Complaints about lengthy turnaround times for health care related regulatory decisions dominated a Wednesday listening session on Connecticut’s Certificate of Need process by the state Office of Health Strategy.
The office hosted two hearings this week on the Certificate of Need process by which it manages health care provider requests to expand or contract services, close facilities, or acquire medical equipment.
The process has come under greater public scrutiny in recent years as the state’s hospitals have increasingly consolidated under a small number of health care networks and many have asked regulators for approval to discontinue services at smaller facilities.
During a morning hearing in the Legislative Office Building, several providers told the office that the process was costly and plagued by delays.
“Simply stated, for us, it should not take up to two years to determine whether a CoN should or should not be granted,” Sally Herlihy, vice president for strategic planning for Nuvance Health, said. “The length of time impacts operations in significant ways.”
The comments followed a proposed final decision issued by OHS last week to deny Nuvance’s request to discontinue labor and delivery services at Sharon Hospital.
“It is an issue,” Jim Iacobellis, the Connecticut Hospital Association’s senior vice president of government and regulatory affairs, said earlier in the hearing. “It takes too long for an application to be determined.”
Iacobellis called for establishing deadlines for the process and limiting the number of extensions. If an application exceeds its deadline without a determination by OHS, it should be deemed approved, he said, adding that a similar system had previously worked in Connecticut.
John Brady, a registered nurse and vice president of AFT Connecticut, agreed the process often took too long. That was the case with Windham Hospital’s request to discontinue labor and delivery services, which stretched on for nearly three years, he said. However, Brady argued the state should prevent hospitals from halting services while the process is ongoing.
“The problem that has caused is that in the case of some of these hospitals — and Windham is one of them — is that the service is gone for those three years,” Brady said. “I don’t think that was the original intent of the legislature. What I suggest is a ‘no shovel in the ground’ approach. If health care wishes to expand or contract services, I think they should get approval prior to that service either being expanded or contracted.”
The Office of Health Strategy began the hearing by acknowledging that the process had recently been protracted. Executive Director Dr. Deidre Gifford said many of the delays were rooted in staffing shortfalls, which the agency has attempted to address.
“There have been long delays in some CoN applications in the recent past,” Gifford, who assumed her current role in January, said. “I’m aware of that. We’re all aware of that at the Office of Health Strategy and we agree with you that those excessively long durations for application processing are something that needs to be changed.”
The office has recently expanded to help address those delays by hiring additional legal staff and analysts and was in the process of hiring an additional compliance attorney, Gifford said.
The agency’s staffing difficulties were also discussed during a Tuesday informational hearing for state legislators on the Certificate of Need process. Kim Martone, the Office of Health Strategy’s chief of staff, said several staff members left or retired from the agency during the pandemic. Another member of the office recently died, she said.
“So, yes, we had a backlog. We were not meeting our deadlines but we are very proud to say that today we are almost done with our backlog and we are proceeding in a timely fashion on our applications both in review and releasing decisions,” Martone said.
Lawmakers have made several attempts at reviewing the Certificate of Need process, including forming a task force group to review the process in 2017. Another legislative task force published its recommendations in January.
On Tuesday, Sen. Saud Anwar, a doctor and South Windsor Democrat who co-chairs the Public Health Committee, said he would like to see the process expedited so that every CoN application would be completed in 30 days with some fast-tracked applications reviewed in just two weeks. He praised OHS for its attention to the sometimes contentious issue.
“In the Public Health Committee we have seen so many bills which are saying from eliminating it altogether or making it change. It’s like you can not get two people in the same room with the same opinion,” Anwar said.