Certificate of Need (CON)
Please Note: Application format may not be altered or modified by an applicant.
Office of Health Strategy CON Covid-19 Waiver / Guidance on Licensed Bed Capacity
|CON COVID-19 Waiver Form 2021-01-07 (Increase in Licensed Bed Capacity) 2021-01-07|
|OHS COVID-19 CON Guidance Document 2021-01-07|
Determinations of whether a project requires CON approval must be obtained in writing from the department. Please submit the appropriate form below to HSP for review:
Prior to filing a CON, notice for 3 consecutive days must be placed in newspapers of substantial distribution to the location proposed. A listing of these newspaper requirements can be found here.
If CON approval is required, applicant must complete:
- CON Main Form
- Supplemental Form (if indicated in table below)
- Financial Worksheet
Notice Regarding CON Filings:
Please be advised that Health Systems Planning (HSP) is in the process of revising its regulations (19-639-3(b)) to enable it to accept new CON filings through the CON Portal. While proceeding through this legal process of changing HSP’s regulations, HSP waives the requirement for Applicant(s) to file paper copies pursuant to Sec. 19a-639a-3.
Note: Should anyone not have the ability to file electronically, the present paper submission process may still be used. If you have any questions regarding a CON filing with HSP, please contact us at HSP@ct.gov or call us directly at (860) 418-7001.
1. CON Main Form
2. CON Supplemental Forms
The supplemental forms correspond to the circumstances listed in Conn. Gen. Stat. section 19a-638(a)(1)-(15) that require CON approval. Some supplemental forms serve more than one application type (e.g., termination of services).
|(1)||Establishment of a new health care facility (mental health and/or substance abuse) -See note below*||Word|
|(2)||Transfer of ownership of a health care facility -(excludes transfer of ownership/sale of hospital – see “Other” below)||Word|
|(3)||Transfer of ownership of a group practice||Word|
|(4)||Establishment of a freestanding emergency department||Word|
Termination of a service:
|(6)||Establishment of an outpatient surgical facility||Word|
|(9)||Establishment of cardiac services||Word|
Acquisition of equipment:
|(12)||Increase in licensed bed capacityof a health care facility||Word|
|(13)||Acquisition of equipment utilizing [new] technologythat has not previously been used in the state||Word|
|(14)||Increase of two or more operating roomswithin any three-year period by an outpatient surgical facility or short-term acute care general hospital||Word|
|Other||Transfer of Ownership / Sale of Hospital|
*This supplemental form should be included with all applications requesting authorization for the establishment of a mental health and/or substance abuse treatment facility. For the establishment of other “health care facilities,” as defined by Conn. Gen. Stat § 19a-630(11) - hospitals licensed by DPH under chapter 386v, specialty hospitals, or a central service facility - complete the Main Form only.
3. CON Financial Worksheet
|The Financial workbook (Excel format) contains: (A) Non-Profit, (B) For-Profit and (C) Sale of Non-Profit Hospitals worksheets. Complete the appropriate worksheet based on the application type (19a-638(a) applications should complete financial worksheet (A) if a Non-Profit entity or (B) if a For-Profit entity. Applications for 19a-486a Sale of Non-Profit Hospitals should complete financial worksheet (C).||Excel|
|Equipment Replacement Form||Word|
CON Modification Form
To download and print forms, you may need to download FREE Adobe Acrobat™ Reader and install it on your computer. Adobe also provides resources designed to help people with visual disabilities access the Adobe Portable Document Format. If you are unable to access these forms for any reason, you may request a paper copy from the agency.