Certificate of Need Process Analysts discussing CON application   
Certificate of Need (CON) authorization is required when a health care facility proposes a medical equipment purchase, introduction of an additional functional or service, a reduction or termination in services, or changes in ownership or control.  Connecticut health care facilities, including ambulatory care centers and outpatient behavioral health programs, must obtain a CON prior to developing, expanding or closing certain services and expending more than $3 million on a capital project.1  Additionally, any person is required to obtain a CON if he/she proposes to acquire major medical equipment with a capital cost in excess of $3 million.  CON approval, regardless of cost, is required for anyone acquiring, purchasing, or accepting donation of a CT scanner, PET scanner, PET/CT scanner, MRI, cineangiography equipment, a linear accelerator or similar equipment utilizing new technology that is being introduced to the state. 

The CON process is a two-step procedure that consists of a Letter of Intent (LOI) and the CON application process.  Details of each of these are discussed below. 

The Applicant notifies OHCA of the intent, description and cost of a project using either a CON Determination (Form 2020) or a Letter of Intent (Form 2030).  The CON Determination (Form 2020) is submitted if an Applicant is unsure if a CON is required for a proposed project.  On Form 2020, the Applicant  provides information regarding the proposal and submits it to OHCA for review.  Based on that information, OHCA determines if a CON is required.  If a CON is required, the Applicant then submits a Letter of Intent (Form 2030). 

A Letter of Intent (Form 2030) provides information required by statute regarding the proposed CON, as specified in Sections 19a-638 and 19a-639 C.G.S.  Once the Letter of Intent (LOI) is filed, the Applicant receives a customized CON Application form and is notified of the filing window for the application, the assigned analyst and the docket number for the proposal.  The filing window for the CON Application is between the 60th and 120th day from the LOI filing date.  A one time 30 day time extension may be requested by the Applicant, extending the filing date to the 150th day. 

OHCA provides public notice of any complete LOI by publishing a legal advertisement in a newspaper in the proposed service area of the proposal, no later than 15 days after the LOI is complete.

Waiver for Replacement Equipment from CON (Form 2040) is considered when major medical equipment, imaging equipment or linear accelerator that was previously authorized under a CON, needs replacement.  A waiver authorizes the provider to replace the equipment without an additional CON.  OHCA reviews the request and supporting evidence and notifies the Applicant of its eligibility.  Supporting evidence shall include the previously obtained CON for the equipment being replaced and documentation that the replacement cost is less than $3 million. 

Exemption from CON (Form 2010) process is available for certain non-profit programs that are currently under contract with a state agency or department, School Based Health Centers and Community Health Centers .  The programs and facilities must provide a letter from the Commissioner, Executive Director or Administrator of the relevant state agency attesting to the need for this program, relocation of program and/or termination of service.  The Community Health Centers must provide evidence that the capital expenditure does not exceed $3 million, it exclusively provides primary services and dental services, and either receives funds from Department of Public Health or is located in a medically underserved area.  OHCA reviews the request and supporting evidence and notifies the Applicant of its eligibility.

Under Registration of the Exempt Facilities 11 categories of health care facilities are removed from the CON process under 19a-639a C.G.S., including Clinical Laboratories, ICFMR’s, Assisted Living Services Agencies, Home Health Agencies, Americares Foundation Clinics, Nursing Homes and Rest Homes.   These facilities must register with OHCA and update their registry information on biannual basis in order to stay in compliance with the statute.

The CON Application process is specific to each proposal.  The application submitted to OHCA must address the following components as required under Section 19a-637 C.G.S, which relates to OHCA’s considerations in deliberations and written findings.  The application is deemed complete when the Applicant successfully addresses each of these requirements.

  • The relationship of the proposal to the Applicant’s long range plan,
  • The financial feasibility of the proposal,
  • The impact on the Applicant’s rates and financial condition,
  • The impact on interests of consumers,
  • The impact on payers for such services,
  • The contributions of the proposal to the quality, accessibility, and cost effectiveness of health care delivery,
  • Competency of facility managers,
  • Sufficiency of rates,
  • Changes in the Applicant’s current utilization,
  • Teaching and research responsibilities of the Applicant,
  • The efforts of the Applicant in improving productivity and containing costs, and
  • Any other factors deemed relevant by the Office.

Within ten business days, the Applicant is notified of any deficiencies in the filings and any additional information that is required.  Upon receipt of a complete filing, the application is deemed compete and OHCA has 90 days from the completion date to render a decision.

OHCA may hold a public hearing with respect to the following:

  1. Use of technology that is new or being introduced to the State;
  2. New or additional health care function or service being introduced to the State; and
  3. Termination of any existing health care function or service, reduction of total beds or closing of health care facility.

OHCA may hold a public hearing with respect to the following:

  1. Any complete CON application submitted to the office under this section if three individuals or an individual representing an entity with five or more people submit a request, in writing, that a public hearing be held on the proposal after the office has published notice of a complete Letter of Intent, and such request is received by the office no later than twenty-one calendar days after the office deems the CON application complete; and
  2. Any complete CON application filed if the proposed total capital expenditure is $20 million or more for land, buildings, or non-clinical equipment acquisition, new building construction or building renovation unless a waiver of hearing is requested pursuant to OHCA Regulations Section 19a-643-45.

Once the application and the hearing process are complete, a decision is prepared to approve, modify or deny the proposed project.  This is competed within 90 days of the receipt of a compete application.

CON Modifications Form (2050) of previously approved or authorized CONs are required if circumstances have changed from the original authorization.  To initiate the modification review, the Applicant submits a letter requesting the proposed modification to OHCA, Following OHCA’s review, the Applicant is notified of the decision regarding the modification request.

Footnotes:

1  Except those specifically exempted in Section 19a-639a.  These facilities are required to register with OHCA annually.  Registration forms are available on this web site.