AN ACT STREAMLINING HEALTH CARE FACILITY APPROVALS.

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House of Representatives

File No. 755
General Assembly
February Session, 2026 (Reprint of File No. 83)

Substitute House Bill No. 5045
As Amended by House Amendment
Schedule "A"

Approved by the Legislative Commissioner
May 1, 2026

AN ACT STREAMLINING HEALTH CARE FACILITY APPROVALS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:

Section 1. (NEW) (Effective October 1, 2026) As used in this section and 1
sections 2 to 12, inclusive, of this act, unless the context otherwise 2
requires: 3
(1) "Affiliate" means a person, entity or organization controlling, 4
controlled by or under common control with another person, entity or 5
organization. "Affiliate" does not include a medical foundation 6
organized under chapter 594b of the general statutes. As used in this 7
subdivision, "controlled by" means the other person, entity or 8
organization, or one of such other person's, entity's or organization's 9
affiliates, officers or management employees, acting in such capacity, 10
acts as a general partner of a general or limited partnership or manager 11
of a limited liability company. 12
(2) "Applicant" means any person or health care facility that applies 13
for a certificate of need pursuant to section 6 or 7 of this act. 14
(3) "Bed capacity" means the total number of inpatient beds in a 15

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facility licensed by the Department of Public Health under sections 19a-16
490 to 19a-503, inclusive, of the general statutes. 17
(4) "Certificate of need" means a certificate issued pursuant to section 18
6 or 7 of this act. 19
(5) "Change of ownership or control" means any change in the 20
ownership or beneficial ownership or the change of control of an entity, 21
including (A) a corporate merger, (B) an acquisition of one or more 22
entities by direct or indirect purchase in any manner of not less than 23
twenty-five per cent of the assets, equity or voting shares of a health care 24
facility, (C) a transfer of control of a board of directors or governing 25
body, or (D) a real estate sale or lease agreement involving not less than 26
twenty per cent of the total assets of a hospital. 27
(6) "Commissioner" means the Commissioner of Public Health, or the 28
commissioner's designee. 29
(7) "Day" means a calendar day. 30
(8) "Department" means the Department of Public Health. 31
(9) "Free clinic" means a private, nonprofit community -based 32
organization that provides medical, dental, pharmaceutical or mental 33
health services at reduced cost or no cost to low-income, uninsured and 34
underinsured individuals. 35
(10) "Health care facility" means (A) a hospital, including any satellite 36
location licensed by the Department of Public Health under chapter 37
368v of the general statutes; (B) specialty hospital; (C) freestanding 38
emergency department; (D) outpatient surgical facility (i) as defined in 39
section 19a-493b of the general statutes and licensed under chapter 368v 40
of the general statutes, or (ii) as established by a short -term acute care 41
general hospital licensed by the department under said chapter; (E) a 42
hospital or other facility or institution operated by the state that 43
provides services that are eligible for reimbursement under Title XVIII 44
or XIX of the federal Social Security Act, 42 USC 301, as amended from 45
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time to time; (F) a central service facility; (G) a mental health facility; (H) 46
a substance abuse treatment facility; (I) any other facility requiring 47
certificate of need review pursuant to section 4 of this act; and (J) any 48
parent company, subsidiary, affiliate or joint venture, or any 49
combination thereof, of any facility described in subparagraphs (A) to 50
(J), inclusive, of this subdivision. 51
(11) "Large group practice" means eight or more full-time equivalent 52
physicians, legally organized in a partnership, professional corporation, 53
limited liability company formed to render professional services, 54
medical foundation, not-for-profit corporation, faculty practice plan or 55
other similar entity (A) in which each physician who is a member of the 56
group provides substantially the full range of services that the physician 57
routinely provides, including, but not limited to, medical care, 58
consultation, diagnosis or treatment, through the joint use of shared 59
office space, facilities, equipment or personnel; (B) for which 60
substantially all of the services of the physicians who are members of 61
the group are provided through the group and are billed in the name of 62
the group practice and amounts so received are treated as receipts of the 63
group; or (C) in which the overhead expenses of, and the income from, 64
the group are distributed in accordance with methods previously 65
determined by members of the group. An entity that otherwise meets 66
the definition of group practice under this section shall be considered a 67
group practice although its shareholders, partners or owners of the 68
group practice include single -physician professional corporations, 69
limited liability companies formed to render professional services or 70
other entities in which beneficial owners are individual physicians. 71
(12) "Panel" means the three -person panel established under section 72
2 of this act to decide all certificate of need applications. 73
(13) "Person" means any individual, partnership, corporation, limited 74
liability company, association, governmental subdivision, agency or 75
public or private organization of any character. "Person" does not 76
include the agency conducting the certificate of need application 77
proceeding under section 6 or 7 of this act. 78
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(14) "Physician" means an individual licensed to practice medicine 79
pursuant to chapter 370 of the general statutes. 80
(15) "Program" means the certificate of need program established 81
pursuant to section 3 of this act. 82
Sec. 2. (NEW) (Effective October 1, 2026) (a) There is established within 83
the department, for administrative purposes only, a panel that shall 84
make all final decisions and rulings regarding certificate of need 85
applications submitted on and after July 1, 2027, pursuant to section 6 86
or 7 of this act, civil penalties and cease and desist orders imposed on 87
and after July 1, 2027, pursuant to section 10 of this act, approvals of 88
policies and procedures effective on and after July 1, 2027, pursuant to 89
section 11 of this act, hospital plans for continued access to care during 90
service termination on and after July 1, 2027, pursuant to section 12 of 91
this act, and sales of nonprofit hospitals pursuant to section 19a-486a of 92
the general statutes. The panel shall consist of three members, who shall 93
include (1) the Commissioner of Public Health, or the commissioner's 94
designee, who shall act as chairperson of the panel, (2) the Secretary of 95
the Office of Policy and Management, or the secretary's designee, and 96
(3) the Commissioner of Social Services, or the Commissioner of Social 97
Services' designee. 98
(b) On and after July 1, 2027, the panel shall hold monthly meetings 99
to review and decide any certificate of need application that has been 100
submitted to the panel at least five days before the meeting date. In 101
addition to the monthly meetings, the chairperson may at any time call 102
a special meeting of the panel to review and decide any application 103
prepared for presentation to the panel or any other matter appropriate 104
for panel review under this section or sections 3 to 12, inclusive, of this 105
act. The panel may cancel a monthly meeting if no application or other 106
business has been appropriately submitted with at least five days' notice 107
to the panel for review at such meeting. 108
Sec. 3. (NEW) (Effective October 1, 2026) (a) There is established within 109
the department a Certificate of Need Program that shall support the 110
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review of certificate of need applications. The commissioner shall 111
designate a director who shall oversee the program. 112
(b) On and after July 1, 2027, (1) each person applying for a certificate 113
of need shall file an application with the Certificate of Need Program, 114
and (2) the program shall prepare a report regarding the certificate of 115
need application. 116
(c) On and after July 1, 2027, the Certificate of Need Program shall 117
make all determinations as to whether a certificate of need is required 118
pursuant to section 4 of this act. 119
(d) The Certificate of Need Program shall monitor compliance with 120
the provisions of sections 2 to 12, inclusive, of this act and with any order 121
or decision, including any conditions placed thereon, that is issued by 122
the panel. In any enforcement action made under section 10 of this act, 123
the Certificate of Need Program shall present the allegations set forth in 124
the enforcement action at the public hearing before the panel. 125
Sec. 4. (NEW) (Effective October 1, 2026) (a) On and after July 1, 2027, 126
a certificate of need issued by the panel shall be required for: 127
(1) The establishment of a new health care facility; 128
(2) A change of ownership or control of a health care facility; 129
(3) A change of ownership or control of a large group practice to any 130
entity other than a (A) physician, or (B) group of two or more physicians 131
legally organized in a partnership, professional corporation or limited 132
liability company formed to render professional services and not 133
employed by or an affiliate of any hospital, medical foundation, 134
insurance company or other similar entity; 135
(4) The acquisition of computed tomography scanners, magnetic 136
resonance imaging scanners, positron emission tomography scanners or 137
positron emission tomography-computed tomography scanners, by any 138
person, physician, provider, short -term acute care general hospital or 139
children's hospital, except (A) as provided for in subdivision (18) of 140
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subsection (b) of this section, and (B) a certificate of need issued by the 141
panel shall not be required where such scanner is a replacement for a 142
scanner that was previously acquired through certificate of need 143
approval or a certificate of need determination, including a replacement 144
scanner that has dual modalities or functionalities if the applicant 145
already offers similar imaging services for each of the scanner's 146
modalities or functionalities that will be utilized; 147
(5) An increase in the licensed bed capacity of a health care facility; 148
(6) The acquisition of equipment utilizing technology that has not 149
previously been utilized in the state; 150
(7) An increase of two or more operating rooms within any three-year 151
period by an outpatient surgical facility, as defined in section 19a -493b 152
of the general statutes, or by a short-term acute care general hospital; 153
(8) The establishment of cardiac services, including inpatient and 154
outpatient cardiac catheterization, interventional cardiology and 155
cardiovascular surgery; and 156
(9) The acquisition of nonhospital-based linear accelerators, except a 157
certificate of need issued by the panel shall not be required where such 158
accelerator is a replacement for an accelerator that was previously 159
acquired through certificate of need approval or a certificate of need 160
determination. 161
(b) On and after July 1, 2027, a certificate of need issued by the panel 162
shall not be required for: 163
(1) A health care facility owned and operated by the federal 164
government; 165
(2) The establishment of offices by a licensed private practitioner, 166
whether for individual or group practice, except when a certificate of 167
need is required in accordance with the requirements of section 19a -168
493b of the general statutes or subdivision (3), (4) or (6) of subsection (a) 169
of this section; 170
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(3) A health care facility operated by a religious group that 171
exclusively relies upon spiritual means through prayer for healing; 172
(4) Residential care homes, nursing homes and rest homes, as defined 173
in section 19a-490 of the general statutes; 174
(5) An assisted living services agency, as defined in section 19a-490 of 175
the general statutes; 176
(6) A home health agency, as defined in section 19a-490 of the general 177
statutes; 178
(7) Hospice services, as described in section 19a-122b of the general 179
statutes; 180
(8) An outpatient rehabilitation facility; 181
(9) Outpatient chronic dialysis services; 182
(10) Transplant services; 183
(11) A free clinic; 184
(12) A school-based health center and an expanded school health site, 185
as such terms are defined in section 19a-6r of the general statutes, a 186
community health center, as defined in section 19a-490a of the general 187
statutes, a not-for-profit outpatient clinic licensed in accordance with the 188
provisions of chapter 368v of the general statutes and a federally 189
qualified health center; 190
(13) A program licensed or funded exclusively by the Department of 191
Children and Families, provided such program is not a psychiatric 192
residential treatment facility; 193
(14) Any facility, institution or provider that is (A) operated as a 194
nonprofit or by the state, and (B) solely providing behavioral health or 195
substance use disorder treatment services; 196
(15) A health care facility operated by a nonprofit educational 197
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institution exclusively for students, faculty and staff of such institution 198
and their dependents; 199
(16) An outpatient clinic or program operated exclusively by or 200
contracted to be operated exclusively by a municipality, municipal 201
agency, municipal board of education or a health district, as described 202
in section 19a-241 of the general statutes; 203
(17) A residential facility for persons with intellectual disability 204
licensed pursuant to section 17a-227 of the general statutes and certified 205
to participate in the Title XIX Medicaid program as an intermediate care 206
facility for individuals with intellectual disabilities; 207
(18) Replacement of existing computed tomography scanners, 208
magnetic resonance imaging scanners, positron emission tomography 209
scanners or positron emission tomography -computed tomography 210
scanners, if such equipment was acquired through certificate of need 211
approval or a certificate of need determination, provided a health care 212
facility, provider, physician or person notifies the Department of Public 213
Health of the date on which the equipment is replaced and the 214
disposition of the replaced equipment, including if a replacement 215
scanner has dual modalities or functionalities and the applicant already 216
offers similar imaging services for each of the equipment's modalities or 217
functionalities that will be utilized; 218
(19) Acquisition of cone-beam dental imaging equipment that is to be 219
used exclusively by a dentist licensed pursuant to chapter 379 of the 220
general statutes; 221
(20) The partial or total elimination of services provided by an 222
outpatient surgical facility, as defined in section 19a-493b of the general 223
statutes; 224
(21) The termination of services for which the Department of Public 225
Health has requested the facility to relinquish its license; 226
(22) Acquisition of any equipment by any person that is to be used 227
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exclusively for scientific research, provided the equipment shall not be 228
used in the diagnosis, treatment or prevention of any medical condition 229
for humans; 230
(23) The establishment of a harm reduction center through the pilot 231
program established pursuant to section 17a-673c of the general 232
statutes; 233
(24) On or before June 30, 2028, a birth center, as defined in 234
section 19a-490 of the general statutes, that is enrolled as a provider in 235
the Connecticut medical assistance program, as defined in section 17b-236
245g of the general statutes; 237
(25) An association between a group practice and a management 238
services organization under which such management services 239
organization does not directly share in the profits or net revenue of the 240
group practice but rather is paid a fair market value through a contract 241
for services rendered; and 242
(26) The relocation of a health care facility within the same town or 243
within ten miles of the existing facility location, provided such 244
relocation will not result in a substantial change to the payer mix or 245
patient population served by the facility. 246
(c) On and after July 1, 2027, any person, health care facility or 247
institution that is unsure whether a certificate of need is required for a 248
particular proposal under this section shall send a letter to the 249
Certificate of Need Program that describes the proposal and requests 250
that the program make a determination as to whether a certificate of 251
need is required for such proposal. A person, health care facility or 252
institution making such request shall provide the program with any 253
information the program requests as part of its determination process. 254
The program shall provide a determination not later than thirty days 255
after receipt of such request. 256
(d) On and after July 1, 2027, any acquiring person or entity in a 257
change of ownership or control of a large group practice to any person 258
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or entity that does not require a certificate of need pursuant to 259
subdivision (3) of subsection (a) of this section shall submit notices to 260
the program, in a form and manner prescribed by the commissioner, of 261
such transfer consistent with this subsection. 262
(1) Not less than thirty days prior to the closing of a transaction, the 263
acquiring person or entity shall submit a notice for each such group 264
practice, in a form and manner prescribed by the commissioner, setting 265
forth: (A) The names and medical specialties of each physician 266
practicing medicine with the group practice; (B) the names of the 267
business entities that provide clinical or managerial services as part of 268
the group practice; (C) the address for each location where clinical 269
services are provided by the group practice; (D) a description of the 270
clinical services provided at each location of the group practice; (E) the 271
zip codes of the primary service area served by each location of the 272
group practice; and (F) the resulting name, ownership, and business 273
type of the group practice after the proposed change of ownership, 274
control or affiliation, including the name and business type of any 275
person or entity that will control, directly or indirectly, at least ten per 276
cent of the large group practice. The program shall, unless otherwise 277
prohibited by federal or state law, post such information on its Internet 278
web site. 279
(2) Not later than thirty days after the close of the transaction or after 280
the abandonment of such transaction, the acquiring person or entity 281
shall submit a report indicating the date on which the transaction closed 282
or was abandoned. 283
(3) When the provision of thirty days' notice pursuant to subdivision 284
(1) of this subsection is not practicable due to circumstances outside of 285
the acquiring person or entity's control, such as death, incapacity or 286
other exigent circumstances, the acquiring person or entity shall provide 287
notice to the program as soon as practicable but in no case later than 288
fourteen days after the close of the transaction. 289
(e) Not later than January 1, 2028, the commissioner shall report to 290
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the Governor and, in accordance with the provisions of section 11-4a of 291
the general statutes, to the joint standing committee of the General 292
Assembly having cognizance of matters relating to public health 293
concerning the commissioner's recommendations, if any, regarding an 294
exemption from certificate of need requirements related to temporary 295
increases in licensed bed capacity of a hospital due to a surge in 296
admissions that cannot be accommodated by the hospital's existing 297
licensed bed capacity. 298
Sec. 5. (NEW) (Effective October 1, 2026 ) (a) In any deliberation 299
involving a certificate of need application filed pursuant to section 6 of 300
this act, the panel shall determine whether the applicant has 301
demonstrated, by a preponderance of the evidence, that the proposal is 302
in the public's interest. In making such determination, the panel shall 303
consider, consistent with any relevant regulations, policies or 304
procedures of the department, the following factors: 305
(1) Whether the proposal promotes delivery of high -quality care in 306
the primary service area of the applicant; 307
(2) Whether the proposal promotes access to health care services, 308
including Medicaid access, in the primary service area of the applicant; 309
(3) Whether the proposal promotes delivery of cost -effective care in 310
the primary service area of the applicant; 311
(4) Whether the proposal promotes financial stability of the health 312
care system, including, but not limited to, whether the proposal is 313
financially feasible for the applicant and whether there is any evidence 314
of prior financial mismanagement or misconduct by the applicant; 315
(5) Whether there is a clear public need for the proposal and the 316
services to be provided under the proposal; and 317
(6) Whether the proposal would result in an unnecessary duplication 318
of services. 319
(b) In analyzing whether a certificate of need application satisfies the 320
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certificate of need criteria set forth in subsection (a) of this section, the 321
panel and the Certificate of Need Program may engage, when, in the 322
sole discretion of the director, an expert with specialized knowledge is 323
required, any third -party consultant that the panel or program deems 324
necessary to analyze the application materials and proposal set forth in 325
the application pursuant to such criteria. All costs associated with such 326
third-party consultant shall be borne by the applicant, provided the total 327
costs for all consultants to the panel and the program under this 328
subsection for a single application shall not exceed one hundred 329
thousand dollars. Each third -party consultant engaged under this 330
subsection shall submit each invoice for consulting services directly to 331
the applicant for payment not later than thirty days after the issuance of 332
the invoice. The provisions of chapter 57 of the general statutes and 333
sections 4-212 to 4-219, inclusive, and 4e-19 of the general statutes shall 334
not apply to any retainer agreement executed pursuant to this 335
subsection. 336
(1) No consultant shall be retained in connection with the processing 337
of an application under the expedited review process described in 338
section 7 of this act unless such expedited application is referred for a 339
full review pursuant to subsection (g) of section 7 of this act. 340
(2) If the program determines that a consultant is necessary under this 341
subsection, the program shall provide notice to the applicant prior to 342
expending any money and provide the applicant the opportunity to 343
withdraw the application prior to incurring any consulting fees. 344
(3) Not later than July 1, 2028, and annually thereafter, the 345
commissioner shall report to the Governor and, in accordance with the 346
provisions of section 11 -4a of the general statutes, to the joint standing 347
committee of the General Assembly having cognizance of matters 348
relating to public health regarding all consultants engaged under this 349
subsection, including (A) the number of engagements, (B) the categories 350
of certificate of need proposals for which the engagements were made, 351
(C) the amount spent on each engagement, (D) the nature of the 352
expertise sought in each engagement, and (E) any reports produced 353
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under each engagement. 354
Sec. 6. (NEW) (Effective October 1, 2026) (a) On and after July 1, 2027, 355
an applicant seeking a certificate of need shall submit an application to 356
the Certificate of Need Program, in a form and manner prescribed by 357
the commissioner, and include all information required pursuant to the 358
regulations, policies and procedures promulgated pursuant to section 359
11 of this act. Each application shall be submitted based on monthly 360
deadlines, including submission dates of the fifteenth day of each 361
month. 362
(b) The applicant shall include with the application a nonrefundable 363
application fee based on the total cost associated with the project. The 364
amount of the fee shall be as follows: (1) One thousand dollars for a 365
project that will cost not greater than fifty thousand dollars; (2) two 366
thousand dollars for a project that will cost greater than fifty thousand 367
dollars but not greater than one hundred thousand dollars; (3) three 368
thousand dollars for a project that will cost greater than one hundred 369
thousand dollars but not greater than five hundred thousand dollars; (4) 370
four thousand dollars for a project that will cost greater than five 371
hundred thousand dollars but not greater than one million dollars; (5) 372
five thousand dollars for a project that will cost greater than one million 373
dollars but not greater than five million dollars; (6) eight thousand 374
dollars for a project that will cost greater than five million dollars but 375
not greater than ten million dollars; and (7) ten thousand dollars for a 376
project that will cost greater than ten million dollars. 377
(c) Not later than twenty -one days prior to the deadline to submit a 378
certificate of need application described in subsection (a) of this section, 379
an applicant for a certificate of need shall submit a notice to the program 380
for posting on the program's Internet web site. If the applicant has not 381
submitted the application on or before ninety days after submission of 382
such notice, a new notice shall be required under this subsection prior 383
to submitting the application. Such notice shall include, but need not be 384
limited to: 385
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(1) The identity of the applicant and any known parties to the 386
application; 387
(2) The street address and town where the proposal that is the subject 388
of the application is located; and 389
(3) A brief description in plain language of the proposal, including a 390
reference to the subdivision of subsection (a) of section 4 of this act 391
under which the application is being submitted. 392
(d) Any person wishing to request party or intervenor status in 393
connection with a certificate of need application shall file a notice of such 394
person's intent, including a statement of whether such person seeks a 395
hearing on the application, with the program not later than twenty days 396
after the posting on the program's Internet web site of the applicant's 397
notice of the intent to file the application. Any person who files such a 398
notice of intent under this subsection, or who demonstrates good cause 399
for failing to file such a notice, may file a petition for party or intervenor 400
status not later than twenty -one days after the applicant's filing of the 401
certificate of need application. 402
(1) If a petition for party or intervenor status is filed, the panel shall 403
appoint a hearing officer to resolve the request. 404
(2) The applicant may object to any request for party or intervenor 405
status not later than five days after the request is filed. 406
(3) The hearing officer shall render a decision on the petition not later 407
than fifteen days after the request is filed. 408
(4) If a request to intervene is granted, the decision granting 409
intervention shall set out the scope of intervention rights granted, 410
including whether or not an intervenor's request for a hearing is granted 411
or whether intervention is limited to submission of written materials. 412
(e) Not later than fifteen days after the deadline to submit an 413
application described in subsection (a) of this section, the program shall 414
notify each certificate of need applicant whether the applicant's 415
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application is deemed complete. To be deemed complete, the applicant 416
shall have submitted relevant responses to all application questions and 417
data requests in the application. For any application that is deemed 418
incomplete, the program shall, not later than five days after deeming 419
such application incomplete, notify the applicant, in writing, of each 420
application and data element that was not adequately addressed by the 421
applicant. The program shall not review any incomplete application 422
until the applicant submits a revised and completed application that 423
adequately addresses such application and data elements to the 424
program in a subsequent application period. The subsequent filing of 425
the revised application shall not require any additional filing fee unless 426
the total cost of the proposal is amended such that a different fee would 427
be required under subsection (b) of this section, in which case the 428
applicant shall submit the net difference. 429
(f) The program shall submit a report to the record summarizing the 430
certificate of need application and providing an analysis of each 431
criterion listed in section 5 of this act. The program shall provide such 432
report no later than ten days prior to any public hearing and in no case 433
later than ninety days after the application was deemed complete. 434
(1) The program may request additional information from the 435
applicant during the course of analyzing the certificate of need 436
application. Any such request shall not delay timelines for review of the 437
application except by mutual agreement of the applicant and the 438
program. All additional information shall, unless otherwise prohibited 439
by federal or state law, be made part of the public certificate of need 440
record. 441
(2) The program may supplement the record with relevant data, 442
analyses, reports or other similar evidence not later than seventy -five 443
days after the application is deemed complete, provided the applicant 444
shall have ten days to respond, in writing, to such evidence. Any 445
response from the applicant shall be included in the record. 446
(g) The panel, or a hearing officer designated by the panel, shall hold 447
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a public hearing on each properly filed and complete certificate of need 448
application filed under this section unless the applicant waives the 449
applicant's right to a public hearing. 450
(1) An applicant may waive the applicant's right to a public hearing, 451
in writing, not later than thirty days after the application is deemed 452
complete, if the applicant is the only party to the proceeding and no 453
person is granted intervenor status pursuant to section 4 -177a of the 454
general statutes and subsection (d) of this section. Such waiver shall 455
constitute a waiver of the applicant's right to appeal under section 4-183 456
of the general statutes. 457
(2) The panel shall convene a public hearing on an application not 458
later than ninety days after the program deems the application as 459
properly filed and complete. 460
(3) The hearing record shall close not later than ten days after the 461
adjournment of the hearing unless the applicant and program mutually 462
agree to maintain the record open for some period. Any transcript of the 463
hearing shall be made part of the record without needing to reopen the 464
record. If no hearing is held, the record shall close ten days after the 465
submission of the report. 466
(4) The panel may appoint a hearing officer to administer any hearing 467
under this section and to draft the proposed final decision consistent 468
with this section and chapter 54 of the general statutes. A hearing officer 469
appointed by the panel may draft a proposed final decision even for 470
dockets in which the applicant waived the right to a hearing and no 471
hearing was held. 472
(h) Not later than sixty days after the record of the public hearing is 473
closed, or one hundred fifty days after the application was deemed 474
complete if the applicant affirmatively waives a public hearing, the 475
hearing officer, if one is appointed, shall transmit the report required 476
pursuant to this section, the record of such hearing, if any, and the 477
hearing officer's proposed final decision to the panel for consideration 478
at the panel's next monthly meeting. If no hearing officer is appointed 479
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for a docket that did not have a hearing, the director of the program shall 480
prepare and submit the proposed final decision. If the proposed final 481
decision recommends conditions pursuant to this section, the program 482
or hearing officer shall meet with the applicant, unless otherwise 483
prohibited by law, at least five days before transmitting such proposed 484
final decision, to preview the conditions to be proposed. 485
(i) An applicant may file written briefs or exceptions and request oral 486
argument regarding the proposed final decision not later than fourteen 487
days after the publication of such proposed final decision. 488
(j) At the panel meeting to review one or more certificate of need 489
applications filed under this section, the panel shall vote on the 490
disposition of each application that has been submitted to the panel at 491
least five days prior to such meeting. The panel shall decide any 492
presented application by majority vote. The panel may approve the 493
application, with or without conditions, deny the application or remand 494
the application to the hearing officer for further development of the 495
record for presentation at the next panel meeting, or order the program 496
and applicant to engage in agreed settlement negotiations. 497
(1) Any proposed final decision that is approved by the vote of the 498
panel shall be automatically converted to a final decision upon the 499
approval vote of the panel. 500
(2) Any proposed final decision that is voted to be modified by the 501
panel shall be modified consistent with the direction of the panel and 502
posted as a final decision of the panel not later than thirty days after the 503
panel's vote to modify, provided, at least five days before posting the 504
modified final decision, the program or hearing officer shall meet with 505
the applicant, unless otherwise prohibited by law, to preview the 506
conditions to be finalized. 507
(3) Any docket remanded for further development of the record and 508
presentation at the next meeting shall not be so remanded more than 509
twice by the panel unless by mutual agreement of the panel and the 510
applicant. 511
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(4) Any docket referred for settlement negotiations shall have the 512
resulting negotiated proposed settlement presented at the next panel 513
meeting. The panel shall vote on the proposed settlement and may 514
approve the proposed settlement or reject such settlement and move to 515
one of the other available dispositions of the docket. 516
(5) Nothing in this section shall preclude the program and the 517
applicant from engaging in negotiations to reach an agreed settlement 518
at an earlier point in the process, provided such negotiations occur not 519
earlier than thirty days after the application has been deemed complete. 520
Any negotiated agreement shall be presented for review and a vote on 521
the disposition thereof at the next meeting of the panel that is at least 522
five days after the date of the settlement. 523
(k) The Certificate of Need Program may recommend, and the panel 524
may impose, any condition on an approval of a certificate of need 525
application filed under this section, provided (1) any such condition is 526
consistent with the purposes of sections 2 to 12, inclusive, of this act, and 527
(2) the program or hearing officer shall meet with the applicant, unless 528
otherwise prohibited by law, at least five days before issuing a proposed 529
final decision or a final decision that imposes any such condition, to 530
preview each such condition to be met by the applicant. The applicant 531
and any party to the application may request an amendment to or relief 532
from any condition, in a form and manner prescribed by the 533
commissioner, due to changed circumstances, hardship or for other 534
good cause. The panel may grant or deny any such request. The 535
determination to deny such request shall not be subject to appeal under 536
section 4-183 of the general statutes. 537
(l) Any final decision issued pursuant to this section for a docket in 538
which a public hearing was held, either under subsection (e) of this 539
section or as a result of the docket being remanded by the panel for 540
further development of the record pursuant to subsection (j) of this 541
section, shall be subject to appeal under section 4 -183 of the general 542
statutes. 543
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(m) Any deadlines in this section may be extended by mutual 544
agreement of the program and the applicant. 545
Sec. 7. (NEW) (Effective October 1, 2026 ) (a) Not later than January 1, 546
2028, the panel shall create an expedited review pathway for certain 547
categories of applications for certificates of need required under 548
subsection (a) of section 4 of this act, or subcategories thereof. On and 549
after January 1, 2028, an applicant may request an expedited review of 550
the following categories of applications: 551
(1) The relocation of a health care facility greater than ten miles away 552
from its current location and outside the current town in which it is 553
located; 554
(2) The increase in the number of inpatient or outpatient hospital 555
beds; 556
(3) The acquisition of computed tomography scanners, magnetic 557
resonance imaging scanners, positron emission tomography scanners or 558
positron emission tomography-computed tomography scanners, by any 559
person, physician, provider, short -term acute care general hospital or 560
children's hospital, where certificate of need approval is required for 561
such acquisition; 562
(4) An increase of two or three operating rooms, within any three -563
year period, by an outpatient surgical facility, as defined in section 19a-564
493b of the general statutes, or by a short -term acute care general 565
hospital; and 566
(5) Any other category designated by the commissioner in 567
regulations adopted in accordance with the provisions of chapter 54 of 568
the general statutes. 569
(b) On and after January 1, 2028, an applicant requesting expedited 570
review of a certificate of need application shall submit such application, 571
in a form and manner prescribed by the commissioner, pursuant to the 572
deadlines described in subsection (a) of section 6 of this act and provide 573
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the same application fee described in subsection (b) of said section and 574
notice of intent to the program as described in subsection (c) of said 575
section. 576
(c) An application processed through the expedited pathway shall 577
not be entitled to a hearing before a hearing officer, except (1) the 578
program may hold a hearing before a hearing officer appointed by the 579
panel not later than thirty days after deeming the application complete 580
without affecting any other timelines under this subsection, or (2) the 581
panel may remove the application from the expedited pathway and 582
have it processed through the standard pathway described in section 6 583
of this act. 584
(d) Not later than fifteen days after submitting an application for a 585
certificate of need for expedited review under this section, the program 586
shall notify the applicant requesting expedited review whether such 587
applicant's application is deemed complete and whether the application 588
meets the requirements for expedited review. 589
(1) For any application that is deemed incomplete, the Certificate of 590
Need Program shall, not later than five days after deeming such 591
application incomplete, notify the applicant, in writing, of any 592
application or data elements that were not adequately addressed by the 593
applicant. The program shall not review such an application until the 594
applicant submits an application that adequately addresses such 595
application or data elements to the program in a subsequent application 596
period. 597
(2) For any application that is deemed complete but ineligible for 598
expedited review under this section, the Certificate of Need Program 599
shall review the application under the standard process set forth in 600
section 6 of this act. 601
(e) Any person who wishes to seek intervenor or party status shall 602
file a request to do so not later than fourteen days after the filing of a 603
certificate of need application filed under the expedited pathway. 604
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(1) The panel shall appoint a hearing officer to review any request to 605
intervene or for party status. 606
(2) The applicant may respond to such request not later than five days 607
after filing. 608
(3) The hearing officer shall resolve the request for party or intervenor 609
status not later than five days after the applicant's response. 610
(4) If party or intervenor status is granted, the application shall be 611
removed from the expedited pathway and processed through the 612
standard pathway described in section 6 of this act. In determining 613
whether to grant intervention, the hearing officer shall consider the 614
unique nature of the expedited process and potential burden imposed 615
by permitting intervention. 616
(5) The date of any referral of an application under this subsection to 617
the standard pathway shall be considered the date on which the 618
application was deemed complete. 619
(f) For any complete application that is eligible for expedited review 620
under this section, the Certificate of Need Program shall complete its 621
analysis and the director shall issue a proposed final decision not later 622
than sixty days after the application is deemed complete and eligible for 623
expedited review under this section and present the application to the 624
panel at its next meeting. 625
(g) An applicant may file written briefs or exceptions and request oral 626
argument regarding the proposed final decision not later than seven 627
days after the publication of such proposed final decision. The program 628
shall submit the proposed final decision and any subsequent 629
submissions from the applicant to the panel. 630
(h) The panel shall base its decision in the expedited pathway on the 631
same standards and guidelines as those in subsection (a) of section 5 of 632
this act. At the panel's meeting to consider an expedited application, the 633
panel shall vote on the disposition of the certificate of need application. 634
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The panel may approve the application, with or without conditions, 635
deny the application, remand the application to the program for further 636
development of the record for presentation at the next panel meeting, 637
remand the application for further development of the record in the 638
standard certificate of need application process pursuant to section 6 of 639
this act, or order the program and applicant to engage in agreed 640
settlement negotiations. 641
(1) Any proposed final decision that is approved by the vote of the 642
panel shall be automatically converted to a final decision upon such 643
approval. 644
(2) Any proposed final decision that is voted to be modified by the 645
panel shall be modified consistent with the direction of the panel and 646
posted as a final decision of the panel not later than twenty -one days 647
after the panel's vote to modify, provided, at least five days before 648
posting the modified final decision, the program or hearing officer shall 649
meet with the applicant, unless otherwise prohibited by law, to preview 650
the conditions to be finalized. 651
(3) Any docket remanded for further development of the record and 652
presentation at the next meeting shall not be so remanded more than 653
twice by the panel unless by mutual agreement of the panel and the 654
applicant. 655
(4) Any docket remanded for processing under the standard 656
certificate of need application pursuant to section 6 of this act shall have 657
the date of the panel's vote be the date on which the application is 658
considered to be deemed complete in the standard process. 659
(5) Any docket referred for settlement negotiations shall have the 660
resulting negotiated proposed settlement presented at the next panel 661
meeting. The panel shall vote on the proposed settlement and may 662
approve the proposed settlement or reject such settlement and move to 663
one of the other available dispositions of the docket. 664
(6) Nothing in this section shall preclude the program and the 665
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applicant from engaging in negotiations to reach an agreed settlement 666
at an earlier point in the process, provided such negotiations occur not 667
earlier than fifteen days after the application has been deemed complete. 668
Any negotiated agreement shall be presented for review and a vote on 669
the disposition thereof at the next meeting of the panel that is at least 670
five days after the date of the settlement. 671
(i) The Certificate of Need Program may recommend, and the panel 672
may impose any condition on, an approval of an expedited certificate of 673
need application, provided (1) any such condition is consistent with the 674
purposes of sections 2 to 12, inclusive, of this act, and (2) the program or 675
hearing officer shall meet with the applicant, unless otherwise 676
prohibited by law, at least five days before issuing a proposed final 677
decision or a final decision that imposes any such condition, to preview 678
each such condition to be met by the applicant. The applicant and any 679
party to the application may request an amendment to or relief from any 680
condition, in a form and manner prescribed by the commissioner, due 681
to changed circumstances, hardship or for other good cause. The panel 682
may grant or deny any such request. The determination to deny such 683
request shall not be subject to appeal under section 4-183 of the general 684
statutes. 685
(j) Not later than July 1, 2029, the Certificate of Need Program, in 686
consultation with relevant stakeholders, shall submit a report, in 687
accordance with the provisions of section 11 -4a of the general statutes, 688
to the joint standing committee of the General Assembly having 689
cognizance of matters relating to public health regarding the expedited 690
pathway, including (1) the average time from application submission to 691
final decision, (2) the number of applications processed through the 692
expedited process in comparison to the standard process, (3) the number 693
of applications filed under the expedited pathway that have been 694
transferred to the standard pathway and the reasons for such transfer, 695
and (4) any recommendations for process changes to the expedited 696
pathway. 697
(k) Any deadlines in this section may be extended by mutual 698
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agreement of the program and the applicant. 699
Sec. 8. (NEW) (Effective October 1, 2026 ) (a) For a certificate of need 700
issued pursuant to an application filed on or after July 1, 2027, the 701
certificate of need shall be valid (1) only for the proposal described in 702
the application, and (2) for two years from the date of issuance by the 703
panel. During the period of time that such certificate is valid and the 704
thirty-day period following the expiration of the certificate, the holder 705
of the certificate shall provide the Certificate of Need Program with such 706
information as the program may request on the development of the 707
proposal covered by the certificate. 708
(b) Upon request from a certificate of need holder, the program may 709
extend the duration of a certificate of need for such additional period of 710
time as the program determines is reasonably necessary to 711
expeditiously complete the proposal. Not later than five business days 712
after receiving a request to extend the duration of a certificate of need, 713
the program shall post such request on its Internet web site. Any person 714
who wishes to comment on extending the duration of the certificate of 715
need shall provide written comments to the program on the requested 716
extension not later than thirty days after the date the program posts 717
notice of the request for an extension of time on its Internet web site. 718
(c) If the program determines that (1) commencement, construction 719
or other preparation has not been substantially undertaken during a 720
valid certificate of need period, or (2) the certificate of need holder has 721
not made a good-faith effort to complete the proposal as approved, the 722
program may withdraw, revoke or rescind the certificate of need 723
pursuant to the requirements set forth in chapter 54 of the general 724
statutes. 725
(d) For a certificate of need issued pursuant to an application filed on 726
or after July 1, 2027, the (1) certificate of need shall not be transferable 727
or assignable, and (2) project that is the subject of the certificate of need 728
shall not be transferred from a certificate holder to another person. 729
Sec. 9. (NEW) (Effective October 1, 2026) (a) On and after July 1, 2027, 730
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sHB5045 / File No. 755 25

the Certificate of Need Program shall conduct a cost and market impact 731
review for any transaction involving the transfer of ownership or 732
control of a hospital in which (1) an application for a certificate of need 733
has been filed pursuant to subdivision (2) of subsection (a) of section 4 734
of this act or a notice of material change has been filed with the Attorney 735
General's office pursuant to section 19a-486i of the general statutes that 736
involves the transfer of ownership of a hospital, as defined in section 737
19a-639 of the general statutes, as amended by this act, and (2) the 738
purchaser is (A) a hospital, as defined in section 19a -490 of the general 739
statutes, whether located within or outside the state, that had net patient 740
revenue for fiscal year 2025 in an amount greater than one billion 741
dollars, (B) a hospital system, as defined in section 19a -486i of the 742
general statutes, whether located within or outside the state, that had 743
net patient revenue for fiscal year 2025 in an amount greater than one 744
billion dollars, or (C) any person that is organized or operated for profit. 745
(b) The program shall develop a set of data requests to be used for 746
applications filed on and after July 1, 2027, for all cost and market impact 747
reviews. An applicant that is the subject of a cost and market impact 748
review shall submit all data necessary for such review at the same time 749
that the hospital initiates the application process for a certificate of need 750
with the program or that it submits a notice of material change to the 751
Attorney General under section 19a -486i of the general statutes, 752
whichever is earlier. The program shall review the data submission for 753
completeness not later than thirty days after submission. If the data 754
submission is incomplete, the program shall notify the applicant that it 755
is incomplete and identify which data elements are incomplete. 756
(c) The program shall keep confidential all nonpublic information 757
and documents obtained pursuant to this section and shall not disclose 758
the information or documents to any person without the consent of the 759
person that produced the information or documents, except in a 760
preliminary report or final report issued in accordance with this section 761
if the program believes that such disclosure should be made in the 762
public interest after taking into account any privacy, trade secret or anti-763
competitive considerations. Such information and documents shall not 764
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be deemed a public record under section 1 -210 of the general statutes 765
and shall be exempt from disclosure. 766
(d) The cost and market impact review conducted pursuant to this 767
section shall examine factors relating to the businesses and relative 768
market positions of the transacting parties as defined in subsection (d) 769
of section 19a -639 of the general statutes, as amended by this act, and 770
may include, but need not be limited to: (1) The transacting parties' size 771
and market share within its primary service area, by major service 772
category and within its dispersed service areas; (2) the transacting 773
parties' prices for services, including the transacting parties' relative 774
prices compared to other health care providers for the same services in 775
the same market; (3) the transacting parties' health status adjusted total 776
medical expense, including the transacting parties' health status 777
adjusted total medical expense compared to that of similar health care 778
providers; (4) the quality of the services provided by the transacting 779
parties, including patient experience; (5) the transacting parties' cost and 780
cost trends in comparison to total health care expenditures state wide; 781
(6) the availability and accessibility of services similar to those provided 782
by each transacting party, or proposed to be provided as a result of the 783
transfer of ownership of a hospital within each transacting party's 784
primary service areas and dispersed service areas; (7) the impact of the 785
proposed transfer of ownership of the hospital on competing options for 786
the delivery of health care services within each transacting party's 787
primary service area and dispersed service area including the impact on 788
existing service providers; (8) the methods used by the transacting 789
parties to attract patient volume and to recruit or acquire health care 790
professionals or facilities; (9) the role of each transacting party in serving 791
at-risk, underserved and government payer patient populations, 792
including those with behavioral, substance use disorder and mental 793
health conditions, within each transacting party's primary service area 794
and dispersed service area; (10) the role of each transacting party in 795
providing low margin or negative margin services within each 796
transacting party's primary service area and dispersed service area; (11) 797
consumer concerns, including, but not limited to, complaints or other 798
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allegations that a transacting party has engaged in any unfair method of 799
competition or any unfair or deceptive act or practice; and (12) any other 800
factors that the program determines to be in the public interest. 801
(e) The program shall submit the preliminary report to the applicant 802
and to the Attorney General not later than ninety days after the data 803
submissions are deemed complete. The applicant shall respond, in 804
writing, not later than fifteen days after receipt of such preliminary 805
report with any comments regarding such report. Once the applicant 806
has submitted such written comments or waived the opportunity to 807
make such a submission, the program shall make the preliminary report 808
and the applicant's comments public. The program shall issue a final 809
report not later than one hundred twenty days after the application was 810
deemed complete and make such final report part of the public 811
certificate of need record of such application. 812
(f) Nothing in this section shall prohibit a transfer of ownership of a 813
hospital, provided any such proposed transfer shall not be completed 814
(1) less than thirty days after the program has issued a final report on a 815
cost and market impact review, if such review is required, or (2) while 816
any action brought by the Attorney General pursuant to subsection (g) 817
of this section is pending and before a final judgment on such action is 818
issued by a court of competent jurisdiction. 819
(g) After the program issues a final report on a transfer of ownership 820
of a hospital under subsection (e) of this section, the Attorney General 821
may: (1) Conduct an investigation to determine whether the transacting 822
parties engaged or, as a result of completing the transfer of ownership 823
of the hospital, are expected to engage in unfair methods of competition, 824
anti-competitive behavior or other conduct in violation of chapter 624 825
or 735a of the general statutes or any other state or federal law; and (2) 826
if appropriate, take action under chapter 624 or 735a of the general 827
statutes or any other state law to protect consumers in the health care 828
market. The program's final report may be evidence in any such action. 829
(h) For the purposes of this section, the provisions of chapter 735a of 830
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the general statutes may be directly enforced by the Attorney General. 831
Nothing in this section shall be construed to modify, impair or 832
supersede the operation of any state antitrust law or otherwise limit the 833
authority of the Attorney General to (1) take any action against a 834
transacting party as authorized by any law; or (2) protect consumers in 835
the health care market under any law. Notwithstanding subdivision (1) 836
of subsection (a) of section 42 -110c of the general statutes, the 837
transacting parties shall be subject to chapter 735a of the general 838
statutes. 839
(i) The program shall retain an independent consultant with expertise 840
on the economic analysis of the health care market and health care costs 841
and prices to conduct each cost and market impact review, as described 842
in this section. The program shall submit bills for such services to the 843
purchaser, as defined in subsection (d) of section 19a-639 of the general 844
statutes, as amended by this act. Such purchaser shall pay such bills not 845
later than thirty days after receipt thereof. Such bills shall not exceed 846
two hundred fifty thousand dollars per application. The provisions of 847
chapter 57 of the general statutes, sections 4 -212 to 4 -219, inclusive, of 848
the general statutes and section 4e -19 of the general statutes shall not 849
apply to any agreement executed pursuant to this subsection. 850
Sec. 10. (NEW) (Effective October 1, 2026) (a) On and after July 1, 2027, 851
the director of the Certificate of Need Program shall investigate all 852
inquiries concerning compliance with the provisions of sections 2 to 12, 853
inclusive, of this act. 854
(b) The panel, or any agent authorized by the panel to conduct any 855
inquiry, investigation or hearing under the provisions of sections 2 to 856
12, inclusive, of this act, shall have authority to administer oaths and 857
take testimony under oath relative to the matter of inquiry or 858
investigation. At any hearing under this section, the panel or such 859
authorized agent may subpoena witnesses and require the production 860
of records, papers and documents pertinent to such inquiry. If any 861
person disobeys such process or, having appeared in obedience thereto, 862
refuses to answer any pertinent question put to such person by the panel 863
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or such panel's authorized agent or to produce any records and papers 864
pursuant thereto, the panel or such panel's authorized agent may apply 865
to the superior court for the judicial district of Hartford or for the judicial 866
district wherein the person resides or the business that is the subject of 867
the inquiry has been conducted, or to any judge of said court if the same 868
is not in session, setting forth such disobedience to process or refusal to 869
answer, and said court or such judge shall cite such person to appear 870
before said court or such judge to answer such question or to produce 871
such records and papers. 872
(c) Any person or health care facility or institution that is required to 873
acquire a certificate of need for any of the activities described in 874
subsection (a) of section 4 of this act and negligently undertakes any of 875
the activities described in said section without such certificate of need, 876
any person, or health care facility or institution that is subject to any 877
terms or conditions enumerated in a certificate of need decision or 878
agreed settlement approved by the panel and negligently fails to comply 879
with any such enumerated term or condition, and any person or entity 880
that is required to submit a notice to the program pursuant to subsection 881
(d) of section 4 of this act or section 12 of this act and negligently fails to 882
submit such notice shall be subject to a civil penalty of up to one 883
thousand dollars a day for each day such person, entity or institution 884
conducts any of the described activities without certificate of need 885
approval as required by section 4 of this act, or for each day any 886
enumerated term or condition is not met or for each day that the notice 887
was not timely submitted. Any civil penalty proceeding authorized by 888
this section shall be initiated by the program, which shall also present 889
allegations of such negligence at a hearing before the panel in 890
accordance with subsections (b) to (f), inclusive, of this section. 891
(d) If the program has reason to believe that a person or health care 892
facility or institution has committed a violation for which a civil penalty 893
is authorized pursuant to subsection (c) of this section or subsection (e) 894
of section 19a-632 of the general statutes, the program shall notify such 895
person or health care facility or institution by first class mail or personal 896
service. The notice shall include: (1) A reference to the sections of the 897
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statute, regulation or settlement agreement involved; (2) a short and 898
plain statement of the matters asserted or charged; (3) a statement of the 899
amount of the civil penalty or penalties to be imposed; (4) the initial date 900
of the imposition of the penalty; and (5) a statement of the party's right 901
to a hearing. 902
(e) The person or health care facility or institution to whom the notice 903
is addressed shall have fifteen business days after the date of mailing of 904
the notice to make written application to the program to (1) request a 905
hearing to contest the imposition of the penalty, (2) request an extension 906
of time to file the required data, or (3) comply with enumerated 907
conditions of an agreed settlement. A failure to make a timely request 908
for a hearing or an extension of time to file the required data or a denial 909
of a request for an extension of time shall result in a final order for the 910
imposition of the penalty. All hearings under this section shall be 911
conducted pursuant to chapter 54 of the general statutes. The panel may 912
mitigate or waive the penalty upon such terms and conditions as, in its 913
discretion, it deems proper or necessary upon consideration of any 914
extenuating factors or circumstances. 915
(f) A final order of the panel assessing a civil penalty imposed after a 916
hearing before the panel pursuant to subsection (d) of this section shall 917
be subject to appeal as set forth in section 4 -183 of the general statutes, 918
except that any such appeal shall be taken to the superior court for the 919
judicial district of New Britain. Such final order shall not be subject to 920
appeal under any other provision of the general statutes. No challenge 921
to any such final order shall be allowed as to any issue which could have 922
been raised by an appeal of an earlier order, denial or other final 923
decision by the panel. 924
(g) If any person or health care facility or institution fails to pay any 925
civil penalty under this section after the assessment of such penalty has 926
become final, the amount of such penalty may be deducted from 927
payments to such person or health care facility or institution from the 928
Medicaid account. 929
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(h) In addition to any civil penalty imposed under this section, if the 930
director of the program or the director's authorized agent has received 931
information and has a reasonable belief that any person or health care 932
facility or institution has violated or is violating any provision of 933
sections 2 to 12, inclusive, of this act, or any policy and procedure or 934
order of the panel, the director or such agent shall notify such person or 935
health care facility or institution by first class mail or personal service. 936
The notice shall include: (1) A reference to the sections of the general 937
statutes, regulations of Connecticut state agencies or orders alleged or 938
believed to have been violated; (2) a short and plain language statement 939
of the matters asserted or charged; (3) a description of the activity 940
alleged to have violated a statute or regulation identified pursuant to 941
subdivision (1) of this subsection; (4) a statement concerning the right to 942
a hearing of such person or health care facility or institution; and (5) a 943
statement that such person or health care facility or institution may, not 944
later than ten business days after receipt of such notice, make a written 945
request for a hearing on the matters asserted, to be sent to the 946
commissioner or such agent. 947
(i) The person or health care facility or institution to whom such 948
notice is provided pursuant to subsection (h) of this section may, not 949
later than ten business days after receipt of the notice, make written 950
application to the program to request a hearing to demonstrate that such 951
violation has not occurred, a certificate of need was not required or each 952
required certificate of need was obtained. A failure to make a timely 953
request for a hearing shall result in the panel issuing a cease and desist 954
order. Each hearing held under this subsection shall be conducted as a 955
contested case pursuant to chapter 54 of the general statutes. 956
(j) If the panel finds, by a preponderance of the evidence, following a 957
hearing held under subsection (i) of this section that such person or 958
health care facility or institution has violated or is violating any 959
provision of sections 2 to 12, inclusive, of this act, or any regulation or 960
order of the department, the panel shall issue a cease and desist order to 961
such person or health care facility or institution that shall be considered 962
a final decision subject to appeal to the Superior Court in accordance 963
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with section 4-183 of the general statutes. 964
(k) Any cease and desist order issued under this section may be 965
enforced by the Attorney General pursuant to section 19a -642 of the 966
general statutes. 967
(l) Any civil penalty proceeding and any investigation or cease and 968
desist proceeding may be conducted simultaneously in a unified 969
proceeding. 970
Sec. 11. (NEW) (Effective October 1, 2026 ) The commissioner shall 971
adopt regulations, in accordance with the provisions of chapter 54 of the 972
general statutes, to implement the provisions of sections 2 to 12, 973
inclusive, of this act. The commissioner may implement policies and 974
procedures necessary to administer the provisions of said sections while 975
in the process of adopting such policies and procedures as regulation, 976
provided, prior to implementing such policies and procedures, the 977
department shall convene a working group with relevant stakeholders 978
to provide input on the development of such policies and procedures. 979
The commissioner shall convene the working group not later than 980
January 1, 2027. Policies and procedures implemented pursuant to this 981
section shall be valid until the earlier of two years from the date of their 982
implementation or the time final regulations are adopted. 983
Sec. 12. (NEW) (Effective October 1, 2026) (a) On and after July 1, 2027, 984
a hospital may temporarily pause a service for up to ninety days, 985
provided, if a hospital intends to indefinitely terminate a service line or 986
pause a service line for more than ninety days, the hospital shall notify 987
the Certificate of Need Program, in writing, not less than ninety days 988
prior to commencing such pause or termination. For purposes of this 989
section, "service line" means a category of inpatient and outpatient 990
services but does not include services provided by an emergency 991
department. 992
(b) Except as provided in subsection (d) of this section, not less than 993
ninety days prior to commencing any termination of service by a 994
hospital or any pause of a service intended to last more than ninety days, 995
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the hospital shall provide notice, either electronically or in writing, to 996
the program that includes the following information: 997
(1) A description of the service to be paused or terminated; 998
(2) Current and historical utilization rates for such service; 999
(3) A description of the anticipated impact of such pause or 1000
termination on individuals and health care facilities in the hospital's 1001
primary service area; 1002
(4) The date set for the pause or termination of service and, if 1003
applicable, the anticipated date of resumption of such service; 1004
(5) A detailed account of any community engagement and planning 1005
that has occurred prior to such notice or that is scheduled to occur prior 1006
to the pause or termination; and 1007
(6) Any other information the director may require. 1008
(c) The hospital shall also send a copy of such notice to the office of 1009
the Attorney General, the Department of Social Services, the Office of 1010
the Healthcare Advocate, and, if it relates to a behavioral health service 1011
or substance use disorder treatment service, the Department of Mental 1012
Health and Addiction Services and the Behavioral Health Advocate. 1013
(d) When the provision of ninety days' notice of the cessation of a 1014
service line is not practicable due to circumstances outside of the 1015
hospital's control, such as the death of the provider of such service or 1016
due to natural disaster, the hospital shall provide notice to the program 1017
as soon as practicable but in no case later than fourteen days after the 1018
initiation of the unanticipated cessation. 1019
(e) The program shall hold a public hearing concerning the proposed 1020
pause or termination of service, the impact on the hospital's primary 1021
service area and the proposed plans for ensuring continued access to 1022
high-quality, affordable health care in such service area. The hearing 1023
record and any submitted public comments shall inform the panel's 1024
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review of the proposed plan and any imposed conditions pursuant to 1025
subsection (f) of this section. 1026
(f) Not later than sixty days prior to commencing the pause or 1027
termination of a service, the hospital shall submit a plan for ensuring 1028
access to such service following the hospital's pause or termination of 1029
such service. If the cessation of the service is due to an unplanned event 1030
outside the control of the hospital, as described in subsection (d) of this 1031
section, the hospital shall submit the plan for ensuring access to the 1032
service within fourteen days of the hospital's cessation of the service 1033
line. The plan shall include: 1034
(1) Information on utilization of such service prior to the proposed 1035
pause or termination; 1036
(2) Information on the location and service capacity of alternative 1037
sites that provide such service; 1038
(3) Travel times to alternative sites that provide such service; 1039
(4) An assessment of transportation needs after the pause or 1040
termination and a plan for meeting such needs; 1041
(5) A protocol that details mechanisms to maintain continuity of care 1042
for patients who receive such paused or terminated service; 1043
(6) A protocol that describes how patients in the hospital's primary 1044
service area will obtain such service at alternative sites that provide such 1045
service; and 1046
(7) A communication plan for ensuring all affected patients in the 1047
hospital's primary service area are aware of the pause or termination of 1048
such service, where they may obtain such service at an alternative site 1049
and the assistance available from the hospital to obtain such service to 1050
preserve continuity of care. 1051
(g) The program shall review the plan submitted by the hospital 1052
pursuant to subsection (f) of this section to determine if the plan ensures 1053
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continued access to the service to be paused or terminated. The program 1054
shall complete its review of the plan and submit to the hospital and 1055
panel written recommendations regarding the approval, modification 1056
or imposition of conditions upon the plan not later than ten days after 1057
receiving the plan from the hospital. The panel shall hold a meeting on 1058
the plan not later than ten days after receipt of such recommendations. 1059
The hospital may submit a response to such recommendations at or 1060
prior to such meeting. Not later than ten days after such meeting, the 1061
panel shall approve the plan, require modifications to the plan or add 1062
conditions to the plan. 1063
(h) The panel's decision approving or modifying the plan shall 1064
constitute a final decision subject to appeal under section 4 -183 of the 1065
general statutes. 1066
(i) The program shall monitor implementation of the hospital's plan 1067
for preserving access to a health care service following a pause of 1068
termination of such service under this section. If the hospital fails to 1069
implement any aspect of the plan as approved by the panel pursuant to 1070
subsection (g) of this section, the program may impose a performance 1071
improvement plan on the hospital. Failure to comply with the 1072
performance improvement plan and continued failure to perform under 1073
the plan may result in the imposition of civil penalties pursuant to 1074
section 10 of this act. 1075
Sec. 13. Subsection (a) of section 19a -612d of the general statutes is 1076
repealed and the following is substituted in lieu thereof (Effective October 1077
1, 2026): 1078
(a) The Commissioner of Health Strategy shall oversee the Health 1079
Systems Planning Unit and shall exercise independent decision-making 1080
authority over all certificate of need decisions for applications for a 1081
certificate of need filed on or before June 30, 2027. 1082
Sec. 14. Subsections (a) to (e), inclusive, of section 19a -638 of the 1083
general statutes are repealed and the following is substituted in lieu 1084
thereof (Effective October 1, 2026): 1085
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(a) [A] On and before June 30, 2027, a certificate of need issued by the 1086
unit shall be required for: 1087
(1) The establishment of a new health care facility; 1088
(2) A transfer of ownership of a health care facility; 1089
(3) A transfer of ownership of a large group practice to any entity 1090
other than a (A) physician, or (B) group of two or more physicians, 1091
legally organized in a partnership, professional corporation or limited 1092
liability company formed to render professional services and not 1093
employed by or an affiliate of any hospital, medical foundation, 1094
insurance company or other similar entity; 1095
(4) The establishment of a freestanding emergency department; 1096
(5) The termination of inpatient or outpatient services offered by a 1097
hospital, including, but not limited to, the termination by a short -term 1098
acute care general hospital or children's hospital of inpatient and 1099
outpatient mental health and substance abuse services; 1100
(6) The establishment of an outpatient surgical facility, as defined in 1101
section 19a-493b, or as established by a short -term acute care general 1102
hospital; 1103
(7) The termination of surgical services by an outpatient surgical 1104
facility, as defined in section 19a -493b, or a facility that provides 1105
outpatient surgical services as part of the outpatient surgery department 1106
of a short -term acute care general hospital, provided termination of 1107
outpatient surgical services due to (A) insufficient patient volume, or (B) 1108
the termination of any subspecialty surgical service, shall not require 1109
certificate of need approval; 1110
(8) The termination of an emergency department by a short -term 1111
acute care general hospital; 1112
(9) The establishment of cardiac services, including inpatient and 1113
outpatient cardiac catheterization, interventional cardiology and 1114
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cardiovascular surgery; 1115
(10) The acquisition of computed tomography scanners, magnetic 1116
resonance imaging scanners, positron emission tomography scanners or 1117
positron emission tomography-computed tomography scanners, by any 1118
person, physician, provider, short -term acute care general hospital or 1119
children's hospital, except (A) as provided for in subdivision (22) of 1120
subsection (b) of this section, and (B) a certificate of need issued by the 1121
unit shall not be required where such scanner is a replacement for a 1122
scanner that was previously acquired through certificate of need 1123
approval or a certificate of need determination, including a replacement 1124
scanner that has dual modalities or functionalities if the applicant 1125
already offers similar imaging services for each of the scanner's 1126
modalities or functionalities that will be utilized; 1127
(11) The acquisition of nonhospital based linear accelerators, except a 1128
certificate of need issued by the unit shall not be required where such 1129
accelerator is a replacement for an accelerator that was previously 1130
acquired through certificate of need approval or a certificate of need 1131
determination; 1132
(12) An increase in the licensed bed capacity of a health care facility, 1133
except as provided in subdivision (23) of subsection (b) of this section; 1134
(13) The acquisition of equipment utilizing technology that has not 1135
previously been utilized in the state; 1136
(14) An increase of two or more operating rooms within any three -1137
year period, commencing on and after October 1, 2010, by an outpatient 1138
surgical facility, as defined in section 19a-493b, or by a short-term acute 1139
care general hospital; and 1140
(15) The termination of inpatient or outpatient services offered by a 1141
hospital or other facility or institution operated by the state that 1142
provides services that are eligible for reimbursement under Title XVIII 1143
or XIX of the federal Social Security Act, 42 USC 301, as amended. 1144
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(b) [A] On and before June 30, 2027, a certificate of need issued by the 1145
unit shall not be required for: 1146
(1) Health care facilities owned and operated by the federal 1147
government; 1148
(2) The establishment of offices by a licensed private practitioner, 1149
whether for individual or group practice, except when a certificate of 1150
need is required in accordance with the requirements of section 19a -1151
493b or subdivision (3), (10) or (11) of subsection (a) of this section; 1152
(3) A health care facility operated by a religious group that 1153
exclusively relies upon spiritual means through prayer for healing; 1154
(4) Residential care homes, as defined in subsection (c) of section 19a-1155
490, and nursing homes and rest homes, as defined in subsection (o) of 1156
section 19a-490; 1157
(5) An assisted living services agency, as defined in section 19a-490; 1158
(6) Home health agencies, as defined in section 19a-490; 1159
(7) Hospice services, as described in section 19a-122b; 1160
(8) Outpatient rehabilitation facilities; 1161
(9) Outpatient chronic dialysis services; 1162
(10) Transplant services; 1163
(11) Free clinics, as defined in section 19a-630; 1164
(12) School-based health centers and expanded school health sites, as 1165
such terms are defined in section 19a -6r, community health centers, as 1166
defined in section 19a -490a, not-for-profit outpatient clinics licensed in 1167
accordance with the provisions of chapter 368v and federally qualified 1168
health centers; 1169
(13) A program licensed or funded by the Department of Children 1170
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and Families, provided such program is not a psychiatric residential 1171
treatment facility; 1172
(14) Any nonprofit facility, institution or provider that has a contract 1173
with, or is certified or licensed to provide a service for, a state agency or 1174
department for a service that would otherwise require a certificate of 1175
need. The provisions of this subdivision shall not apply to a short -term 1176
acute care general hospital or children's hospital, or a hospital or other 1177
facility or institution operated by the state that provides services that are 1178
eligible for reimbursement under Title XVIII or XIX of the federal Social 1179
Security Act, 42 USC 301, as amended; 1180
(15) A health care facility operated by a nonprofit educational 1181
institution exclusively for students, faculty and staff of such institution 1182
and their dependents; 1183
(16) An outpatient clinic or program operated exclusively by or 1184
contracted to be operated exclusively by a municipality, municipal 1185
agency, municipal board of education or a health district, as described 1186
in section 19a-241; 1187
(17) A residential facility for persons with intellectual disability 1188
licensed pursuant to section 17a -227 and certified to participate in the 1189
Title XIX Medicaid program as an intermediate care facility for 1190
individuals with intellectual disabilities; 1191
(18) Replacement of existing computed tomography scanners, 1192
magnetic resonance imaging scanners, positron emission tomography 1193
scanners, positron emission tomography -computed tomography 1194
scanners, or nonhospital based linear accelerators, if such equipment 1195
was acquired through certificate of need approval or a certificate of need 1196
determination, provided a health care facility, provider, physician or 1197
person notifies the unit of the date on which the equipment is replaced 1198
and the disposition of the replaced equipment, including if a 1199
replacement scanner has dual modalities or functionalities and the 1200
applicant already offers similar imaging services for each of the 1201
equipment's modalities or functionalities that will be utilized; 1202
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(19) Acquisition of cone-beam dental imaging equipment that is to be 1203
used exclusively by a dentist licensed pursuant to chapter 379; 1204
(20) The partial or total elimination of services provided by an 1205
outpatient surgical facility, as defined in section 19a -493b, except as 1206
provided in subdivision (6) of subsection (a) of this section and section 1207
19a-639e, as amended by this act; 1208
(21) The termination of services for which the Department of Public 1209
Health has requested the facility to relinquish its license; 1210
(22) Acquisition of any equipment by any person that is to be used 1211
exclusively for scientific research that is not conducted on humans; 1212
(23) On or before [June 30, 2026 ] June 30, 2027 , an increase in the 1213
licensed bed capacity of a mental health facility, provided (A) the mental 1214
health facility demonstrates to the unit, in a form and manner prescribed 1215
by the unit, that it accepts reimbursement for any covered benefit 1216
provided to a covered individual under: (i) An individual or group 1217
health insurance policy providing coverage of the type specified in 1218
subdivisions (1), (2), (4), (11) and (12) of section 38a -469; (ii) a self -1219
insured employee welfare benefit plan established pursuant to the 1220
federal Employee Retirement Income Security Act of 1974, as amended 1221
from time to time; or (iii) HUSKY Health, as defined in section 17b-290, 1222
and (B) if the mental health facility does not accept or stops accepting 1223
reimbursement for any covered benefit provided to a covered 1224
individual under a policy, plan or program described in clause (i), (ii) or 1225
(iii) of subparagraph (A) of this subdivision, a certificate of need for such 1226
increase in the licensed bed capacity shall be required; [.] 1227
(24) The establishment at harm reduction centers through the pilot 1228
program established pursuant to section 17a-673c; or 1229
(25) On or before [June 30, 2028 ] June 30, 2027 , a birth center, as 1230
defined in section 19a-490, that is enrolled as a provider in the 1231
Connecticut medical assistance program, as defined in section 17b-245g. 1232
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(c) (1) Any person [,] or health care facility or institution that is unsure 1233
whether a certificate of need is required under this section, or (2) any 1234
health care facility that proposes to relocate pursuant to section 19a -1235
639c, as amended by this act, shall send a letter to the unit that describes 1236
the project and requests that the unit make a determination as to 1237
whether a certificate of need is required. In the case of a relocation of a 1238
health care facility, the letter shall include information described in 1239
section 19a -639c, as amended by this act . A person [,] or health care 1240
facility or institution making such request shall provide the unit with 1241
any information the unit requests as part of its determination process. 1242
The unit shall provide a determination within thirty days of receipt of 1243
such request. 1244
(d) The Commissioner of Health Strategy may implement policies 1245
and procedures necessary to administer the provisions of this section 1246
while in the process of adopting such policies and procedures as 1247
regulation, provided the commissioner holds a public hearing prior to 1248
implementing the policies and procedures and posts notice of intent to 1249
adopt regulations on the office's Internet web site and the eRegulations 1250
System not later than twenty days after the date of implementation. 1251
Policies and procedures implemented pursuant to this section shall be 1252
valid until the time final regulations are adopted. 1253
(e) On or before [June 30, 2026] June 30, 2027, a mental health facility 1254
seeking to increase licensed bed capacity without applying for a 1255
certificate of need, as permitted pursuant to subdivision (23) of 1256
subsection (b) of this section, shall notify the Office of Health Strategy, 1257
in a form and manner prescribed by the commissioner, regarding (1) 1258
such facility's intent to increase licensed bed capacity, (2) the address of 1259
such facility, and (3) a description of all services that are being or will be 1260
provided at such facility. 1261
Sec. 15. Subsections (a) to (e), inclusive, of section 19a-639 of the 2026 1262
supplement to the general statutes are repealed and the following is 1263
substituted in lieu thereof (Effective October 1, 2026): 1264
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sHB5045 / File No. 755 42

(a) In any deliberations involving a certificate of need application 1265
filed on or before June 30, 2027, pursuant to section 19a-638, as amended 1266
by this act, the unit shall take into consideration and make written 1267
findings concerning each of the following guidelines and principles: 1268
(1) Whether the proposed project is consistent with any applicable 1269
policies and standards adopted in regulations by the Office of Health 1270
Strategy; 1271
(2) The relationship of the proposed project to the state -wide health 1272
care facilities and services plan; 1273
(3) Whether there is a clear public need for the health care facility or 1274
services proposed by the applicant; 1275
(4) Whether the applicant has satisfactorily demonstrated how the 1276
proposal will impact the financial strength of the health care system in 1277
the state or that the proposal is financially feasible for the applicant; 1278
(5) Whether the applicant has satisfactorily demonstrated how the 1279
proposal will improve quality, accessibility and cost effectiveness of 1280
health care delivery in the region, including, but not limited to, 1281
provision of or any change in the access to services for Medicaid 1282
recipients and indigent persons; 1283
(6) The applicant's past and proposed provision of health care 1284
services to relevant patient populations and payer mix, including, but 1285
not limited to, access to services by Medicaid recipients and indigent 1286
persons; 1287
(7) Whether the applicant has satisfactorily identified the population 1288
to be served by the proposed project and satisfactorily demonstrated 1289
that the identified population has a need for the proposed services; 1290
(8) The utilization of existing health care facilities and health care 1291
services in the service area of the applicant; 1292
(9) Whether the applicant has satisfactorily demonstrated that the 1293
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sHB5045 / File No. 755 43

proposed project shall not result in an unnecessary duplication of 1294
existing or approved health care services or facilities; 1295
(10) Whether an applicant, who has failed to provide or reduced 1296
access to services by Medicaid recipients or indigent persons, has 1297
demonstrated good cause for doing so, which shall not be demonstrated 1298
solely on the basis of differences in reimbursement rates between 1299
Medicaid and other health care payers; 1300
(11) Whether the applicant has satisfactorily demonstrated that the 1301
proposal will not negatively impact the diversity of health care 1302
providers and patient choice in the geographic region; and 1303
(12) Whether the applicant has satisfactorily demonstrated that any 1304
consolidation resulting from the proposal will not adversely affect 1305
health care costs or accessibility to care. 1306
(b) [In] On or before June 30, 2027, in deliberations as described in 1307
subsection (a) of this section, there shall be a presumption in favor of 1308
approving the certificate of need application for a transfer of ownership 1309
of a large group practice, as described in subdivision (3) of subsection 1310
(a) of section 19a-638, as amended by this act, when an offer was made 1311
in response to a request for proposal or similar voluntary offer for sale. 1312
(c) The unit, as it deems necessary, may revise or supplement the 1313
guidelines and principles, set forth in subsection (a) of this section, 1314
through regulation. 1315
(d) (1) For purposes of this subsection and subsection (e) of this 1316
section: 1317
(A) "Affected community" means a municipality where a hospital is 1318
physically located or a municipality whose inhabitants are regularly 1319
served by a hospital; 1320
(B) "Hospital" has the same meaning as provided in section 19a-490; 1321
(C) "New hospital" means a hospital as it exists after the approval of 1322
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sHB5045 / File No. 755 44

an agreement pursuant to section 19a -486b or a certificate of need 1323
application for a transfer of ownership of a hospital; 1324
(D) "Purchaser" means a person who is acquiring, or has acquired, 1325
any assets of a hospital through a transfer of ownership of a hospital; 1326
(E) "Transacting party" means a purchaser and any person who is a 1327
party to a proposed agreement for transfer of ownership of a hospital; 1328
(F) "Transfer" means to sell, transfer, lease, exchange, option, convey, 1329
give or otherwise dispose of or transfer control over, including, but not 1330
limited to, transfer by way of merger or joint venture not in the ordinary 1331
course of business; and 1332
(G) "Transfer of ownership of a hospital" means a transfer that 1333
impacts or changes the governance or controlling body of a hospital, 1334
including, but not limited to, all affiliations, mergers or any sale or 1335
transfer of net assets of a hospital and for which a certificate of need 1336
application or a certificate of need determination letter is filed on or after 1337
December 1, 2015. 1338
(2) In any deliberations involving a certificate of need application 1339
filed on or before June 30, 2027, pursuant to section 19a-638, as amended 1340
by this act, that involves the transfer of ownership of a hospital, the unit 1341
shall, in addition to the guidelines and principles set forth in subsection 1342
(a) of this section and those prescribed through regulation pursuant to 1343
subsection (c) of this section, take into consideration and make written 1344
findings concerning each of the following guidelines and principles: 1345
(A) Whether the applicant fairly considered alternative proposals or 1346
offers in light of the purpose of maintaining health care provider 1347
diversity and consumer choice in the health care market and access to 1348
affordable quality health care for the affected community; and 1349
(B) Whether the plan submitted pursuant to section 19a -639a, as 1350
amended by this act, demonstrates, in a manner consistent with this 1351
chapter, how health care services will be provided by the new hospital 1352
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sHB5045 / File No. 755 45

for the first three years following the transfer of ownership of the 1353
hospital, including any consolidation, reduction, elimination or 1354
expansion of existing services or introduction of new services. 1355
(3) The unit shall deny any certificate of need application involving a 1356
transfer of ownership of a hospital unless the commissioner finds that 1357
the affected community will be assured of continued access to high 1358
quality and affordable health care after accounting for any proposed 1359
change impacting hospital staffing. 1360
(4) The unit may deny any certificate of need application involving a 1361
transfer of ownership of a hospital subject to a cost and market impact 1362
review pursuant to section 19a -639f, as amended by this act, if the 1363
commissioner finds that (A) the affected community will not be assured 1364
of continued access to high quality and affordable health care after 1365
accounting for any consolidation in the hospital and health care market 1366
that may lessen health care provider diversity, consumer choice and 1367
access to care, and (B) any likely increases in the prices for health care 1368
services or total health care spending in the state may negatively impact 1369
the affordability of care. 1370
(5) The unit may place any conditions on the approval of a certificate 1371
of need application involving a transfer of ownership of a hospital 1372
consistent with the provisions of this chapter. Before placing any such 1373
conditions, the unit shall weigh the value of such conditions in 1374
promoting the purposes of this chapter against the individual and 1375
cumulative burden of such conditions on the transacting parties and the 1376
new hospital. For each condition imposed, the unit shall include a 1377
concise statement of the legal and factual basis for such condition and 1378
the provision or provisions of this chapter that it is intended to promote. 1379
Each condition shall be reasonably tailored in time and scope. The 1380
transacting parties or the new hospital shall have the right to make a 1381
request to the unit for an amendment to, or relief from, any condition 1382
based on changed circumstances, hardship or for other good cause. 1383
(6) In any deliberations involving a certificate of need application 1384
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filed pursuant to section 19a -638, as amended by this act, that involves 1385
the transfer of ownership of a hospital and is subject to a cost and market 1386
impact review, the unit may consider (A) the preliminary report and 1387
response to the preliminary report, (B) the final report, and (C) any 1388
written comments from the parties regarding the reports issued or 1389
submitted as part of the review. The unit shall not place the preliminary 1390
report in the public record until the transacting parties have had an 1391
opportunity to respond to the findings of the preliminary report 1392
pursuant to subsection (f) of section 19a-639f. 1393
(e) (1) If the certificate of need application filed on or before June 30, 1394
2027, (A) involves the transfer of ownership of a hospital, (B) the 1395
purchaser is a hospital, as defined in section 19a -490, whether located 1396
within or outside the state, that had net patient revenue for fiscal year 1397
2013 in an amount greater than one billion five hundred million dollars 1398
or a hospital system, as defined in section 19a -486i, whether located 1399
within or outside the state, that had net patient revenue for fiscal year 1400
2013 in an amount greater than one billion five hundred million dollars, 1401
or any person that is organized or operated for profit, and (C) such 1402
application is approved, the unit shall hire an independent consultant 1403
to serve as a post-transfer compliance reporter for a period of three years 1404
after completion of the transfer of ownership of the hospital. Such 1405
reporter shall, at a minimum: (i) Meet with representatives of the 1406
purchaser, the new hospital and members of the affected community 1407
served by the new hospital not less than quarterly; and (ii) report to the 1408
unit not less than quarterly concerning (I) efforts the purchaser and 1409
representatives of the new hospital have taken to comply with any 1410
conditions the unit placed on the approval of the certificate of need 1411
application and plans for future compliance, and (II) community 1412
benefits and uncompensated care provided by the new hospital. The 1413
purchaser shall give the reporter access to its records and facilities for 1414
the purposes of carrying out the reporter's duties. The purchaser shall 1415
hold a public hearing in the municipality in which the new hospital is 1416
located not less than annually during the reporting period to provide 1417
for public review and comment on the reporter's reports and findings. 1418
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sHB5045 / File No. 755 47

(2) If the reporter finds that the purchaser has breached a condition 1419
of the approval of the certificate of need application, the unit may, in 1420
consultation with the purchaser, the reporter and any other interested 1421
parties it deems appropriate, implement a performance improvement 1422
plan designed to remedy the conditions identified by the reporter and 1423
continue the reporting period for up to one year following a 1424
determination by the unit that such conditions have been resolved. 1425
(3) The purchaser shall provide funds, in an amount determined by 1426
the unit not to exceed two hundred thousand dollars annually, for the 1427
hiring of the post-transfer compliance reporter. 1428
Sec. 16. Section 19a -639a of the general statutes is repealed and the 1429
following is substituted in lieu thereof (Effective October 1, 2026): 1430
(a) [An] On or before June 30, 2027, an application for a certificate of 1431
need shall be filed with the unit in accordance with the provisions of this 1432
section and any regulations adopted by the Office of Health Strategy . 1433
The application shall address the guidelines and principles set forth in 1434
(1) subsection (a) of section 19a -639, as amended by this act , and (2) 1435
regulations adopted by the department. The applicant shall include 1436
with the application a nonrefundable application fee based on the cost 1437
of the project. The amount of the fee shall be as follows: (A) One 1438
thousand dollars for a project that will cost not greater than fifty 1439
thousand dollars; (B) two thousand dollars for a project that will cost 1440
greater than fifty thousand dollars but not greater than one hundred 1441
thousand dollars; (C) three thousand dollars for a project that will cost 1442
greater than one hundred thousand dollars but not greater than five 1443
hundred thousand dollars; (D) four thousand dollars for a project that 1444
will cost greater than five hundred thousand dollars but not greater than 1445
one million dollars; (E) five thousand dollars for a project that will cost 1446
greater than one million dollars but not greater than five million dollars; 1447
(F) eight thousand dollars for a project that will cost greater than five 1448
million dollars but not greater than ten million dollars; and (G) ten 1449
thousand dollars for a project that will cost greater than ten million 1450
dollars. 1451
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(b) Prior to the filing of a certificate of need application pursuant to 1452
subsection (a) of this section , the applicant shall (1) publish notice that 1453
an application is to be submitted to the unit (A) in a newspaper having 1454
a substantial circulation in the area where the project is to be located, 1455
and (B) on the applicant's Internet web site in a clear and conspicuous 1456
location that is easily accessible by members of the public, (2) request 1457
the publication of notice (A) in at least two sites within the affected 1458
community that are commonly accessed by the public, such as a town 1459
hall or library, and (B) on any existing Internet web site of the 1460
municipality or local health department, and (3) submit such notice to 1461
the unit for posting on such unit's Internet web site. Such newspaper 1462
notice shall be published for not less than three consecutive days, with 1463
the final date of consecutive publication occurring not later than twenty 1464
days prior to the date of filing of the certificate of need application, and 1465
contain a brief description of the nature of the project and the street 1466
address where the project is to be located. Postings in the affected 1467
community and on the applicant's Internet web site shall remain until 1468
the decision on the application is rendered. The unit shall not invalidate 1469
any notice due to changes or removal of the notice from a community 1470
Internet web site of which the applicant has no control. An applicant 1471
shall file the certificate of need application with the unit not later than 1472
ninety days after publishing notice of the application in a newspaper in 1473
accordance with the provisions of this subsection. The unit shall not 1474
accept the applicant's certificate of need application for filing unless the 1475
application is accompanied by the application fee prescribed in 1476
subsection (a) of this section and proof of compliance with the 1477
publication requirements prescribed in this subsection. 1478
(c) (1) Not later than five business days after receipt of a properly filed 1479
certificate of need application under this section, the unit shall publish 1480
notice of the application on its Internet web site. Not later than thirty 1481
days after the date of filing of the application, the unit may request such 1482
additional information as the unit determines necessary to complete the 1483
application. In addition to any information requested by the unit, if the 1484
application involves the transfer of ownership of a hospital, as defined 1485
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sHB5045 / File No. 755 49

in section 19a-639, as amended by this act, the applicant shall submit to 1486
the unit (A) a plan demonstrating how health care services will be 1487
provided by the new hospital for the first three years following the 1488
transfer of ownership of the hospital, including any consolidation, 1489
reduction, elimination or expansion of existing services or introduction 1490
of new services, and (B) the names of persons currently holding a 1491
position with the hospital to be purchased or the purchaser, as defined 1492
in section 19a-639, as amended by this act, as an officer, director, board 1493
member or senior manager, whether or not such person is expected to 1494
hold a position with the hospital after completion of the transfer of 1495
ownership of the hospital and any salary, severance, stock offering or 1496
any financial gain, current or deferred, such person is expected to 1497
receive as a result of, or in relation to, the transfer of ownership of the 1498
hospital. 1499
(2) The applicant shall, not later than sixty days after the date of the 1500
unit's request, submit any requested information and any information 1501
required under this subsection to the unit. If an applicant fails to submit 1502
such information to the unit within the sixty-day period, the unit shall 1503
consider the application to have been withdrawn. 1504
(3) The unit shall make reasonable efforts to limit the requests for 1505
additional information to two such requests and, in all cases, cease all 1506
requests for additional information not later than six months after 1507
receiving the application. 1508
(d) Upon deeming an application filed under this section complete, 1509
the unit shall provide notice of this determination to the applicant and 1510
to the public in accordance with regulations adopted by the department. 1511
In addition, the unit shall post such notice on its Internet web site and 1512
notify the applicant not later than five days after deeming the 1513
application complete. The date on which the unit posts such notice on 1514
its Internet web site shall begin the review period. Except as provided 1515
in this subsection, (1) the review period for an application deemed 1516
complete shall be ninety days from the date on which the unit posts such 1517
notice on its Internet web site; and (2) the unit shall issue a decision on 1518
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sHB5045 / File No. 755 50

an application deemed complete prior to the expiration of the ninety -1519
day review period in matters without a public hearing. The review 1520
period for an application deemed complete that involves a transfer of a 1521
large group practice, as described in subdivision (3) of subsection (a) of 1522
section 19a-638, as amended by this act , when the offer was made in 1523
response to a request for proposal or similar voluntary offer for sale, 1524
shall be sixty days from the date on which the unit posts notice on its 1525
Internet web site. Upon request or for good cause shown, the unit may 1526
extend the review period for a period of time not to exceed sixty days. 1527
If the review period is extended, the unit shall issue a decision on the 1528
completed application prior to the expiration of the extended review 1529
period. If the unit holds a public hearing concerning a completed 1530
application in accordance with subsection (e) or (f) of this section, the 1531
unit shall issue a decision on the completed application not later than 1532
sixty days after the date the unit closes the public hearing record. 1533
(e) Except as provided in this subsection, the unit shall hold a public 1534
hearing on a [properly filed and completed] certificate of need 1535
application properly filed and completed under this section if three or 1536
more individuals or an individual representing an entity with five or 1537
more people submits a request, in writing, that a public hearing be held 1538
on the application. For a [properly filed and completed ] certificate of 1539
need application properly filed and completed under this section 1540
involving a transfer of ownership of a large group practice, as described 1541
in subdivision (3) of subsection (a) of section 19a -638, as amended by 1542
this act, when an offer was made in response to a request for proposal 1543
or similar voluntary offer for sale, a public hearing shall be held if 1544
twenty-five or more individuals or an individual representing twenty -1545
five or more people submits a request, in writing, that a public hearing 1546
be held on the application. Any request for a public hearing shall be 1547
made to the unit not later than thirty days after the date the unit deems 1548
the application to be complete. 1549
(f) (1) The unit shall hold a public hearing with respect to each 1550
certificate of need application filed pursuant to section 19a -638, as 1551
amended by this act, after December 1, 2015, and on or before June 30, 1552
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sHB5045 / File No. 755 51

2027, that concerns any transfer of ownership involving a hospital. Such 1553
hearing shall be held in the municipality in which the hospital that is the 1554
subject of the application is located. 1555
(2) The unit may hold a public hearing with respect to any certificate 1556
of need application submitted under this [chapter] section. The unit 1557
shall provide not less than two weeks' advance notice to the applicant, 1558
in writing, and to the public by publication in a newspaper having a 1559
substantial circulation in the area served by the health care facility or 1560
provider. In conducting its activities under this chapter, the unit may 1561
hold hearings with respect to applications of a similar nature at the same 1562
time. The applicant shall post a copy of the unit's hearing notice on the 1563
applicant's Internet web site in a clear and conspicuous location that is 1564
easily accessible by members of the public. Such applicant shall request 1565
the publication of notice in at least two sites within the affected 1566
community that are commonly accessed by the public, such as a town 1567
hall or library, as well as on any existing Internet web site of the 1568
municipality or local health department. The unit shall not invalidate 1569
any notice due to changes or removal of the notice from a community 1570
Internet web site of which the applicant has no control. 1571
(g) For applications submitted on or after October 1, 2023, and on or 1572
before June 30, 2027, the unit may retain an independent consultant with 1573
expertise in the specific area of health care that is the subject of the 1574
application filed by an applicant if the review and analysis of an 1575
application cannot reasonably be conducted by the unit without the 1576
expertise of an industry analyst or other actuarial consultant. The unit 1577
shall submit bills for independent consultant services to the applicant. 1578
Such applicant shall pay such bills not later than thirty days after receipt 1579
of such bills. Such bills shall be a reasonable amount per application. 1580
The provisions of chapter 57 and sections 4 -212 to 4-219, inclusive, and 1581
4e-19 shall not apply to any retainer agreement executed pursuant to 1582
this subsection. 1583
[(h) The Commissioner of Health Strategy may implement policies 1584
and procedures necessary to administer the provisions of this section 1585
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sHB5045 / File No. 755 52

while in the process of adopting such policies and procedures as 1586
regulation, provided the commissioner holds a public hearing prior to 1587
implementing the policies and procedures and posts notice of intent to 1588
adopt regulations on the office's Internet web site and the eRegulations 1589
System not later than twenty days after the date of implementation. 1590
Policies and procedures implemented pursuant to this section shall be 1591
valid until the time final regulations are adopted.] 1592
Sec. 17. Section 19a -639b of the general statutes is repealed and the 1593
following is substituted in lieu thereof (Effective October 1, 2026): 1594
(a) A certificate of need issued under section 19a -638a shall be valid 1595
only for the project described in the application. A certificate of need 1596
issued under said section shall be valid for two years from the date of 1597
issuance by the unit. During the period of time that such certificate is 1598
valid and the thirty -day period following the expiration of the 1599
certificate, the holder of the certificate shall provide the unit with such 1600
information as the unit may request on the development of the project 1601
covered by the certificate. 1602
(b) [Upon] On or before June 30, 2027, upon request from a certificate 1603
holder, the unit may extend the duration of a certificate of need for such 1604
additional period of time as the unit determines is reasonably necessary 1605
to expeditiously complete the project. Not later than five business days 1606
after receiving a request to extend the duration of a certificate of need, 1607
the unit shall post such request on its web site. Any person who wishes 1608
to comment on extending the duration of the certificate of need shall 1609
provide written comments to the unit on the requested extension not 1610
later than thirty days after the date the unit posts notice of the request 1611
for an extension of time on its web site. The unit shall hold a public 1612
hearing on any request to extend the duration of a certificate of need 1613
made under this subsection if three or more individuals or an individual 1614
representing an entity with five or more people submits a request, in 1615
writing, that a public hearing be held on the request to extend the 1616
duration of a certificate of need. 1617
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sHB5045 / File No. 755 53

(c) [In] On or before June 30, 2027, in the event that the unit 1618
determines that: (1) Commencement, construction or other preparation 1619
has not been substantially undertaken during a valid certificate of need 1620
period; or (2) the certificate holder has not made a good -faith effort to 1621
complete the project as approved, the unit may withdraw, revoke or 1622
rescind the certificate of need. 1623
(d) [A] On or before June 30, 2027, a certificate of need shall not be 1624
transferable or assignable nor shall a project be transferred from a 1625
certificate holder to another person. 1626
(e) The Commissioner of Health Strategy may implement policies 1627
and procedures necessary to administer the provisions of this section 1628
while in the process of adopting such policies and procedures as 1629
regulation, provided the commissioner holds a public hearing prior to 1630
implementing the policies and procedures and posts notice of intent to 1631
adopt regulations on the office's Internet web site and the eRegulations 1632
System not later than twenty days after the date of implementation. 1633
Policies and procedures implemented pursuant to this section shall be 1634
valid until the time final regulations are adopted. 1635
Sec. 18. Subsection (a) of section 19a -639c of the general statutes is 1636
repealed and the following is substituted in lieu thereof (Effective October 1637
1, 2026): 1638
(a) [Any] On or before June 30, 2027, any health care facility that 1639
proposes to relocate a facility shall submit a letter to the unit, as 1640
described in subsection (c) of section 19a-638, as amended by this act. In 1641
addition to the requirements prescribed in said subsection (c), in such 1642
letter the health care facility shall demonstrate to the satisfaction of the 1643
unit that the population served by the health care facility and the payer 1644
mix will not substantially change as a result of the facility's proposed 1645
relocation. If the facility is unable to demonstrate to the satisfaction of 1646
the unit that the population served and the payer mix will not 1647
substantially change as a result of the proposed relocation, the health 1648
care facility shall apply for certificate of need approval pursuant to 1649
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sHB5045 / File No. 755 54

subdivision (1) of subsection (a) of section 19a -638, as amended by this 1650
act, in order to effectuate the proposed relocation. The unit shall provide 1651
a determination not later than thirty days after receipt of such letter. 1652
Sec. 19. Subsections (a) to (c), inclusive, of section 19a -639e of the 1653
general statutes are repealed and the following is substituted in lieu 1654
thereof (Effective October 1, 2026): 1655
(a) Unless otherwise required to file a certificate of need application 1656
pursuant to the provisions of subsection (a) of section 19a -638, as 1657
amended by this act, any health care facility that proposes on or before 1658
June 30, 2027, to terminate a service that was authorized pursuant to a 1659
certificate of need issued under [this chapter] section 19a-638a shall file 1660
a modification request with the unit not later than sixty days prior to the 1661
proposed date of the termination of the service. The unit may request 1662
additional information from the health care facility as necessary to 1663
process the modification request. In addition, the unit shall hold a public 1664
hearing on any request from a health care facility to terminate a service 1665
pursuant to this section if three or more individuals or an individual 1666
representing an entity with five or more people submits a request, in 1667
writing, that a public hearing be held on the health care facility's 1668
proposal to terminate a service. 1669
(b) Unless otherwise required to file a certificate of need application 1670
pursuant to the provisions of subsection (a) of section 19a -638, as 1671
amended by this act, any health care facility that proposes on or before 1672
June 30, 2027, to terminate all services offered by such facility, that were 1673
authorized pursuant to one or more certificates of need issued under 1674
[this chapter ] section 19a -639a, as amended by this act , shall provide 1675
notification to the unit not later than sixty days prior to the termination 1676
of services and such facility shall surrender its certificate of need not 1677
later than thirty days prior to the termination of services. 1678
(c) Unless otherwise required to file a certificate of need application 1679
pursuant to the provisions of subsection (a) of section 19a -638, as 1680
amended by this act, any health care facility that proposes on or before 1681
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sHB5045 / File No. 755 55

June 30, 2027, to terminate the operation of a facility or service for which 1682
a certificate of need was not obtained shall notify the unit not later than 1683
sixty days prior to terminating the operation of the facility or service. 1684
Sec. 20. Subsections (a) and (b) of section 19a -639f of the general 1685
statutes are repealed and the following is substituted in lieu thereof 1686
(Effective October 1, 2026): 1687
(a) The Health Systems Planning Unit of the Office of Health Strategy 1688
shall conduct a cost and market impact review in each case where (1) an 1689
application for a certificate of need filed on or before June 30, 2027, 1690
pursuant to section 19a -638, as amended by this act, involves the 1691
transfer of ownership of a hospital, as defined in section 19a -639, as 1692
amended by this act, and (2) the purchaser in a transaction occurring on 1693
or before June 30, 2027, is a hospital, as defined in section 19a -490, 1694
whether located within or outside the state, that had net patient revenue 1695
for fiscal year 2013 in an amount greater than one billion five hundred 1696
million dollars, or a hospital system, as defined in section 19a -486i, 1697
whether located within or outside the state, that had net patient revenue 1698
for fiscal year 2013 in an amount greater than one billion five hundred 1699
million dollars or any person that is organized or operated for profit. 1700
(b) Not later than twenty -one days after receipt of a properly filed 1701
certificate of need application involving the transfer of ownership of a 1702
hospital filed on or after December 1, 2015, and on or before June 30, 1703
2027, as described in subsection (a) of this section, the unit shall initiate 1704
such cost and market impact review by sending the transacting parties 1705
a written notice that shall contain a description of the basis for the cost 1706
and market impact review as well as a request for information and 1707
documents. Not later than thirty days after receipt of such notice, the 1708
transacting parties shall submit to the unit a written response. Such 1709
response shall include, but need not be limited to, any information or 1710
documents requested by the unit concerning the transfer of ownership 1711
of the hospital. The unit shall have the powers with respect to the cost 1712
and market impact review as provided in section 19a-633. 1713
Sec. 21. Section 19a -641 of the general statutes is repealed and the 1714
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sHB5045 / File No. 755 56

following is substituted in lieu thereof (Effective October 1, 2026): 1715
Any health care facility or institution and any state health care facility 1716
or institution aggrieved by any final decision of said unit issued on an 1717
application filed on or before June 30, 2027, under the provisions of 1718
sections 19a -630 to 19a -639e, inclusive, as amended by this act, may 1719
appeal from such decision in accordance with the provisions of section 1720
4-183, except venue shall be in the judicial district in which it is located. 1721
Such appeal shall have precedence in respect to order of trial over all 1722
other cases except writs of habeas corpus, actions brought by or on 1723
behalf of the state, including information on the relation of private 1724
individuals, and appeals from awards or decisions of administrative 1725
law judges. 1726
This act shall take effect as follows and shall amend the following
sections:

Section 1 October 1, 2026 New section
Sec. 2 October 1, 2026 New section
Sec. 3 October 1, 2026 New section
Sec. 4 October 1, 2026 New section
Sec. 5 October 1, 2026 New section
Sec. 6 October 1, 2026 New section
Sec. 7 October 1, 2026 New section
Sec. 8 October 1, 2026 New section
Sec. 9 October 1, 2026 New section
Sec. 10 October 1, 2026 New section
Sec. 11 October 1, 2026 New section
Sec. 12 October 1, 2026 New section
Sec. 13 October 1, 2026 19a-612d(a)
Sec. 14 October 1, 2026 19a-638(a) to (e)
Sec. 15 October 1, 2026 19a-639(a) to (e)
Sec. 16 October 1, 2026 19a-639a
Sec. 17 October 1, 2026 19a-639b
Sec. 18 October 1, 2026 19a-639c(a)
Sec. 19 October 1, 2026 19a-639e(a) to (c)
Sec. 20 October 1, 2026 19a-639f(a) and (b)
Sec. 21 October 1, 2026 19a-641

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sHB5045 / File No. 755 57

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of
the General Assembly, solely for purposes of information, summarization and explanation and do not
represent the intent of the General Assembly or either chamber thereof for any purpose. In general,
fiscal impacts are based upon a variety of informational sources, including the analyst’s professional
knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final
products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note

State Impact:
Agency Affected Fund-Effect FY 27 $ FY 28 $
Office of Health Strategy GF - Transfer
from
2,029,146 None
Public Health, Dept. GF - Transfer to 2,029,146 None
Office of Health Strategy IF - Transfer from 784,018 None
Public Health, Dept. IF - Transfer to 784,018 None
UConn Health Ctr. OF - Potential
Cost
See Below See Below
UConn Health Ctr. OF - Savings See Below See Below
Note: GF=General Fund; IF=Insurance Fund; OF=Operating Fund

Municipal Impact: None
Explanation
The bill makes various changes to the Certificate of Need (CON)
process, resulting in the fiscal impacts described below.
Sections 2, 3, and 13 transfer the Certificate of Need (CON) program
operations from the Office of Health Strategy to a new CON unit in the
Department of Public Health (DPH), resulting in FY 27 transfers of: (1)
General Fund funding of $2,029,146 and 19 supported positions; and (2)
Insurance Fund funding of $784,018 and four supported positions. This
unit will support a new CON panel,1 placed within DPH for
administrative purposes only, t hat will make final decisions on CON -
related determinations.

1 The panel consists of the DPH and Department of Social Services commissioners and
the Office of Policy and Management secretary (or their designees ), with the DPH
commissioner or their designee serving as the panel’s chair.
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sHB5045 / File No. 755 58

Section 5 results in a potential savings to the UConn Health Center,
beginning in FY 27, by capping consultant costs2 incurred during certain
kinds of CON review. Savings will vary to the extent that these
consultant costs currently exceed the bill’s cap.
Section 9 results in a potential cost of up to $250,000 3 to the UConn
Health Center to the extent that it must conduct a cost and market
impact review under the Certificate of Need (CON) process. The bill
lowers the net patient revenue threshold, from above $1.5 billion in FY
13 to above $1 billion in FY 25, th at requires hospitals to conduct such
reviews during the CON process, for certain transactions. UConn
Health's net patient revenue in FY 26 is estimated to be $1.2 billion.
Sections 9 and 10 also allow the Office of the Attorney General
(OAG) to conduct investigations or take action on a transfer of
ownership of a hospital, resulting in no fiscal impact to the state because
the OAG has the expertise to meet the requirements of the bill. Thes e
sections also make various conforming changes regarding the OAG
which result in no fiscal impact.
House "A" strikes the underlying bill and its associated fiscal impact,
resulting in the impacts above.
The Out Years
The annualized ongoing fiscal impact identified above would
continue into the future subject to inflation.

2 The bill limits fees charged to the applicant for consultancy services to $200,000 per
application (current law has no cap except that the fee be reasonable).
3 The bill increases the maximum billable amount per application that requires a cost
and market impact review to $250,000 (compared to $200,000 under current law).
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sHB5045 / File No. 755 59

OLR Bill Analysis
sHB 5045 (as amended by House "A")*

AN ACT STREAMLINING HEALTH CARE FACILITY APPROVALS.

SUMMARY
Starting July 1, 2027, this bill replaces the Office of Health Strategy
(OHS)-administered health care facility certificate of need (CON)
program with a new program overseen by a panel comprised of the
public health (DPH) and social services (DSS) commissioners and Office
of Policy and Management (OPM) secretary or their designees. It creates
a new CON program within DPH to support the review of CON
applications, and requires the panel to meet at least monthly to review
and decide these applications.
The bill’s new process differs in various respects from the current
one. For example, it:
1. eliminates required CON approval for certain service
terminations, and creates a separate process to oversee only
hospital service pauses or terminations;
2. makes other changes to when CON approval is required,
including by modifying certain exemptions;
3. shortens the list of factors that must be considered in the CON
review process;
4. generally requires a public hearing for all CON applications
(unless waived by the applicant under certain conditions),
instead of only a subset as under current law;
5. requires the panel to create an expedited CON review pathway
for certain application categories or subcategories; and
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6. expands the circumstances when a CON application for a
hospital transfer is subject to a cost and market impact review.
Under the bill, the current OHS CON program continues for
applications submitted on or before June 30, 2027 (§§ 13 -21). As under
current law, that program is administered by OHS’s Health Systems
Planning Unit, with the OHS commissioner having independent
decision-making authority over CON decisions. For the current
program, the bill extends from June 30, 2026, to June 30, 2027, an existing
CON exemption for increases in the licensed bed capacity for mental
health facilities under certain situations (§ 14).
The bill also makes minor, technical, and conforming changes.
*House Amendment “A” replaces the underlying bill and makes
several changes, such as (1) delaying the start date for the new CON
process by six months; (2) changing the categories of activities subject to
CON approval to more closely mirror current law; (3) adding
applications fees, mirroring current law; (4) requiring the panel to meet
at least monthly rather than quarterly; (5) adding a notice requirement
for certain large group practice transactions that are not subject to CON
review; (6) requiring, rath er than allowing, the panel to create an
expedited review pathway; (7) adding several reporting requirements;
and (8) making various other changes to program deadlines and
procedures.
EFFECTIVE DATE: October 1, 2026
§§ 2, 3 & 13 — CON PANEL AND DPH CON PROGRAM
The bill creates a three -person panel, placed within DPH for
administrative purposes only, to make final decisions on CON -related
determinations under the new process. The panel consists of the DPH
and DSS commissioners and OPM secretary or their designees . The
DPH commissioner or her designee serves as the panel’s chairperson.
Specifically, the panel must make final decisions and rulings on the
following (under the bill, except where noted):
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1. CON applications submitted on or after July 1, 2027;
2. civil penalties and cease and desist orders imposed on or after
that date;
3. approvals of policies and procedures effective on and after that
date;
4. hospital plans for continued access to care during service
terminations on and after that date; and
5. nonprofit hospital sales under existing law’s procedures (see
BACKGROUND).
Starting July 1, 2027, the panel generally must meet at least monthly
to review and decide CON applications that were submitted to the panel
at least five days before the meeting. The panel chairperson may call
special meetings at other times to review and decide these applications
or any other matter appropriate for panel review under the bill. The
panel may cancel a monthly meeting if no CON applications or other
business has been appropriately submitted to it with at least five days’
notice before the scheduled meeting.
The bill also creates a CON program within DPH to support the
review of CON applications. The DPH commissioner must designate a
director to oversee the program. Under the bill, starting July 1, 2027:
1. anyone applying for a CON must file the application with DPH’s
CON program (rather than with OHS as under current law),
2. the program must prepare a report on the application, and
3. the program must make all determinations as to whether a CON
is required (subject to the panel’s final decision).
The program must also monitor compliance with the bill’s new CON
process and with any panel -issued order or decision, including any
associated panel-imposed conditions. In any enforcement action under
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the bill (see § 10 below), the program must present the allegations at the
panel’s public hearing.
The provisions described below apply on and after July 1, 2027, or to
CON applications filed on or after that date, as applicable.
§§ 1, 4, 14 & 18 — CON REQUIREMENT AND EXEMPTIONS
The following table compares the activities requiring CON approval
under the current OHS program and the bill’s new process.
Table: Activities Requiring CON Approval
Current Law Bill
Establishment of a new “health care facility”
(see below)
Same as current law
Transfer of ownership of a health care
facility
“Change of ownership or control” of a health
care facility (see below)
Transfer of ownership of a large group
practice (eight or more physicians) to any
entity other than a (1) physician or (2)
physician group meeting certain
requirements (for example, not affiliated with
a hospital)
Change of ownership or control of a large
group practice (with the same exceptions)

(The bill does not carry forward a current
provision that creates a presumption in favor
of approving a CON for group practice
ownership transfers when the offer was
made in response to a voluntary offer for
sale)

See below for required notice of certain
other large group practice transactions
Establishment of a freestanding emergency
department
Same as current law (under bill’s definition
of “health care facility”)
Establishment of an outpatient surgical
facility
Same as current law (under bill’s definition
of “health care facility”)
Establishment of cardiac services, including
inpatient and outpatient cardiac
catheterization, interventional cardiology,
and cardiovascular surgery
Same as current law
Acquisition of CT, MRI, PET, or PET-CT
scanners, with certain exceptions (for
example, replacements under specified
conditions)
Same as current law
Acquisition of non-hospital based linear
accelerators, except for replacements under
Same as current law
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Current Law Bill
specified conditions
Increase in a facility’s licensed bed capacity,
except for certain mental health facilities
Same as current law, other than the
exception (see below)

See below for related DPH reporting
requirement
Acquisition of equipment using technology
that is new to the state
Same as current law
Increase of two or more operating rooms
within a three-year period by an outpatient
surgical facility or short-term acute care
general hospital
Same as current law
Termination of the following:
• hospital inpatient or outpatient services
• certain outpatient surgical services by
outpatient surgical facilities or certain
hospitals
• a short-term acute care hospital’s
emergency department
• inpatient or outpatient services offered
by state-operated facilities that provide
services eligible for Medicare or
Medicaid reimbursement
Under this law, a termination is the
combined stop to a service for more than
180 days over a two-year period
Not required, but the bill creates a new
review process for certain hospital service
pauses or terminations (see § 12 below)

The bill’s list of exemptions from CON requirements under the new
process is generally similar to the current OHS -led process. For
example, the exemptions include, among several others, (1) nursing
homes and certain other long -term care facilities (they ar e subject to a
separate DSS CON process), (2) free clinics, and (3) school-based health
centers.
The bill adds new exemptions for:
1. a state -operated or nonprofit facility, institution, or provider
solely providing behavioral health or substance use disorder
treatment services; and
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2. an association between a group practice and management service
organization (MSO) in which the MSO is paid fair market value
through a contract rather than being paid through profit or
revenue sharing.
The bill differs from current law in some other respects, including the
following:
1. specifying that the exemption for Department of Children and
Families (DCF)-funded programs only applies if DCF exclusively
funds them (as under current law, psychiatric residential
treatment facilities are not exempt);
2. not carrying forward a current exemption for certain nonprofits
that contract with, or are certified or licensed to provide a service
for, a state agency for services otherwise requiring CON
approval; and
3. not carrying forward a current exemption for increases in the
licensed bed capacity of mental health facilities that meet
specified criteria (the bill extends the current exemption under
the OHS CON program by one year).
Also, under current law, a facility seeking to relocate must first show
that doing so will not substantially change the population served or the
payer mix; if the facility cannot show this, then it must get CON
approval. The bill instead creates a specific CON exemption for a health
care facility’s relocation within the same town or within 10 miles of the
existing location, as long as the move does not substantially change the
facility’s patient population or payer mix.
Additionally, the bill requires the DPH commissioner, by January 1,
2028, to report to the governor and Public Health Committee any
recommendations regarding a CON exemption for temporary increases
in a hospital’s licensed bed capacity due to an admissions surge that
cannot be met by the hospital’s existing licensed bed capacity.
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“Health Care Facilities” Definition
Under the current CON law, “health care facilities” are hospitals;
specialty hospitals; freestanding emergency departments; outpatient
surgical facilities; state-operated facilities that provide services eligible
for Medicare or Medicaid reimbursement; cen tral service facilities;
mental health facilities; substance abuse treatment facilities; any other
facilities requiring a CON; and any of these facilities’ parent companies,
subsidiaries, affiliates, or joint ventures, or any combination of them.
The bill specifies that the term includes hospitals’ satellite locations.
It also includes within the term outpatient surgical facilities that are
established by acute -care hospitals, in addition to those that are
independently licensed as under current law. (While current law does
not include the former in the “health care facility” definition, it requires
CON approval to establish either type of outpatient surgical facility.)
“Change of Ownership or Control” Definition
For the current CON program, ownership transfers requiring CON
approval are those transfers that impact or change the facility’s (or other
applicable group practice’s) governance or controlling body, including
all affiliations, mergers, or any sale or transfer of the facility’s net assets.
The bill instead requires CON approval for a “change of ownership
or control” of a health care facility or certain group practices (see above).
This is any change in the entity’s ownership, beneficial ownership, or
control, specifically including:
1. a corporate merger;
2. an acquisition, by direct or indirect purchase in any way, of at
least 25% of a health care entity’s assets, equity, or voting shares;
3. a transfer of control of the entity’s board or governing body; or
4. a real estate sale or lease of at least 20% of a hospital’s assets.
CON Determination Letter
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Similar to current law, the bill requires anyone who is unsure
whether a CON is required to send a letter to the CON program
describing the proposal and asking the program to determine if a CON
is required. The person or facility making the request must give the
program any information it needs to determine this. The program must
make its decision within 30 days after getting the request.
Notice of Certain Large Group Practice Transactions
Starting July 1, 2027, if anyone acquires ownership or control of a
large group practice and CON approval is not required (because the
buyer is a physician or physician group meeting certain criteria), the
acquiring person or entity must notify the CON program about the
transaction.
Generally, at least 30 days before the transaction’s closing, the
acquiring person or entity must submit a notice with certain information
about the group practice, and (unless otherwise prohibited by law) the
CON program must post this information on its website. If 30 days’
prior notice is not practicable due to circumstances beyond the
acquiring person’s or entity’s control, they must give the notice as soon
as practicable, but no later than 14 days after the transaction closes.
The notice must include the following:
1. the names and medical specialties of the group’s physicians;
2. the names of the business es providing clinical or managerial
services as part of the group practice;
3. the address for the locations where the practice provides clinical
services and a description of these services for each location;
4. the zip codes of the primary service area served by each of these
locations; and
5. the resulting name, ownership, and business type of the group
practice after the proposed change of ownership, control, or
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affiliation, including the name and business type of any person
or entity that will directly or indirectly control at least 10% of the
practice.
Also, the bill requires the acquiring person or entity, within 30 days
after the transaction is closed (or abandoned), to report the date it
occurred.
§§ 5 & 15 — REVIEW FACTORS AND CONSULTANTS
The bill requires the panel, in any deliberation on a CON application,
to determine by a preponderance of the evidence whether the
application shows that the proposal is in the public’s interest. In doing
so, the panel must consider certain factors, consistent with any relevant
DPH regulations, policies, or procedures. Specifically, the panel must
consider whether the proposal:
1. promotes delivery of high -quality and cost-effective care in the
applicant’s primary service area;
2. promotes health care services access, including Medicaid access,
in that area;
3. promotes the health care system’s financial stability, including
whether the proposal is financially feasible for the applicant and
whether there is any evidence of the applicant’s prior financial
mismanagement or misconduct;
4. meets a clear public need (for the proposal and services provided
under it); and
5. would result in an unnecessary duplication of services.
Current law requires consideration of a longer list of factors,
including similar matters as under the bill and other factors such as (1)
the applicant’s past and proposed provision of health care services to
relevant populations and payer mix and (2) whether the applicant has
shown that the proposal will not negatively impact provider diversity
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and patient choice in the region. Current law, unlike the bill, also
requires additional factors to be considered in deliberations for hospital
ownership transfers.
Generally similar to current law, the bill allows the panel and the
CON program to engage a third-party consultant to help in this analysis.
But they may do so only if the CON program director, in his or her sole
discretion, determines that there is a need for an expert with specialized
knowledge. As under current law, the consultant must submit the bills
for its services directly to the applicant, who must pay within 30 days
after receiving them. The bill sets a $100,000 limit on these bills per
application.
Under the bill, before retaining a consultant, the program must notify
the applicant and give them the opportunity to withdraw the
application before incurring any consulting fees. The bill prohibits the
panel and program from retaining a consultant for an application under
the expedited review process (see § 7 below) unless the application is
referred for a full review.
Starting by July 1, 2028, the DPH commissioner must annually report
to the governor and Public Health Committee on consultants engaged
under this process, including (1) the number, (2) the categories of CON
proposals for which they were engaged, (3) the am ount spent for each
engagement, (4) the type of expertise sought, and (5) any reports they
produced.
§§ 6 & 16 — APPLICATION PROCESS
The bill requires CON applicants under the new process to submit
applications to DPH’s CON program, in a way the commissioner sets.
The applications must (1) include all information required under DPH
regulations, policies, and procedures (see § 11 below) and (2) be
submitted based on monthly deadlines, including submission dates on
the 15th of each month. As under current law, applicants must submit a
nonrefundable application fee ranging from $1,000 to $10,000, based on
the project’s costs.
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Notice Posting and Determination of Application’s Completeness
Under the bill, within 21 days before the CON application deadline,
the applicant must give the CON program a notice for posting on the
program’s website. The notice must (1) identify the applicant, any
known parties to the application, and the proposal’s address and (2)
briefly describe the proposal in plain language, including a reference to
the bill’s provision requiring CON approval (see § 4). If the applicant
does not submit the application within 90 days after submitting this
notice, the applicant must submit a new notice before applying.
Within 15 days after the application deadline, the program must
notify the applicant whether the application is deemed complete. To be
deemed complete, the applicant must have submitted relevant
responses to all of the application’s questions and data requests. Within
five days after deeming an application incomplete, the program must
give the applicant written notice about any application or data elements
that were inadequately addressed. The program must not review the
application until the applicant resu bmits it, with the missing elements,
in a subsequent application period. When submitting a revised
application, no additional filing fee is required unless the proposal’s
total cost differs from the previous projected costs, in which case the
applicant must submit the net difference in fees.
The bill’s notice and application process differs in several respects
from the current process. Among other things, current law requires the
applicant to also post a notice in the newspaper and at least two
community locations.
Request for Party or Intervenor Status
Under the bill, someone wishing to request party or intervenor status
in connection with a CON application must file a notice with the
program within 20 days after the CON applicant’s notice was posted on
the program’s website. The proposed party’s or intervenor’s notice must
indicate whether they seek a hearing on the application. Someone who
files this notice (or shows good cause for failing to do so) may file a
petition for party or intervenor status up to 21 days after the CON
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applicant files the application.
After someone files a petition for party or intervenor status, the (1)
panel must appoint a hearing officer to decide the matter, (2) applicant
has five days to object, and (3) hearing officer must issue a decision
within 15 days. If the hearing officer gr ants a request to intervene, the
decision must set the scope of the approval, including whether the (1)
intervenor’s hearing request is granted or (2) intervention is limited to
submitting written materials.
Program Report and Requests for Additional Information
Under the bill, the CON program must submit a report to the record
summarizing the application and analyzing each of the required review
factors (see above). The program must do so at least 10 days before any
public hearing and no later than 90 days after the application was
deemed complete.
The bill allows the program to request additional information from
the applicant while analyzing the application. These requests must not
delay review timelines unless mutually agreed to by the applicant and
program. Unless otherwise prohibited by law, all additional
information becomes part of the public CON record.
The bill also allows the program to supplement the record with
relevant data, analyses, reports, or other similar evidence within 75 days
after the application is deemed complete. The applicant must have 10
days to submit a written response to this evidence, and those responses
must be included in the record.
Public Hearings and Proposed Decisions
With certain exceptions, current law requires a hearing on CON
applications only if requested by a specified number of people. By
contrast, under the bill, the panel, or a hearing officer the panel
designates, generally must hold a public hearing on any ap plication
within 90 days after the program deems it as properly filed and
complete.
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But the applicant may waive the right to a hearing if the applicant is
the only party and no one has been granted intervenor status. The
applicant must do so in writing within 30 days after the application is
deemed complete. Applicants that waive a hearing also waive their right
to appeal.
Under the bill, the hearing record closes no later than 10 days after
the hearing adjourns, unless the applicant and program both agree to
keep the record open for a period. Any hearing transcript becomes part
of the record without needing to reopen it. If a hearing is not held, the
record closes 10 days after the program’s report is submitted.
The bill allows the panel to appoint a hearing officer to administer
any hearing under these provisions and to draft a proposed final
decision (even when no hearing was held) consistent with the bill and
the Uniform Administrative Procedure Act.
If a hearing officer was appointed, he or she must send the program
report, the hearing record (if any), and his or her proposed final decision
to the panel for its consideration at the next monthly meeting. The
hearing officer must do so within 60 days af ter the hearing record is
closed (or 150 days after the application was deemed complete, if the
applicant waives the hearing). If there was no appointed hearing officer
and no hearing, the program director must prepare and submit the
proposed final decisio n. If the hearing officer’s or director’s proposed
decision recommends conditions, the hearing officer or director, as
applicable, must meet with the applicant (unless the law otherwise
prohibits this) at least five days before sending the proposed decisio n,
to preview the proposed conditions.
The bill allows applicants, within 14 days after a proposed final
decision is published, to file written briefs or exceptions and request oral
argument.
Panel Meeting and Decision
Under the bill, when the panel holds a meeting to review CON
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applications, it must vote on each application that was submitted to it at
least five days earlier. The panel must make its decisions by majority
vote and may:
1. approve the application with or without conditions,
2. deny it,
3. send it back to the hearing officer to further develop the record
for presentation at the next meeting (this may occur no more than
twice unless the panel and applicant both agree), or
4. order the program and applicant to engage in agreed settlement
negotiations.
Under the bill, any proposed final decision that the panel votes to
approve is automatically converted to a final decision. If the panel votes
to modify a proposed final decision, it must be modified as the panel
directs and posted as a final decision no later than 30 days after the vote.
Unless otherwise prohibited by law, at least five days before the
modified final decision is posted, the program or hearing officer must
meet with the applicant to preview the conditions to be finalized.
If the docket is referred for settlement negotiations, the negotiated
proposed settlement must be presented at the next panel meeting. The
panel must vote on the proposed settlement and may approve it or reject
it and choose another available option.
The bill does not prevent the program and an applicant from
engaging in negotiations to reach an agreed settlement earlier in the
process, starting 30 days after the application is deemed complete. Any
negotiated agreement must be presented for review and a vote at the
next panel meeting that is at least five days after the settlement’s date.
The bill allows the CON program to recommend, and the panel to
impose, any conditions on a CON approval that are consistent with the
bill’s purposes. Unless otherwise prohibited by law, the program or
hearing officer must meet with the applicant at least five days before
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issuing a proposed final decision or final decision imposing conditions,
to preview them. The applicant and any party to the application may
request an amendment or relief from any condition due to changed
circumstances, hardship, or other good cause. The panel may grant or
deny the request, and its decision is not subject to appeal.
Under the bill, if there was a hearing on the application (including in
cases where the panel remanded the matter to further develop the
record), any final decision is subject to appeal to Superior Court.
Deadline Extension
The bill specifies that the CON program and applicant may agree to
extend any of these deadlines.
§ 7 — EXPEDITED REVIEW PATHWAY
The bill requires the panel, by January 1, 2028, to create an expedited
review pathway for certain CON application categories or
subcategories. This applies to:
1. the relocation of a health care facility more than 10 miles from its
current location and outside its current town;
2. an increase in inpatient or outpatient hospital beds;
3. the acquisition of CT, MRI, PET, or PET -CT scanners by any
person, physician, provider, short -term acute care general
hospital, or children’s hospital (when CON approval is required
for these acquisitions);
4. an increase of two or three operating rooms within a three -year
period by an outpatient surgical facility or short -term acute care
general hospital; and
5. any other category the DPH commissioner designates in
regulations.
Applicants may request expedited review starting January 1, 2028,
and must submit their CON applications under the same deadlines,
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application fee, and notice of intent requirements as described above for
the standard pathway (see § 6) . Applications under the expedited
pathway are not entitled to a hearing before a hearing officer, except the
(1) program may hold a hearing before an appointed hearing officer no
later than 30 days after deeming the application complete, without
affecting other timelines, or (2) panel may transfer the application from
the expedited pathway to the standard pathway described above.
Within 15 days after an expedited review is submitted, the program
must notify the applicant whether the application is deemed complete
and whether it qualifies for expedited review.
If the program deems an application incomplete, within five days it
must give the applicant written notice about which elements of the
submitted application or data were inadequate. The program must not
review the application until the applicant resubmits it, with the missing
elements, in a subsequent application period.
If the program deems the application complete but ineligible for
expedited review, it must review the application under the bill’s
standard process. On the other hand, if the program deems the
application eligible for expedited review, it must complete its analysis,
and the director must issue a proposed final decision, within 60 days
after that determination and present the application to the panel at its
next meeting.
Request for Party or Intervenor Status
As with the standard pathway, the bill allows anyone to seek
intervenor or party status for expedited applications, but under a
streamlined process. The person must file the request within 14 days
after the CON application was filed.
After someone makes such a request, the (1) panel must appoint a
hearing officer to review the matter, (2) applicant has five days to
respond, and (3) hearing officer must make a decision within five days.
If the hearing officer grants the request, the application must be
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removed from the expedited pathway and processed through the
standard one (and the referral date to the standard pathway is
considered to be the date the application was deemed complete). In
making the decision, the hearing officer must consider the unique
nature of the expedited process and potential burden of allowing
intervention.
Panel Decision
The bill allows applicants under the expedited process to file written
briefs or exceptions and request oral argument on the proposed final
decision, no later than seven days after it is published. The program
must submit to the panel the proposed final de cision and any of the
applicant’s subsequent submissions.
Under the bill, the panel must vote on an expedited application and
approve it (with or without conditions), deny it, remand it to the
program to further develop the record for the next panel meeting,
remand it to further develop the record under the stand ard process, or
order the program and applicant to engage in agreed settlement
negotiations. The panel must base its decision on the same standards
and guidelines that apply to the standard pathway.
The bill applies to expedited approvals similar provisions as under
the standard process on (1) the automatic conversion of approved
proposed final decisions to final decisions, (2) panel decisions that are
voted to be modified, (3) dockets remanded for further development of
the record or referred for settlement negotiations, (4) settlement
negotiations earlier in the process, (5) the panel’s authority to set
conditions on its approval , and (6) the applicant’s or party’s ability to
request an amendment or relief from any condition. (In a few cases, the
deadlines under the expedited process are shorter.)
Additionally, for any docket remanded for processing under the
standard process, the date of the panel’s vote is the date the application
is considered to be deemed complete under the standard process.
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(PA 25 -2, unchanged by the bill, created a separate OHS -
administered emergency CON process for bankruptcy -related hospital
ownership transfers.)
Deadline Extension
As under the standard process, the program and applicant may agree
to extend any of these deadlines.
Reporting Requirement
The bill requires the CON program, by July 1, 2029, and in
consultation with relevant stakeholders, to report to the Public Health
Committee on the expedited pathway, including (1) the average time
from application submission to final decision, (2) the num ber of
applications processed through the expedited process compared to the
standard process, (3) the number of applications filed under the
expedited pathway that were transferred to the standard pathway and
the reasons why, and (4) any recommended changes to the expedited
pathway.
§§ 8 & 17 — VALIDITY, REVOCATION, AND RELATED MATTERS
Generally mirroring current law, under the bill:
1. a CON is valid only for (a) the proposal described in the
application and (b) two years from the date it is issued;
2. the CON holder must give the program any information it
requests about the proposal’s development during these two
years and for 30 days after it expires;
3. if the CON holder asks, the program may extend the CON’s
duration as it deems necessary, subject to a public comment
period (unlike current law, the bill does not require a public
hearing on these requests if a certain number of people ask for it);
4. the program may withdraw, revoke, or rescind the CON, under
the Uniform Administrative Procedure Act, if it determines that
the (a) project has not substantially begun during a valid CON
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period or (b) CON holder has not made a good -faith effort to
complete the proposal as approved; and
5. a CON is not transferable or assignable and the project cannot be
transferred to someone else.
§§ 9 & 20 — COST AND MARKET IMPACT REVIEW
Under a generally similar process as current law, the bill requires the
CON program to conduct a Cost and Market Impact Review (CMIR) of
certain CON applications that propose to transfer a hospital’s
ownership or control, to examine the businesses and rela tive market
provisions of the transacting parties. The bill’s requirement also applies
to notice of material change filings (see BACKGROUND) with the
attorney general’s office for these same transfers.
In either case, the bill’s requirement applies to hospital ownership
transfers when the purchaser is (1) an in - or out-of-state hospital or a
hospital system that had net patient revenue exceeding $1 billion for FY
25 or (2) organized or operated for profit. (The current threshold for (1)
is $1.5 billion revenue for FY 13.)
The CON program must hire an independent consultant to conduct
the review at the purchaser’s expense, with similar requirements as
under current law, except the maximum bills per application are
$250,000 under the bill compared to $200,000 currently.
The bill requires the program to develop a set of data requests for
these CMIRs. The applicant must submit all necessary CMIR data when
the applicant begins the CON application process or submits its material
change notice, whichever is earlier. The progra m must review the data
submission for completeness within 30 days, and notify the applicant
about any missing elements.
Under the bill, the CON program must submit a preliminary CMIR
report to the applicant and the attorney general within 90 days after the
data submissions are complete. The applicant then has 15 days to
respond in writing. After the applicant responds (or w aives the
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opportunity to do so), the program must make the preliminary report
and the applicant’s comments public. Within 120 days after the CON
application was completed, the program must issue a final CMIR report
and make it part of the public CON record for that application.
In several respects, the bill’s CMIR provisions mirror those under
current law. These include provisions on the:
1. confidentiality of submitted nonpublic information and limited
exceptions to it;
2. factors that may be examined in the review, such as the parties’
size and market share, prices for services, and service quality;
3. attorney general’s authority, after the final CMIR report is issued,
to investigate certain matters (for example, possible antitrust
violations) or take related actions; and
4. required stay of the proposed transfer for a 30 -day period after
the CMIR final report is issued or while a court case brought by
the attorney general is pending.
§ 10 — INVESTIGATIONS AND ENFORCEMENT
The bill requires the CON program’s director to investigate all
inquiries about compliance with the bill’s new CON process. It gives the
panel similar enforcement authority as OHS has under current law to
investigate alleged CON violations. For example, it allows the panel, or
its authorized agent, to (1) administer oaths and take testimony under
oath relating to the matter under investigation and (2) subpoena
witnesses or require the production of documents or other materials,
subject to judicial enforcement.
Similar to current law, it sets a civil penalty (through proceedings
brought by the CON program) for any person or health care facility or
institution that negligently (1) undertakes an activity without a required
CON approval or (2) fails to comply with a CON decision’s terms or
conditions or a panel -approved agreed settlement. It also sets this
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penalty for any person or entity who negligently fails to submit a
required notice about (1) changes in ownership or control of a large
group practice that is not subject to CON approval (see § 4) or (2) a
hospital’s pause for more than 90 days or indefini te termination of a
service line (see § 12). As under current law, the maximum penalty is
$1,000 per day. The CON program must present allegations of this
negligence at a hearing before the panel.
The bill generally mirrors current procedures (and related deadlines)
for these penalties, such as prior notice, the right to a hearing, and the
right to appeal. It similarly mirrors a current provision that makes
failing to pay the penalty after the final assessment grounds for
deducting Medicaid payments.
It also generally mirrors current law for cease and desist orders, by
allowing the CON program to pursue this remedy when the director (or
his or her agent) has received information or reasonably believes that
someone has or is violating the bill’s new CON procedures or
requirements. The bill includes prior notice, hearing, and appeal
provisions that are similar to current law, with the panel holding the
hearings and issuing the order.
The bill allows any civil penalty proceeding and investigation or
cease and desist proceeding to be held together in one proceeding.
§§ 11 & 16 — REGULATIONS AND POLICIES AND PROCEDURES
The bill requires the DPH commissioner to adopt regulations to
implement the new CON process. It also allows her to implement
policies and procedures while in the process of adopting regulations, as
long as she first convenes a working group by January 1, 2027, with
relevant stakeholders to give input. The policies and procedures are
valid for a maximum of two years or until the regulations are adopted ,
whichever is earlier.
The bill eliminates OHS’s ability under current law to implement
policies and procedures while adopting regulations for the CON
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process.
§§ 12 & 19 — HOSPITAL SERVICE PAUSES OR TERMINATIONS
Under current law, in addition to required CON approval for certain
service terminations (see above), health care facilities must give OHS 60
days’ notice of other service terminations, with the specific procedures
differing based on whether the service or iginally needed CON
approval.
By contrast, the bill’s new process generally addresses service
terminations only by hospitals and does not set related notification
requirements for other facilities. It allows a hospital to temporarily
pause a service for up to 90 days. If the hospital i ntends to pause a
service line for longer than that or to indefinitely terminate a service line,
it must generally notify the CON program at least 90 days in advance.
If 90 days’ notice is not practicable due to circumstances beyond the
hospital’s control (such as a provider’s death), the hospital must give
notice as soon as practicable but no later than 14 days. Under the bill, a
“service line” is a category of inpatient or outpatient service, except for
emergency department services.
The notice may be in writing or electronic, and must include:
1. a description of the service to be paused or terminated;
2. current and historical utilization rates for it;
3. the anticipated impact of the pause or termination on people and
health care facilities in the hospital’s primary service area;
4. the date set for the pause or termination and, if applicable, the
anticipated date to resume the service;
5. a detailed account of any community engagement and planning
that has been done or that is scheduled to take place before the
pause or termination; and
6. any other information the director requires.
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The hospital must also send a copy of the notice to (1) the attorney
general’s office, DSS, and the Office of the Healthcare Advocate, and (2)
if it relates to a behavioral health or substance use disorder treatment
service, the Department of Mental Health and Addiction Services and
Behavioral Health Advocate.
Under the bill, the program must hold a public hearing on the
proposed pause or termination, the impact on the hospital’s primary
service area, and the proposed plan for ensuring continued access to
high-quality affordable health care in that area. The hearing record and
any submitted public comments must inform the panel’s review of the
proposal plan and any imposed conditions (see below).
Plan for Continued Access
The bill requires a hospital, generally at least 60 days before the pause
or termination, to submit a plan for ensuring access to the service
afterwards. If the service ended due to an unplanned event outside of
the hospital’s control, the hospital must submit the plan within 14 days.
The plan must include:
1. information on service utilization before the proposed pause or
termination;
2. information on the location and service capacity of alternative
sites that provide the service and travel times to them;
3. an assessment of transportation needs after the pause or
termination and a plan to meet them;
4. a protocol that details ways to maintain continuity of care for
patients and describes how patients in the hospital’s primary
service area will get the service at other sites; and
5. a communication plan to ensure that all affected patients in that
area are aware of the pause or termination, where else they may
get the service, and the hospital’s available help to get it.
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Under the bill, the CON program must review the hospital’s plan to
determine if it ensures continued access to the service. Within 10 days
after receiving the plan, the program must review it and give the
hospital and panel written recommendations to appro ve the plan,
modify it, or impose conditions on it.
The panel then must hold a meeting on the plan within 10 days. The
hospital may submit a response to the recommendations at the meeting.
Within 10 days after the meeting, the panel must make its decision, and
the panel’s decision approving or modifying a p lan is a final decision
subject to appeal to Superior Court.
The CON program must monitor the plan’s implementation. If the
hospital fails to implement any aspect of the approved plan, the
program may impose a performance improvement plan. The hospital
may be subject to civil penalties (see § 10 above) for failure t o comply
with the performance improvement plan and continued failure to
perform under the plan.
BACKGROUND
Nonprofit Hospital Sales
Under existing law, a nonprofit hospital needs approval from the
OHS commissioner and attorney general before entering into an
agreement to transfer a material amount of its assets or operations or
change control of its operations to a for -profit purchaser. Among other
things, the hospital and purchaser must submit a CON determination
letter as part of this process. OHS and the attorney general’s office must
evaluate several factors in deciding whether to approve the transaction
(CGS § 19a-486 et seq.).
Notice of Material Change
Existing law requires prior notice to the attorney general before
parties may complete a transaction resulting in (1) a material change to
a physician group practice’s business or corporate structure or (2) an
affiliation between one hospital or hospital s ystem and another, so the
attorney general can review the transaction under the antitrust laws
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(CGS § 19a-486i).
Related Bill
sHB 5030 (File 680), favorably reported by the Appropriations
Committee, eliminates OHS and transfers the CON program to DPH.
COMMITTEE ACTION
Public Health Committee
Joint Favorable
Yea 22 Nay 10 (03/09/2026)

Finance, Revenue and Bonding Committee
Joint Favorable
Yea 43 Nay 11 (04/14/2026)