outpatient mental health and substance abuse services; 17
43	45		(6) The establishment of an outpatient surgical facility, as defined in 18
44	46		section 19a-493b, or as established by a short-term acute care general 19
45	47		hospital; 20
46	48		(7) The termination of surgical services by an outpatient surgical 21
47	49		facility, as defined in section 19a-493b, or a facility that provides 22
48	50		outpatient surgical services as part of the outpatient surgery department 23
49	51		of a short-term acute care general hospital, provided termination of 24
50	52		outpatient surgical services due to (A) insufficient patient volume, or (B) 25
51	53		the termination of any subspecialty surgical service, shall not require 26
52	54		certificate of need approval; 27
53	55		(8) The termination of an emergency department by a short-term 28
54	56		acute care general hospital; 29
55	57		(9) The establishment of cardiac services, including inpatient and 30
56	58		outpatient cardiac catheterization, interventional cardiology and 31
57	59		cardiovascular surgery; 32
58	60		(10) The acquisition of computed tomography scanners, magnetic 33
59	61		resonance imaging scanners, positron emission tomography scanners or 34
60	62		positron emission tomography-computed tomography scanners, by any 35
61	63		person, physician, provider, short-term acute care general hospital or 36
62	64		children's hospital, except (A) as provided for in subdivision (22) of 37
63	65		subsection (b) of this section, and (B) a certificate of need issued by the 38
64	66		unit shall not be required where such scanner is a replacement for a 39
65	67		scanner that was previously acquired through certificate of need 40
66	68		approval or a certificate of need determination, including a replacement 41
67	69		scanner that has dual modalities or functionalities if the applicant 42
68	70		already offers similar imaging services for each of the scanner's 43
69		-	modalities or functionalities that will be utilized; 44 Raised Bill No. 1539
	71	+	modalities or functionalities that will be utilized; 44
	72	+	Raised Bill No. 1539
70	73
71	74
72		-	LCO 6493 3 of 16
	75	+
	76	+	LCO No. 6493 3 of 16
73	77
74	78		(11) The acquisition of nonhospital based linear accelerators, except a 45
75	79		certificate of need issued by the unit shall not be required where such 46
76	80		accelerator is a replacement for an accelerator that was previously 47
77	81		acquired through certificate of need approval or a certificate of need 48
78	82		determination; 49
79	83		(12) An increase in the licensed bed capacity of a health care facility, 50
80	84		except as provided in subdivision (23) of subsection (b) of this section; 51
81	85		(13) The acquisition of equipment utilizing technology that has not 52
82	86		previously been utilized in the state; 53
83	87		(14) An increase of two or more operating rooms within any three-54
84	88		year period, commencing on and after October 1, 2010, by an outpatient 55
85	89		surgical facility, as defined in section 19a-493b, or by a short-term acute 56
86	90		care general hospital; [and] 57
87	91		(15) The termination of inpatient or outpatient services offered by a 58
88	92		hospital or other facility or institution operated by the state that 59
89	93		provides services that are eligible for reimbursement under Title XVIII 60
90	94		or XIX of the federal Social Security Act, 42 USC 301, as amended from 61
91	95		time to time; and 62
92	96		(16) Any investment in a health care facility by a private equity 63
93	97		company in which the private equity company acquires a controlling 64
94	98		interest, either directly or indirectly, in a health care facility, or 65
95	99		otherwise obtains the ability to exercise operational control, managerial 66
96	100		control or decision-making authority over such facility. 67
97	101		Sec. 2. Section 19a-639 of the general statutes is repealed and the 68
98	102		following is substituted in lieu thereof (Effective October 1, 2025): 69
99	103		(a) In any deliberations involving a certificate of need application 70
100	104		filed pursuant to section 19a-638, as amended by this act, the unit shall 71
101	105		take into consideration and make written findings concerning each of 72
102	106		the following guidelines and principles: 73
103		-	~~(1) Whether the proposed project is consistent with any applicable 74~~ Raised Bill No. 1539
	107	+	Raised Bill No. 1539
104	108
105	109
106		-	LCO 6493 4 of 16
107	110
	111	+	LCO No. 6493 4 of 16
	112	+
	113	+	(1) Whether the proposed project is consistent with any applicable 74
108	114		policies and standards adopted in regulations by the Office of Health 75
109	115		Strategy; 76
110	116		(2) The relationship of the proposed project to the state-wide health 77
111	117		care facilities and services plan; 78
112	118		(3) Whether there is a clear public need for the health care facility or 79
113	119		services proposed by the applicant; 80
114	120		(4) Whether the applicant has satisfactorily demonstrated how the 81
115	121		proposal will impact the financial strength of the health care system in 82
116	122		the state or that the proposal is financially feasible for the applicant; 83
117	123		(5) Whether the applicant has satisfactorily demonstrated how the 84
118	124		proposal will improve quality, accessibility and cost effectiveness of 85
119	125		health care delivery in the region, including, but not limited to, 86
120	126		provision of or any change in the access to services for Medicaid 87
121	127		recipients and indigent persons; 88
122	128		(6) The applicant's past and proposed provision of health care 89
123	129		services to relevant patient populations and payer mix, including, but 90
124	130		not limited to, access to services by Medicaid recipients and indigent 91
125	131		persons; 92
126	132		(7) Whether the applicant has satisfactorily identified the population 93
127	133		to be served by the proposed project and satisfactorily demonstrated 94
128	134		that the identified population has a need for the proposed services; 95
129	135		(8) The utilization of existing health care facilities and health care 96
130	136		services in the service area of the applicant; 97
131	137		(9) Whether the applicant has satisfactorily demonstrated that the 98
132	138		proposed project shall not result in an unnecessary duplication of 99
133	139		existing or approved health care services or facilities; 100
134	140		(10) Whether an applicant, who has failed to provide or reduced 101
135		-	access to services by Medicaid recipients or indigent persons, has 102
136		-	demonstrated good cause for doing so, which shall not be demonstrated 103 Raised Bill No. 1539
	141	+	Raised Bill No. 1539
137	142
138	143
139		-	LCO 6493 5 of 16
140	144
	145	+	LCO No. 6493 5 of 16
	146	+
	147	+	access to services by Medicaid recipients or indigent persons, has 102
	148	+	demonstrated good cause for doing so, which shall not be demonstrated 103
141	149		solely on the basis of differences in reimbursement rates between 104
142	150		Medicaid and other health care payers; 105
143	151		(11) Whether the applicant has satisfactorily demonstrated that the 106
144	152		proposal will not negatively impact the diversity of health care 107
145	153		providers and patient choice in the geographic region; and 108
146	154		(12) Whether the applicant has satisfactorily demonstrated that any 109
147	155		consolidation resulting from the proposal will not adversely affect 110
148	156		health care costs or accessibility to care. 111
149	157		(b) In deliberations as described in subsection (a) of this section, there 112
150	158		shall be a presumption in favor of approving the certificate of need 113
151	159		application for a transfer of ownership of a large group practice, as 114
152	160		described in subdivision (3) of subsection (a) of section 19a-638, as 115
153	161		amended by this act, when an offer was made in response to a request 116
154	162		for proposal or similar voluntary offer for sale. 117
155	163		(c) The unit, as it deems necessary, may revise or supplement the 118
156	164		guidelines and principles, set forth in subsection (a) of this section, 119
157	165		through regulation. 120
158	166		(d) (1) For purposes of this subsection and subsection (e) of this 121
159	167		section: 122
160	168		(A) "Affected community" means a municipality where a hospital is 123
161	169		physically located or a municipality whose inhabitants are regularly 124
162	170		served by a hospital; 125
163	171		(B) "Hospital" has the same meaning as provided in section 19a-490; 126
164	172		(C) "New hospital" means a hospital as it exists after the approval of 127
165	173		an agreement pursuant to section 19a-486b or a certificate of need 128
166	174		application for a transfer of ownership of a hospital; 129
167		-	(D) "Purchaser" means a person who is acquiring, or has acquired, 130
168		-	any assets of a hospital through a transfer of ownership of a hospital; 131 Raised Bill No. 1539
	175	+	Raised Bill No. 1539
169	176
170	177
171		-	LCO 6493 6 of 16
172	178
	179	+	LCO No. 6493 6 of 16
	180	+
	181	+	(D) "Purchaser" means a person who is acquiring, or has acquired, 130
	182	+	any assets of a hospital through a transfer of ownership of a hospital; 131
173	183		(E) "Transacting party" means a purchaser and any person who is a 132
174	184		party to a proposed agreement for transfer of ownership of a hospital; 133
175	185		(F) "Transfer" means to sell, transfer, lease, exchange, option, convey, 134
176	186		give or otherwise dispose of or transfer control over, including, but not 135
177	187		limited to, transfer by way of merger or joint venture not in the ordinary 136
178	188		course of business; and 137
179	189		(G) "Transfer of ownership of a hospital" means a transfer that 138
180	190		impacts or changes the governance or controlling body of a hospital, 139
181	191		including, but not limited to, all affiliations, mergers or any sale or 140
182	192		transfer of net assets of a hospital and for which a certificate of need 141
183	193		application or a certificate of need determination letter is filed on or after 142
184	194		December 1, 2015. 143
185	195		(2) In any deliberations involving a certificate of need application 144
186	196		filed pursuant to section 19a-638, as amended by this act, that involves 145
187	197		the transfer of ownership of a hospital, the unit shall, in addition to the 146
188	198		guidelines and principles set forth in subsection (a) of this section and 147
189	199		those prescribed through regulation pursuant to subsection (c) of this 148
190	200		section, take into consideration and make written findings concerning 149
191	201		each of the following guidelines and principles: 150
192	202		(A) Whether the applicant fairly considered alternative proposals or 151
193	203		offers in light of the purpose of maintaining health care provider 152
194	204		diversity and consumer choice in the health care market and access to 153
195	205		affordable quality health care for the affected community; and 154
196	206		(B) Whether the plan submitted pursuant to section 19a-639a, as 155
197	207		amended by this act, demonstrates, in a manner consistent with this 156
198	208		chapter, how health care services will be provided by the new hospital 157
199	209		for the first three years following the transfer of ownership of the 158
200	210		hospital, including any consolidation, reduction, elimination or 159
	211	+	Raised Bill No. 1539
	212	+
	213	+
	214	+
	215	+	LCO No. 6493 7 of 16
	216	+
201	217		expansion of existing services or introduction of new services. 160
202	218		(3) The unit shall deny any certificate of need application involving a 161
203		-	transfer of ownership of a hospital unless the commissioner finds that 162 Raised Bill No. 1539
204		-
205		-
206		-	LCO 6493 7 of 16
207		-
	219	+	transfer of ownership of a hospital unless the commissioner finds that 162
208	220		the affected community will be assured of continued access to high 163
209	221		quality and affordable health care after accounting for any proposed 164
210	222		change impacting hospital staffing. 165
211	223		(4) The unit may deny any certificate of need application involving a 166
212	224		transfer of ownership of a hospital subject to a cost and market impact 167
213	225		review pursuant to section 19a-639f if the commissioner finds that (A) 168
214	226		the affected community will not be assured of continued access to high 169
215	227		quality and affordable health care after accounting for any consolidation 170
216	228		in the hospital and health care market that may lessen health care 171
217	229		provider diversity, consumer choice and access to care, and (B) any 172
218	230		likely increases in the prices for health care services or total health care 173
219	231		spending in the state may negatively impact the affordability of care. 174
220	232		(5) The unit may place any conditions on the approval of a certificate 175
221	233		of need application involving a transfer of ownership of a hospital 176
222	234		consistent with the provisions of this chapter. Before placing any such 177
223	235		conditions, the unit shall weigh the value of such conditions in 178
224	236		promoting the purposes of this chapter against the individual and 179
225	237		cumulative burden of such conditions on the transacting parties and the 180
226	238		new hospital. For each condition imposed, the unit shall include a 181
227	239		concise statement of the legal and factual basis for such condition and 182
228	240		the provision or provisions of this chapter that it is intended to promote. 183
229	241		Each condition shall be reasonably tailored in time and scope. The 184
230	242		transacting parties or the new hospital shall have the right to make a 185
231	243		request to the unit for an amendment to, or relief from, any condition 186
232	244		based on changed circumstances, hardship or for other good cause. 187
233	245		(e) (1) If the certificate of need application (A) involves the transfer of 188
234	246		ownership of a hospital, (B) the purchaser is a hospital, as defined in 189
235	247		section 19a-490, whether located within or outside the state, that had net 190
	248	+	Raised Bill No. 1539
	249	+
	250	+
	251	+
	252	+	LCO No. 6493 8 of 16
	253	+
236	254		patient revenue for fiscal year 2013 in an amount greater than one billion 191
237	255		five hundred million dollars or a hospital system, as defined in section 192
238	256		19a-486i, whether located within or outside the state, that had net 193
239	257		patient revenue for fiscal year 2013 in an amount greater than one billion 194
240		-	five hundred million dollars, or any person that is organized or operated 195 Raised Bill No. 1539
241		-
242		-
243		-	LCO 6493 8 of 16
244		-
	258	+	five hundred million dollars, or any person that is organized or operated 195
245	259		for profit, and (C) such application is approved, the unit shall hire an 196
246	260		independent consultant to serve as a post-transfer compliance reporter 197
247	261		for a period of three years after completion of the transfer of ownership 198
248	262		of the hospital. Such reporter shall, at a minimum: (i) Meet with 199
249	263		representatives of the purchaser, the new hospital and members of the 200
250	264		affected community served by the new hospital not less than quarterly; 201
251	265		and (ii) report to the unit not less than quarterly concerning (I) efforts 202
252	266		the purchaser and representatives of the new hospital have taken to 203
253	267		comply with any conditions the unit placed on the approval of the 204
254	268		certificate of need application and plans for future compliance, and (II) 205
255	269		community benefits and uncompensated care provided by the new 206
256	270		hospital. The purchaser shall give the reporter access to its records and 207
257	271		facilities for the purposes of carrying out the reporter's duties. The 208
258	272		purchaser shall hold a public hearing in the municipality in which the 209
259	273		new hospital is located not less than annually during the reporting 210
260	274		period to provide for public review and comment on the reporter's 211
261	275		reports and findings. 212
262	276		(2) If the reporter finds that the purchaser has breached a condition 213
263	277		of the approval of the certificate of need application, the unit may, in 214
264	278		consultation with the purchaser, the reporter and any other interested 215
265	279		parties it deems appropriate, implement a performance improvement 216
266	280		plan designed to remedy the conditions identified by the reporter and 217
267	281		continue the reporting period for up to one year following a 218
268	282		determination by the unit that such conditions have been resolved. 219
269	283		(3) The purchaser shall provide funds, in an amount determined by 220
270	284		the unit not to exceed two hundred thousand dollars annually, for the 221
271	285		hiring of the post-transfer compliance reporter. 222
	286	+	Raised Bill No. 1539
	287	+
	288	+
	289	+
	290	+	LCO No. 6493 9 of 16
	291	+
272	292		(f) Nothing in subsection (d) or (e) of this section shall apply to a 223
273	293		transfer of ownership of a hospital in which either a certificate of need 224
274	294		application is filed on or before December 1, 2015, or where a certificate 225
275	295		of need determination letter is filed on or before December 1, 2015. 226
276		-	(g) The unit shall deny any certificate of need application involving 227 Raised Bill No. 1539
277		-
278		-
279		-	LCO 6493 9 of 16
280		-
	296	+	(g) The unit shall deny any certificate of need application involving 227
281	297		the termination of labor and delivery services by a hospital unless labor 228
282	298		and delivery services may be obtained at another hospital located not 229
283	299		more than twenty-five miles away from such hospital. 230
284	300		Sec. 3. Section 19a-639a of the general statutes is repealed and the 231
285	301		following is substituted in lieu thereof (Effective October 1, 2025): 232
286	302		(a) An application for a certificate of need shall be filed with the unit 233
287	303		in accordance with the provisions of this section and any regulations 234
288	304		adopted by the Office of Health Strategy. The application shall address 235
289	305		the guidelines and principles set forth in (1) subsection (a) of section 19a-236
290	306		639, as amended by this act, and (2) regulations adopted by the 237
291	307		department. The applicant shall include with the application a 238
292	308		nonrefundable application fee based on the cost of the project. The 239
293	309		amount of the fee shall be as follows: (A) One thousand dollars for a 240
294	310		project that will cost not greater than fifty thousand dollars; (B) two 241
295	311		thousand dollars for a project that will cost greater than fifty thousand 242
296	312		dollars but not greater than one hundred thousand dollars; (C) three 243
297	313		thousand dollars for a project that will cost greater than one hundred 244
298	314		thousand dollars but not greater than five hundred thousand dollars; 245
299	315		(D) four thousand dollars for a project that will cost greater than five 246
300	316		hundred thousand dollars but not greater than one million dollars; (E) 247
301	317		five thousand dollars for a project that will cost greater than one million 248
302	318		dollars but not greater than five million dollars; (F) eight thousand 249
303	319		dollars for a project that will cost greater than five million dollars but 250
304	320		not greater than ten million dollars; and (G) ten thousand dollars for a 251
305	321		project that will cost greater than ten million dollars. 252
306	322		(b) Prior to the filing of a certificate of need application, the applicant 253
	323	+	Raised Bill No. 1539
	324	+
	325	+
	326	+
	327	+	LCO No. 6493 10 of 16
	328	+
307	329		shall (1) publish notice that an application is to be submitted to the unit 254
308	330		(A) in a newspaper having a substantial circulation in the area where 255
309	331		the project is to be located, and (B) on the applicant's Internet web site 256
310	332		in a clear and conspicuous location that is easily accessible by members 257
311	333		of the public, (2) request the publication of notice (A) in at least two sites 258
312	334		within the affected community that are commonly accessed by the 259
313		-	public, such as a town hall or library, and (B) on any existing Internet 260 Raised Bill No. 1539
314		-
315		-
316		-	LCO 6493 10 of 16
317		-
	335	+	public, such as a town hall or library, and (B) on any existing Internet 260
318	336		web site of the municipality or local health department, and (3) submit 261
319	337		such notice to the unit for posting on such unit's Internet web site. Such 262
320	338		newspaper notice shall be published for not less than three consecutive 263
321	339		days, with the final date of consecutive publication occurring not later 264
322	340		than twenty days prior to the date of filing of the certificate of need 265
323	341		application, and contain a brief description of the nature of the project 266
324	342		and the street address where the project is to be located. Postings in the 267
325	343		affected community and on the applicant's Internet web site shall 268
326	344		remain until the decision on the application is rendered. The unit shall 269
327	345		not invalidate any notice due to changes or removal of the notice from 270
328	346		a community Internet web site of which the applicant has no control. An 271
329	347		applicant shall file the certificate of need application with the unit not 272
330	348		later than ninety days after publishing notice of the application in a 273
331	349		newspaper in accordance with the provisions of this subsection. The 274
332	350		unit shall not accept the applicant's certificate of need application for 275
333	351		filing unless the application is accompanied by the application fee 276
334	352		prescribed in subsection (a) of this section and proof of compliance with 277
335	353		the publication requirements prescribed in this subsection. 278
336	354		(c) (1) Not later than five business days after receipt of a properly filed 279
337	355		certificate of need application, the unit shall publish notice of the 280
338	356		application on its Internet web site. Not later than thirty days after the 281
339	357		date of filing of the application, the unit may request such additional 282
340	358		information as the unit determines necessary to complete the 283
341	359		application. In addition to any information requested by the unit, if the 284
342	360		application involves the transfer of ownership of a hospital, as defined 285
343	361		in section 19a-639, as amended by this act, the applicant shall submit to 286
	362	+	Raised Bill No. 1539
	363	+
	364	+
	365	+
	366	+	LCO No. 6493 11 of 16
	367	+
344	368		the unit (A) a plan demonstrating how health care services will be 287
345	369		provided by the new hospital for the first three years following the 288
346	370		transfer of ownership of the hospital, including any consolidation, 289
347	371		reduction, elimination or expansion of existing services or introduction 290
348	372		of new services, and (B) the names of persons currently holding a 291
349	373		position with the hospital to be purchased or the purchaser, as defined 292
350	374		in section 19a-639, as amended by this act, as an officer, director, board 293
351		-	member or senior manager, whether or not such person is expected to 294 Raised Bill No. 1539
352		-
353		-
354		-	LCO 6493 11 of 16
355		-
	375	+	member or senior manager, whether or not such person is expected to 294
356	376		hold a position with the hospital after completion of the transfer of 295
357	377		ownership of the hospital and any salary, severance, stock offering or 296
358	378		any financial gain, current or deferred, such person is expected to 297
359	379		receive as a result of, or in relation to, the transfer of ownership of the 298
360	380		hospital. 299
361	381		(2) The applicant shall, not later than sixty days after the date of the 300
362	382		unit's request, submit any requested information and any information 301
363	383		required under this subsection to the unit. If an applicant fails to submit 302
364	384		such information to the unit within the sixty-day period, the unit shall 303
365	385		consider the application to have been withdrawn. 304
366	386		(3) The unit shall make reasonable efforts to limit the requests for 305
367	387		additional information to two such requests and, in all cases, cease all 306
368	388		requests for additional information not later than six months after 307
369	389		receiving the application. 308
370	390		(d) Upon deeming an application complete, the unit shall provide 309
371	391		notice of this determination to the applicant and to the public in 310
372	392		accordance with regulations adopted by the department. In addition, 311
373	393		the unit shall post such notice on its Internet web site and notify the 312
374	394		applicant not later than five days after deeming the application 313
375	395		complete. The date on which the unit posts such notice on its Internet 314
376	396		web site shall begin the review period. Except as provided in this 315
377	397		subsection, (1) the review period for an application deemed complete 316
378	398		shall be ninety days from the date on which the unit posts such notice 317
379	399		on its Internet web site; and (2) the unit shall issue a decision on an 318
	400	+	Raised Bill No. 1539
	401	+
	402	+
	403	+
	404	+	LCO No. 6493 12 of 16
	405	+
380	406		application deemed complete prior to the expiration of the ninety-day 319
381	407		review period in matters without a public hearing. The review period 320
382	408		for an application deemed complete that involves a transfer of a large 321
383	409		group practice, as described in subdivision (3) of subsection (a) of 322
384	410		section 19a-638, as amended by this act, when the offer was made in 323
385	411		response to a request for proposal or similar voluntary offer for sale, 324
386	412		shall be sixty days from the date on which the unit posts notice on its 325
387	413		Internet web site. Upon request or for good cause shown, the unit may 326
388		-	extend the review period for a period of time not to exceed sixty days. 327 Raised Bill No. 1539
389		-
390		-
391		-	LCO 6493 12 of 16
392		-
	414	+	extend the review period for a period of time not to exceed sixty days. 327
393	415		If the review period is extended, the unit shall issue a decision on the 328
394	416		completed application prior to the expiration of the extended review 329
395	417		period. If the unit holds a public hearing concerning a completed 330
396	418		application in accordance with subsection (e) or (f) of this section, the 331
397	419		unit shall issue a decision on the completed application not later than 332
398	420		sixty days after the date the unit closes the public hearing record. If the 333
399	421		Commissioner of Health Strategy enters into an agreed settlement with 334
400	422		an applicant or negotiations for an agreed settlement, the commissioner 335
401	423		shall post notice of such agreed settlement or negotiations on the Office 336
402	424		of Health Strategy's Internet web site. 337
403	425		(e) Except as provided in this subsection, the unit shall hold a public 338
404	426		hearing on a properly filed and completed certificate of need application 339
405	427		if three or more individuals or an individual representing an entity with 340
406	428		five or more people submits a request, in writing, that a public hearing 341
407	429		be held on the application. For a properly filed and completed certificate 342
408	430		of need application involving a transfer of ownership of a large group 343
409	431		practice, as described in subdivision (3) of subsection (a) of section 19a-344
410	432		638, as amended by this act, when an offer was made in response to a 345
411	433		request for proposal or similar voluntary offer for sale, a public hearing 346
412	434		shall be held if twenty-five or more individuals or an individual 347
413	435		representing twenty-five or more people submits a request, in writing, 348
414	436		that a public hearing be held on the application. Any request for a public 349
415	437		hearing shall be made to the unit not later than thirty days after the date 350
416	438		the unit deems the application to be complete. 351
	439	+	Raised Bill No. 1539
	440	+
	441	+
	442	+
	443	+	LCO No. 6493 13 of 16
	444	+
417	445		(f) (1) The unit shall hold a public hearing with respect to each 352
418	446		certificate of need application filed pursuant to section 19a-638, as 353
419	447		amended by this act, after December 1, 2015, that concerns any transfer 354
420	448		of ownership involving a hospital. Such hearing shall be held in the 355
421	449		municipality in which the hospital that is the subject of the application 356
422	450		is located. 357
423	451		(2) The unit may hold a public hearing with respect to any certificate 358
424	452		of need application submitted under this chapter. The unit shall provide 359
425		-	not less than two weeks' advance notice to the applicant, in writing, and 360 Raised Bill No. 1539
426		-
427		-
428		-	LCO 6493 13 of 16
429		-
	453	+	not less than two weeks' advance notice to the applicant, in writing, and 360
430	454		to the public by publication in a newspaper having a substantial 361
431	455		circulation in the area served by the health care facility or provider. In 362
432	456		conducting its activities under this chapter, the unit may hold hearings 363
433	457		with respect to applications of a similar nature at the same time. The 364
434	458		applicant shall post a copy of the unit's hearing notice on the applicant's 365
435	459		Internet web site in a clear and conspicuous location that is easily 366
436	460		accessible by members of the public. Such applicant shall request the 367
437	461		publication of notice in at least two sites within the affected community 368
438	462		that are commonly accessed by the public, such as a town hall or library, 369
439	463		as well as on any existing Internet web site of the municipality or local 370
440	464		health department. The unit shall not invalidate any notice due to 371
441	465		changes or removal of the notice from a community Internet web site of 372
442	466		which the applicant has no control. 373
443	467		(g) For applications submitted on or after October 1, 2023, the unit 374
444	468		may retain an independent consultant with expertise in the specific area 375
445	469		of health care that is the subject of the application filed by an applicant 376
446	470		if the review and analysis of an application cannot reasonably be 377
447	471		conducted by the unit without the expertise of an industry analyst or 378
448	472		other actuarial consultant. The unit shall submit bills for independent 379
449	473		consultant services to the applicant. Such applicant shall pay such bills 380
450	474		not later than thirty days after receipt of such bills. Such bills shall be a 381
451	475		reasonable amount per application. The provisions of chapter 57 and 382
452	476		sections 4-212 to 4-219, inclusive, and 4e-19 shall not apply to any 383
453	477		retainer agreement executed pursuant to this subsection. 384
	478	+	Raised Bill No. 1539
	479	+
	480	+
	481	+
	482	+	LCO No. 6493 14 of 16
	483	+
454	484		(h) Notwithstanding the provisions of this chapter and section 4-177a, 385
455	485		the unit shall not grant any request for intervenor status in any public 386
456	486		hearing conducted pursuant to the provisions of this section involving 387
457	487		a certificate of need application filed by a group practice. For the 388
458	488		purposes of this subsection, "group practice" means five or less 389
459	489		physicians, legally organized in a partnership, professional corporation, 390
460	490		limited liability company formed to render professional services, 391
461	491		medical foundation, not-for-profit corporation, faculty practice plan or 392
462	492		other similar entity having investments of not more than two million 393
463		-	dollars (1) in which each physician who is a member of the group 394 Raised Bill No. 1539
464		-
465		-
466		-	LCO 6493 14 of 16
467		-
	493	+	dollars (1) in which each physician who is a member of the group 394
468	494		provides substantially the full range of services that the physician 395
469	495		routinely provides, including, but not limited to, medical care, 396
470	496		consultation, diagnosis or treatment, through the joint use of shared 397
471	497		office space, facilities, equipment or personnel; (2) for which 398
472	498		substantially all of the services of the physicians who are members of 399
473	499		the group are provided through the group and are billed in the name of 400
474	500		the group practice and amounts so received are treated as receipts of the 401
475	501		group; or (3) in which the overhead expenses of, and the income from, 402
476	502		the group are distributed in accordance with methods previously 403
477	503		determined by members of the group. An entity that otherwise meets 404
478	504		the definition of group practice under this section shall be considered a 405
479	505		group practice although its shareholders, partners or owners of the 406
480	506		group practice include single-physician professional corporations, 407
481	507		limited liability companies formed to render professional services or 408
482	508		other entities in which beneficial owners are individual physicians. 409
483	509		(i) (1) Notwithstanding the provisions of this section, the unit shall 410
484	510		develop and implement an expedited certificate of need review process 411
485	511		for certificate of need applications concerning an increase in the licensed 412
486	512		bed capacity of a health care facility. The unit shall issue a decision on 413
487	513		any certificate of need application filed pursuant to the provisions of this 414
488	514		subsection not more than thirty days after the unit receives an 415
489	515		applicant's complete certificate of need application. 416
490	516		(2) Notwithstanding the provisions of this section, the expedited 417
	517	+	Raised Bill No. 1539
	518	+
	519	+
	520	+
	521	+	LCO No. 6493 15 of 16
	522	+
491	523		certificate of need review process established pursuant to the provisions 418
492	524		of this subsection shall (A) allow the unit to resolve an expedited 419
493	525		certificate of need application by (i) agreed settlement with the 420
494	526		applicant, (ii) making a determination approving the expedited 421
495	527		certificate of need application with or without conditions, or (iii) 422
496	528		requiring the applicant to submit a certificate of need application 423
497	529		pursuant to the provisions of subsections (a) to (f), inclusive, of this 424
498	530		section, and (B) not require a public hearing on an expedited certificate 425
499	531		of need application. 426
500		-	(3) If the unit requires an applicant to submit a certificate of need 427 Raised Bill No. 1539
501		-
502		-
503		-	LCO 6493 15 of 16
504		-
	532	+	(3) If the unit requires an applicant to submit a certificate of need 427
505	533		application pursuant to subparagraph (A)(iii) of subdivision (2) of this 428
506	534		subsection, the unit shall (A) treat the expedited review application as a 429
507	535		properly filed certificate of need application, (B) issue any request for 430
508	536		additional information not later than thirty days after issuing a notice 431
509	537		requiring an applicant to submit a certificate of need application 432
510	538		pursuant to said subparagraph, and (C) follow the procedures described 433
511	539		in subsections (c) to (g), inclusive, of this section. 434
512	540		(4) The expedited certificate of need review process established 435
513	541		pursuant to the provisions of this subsection shall not be considered a 436
514	542		contested case, as defined in section 4-166. The unit's decision on any 437
515	543		expedited certificate of need application submitted pursuant to the 438
516	544		provisions of this subsection shall not be considered a final decision, as 439
517	545		defined in section 4-166. 440
518	546		[(h)] (j) The Commissioner of Health Strategy may implement 441
519	547		policies and procedures necessary to administer the provisions of this 442
520	548		section while in the process of adopting such policies and procedures as 443
521	549		regulation, provided the commissioner holds a public hearing prior to 444
522	550		implementing the policies and procedures and posts notice of intent to 445
523	551		adopt regulations on the office's Internet web site and the eRegulations 446
524	552		System not later than twenty days after the date of implementation. 447
525	553		Policies and procedures implemented pursuant to this section shall be 448
526	554		valid until the time final regulations are adopted. 449
	555	+	Raised Bill No. 1539
	556	+
	557	+
	558	+
	559	+	LCO No. 6493 16 of 16
	560	+
527	561		Sec. 4. Section 19a-641 of the general statutes is repealed and the 450
528	562		following is substituted in lieu thereof (Effective October 1, 2025): 451
529	563		Any health care facility or institution and any state health care facility 452
530	564		or institution aggrieved by any final decision of said unit under the 453
531	565		provisions of sections 19a-630 to 19a-639e, inclusive, may appeal from 454
532	566		such decision in accordance with the provisions of section 4-183, except 455
533	567		venue shall be in the judicial district in which it is located. Such appeal 456
534	568		shall have precedence in respect to order of trial over all other cases 457
535	569		except writs of habeas corpus, actions brought by or on behalf of the 458
536		-	state, including information on the relation of private individuals, and 459 Raised Bill No. 1539
537		-
538		-
539		-	LCO 6493 16 of 16
540		-
	570	+	state, including information on the relation of private individuals, and 459
541	571		appeals from awards or decisions of administrative law judges. The 460
542	572		Commissioner of Health Strategy shall post notice of such appeal on the 461
543	573		Office of Health Strategy's Internet web site. 462
544	574		This act shall take effect as follows and shall amend the following
545	575		sections:
546	576
547	577		Section 1 October 1, 2025 19a-638(a)
548	578		Sec. 2 October 1, 2025 19a-639
549	579		Sec. 3 October 1, 2025 19a-639a
550	580		Sec. 4 October 1, 2025 19a-641
551	581
552		-	PH Joint Favorable
	582	+	Statement of Purpose:
	583	+	To (1) require a certificate of need for certain private equity investments
	584	+	in health care facilities, (2) require the denial of certificate of need
	585	+	applications involving the closure of labor and delivery units unless an
	586	+	alternate labor and delivery unit is located not more than twenty-five
	587	+	miles away, (3) prohibit intervenors in certificate of need applications
	588	+	involving certain physician group practices, (4) establish an expedited
	589	+	certificate of need review process for increases in the licensed bed
	590	+	capacity of health care facilities, and (5) require the Commissioner of
	591	+	Health Strategy to post notice of any appeal or agreed settlement
	592	+	relating to a certificate of need application.
	593	+
	594	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	595	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	596	+	underlined.]
553	597