Sec. 19a-638. (Formerly Sec. 19a-154). Certificate of need. Request for approval of transfer or ownership or control, change in function or service, capital expenditures and acquisition of equipment.
Sec. 19a-638. (Formerly Sec. 19a-154). Certificate of need. Request for approval of transfer or ownership or control, change in function or service, capital
expenditures and acquisition of equipment. Letter of intent. Approval process. (a)
Except as provided in sections 19a-487a and 19a-639a to 19a-639c, inclusive:
(1) Each health care facility or institution, that intends to (A) transfer all or part of
its ownership or control, (B) change the governing powers of the board of a parent
company or an affiliate, whatever its designation, or (C) change or transfer the powers
or control of a governing or controlling body of an affiliate, shall submit to the office,
prior to the proposed date of such transfer or change, a request for permission to undertake such transfer or change.
(2) Each health care facility or institution or state health care facility or institution,
including any inpatient rehabilitation facility, which intends to introduce any additional
function or service into its program of health care shall submit to the office, prior to the
proposed date of the institution of such function or service, a request for permission to
undertake such function or service.
(3) Each health care facility or institution or state health care facility or institution
which intends to terminate a health service offered by such facility or institution or
reduce substantially its total bed capacity, shall submit to the office, prior to the proposed
date of such termination or decrease, a request to undertake such termination or decrease.
(4) Except as provided in sections 19a-639a to 19a-639c, inclusive, each applicant,
prior to submitting a certificate of need application under this section or section 19a-639, or under both sections, shall submit a request, in writing, for application forms and
instructions to the office. The request shall be known as a letter of intent. A letter of
intent shall include: (A) The name of the applicant or applicants; (B) a statement indicating whether the application is for (i) a new, replacement or additional facility, service
or function, (ii) the expansion or relocation of an existing facility, service or function,
(iii) a change in ownership or control, (iv) a termination of a service or a reduction in
total bed capacity and the bed type, (v) any new or additional beds and their type, (vi)
a capital expenditure over three million dollars, (vii) the purchase, lease or donation
acceptance of major medical equipment costing over three million dollars, (viii) a CT
scanner, PET scanner, PET/CT scanner or MRI scanner, cineangiography equipment,
a linear accelerator or other similar equipment utilizing technology that is new or being
introduced into the state, or (ix) any combination thereof; (C) the estimated capital cost,
value or expenditure; (D) the town where the project is or will be located; and (E) a
brief description of the proposed project. The office shall provide public notice of any
complete letter of intent submitted under this section or section 19a-639, or both, by
publication in a newspaper having a substantial circulation in the area served or to be
served by the applicant. Such notice shall be submitted for publication not later than
twenty-one days after the date the office determines that a letter of intent is complete.
No certificate of need application will be considered submitted to the office unless a
current letter of intent, specific to the proposal and in compliance with this subsection,
has been on file with the office for not less than sixty days. A current letter of intent is
a letter of intent that has been on file at the office up to and including one hundred twenty
days, except that an applicant may request a one-time extension of a letter of intent of
up to an additional thirty days for a maximum total of up to one hundred fifty days if,
prior to the expiration of the current letter of intent, the office receives a written request
to so extend the letter of intent's current status. The extension request shall fully explain
why an extension is requested. The office shall accept or reject the extension request
not later than seven days from the date the office receives such request and shall so
notify the applicant.
(b) The office shall make such review of a request made pursuant to subdivision
(1), (2) or (3) of subsection (a) of this section as it deems necessary. In the case of a
proposed transfer of ownership or control, the review shall include, but not be limited
to, the financial responsibility and business interests of the transferee and the ability of
the institution to continue to provide needed services or, in the case of the introduction
of a new or additional function or service expansion or the termination of a service
or function, ascertaining the availability of such service or function at other inpatient
rehabilitation facilities, health care facilities or institutions or state health care facilities
or institutions or other providers within the area to be served, the need for such service
or function within such area and any other factors which the office deems relevant to a
determination of whether the facility or institution is justified in introducing or terminating such functions or services into or from its program. The office shall grant, modify
or deny such request no later than ninety days after the date of receipt of a complete
application, except as provided for in this section. Upon the request of the applicant, the
review period may be extended for an additional fifteen days if the office has requested
additional information subsequent to the commencement of the review period. The commissioner may extend the review period for a maximum of thirty days if the applicant
has not filed in a timely manner information deemed necessary by the office. Failure
of the office to act on such request within such review period shall be deemed approval
thereof. The ninety-day review period, pursuant to this subsection, for an application
filed by a hospital, as defined in section 19a-490, and licensed as a short-term acute-care general hospital or children's hospital by the Department of Public Health or an
affiliate of such a hospital or any combination thereof, shall not apply if, in the certificate
of need application or request, the hospital or applicant projects either (1) that, for the
first three years of operation taken together, the total impact of the proposal on the
operating budget of the hospital or an affiliate of such a hospital or any combination
thereof will exceed one per cent of the actual operating expenses of the hospital for the
most recently completed fiscal year as filed with or determined by the office, or (2) that
the total capital expenditure for the project will exceed fifteen million dollars. If the
office determines that an application is not subject to the ninety-day review period
pursuant to this subsection, it shall remain so excluded for the entire review period of
that application, even if the application or circumstances change and the application no
longer meets the stated terms of the exclusion. Upon a showing by such facility or
institution that the need for such function, service or termination or change of ownership
or control is of an emergency nature, in that the function, service or termination or
change of ownership or control is necessary to maintain continued access to the health
care services provided by the facility or institution, or to comply with requirements of
any federal, state or local health, fire, building or life safety code, the commissioner
may waive the letter of intent requirement, provided such request shall be submitted
not less than fourteen days before the proposed date of institution of the function, service
or termination or change of ownership or control.
(c) (1) The office may hold a public hearing with respect to any complete certificate
of need application submitted under this section. At least two weeks' notice of such
public hearing shall be given to the applicant, in writing, and to the public by publication
in a newspaper having a substantial circulation in the area served by the facility, institution or provider. At the discretion of the office, such hearing may be held in Hartford
or in the area so served or to be served. In conducting its activities under this section,
section 19a-639, or under both sections, the office may hold hearings on applications
of a similar nature at the same time.
(2) The office may hold a public hearing after consideration of criteria that include,
but need not be limited to, whether the proposal involves: (A) The provision of a new
or additional health care function or service through the use of technology that is new
or being introduced into the state; (B) the provision of a new or additional health care
function or service that is not provided in either a region designated by the applicant or
in the applicant's existing primary service area as defined by the office; or (C) the
termination of an existing health care function or service, the reduction of total beds or
the closing of a health care facility.
(3) The office shall hold a public hearing with respect to any complete certificate
of need application submitted to the office under this section if (A) three individuals or
an individual representing an entity with five or more people submit a request, in writing,
that a public hearing be held on the proposal after the office has published notice of a
complete letter of intent, and (B) such request is received by the office not later than
twenty-one days after the date that the office deems the certificate of need application
complete.
(P.A. 73-117, S. 13, 31; P.A. 77-192, S. 7, 13; 77-304, S. 2; 77-601, S. 7, 11; P.A. 79-98, S. 1, 4; P.A. 80-73, S. 4; P.A.
81-211; 81-441, S. 1; 81-465, S. 5, 9, 18; P.A. 82-415, S. 15, 18; P.A. 83-215, S. 1, 3; P.A. 86-374, S. 2, 6; P.A. 87-192,
S. 1, 3; 87-420, S. 11, 14; P.A. 89-72, S. 1, 5; 89-325, S. 12, 26; P.A. 91-48, S. 1, 4; June Sp. Sess. P.A. 91-8, S. 27, 63;
June Sp. Sess. P.A. 91-12, S. 10; P.A. 92-220, S. 1, 2; P.A. 93-229, S. 3, 21; 93-262, S. 1, 17, 87; 93-381, S. 9, 39; 93-406, S. 1, 6; 93-435, S. 59, 95; P.A. 94-236, S. 9, 10; P.A. 95-257, S. 12, 21, 39, 46, 58; P.A. 97-112, S. 2; P.A. 98-150,
S. 2, 17; P.A. 02-89, S. 34; P.A. 03-17, S. 1; P.A. 05-75, S. 2; 05-93, S. 1; 05-280, S. 58; P.A. 06-28, S. 1; 06-64, S. 6; 06-196, S. 214; P.A. 08-14, S. 3.)
History: P.A. 77-192 included state health care facilities or institutions in provisions of section; P.A. 77-304 specified
applicability to facilities or institutions which intend to "transfer all or any part of its ownership or control prior to being
initially licensed" and specified factors to be considered in review if transfer of ownership or control is proposed; P.A.
77-601 added provisions concerning applicability of provisions to home health care, homemaker-home health aide, or
coordination assessment and monitoring agencies and added Subsec. (b) re approval of home health care, homemaker-home health aide or coordination, assessment and monitoring agencies; P.A. 79-98 made provisions applicable to inpatient
rehabilitation facilities affiliated with Easter Seal Society; P.A. 80-73 allowed commission to modify requests as well as
to grant or deny requests in Subsec. (a); P.A. 81-211 mandated commission approval in Subsec. (a) for decreases in services
to medical assistance patients by termination of Medicaid provider agreements; P.A. 81-441 amended the commission on
hospitals and health care certificate of need review process by exempting from review outpatient, i.e. "ambulatory", services
provided by a health maintenance organization and by extending review to any facility plan to terminate a health service
or to substantially decrease bed capacity; P.A. 81-465 amended Subsec. (a) to exempt home health care and homemaker-home health care agencies from commission review relative to transfers of ownership prior to initial licensure or increased
staffing or services, and added provisions, codified by the Revisors as Subsec. (c), re coordination of activities between
commission and health systems agencies; P.A. 82-415 eliminated exception for ambulatory service programs by health
maintenance organizations from provision requiring submission of request for permission to add a function or service or
to increase staff in Subsec. (a); Sec. 19-73l transferred to Sec. 19a-154 in 1983; P.A. 83-215 exempted ambulatory services
established and conducted by a health maintenance organization from certificate of need review, provided for a 15-day
extension of the 90-day review period if additional information is requested by the commissioner or a motion to approve,
modify or deny a request results in a tie vote and authorized the adoption of regulations to establish a schedule for the
submission of similar requests; P.A. 86-374 deleted references to coordination, assessment and monitoring agencies,
including all of Subsec. (b), relettering Subsec. (c) accordingly; P.A. 87-192 deleted references to 90-day review period
and added the provision re extension of the review period for 30 days; P.A. 87-420 deleted references to health systems
agency and deleted the provision re coordination of activities with health systems agencies; P.A. 89-72 amended Subsec.
(b) to change "shall" to "may" with regard to holding of hearings, adopting of regulations and establishing of a schedule
which provides for completed applications pertaining to similar types of services; P.A. 89-325 deleted provisions re the
decrease in services to recipients of medical assistance benefits in Subsec. (a); P.A. 91-48 restated Subsec. (a) provision
re agencies required to request permission to undertake transfer of ownership or control, to institute additional functions
or services or to terminate functions and services or to reduce bed capacity; June Sp. Sess. P.A. 91-8 added Subsecs. (d),
(e) and (f) re moratorium on certificate of need for additional nursing home beds, on additional requests for beds from
residential facilities for the mentally retarded, and any requests to modify the capital cost or expiration date of approval;
June Sp. Sess. P.A. 91-12 amended Subsec. (c) requiring the commission to adopt regulations requiring that applications
for certificates be submitted in cycles; P.A. 92-220 amended Subsec. (d) by extending moratorium through June 30, 1994,
and adding provision re date by which construction shall begin and date by which nursing home shall be licensed under
certificates of need in effect August 1, 1991, amended Subsec. (e) by deleting provision re expiration of approval of
additional nursing home beds granted on or before July 1, 1991, and substituting definition of "a continuing care facility
which guarantees life care for its residents", added Subsec. (g) re joint request for merger of certificates of need, added
Subsec. (h) re when construction shall be deemed to have begun, added Subsec. (i) re when financing shall be deemed to
have been obtained, and added Subsec. (j) re when financing shall be deemed to have been obtained on and after March
1, 1993; P.A. 93-229 added Subsec. (a)(4) re submission of letter of intent, amended Subsec. (b) re exception to 90-day
review period, adding language explaining that emergency nature to include compliances with fire, building or life safety
code and that the letter of intent may be waived and amended Subsec. (c) to change "shall" to "may" re adoption of
regulations, effective June 4, 1993; P.A. 93-262 deleted homemaker-home health aide agencies and added nursing homes,
homes for the aged, rest homes and certain residential facilities for the mentally retarded as facilities to which section
applies, deleted Subsecs. (d) to (g), inclusive, and (i) re requests for additional nursing home beds, continuing care facilities,
requests for beds in residential facilities for the mentally retarded, certificates of need and financing methods, relettering
remaining Subsecs. as necessary, effective July 1, 1993; P.A. 93-381 replaced department of health services with department
of public health and addiction services, effective July 1, 1993; P.A. 93-406 added Subsecs. (f) and (g) re expiration of
certificates of need for nursing home beds, effective June 29, 1993 (Revisor's note: Pursuant to P.A. 93-262, 93-381 and
93-435 references to commissioners and departments of health services and income maintenance were replaced editorially
by the Revisors by references to commissioners and departments of public health and addiction services and social services,
respectively); P.A. 94-236 deleted former Subsec. (g) regarding nonexpiration of certificate of need if additional beds are
used for a continuing care facility, effective June 7, 1994; P.A. 95-257 replaced Commission on Hospitals and Health Care
and "commission" with Office of Health Care Access and "office" or "commissioner", replaced Department of Public
Health and Addiction Services with Department of Public Health and deleted reference to a tie vote of the former commission, effective July 1, 1995; Sec. 19a-154 transferred to Sec. 19a-638 in 1997; P.A. 97-112 replaced "home for the aged"
with "residential care home"; P.A. 98-150 added reference to exceptions in introductory language of Subsec. (a) and deleted
the exceptions throughout section, reworded transfer as Subpara. (A) in Subsec. (a)(1) and added Subparas. (B) and (C),
changed "transfer" to "transfer or change" in Subsec. (a)(1), amended Subdiv. (a)(4) by adding "replacement or additional",
adding "or relocation" to "expansion" adding references to change in ownership or control, termination of services or
reduction in bed capacity or type, capital expenditure over $1,000,000 and acquisition of specified equipment over
$400,000, added "value or expenditure" to Subdiv. (a)(4)(C), changed 90 days to 60 in Subdiv. (a)(4)(E) and added
exception re one-time extension, amended Subsec. (b) by adding "new" and "expansion or the termination" to service or
function and adding reference to termination or change of ownership throughout Subsec., added "affiliate of such hospital
or any combination thereof", replaced reference to future budget adjustments with Subdivs. (1), (2) and language re
exclusion during review period, amended Subsec. (c) by deleting obsolete authority to adopt regulations and made technical
changes throughout, effective June 5, 1998; P.A. 02-89 amended Subsec. (a) to replace reference to Sec. 19a-639d with
Sec. 19a-639c, reflecting repeal of Sec. 19a-639d by the same public act; P.A. 03-17 amended Subsec. (a)(3) by replacing
"decrease" with "reduce" and changed licensed bed capacity to total bed capacity and required notice when letter of intent
received in Subsec. (a)(4), made technical changes in Subsec. (b) and added Subsec. (c)(1) to (3) re public hearings on
complete certificate of need applications under certain circumstances; P.A. 05-75 added Subsec. (c)(3) by adding Subpara.
(A) designator and new Subpara. (B) establishing a 21 calendar day deadline for requesting a public hearing on a completed
certificate of need application; P.A. 05-93 amended Subsec. (a)(4) by eliminating, with certain exceptions, the $400,000
capital expenditure threshold for certificate of need review of proposals involving the purchase, lease or donation acceptance
of various types of scanning equipment and linear accelerators and by making technical changes, effective July 1, 2005;
P.A. 05-280 amended Subsec. (a) by adding reference to Sec. 19a-487a, effective July 1, 2005; P.A. 06-28 amended Subsec.
(a)(4) by increasing the capital expenditure threshold and major medical equipment acquisition threshold for certificate
of need review to $3,000,000, effective July 1, 2006; P.A. 06-64 amended Subsec. (b) by allowing waiver of letter of intent
requirement when a function, service or termination or change of ownership or control is necessary to maintain continued
access to health care services provided by a facility or institution, effective July 1, 2006; P.A. 06-196 made technical
changes in Subsec. (a)(4), effective June 7, 2006; P.A. 08-14 amended Subsec. (a)(4) by substituting 21 days for 15 business
days, substituting 7 days for 5 business days and making technical changes, amended Subsec. (b) by substituting not less
than 14 days for at least 10 business days, amended Subsec. (c)(3) by making a technical change, and deleted Subsecs. (d)
to (f), effective July 1, 2008.
See chapter 54 re uniform administrative procedure.
See Sec. 17b-347 re transfer of Medicaid patients to participating facility by nursing home which terminates its provider
agreement.
Annotation to former section 19-73l:
Cited. 33 CS 86.
Annotations to former section 19a-154:
Cited. 200 C. 133. Cited. 208 C. 663. Cited. 214 C. 321. Cited. 226 C. 105. Cited. 235 C. 128. Cited. 238 C. 216.
Subsec. (a):
Cited. 200 C. 489.