CT lawmakers propose new licensing requirement for hospital executives; would include degree, exam mandates
HBJ PHOTO | DAVID KRECHEVSKY
The State Capitol in Hartford.
Intent on finding a way to hold hospital administrators accountable for the decisions they make, the state legislature is considering legislation to require hospital executives to be licensed.
The proposal is included in Senate Bill 7. Sections 22-26 of the revised bill create a new licensure category for healthcare administrators, to be administered by the state Department of Public Health.
To be granted a license, an applicant would be required to have a degree in healthcare administration, public health or a related field; pass an exam administered by DPH that tests the applicant's “knowledge of health care laws, patient safety protocols and health-related ethical guidelines”; and submit an application to DPH.
The bill sets the application fee at $200. Administrators also would be required to renew the license annually for a $105 fee.
The bill also would give DPH the power to “hear all charges of unacceptable conduct” brought against a hospital administrator. It defines “unacceptable conduct” in a number of ways, including making a “fiscal or operational decision that results in injury to a patient or creates an unreasonable risk that a patient may be harmed.”
It also makes the administrator responsible if he or she had direct oversight of a licensed healthcare provider who violated a state or federal law.
Sen. Saud Anwar (D-South Windsor), co-chair of the legislature’s Public Health Committee, said Thursday the bill is necessary.
Hospital administrators should have a license to function in the state, he said, “Because if a nurse by mistake harms a patient, or a physician by mistake harms a patient, that would have consequences to their license.”
He continued, “You have these unlicensed individuals from out of state that come to our state and make decisions which do not harm just one patient, but thousands of patients, and without having any responsibility and without having any consequences.”
Unlike medical professionals, such as physicians or nurses, or administrators of nursing homes or long-term care facilities, administrators at acute-care hospitals are not required to be licensed.
In fact, the state Office of Fiscal Analysis states in a note on the bill that a review conducted by DPH “failed to identify a similar credential in neighboring and nearby states.”
The bill directs DPH to design an exam to test an applicant’s knowledge of healthcare laws, patient safety protocols and health-related ethical guidelines, but OFA also notes that there “does not appear to be an existing model to help develop the design and content of DPH's health care administrator licensure exam, and the department lacks the necessary expertise to meet the bill's requirements.”
DPH would be required to hire an expert healthcare consultant to help develop the exam, “at an estimated cost of $20,800 in FY 26,” OFA states.
A public hearing on the bill was held on March 24, during which DPH Commissioner Manisha Juthani stated her opposition to the licensing section of the bill.
Juthani said that creating a new licensure category for hospital administrators will require funding for the department not included in Gov. Ned Lamont’s proposed budget, and would create more confusion and inefficiencies in the regulation and operation of hospitals.
The Connecticut Hospital Association (CHA) submitted written testimony for the public hearing that agrees with Juthani’s assessment.
“The entirety of hospital-related healthcare would come to a screeching halt upon implementation, because the proposal imposes unworkable pre-conditions for hundreds, if not thousands, of disparate hospital-based professionals who currently serve in managerial roles with a level of oversight for clinical staff at every hospital in the state,” the CHA said.
It adds that the definition of “hospital administrator” is so broad, it would “apply to every professional employed by a hospital who is ‘a nonclinical hospital manager with direct supervisory authority over clinical health care providers,’ which it said touches “on almost every aspect of hospital operations.”
CHA adds that approving the licensure sections of the bill will “substantially increase operating costs, create a workforce crisis that will threaten to halt hospital operations statewide, and place significant added burdens on DPH to administer.”
The Connecticut Medical Society (CMS) also submitted testimony opposing the bill.
One who spoke in favor of the bill was Cassandra Esposito, an advanced practice registered nurse (APRN) and president of the Connecticut Nurses Association, who said licensure of hospital administrators is “long overdue.”
“Licensure alone will not resolve every challenge in our healthcare system, but it represents a meaningful first step toward building a more accountable and competent leadership structure,” Esposito said. “Holding hospital administrators to standardized requirements reinforces the alignment between executive decision-making and the core principles that guide those providing direct care: safety, integrity, transparency and patient-centered care.”
Before moving the bill to the Senate calendar, where it was assigned File No. 604, the Public Health Committee held a vote on a motion proposed by Sen. Heather Somers (R-Mystic) to remove the licensure part of the bill, Sections 22-26. That effort, however, failed by a 19-9 vote.
The bill now awaits action in the Senate.
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