Did Connecticut mental health facilities need approval before cutting services or beds?

Plain-English summary

In 2003, a senator asked whether Connecticut's Department of Mental Health and Addiction Services needed certificate-of-need review before closing or reducing several state facilities and programs. The AG said the named facilities qualified as state health care facilities. They needed review before ending a health service or substantially decreasing total bed capacity. He concluded that a proposed forty-bed reduction at Connecticut Valley Hospital met the bed-capacity trigger.

The AG did not decide whether other proposed program terminations at three centers ended a statutory health service. He said the department had not supplied enough detail about their type and scope. A proposed closure of River Valley Services had also been withdrawn before the opinion was issued.

Currency note

This opinion was issued in 2003. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Mental health administrators at the time

The opinion identified advance review as required for covered service terminations and substantial bed reductions. For several programs, it left classification open pending more facts.

Health care regulators at the time

The AG noted that the Office of Health Care Access was making a formal determination about the Connecticut Valley Hospital bed reduction. His opinion found the proposed scale significant enough to require the certificate-of-need request.

Common questions

Q: Did state operation exempt these mental health facilities from review?
A: No. The AG said the statute expressly included state health care facilities meeting its definition.

Q: Did the proposed hospital bed cut require a request?
A: Yes. The AG treated the forty-bed proposal as a substantial decrease because it removed half the relevant male rehabilitation beds.

Q: Did every proposed program cut receive a final answer?
A: No. The AG said he needed more information to know whether the proposed changes ended a health service.

Background and statutory framework

Conn. Gen. Stat. § 19a-638(a)(3) required advance requests for termination of health services or substantial bed-capacity decreases. Conn. Gen. Stat. § 19a-630(2) defined a covered state facility by operation and eligibility of services for federal reimbursement. The AG applied those provisions to the facilities listed in the request.

Citations and references

Statutes cited in the opinion: Conn. Gen. Stat. § 19a-638(a)(3); Conn. Gen. Stat. § 19a-630(2).

Source

• Landing page: https://portal.ct.gov/AG/Opinions
• Opinion page: https://portal.ct.gov/ag/opinions/2003-formal-opinions/the-honorable-kevin-b-sullivan-state-senate-2003001-formal-opinion-attorney-general-of-connecticut

Original opinion text

The Honorable Kevin B. Sullivan, State Senate, 2003-001 Formal Opinion, Attorney General of Connecticut

Attorney General's Opinion

Attorney General, Richard Blumenthal

January 10, 2003

The Honorable Kevin B. Sullivan

President Pro Tempore

State Senate

Hartford, CT 06106-1591

Dear Senator Sullivan:

You have requested an opinion as to whether the Department of Mental Health and Addiction Services (DMHAS) is required to apply to the Office of Health Care Access (OHCA) to obtain a certificate of need authorizing the reduction or elimination of health care services provided by DMHAS. The law specifies that as to all of the facilities set forth in your request, DMHAS is required to apply to OHCA for a certificate of need if DMHAS is either terminating a health service or substantially decreasing total bed capacity, prior to the proposed date of any such termination or decrease.

The controlling certificate of need statute provides as follows:

Each health care facility or institution or state health care facility of institution which intends to terminate a health service offered by such facility or institution or decrease substantially its total bed capacity, shall submit to the office, prior to the proposed date of such termination or decrease, a request to undertake such termination or decrease.
Conn. Gen. Stat. § 19a-638(a)(3).

The term "state health care facility or institution" is defined as "a hospital or other such facility or institution operated by the state providing services which are eligible for reimbursement under Title XVIII or XIX of the federal Social Security Act [Medicare and Medicaid]…." Conn. Gen. Stat. § 19a-630(2). The specific DMHAS facilities identified in your request are River Valley Services, Connecticut Valley Hospital, Capitol Region Mental Health Center and the Southwest Connecticut Mental Health System, which includes both the F.S. DuBois Center and the Greater Bridgeport Community Mental Health Center. See, Conn. Gen. Stat. § 17a-450(b). We have been advised by DMHAS that each of those facilities provides services eligible for Medicare or Medicaid reimbursement and consequently is a "state health care facility or institution" for certificate of need purposes.

"'It is well established that [i]f…language…is clear and unambiguous, we will interpret it in accordance with its plain meaning absent a compelling reason to the contrary….'" Office of Consumer Counsel v. Department of Public Utility Control, 252 Conn. 115, 121 (2000) (Citations omitted). The clear and unambiguous language of Conn. Gen. Stat. § 19a-638 compels the conclusion that DMHAS is required to submit a certificate of need request to OHCA prior to terminating a health service or substantially decreasing the total bed capacity at River Valley Services, Connecticut Valley Hospital, Capitol Region Mental Health Center or the Southwest Connecticut Mental Health System.

In your letter you indicate your understanding that DMHAS is proposing to: (1) close River Valley Services in Middletown; (2) close forty beds at Connecticut Valley Hospital; and (3) terminate programs at Capitol Region Mental Health Center, F.S. DuBois Center and the Greater Bridgeport Community Mental Health Center. On January 7, 2003, Governor Rowland announced that River Valley Services will not be closed, but will remain open and continue to provide services in Middlesex County.

With respect to the proposed closure of beds at Connecticut Valley Hospital, our understanding is that these are forty inpatient rehabilitation beds for males with substance abuse disorders and that these beds constitute one-half of the total number of rehabilitation beds for males with substance abuse disorders at Connecticut Valley Hospital. Closing these forty beds would reduce the overall capacity of Connecticut Valley Hospital from 560 to 520 beds. Given their significance in capacity for inpatient rehabilitation beds for males with substance abuse disorders, i.e., fifty percent (50%) of hospital capacity, this proposal would require a certificate of need as a substantial decrease in total bed capacity. We have been advised the DMHAS has requested a determination from OHCA as to whether a certificate of need is required for this proposal and that OHCA is engaged in formally making that determination.

As to the termination of programs at Capitol Region Mental Health Center, F.S. DuBois Center and the Greater Bridgeport Community Mental Health Center, the requirement for a certificate of need would depend on whether this proposal would result in the termination of any "health service" at any of those facilities. While Conn. Gen. Stat. § 19a-638(a)(3) does not define the term "health service," the definition of "health care facility of institution" for purposes of certificate of need review refers to "the prevention, diagnosis or treatment of human health conditions…" Conn. Gen. Stat. § 19a-630(1). At this time, we do not have sufficient information about the specifics of any proposed program termination – such as the type and scope -- to address the question of whether these are health services. We are awaiting receipt of additional information from DMHAS specific to this aspect of its proposal, which should provide a basis for determining whether a certificate of need is required for any program termination at Capitol Region Mental Health Center, F.S. DuBois Center or the Greater Bridgeport Community Mental Health Center.

I will keep you informed of further developments in this area as they occur.

Very truly yours,

RICHARD BLUMENTHAL

ATTORNEY GENERAL