Certificate of Need (CON)

Overview

The Department of Social Services (DSS) is responsible for the Certificate of Need (CON) process for nursing homes, residential care homes and intermediate care facilities for individuals with intellectual disabilities. The Office of Health Strategy is responsible for the CON process as it relates to hospitals. CON programs work to focus spending on under-served areas, and to ensure healthcare costs are controlled. The CON process does not block change, but merely calls for an assessment of costs while providing the public with an opportunity for input. Connecticut’s CON legislation is outlined in Connecticut General Statutes 17b-352 through 17b-354.

Certificate of Need approval is required prior to undertaking the following activities:

  • When a facility wishes to introduce any new or additional function or service into its program of care;
  • Termination of a health service including facility closure or a substantial decrease in total bed capacity;
  • New facilities associated with a continuing care facility provided such beds do not participate in the Medicaid program;
  • Incur capital expenditures exceeding either $2,000,000 or capital expenditure exceeding $1,000,000 with an increase in facility square footage by 5,000 square feet or 5% of existing square footage;
  • Requests to license a new residential care facility or intermediate care facility for the intellectually disabled;
  • Add beds restricted to use by residents with AIDS or traumatic brain injuries;
  • Medicaid certified beds to be relocated from one licensed nursing facility to another licensed nursing facility to meet a priority need identified in the strategic plan developed pursuant to subsection (c) of section 17b-369 of the Connecticut General Statutes.

*** If you are unsure if a CON is required, contact DSS for guidance.***

The CON process begins with an applicant's submission of a Letters of Intent (LOI). Letters of Intent must include:

  • Name of the applicant or applicants
  • Statement indicating the project type
  • Estimated capital cost
  • Town where the project is or will be located
  • Brief description of the proposed project. 
When a facility submits an LOI to DSS, the facility must also:
  • Notify in writing the Office of the Long-Term Care Ombudsman;
  • Notify in writing all patients, guardians or conservators, if any, or legally liable relatives or other responsible parties;
  • Post a public notice in a conspicuous location at the facility.

DSS will review the letter of intent to determine if a CON application is required. If it is determined a CON is required, DSS will send a CON application after receiving the letter of intent. Once a CON application is issued, the provider will have 180-days to file the CON application with DSS. If the CON application is not received within 180-days, the CON application will be deemed withdrawn and the facility will have to start the process over by submitting another letter of intent.

When determining whether a CON request will be granted, modified or denied, DSS may consider the following:

  1. The relationship of the request to the state health plan.
  2. The financial responsibility and business interests of the applicant and any other interested parties.
  3. Ability of the facility to continue to provide needed services.
  4. Financial feasibility of the request and its impact on the applicant's rates and financial condition.
  5. Proposed transfer of ownership or control prior to initial licensure.
  6. Contribution of the request to the quality, accessibility and cost-effectiveness of health care delivery in the region.
  7. Whether there is clear public need for the request.
  8. Needs of the current and prospective residents of the facility.
  9. Need for the service or function within the geographic area.
  10. Any other consideration the Commissioner deems necessary.

Certificate of Need Process for Elimination of Three and Four Bed Rooms and Low Utilization

If a facility wishes to file a Certificate of Need (CON) for 1) the termination of CCNH/RHNS beds in order to eliminate all three and four bed rooms and 2) the termination of CCNH/RHNS beds due to low utilization or other reasons, please follow the process below:

Letter of Intent Submission:

  • A provider should submit a letter of intent that includes the following information: 1) the name of the applicant; 2) a statement indicating whether the application is for termination of CCNH/RHNS beds in order to eliminate all three and four bed rooms in the facility OR if the application is for termination of CCNH/RHNS beds due to low utilization and/or other reason(s); 3) the number current licensed CCNH/RHNS beds and the number of beds proposed for termination; 4) the estimated capital cost, if any; 5) the town where the proposed project is located; and 6) a brief description of the proposal.
  • Submit the letter of intent via email to con-ratesetting.dss@ct.gov to the attention of:

Nicole Godburn, Fiscal Manager
Reimbursement and CON
Division of Health Services
Department of Social Services
55 Farmington Avenue
Hartford, CT 06106

Letter of Intent Processing:

  • If the letter of intent reflects a non-substantial number of beds proposed for termination, then the Department may issue a determination letter approving the bed terminations and a CON application would not be required. Determinations will be issued on a rolling basis. Please note that the facility’s bed termination history, if applicable, will be reviewed and may impact a facility’s eligibility for CCNH/RHNS bed termination approval through a Determination.
  • If the letter intent reflects the elimination of all 3 and 4 bed rooms and the proposal is considered to be a substantial termination of beds, then a short form CON application will be returned. Submitted applications for the elimination of 3 and 4 bed rooms will be reviewed by the Department in the order received and as practicable.
  • If the letter of intent reflects a substantial termination due to low utilization or other reason, then a full CON application will be returned. The application needs to be deemed complete by March 15th or September 15th to be considered in the current batch. The provider should give ample time to submit the letter of intent, have an application returned, complete and submit the application, respond to any completeness questions from the Department, and receive notification from the Department that the application is complete.

Will the Department give me feedback on my proposal prior to submission of my letter of intent?
For feedback on a specific proposal, a letter of intent should be submitted.

Where are the requirements for the elimination of 3 and 4 bed rooms and the batch review process in Statute? 
The requirements for the elimination of 3 and 4 bed rooms and the batch review process were announced under the Coronavirus Relief Fund (CRF) Funding package released in December 2020 and neither is in Statute. Please read the December 2020 announcement for more information.