Certificate of Need (CON)

CON Forms

CON Application Fees

Pursuant to Public Act 22-118, Sec. 225, the following fee schedule shall apply to all CON applications filed on or after July 18, 2022:

CON Application Fee	Estimated Cost of Proposal
$1,000	<$50,000
$2,000	$50,000< cost <$100,000
$3,000	$100,000< cost <$500,000
$4,000	$500,000< cost <$1,000,000
$5,000	$1,000,000< cost <$5,000,000
$8,000	$5,000,000< cost <$10,000,000
$10,000	$10,000,000< cost

Office of Health Strategy CON Covid-19 Waiver / Guidance on Licensed Bed Capacity

CON COVID-19 Waiver Form 2021-01-07 (Increase in Licensed Bed Capacity) 2021-01-07

OHS COVID-19 CON Guidance Document 2021-01-07

***NEW July 2022 Mental Health Facility CON Exemption (Increase in Licensed Bed Capacity) Notification Form

Determinations of whether a project requires CON approval must be obtained in writing from the department. Please submit the appropriate form below to HSP for review:

Newspaper listing:

Prior to filing a CON, notice for 3 consecutive days must be placed in newspapers of substantial distribution to the location proposed. A listing of these newspaper requirements can be found here.

CON Determination Form	Word	PDF
CON Determination Form - Relocation	Word	PDF

If CON approval is required, applicant must complete:

CON Main Form
Supplemental Form (if indicated in table below)
Financial Worksheet

Notice Regarding CON Filings:

Please be advised that Health Systems Planning (HSP) is in the process of revising its regulations (19-639-3(b)) to enable it to accept new CON filings through the CON Portal. While proceeding through this legal process of changing HSP’s regulations, HSP waives the requirement for Applicant(s) to file paper copies pursuant to Sec. 19a-639a-3.

Note: Should anyone not have the ability to file electronically, the present paper submission process may still be used. If you have any questions regarding a CON filing with HSP, please contact us at HSP@ct.gov or call us directly at (860) 418-7001.

1. CON Main Form

The Main Form must be completed by all applicants

Word

PDF

2. CON Supplemental Forms

The supplemental forms correspond to the circumstances listed in Conn. Gen. Stat. section 19a-638(a)(1)-(15) that require CON approval. Some supplemental forms serve more than one application type (e.g., termination of services).

Conn.Gen. Stat. Section 19a- 638(a)	Supplemental Forms
(1)	Establishment of a new health care facility (mental health and/or substance abuse) -See note below*	Word	PDF
(2)	Transfer of ownership of a health care facility -(excludes transfer of ownership/sale of hospital – see “Other” below)	Word	PDF
(3)	Transfer of ownership of a group practice	Word	PDF
(4)	Establishment of a freestanding emergency department	Word	PDF
(5) (7) (8) (15)	Termination of a service: Termination of inpatient or outpatient services offered by a hospital Termination of surgical services by an outpatient surgical facility Termination of an emergency department by a short-term acute care general hospital Termination of inpatient or outpatient services offered by a hospital or other facility or institution operated by the state that provides services that are eligible for reimbursement under Title XVIII or XIX of the federal Social Security Act, 42 USC 301, as amended	Word	PDF
(6)	Establishment of an outpatient surgical facility	Word	PDF
(9)	Establishment of cardiac services	Word	PDF
(10) (11)	Acquisition of equipment: Acquisition of computed tomography scanners, magnetic resonance imaging scanners, positron emission tomography scanners or positron emission tomography-computed tomography scanners Acquisition of nonhospital based linear accelerators	Word	PDF
(12)	Increase in licensed bed capacityof a health care facility	Word	PDF
(13)	Acquisition of equipment utilizing [new] technologythat has not previously been used in the state	Word	PDF
(14)	Increase of two or more operating roomswithin any three-year period by an outpatient surgical facility or short-term acute care general hospital	Word	PDF

Other	Transfer of Ownership / Sale of Hospital	Word	PDF

*This supplemental form should be included with all applications requesting authorization for the establishment of a mental health and/or substance abuse treatment facility. For the establishment of other “health care facilities,” as defined by Conn. Gen. Stat § 19a-630(11) - hospitals licensed by DPH under chapter 386v, specialty hospitals, or a central service facility - complete the Main Form only.

3. CON Financial Worksheet

The Financial workbook (Excel format) contains: (A) Non-Profit, (B) For-Profit and (C) Sale of Non-Profit Hospitals worksheets. Complete the appropriate worksheet based on the application type (19a-638(a) applications should complete financial worksheet (A) if a Non-Profit entity or (B) if a For-Profit entity. Applications for 19a-486a Sale of Non-Profit Hospitals should complete financial worksheet (C).

Excel

Notification Forms

Equipment Replacement Form