Office of Health Care Access

 

 

At a Glance

 

MARY M. HEFFERNAN, Commissioner

Established - 1994 

Statutory authority - CGS Chapter 368z

Central office - 410 Capitol Avenue,

Hartford, CT 06134

Number of employees – 31

Recurring operating expenses – $2,867,875

Organizational structure – Office of the Commissioner, Fiscal and Administrative Services Unit, Health care Information Services Unit, Health System Development Unit, Public Relations Unit, Research and Planning Unit.

 

Mission

The mission of the Office of Health Care Access 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 Responsibility

     State statutes empower the Office of Health Care Access (OHCA) to gather and analyze significant amounts of health care data, thus positioning the agency as an informed contributor to State health care policy deliberations. OHCA’s role as policy advisor and information resource permits the agency to assess and report on health care access, cost and delivery within the state and to assist policy makers and the industry in crafting and sustaining a superior health care system for all Connecticut residents.

 

Public Service

     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.

     OHCA encourages health system development by overseeing and coordinating statewide health system planning and by administering the Certificate of Need (CON) program for hospitals, other types of health care facilities and for all imaging equipment and linear accelerators costing over $400,000.  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. The CON process also helps limit excess costs to the evolving health care system by preventing unnecessary duplication of health care technology, services, and programs.

     The State continues to be the largest purchaser of health care in connecticut, spending close to $4 billion each year.  Under OHCA’s ACHIEVE initiative, the agency developed a results management database, a financial reporting tool that uses data readily available from the State’s health plan vendors to track and evaluate monthly claims data.  OHCA is providing this information to the Office of Policy and Management to support ongoing development and assessment of the budget for State employee/retiree health benefit costs. 

     The functions administered by OHCA enable State policy makers to monitor the health care system, identify areas of potential need, coordinate State policy and actions, formulate solutions for meeting identified needs, and fully leverage the State’s significant buying power in a coordinated manner to control cost and increase quality.

     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.ohca.state.ct.us.

 

Improvements/Achievements 2002-03

     In order to address its statutory requirements and fulfill its mission, OHCA regulates the constantly evolving hospital and health care industry.  During the 2003 session of the General Assembly, OHCA successfully supported passage of several new 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 reducing time-consuming and costly burdens on the industry and in many cases, the State.

     Public Act 03-73, AN ACT CONCERNING THE SALE OF NONPROFIT HOSPITALS, a collaborative effort among legislators, OHCA and the Office of the Attorney General, modifies procedures that must be followed when reviewing any proposed sale of a nonprofit hospital to a for-profit entity.  Special attention is given to streamlining the application and review process while maintaining important safeguards that protect the public’s interest and maintain Connecticut’s high-quality health care delivery system.   

     Public Act 03-274, AN ACT CONCERNING OUTPATIENT SURGICAL FACILITIES, defines an Outpatient Surgical Facility as any entity, individual, firm, partnership, corporation, limited liability company or association, other than a hospital, engaged in providing surgical services for human health conditions that include the use of moderate or deep sedation, moderate or deep analgesia or general anesthesia. The Act states, in part that:
Any Outpatient Surgical Facility currently in operation must provide satisfactory evidence to OHCA that it was in operation on or before July 1, 2003.  Any Outpatient Surgical Facility in development prior to July 1, 2003, was able to obtain a Determination from OHCA that a Certificate of Need was not required by providing satisfactory evidence that it commenced development prior to July 1, 2003.  Such determination must have been obtained from OHCA on or before July 1, 2003.  The law imposes a one-year moratorium on the development of these facilities without CON approval. The new law also establishes licensing requirements and standards for outpatient surgical facilities, based on the understanding that patient safety and quality of care standards that exist for surgeries conducted in inpatient settings also need to exist for outpatient surgery. 

    

     Public Act 03-275, AN ACT CONCERNING A DEMONSTRATION PROJECT FOR LONG-TERM ACUTE CARE HOSPITALS, will establish four demonstration projects for long-term acute care hospitals within short-term acute care hospitals or children's hospitals, in order to study the benefits of such facilities.  This pilot program is being considered as a way to provide high-quality, long-term acute care in hospitals in a manner that does not heavily rely on the use of acute care hospital intensive care beds.

     Additional improvements in state fiscal year 2003 include $71.7 million in enhanced Medicaid or Disproportionate Share Payments to Hospitals (DSH) program payments made to acute care hospitals, resulting in over $35.8 million in federal matching funds coming to Connecticut.                                                                                                                          OHCA also continued its planning activities and received an additional $95,000 in supplemental funding under its U.S. Health Resources and Services Administration grant.  This State Planning Grant provides the agency with an opportunity to develop a realistic plan to increase access to health insurance coverage in Connecticut.  Policy analysis and development activities conducted under the grant led to a proposal to pilot a small employer health insurance subsidy initiative.                                                                                                                                                                   The Certificate of Need (CON) regulatory process is a review of certain proposed capital expenditures by heath care facilities, acquisition of major medical equipment, institution of new services or functions, termination of services, transfer of ownership, and decreases in total bed capacity. Generally, a CON is a formal OHCA statement that a health care facility’s CON application request is needed.   The CON program continues to protect the health care system and provide savings in system costs while significantly simplifying procedures and reducing time and paperwork for applicants and the agency. During the 02-03 state fiscal year, OHCA performed 66 full CON reviews or modifications and 92 CON determinations.                                                                                                                      In October 2002, OHCA completed a months-long review and issued a Declaratory Ruling in response to a hospital’s petition for clarification of a statutory definition.  In its ruling, OHCA declared that the term Imaging Equipment, as used in Connecticut General Statutes, Section 19a-639(c), is singular.

 

Information Reported as Required by State Statute

·         OHCA published its Third Annual Report on Graduate Medical Education as required under Public Act No. 99-172 in December 2002.

·         In accordance with Section 19a-670, Conn. Gen. Statutes, OHCA’s Annual Report on the Financial Status of   Connecticut’s Short Term Acute Care Hospitals was published in February 2003.

·         OHCA continues to prepare its own Affirmative Action Plan, which was submitted in February 2003, and    approved in May. This plan complies with Conn. Gen. Statutes Secs. 46a-70 through 46a-78.

·         Published in March 2003, OHCA’s 2002 Annual Report to the Governor and the General Assembly more fully describes agency achievements, objectives, and initiatives.

·         OHCA continues to maintain a registry of health care facilities that have sought exemption from CON review in accordance with Sec. 19a-639a, Conn. Gen. Statutes.  Eligible facilities that fail to register annually remain subject to CON.