Sec. 17b-239. (Formerly Sec. 17-312). Payments to hospitals. Regulations.
Sec. 17b-239. (Formerly Sec. 17-312). Payments to hospitals. Regulations. (a)
The rate to be paid by the state to hospitals receiving appropriations granted by the
General Assembly and to freestanding chronic disease hospitals, providing services to
persons aided or cared for by the state for routine services furnished to state patients,
shall be based upon reasonable cost to such hospital, or the charge to the general public
for ward services or the lowest charge for semiprivate services if the hospital has no
ward facilities, imposed by such hospital, whichever is lowest, except to the extent, if
any, that the commissioner determines that a greater amount is appropriate in the case
of hospitals serving a disproportionate share of indigent patients. Such rate shall be
promulgated annually by the Commissioner of Social Services. Nothing contained in
this section shall authorize a payment by the state for such services to any such hospital
in excess of the charges made by such hospital for comparable services to the general
public. Notwithstanding the provisions of this section, for the rate period beginning July
1, 2000, rates paid to freestanding chronic disease hospitals and freestanding psychiatric
hospitals shall be increased by three per cent. For the rate period beginning July 1, 2001,
a freestanding chronic disease hospital or freestanding psychiatric hospital shall receive
a rate that is two and one-half per cent more than the rate it received in the prior fiscal
year and such rate shall remain effective until December 31, 2002. Effective January
1, 2003, a freestanding chronic disease hospital or freestanding psychiatric hospital shall
receive a rate that is two per cent more than the rate it received in the prior fiscal year.
Notwithstanding the provisions of this subsection, for the period commencing July 1,
2001, and ending June 30, 2003, the commissioner may pay an additional total of no
more than three hundred thousand dollars annually for services provided to long-term
ventilator patients. For purposes of this subsection, "long-term ventilator patient" means
any patient at a freestanding chronic disease hospital on a ventilator for a total of sixty
days or more in any consecutive twelve-month period. Effective July 1, 2007, each
freestanding chronic disease hospital shall receive a rate that is four per cent more than
the rate it received in the prior fiscal year.
(b) Effective October 1, 1991, the rate to be paid by the state for the cost of special
services rendered by such hospitals shall be established annually by the commissioner
for each such hospital based on the reasonable cost to each hospital of such services
furnished to state patients. Nothing contained herein shall authorize a payment by the
state for such services to any such hospital in excess of the charges made by such hospital
for comparable services to the general public.
(c) The term "reasonable cost" as used in this section means the cost of care furnished such patients by an efficient and economically operated facility, computed in
accordance with accepted principles of hospital cost reimbursement. The commissioner
may adjust the rate of payment established under the provisions of this section for the
year during which services are furnished to reflect fluctuations in hospital costs. Such
adjustment may be made prospectively to cover anticipated fluctuations or may be made
retroactive to any date subsequent to the date of the initial rate determination for such
year or in such other manner as may be determined by the commissioner. In determining
"reasonable cost" the commissioner may give due consideration to allowances for fully
or partially unpaid bills, reasonable costs mandated by collective bargaining agreements
with certified collective bargaining agents or other agreements between the employer
and employees, provided "employees" shall not include persons employed as managers
or chief administrators, requirements for working capital and cost of development of
new services, including additions to and replacement of facilities and equipment. The
commissioner shall not give consideration to amounts paid by the facilities to employees
as salary, or to attorneys or consultants as fees, where the responsibility of the employees,
attorneys or consultants is to persuade or seek to persuade the other employees of the
facility to support or oppose unionization. Nothing in this subsection shall prohibit the
commissioner from considering amounts paid for legal counsel related to the negotiation
of collective bargaining agreements, the settlement of grievances or normal administration of labor relations.
(d) The state shall also pay to such hospitals for each outpatient clinic and emergency
room visit a reasonable rate to be established annually by the commissioner for each
hospital, such rate to be determined by the reasonable cost of such services. The emergency room visit rates in effect June 30, 1991, shall remain in effect through June 30,
1993, except those which would have been decreased effective July 1, 1991, or July 1,
1992, shall be decreased. Nothing contained herein shall authorize a payment by the
state for such services to any hospital in excess of the charges made by such hospital
for comparable services to the general public. For those outpatient hospital services paid
on the basis of a ratio of cost to charges, the ratios in effect June 30, 1991, shall be
reduced effective July 1, 1991, by the most recent annual increase in the consumer price
index for medical care. For those outpatient hospital services paid on the basis of a ratio
of cost to charges, the ratios computed to be effective July 1, 1994, shall be reduced
by the most recent annual increase in the consumer price index for medical care. The
emergency room visit rates in effect June 30, 1994, shall remain in effect through December 31, 1994. The Commissioner of Social Services shall establish a fee schedule for
outpatient hospital services to be effective on and after January 1, 1995. Except with
respect to the rate periods beginning July 1, 1999, and July 1, 2000, such fee schedule
shall be adjusted annually beginning July 1, 1996, to reflect necessary increases in the
cost of services. Notwithstanding the provisions of this subsection, the fee schedule for
the rate period beginning July 1, 2000, shall be increased by ten and one-half per cent,
effective June 1, 2001. Notwithstanding the provisions of this subsection, outpatient
rates in effect as of June 30, 2003, shall remain in effect through June 30, 2005. Effective
July 1, 2006, subject to available appropriations, the commissioner shall increase outpatient service fees for services that may include clinic, emergency room, magnetic resonance imaging, and computerized axial tomography. Not later than October 1, 2006,
the commissioner shall submit a report, in accordance with section 11-4a, to the joint
standing committees of the General Assembly having cognizance of matters relating to
public health, human services and appropriations and the budgets of state agencies,
identifying such fee increases and the associated cost increase estimates.
(e) The commissioner shall adopt regulations, in accordance with the provisions of
chapter 54, establishing criteria for defining emergency and nonemergency visits to
hospital emergency rooms. All nonemergency visits to hospital emergency rooms shall
be paid at the hospital's outpatient clinic services rate. Nothing contained in this subsection or the regulations adopted hereunder shall authorize a payment by the state for such
services to any hospital in excess of the charges made by such hospital for comparable
services to the general public.
(f) On and after October 1, 1984, the state shall pay to an acute care general hospital
for the inpatient care of a patient who no longer requires acute care a rate determined
by the following schedule: For the first seven days following certification that the patient
no longer requires acute care the state shall pay the hospital at a rate of fifty per cent of
the hospital's actual cost; for the second seven-day period following certification that
the patient no longer requires acute care the state shall pay seventy-five per cent of the
hospital's actual cost; for the third seven-day period following certification that the
patient no longer requires acute care and for any period of time thereafter, the state shall
pay the hospital at a rate of one hundred per cent of the hospital's actual cost. On and
after July 1, 1995, no payment shall be made by the state to an acute care general hospital
for the inpatient care of a patient who no longer requires acute care and is eligible for
Medicare unless the hospital does not obtain reimbursement from Medicare for that stay.
(g) Effective June 1, 2001, the commissioner shall establish inpatient hospital rates
in accordance with the method specified in regulations adopted pursuant to this section
and applied for the rate period beginning October 1, 2000, except that the commissioner
shall update each hospital's target amount per discharge to the actual allowable cost per
discharge based upon the 1999 cost report filing multiplied by sixty-two and one-half
per cent if such amount is higher than the target amount per discharge for the rate period
beginning October 1, 2000, as adjusted for the ten per cent incentive identified in Section
4005 of Public Law 101-508. If a hospital's rate is increased pursuant to this subsection,
the hospital shall not receive the ten per cent incentive identified in Section 4005 of
Public Law 101-508. For rate periods beginning October 1, 2001, through September
30, 2006, the commissioner shall not apply an annual adjustment factor to the target
amount per discharge. Effective April 1, 2005, the revised target amount per discharge
for each hospital with a target amount per discharge less than three thousand seven
hundred fifty dollars shall be three thousand seven hundred fifty dollars. Effective October 1, 2007, the commissioner, in consultation with the Secretary of the Office of Policy
and Management, shall establish, within available appropriations, an increased target
amount per discharge of not less than four thousand two hundred fifty dollars for each
hospital with a target amount per discharge less than four thousand two hundred fifty
dollars for the rate period ending September 30, 2007, and the commissioner may apply
an annual adjustment factor to the target amount per discharge for hospitals that are not
increased as a result of this adjustment. Not later than October 1, 2008, the commissioner
shall submit a report to the joint standing committees of the General Assembly having
cognizance of matters relating to public health, human services and appropriations and
the budgets of state agencies identifying any increased target amount per discharge
established or annual adjustment factor applied on or after October 1, 2006, and the
associated cost increase estimates related to such actions.
(1949, 1953, S. 1586d; 1961, P.A. 474, S. 2; 1967, P.A. 726, S. 1; 1969, P.A. 339, S. 1; P.A. 73-117, S. 23, 31; P.A.
77-574, S. 4, 6; P.A. 79-560, S. 26, 39; P.A. 81-472, S. 111, 159; P.A. 84-367, S. 1, 3; P.A. 85-482, S. 1, 2; P.A. 87-27,
S. 1; 87-516, S. 1, 5; P.A. 88-156, S. 19; P.A. 89-296, S. 6, 9; June Sp. Sess. P.A. 91-8, S. 13, 43, 63; May Sp. Sess. P.A.
92-16, S. 25, 89; P.A. 93-262, S. 1, 87; May Sp. Sess. P.A. 94-5, S. 2, 30; P.A. 95-160, S. 25, 69; 95-306, S. 1, 7; 95-351,
S. 28, 30; P.A. 96-139, S. 12, 13; P.A. 98-131, S. 1, 2; P.A. 99-279, S. 13, 14, 45; June Sp. Sess. P.A. 00-2, S. 15, 53; June
Sp. Sess. P.A. 01-2, S. 11, 66, 69; June Sp. Sess. P.A. 01-3, S. 1, 2, 6; June Sp. Sess. P.A. 01-9, S. 119, 120, 121, 129, 131;
May 9 Sp. Sess. P.A. 02-7, S. 57; June 30 Sp. Sess. P.A. 03-3, S. 67, 68; P.A. 04-258, S. 1, 3; May Sp. Sess. P.A. 04-2, S.
34; P.A. 05-280, S. 6; P.A. 06-188, S. 21; June Sp. Sess. P.A. 07-2, S. 27.)
History: 1961 act changed technical language, added standard of comparable charges to Subsec. (a), deleted requirement
of Subsec. (b) that special services be professional and added Subsec. (c); 1967 act changed term "welfare" to "state"
patients, restricted standard of comparable charges in Subsec. (a), made allowances for unpaid bills, working capital
requirements and services development costs in determination of "actual cost" in Subsec. (c) and added Subsec. (d); 1969
act allowed alternative rates in Subsec. (a) based on charges for ward or semiprivate facilities and placed limit on rate for
outpatient clinic visit in Subsec. (d); P.A. 73-117 replaced hospital cost commission with committee established in accordance with Sec. 17-311; P.A. 77-574 included allowances for costs associated with collective bargaining agreements in
Subsec. (c); P.A. 79-560 replaced committee with commissioner of income maintenance; P.A. 81-472 made technical
changes; P.A. 84-367 changed the basis of the rate from "actual" to "reasonable" cost and added Subsec. (e) setting rates
for the inpatient care of patients who no longer require acute care; P.A. 85-482 amended Subsec. (d) by substituting 116%
for 150% of combined average fee of general practitioner and specialist for office visit as maximum rate for an outpatient
clinic visit; P.A. 87-27 amended Subsec. (c) to exclude from "reasonable cost" amounts paid to employees, attorneys or
consultants due to unionization disputes; P.A. 87-516 allowed the commissioner to establish a rate cap if he receives
approval for a disproportionate share exemption pursuant to federal regulations; P.A. 88-156 added freestanding chronic
disease hospitals providing services to persons aided or cared for by the state for routine services furnished to state patients
and gave the commissioner the discretion to set a higher rate for hospitals serving a disproportionate share of indigent
patients; P.A. 89-296 amended Subsec. (d) to prohibit the state from paying a hospital for services in excess of the charges
made by the hospital for comparable services to the public, added a new Subsec. (e) requiring the commissioner to adopt
regulations establishing criteria for defining emergency and nonemergency visits to hospital emergency rooms and relettered former Subsec. (e) as Subsec. (f); June Sp. Sess. P.A. 91-8 amended Subsec. (b) to add a provision re payment by
the state of charges in excess of charges made when comparable service is rendered to the general public and amended
Subsec. (d) re rates paid by the state for outpatient clinic, services, emergency room visits and outpatient hospital services
paid on the basis of a ratio of cost to charges; May Sp. Sess. P.A. 92-16 amended Subsec. (d) by providing that emergency
room visit rates in effect on June 30, 1991, shall remain in effect through June 30, 1993, except that those which would
decrease on July 1, 1992, shall decrease; P.A. 93-262 authorized substitution of commissioner and department of social
services for commissioner and department of income maintenance, effective July 1, 1993; May Sp. Sess. P.A. 94-5 amended
Subsec. (d) to add a formula concerning outpatient hospital services paid on the basis of a ratio of cost to charges and
required the commissioner to establish a fee schedule for outpatient hospital services, effective July 1, 1994; Sec. 17-312
transferred to Sec. 17b-239 in 1995; P.A. 95-160 amended Subsec. (a) by adding a provision for rates to be paid to
freestanding chronic disease hospitals, effective July 1, 1995; P.A. 95-306 amended Subsec. (f) by prohibiting payment
to an acute care general hospital for inpatient care of a patient if such patient is no longer in need of such care and is eligible
for Medicare, unless Medicare reimbursement is not received for such care, effective July 1, 1995; P.A. 95-351 amended
Subsec. (a) by providing that the commissioner use the "actual charge based on utilized service" instead of the "cost of
service" when determining rates paid to freestanding chronic disease hospitals, effective July 1, 1995; P.A. 96-139 changed
effective date of P.A. 95-160 but without affecting this section; P.A. 98-131 added new Subsec. (g) requiring commissioner
to establish hospital inpatient rates, effective July 1, 1998; P.A. 99-279 amended Subsec. (d) to eliminate annual increases
in the fee schedule for outpatient hospital services for the rate periods beginning July 1, 1999, and July 1, 2000, and
amended Subsec. (g) to provide an exception for the rate period beginning October 1, 1998, from the application of the
3% annual adjustment factor to the target amount per discharge, to prohibit the commissioner from applying an annual
adjustment factor for succeeding rate periods, and to make a technical change, effective July 1, 1999; June Sp. Sess. P.A.
00-2 amended Subsec. (a) by deleting provisions re rates paid to freestanding chronic disease hospitals on and after July 1,
1995, and inserting provisions re rates paid to freestanding chronic disease hospitals and freestanding psychiatric hospitals,
beginning July 1, 2000, and thereafter, effective July 1, 2000; June Sp. Sess. P.A. 01-2 amended Subsec. (a) to make a
technical change for the purpose of gender neutrality, to require commissioner to use the rate of the highest-paid freestanding
chronic disease hospital for any freestanding chronic disease hospital having more than an average of 15% of its inpatient
days utilized as long-term ventilator patient days beginning for the rate period ending in 2001, in lieu of rate paid for period
when determining rates paid on and after July 1, 2001, notwithstanding provisions of subsection, and to define term "long-term ventilator patient", effective July 1, 2001, and further amended Subsec. (a) to remove discretion of commissioner re
determination of appropriate amount in the case of hospitals serving a disproportionate number share of indigent patients
and to replace provisions re rates paid to freestanding chronic disease hospitals and freestanding psychiatric hospitals for
rate period beginning July 1, 2001, effective July 2, 2001; June Sp. Sess. P.A. 01-3 amended Subsec. (d) by deleting
provisions re rate for outpatient clinic visit and rate cap for outpatient clinics upon approval of disproportionate share
exemption and adding provision re increase of fee schedule for rate period beginning July 1, 2001, and amended Subsec.
(g) by deleting former provisions and adding provisions re establishment of inpatient hospital rates, effective July 1, 2001;
June Sp. Sess. P.A. 01-9 amended Subsec. (d) to make 10.5% increase applicable to rate period beginning July 1, 2000,
and effective June 1, 2001, and amended Subsec. (g) to make June 1, 2001, the date by which the commissioner is to
establish inpatient hospital rates, effective July 1, 2001, and revised effective date of June Sp. Sess. P.A. 01-2 but without
affecting this section; May 9 Sp. Sess. P.A. 02-7 amended Subsec. (a) by delaying from July 1, 2002, to January 1, 2003,
a 2% rate increase to a free standing chronic disease hospital and a free standing psychiatric hospital and maintaining
effectiveness of existing rate until December 31, 2002, effective August 15, 2002; June 30 Sp. Sess. P.A. 03-3 amended
Subsec. (d) to provide that outpatient rates in effect as of June 30, 2003, shall remain in effect through June 30, 2005, and
amended Subsec. (g) by replacing "and October 1, 2002," with" through September 30, 2005," re period of time during
which commissioner shall not apply an annual adjustment factor to target amount per discharge, effective August 20, 2003;
P.A. 04-258 amended Subsec. (a) by providing that each freestanding chronic disease hospital shall receive a rate that is
2% more than the rate it received in the prior fiscal year and amended Subsec. (g) by substituting September 30, 2004, for
September 30, 2005, re time period during which the commissioner shall not apply an annual adjustment factor to the
target amount per discharge and adding provisions re revised target amount per discharge for the periods commencing
April 1, 2005, April 1, 2006, and April 1, 2007, effective July 1, 2004; May Sp. Sess. P.A. 04-2 amended Subsec. (g) by
substituting March 31, 2008, for September 30, 2004, effective July 1, 2004; P.A. 05-280 amended Subsec. (g) by changing
effective date for the $4,000 revised target amount per discharge from April 1, 2006, to October 1, 2006, and changing
effective date for the $4,250 revised target amount per discharge from April 1, 2007, to October 1, 2007, effective July 1,
2005; P.A. 06-188 amended Subsec. (a) to make a technical change, amended Subsec. (d) to allow commissioner, within
available appropriations, to increase outpatient service fees for services that include clinic, emergency room, magnetic
resonance imaging and computerized axial tomography and thereafter report to the General Assembly on such fee increases
and the associated cost increase estimates, and amended Subsec. (g) to substitute "September 30, 2006" for "March 31,
2008" re time period during which commissioner shall not apply annual adjustment factor to target amount per discharge,
and to substitute former provisions re target amount per discharge that were to take effect October 1, 2006, and October
1, 2007, with new language re target amount per discharge to take effect on October 1, 2006, and reporting requirement
on cost estimates for new target amount per discharge, effective July 1, 2006; June Sp. Sess. P.A. 07-2 amended Subsec.
(a) by replacing "July 1, 2004" with "July 1, 2007" and "two" with "four" re percentage increase in the rate provided to
freestanding chronic disease hospitals over the rate provided in prior fiscal year and amended Subsec. (g) by replacing
provisions re increased target amount per discharge effective October 1, 2006, with provisions requiring commissioner to
establish increased target amount per discharge effective October 1, 2007, and to report to the General Assembly on the
costs associated with such action, effective July 1, 2007.
Annotations to former section 17-312:
Cited. 175 C. 49. Cited. 181 C. 130.