HB 7050, An Act Concerning The Office Of Health Strategy’s Recommendations Regarding The Certificate Of Need Program

TESTIMONY OF THE CONNECTICUT HOSPITAL ASSOCIATION
SUBMITTED TO THE PUBLIC HEALTH COMMITTEE

Monday, March 24, 2025

The Connecticut Hospital Association (CHA) appreciates this opportunity to submit testimony concerning HB 7050, An Act Concerning The Office Of Health Strategy’s Recommendations Regarding The Certificate Of Need Program. CHA has concerns about the bill as written.

Connecticut hospitals and health systems care for patients, strengthen the state’s economy, and support vulnerable communities across the state. Every day, they work to improve healthcare access, affordability, and health equity. Even as they face ongoing challenges, hospitals provide world-class care to everyone who walks through their doors, regardless of their ability to pay. Hospitals also support an exemplary workforce as the largest collective employer in the state, contribute significantly to the state’s economy, and invest in their communities addressing social drivers of health.

CHA continues to advocate for a certificate of need (CON) process that is timely, equitable, efficient, and not cost-prohibitive for applicants and stakeholders.

Section 1 of the bill allows the Office of Health Strategy (OHS) to use policies and procedures while regulations are pending. CHA opposes the continued use of this practice and urges the agency to return to the established regulatory process set in place by the legislature. While we recognize that the intention of using policies and procedures in place of regulations is the ability to rapidly implement changes, this practice has been misused and does not absolve the agency of implementing regulations and ensuring that proper checks and balances are present from the very beginning of the process.

Section 2 of the bill sets limitations on the “termination of services” definition by restricting it to a combined total of more than 180 days within two consecutive years or 30 consecutive days. We believe the proposed timeframe is insufficient to assess the specific needs of a facility and for that facility to determine whether there is a legitimate “termination” of services or rather a pause in care delivery. We request that the original 180-day timeframe remain in place.

Section 4 of the bill proposes changes to the cost and market impact review process, allowing OHS to consider the preliminary report, response to the preliminary report, final report, and any written comments from the parties regarding the reports issued or submitted as part of the review. We believe the Attorney General is in a better position to conduct a cost and market impact review and recommend that this authority be shifted to that office. Should OHS continue to retain this responsibility, we believe that the language in the bill should be made clear to require, rather than only allow, OHS to consider comments from the parties in the cost and market impact report process. Section 4 should also be amended to detail its response to each comment made by the parties.

Section 5 of the bill proposes that OHS “may develop and implement” an expedited process for “a service, facility, or equipment identified as having a significant unmet need” based on the geographic region of the applicant in the most recent Statewide Facilities and Services Plan. We are concerned that the broad applicability of an expedited process as the bill’s language suggests will create additional uncertainty. There are numerous tradeoffs to an expedited process, including the applicant’s loss of a right to a hearing, the ability to contest a case, increased likelihood of entering into an agreed settlement, or a requirement to follow the regular application process. Therefore, to narrow this focus, CHA requests that OHS develop a separate expedited CON process specifically for the establishment, transfer, or expansion of behavioral health and substance use disorder treatment services, the acquisition of imaging equipment, and the termination of services. This process should include, but not be limited to, OHS’s creation of a short-form application and a decision issued within 30 days.

CHA requests that the Public Health Committee conduct a review of the costs across healthcare related to delays and inefficiencies in the CON process prior to allowing OHS to increase the costs to applicants. Notably, Section 6 of the bill allows an increase in how much OHS can charge an applicant for the services of an independent consultant from $200,000 to $300,000 per application. We recommend the committee review factors such as these as it considers ways to reduce delays, improve internal staff expertise, and ensure that the CON process remains collaborative and efficient.

We believe the CON process needs a much more significant overhaul and recommend the committee consider including additional improvements to the CON process, including but not limited to:

    • Prohibiting OHS from requiring applicants to meet requirements or obligations that are not set forth in statute or regulation
    • Authorizing a committee review of the structure of the CON process, including review of the cost to healthcare providers due to delays and inefficiencies in the CON process and an examination of the CON process in other states, including, but not limited to, New York and Massachusetts
    • Streamlining the CON process by not requiring a CON for the relocation of any outpatient service within the same municipality, a reduction or increase in the number of inpatient or outpatient beds by nine or fewer in a two-year cycle, the termination of inpatient or outpatient services due to insufficient patient volume or the inability to recruit or retain an adequate number of providers, or the termination of any subspecialty surgical service
    • Developing an expedited CON process for the establishment, transfer, or expansion of behavioral health and substance use disorder treatment services, for the acquisition of imaging equipment, and for terminations of services
    • Reducing delays by limiting requests for information, using only information in the record and available to all parties in making decisions, requiring timeliness in noticing and holding hearings, and deeming applications approved should OHS not meet statutory timeframes

Thank you for your consideration of our position. For additional information, contact CHA Government Relations at (203) 294-7301.