LCO No. 3668 1 of 16
General Assembly Raised Bill No. 804
January Session, 2019
LCO No. 3668
Referred to Committee on AGING
Introduced by:
(AGE)
AN ACT REQUIRING THE STATE OMBUDSMAN TO INVESTI GATE
COMPLAINTS CONCERNIN G RECIPIENTS OF HOME AND
COMMUNITY-BASED SERVICES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 17a-405 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective July 1, 2019): 2
(a) As used in this chapter: 3
(1) "State agency" means the Department of Rehabilitation Services. 4
(2) "Office" or "Office of the Long-Term Care Ombudsman" means 5
the organizational unit which is headed by the State Long-Term Care 6
Ombudsman established in this section. 7
(3) "State Ombudsman" means the individual who heads the office 8
established in this section. 9
(4) "Assistant State Ombudsman" means the person appointed by 10
the State Ombudsman to assist the State Ombudsman in carrying out 11 Raised Bill No. 804
LCO No. 3668 2 of 16
the duties of the State Ombudsman pursuant to section 17a-408, as 12
amended by this act. 13
[(4)] (5) "Program" means the long-term care ombudsman program 14
established in this section. 15
[(5)] (6) "Representative of the office" includes the Assistant State 16
Ombudsman, a regional ombudsman, a residents' advocate or an 17
employee of the Office of the Long-Term Care Ombudsman who is 18
individually designated by the State Ombudsman. 19
(7) "Recipient" means an individual receiving home and 20
community-based services who is sixty years of age or older. 21
[(6)] (8) "Resident" means an individual who resides in a long-term 22
care facility. 23
[(7)] (9) "Long-term care facility" means any skilled nursing facility, 24
as defined in Section 1819(a) of the Social Security Act, (42 USC 1395i-25
3(a)) any nursing facility, as defined in Section 1919(a) of the Social 26
Security Act, (42 USC 1396r(a)) a board and care facility as defined in 27
Section 102(19) of the federal Older Americans Act, (42 USC 3002(19)) 28
and for purposes of ombudsman program coverage, an institution 29
regulated by the state pursuant to Section 1616(e) of the Social Security 30
Act, (42 USC 1382e(e)) and any other adult care home similar to a 31
facility or nursing facility or board and care home. 32
[(8)] (10) "Commissioner" means the Commissioner of Rehabilitation 33
Services. 34
[(9)] (11) "Applicant" means an individual who has applied for 35
admission to a long-term care facility or for home and community-36
based services. 37
(12) "Home and community-based services" means long-term care 38
provided in a home or community setting, or both, to a recipient. 39
[(10)] (13) "Resident representative" means (A) an individual chosen 40 Raised Bill No. 804
LCO No. 3668 3 of 16
by the resident or recipient to act on behalf of the resident or recipient 41
in order to support the resident or recipient in decision making, 42
accessing medical, social or other personal information of the resident 43
or recipient, managing financial matters, or receiving notifications; (B) 44
a person authorized by state or federal law to act on behalf of the 45
resident or recipient in order to support the resident or recipient in 46
decision making, accessing medical, social or other personal 47
information of the resident or recipient, managing financial matters, or 48
receiving notifications; (C) a legal representative, as used in Section 712 49
of the Older Americans Act; or (D) the court-appointed guardian or 50
conservator of a resident or recipient. 51
(b) There is established an independent Office of the Long-Term 52
Care Ombudsman within the Department of Rehabilitation Services. 53
The Commissioner of Rehabilitation Services shall appoint a State 54
Ombudsman who shall be selected from among individuals with 55
expertise and experience in the fields of long-term care and advocacy 56
to head the office and the State Ombudsman shall appoint an Assistant 57
State Ombudsman and regional ombudsmen. In the event the State 58
Ombudsman or a regional ombudsman is unable to fulfill the duties of 59
the office, the commissioner shall appoint an acting State Ombudsman. 60
[and the State Ombudsman shall appoint] In the event the Assistant 61
State Ombudsman or a regional ombudsman is unable to fulfill the 62
duties of the office, the State Ombudsman shall appoint an acting 63
Assistant State Ombudsman or an acting regional ombudsman. 64
(c) Notwithstanding the provisions of subsection (b) of this section, 65
on and after July 1, 1990, the positions of State Ombudsman and 66
regional ombudsmen shall be classified service positions. The State 67
Ombudsman and regional ombudsmen holding said positions on said 68
date shall continue to serve in their positions as if selected through 69
classified service procedures. As vacancies occur in such positions 70
thereafter, such vacancies shall be filled in accordance with classified 71
service procedures. 72
(d) The activities of the State Ombudsman or representatives of the 73 Raised Bill No. 804
LCO No. 3668 4 of 16
office do not constitute lobbying under 45 CFR Part 93. 74
Sec. 2. Subsection (a) of section 17a-406 of the general statutes is 75
repealed and the following is substituted in lieu thereof (Effective July 76
1, 2019): 77
(a) Residents' advocates shall be appointed by the State 78
Ombudsman, in consultation with the regional ombudsmen, for each 79
region in sufficient number to serve the long-term care facilities and 80
recipients of home and community-based services within such region. 81
Such residents' advocates shall, if possible, be residents of the region in 82
which they will serve, and shall have demonstrated an interest in the 83
care of individuals who reside in long-term care facilities or who are 84
recipients of home and community -based services. Residents' 85
advocates shall serve without compensation but may be reimbursed 86
for reasonable expenses incurred in the performance of their duties, 87
within available appropriations. 88
Sec. 3. Section 17a-407 of the general statutes is repealed and the 89
following is substituted in lieu thereof (Effective July 1, 2019): 90
No person may perform any functions as a residents' advocate until 91
the person has successfully completed a course of training required by 92
the State Ombudsman. Any residents' advocate who fails to complete 93
such a course within a reasonable time after appointment may be 94
removed by the State Ombudsman or the regional ombudsman for the 95
region in which such residents' advocate serves. The Commissioner of 96
Rehabilitation Services, after consultation with the State Ombudsman, 97
shall adopt regulations, in accordance with the provisions of chapter 98
54, to carry out the provisions of this section. Such regulations shall 99
include, but need not be limited to, the course of training required by 100
this section. 101
Sec. 4. Section 17a-408 of the general statutes is repealed and the 102
following is substituted in lieu thereof (Effective July 1, 2019): 103
(a) The State Ombudsman shall establish and operate ombudsman 104 Raised Bill No. 804
LCO No. 3668 5 of 16
programs in this state pursuant to Sections 711 to 713, inclusive, of the 105
federal Older Americans Act of 1965, as amended from time to time, 106
and all regulations promulgated thereunder. 107
(b) The State Ombudsman shall serve on a full-time basis, and shall, 108
to the extent permissible under federal law and within available 109
appropriations, personally or through representatives of the office: 110
(1) Identify, investigate and resolve complaints that: 111
(A) Are made by, or on behalf of, residents and recipients or, as to 112
complaints involving the application for (i) admission to a long-term 113
care facility, or (ii) home and community-based services by or on 114
behalf of applicants; and 115
(B) Relate to action, inaction or decisions that may adversely affect 116
the health, safety, welfare or rights of the residents and recipients, 117
including the welfare and rights of the residents and recipients with 118
respect to the appointment and activities of guardians and 119
representative payees, of (i) providers or representatives of providers 120
of long-term care services, including home and community-based 121
services, (ii) public agencies, or (iii) health and social service agencies; 122
(2) Provide services to protect the health, safety, welfare and rights 123
of the residents and recipients; 124
(3) Inform the residents and recipients about means of obtaining 125
services provided by providers or agencies described in subparagraph 126
(B) of subdivision (1) of this subsection or services described in 127
subdivision (2) of this subsection; 128
(4) Ensure that the residents, recipients and [, as to issues involving 129
applications for admission to long-term care facilities,] applicants have 130
regular and timely access to the services provided through the office 131
and that the residents, recipients, applicants and other complainants 132
receive timely responses from representatives of the office to 133
complaints; 134 Raised Bill No. 804
LCO No. 3668 6 of 16
(5) Represent the interests of the residents, recipients and [of] 135
applicants in relation to issues concerning applications to long-term 136
care facilities, or for home and community-based services before 137
governmental agencies and seek administrative, legal and other 138
remedies to protect the health, safety, welfare and rights of the 139
residents, recipients and applicants; 140
(6) Provide administrative and technical assistance to 141
representatives of the office and training in areas including, but not 142
limited to, Alzheimer's disease and dementia symptoms and care; 143
(7) (A) Analyze, comment on and monitor the development and 144
implementation of federal, state and local laws, regulations, and other 145
governmental policies and actions that pertain to the health, safety, 146
welfare and rights of the residents and recipients with respect to the 147
adequacy of long-term care facilities and home and community-based 148
services in this state and to the rights of applicants in relation to 149
applications to long-term care facilities and for home and community-150
based services; 151
(B) Recommend any changes in such laws, regulations, policies and 152
actions as the office determines to be appropriate; and 153
(C) Facilitate public comment on such laws, regulations, policies 154
and actions; 155
(8) Advocate for: 156
(A) Any changes in federal, state and local laws, regulations and 157
other governmental policies and actions that pertain to the health, 158
safety, welfare and rights of residents and recipients with respect to 159
the adequacy of long-term care facilities and home and community-160
based services in this state and to the health, safety, welfare and rights 161
of applicants [which] that the State Ombudsman determines to be 162
appropriate; 163
(B) Appropriate action by groups or agencies with jurisdictional 164 Raised Bill No. 804
LCO No. 3668 7 of 16
authority to deal with problems affecting individual residents and 165
recipients and the general resident population and applicants in 166
relation to issues concerning applications to long-term care facilities 167
and for home and community-based services; and 168
(C) The enactment of legislative recommendations by the General 169
Assembly and of regulatory recommendations by commissioners of 170
Connecticut state agencies; 171
(9) (A) Provide for training representatives of the office; 172
(B) Promote the development of citizen organizations to participate 173
in the program; and 174
(C) Provide technical support for the development of resident and 175
family councils to protect the well-being and rights of residents; 176
(10) Coordinate ombudsman services with the protection and 177
advocacy systems for individuals with developmental disabilities and 178
mental illnesses established under (A) Part A of the [Development] 179
Developmental Disabilities Assistance and Bill of Rights Act (42 USC 180
6001, et seq.), and (B) The Protection and Advocacy for Mentally Ill 181
Individuals Act of 1986 (42 USC 10801 et seq.); 182
(11) Coordinate, to the greatest extent possible, ombudsman services 183
with legal assistance provided under Section 306(a)(2)(C) of the federal 184
Older Americans Act of 1965, (42 USC 3026(a)(2)(C)) as amended from 185
time to time, through the adoption of memoranda of understanding 186
and other means; 187
(12) Create, and periodically update as needed, a training manual 188
for nursing home facilities identified in section 19a-522c that provides 189
guidance on structuring and implementing the training required by 190
said section; 191
(13) Develop policies and procedures regarding the communication 192
and documentation of informed consent in the case of resident or 193
recipient complaints, including, but not limited to, the use of auxiliary 194 Raised Bill No. 804
LCO No. 3668 8 of 16
aids and services or the use of a resident representative; and 195
(14) Carry out such other activities and duties as may be required 196
under federal law. 197
Sec. 5. Section 17a-409 of the general statutes is repealed and the 198
following is substituted in lieu thereof (Effective July 1, 2019): 199
The State Ombudsman is authorized to investigate and make 200
reports and recommendations concerning any act or the failure to act 201
by any agency, official or public employee, with respect to their 202
responsibilities and duties in connection with long-term care facilities 203
or home and community-based services, except the courts and their 204
personnel, legislative bodies and their personnel and the chief 205
executive of the state and the chief executive's personal staff and all 206
elected officials. 207
Sec. 6. Section 17a-410 of the general statutes is repealed and the 208
following is substituted in lieu thereof (Effective July 1, 2019): 209
The regional ombudsmen shall, in accordance with the policies and 210
procedures established by the Office of the Long-Term Care 211
Ombudsman and within available appropriations: 212
(1) Provide services to protect the health, safety, welfare and rights 213
of residents and recipients; 214
(2) Ensure that residents and recipients in service areas have regular 215
timely access to representatives of the office and timely responses to 216
complaints and requests for assistance; 217
(3) Identify, investigate and resolve complaints made by or on 218
behalf of residents and recipients that relate to action, inaction or 219
decisions that may adversely affect [the] their health, safety, welfare or 220
rights [of the residents] or by, or on behalf of, applicants in relation to 221
issues concerning applications for admission to long-term care 222
facilities or for home and community-based services; 223 Raised Bill No. 804
LCO No. 3668 9 of 16
(4) Represent the interests of residents, recipients and applicants, in 224
relation to their applications [to long-term care facilities] for admission 225
to long-term care facilities or for home and community-based services, 226
before government agencies and seek administrative, legal and other 227
remedies to protect the health, safety, welfare and rights of the 228
residents, recipients and applicants; 229
(5) (A) Review and, if necessary, comment on any existing and 230
proposed laws, regulations and other government policies and actions 231
that pertain to the rights and well-being of residents, recipients and 232
applicants in relation to their applications, [to long-term care facilities,] 233
and (B) facilitate the ability of the public to comment on the laws, 234
regulations, policies and actions; 235
(6) Support the development of resident and family councils; and 236
(7) Carry out other activities that the State Ombudsman determines 237
to be appropriate. 238
Sec. 7. Section 17a-411 of the general statutes is repealed and the 239
following is substituted in lieu thereof (Effective July 1, 2019): 240
(a) Residents' advocates, under supervision of the regional 241
ombudsmen, shall assist the regional ombudsmen in the performance 242
of all duties and responsibilities of the regional ombudsmen as 243
described in section 17a-410, as amended by this act. 244
(b) All long-term care facilities shall post or cause to be posted in a 245
conspicuous place therein a list of the names of the appropriate 246
residents' advocates and the names, addresses, and telephone numbers 247
of the appropriate regional ombudsmen. 248
(c) All providers of home and community-based services shall 249
provide their clients with a list of residents' advocates and the names, 250
addresses and telephone numbers of the appropriate regional 251
ombudsmen. 252
[(c)] (d) The Commissioner of Rehabilitation Services shall have 253 Raised Bill No. 804
LCO No. 3668 10 of 16
authority to seek funding for the purposes contained in this section 254
from public and private sources, including, but not limited to, any 255
federal or state funded programs. 256
Sec. 8. Section 17a-414 of the general statutes is repealed and the 257
following is substituted in lieu thereof (Effective July 1, 2019): 258
(a) The state agency shall, within available appropriations, ensure 259
that: 260
(1) Adequate legal counsel is available and is able, without conflict 261
of interest, to: (A) Provide advice and consultation needed to protect 262
the health, safety, welfare and rights of residents, recipients and 263
applicants in relation to their applications; [to long-term care facilities;] 264
and (B) assist the State Ombudsman and representatives of the office in 265
the performance of the official duties of the State Ombudsman and 266
representatives of the office; and 267
(2) Administrative, legal and other appropriate remedies are 268
pursued on behalf of residents, recipients and applicants in relation to 269
their applications. [to long-term care facilities.] 270
(b) The Assistant State Ombudsman, regional ombudsmen and 271
residents' advocates shall be considered state employees under section 272
4-141 for the purposes of any civil action for damages on account of 273
any act or omission that is not wanton, wilful or malicious and that is 274
within the scope of employment or duties under sections 17a-405 to 275
17a-417, inclusive, as amended by this act, 19a-531 and 19a-532. 276
Sec. 9. Section 17a-415 of the general statutes is repealed and the 277
following is substituted in lieu thereof (Effective July 1, 2019): 278
(a) The State Ombudsman, Assistant State Ombudsman, regional 279
ombudsmen and representatives of the office shall have: 280
(1) Access to long-term care facilities and residents; 281
(2) Appropriate access to review the medical and social records of a 282 Raised Bill No. 804
LCO No. 3668 11 of 16
resident or recipient, if (A) the representative of the office has the 283
permission of the resident, recipient or the legal representative of the 284
resident or recipient, (B) the resident or recipient is unable to consent 285
to the review and has no legal representative, or (C) access to the 286
records is necessary to investigate a complaint and a resident 287
representative refuses to give permission, a representative of the office 288
has reasonable cause to believe that the resident representative is not 289
acting in the best interests of the resident or recipient, and the 290
representative of the office obtains the approval of the [ombudsman] 291
State Ombudsman; 292
(3) Access to the administrative records, policies and documents, to 293
which the residents have, or the general public has access, of long-term 294
care facilities; and 295
(4) Access to and, on request, copies of all licensing and certification 296
records maintained by the state with respect to long-term care facilities 297
and providers of home and community-based services. 298
(b) Any person or entity who wilfully interferes with 299
representatives of the office in the performance of the official duties of 300
the representatives of the office, or any long-term care facility, home 301
and community-based service provider or other entity which retaliates 302
or exacts reprisals with respect to any resident, recipient, employee or 303
other person for filing a complaint with, providing information to, or 304
otherwise cooperating with any representative of the office, or long-305
term care facility which refuses to permit the State Ombudsman, [or] 306
Assistant State Ombudsman, any regional ombudsman or any 307
residents' or recipients' advocate entry into such facility or refuses to 308
cooperate with the State Ombudsman, or any regional ombudsman or 309
any residents' or recipients' advocate in the carrying out of [their] his 310
or her mandated duties and responsibilities enumerated under 311
sections 17a-405 to 17a-417, inclusive, as amended by this act, 19a-531 312
and 19a-532 or refuses to permit [residents] any resident or recipient or 313
staff to communicate freely with the State Ombudsman, [or] Assistant 314
State Ombudsman, any regional ombudsman or any residents' or 315 Raised Bill No. 804
LCO No. 3668 12 of 16
recipients' advocate shall be subject to the penalty prescribed for a 316
class B violation under section 19a-527. 317
(c) In carrying out the duties enumerated in sections 17a-405 to 17a-318
417, inclusive, as amended by this act, 19a-531 and 19a-532, the State 319
Ombudsman, the Assistant State Ombudsman, the regional 320
ombudsmen and the residents' or recipients' advocates shall have 321
access to all relevant public records, except that records which are 322
confidential to a resident or recipient shall only be divulged with the 323
written consent of the resident or recipient. 324
(d) In the performance of the duties and responsibilities enumerated 325
under sections 17a-405 to 17a-417, inclusive, as amended by this act, 326
19a-531 and 19a-532, the State Ombudsman, the Assistant State 327
Ombudsman, the regional ombudsmen and the residents' or recipients' 328
advocates may utilize any other state department, agency or 329
commission, or any other public or private agencies, groups or 330
individuals who are appropriate and who may be available. 331
Sec. 10. Section 17a-417 of the general statutes is repealed and the 332
following is substituted in lieu thereof (Effective July 1, 2019): 333
The Commissioner of Rehabilitation Services shall require the State 334
Ombudsman to, within available appropriations: 335
(1) Prepare an annual report: 336
(A) Describing the activities carried out by the office in the year for 337
which the report is prepared; 338
(B) Containing and analyzing the data collected under section 17a-339
418, as amended by this act; 340
(C) Evaluating the problems experienced by and the complaints 341
made by or on behalf of residents and recipients; 342
(D) Containing recommendations for (i) improving the quality of 343
the care and life of the residents and recipients, and (ii) protecting the 344 Raised Bill No. 804
LCO No. 3668 13 of 16
health, safety, welfare and rights of the residents and recipients; 345
(E) (i) Analyzing the success of the program including success in 346
providing services to residents [of long-term care facilities] and 347
recipients; and (ii) identifying barriers that prevent the optimal 348
operation of the program; and 349
(F) Providing policy, regulatory and legislative recommendations to 350
solve identified problems, to resolve the complaints, to improve the 351
quality of the care and life of residents and recipients, to protect [the] 352
their health, safety, welfare and rights [of residents] and to remove the 353
barriers that prevent the optimal operation of the program. 354
(2) Analyze, comment on and monitor the development and 355
implementation of federal, state and local laws, regulations and other 356
government policies and actions that pertain to long-term care facilities 357
and home and community-based services, and to the health, safety, 358
welfare and rights of residents and recipients in the state, and 359
recommend any changes in such laws, regulations and policies as the 360
office determines to be appropriate. 361
(3) (A) Provide such information as the office determines to be 362
necessary to public and private agencies, legislators and other persons, 363
regarding (i) the problems and concerns of [older individuals residing 364
in long-term care facilities] residents and recipients; and (ii) 365
recommendations related to the problems and concerns; and (B) make 366
available to the public and submit to the federal assistant secretary for 367
aging, the Governor, the General Assembly, the Department of Public 368
Health and other appropriate governmental entities, each report 369
prepared under subdivision (1) of this section. 370
Sec. 11. Section 17a-418 of the general statutes is repealed and the 371
following is substituted in lieu thereof (Effective July 1, 2019): 372
The state agency shall establish a state-wide uniform system to: (1) 373
Collect and analyze data relating to complaints and conditions in long-374
term care facilities and, [to residents] within available appropriations, 375 Raised Bill No. 804
LCO No. 3668 14 of 16
complaints relating to services provided to residents and recipients for 376
the purpose of identifying and resolving significant problems; and (2) 377
submit the data, on a regular basis to: (A) The Department of Public 378
Health; (B) other state and federal entities that the State Ombudsman 379
determines to be appropriate; and (C) the National Ombudsman 380
Resource Center, established in Section 202(a)(21) of the federal Older 381
Americans Act of 1965, as amended from time to time. 382
Sec. 12. Section 17a-419 of the general statutes is repealed and the 383
following is substituted in lieu thereof (Effective July 1, 2019): 384
The state agency shall: 385
(1) Provide that the files and records maintained by the program 386
may be disclosed only at the discretion of the State Ombudsman or the 387
person designated by the ombudsman to disclose the files and records; 388
and 389
(2) Prohibit the disclosure of the identity of any complainant, [or] 390
resident or recipient with respect to whom the office maintains such 391
files or records unless (A) the complainant, [or] resident or recipient, or 392
the legal representative of the complainant, [or] resident or recipient, 393
consents to the disclosure and the consent is given in writing; (B) (i) the 394
complainant, [or] resident or recipient gives consent orally; and (ii) the 395
consent is documented contemporaneously in a writing made by a 396
representative of the office in accordance with such requirements as 397
the state agency shall establish; or (iii) the disclosure is required by 398
court order. 399
Sec. 13. Section 17a-420 of the general statutes is repealed and the 400
following is substituted in lieu thereof (Effective July 1, 2019): 401
In planning and operating the program, the state agency, in 402
consultation with the State Ombudsman, shall consider the views of 403
area agencies on aging, long-term care facility residents, recipients and 404
providers of long-term care, including home and community-based 405
services. 406 Raised Bill No. 804
LCO No. 3668 15 of 16
Sec. 14. Subdivision (3) of section 17a-421 of the general statutes is 407
repealed and the following is substituted in lieu thereof (Effective July 408
1, 2019): 409
(3) Ensure that the State Ombudsman: (A) Does not have a direct 410
involvement in the licensing or certification of a long-term care facility 411
or of a provider of a long-term care service, including a home and 412
community-based service; (B) does not have an ownership or 413
investment interest, represented by equity, debt or other financial 414
relationship, in a long-term care facility or a long-term care service, 415
including a home and community-based service; (C) is not employed 416
by, or participating in the management of, a long-term care facility or a 417
home and community-based service and has not been employed by or 418
participated in such management in the twelve months prior to being 419
State Ombudsman; and (D) does not receive, or have the right to 420
receive, directly or indirectly, remuneration, in cash or in kind, under a 421
compensation arrangement with an owner or operator of a long-term 422
care facility or a home and community-based service; and 423
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2019 17a-405
Sec. 2 July 1, 2019 17a-406(a)
Sec. 3 July 1, 2019 17a-407
Sec. 4 July 1, 2019 17a-408
Sec. 5 July 1, 2019 17a-409
Sec. 6 July 1, 2019 17a-410
Sec. 7 July 1, 2019 17a-411
Sec. 8 July 1, 2019 17a-414
Sec. 9 July 1, 2019 17a-415
Sec. 10 July 1, 2019 17a-417
Sec. 11 July 1, 2019 17a-418
Sec. 12 July 1, 2019 17a-419
Sec. 13 July 1, 2019 17a-420
Sec. 14 July 1, 2019 17a-421(3)
Raised Bill No. 804
LCO No. 3668 16 of 16
Statement of Purpose:
To expand the investigatory oversight of the State Ombudsman to
include home and community-based services.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
not underlined.]