DPH: Frequently Asked Questions
FAQ

Frequently Asked Questions

 
Please click on the section name below to expand or collapse it:
 
 
{bullet} General
 
  1. What is OHCA?
    OHCA stands for Office of Health Care Access. It is an office of the Department of Public Health.

  2. What does OHCA do?
    The major functions of the Office of Health Care Access (OHCA) are the administration of the Certificate of Need (CON) program; preparation of the Statewide Health Care Facilities and Services Plan; health care data collection, analysis and reporting; and hospital financial review and reporting.

    The CON program promotes appropriate health facility and service development that addresses a public need. The CON program strives to ensure accessibility for needed services while limiting duplication or excess capacity of facilities and services.

    OHCA has statutory authority to gather and analyze significant amounts of hospital financial, billing and discharge data. Information collected, verified, analyzed and reported includes hospital expenses and revenues, uncompensated care volumes, and other financial data as well as hospital utilization, demographic, clinical, charge, payer and provider statistics. The office produces an annual acute care hospital financial stability report and biennial utilization report reflective of these data analyses.

    The office posts these reports on the website, as well as separate hospital utilization tables and financial dashboards and a page dedicated to assisting consumers with hospital billing and other hospital concerns. OHCA continues to review requests by consumers to verify that their hospital charges are in agreement with the hospital charge masters.

  3. How do I contact someone at OHCA?
    The main number to contact OHCA is (860) 418-7001 or you can send an email to OHCA@ct.gov.

  4. Does OHCA handle facility and individual licensing and license renewals?
    No, please contact the licensing section at (860) 509-7603 and follow the appropriate prompts..

  5. Can I contact OHCA to obtain health insurance for myself and my family?
    No, OHCA does not provide health insurance. Please contact Access Health CT @ or (855) 805-4325 or (860) 757-5300 or https://www.accesshealthct.com/.

  6. Is OHCA the same as Access Health CT?
    No, we are separate state departments.

  7. Can OHCA help me settle a dispute with my healthcare insurance?
    No, please contact Office of Health Care Advocate @ (866) 466-4446 or http://www.ct.gov/oha/.

  8. Can I file a complaint with OHCA regarding a physician, nurse, hospital, nursing home etc.?
    No, please visit DPH website for contact information. http://www.ct.gov/dph/.

  9. Where do I apply for State of Connecticut medical assistance, HUSKY, or Medicaid?
    Please contact the Department of Social Services website for more information or call (800) 842-4524 or http://ct.gov/dss/.

  10. How do I contact my social worker?
    Please visit the Department of Social Services website @ http://ct.gov/dss/.

  11. How can I obtain my medical files?
    Please visit the Department of Public Health website @ http://www.ct.gov/dph/ for further information.

{bullet} Certificate of Need Unit
 
  1. What is a Certificate of Need (“CON”)?
    Certificate of Need (“CON”) is an effort to contain costs, improve quality and increase access for many of Connecticut major health care services. It is a program that is regulated by 19a-638 of the Connecticut General Statutes. You can click on the following link to go to OHCA’s CON page: http://www.ct.gov/dph/.

  2. How do I know that I need to file a CON?
    Three simple ways:

    • You can review 19a-638 of the Connecticut General Statutes that lets you know, what does and what does not require a CON.

    • You can submit a completed CON Determination Form to with all the relevant facts about your project/proposal and OHCA will send you a formal written CON Determination stating whether your proposal/project requires you to file for a CON.

    • You can contact OHCA directly by telephone (860) 418-7001 or email (ohcauser@ct.gov).

  3. What Connecticut General Statutes (“C.G.S.”) guide the CON?
    There are two (2) primary C.G.S. that guide CON, they are 19a-638 (that explains what does and what does not require a CON and 19a-639 (explains the CON process and review criteria).

  4. What is a CON Determination and when should I file one?
    Whenever you are unclear whether your proposal/project requires a CON, you can submit a completed CON Determination Form and OHCA will reply back in writing whether or not your proposal/project requires you to file a CON.

  5. How do I start the CON process?
    By publishing a notice to the public in the local major newspaper for 3 days in a row, 20 days prior to submitting the completed CON application to OHCA. Please see http://www.ct.gov/dph/ for the overall CON process or contact OHCA at (860) 418-7001 for process related details and answers to your questions.

  6. Where can I get CON forms to fill out?
    CON forms are located on OHCA’s website under OHCA Forms (http://www.ct.gov/dph/ or on OHCA’s Certificate of Need page under Information by Provider (http://www.ct.gov/dph/

  7. Is there a fee required when filing a CON Application with OHCA?
    Yes, currently there is a flat $500 fee required when filing a CON with OHCA.

  8. Who can I talk to about the CON process at OHCA? How do I get in touch with them?
    You can contact OHCA with any CON questions at (860) 418-7001.

  9. What criteria does OHCA do to review a CON Application?
    The criteria used to review CON applications are listed under 19a-639.

  10. Where can I find previously filed CON Applications, Decisions, and Determinations?
    All CON Applications, Decisions and Determinations are found on OHCA website, listed under Certificate of Need.

  11. What is a CON Modification?
    A CON Modification is a process by which a previously rendered CON Decision or a previously signed Agreed Settlement is altered. It’s principally guided by 4-181b C.G.S.

  12. Where do I find previous CON Modifications?
    Similar to all other OHCA public documents, copies of CON Modifications are located on OHCA’s webpage under Certificate of Need.

  13. Who is the final decision maker for CON Determinations, Decisions and Modifications rendered by OHCA?
    OHCA Commissioner, who is the Deputy Commissioner of Department of Public Health, is the final decision maker for all final actions. OHCA Commissioner may designate OHCA Director of Operations or another person to sign a document on her behalf.

  14. When does OHCA hold a public hearing?
    Once a CON application has been deemed Complete (meaning OHCA has gathered the information in the CON application it deems necessary), there are two ways a public hearing can be held. One, OHCA can choose to take any CON application to a public hearing for an reason, or if three (3) or more individual's or a person or entity, representing five or more individuals request a public hearing within 30 days of a CON application being deemed Complete.

  15. Can I attend a public hearing?
    All public hearings are open to all public to attend. If someone wishes to participate in a public hearing, they may request intervenor status in the particular hearing under the appropriate Connecticut General Statute.

  16. Where do I find information regarding an OHCA public hearing?
    When a public hearing is scheduled, OHCA publishes a legal notice informing the public in the major local newspaper where the proposal/project is to be located. In addition to that, OHCA files its weekly Calendar with the Secretary of State and OHCA publishes information about the public hearing on the front webpage of OHCA’s website and on the Department of Public Health’s Calendar on OHCA/DPH’s website.

  17. How do I know what CONs are currently being reviewed by OHCA?
    On weekly basis, OHCA produces and publishes a CON Status Report that is published on OHCA’s website under “Status Reports."

  18. What’s the status of a particular CON?
    On weekly basis, OHCA produces and publishes a CON Status Report that is published on OHCA’s website under “Status Reports.”

  19. What is a Docket Number?
    A number called the “Docket Number” is assigned to each CON related filing with OHCA. This is a way to track all projects internally and externally.

  20. What is a Health Care Facility?
    Health Care Facility is a term that OHCA uses to define the five (5) types of facilities that it regulates. The term Health Care Facility is defined for OHCA’s purposes under Section 19a-630 of the Connecticut General Statutes.

  21. Do I need a CON to get a license for the facility I want to open?
    OHCA does not give out licenses. You have to contact Department of Public Health’s Licensing section directly to inquire if your particular facility/service requires a license. You can reach them at (860) 509-7603.

  22. I’m replacing and/or relocating my current MRI, CT, PET, PET-CT, or LinAc. Do I need to file anything with OHCA?
    If the scanner you are looking to relocate or replace has previous CON authorization (approving your initial acquisition of the machine), you may download a CON Replacement/Relocation form from OHCA website under OHCA Forms and once you complete and submit it with the appropriate Docket Number of the previous CON authorization, that’s all you have to do. Once OHCA verifies your previous CON authorization, it will post your notice to OHCA on our website under CON Notifications and you are all set.

  23. Do I need to file a CON for removing/terminating my current MRI, CT, PET, PET-CT, or LinAC?
    If you are a Hospital and terminating any service, it is required for you to file a CON. Removing/terminating your current imaging service would be considered a termination. If you are not a hospital and removing/terminating your imaging service, you do not need to file a CON.

  24. When does OHCA post information related to CONs on its website? How often?
    OHCA makes every effort to post CON related documents on the website as soon as possible. As a matter of fact, most documents are posted within 24 hours of being received or sent out.

  25. How do I get a copy of a CON application, CON Determination or any other CON related documents?
    You may request a copy of any CON related document (unless it’s deemed Confidential by OHCA) through the Freedom of Information (“FOI”) process. Please see OHCA FOI process here: http://www.ct.gov/dph/

{bullet} Hospital Financial Reporting Unit (Annual Reporting & Twelve Month Filings)
 
  1. What are an Annual Filing and a Twelve Month Actual Filing?
    Section 19a-643-206 of the Regulations of Connecticut State Agencies requires hospitals to report annually on their actual operating results for the previous fiscal year, (October 1st, to September 30th), to the Department of Public Health, Office of Health Care Access (“OHCA”). Pursuant to Section 19a-643-206(b) and (c) of OHCA’s Regulations, the annual filings contain information including audited financial statements, Medicare Cost Reports, hospital and parent corporation legal charts of corporate structure, hospital uncompensated care policies and procedures, and various hospital financial data and aggregate utilization statistics.

  2. How do I find out which reports are in the Annual Filing and which reports are in the Twelve Month Filing?
    If you go to the main hospital financial data page indicated below you can click on Annual Reporting filing or Twelve Month Actual Filing which will provide the reports that are part of each filing. http://www.ct.gov/dph/

  3. When are hospitals Annual Reporting and Twelve Month filings due to OHCA?
    Acute care hospitals are required to file their Annual Reporting documents each year by February 28th and their Twelve Month Actual Filings by March 31st.

  4. When will the Annual Reporting and Twelve Month Filings be complete?
    Upon receipt of the filings, the hospital filings are reviewed by OHCA analysts and questions may be asked of the hospitals. The process is usually completed each year by June.

  5. How do I get a copy of the current year and past year’s Annual Reporting and Twelve Month Filings?
    OHCA has made the two filings available for download on our website in both Excel and PDF formats beginning with FY 2009. Go to the main hospital financial data page indicated above and click on either the Annual Filing or Twelve Month Filing. This will bring you to a listing of hospitals where you will have the option of viewing the filing as an Excel or PDF file. http://www.ct.gov/dph/

  6. What do I have to do if I want to request components of the individual hospital filings that are not posted to the website?
    As noted above, many of the components from the filings can be accessed from the OHCA website. If a report is not provided on the website please complete an FOI request form or contact OHCA at (860) 418-7001. Clicking on the following link will bring you to the FOI page on the website. http://www.ct.gov/dph/

  7. Besides the Annual Reporting and Twelve Month Actual Filings, is there any other financial data available on the OHCA website?
    Yes. Some of the data OHCA currently provides are audited financial statements, hospital dashboards; yearly filing instructions, a map of hospital locations, the financial stability report, and hospital submitted organizational charts, and each hospital's top ten highest paid positions.

  8. Which regulations require the Annual Reporting and Twelve Month Filing for each acute care hospital?
    Clicking on the following link will bring you to a page with OHCA’s financial review regulations. A document of Hospital Financial Review Regulations

  9. When will OHCA’s Annual Report on the Financial Status of Connecticut’s Short Term Acute Care Hospitals be released?
    The report is usually made available to the public with the most recently completed fiscal year data filed by the acute care hospitals in October of each year.

{bullet} Specialty Hospital Filings
 
  1. What is a specialty hospital?
    Pursuant to Connecticut General Statute subsection 19a-644(d), a facility licensed as a hospital by the Department of Public Health other than a general hospital.

  2. Do specialty hospitals file any financial data with OHCA?
    OHCA receives financial statements from specialty hospitals which are due 5 months after the end of the hospital’s fiscal year end. The submitted filings can be found in the financial section of OHCA’s website.

{bullet} Hospital Pricemasters
 
  1. What statute authorizes the Department of Public Health – Office of Health Care Access to collect pricemaster data from each Acute Care General Hospital?
    Clicking on the following link will bring you to a page with the OHCA’s statutes:
    http://www.cga.ct.gov/current/pub/chap_368z.htm#sec_19a-681

  2. What is required for the pricemaster filing?
    Section 19a-643-204(b) of the Regulations of Connecticut State Agencies provides the details of what OHCA requires to be filed by clicking on the following link:
    A document of Hospital Financial Review Regulations

  3. What is a detailed bill?
    Pursuant to C.G.S. § 19a-681(a)(1), as amended by Public Act 13-234:

    “ …………(a)(1) "Detailed patient bill" means a patient billing statement that includes, in each line item, the hospital's current pricemaster code, a description of the charge and the billed amount;…………”

  4. When are the pricemasters required to be filed?
    All Hospitals must file their pricemasters, effective October 1 as of each fiscal year as of the date specified by the Office of Health Care Access. New or revised charges not previously reported to OHCA must be submitted in subsequent filings by the fifteenth calendar day of the following month. For example, the new or revised charges added during the month of November must be filed with OHCA by no later than December 15th.

  5. In what electronic format does OHCA require the pricemasters to be filed?
    OHCA requires the pricemasters to be emailed electronically in an MS Excel format.

  6. What is the penalty for noncompliance with the requirements of C.G.S. § 19a-681?
    Pursuant to C.G.S. § 19a-681(c), as amended by Public Act 13-234:

    ”…..(c) Upon the request of the Department of Public Health or a patient, a hospital shall provide to the department or the patient a detailed patient bill. If the billing detail by line item on a detailed patient bill does not agree with the detailed schedule of charges on file with the office for the date of service specified on the bill, the hospital shall be subject to a civil penalty of five hundred dollars per occurrence payable to the state not later than fourteen days after the date of notification. The penalty shall be imposed in accordance with section 19a-653, as amended by this act. The office may issue an order requiring such hospital, not later than fourteen days after the date of notification of an overcharge to a patient, to adjust the bill to be consistent with the detailed schedule of charges on file with the office for the date of service specified on the detailed patient bill.”

  7. Are acute care hospital pricemasters available on OHCA’s website?
    Yes, the hospitals’ most current pricemaster filing can be found, if you click on the following link:

    http://www.ct.gov/dph/

    Pricemasters filed prior to the most current pricemaster filing are available through the Freedom of Information (FOI) process.

{bullet} Consumer Assistance Process
 
  1. How do I know if I have been billed correctly by the hospital?
    As a consumer of health services, you are entitled to an itemized copy of your hospital bill that details all the services and supplies you received. The line-item bill should outline every service provided, and should include item and procedure codes. If you require assistance obtaining the bill you can contact OHCA at 860-418-7001.

  2. What if I don’t understand the charges on my hospital bill?
    If the charges on your hospital bill are unclear, you may call the hospital’s billing department and ask for a written explanation of the charges in question. The telephone number for the billing department is usually located on your bill or you could visit our Consumer Assistance Process webpage at http://www.ct.gov/dph/ where you will find a table that includes a list of Hospital contact information. The table also provides PDF copies of all Connecticut Acute Care Hospitals' Collection Policies and Procedures which provide detail information on the Hospitals' collection practices.

  3. What if I feel that my hospital’s billing practices are unfair?
    Many hospitals are open to payment arrangements that may better suit the financial needs of their patients. Do not assume that any amount you pay on your bill is considered a "good faith effort" -- you and the hospital must mutually agree to the payment arrangement.

  4. What if I find that I am unable to pay my hospital bills?
    Many hospitals in Connecticut receive funds from the federal government and private donors to assist them in providing free or reduced cost care to patients who need financial assistance. Ask your hospital for information and assistance in applying for any such funds. The hospital may have a social worker available to assist you. The process of applying for free care funds usually involves applying first to your city and/or state (of residence) for Medicaid. If you are denied by this program, you are not automatically excluded from coverage under the hospital’s free care fund. Many hospitals’ charity funds have less stringent standards than Medicaid.

  5. Am I entitled to a copy of my medical records?
    According to the General Statutes of Connecticut, you, the patient (or your authorized representative), may obtain a copy of your medical (but not psychiatric, mental health or substance abuse) records upon submitting a written request to your provider. Your medical record may include but is not limited to: bills, x-rays, copies of laboratory reports, prescriptions and other technical information that has been used to assess and treat your health condition.

  6. With my existing health problems, where or how can I access affordable health care insurance?
    If you are having trouble obtaining adequate health insurance, you may wish to contact the Access Health CT, Connecticut’s Official Health Insurance Marketplace, for assistance at 1-855-805-HEALTH (1-855-805-4325), TTY: 1-855-789-2428 or call 2-1-1

  7. What should I do if my appeal for a higher reimbursement rate fails?
    If you get your insurance through your employer, contact your Benefits Administrator at work. The Benefits Administrator will be able to tell you what kind of insurance you have and in many cases, can persuade your insurance company to reconsider your appeal. If you are not successful in getting help from your Benefits Administrator, you may wish to seek assistance through the appropriate state or federal agency listed below.

    If you have a managed care plan or if your employer (or you) has purchased an insurance policy, you should contact the State Department of Insurance for the state where you reside. In Connecticut, contact:

    Connecticut Insurance Department
    Attn: Consumer Affairs Division
    P.O. Box 816
    Hartford, CT 06142
    You may also call at (800) 203-3447 or Fax at (860) 297-3872 Or call Office of Health Care Advocate @ (866) 466-4446

  8. I am concerned about my physician’s fees and billing practices. What recourse do I have?
    The State of Connecticut does not regulate private physician fees or billing practices. If you are concerned about a billing problem, you must contact your physician directly. In most cases physicians and their staff are helpful and resourceful in resolving a patient’s billing issue. However, if your concerns involve the quality of care your physician provided, you may contact:

    State of Connecticut Department of Public Health
    Practitioner Licensing & Investigations Section
    410 Capitol Avenue,
    MS #12HSR P.O. Box 340308
    Hartford, CT 06134.
    You may also call at (860) 509-7400.




Content Last Modified on 5/9/2014 11:29:44 AM