Number of employees – 27

Recurring operating expenses – $2,257,361

Organization structure - Office of the Commissioner, Certificate of Need, Financial Analysis and Forecasting & Compliance Unit, Research & Planning Unit.

Mission

The mission of the Office of Health Care Access (OHCA) is to ensure that the citizens of Connecticut have access to a quality health care delivery system. The agency fulfills its mission by advising policy makers of health care issues, informing the public and the industry of statewide and national trends, and designing and directing health care system development.

Statutory Authority

OHCA oversees the state’s health care delivery system to ensure that access to affordable, quality care is available to the citizens of the state. The agency’s major functions are administration of the certificate of need (CON) program; health care data collection, analysis and reporting; and hospital financial review and reporting.

The agency is responsible for managing the CON program in order to promote appropriate health facility and service development and access to health care. The CON process ensures that a proposed project meets public need while preventing excessive, unnecessary, or duplicative development of facilities or services and that no reduction or termination of service will have an adverse effect on health care access. The process also allows for public opportunity to comment during health facility/service project development.

State statutes also empower OHCA with the ability to initiate a formal investigation or inquiry, if necessary, with the authority by law to subpoena witnesses and require the production of pertinent records, papers and documents.

In addition, the Office of Health Care Access has statutory authority to gather and analyze significant amounts of hospital financial data and hospital billing and discharge data. Information collected, verified, analyzed and reported on includes hospital expenses and revenues, uncompensated care volumes, and other financial data as well as hospital utilization, demographic, clinical, charge, payer and provider statistics.

Public Service

The Office of Health Care Access’ CON program, data collection, research, analysis and planning activities and related initiatives have a significant impact on the health care delivery system within Connecticut.

OHCA guides health system development by overseeing and coordinating statewide health system planning and by administering the CON program for hospitals, other types of health care facilities and for all acquisition of CT scanners, MRI scanners, PET and PET/CT scanners, linear accelerators, cineangiography equipment, new technology being introduced to the state and major medical equipment. The certificate of need program is designed to promote cost containment, prevent unnecessary duplication of health care facilities and services, guide the establishment of health facilities and services and ensure that high quality health services are provided. The process ensures that capital and technology investments in the health care industry are in the best interest of the citizens of Connecticut. In addition, the CON program encourages health care industry leaders to consider collaborative efforts and multiple perspectives in developing an effective, responsive health care system. The program also provides an opportunity for consumer, provider and payer participation during the application process.

OHCA contributes to the overall financial well being of the state’s health care delivery system by analyzing acute care hospitals’ financial condition and by assisting the Department of Social Services in administering the disproportionate share payments to hospitals (DSH) program. The DSH program protects access to hospital care for the uninsured and underinsured by providing financial assistance to hospitals that provide a disproportionate amount of such care. Hospitals and other health care facilities must be financially viable in order to deliver quality, cost-effective health care. By collecting and analyzing numerous financial data, OHCA is able to provide a picture of the financial well-being of Connecticut’s hospitals.

OHCA’s data collection, analysis and public release of health care utilization information is a cornerstone of the agency, and allows the agency to function as both policy advisor and information resource to a variety of organizations and individuals. OHCA regularly provides legislators, health care policy makers, the health care industry and members of the general public with detailed analyses of health care trends and health care topics relevant to public policy and public interest.

In addition, the agency continues to plan for providing access to affordable health insurance for all state residents. OHCA has focused on educating policy makers regarding access to health care coverage through data collection, the synthesis of information and the preparation of briefings and presentations.

OHCA uses numerous vehicles to inform the public, legislators and the health care industry of important health care issues and trends. OHCA’s website offers current information about the agency and its activities, access to complete OHCA reports and publications, Certificate of Need decisions, and hospital budget and utilization data. The site also includes statutes, regulations, legal notices, relevant forms, and links to relevant national, federal, state, and organizational health care-related websites. The address is: www.ct.gov/ohca.

Improvements/Achievements 2005-06

In order to address its statutory requirements and fulfill its mission, OHCA regulates the constantly evolving hospital and health care industry. During the 2006 session of the General Assembly, OHCA successfully supported the passage of laws that will make a significant positive impact upon the State’s ability to remain responsive and flexible in regulating the rapidly changing health care environment, while ensuring the quality of health care services. The new Public Acts focus on enhancements to certificate of need regulation related to imaging equipment and affiliates of health care institutions as well as overall improvements to internal operations and efficiencies of the agency.

Public Act 06-28 -- An Act Concerning Certificate of Need Expenditure Thresholds

This act has two overall provisions of interest: 1) the raising of all capital expenditure thresholds to $3 million and 2) adding an “in operation” date for certain radiology services.

1) This act increases the CON threshold for all capital expenditures, including major medical equipment, to $3 million.

2) The act requires each health care facility, institution or provider that purchases, leases or accepts donation of a CT scanner, PET scanner, PET/CT scan, MRI scanner, cineangiography equipment or linear accelerator equipment has such equipment in operation by July 1, 2006 or CON authorization would be required.

Public Act 06-64 -- An Act Concerning Revisions to the Office of Health Care Access Statutes

The act can be divided into three distinct areas of interest, 1) waiver from certificate of need (CON) in emergency situations; 2) exemption from CON for replacement equipment; and 3) exemption from CON for non-profit health services.

1) The current statute allows an applicant to request a waiver from the 60-day letter of intent (LOI) phase of the CON process under very specific conditions. The act expands the existing statute by allowing a healthcare facility to request a waiver in situations where a healthcare facility demonstrates that the 60-day LOI phase would compromise the ability of the healthcare facility to provide access to care. This waiver is only applicable to services currently provided by the healthcare facility.

2) The Commissioner has the authority to waive from CON certain equipment previously obtained through the CON process. The act repeals a requirement which precluded the Commissioner from granting such a waiver if the applicant is replacing equipment that costs more than 10 percent of original cost for each 12-month period that has elapsed since the original CON approval.

3) The Commissioner of OHCA may grant an exemption from CON to non-profit facilities, institutions or providers currently under contract with a state agency or department who are seeking to engage in, relocate or terminate a service. A Commissioner of the agency with which the non-profit facility, institution or provider has a contract must request an exemption in writing. In the case of a relocation or termination of services the request must ensure access to care will continue to be met in a better or satisfactory manner and specifies how this will be done.

In addition to the above legislative accomplishments, OHCA maintained a continued focus on issues related to hospital finance, hospital utilization and access to health care coverage. Agency accomplishments include:

· In FY 2005, the agency undertook a study to identify possible gaps in the primary health care system, disease management and access to health services leading to disease severity and ultimately, hospitalization.

· The agency also examined whether the licensed hospital psychiatric inpatient bed capacity for children in the state is sufficient and what steps would be required to expand capacity.

· OHCA continued to study and assess the numerous factors that influence the level of health care coverage in the state. For the fifth consecutive year, OHCA received federal state planning grant funds to assist in examining the issue of the uninsured and planning for insurance coverage options. Grant funds were used to field surveys of working families and employers of low wageworkers in order to better quantify the working uninsured and barriers faced in obtaining employer sponsored insurance coverage.

· To better understand utilization and access issues faced by Connecticut’s acute care emergency departments, OHCA convened a work group in 2005. As part of it is activities, the work group provided recommendations for addressing and improving bed, staffing, wait time, transportation and internal process systems issues.

· OHCA also prepared proposed changes to its Financial and Inpatient Hospital Discharge Abstract and Billing Regulations, in an effort to streamline reporting processes and better align agency data collection activities with current federal and state practices.

Information Reported as Required by State Statute

· In accordance with Conn. Gen. Statutes Sec. 19a-670, OHCA’s Annual Report on the Financial Status of Connecticut’s Short Term Acute Care Hospitals was published in February 2006.

· OHCA’s Affirmative Action Plan was submitted to the Commission on Human Rights and Opportunities on February 15, 2006 and approved by the Commission at its May 11, 2006 meeting. This plan complies with Conn. Gen. Statutes Secs. 46a-70 through 46a-78.

· In accordance with Section 91 of Public Act 05-280, Conn. Gen. Statutes, OHCA’s Report of the Committee to Examine Hospital Inpatient Behavioral Health Bed Capacity for Children was published in January 2006.

· Published in March 2006, OHCA’s 2005 Annual Report to the Governor and the General Assembly more fully describes agency achievements, objectives, and initiatives.

· OHCA maintains a registry of health care facilities that have sought exemption from CON review in accordance with Conn. Gen. Statutes Sec. 19a-639a.