HB 5045 — AN ACT STREAMLINING HEALTH CARE FACILITY APPROVALS.

(3) A change of ownership or control of a large group practice involvingto any entity other than a (A) physician, or (B) group practiceof thattwo hasor totalmore assets,physicians annuallegally revenuesorganized orin anticipateda combinedpartnership, annualprofessional revenuescorporation ofor atlimited leastliability tencompany millionformed dollars,to includingrender bothprofessional in-stateservices and out-of-statenot assetsemployed by or revenues,an oraffiliate thatof includesany ahospital, privatemedical equityfoundation, insurance company or other similar entity;

(4) The acquisition of computed tomography scanners, magnetic resonance imaging scanners, positronemission tomography scanners or positron emission tomography-computedtomography scanners, by any person, physician, provider, short-term acute care general hospital or children's hospital, except (A) as provided for in subdivision (22)(18) of subsectionsHB5045 (b)/ ofFile thisNo. section, and (B) a certificate of need issued by the panel shall not be required where such scanner is a replacement for a scanner that was previously acquired through certificate of need approval or a certificate of need determination, including a replacement scanner that has dual modalities or functionalities if the applicant already offers similar imaging services for each of the scanner's modalities or functionalities that will be utilized;

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755 subsection (b) of this section, and (B) a certificate of need issued by the panel shall not be required where such scanner is a replacement for a scanner that was previously acquired through certificate of need approval or a certificate of need determination, including a replacement scanner that has dual modalities or functionalities if the applicant already offers similar imaging services for each of the scanner's modalities or functionalities that will be utilized;

and (7)An increase oftwo or moreoperating roomswithin any three-year period by an outpatient surgical facility, as defined in section 19a-493b of the general statutes, or by a short-term acute care general hospital.hospital;

LCO(8) 5The establishment of 47cardiac Substituteservices, Billincluding No.inpatient and outpatient cardiac catheterization, interventional cardiology and cardiovascular surgery;

5045and (b)(9) OnThe andacquisition afterof Januarynonhospital-based 1,linear 2027,accelerators, except a certificate of need issued by the panel shall not be required for:where such accelerator is a replacement for an accelerator that was previously acquired through certificate of need approval or a certificate of need determination.

(b) On and after July 1, 2027, a certificate of need issued by the panel shall not be required for:

(3)sHB5045 A/ healthFile careNo. facility operated by a religious group that exclusively relies upon spiritual means through prayer for healing;

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755 (3) A health care facility operated by a religious group that exclusively relies upon spiritual means through prayer for healing;

(12) A school-based health center and an expanded school health site, as such terms are defined in section 19a-6r of the general statutes, a community health center, as defined in section 19a-490a of the general statutes,anot-for-profitoutpatientcliniclicensedinaccordancewiththe LCOprovisions 6of chapter 368v of 47the Substitutegeneral Billstatutes No.and a federally qualified health center;

5045 provisions of chapter 368v of the general statutes and a federally qualified health center;

(14) Any nonprofit facility, institution or provider that is (A) operated as a nonprofit or by the state, and (B) solely providing behavioral health or substance use disorder treatment services;

(15) A health care facility operated by a nonprofit educational institutionsHB5045 exclusively/ forFile students,No. faculty and staff of such institution and their dependents;

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755 institution exclusively for students, faculty and staff of such institution and their dependents;

(19) Acquisition of cone-beam dental imaging equipment;equipment that is to be used exclusively by a dentist licensed pursuant to chapter 379 of the general statutes;

LCO(20) 7The partial or total elimination of 47services Substituteprovided Billby No.an outpatient surgical facility, as defined in section 19a-493b of the general statutes;

5045 (20) The partial or total elimination of services provided by an outpatient surgical facility, as defined in section 19a-493b of the general statutes;

(22) Acquisition of any equipment by any person that is to be used exclusivelysHB5045 for/ scientificFile research,No. provided the equipment shall not be used in the diagnosis, treatment or prevention of any medical condition for humans;

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755 exclusively for scientific research, provided the equipment shall not be used in the diagnosis, treatment or prevention of any medical condition for humans;

(c) On and after JanuaryJuly 1, 2027, any personperson, or health care facility or institution that is unsure whether a certificate of need is required for a particular proposal under this section shall send a letter to the Certificate of Need UnitProgram that describes the proposal and requests that the Certificateprogram of Need Unit make a determination as to whether a LCOcertificate 8 of 47need Substituteis Billrequired No.for such proposal.

5045A certificateperson, ofhealth needcare isfacility requiredor forinstitution making such proposal.request shall provide the program with any information the program requests as part of its determination process.

AThe personprogram or health care facility or institution making such request shall provide thea unitdetermination withnot anylater informationthan thethirty Certificatedays ofafter Needreceipt Unit requests as part of itssuch determinationrequest. process.

The(d) CertificateOn ofand Needafter UnitJuly shall1, provide2027, aany determinationacquiring notperson lateror thanentity thirtyin daysa afterchange receiptof ownership or control of sucha request.large group practice to any person sHB5045 / File No.

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755 or entity that does not require a certificate of need pursuant to subdivision (3) of subsection (a) of this section shall submit notices to the program, in a form and manner prescribed by the commissioner, of such transfer consistent with this subsection.

(1) Not less than thirty days prior to the closing of a transaction, the acquiring person or entity shall submit a notice for each such group practice, in a form and manner prescribed by the commissioner, setting forth:

(A) The names and medical specialties of each physician practicing medicine with the group practice;

(B) the names of the business entities that provide clinical or managerial services as part of the group practice;

(C) the address for each location where clinical services are provided by the group practice;

(D) a description of the clinical services provided at each location of the group practice;

(E) the zip codes of the primary service area served by each location of the group practice;

and (F) the resulting name, ownership, and business type of the group practice after the proposed change of ownership, control or affiliation, including the name and business type of any person or entity that will control, directly or indirectly, at least ten per cent of the large group practice.

The program shall, unless otherwise prohibited by federal or state law, post such information on its Internet web site.

(2) Not later than thirty days after the close of the transaction or after the abandonment of such transaction, the acquiring person or entity shall submit a report indicating the date on which the transaction closed or was abandoned.

(3) When the provision of thirty days' notice pursuant to subdivision (1) of this subsection is not practicable due to circumstances outside of the acquiring person or entity's control, such as death, incapacity or otherexigentcircumstances,theacquiringpersonorentityshallprovide notice to the program as soon as practicable but in no case later than fourteen days after the close of the transaction.

(e) Not later than January 1, 2028, the commissioner shall report to sHB5045 / File No.

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755 the Governor and, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to public health concerning the commissioner's recommendations, if any, regarding an exemption from certificate of need requirements related to temporary increases in licensed bed capacity of a hospital due to a surge in admissions that cannot be accommodated by the hospital's existing licensed bed capacity.

In making such determination, the panel shall considerconsider, consistent with any relevant regulations, policies or procedures of the following:department, the following factors:

(1)Whether(1) theproposalsetWhether forthintheapplicationisconsistentthe withproposal anypromotes policiesdelivery andof procedureshigh-quality promulgatedcare byin the panel;primary service area of the applicant;

(2) Whether the proposal promotes deliveryaccess ofto high-qualityhealth care services, including Medicaid access, in the primary service area of the applicant;

(3) Whether the proposal promotes access,delivery includingof Medicaidcost-effective access,care in the primary service area of the applicant;

(4) Whether the proposal promotes deliveryfinancial stability of cost-effectivethe health care insystem, including, but not limited to, whether the primaryproposal serviceis areafinancially feasible for the applicant and whether there is any evidence of prior financial mismanagement or misconduct by the applicant;

(5) Whether thethere proposalis promotesa financialclear stabilitypublic ofneed thefor health care system, including, but not limited to, whether the proposal isand financially feasible for the applicantservices andto whetherbe thereprovided isunder any evidence of prior financial mismanagement or misconduct by the applicant;proposal;

and (6) Whether there is a clear public need for the proposal andwould theresult servicesin toan beunnecessary providedduplication underof theservices. proposal;

and(b) (7)In Whetheranalyzing thewhether proposala wouldcertificate resultof inneed anapplication unnecessarysatisfies duplicationthe ofsHB5045 services./ File No.

(b)755 InsHB5045 analyzingFile whether a certificate of need application satisfies the certificate of need criteria set forth in subsection (a) of this section, the LCO 9 of 47 Substitute Bill No.

5045755 certificate of need criteria set forth in subsection (a) of this section, the panel and the Certificate of Need UnitProgram may engageengage, when, in the sole discretion of the director, an expert with specialized knowledge is required, any third-party consultant that the panel or unitprogram deems necessary to analyze the application materials and proposal set forth in the application pursuant to such criteria.

All costs associated with such third-partythird-partyconsultantshallbebornebytheapplicant,providedthetotal consultant shall be borne by the applicant, provided the total costs for all consultants to the panel and the Certificateprogram ofunder Needthis Unitsubsection for a single application shall not exceed twoone hundred thousand dollars.

Each third-third-party party consultant engaged under this subsection shall submit each invoice for consulting services directly to the applicant for payment not later than thirty days after the issuance of the invoice.

(1) No consultant shall be retained in connection with the processing of an application under the expedited review process described in section 7 of this act unless such expedited application is referred for a full review pursuant to subsection (g) of section 7 of this act.

(2)Iftheprogramdeterminesthataconsultantisnecessaryunderthis subsection, the program shall provide notice to the applicant prior to expending any money and provide the applicant the opportunity to withdraw the application prior to incurring any consulting fees.

(3) Not later than July 1, 2028, and annually thereafter, the commissioner shall report to the Governor and, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to public health regarding all consultants engaged under this subsection, including (A) the number of engagements, (B) the categories of certificate of need proposals for which the engagements were made, (C) the amount spent on each engagement, (D) the nature of the expertise sought in each engagement, and (E) any reports produced sHB5045 / File No.

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755 under each engagement.

(NEW) (Effective October 1, 2026) (a) On and after JanuaryJuly 1, 2027, an applicant seeking a certificate of need shall submit an application to the Certificate of Need Unit,Program, in a form and manner prescribed by the unit,commissioner, and include all information required pursuant to the regulations, policies and procedures promulgated pursuant to section 11 of this act.

Each application shall be submitted based on quarterlymonthly deadlinesdeadlines, establishedby thepanel, including submission datesofMarchfirst,Junedates first,of Septemberthe firstfifteenth andday Decemberof first.each month.

(1)(b) ForThe anyapplicant certificateshall ofinclude needwith the application submitted under this section that includes a changenonrefundable ofapplication ownershipfee orbased controlon ofthe atotal healthcost careassociated facility or institution that is required to be approved in accordance with section 19a-493 of thegeneral statutes, such application shall include the applicationproject. required by said section for such approval.

(2)The Uponamount deeming an application made under subdivision (1) of this subsection complete, the Certificatefee of Need Unit shall submitbe theas changefollows: of ownership or control application to the commissioner for review under section 19a-493 of the general statutes.

After(1) theOne commissionerthousand completesdollars thefor reviewa underproject saidthat section,will thecost commissionernot shallgreater providethan thefifty determinationthousand ofdollars; such review and any supporting documentation to the Certificate of Need Unit to be added LCO 10 of 47 Substitute Bill No.

5045(2) totwo thethousand recorddollars for thea certificateproject ofthat needwill application,cost andgreater thethan processfifty ofthousand reviewingdollars suchbut applicationnot undergreater thisthan sectionone shallhundred resume.thousand dollars;

A(3) certificatethree ofthousand needdollars shallfor nota beproject issuedthat towill ancost applicantgreater forthan whomone thehundred commissionerthousanddollarsbut hasnot deniedgreater anthanfive applicationhundredthousanddollars;(4) four thousand dollars for changea ofproject ownershipthat underwill sectioncost 19a-greater 493than offive thehundred generalthousand statutes.dollars but not greater than one million dollars;

(3)(5) Nothingfive inthousand sectionsdollars 2for toa 12,project inclusive,that ofwill thiscost actgreater shallthan affectone themillion authoritydollars ofbut thenot Commissionergreater ofthan Publicfive Healthmillion provideddollars; under chapter 368v of the general statutes.

(b)(6) Noteight laterthousand thandollars thirty days prior to the deadline to submit a certificate of need application described in subsection (a) of this section, an applicant for a certificateproject ofthat needwill shallcost submitgreater athan noticefive tomillion thedollars Certificatebut ofnot Needgreater Unitthan forten postingmillion ondollars; the unit's Internet web site.

and (7) ten thousand dollars for a project that will cost greater than ten million dollars.

(c) Not later than twenty-one days prior to the deadline to submit a certificate of need application described in subsection (a) of this section, an applicant for a certificate of need shall submit a notice to the program for posting on the program's Internet web site.

If the applicant has not submitted the application on or before ninety days after submission of such notice, a new notice shall be required under this subsection prior to submitting the application.

(1)sHB5045 The/ identityFile ofNo. the applicant and any known parties to the application;

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755 (1) The identity of the applicant and any known parties to the application;

(c)(d) NotAny laterperson thanwishing thirtyto daysrequest afterparty theor deadlineintervenor tostatus submitin anconnectionwithacertificateofneedapplicationshallfileanoticeofsuch applicationperson's describedintent, inincluding subsectiona (a)statement of thiswhether section,such person seeks a hearing on the Certificateapplication, ofwith Needthe Unitprogram shallnot notifylater eachthan certificatetwenty ofdays needafter applicantthe whetherposting on the program's Internet web site of the applicant's applicationnotice isof deemedthe complete.intent to file the application.

ForAny anyperson applicationwho thatfiles issuch deemeda incomplete,notice theof unitintent shall,under notthis latersubsection, thanor fifteenwho daysdemonstrates aftergood deemingcause suchfor applicationfailing incomplete,to notifyfile thesuch applicant,a innotice, writing,may offile eacha applicationpetition andfor dataparty elementor thatintervenor wasstatus not adequatelylater addressedthan bytwenty-one days after the applicant.applicant's filing of the certificate of need application.

The(1) unitIf shalla notpetition reviewfor anyparty incompleteor applicationintervenor untilstatus theis applicantfiled, submitsthe apanel revisedshall andappoint completeda applicationhearing thatofficer adequately addresses such application and data elements to resolve the unitrequest. in a subsequent application period.

LCO(2) 11The ofapplicant 47may Substituteobject Billto No.any request for party or intervenor status not later than five days after the request is filed.

5045(3) (d) The panelhearing officer shall holdrender a publicdecision hearing on eachthe properlypetition filednot andlater completethan certificatefifteen ofdays needafter application filed under this section unless the applicantrequest waivesis thefiled. applicant's right to a public hearing.

An(4) applicantIf maya waiverequest the applicant's right to aintervene publicis hearinggranted, if the applicantdecision isgranting theintervention onlyshall partyset toout the proceedingscope andof nointervention personrights isgranted, grantedincluding intervenorwhether statusor pursuantnot toanintervenor'srequest sectionfor 4-177aofahearing theisgranted generalor statutes.Suchwhether waiverintervention shallis constitutelimited a waiver of the applicant's right to appealsubmission under section 4-183 of thewritten generalmaterials. statutes.

The(e) panelNot shalllater convenethan afifteen publicdays hearingafter onthe deadline to submit an application notdescribed laterin thansubsection ninety(a) daysof afterthis section, the unitprogram deemsshall thenotify applicationeach ascertificate properlyof filedneed andapplicant complete.whether the applicant's sHB5045 / File No.

Any755 personsHB5045 seekingFile toNo. participate as an intervenor in the public hearing shall file a request, in a form and manner prescribed by the executive director of the Certificate of Need Unit, not later than thirty days after the posting of the notice of the application.

Not755 laterapplication than sixty days after the record of the public hearing is closed,deemed orcomplete. after the applicant affirmatively waives a public hearing, the hearing officer shall transmit the report required pursuant to subsection (e) of this section and record of such hearing, if any, and the hearing officer's proposed final decision to the panel for consideration at the panel's next quarterly meeting.

(e)To Thebe executivedeemed directorcomplete, of the Certificateapplicant of Need Unit shall submithave asubmitted reportrelevant summarizingresponses theto certificateall of need application questions and providingdata anrequests analysis of each criterion listed in section 4 of this act to the panelapplication. or any designated hearing officer prior to a public hearing held pursuant to subsection (d) of this section or at the panel meeting at which the application is reviewed.

TheFor unitany shallapplication providethat suchis reportdeemed toincomplete, the panelprogram orshall, hearingnot officerlater andpostthan five days after deeming such reportapplication ontheunit'sincomplete, Internetnotify webthe siteapplicant, notin laterwriting, thanof fiveeach daysapplication priorand todata anyelement publicthat hearingwas ornot scheduledadequately meetingaddressed onby the application.applicant.

(f)The Atprogram theshall panelnot meetingreview toany reviewincomplete application until the applicant submits a certificaterevised ofand needcompleted application filedthat underadequately thisaddresses section,such theapplication paneland shalldata voteelements onto the dispositionprogram ofin thea application.subsequent application period.

The panelsubsequent mayfiling approveof the application,revised withapplication orshall withoutnot conditions,require denyany theadditional applicationfiling orfee remandunless the applicationtotal tocost of the hearingproposal officeris foramended furthersuch developmentthat a different fee would be required under subsection (b) of thethis recordsection, forin presentationwhich atcase the nextapplicant panelshall meeting.submit the net difference.

LCO(f) 12The program shall submit a report to the record summarizing the certificate of 47need Substituteapplication Billand No.providing an analysis of each criterion listed in section 5 of this act.

5045 (g) The Certificateprogram ofshall Needprovide Unitsuch mayreport recommend,no andlater thethan panelten maydays impose,prior to any conditiononpublic anhearing approvalofand ain certificateno ofcase needlater applicationthan filedninety underdays thisafter section, provided any such condition is consistent with the purposesapplication ofwas sectionsdeemed 2complete. to 12, inclusive, of this act.

(1) The applicantprogram andmay any partyto theapplicationmay request anamendmentadditional toinformation orrelieffromfrom anythe condition,applicant induring athe formcourse andof manneranalyzing prescribed by the unit,certificate dueof toneed changedapplication. circumstances, hardship or for other good cause.

Any such request shall not delay timelines for review of the application except by mutual agreement of the applicant and the program.

All additional information shall, unless otherwise prohibited by federal or state law, be made part of the public certificate of need record.

(2) The program may supplement the record with relevant data, analyses, reports or other similar evidence not later than seventy-five days after the application is deemed complete, provided the applicant shall have ten days to respond, in writing, to such evidence.

Any response from the applicant shall be included in the record.

(g) The panel, or a hearing officer designated by the panel, shall hold sHB5045 / File No.

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755 a public hearing on each properly filed and complete certificate of need application filed under this section unless the applicant waives the applicant's right to a public hearing.

(1) An applicant may waive the applicant's right to a public hearing, in writing, not later than thirty days after the application is deemed complete, if the applicant is the only party to the proceeding and no person is granted intervenor status pursuant to section 4-177a of the general statutes and subsection (d) of this section.

Such waiver shall constitute a waiver of the applicant's right to appeal under section 4-183 of the general statutes.

(2) The panel shall convene a public hearing on an application not later than ninety days after the program deems the application as properly filed and complete.

(3) The hearing record shall close not later than ten days after the adjournment of the hearing unless the applicant and program mutually agree to maintain the record open for some period.

Any transcript ofthe hearing shall be made part of the record without needing to reopen the record.

If no hearing is held, the record shall close ten days after the submission of the report.

(4)The panel may appoint ahearing officer to administer any hearing under this section and to draft the proposed final decision consistent with this section and chapter 54 of the general statutes.

A hearing officer appointed by the panel may draft a proposed final decision even for dockets in which the applicant waived the right to a hearing and no hearing was held.

(h) Not later than sixty days after the record of the public hearing is closed, or one hundred fifty days after the application was deemed complete if the applicant affirmatively waives a public hearing, the hearing officer, if one is appointed, shall transmit the report required pursuant to this section, the record of such hearing, if any, and the hearing officer's proposed final decision to the panel for consideration at the panel's next monthly meeting.

If no hearing officer is appointed sHB5045 / File No.

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755 foradocketthatdidnothaveahearing,thedirectoroftheprogramshall prepare and submit the proposed final decision.

If the proposed final decision recommends conditions pursuant to this section, the program or hearing officer shall meet with the applicant, unless otherwise prohibited by law, at least five days before transmitting such proposed final decision, to preview the conditions to be proposed.

(i) An applicant may file written briefs or exceptions and request oral argument regarding the proposed final decision not later than fourteen days after the publication of such proposed final decision.

(j) At the panel meeting to review one or more certificate of need applications filed under this section, the panel shall vote on the disposition of each application that has been submitted to the panel at least five days prior to such meeting.

The panel shall decide any presented application by majority vote.

The panel may approve the application, with or without conditions, deny the application or remand the application to the hearing officer for further development of the record for presentation at the next panel meeting, or order the program and applicant to engage in agreed settlement negotiations.

(1) Any proposed final decision that is approved by the vote of the panel shall be automatically converted to a final decision upon the approval vote of the panel.

(2) Any proposed final decision that is voted to be modified by the panel shall be modified consistent with the direction of the panel and posted as a final decision of the panel not later than thirty days after the panel's vote to modify, provided, at least five days before posting the modified final decision, the program or hearing officer shall meet with the applicant, unless otherwise prohibited by law, to preview the conditions to be finalized.

(3) Any docket remanded for further development of the record and presentation at the next meeting shall not be so remanded more than twice by the panel unless by mutual agreement of the panel and the applicant.

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755 (4) Any docket referred for settlement negotiations shall have the resulting negotiated proposed settlement presented at the next panel meeting.

The panel shall vote on the proposed settlement and may approve the proposed settlement or reject such settlement and move to one of the other available dispositions of the docket.

(5) Nothing in this section shall preclude the program and the applicant from engaging in negotiations to reach an agreed settlement at an earlier point in the process, provided such negotiations occur not earlier than thirty days after the application has been deemed complete.

Any negotiated agreement shall be presented for review and a vote on the disposition thereof at the next meeting of the panel that is at least five days after the date of the settlement.

(k) The Certificate of Need Program may recommend, and the panel may impose, any condition on an approval of a certificate of need application filed under this section, provided (1) any such condition is consistent withthepurposesofsections 2to 12,inclusive, ofthisact,and (2) the program or hearing officer shall meet with the applicant, unless otherwise prohibited by law,at least five days before issuing a proposed final decision or a final decision that imposes any such condition, to preview each such condition to be met by the applicant.

The applicant and any party to the application may request an amendment to or relief from any condition, in a form and manner prescribed by the commissioner, due to changed circumstances, hardship or for other good cause.

(l) Any final decision issued pursuant to this section for a docket in which a public hearing was held, either under subsection (e) of this section or as a result of the docket being remanded by the panel for further development of the record pursuant to subsection (j) of this section, shall be subject to appeal under section 4-183 of the general statutes.

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755 (m) Any deadlines in this section may be extended by mutual agreement of the program and the applicant.

(NEW) (Effective October 1, 2026) (a) TheNot later than January 1, 2028, the panel mayshall create an expedited review pathway andfor designatecertain categories of applications for certificates of need required under subsection (a) of section 24 of this act, or subcategories thereof,thereof. as eligible for expedited review on and after January 1, 2027.

(b) On and after January 1, 2027,2028, an applicant requestingmay request an expedited review of a certificate of need application shall submit such application pursuant to the deadlinesfollowing describedcategories in subsection (a) of sectionapplications: 6 of this act and provide the same notice to the Certificate of Need Unit as described in subsection (b) of said section.

(c)(1) AnThe applicantrelocation requestingof sucha expeditedhealth reviewcare shallfacility submitgreater anthan applicationten formiles suchaway expeditedfrom reviewits tocurrent thelocation Certificate of Need Unit, in a form and manneroutside prescribedthe bycurrent thetown executivein directorwhich ofit theis unit.located;

(d)(2) NotThe laterincrease thanin thirty days after submitting an application for a certificate of need for expedited review under this section, the Certificatenumber of Needinpatient Unitor shalloutpatient notifyhospital thebeds; applicant requesting expedited review whether such applicant's application is deemed complete and whether the application meets the requirements for expedited review.

(1)(3) ForThe anyacquisition applicationof thatcomputed istomography deemedscanners, incomplete,magnetic theresonance Certificateimaging ofscanners, Needpositronemission Unittomography shall,scanners notor laterpositron thanemission fifteentomography-computedtomography daysscanners, afterby deemingany suchperson, applicationphysician, incomplete,provider, notifyshort-term theacute applicant,care ingeneral writing,hospital or children's hospital, where certificate of anyneed applicationapproval is required for such acquisition;  (4) An increase of two or datathree elementsoperating thatrooms, werewithin notany adequatelythree- addressedyear period, by an outpatient surgical facility, as defined in section 19a- 493b of the LCOgeneral 13statutes, ofor 47by Substitutea Billshort-term No.acute care general hospital;

5045and applicant.(5) Any other category designated by the commissioner in regulations adopted in accordance with the provisions of chapter 54 of the general statutes.

The(b) departmentOn shalland notafter reviewJanuary such1, 2028, an applicationapplicant untilrequesting theexpedited applicantreview submitsof ana applicationcertificate thatof adequatelyneed addressesapplication shall submit such applicationapplication, orin dataa elementsform and manner prescribed by the commissioner, pursuant to the departmentdeadlines described in asubsection subsequent(a) applicationof period.section 6 of this act and provide sHB5045 / File No.

(2)755 ForsHB5045 anyFile applicationNo. that is deemed complete but ineligible for expedited review under this section, the Certificate of Need Unit shall review the application under the standard process set forth in section 6 of this act.

(e)755 Forthe anysame complete application thatfee isdescribed eligiblein forsubsection expedited(b) review under this section, the Certificate of Needsaid Unitsection shall complete its analysis not later than sixty days after the application is deemed complete and eligiblenotice forof expeditedintent reviewto under this section and present the applicationprogram toas thedescribed panelin atsubsection its(c) nextof meeting.said section.

(f)(c) NotwithstandingAn application processed through the provisionsexpedited ofpathway subsectionshall (d)not ofbe sectionentitled 6to ofa thishearing act,before a hearing officer, except (1) the panelprogram may hold a publichearing before a hearing regardingofficer anyappointed by the panel not later than thirty days after deeming the application complete andwithout eligibleaffecting any other timelines under this subsection, or (2) the panel may remove the application from the expedited certificatepathway and have it processed through the standard pathway described in section 6 of needthis application.act.

(g)(d) AtNot thelater panel'sthan meetingfifteen todays considerafter submitting an application for a certificate of need for expedited application,review under this section, the panelprogram shall votenotify onthe applicant requesting expedited review whether such applicant's application is deemed complete and whether the dispositionapplication ofmeets the certificaterequirements offor needexpedited application.review.

The(1) panelFor mayany approveapplication that is deemed incomplete, the application,Certificate withof orNeed withoutProgram conditions,shall, denynot thelater applicationthan orfive remanddays theafter deeming such application toincomplete, notify the hearingapplicant, officerin forwriting, furtherof developmentany ofapplication theor recorddata forelements presentationthat atwere thenot nextadequately paneladdressed meeting.by the applicant.

(h) The Certificateprogram ofshall Neednot Unitreview maysuch recommend,an andapplication until the panelapplicant maysubmits impose any conditionon, an approvalofapplication anthat expeditedadequately certificateaddresses ofneed application, provided any such conditionapplication isor consistentdata withelements to the purposesprogram ofin sectionsa 2subsequent toapplication 12,period. inclusive, of this act.

The(2) applicantFor and any partytoapplication theapplicationmaythat requestis anamendmentdeemed tocomplete orbut relieffromanyineligible condition,for inexpedited areview formunder andthis mannersection, prescribedthe byCertificate of Need Program shall review the unit,application dueunder tothe changedstandard circumstances,process hardshipset orforth forin othersection good6 cause.of this act.

(e) Any person who wishes to seek intervenor or party status shall file a request to do so not later than fourteen days after the filing of a certificate of need application filed under the expedited pathway.

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755 (1) The panel shall appoint a hearing officer to review any request to intervene or for party status.

(2)The applicant may respondto suchrequestnot later thanfive days after filing.

(3)Thehearingofficershallresolvetherequestforpartyorintervenor status not later than five days after the applicant's response.

(4) If party or intervenor status is granted, the application shall be removed from the expedited pathway and processed through the standard pathway described in section 6 of this act.

In determining whether to grant intervention, the hearing officer shall consider the unique nature of the expedited process and potential burden imposed by permitting intervention.

(5) The date of any referral of an application under this subsection to the standard pathway shall be considered the date on which the application was deemed complete.

(f) For any complete application that is eligible for expedited review under this section, the Certificate of Need Program shall complete its analysis and the director shall issue a proposed final decision not later than sixty days after the application is deemed complete and eligible for expedited review under this section and present the application to the panel at its next meeting.

(g)An applicant may filewrittenbriefsor exceptionsandrequest oral argument regarding the proposed final decision not later than seven days after the publication of such proposed final decision.

The program shall submit the proposed final decision and any subsequent submissions from the applicant to the panel.

(h) The panel shall base its decision in the expedited pathway on the same standards and guidelines as those in subsection (a) of section 5 of this act.

At the panel's meeting to consider an expedited application, the panel shall vote on the disposition of the certificate of need application.

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755 The panel may approve the application, with or without conditions, deny the application, remand the application to the program for further development of the record for presentation at the next panel meeting, remand the application for further development of the record in the standard certificate of need application process pursuant to section 6 of this act, or order the program and applicant to engage in agreed settlement negotiations.

(1) Any proposed final decision that is approved by the vote of the panel shall be automatically converted to a final decision upon such approval.

(2) Any proposed final decision that is voted to be modified by the panel shall be modified consistent with the direction of the panel and posted as a final decision of the panel not later than twenty-one days after the panel's vote to modify, provided, at least five days before posting the modified final decision, the program or hearing officer shall meet with the applicant, unless otherwise prohibited by law, to preview the conditions to be finalized.

(3) Any docket remanded for further development of the record and presentation at the next meeting shall not be so remanded more than twice by the panel unless by mutual agreement of the panel and the applicant.

(4) Any docket remanded for processing under the standard certificate of need application pursuant to section 6 of this act shall have the date of the panel's vote be the date on which the application is considered to be deemed complete in the standard process.

(5) Any docket referred for settlement negotiations shall have the resulting negotiated proposed settlement presented at the next panel meeting.

The panel shall vote on the proposed settlement and may approve the proposed settlement or reject such settlement and move to one of the other available dispositions of the docket.

(6) Nothing in this section shall preclude the program and the sHB5045 / File No.

755 sHB5045 File No.

755 applicant from engaging in negotiations to reach an agreed settlement at an earlier point in the process, provided such negotiations occur not earlierthanfifteendaysaftertheapplicationhasbeendeemedcomplete.

Any negotiated agreement shall be presented for review and a vote on the disposition thereof at the next meeting of the panel that is at least five days after the date of the settlement.

(i) The Certificate of Need Program may recommend, and the panel may impose any condition on, an approval of an expedited certificate of need application, provided (1) any such condition is consistent with the purposes of sections 2 to 12, inclusive, of this act, and (2) the program or hearing officer shall meet with the applicant, unless otherwise prohibited by law, at least five days before issuing a proposed final decision or a final decision that imposes any such condition, to preview each such condition to be met by the applicant.

The applicant and any partyto theapplicationmay request anamendment to or relieffromany condition, in a form and manner prescribed by the commissioner, due to changed circumstances, hardship or for other good cause.

LCO(j) 14Not later than July 1, 2029, the Certificate of 47Need SubstituteProgram, Billin No.consultation with relevant stakeholders, shall submit a report, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to public health regarding the expedited pathway, including (1) the average time from application submission to final decision, (2) the number of applications processed through the expeditedprocessincomparisontothestandardprocess,(3)thenumber of applications filed under the expedited pathway that have been transferred to the standard pathway and the reasons for such transfer, and (4) any recommendations for process changes to the expedited pathway.

5045(k) Sec.Any deadlines in this section may be extended by mutual sHB5045 / File No.

755 sHB5045 File No.

755 agreement of the program and the applicant.

Sec.

(NEW) (Effective October 1, 2026) (a) For a certificate of need issued pursuant to an application filed on or after JanuaryJuly 1, 2027, the certificate of need shall be valid (1) only for the proposal described in the application, and (2) for two years from the date of issuance by the panel.

During the period of time that such certificate is valid and the thirty-day period following the expiration of the certificate, the holder ofofthecertificate theshallprovidetheCertificate certificateofNeedProgramwithsuch shall provide the Certificate of Need Unit with such information as the unitprogram may request on the development of the proposal covered by the certificate.

(b) Upon request from a certificate of need holder, the Certificateprogram of Need Unit may extend the duration of a certificate of need for such additional period of time as the unitprogram determines is reasonably necessary to expeditiously complete the proposal.

Not later than five business days after receiving a request to extend the duration of a certificate of need, the unitprogram shall post such request on its Internet web site.

Any person who wishes to comment on extending the duration of the certificate of need shall provide written comments to the unitprogram on the requested extension not later than thirty days after the date the unitprogram posts notice of the request for an extension of time on its Internet web site.

(c) If the Certificateprogram of Need Unit determines that (1) commencement, construction or other preparation has not been substantially undertaken during a valid certificate of need period, or (2) the certificate of need holder has not made a good-faith effort to complete the proposal as approved, the unitprogram may withdraw, revoke or rescind the certificate of need.need pursuant to the requirements set forth in chapter 54 of the general statutes.

(d) For a certificate of need issued pursuant to an application filed on or after JanuaryJuly 1, 2027, the (1) certificate of need shall not be transferable or assignable, and (2) project that is the subject of the certificate of need shall not be transferred from a certificate holder to another person.

(NEW) (Effective October 1, 2026) (a) On and after JanuaryJuly 1, LCO2027, 15sHB5045 of/ 47File Substitute Bill No.

5045755 2027,theCertificateofNeedUnitshallconductacostandmarketimpactsHB5045 reviewFile forNo. any transaction where (1) an application for a certificate of need has been filed pursuant to subdivision (2) of subsection (a) of section 4 of this act or a notice of material change has been filed with the Attorney General's office pursuant to section 19a-486i of the general statutes that involves the transfer of ownership of a hospital, as defined in section 19a-639 of the general statutes, as amended by this act, and (2) the purchaser is (A) a hospital, as defined in section 19a-490 of the general statutes, whether located within or outside the state, that had net patient revenue for fiscal year 2025 in an amount greater than one billion dollars, (B) a hospital system, as defined in section 19a-486i of the general statutes, whether located within or outside the state, that had net patient revenue for fiscal year 2025 in an amount greater than one billion dollars, or (C) any person that is organized or operated for profit.

(b)755 Thethe Certificate of Need UnitProgram shall developconduct a setcost and market impact review for any transaction involving the transfer of dataownership requestsor tocontrol beof useda hospital in which (1) an application for applicationsa certificate of need has been filed onpursuant to subdivision (2) of subsection (a) of section 4 of this act or a notice ofmaterial change has been filed with the Attorney General's office pursuant to section 19a-486i of the general statutes that involves the transfer of ownership of a hospital, as defined in section 19a-639 of the general statutes, as amended by this act, and after(2) Januarythe 1,purchaser 2027,is (A) a hospital, as defined in section 19a-490 of the general statutes,whether locatedwithinor outsidethe state, that hadnet patient revenue for allfiscal costyear and2025 marketin impactan reviews.amount greater than one billion dollars, (B) a hospital system, as defined in section 19a-486i of the general statutes, whether located within or outside the state, that had net patient revenue for fiscal year 2025 in an amount greater than one billion dollars, or (C) any person that is organized or operated for profit.

An(b) applicantThe thatprogram is the subject of a cost and market impact review shall submitdevelop all data necessary for such review at the same time that the hospital initiates the application process for a certificateset of needdata withrequests the unit or that it submits a notice of material change to thebe Attorneyused Generalfor underapplicationsfiledonandafterJuly1,2027,forallcostandmarketimpact sectionreviews. 19a-486i of the general statutes, whichever is earlier.

TheAn unitapplicant that is the subject of a cost and market impact review shall submit all data necessary for such review at the datasame submissiontime that the hospital initiates the application process for completenessa notcertificate laterof thanneed thirtywith daysthe afterprogram submission.or that it submits a notice of material change to the Attorney General under section 19a-486i of the general statutes, whichever is earlier.

IfThe theprogram data submission is incomplete, the unit shall notifyreview the applicantdata thatsubmission itfor iscompleteness incompletenot andlater identifythan whichthirty datadays elementsafter aresubmission. incomplete.

(c)If The Certificate of Need Unit shall keep confidential all nonpublic information and documents obtained pursuant to this section and shall not disclose the informationdata orsubmission documentsis toincomplete, any person without the consentprogram ofshall thenotify person that produced the informationapplicant or documents, except in a preliminary report or final report issued in accordance with this section if the unit believes that suchit disclosureis shouldincomplete beand madeidentify inwhich thedata publicelements interestare afterincomplete. taking into account any privacy, trade secret or anti-competitive considerations.

Such(c) The program shall keep confidential all nonpublic information and documents obtained pursuant to this section and shall notbedeemedapublicrecordundersection1-210ofthegeneralstatutesnot LCOdisclose 16the information or documents to any person without the consent of 47the Substituteperson Billthat No.produced the information or documents, except in a preliminary report or final report issued in accordance with this section if the program believes that such disclosure should be made in the public interest after taking into account any privacy, trade secret or anti- competitive considerations.

5045Such information and documents shall benot exemptsHB5045 from/ disclosure.File No.

755 sHB5045 File No.

755 be deemed a public record under section 1-210 of the general statutes and shall be exempt from disclosure.

(11) consumer concerns, including, but not limited to, complaints or other allegationssHB5045 that/ aFile transacting party has engaged in any unfair method of LCO 17 of 47 Substitute Bill No.

5045755 competitionorsHB5045 anyFile unfairNo. or deceptive act or practice;

and(12)any755 otherallegations factors that thea unittransacting determinesparty tohas beengaged in theany publicunfair interest.method of competitionor any unfair or deceptive act or practice;

(e)and(12)any Theother Certificatefactors ofthat Need Unit shall submit the preliminaryprogram reportdetermines to thebe applicantin and to the Attorneypublic Generalinterest. not later than ninety days after the data submissions are deemed complete.

(e) The program shall submit the preliminary report to the applicant and to the Attorney General not later than ninety days after the data submissions are deemed complete.

Once the applicant has submitted such written comments or waived the opportunity to make such a submission, the unitprogram shall make the preliminary report and the applicant's comments public.

The unitprogram shall issue a final report not later than one hundred twenty days after the applicationwasdeemedcompleteapplication andmakewas suchfinalreportdeemed partofthecomplete and make such final report part of the public certificate of need record of such application.

(f) Nothing in this section shall prohibit a transfer of ownership of a hospital, provided any such proposed transfer shall not be completed (1) less than thirty days after the unitprogram has issued a final report on a cost and market impact review, if such review is required, or (2) while any action brought by the Attorney General pursuant to subsection (g) of this section is pending and before a final judgment on such action is issued by a court of competent jurisdiction.

(g)After(g) theCertificateAfter ofNeedUnitthe issuesaprogram finalreportonaissues a final report on a transfer of ownership of a hospital under subsection (e) of this section, the Attorney General may:

(1) Conduct an investigation to determine whether the transacting parties engaged or, as a result of completing the transfer of ownership ofofthehospital,are theexpectedto hospital, are expected to engage ininunfair unfairmethodsofcompetition, methods of competition, anti-competitive behavior or other conduct in violation of chapter 624 or 735a of the general statutes or any other state or federal law;

The unit'sprogram's final report may be evidence in any such action.

(h) For the purposes of this section, the provisions of chapter 735a of LCOsHB5045 18/ ofFile 47 Substitute Bill No.

5045755 thesHB5045 generalFile statutesNo. may be directly enforced by the Attorney General.

Nothing755 inthe thisgeneral sectionstatutes shallmay be construeddirectly toenforced modify,by impair or supersede the operation of any state antitrust law or otherwise limit the authority of the Attorney GeneralGeneral. to (1) take any action against a transacting party as authorized by any law, or (2) protect consumers in the health care market under any law.

Nothing in this section shall be construed to modify, impair or supersede the operation of any state antitrust law or otherwise limit the authority of the Attorney General to (1) take any action against a transacting party as authorized by any law;

or (2) protect consumers in the health care market under any law.

(i)(i)The Theprogramshallretainanindependent Certificate of Need Unit shall retain an independent consultant withwithexpertise expertise on the economic analysis of the health care market and health care costs and prices to conduct each cost and market impact review, as described in this section.

The unitprogram shall submit bills for such services to the purchaser, as defined in subsection (d) of section 19a-639 of the general statutes, as amended by this act.

Such bills shall not exceed two hundred fifty thousand dollars per application.Theapplication. provisionsofchapter 57ofthegeneralstatutes,sections 4-212 to 4-219, inclusive, of the general statutes and section 4e-19 of the general statutes shall not apply to any agreement executed pursuant to this subsection.

The provisions of chapter 57 of the general statutes, sections 4-212 to 4-219, inclusive, of the general statutes and section 4e-19 of the general statutes shall not apply to any agreement executed pursuant to this subsection.

(NEW) (Effective October 1, 2026) (a) On and after JanuaryJuly 1, 2027, the executive director of the Certificate of Need UnitProgram shall investigate all inquiries concerning compliance with the provisions of sections 2 to 12, inclusive, of this act.

If any person disobeys such process or, having appeared in obedience thereto, LCOrefusestoanswerany 19pertinentquestionput oftosuchpersonbythepanel 47sHB5045 Substitute/ BillFile No.

5045755 refusestoansweranysHB5045 pertinentquestionputFile tosuchpersonbythepanelNo. or such panel's authorized agent or to produce any records and papers pursuant thereto, the panel or such panel's authorized agent may apply tothesuperiorcourtforthejudicialdistrictofHartfordorforthejudicial district wherein the person resides or the business that is the subject of the inquiry has been conducted, or to any judge of said court if the same is not in session, setting forth such disobedience to process or refusal to answer, and said court or such judge shall cite such person to appear before said court or such judge to answer such question or to produce such records and papers.

(c)755 Any person or healthsuch carepanel's facilityauthorized agent or institution that is required to acquireproduce a certificate of need for any ofrecords the activities described in subsection (a) of section 4 of this act and negligentlypapers undertakespursuant anythereto, of the activitiespanel describedor insuch saidpanel's sectionauthorized withoutagent suchmay certificateapply oftothesuperiorcourtforthejudicialdistrictofHartfordorforthejudicial need,district andwherein anythe person orresides health care facility or institutionthe business that is the subject to any terms or conditions enumerated in a certificate of needthe decisioninquiry orhas agreedsettlementapprovedbythepanelandnegligentlyfailstocomplybeen withconducted, any such enumerated term or condition, shall be subject to aany civiljudge penalty of upsaid tocourt fiveif thousandthe dollarssame ais daynot forin eachsession, daysetting forth such persondisobedience orto healthprocess care facility or institutionrefusal conductsto anyanswer, ofand thesaid describedcourt activitiesor withoutsuch certificatejudge ofshall needcite approvalsuch asperson requiredto byappear sectionbefore 4said ofcourt this act, or forsuch eachjudge dayto anyanswer enumeratedsuch termquestion or conditionto isproduce notsuch met.records and papers.

(c) Any civilperson penaltyor proceedinghealth authorizedcare byfacility thisor sectioninstitution shallthat beis initiatedrequired byto acquire a certificate of need for any of the Certificateactivities described in subsection (a) of Needsection Unit,4 whichof shallthis alsoact presentand allegationsnegligently undertakes any of the activities described in said section without such negligencecertificate atof aneed, hearingany beforeperson, theor panelhealth care facility or institution that is subject to any terms or conditions enumerated in accordancea certificate of need decision or agreedsettlementapprovedbythepanelandnegligentlyfailstocomply with subsectionsany (b)such enumerated term or condition, and any person or entity that isrequired to (f),submit inclusive,anotice to theprogrampursuant to subsection (d) of section 4 of this section.act or section 12 of this act and negligently fails to submit such notice shall be subject to a civil penalty of up to one thousand dollars a day for each day such person, entity or institution conducts any of the described activities without certificate of need approval as required by section 4 of this act, or for each day any enumerated term or condition is not met or for each day that the notice was not timely submitted.

(d)Any If the Certificate of Need Unit has reason to believe that a person or health care facility or institution has committed a violation for which a civil penalty isproceeding authorized pursuantby to subsection (a) of this section orshall subsectionbe (e)initiated ofby sectionthe 19a-632program, ofwhich theshall generalalso statutes,present theallegations unitof shallsuch notifynegligence suchat persona orhearing healthbefore carethe facilitypanel orin institutionaccordance bywith firstsubsections class(b) mailto or(f), personalinclusive, service.of this section.

(d) If the program has reason to believe that a person or health care facility or institution has committed a violation for which a civil penalty is authorized pursuant to subsection (c) of this section or subsection (e) of section 19a-632 of the general statutes, the program shall notify such person or health care facility or institution by first class mail or personal service.

(1) A reference to the sections of the statute,sHB5045 regulation/ orFile settlementNo. agreement involved;

755 sHB5045 File No.

755 statute, regulation or settlement agreement involved;

(3) a LCOstatement 20of the amount ofthecivilpenalty or penaltiesto beimposed;(4)the initial date of 47the Substituteimposition Billof No.the penalty;

5045 statement of the amount of the civil penalty or penalties to be imposed;

(4) the initial date of the imposition of the penalty;

(e) The person or health care facility or institution to whom the notice is addressed shall have fifteen business days after the date of mailing of the notice to make written application to the Certificateprogram of Need Unit to (1) request a hearing to contest the imposition of the penalty, (2) request an extension of time to file the required data, or (3) comply with enumerated conditions of an agreed settlement.

A failure to make a timely request for a hearing or an extension of time to file the required data or a denial of a request for an extension oftimeof time shall result in a final order for the imposition of the penalty.

(h)sHB5045 In/ additionFile to any civil penalty imposed under this section, if the executive director of the Certificate of Need Unit or the executive LCO 21 of 47 Substitute Bill No.

5045755 director'ssHB5045 authorizedFile agentNo. has received information and has a reasonable belief that any person or health care facility or institution has violated or is violating any provision ofsections 2 to 12, inclusive, ofthis act, or any policy and procedure or order of the panel, the executive director or such agent shall notify such person or health care facility or institution by first class mail or personal service.

755 (h) In addition to any civil penalty imposed under this section, if the director of the program or the director's authorized agent has received information and has a reasonable belief that any person or health care facility or institution has violated or is violating any provision of sections 2 to 12, inclusive, of this act, or any policy and procedure or order of the panel, the director or such agent shall notify such person or health care facility or institution by first class mail or personal service.

(i) The person or health care facility or institution to whom such notice is provided pursuant to subsection (h) of this section may, not later than ten business days after receipt of the notice, make written applicationapplicationtotheprogramtorequest toahearing the Certificate of Need Unit to requestdemonstratethat a hearing to demonstrate that such violation has not occurred, a certificate of need was not required or each required certificate of need was obtained.

A failure to make a timely request for a hearing shall result in the panel issuingaceaseanddesistorder.Eachhearingheldunderthissubsectionissuing shall be conducted as a contestedcease caseand pursuantdesist toorder. chapter 54 of the general statutes.

(j)Each If the panel finds, by a preponderance of the evidence, following a hearing held under subsection (i) of this sectionsubsection that such person or health care facility or institution has violated or is violating any provision of sections 2 to 12, inclusive, of this act, or any regulation or order of the department, the panel shall issue a cease and desist order to such person or health care facility or institution that shall be consideredconducted as a finalcontested decisioncase subjectpursuant to appealchapter to54 the Superior Court in accordance LCO 22 of 47the Substitutegeneral Billstatutes. No.

5045(j) withIf the panel finds, by a preponderance of the evidence, following a hearing held under subsection (i) of this section 4-183that such person or health care facility or institution has violated or is violating any provision of sections 2 to 12, inclusive, of this act, or any regulation or order of the generaldepartment, statutes.the panel shall issue a cease and desist order to such person or health care facility or institution that shall be considered a final decision subject to appeal to the Superior Court in accordance sHB5045 / File No.

755 sHB5045 File No.

755 with section 4-183 of the general statutes.

(NEW) (Effective October 1, 2026) The executivecommissioner directorshall ofadopt theregulations, Certificatein ofaccordance Needwith Unitthe mayprovisions implementof policieschapter and54 proceduresofthe necessarygeneral statutes, to administerimplement the provisions of sectionsections 2 to 12, inclusive, of this act,act. provided (1) the executive director holds a public hearing prior to review by the panel, and (2) such policies and procedures are unanimously approved by the panel.

PoliciesThe commissioner may implement policies and proceduresproceduresnecessary approvedto byadminister theprovisionsofsaidsectionswhile in the panel,process orof anyadopting amendmentsuch thereto,policies shalland notprocedures takeas effectregulation, untilprovided, atprior leastto thirtyimplementing dayssuch afterpolicies and procedures, the paneldepartment votesshall convene a working group with relevant stakeholders to approveprovide input on the development of such policies and procedures.

SuchThe policiescommissioner and procedures shall notconvene be required to be adopted as a regulation in accordance with the provisionsworking ofgroup chapternot 54later ofthan theJanuary general1, statutes.2027.

Policies and procedures implemented pursuant to this section shall be valid until the earlier of two years from the date of their implementation or the time final regulations are adopted.

(NEW) (Effective October 1, 2026) (a) On and after JanuaryJuly 1, 2027, a hospital may temporarily pause a service for up to ninety days, provided, if a hospital intends to indefinitely terminate a service line or pause a service line for more than ninety days, the hospital shall notify the Certificate of Need Unit,Program, in writing, not less than ninety days prior to commencing such pause or termination.

For purposes of this section, "service""service includesline" allmeans a category of inpatient and outpatient services but does not include services provided by an emergency department.

(b) NotExcept as provided in subsection (d) of this section, not less than ninety days prior to commencing any termination of service by a hospitaloranypauseofaserviceintendedtolastmorethanninetydays, thesHB5045 hospital/ shallFile provideNo. notice, either electronically or in writing, to the Certificate of Need Unit that includes the following information:

755 sHB5045 File No.

755 the hospital shall provide notice, either electronically or in writing, to the program that includes the following information:

LCO(2) 23Current ofand 47historical Substituteutilization Billrates No.for such service;

5045 (2) Current and historical utilization rates for such service;

and (6) Any other information the executive director may require.

(d) TheWhen executivethe directorprovision mayof orderninety days' notice of the cessation of a publicservice hearingline concerningis thenot proposedpracticable pausedue orto terminationcircumstances outside of service,the hospital's control, such as the impactdeath onof the hospital'sprovider primaryof such service areaor anddue theto proposednatural plansdisaster, forthe ensuringhospital continuedshall accessprovide notice to high-quality,the affordableprogram healthas caresoon as practicable but in suchno servicecase area.later than fourteen days after the initiation of the unanticipated cessation.

(e) NotThe laterprogram thanshall sixtyhold daysa priorpublic tohearing concerning the proposed pause or termination of a service, the hospitalimpact shallon submitthe ahospital's planprimary service area and the proposed plans for ensuring continued access to suchhigh-quality, servicefollowingthehospital'spauseorterminationofsuchservice.Theaffordable planhealth shallcare include:in such service area.

The hearing record and any submitted public comments shall inform the panel's sHB5045 / File No.

755 sHB5045 File No.

755 review of the proposed plan and any imposed conditions pursuant to subsection (f) of this section.

(f) Not later than sixty days prior to commencing the pause or termination of a service, the hospital shall submit a plan for ensuring access to such service following the hospital's pause or termination of such service.

If the cessation of the service is due to an unplanned event outside the control of the hospital, as described in subsection (d) of this section, the hospital shall submit the plan for ensuring access to the service within fourteen days of the hospital's cessation of the service line.

The plan shall include:

LCO(4) 24An assessment of 47transportation Substituteneeds Billafter No.the pause or termination and a plan for meeting such needs;

5045 (4) An assessment of transportation needs after the pause or termination and a plan for meeting such needs;

(f)(g) The Certificateprogram of Need Unit shall review the plan submitted by the hospital pursuant to subsection (e)(f) of this section to determine if the plan ensures continuedsHB5045 access/ toFile theNo. service to be paused or terminated.

The755 unitsHB5045 shallFile completeNo. its review of the plan and submit to the hospital and panel written recommendations regarding the approval, modification, imposition of conditions upon or rejection of the plan not later than ten days after receiving the plan from the hospital.

755 continued access to theservice to bepausedor terminated.The program shall complete its review of the plan and submit to the hospital and panel written recommendations regarding the approval, modification or imposition of conditions upon the plan not later than ten days after receiving the plan from the hospital.

The hospital may submit a response to such recommendations at or prior to such meeting.

Not later than ten days after such meeting, the panel shall approve the plan, require modifications to the plan,plan or add conditions to the plan or reject the plan.

(g)(h) The Certificatepanel's ofdecision Needapproving Unitor shallmodifying monitor implementation of the hospital's plan forshall preservingconstitute access to a healthfinal caredecision servicesubject followingto aappeal pauseunder ofsection termination4-183 of suchthe servicegeneral understatutes. this section.

If(i) theThe hospitalprogram failsshall tomonitor implementimplementation any aspect of the hospital's plan asfor approvedpreserving byaccess the panel pursuant to subsectiona (f)health ofcare thisservice section,following thea unitpause mayof imposetermination aof performancesuch improvementservice planunder onthis thesection. hospital.

FailureIf tothe complyhospital withfails theto performanceimplement improvementany planaspect andof continuedthe failureplan toas performapproved underby the planpanel maypursuant resultto insubsection the(g) imposition of civilthis penaltiessection, pursuantthe LCOprogram 25may ofimpose 47a Substituteperformance Billimprovement No.plan on the hospital.

5045Failure to comply with the performance improvement planand continuedfailure to performunder the plan may result in the imposition of civil penalties pursuant to section 10 of this act.

(a) The Commissioner of Health Strategy shall oversee the Health Systems Planning Unit and shall exercise independent decision-making authority over all certificate of need decisions for applications for a certificate of need filed on or before DecemberJune 31,30, 2026.2027.

(a)sHB5045 [A]/ OnFile andNo. before December 31, 2026, a certificate of need issued by the unit shall be required for:

755 sHB5045 File No.

755 (a) [A] On and before June 30, 2027, a certificate of need issued by the unit shall be required for:

(6) The establishment of an outpatient surgical facility, as defined in section 19a-493b, or as established by a short-term acute care general LCOhospital; 26 of 47 Substitute Bill No.

5045 hospital;

(9) The establishment of cardiac services, including inpatient and outpatient cardiac catheterization, interventional cardiology and cardiovascularsHB5045 surgery;/ File No.

755 sHB5045 File No.

755 cardiovascular surgery;

(12) An increase in the licensed bed capacity of a health care facility, LCOexcept 27as provided in subdivision (23) of 47subsection Substitute(b) Billof No.this section;

5045 except as provided in subdivision (23) of subsection (b) of this section;

(b)sHB5045 [A]/ OnFile andNo. before December 31, 2026, a certificate of need issued by the unit shall not be required for:

755 sHB5045 File No.

755 (b) [A] On and before June 30, 2027, a certificate of need issued by the unit shall not be required for:

LCO(8) 28Outpatient ofrehabilitation 47facilities; Substitute Bill No.

5045 (8) Outpatient rehabilitation facilities;

(13) A program licensed or funded by the Department of Children andsHB5045 Families,/ providedFile suchNo. program is not a psychiatric residential treatment facility;

755 sHB5045 File No.

755 and Families, provided such program is not a psychiatric residential treatment facility;

(17) A residential facility for persons with intellectual disability licensed pursuant to section 17a-227 and certified to participate in the LCOTitle 29XIX ofMedicaid 47program Substituteas Billan No.intermediate care facility for individuals with intellectual disabilities;

5045 Title XIX Medicaid program as an intermediate care facility for individuals with intellectual disabilities;

(19)sHB5045 Acquisition/ ofFile cone-beamNo. dental imaging equipment that is to be used exclusively by a dentist licensed pursuant to chapter 379;

755 sHB5045 File No.

755 (19) Acquisition of cone-beam dental imaging equipment that is to be used exclusively by a dentist licensed pursuant to chapter 379;

(23) On or before [June 30, 2026] DecemberJune 31,30, 2026,2027, an increase in the licensed bedcapacityofamentalhealthfacility,provided(A)themental healthfacilitydemonstratestotheunit,inaformandmannerprescribed by the unit, that it accepts reimbursement for any covered benefit provided to a covered individual under:

(ii) a self- insured employee welfare benefit plan established pursuant to the LCOfederal 30Employee Retirement Income Security Act of 471974, Substituteas Billamended No.from time to time;

5045 federal Employee Retirement Income Security Act of 1974, as amended from time to time;

or (25) On or before [June 30, 2028] DecemberJune 31,30, 2026,2027, a birth center, as defined in section 19a-490, that is enrolled as a provider in the Connecticut medical assistance program, as defined in section 17b-245g.

(c)(1)AnysHB5045 person/ [,]orhealthcareFile facilityorinstitutionthatisunsureNo. whether a certificate of need is required under this section, or (2) any health care facility that proposes to relocate pursuant to section 19a- 639c, as amended by this act, shall send a letter to the unit that describes the project and requests that the unit make a determination as to whether a certificate of need is required.

755 sHB5045 File No.

755 (c)(1)Any person [,]orhealthcare facilityorinstitutionthatisunsure whether a certificate of need is required under this section, or (2) any health care facility that proposes to relocate pursuant to section 19a- 639c, as amended by this act, shall send a letter to the unit that describes the project and requests that the unit make a determination as to whether a certificate of need is required.

Policies and procedures implemented pursuant to this section shall be LCOvalid 31until ofthe 47time Substitutefinal Billregulations No.are adopted.

5045(e) validOn untilor before [June 30, 2026] June 30, 2027, a mental health facility seeking to increase licensed bed capacity without applying for a certificate of need, as permitted pursuant to subdivision (23) of subsection (b) of this section, shall notify the timeOffice finalof regulationsHealth Strategy, in a form and manner prescribed by the commissioner, regarding (1) such facility's intent to increase licensed bed capacity, (2) the address of such facility, and (3) a description of all services that are adopted.being or will be provided at such facility.

(e) On or before [June 30, 2026] December 31, 2026, a mental health facility seeking to increase licensed bed capacity without applying for a certificate of need, as permitted pursuant to subdivision (23) of subsection (b) of this section, shall notify the Office of Health Strategy, in a form and manner prescribed by the commissioner, regarding (1) such facility's intent to increase licensed bed capacity, (2) the address of such facility, and (3) a description of all services that are being or will be provided at such facility.

(a)sHB5045 In/ anyFile deliberationsNo. involving a certificate of need application filed on or before December 31, 2026, pursuant to section 19a-638, as amended by this act, the unit shall take into consideration and make written findings concerning each of the following guidelines and principles:

755 sHB5045 File No.

755 (a) In any deliberations involving a certificate of need application filed on or before June 30, 2027, pursuant to section 19a-638, as amended by this act, the unit shall take into consideration and make written findings concerning each of the following guidelines and principles:

(5) Whether the applicant has satisfactorily demonstrated how the proposal will improve quality, accessibility and cost effectiveness of health care delivery in the region, including, but not limited to, LCOprovision 32 of 47or Substituteany Billchange No.in the access to services for Medicaid recipients and indigent persons;

5045 provision of or any change in the access to services for Medicaid recipients and indigent persons;

(9) Whether the applicant has satisfactorily demonstrated that the proposedsHB5045 project/ shallFile notNo. result in an unnecessary duplication of existing or approved health care services or facilities;

755 sHB5045 File No.

755 proposed project shall not result in an unnecessary duplication of existing or approved health care services or facilities;

(b) [In] On or before DecemberJune 31,30, 2026,2027, in deliberations as described in subsection (a) of this section, there shall be a presumption in favor of approving the certificate of need application for a transfer of ownership of a large group practice, as described in subdivision (3) of subsection (a) of section 19a-638, as amended by this act, when an offer was made LCOin 33response ofto 47a Substituterequest Billfor No.proposal or similar voluntary offer for sale.

5045 in response to a request for proposal or similar voluntary offer for sale.

(C) "New hospital" means a hospital as it exists after the approval of ansHB5045 agreement/ pursuantFile toNo. section 19a-486b or a certificate of need application for a transfer of ownership of a hospital;

755 sHB5045 File No.

755 an agreement pursuant to section 19a-486b or a certificate of need application for a transfer of ownership of a hospital;

(2) In any deliberations involving a certificate of need application LCOfiled 34on or before June 30, 2027, pursuant to section 19a-638, as amended by this act, that involves the transfer of 47ownership Substituteof Billa No.hospital, the unit shall, in addition to the guidelines and principles set forth in subsection (a) of this section and those prescribed through regulation pursuant to subsection (c) of this section, take into consideration and make written findings concerning each of the following guidelines and principles:

5045 filed on or before December 31, 2026, pursuant to section 19a-638, as amended by this act, that involves the transfer of ownership of a hospital, the unit shall, in addition to the guidelines and principles set forth in subsection (a) of this section and those prescribed through regulation pursuant to subsection (c) of this section, take into consideration and make written findings concerning each of the following guidelines and principles:

and (B) Whether the plan submitted pursuant to section 19a-639a, as amended by this act, demonstrates, in a manner consistent with this chapter, how health care services will be provided by the new hospital forsHB5045 the/ firstFile threeNo. years following the transfer of ownership of the hospital, including any consolidation, reduction, elimination or expansion of existing services or introduction of new services.

755 sHB5045 File No.

755 for the first three years following the transfer of ownership of the hospital, including any consolidation, reduction, elimination or expansion of existing services or introduction of new services.

LCO(5) 35The unit may place any conditions on the approval of 47a Substitutecertificate Billof No.need application involving a transfer of ownership of a hospital consistent with the provisions of this chapter.

5045 (5) The unit may place any conditions on the approval of a certificate of need application involving a transfer of ownership of a hospital consistent with the provisions of this chapter.

(6) In any deliberations involving a certificate of need application filedsHB5045 pursuant/ toFile sectionNo. 19a-638, as amended by this act, that involves thetransferofownershipofahospitalandissubjecttoacostandmarket impact review, the unit may consider (A) the preliminary report and response to the preliminary report, (B) the final report, and (C) any written comments from the parties regarding the reports issued or submitted as part of the review.

755 sHB5045 File No.

755 filed pursuant to section 19a-638, as amended by this act, that involves thetransferofownershipofahospitalandissubjecttoacostandmarket impact review, the unit may consider (A) the preliminary report and response to the preliminary report, (B) the final report, and (C) any written comments from the parties regarding the reports issued or submitted as part of the review.

(e)(1)IfthecertificateofneedapplicationfiledonorbeforeDecember(e) 31,(1) 2026,If the certificate of need application filed on or before June 30, 2027, (A) involves the transfer of ownership of a hospital, (B) the purchaser is a hospital, as defined in section 19a-490, whether located within or outside the state, that had net patient revenue for fiscal year 2013 in an amount greater than one billion five hundred million dollars or a hospital system, as defined in section 19a-486i, whether located within or outside the state, that had net patient revenue for fiscal year 2013 in an amount greater than one billion five hundred million dollars, or any person that is organized or operated for profit, and (C) such application is approved, the unit shall hire an independent consultant toserveasapost-transfercompliancereporterforaperiodofthreeyears LCOafter 36completion of 47the Substitutetransfer Billof No.ownership of the hospital.

5045 after completion of the transfer of ownership of the hospital.

(2)sHB5045 If/ theFile reporterNo. finds that the purchaser has breached a condition of the approval of the certificate of need application, the unit may, in consultation with the purchaser, the reporter and any other interested parties it deems appropriate, implement a performance improvement plan designed to remedy the conditions identified by the reporter and continue the reporting period for up to one year following a determination by the unit that such conditions have been resolved.

755 sHB5045 File No.

755 (2) If the reporter finds that the purchaser has breached a condition of the approval of the certificate of need application, the unit may, in consultation with the purchaser, the reporter and any other interested parties it deems appropriate, implement a performance improvement plan designed to remedy the conditions identified by the reporter and continue the reporting period for up to one year following a determination by the unit that such conditions have been resolved.

(a) [An] On or before DecemberJune 31,30, 2026,2027, an application for a certificate of needneedshallbefiledwith shall be filed with the unit ininaccordance accordancewiththeprovisionsofthis with the provisions of this section and any regulations adopted by the Office of Health Strategy.

The LCOapplicant 37shall ofinclude 47with Substitutethe Billapplication No.a nonrefundable application fee based on the cost of the project.

5045 applicant shallinclude withtheapplicationanonrefundableapplication fee based on the cost of the project.

(C) three thousand dollars for a project that willcostwill cost greater thanonehundredthousanddollarsbutthan notgreaterthanone hundred thousand dollars but not greater than five hundred thousand dollars;

(D) four thousand dollars for a project that willwillcostgreaterthanfivehundredthousanddollarsbutnotgreaterthan cost greater than five hundred thousand dollars but not greater than one million dollars;

(E) five thousand dollars for a project that will cost greater than one million dollars but not greater than five million dollars;(F)eight thousanddollarsfor aproject that willcost greater than five million dollars but not greater than ten million dollars;

(F) eight thousand dollars for a project that will cost greater than five million dollars but not greater than ten million dollars;

(b)sHB5045 Prior/ toFile theNo. filing of a certificate of need application pursuant to subsection (a) of this section, the applicant shall (1) publish notice that an application is to be submitted to the unit (A) in a newspaper having a substantial circulation in the area where the project is to be located, and (B) on the applicant's Internet web site in a clear and conspicuous location that is easily accessible by members of the public, (2) request the publication of notice (A) in at least two sites within the affected community that are commonly accessed by the public, such as a town hall or library, and (B) on any existing Internet web site of the municipality or local health department, and (3) submit such notice to the unit for posting on such unit's Internet web site.

755 sHB5045 File No.

755 (b) Prior to the filing of a certificate of need application pursuant to subsection (a) of this section, the applicant shall (1) publish notice that an application is to be submitted to the unit (A) in a newspaper having a substantial circulation in the area where the project is to be located, and (B) on the applicant's Internet web site in a clear and conspicuous location that is easily accessible by members of the public, (2) request the publication of notice (A) in at least two sites within the affected community that are commonly accessed by the public, such as a town hall or library, and (B) on any existing Internet web site of the municipality or local health department, and (3) submit such notice to the unit for posting on such unit's Internet web site.

The unit shall not invalidate any notice due to changes or removal of the notice from a community LCOInternet 38web site of 47which Substitutethe Billapplicant No.has no control.

5045 Internet web site of which the applicant has no control.

In addition to any information requested by the unit, if the application involves the transfer of ownership of a hospital, as defined insHB5045 section/ 19a-639,File asNo. amended by this act, the applicant shall submit to the unit (A) a plan demonstrating how health care services will be provided by the new hospital for the first three years following the transfer of ownership of the hospital, including any consolidation, reduction, elimination or expansion of existing services or introduction of new services, and (B) the names of persons currently holding a position with the hospital to be purchased or the purchaser, as defined in section 19a-639, as amended by this act, as an officer, director, board member or senior manager, whether or not such person is expected to hold a position with the hospital after completion of the transfer of ownership of the hospital and any salary, severance, stock offering or any financial gain, current or deferred, such person is expected to receive as a result of, or in relation to, the transfer of ownership of the hospital.

755 sHB5045 File No.

755 in section 19a-639, as amended by this act, the applicant shall submit to the unit (A) a plan demonstrating how health care services will be provided by the new hospital for the first three years following the transfer of ownership of the hospital, including any consolidation, reduction, elimination or expansion of existing services or introduction of new services, and (B) the names of persons currently holding a position with the hospital to be purchased or the purchaser, as defined in section 19a-639, as amended by this act, as an officer, director, board member or senior manager, whether or not such person is expected to hold a position with the hospital after completion of the transfer of ownership of the hospital and any salary, severance, stock offering or any financial gain, current or deferred, such person is expected to receive as a result of, or in relation to, the transfer of ownership of the hospital.

LCO(3) 39The ofunit 47shall Substitutemake Billreasonable No.efforts to limit the requests for additional information to two such requests and, in all cases, cease all requests for additional information not later than six months after receiving the application.

5045 (3) The unit shall make reasonable efforts to limit the requests for additional information to two such requests and, in all cases, cease all requests for additional information not later than six months after receiving the application.

and (2) the unit shall issue a decision on ansHB5045 application/ deemedFile completeNo. prior to the expiration of the ninety- day review period in matters without a public hearing.

755 sHB5045 File No.

755 an application deemed complete prior to the expiration of the ninety- day review period in matters without a public hearing.

(e) Except as provided in this subsection, the unit shall hold a public hearing on a [properly filed and completed] certificate of need application properly filed and completed under this section if three or more individuals or an individual representing an entity with five or more people submits a request, in writing, that a public hearing be held LCOon 40the ofapplication. 47 Substitute Bill No.

5045 on the application.

(f) (1) The unit shall hold a public hearing with respect to each certificate of need application filed pursuant to section 19a-638, as amended by this act, after December 1, 2015, and on or before DecemberJune 31,30, 2026,sHB5045 that/ concernsFile anyNo. transfer of ownership involving a hospital.

755 sHB5045 File No.

755 2027, that concerns any transfer of ownership involving a hospital.

LCO(g) 41For applications submitted on or after October 1, 2023, and on or before June30, 2027,the unit mayretainanindependent consultant with expertise in the specific area of 47health Substitutecare Billthat No.is the subject of the application filed by an applicant if the review and analysis of an application cannot reasonably be conducted by the unit without the expertise of an industry analyst or other actuarial consultant.

5045 (g) For applications submitted on or after October 1, 2023, and on or before December 31, 2026, the unit may retain an independent consultant with expertise in the specific area of health care that is the subject of the application filed by an applicant if the review and analysis of an application cannot reasonably be conducted by the unit without the expertise of an industry analyst or other actuarial consultant.

[(h) The Commissioner of Health Strategy may implement policies and procedures necessary to administer the provisions of this section whilesHB5045 in/ theFile processNo. of adopting such policies and procedures as regulation, provided the commissioner holds a public hearing prior to implementing the policies and procedures and posts notice of intent to adopt regulations on the office's Internet web site and the eRegulations System not later than twenty days after the date of implementation.

755 sHB5045 File No.

755 while in the process of adopting such policies and procedures as regulation, provided the commissioner holds a public hearing prior to implementing the policies and procedures and posts notice of intent to adopt regulations on the office's Internet web site and the eRegulations System not later than twenty days after the date of implementation.

(b) [Upon] On or before DecemberJune 31,30, 2026,2027, upon request from a LCOcertificate 42holder, the unit may extend the duration of 47a Substitutecertificate Billof No.need for such additional period of time as the unit determines is reasonably necessary to expeditiously complete the project.

5045 certificate holder, the unit may extend the duration of a certificate of need for such additional period of time as the unit determines is reasonably necessary to expeditiously complete the project.

The unit shall hold a public hearing on any request to extend the duration of a certificate of need made under thisthissubsection subsectionifthree if three or more individualsindividualsor oranindividual an individual representing an entity with five or more people submits a request, in writing, that a public hearing be held on the request to extend the duration of a certificate of need.

(c)sHB5045 [In]/ OnFile orNo. before December 31, 2026, in the event that the unit determines that:

755 sHB5045 File No.

755 (c) [In] On or before June 30, 2027, in the event that the unit determines that:

(d) [A] On or before DecemberJune 31,30, 2026,2027, a certificate of need shall not be transferable or assignable nor shall a project be transferred from a certificate holder to another person.

LCOSec. 43 of 47 Substitute Bill No.

5045 Sec.

(a) [Any] On or before DecemberJune 31,30, 2026,2027, any health care facility that proposes to relocate a facility shall submit a letter to the unit, as described in subsection (c) of section 19a-638, as amended by this act.

If the facility is unable to demonstrate to the satisfaction of the unit that the population served and the payer mix will not substantially change as a result of the proposed relocation, the health care facility shall apply for certificate of need approval pursuant to subdivisionsHB5045 (1)/ ofFile subsectionNo. (a) of section 19a-638, as amended by this act, inorder to effectuate theproposedrelocation.The unit shallprovide a determination not later than thirty days after receipt of such letter.

755 sHB5045 File No.

755 subdivision (1) of subsection (a) of section 19a-638, as amended by this act, inorder to effectuate theproposedrelocation.The unit shallprovide a determination not later than thirty days after receipt of such letter.

(a) Unless otherwise required to file a certificate of need application pursuant to the provisions of subsection (a) of section 19a-638, as amended by this act, any health care facility that proposes on or before DecemberJune 31,30, 2026,2027, to terminate a service that was authorized pursuant to a certificate of need issued under [this chapter] section 19a-638a shall file a modification request with the unit not later than sixty days prior to the proposed date of the termination of the service.

The unit may request additional information from the health care facility as necessary to processprocessthemodificationrequest.Inaddition,the unitshallholdapublic hearing on any request from a health care facility to terminate a service pursuant to this section if three or more individuals or an individual representing an entity with five or more people submits a request, in writing, that a public hearing be held on the modificationhealth request.care facility's proposal to terminate a service.

In(b) addition,Unless theotherwise unitrequired shallto holdfile a publiccertificate hearingof onneed anyapplication requestpursuant fromto athe provisions of subsection (a) of section 19a-638, as amended by this act, any health care facility that proposes on or before June 30, 2027, to terminate aall serviceservices pursuantoffered toby thissuch sectionfacility, ifthat threewere authorized pursuant to one or more individualscertificates orof anneed individualissued representingunder an[this entitychapter] withsection five19a-639a, oras moreamended peopleby submitsthis aact, request,shall inprovide writing,notification thatto athe publicunit hearingnot belater heldthan onsixty days prior to the healthtermination careof LCOservices 44and such facility shall surrender its certificate of 47need Substitutenot Billlater No.than thirty days prior to the termination of services.

5045(c) facility'sUnless proposalotherwise required to terminatefile a service.certificate of need application pursuant to the provisions of subsection (a) of section 19a-638, as amended by this act, any health care facility that proposes on or before sHB5045 / File No.

(b)755 UnlesssHB5045 otherwiseFile requiredNo. to file a certificate of need application pursuant to the provisions of subsection (a) of section 19a-638, as amended by this act, any health care facility that proposes on or before December 31, 2026, to terminate all services offered by such facility, that were authorized pursuant to one or more certificates of need issued under [this chapter] section 19a-639a, as amended by this act, shall provide notification to the unit not later than sixty days prior to the termination of services and such facility shall surrender its certificate of need not later than thirty days prior to the termination of services.

(c)755 UnlessJune otherwise30, required2027, to fileterminate a certificate of need application pursuant to the provisionsoperation of subsectiona (a) of section 19a-638, as amended by this act, any health care facility that proposes on or beforeservice Decemberfor 31,which 2026,a tocertificate terminateof theneed operationwas ofnot aobtained facilityshall ornotify servicethe forunit whichanot certificateofneedwasnotobtainedshallnotifythelater unitnotlater than sixty days prior to terminating the operation of the facility or service.

(a) The Health Systems Planning Unit of the Office of Health Strategy shall conduct a cost and market impact review in each case where (1) an application for a certificate of need filed on or before DecemberJune 31,30, 2026,2027, pursuant to section 19a-638, as amended by this act, involves the transfer of ownership of a hospital, as defined in section 19a-639, as amended by this act, and (2) the purchaser in a transaction occurring on or before DecemberJune 31,30, 2026,2027, is a hospital, as defined in section 19a-490, whether located within or outside the state, that had net patient revenue for fiscal year 2013 in an amount greater than one billion five hundred million dollars, or a hospital system, as defined in section 19a-486i, whether located within or outside the state, that had net patient revenue for fiscal year 2013 in an amount greater than one billion five hundred LCOmillion 45dollars ofor 47any Substituteperson Billthat No.is organized or operated for profit.

5045(b) millionNot dollarslater than twenty-one days after receipt of a properly filed certificate of need application involving the transfer of ownership of a hospital filed on or anyafter personDecember that1, is2015, organizedand on or operatedbefore June 30, 2027, as described in subsection (a) of this section, the unit shall initiate such cost and market impact review by sending the transacting parties a written notice that shall contain a description of the basis for profit.the cost and market impact review as well as a request for information and documents.

(b) Not later than twenty-one days after receipt of a properly filed certificate of need application involving the transfer of ownership of a hospital filed on or after December 1, 2015, and on or before December 31, 2026, as described in subsection (a) of this section, the unit shall initiate such cost and market impact review by sending the transacting parties a written notice that shall contain a description of the basis for the cost and market impact review as well as a request for information and documents.

Section 19a-641 of the general statutes is repealed and the followingsHB5045 is/ substitutedFile inNo. lieu thereof (Effective October 1, 2026):

Any755 healthsHB5045 careFile facilityNo. or institutionandany state health care facility or institution aggrieved by any final decision of said unit issued on an application filed on or before December 31, 2026, under the provisions of sections 19a-630 to 19a-639e, inclusive, as amended by this act, may appeal from such decision in accordance with the provisions of section 4-183, except venue shall be in the judicial district in which it is located.

755 following is substituted in lieu thereof (Effective October 1, 2026):

Any health care facility or institutionandany state health care facility or institution aggrieved by any final decision of said unit issued on an application filed on or before June 30, 2027, under the provisions of sections 19a-630 to 19a-639e, inclusive, as amended by this act, may appeal from such decision in accordance with the provisions of section 4-183, except venue shall be in the judicial district in which it is located.

3 October 1, 2026 New section LCOSec. 46 of 47 Substitute Bill No.

5045 Sec.

7 October 1, 2026 New section October 1, 2026 Sec.

8 October 1, 2026 New section Sec.

14 October 1, 2026 19a-638(a) to (e) October 1, 2026 Sec.

15 October 1, 2026 19a-639(a) to (e) Sec.

21 October 1, 2026 19a-641 PHsHB5045 Joint/ FavorableFile Subst.No.

-LCO755 FINsHB5045 JointFile FavorableNo. LCO 47 of 47

755 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 2,029,146 None from 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 See Below See Below Cost 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, that will make final decisions on CON- related determinations.

1The 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.

sHB5045 / File No.

755 sHB5045 File No.

755 Section 5 results in a potential savings to the UConn Health Center, beginning inFY 27, by capping consultant costs incurredduring 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 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 to above $1 billion in FY 25, that 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.

These 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.

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).

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).

sHB5045 / File No.

755 58 sHB5045 File No.

755 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 sHB5045 / File No.

755 59 sHB5045 File No.

755 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, thebillextendsfromJune30,2026,to June30,2027,anexisting 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, rather 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.