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General Assembly Raised Bill No. 919
January Session, 2019
LCO No. 4096
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT REMOVING THE TER M "HOMEMAKER" IN REF ERENCE TO
HOME HEALTH AIDE AGE NCIES AND SERVICES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 17b-242 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective July 1, 2019): 2
(a) The Department of Social Services shall determine the rates to be 3
paid to home health care agencies and [homemaker-home] home 4
health aide agencies by the state or any town in the state for persons 5
aided or cared for by the state or any such town. For the period from 6
February 1, 1991, to January 31, 1992, inclusive, payment for each 7
service to the state shall be based upon the rate for such service as 8
determined by the Office of Health Care Access, except that for those 9
providers whose Medicaid rates for the year ending January 31, 1991, 10
exceed the median rate, no increase shall be allowed. For those 11
providers whose rates for the year ending January 31, 1991, are below 12
the median rate, increases shall not exceed the lower of the prior rate 13
increased by the most recent annual increase in the consumer price 14
index for urban consumers or the median rate. In no case shall any 15
such rate exceed the eightieth percentile of rates in effect January 31, 16 Raised Bill No. 919
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1991, nor shall any rate exceed the charge to the general public for 17
similar services. Rates effective February 1, 1992, shall be based upon 18
rates as determined by the Office of Health Care Access, except that 19
increases shall not exceed the prior year's rate increased by the most 20
recent annual increase in the consumer price index for urban 21
consumers and rates effective February 1, 1992, shall remain in effect 22
through June 30, 1993. Rates effective July 1, 1993, shall be based upon 23
rates as determined by the Office of Health Care Access except if the 24
Medicaid rates for any service for the period ending June 30, 1993, 25
exceed the median rate for such service, the increase effective July 1, 26
1993, shall not exceed one per cent. If the Medicaid rate for any service 27
for the period ending June 30, 1993, is below the median rate, the 28
increase effective July 1, 1993, shall not exceed the lower of the prior 29
rate increased by one and one-half times the most recent annual 30
increase in the consumer price index for urban consumers or the 31
median rate plus one per cent. The Commissioner of Social Services 32
shall establish a fee schedule for home health services to be effective on 33
and after July 1, 1994. The commissioner may annually modify such 34
fee schedule if such modification is needed to ensure that the 35
conversion to an administrative services organization is cost neutral to 36
home health care agencies and [homemaker-home] home health aide 37
agencies in the aggregate and ensures patient access. Utilization may 38
be a factor in determining cost neutrality. The commissioner shall 39
increase the fee schedule for home health services provided under the 40
Connecticut home-care program for the elderly established under 41
section 17b-342, effective July 1, 2000, by two per cent over the fee 42
schedule for home health services for the previous year. The 43
commissioner may increase any fee payable to a home health care 44
agency or [homemaker-home] home health aide agency upon the 45
application of such an agency evidencing extraordinary costs related to 46
(1) serving persons with AIDS; (2) high-risk maternal and child health 47
care; (3) escort services; or (4) extended hour services. In no case shall 48
any rate or fee exceed the charge to the general public for similar 49
services. A home health care agency or [homemaker-home] home 50
health aide agency which, due to any material change in 51 Raised Bill No. 919
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circumstances, is aggrieved by a rate determined pursuant to this 52
subsection may, within ten days of receipt of written notice of such 53
rate from the Commissioner of Social Services, request in writing a 54
hearing on all items of aggrievement. The commissioner shall, upon 55
the receipt of all documentation necessary to evaluate the request, 56
determine whether there has been such a change in circumstances and 57
shall conduct a hearing if appropriate. The Commissioner of Social 58
Services shall adopt regulations, in accordance with chapter 54, to 59
implement the provisions of this subsection. The commissioner may 60
implement policies and procedures to carry out the provisions of this 61
subsection while in the process of adopting regulations, provided 62
notice of intent to adopt the regulations is published in the Connecticut 63
Law Journal not later than twenty days after the date of implementing 64
the policies and procedures. Such policies and procedures shall be 65
valid for not longer than nine months. 66
(b) The Department of Social Services shall monitor the rates 67
charged by home health care agencies and [homemaker-home] home 68
health aide agencies. Such agencies shall file annual cost reports and 69
service charge information with the department. 70
(c) The home health services fee schedule shall include a fee for the 71
administration of medication, which shall apply when the purpose of a 72
nurse's visit is limited to the administration of medication. 73
Administration of medication may include, but is not limited to, blood 74
pressure checks, glucometer readings, pulse rate checks and similar 75
indicators of health status. The fee for medication administration shall 76
include administration of medications while the nurse is present, the 77
pre-pouring of additional doses that the client will self-administer at a 78
later time and the teaching of self-administration. The department 79
shall not pay for medication administration in addition to any other 80
nursing service at the same visit. The department may establish prior 81
authorization requirements for this service. Before implementing such 82
change, the Commissioner of Social Services shall consult with the 83
chairpersons of the joint standing committees of the General Assembly 84 Raised Bill No. 919
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having cognizance of matters relating to public health and human 85
services. The commissioner shall monitor Medicaid home health care 86
savings achieved through the implementation of nurse delegation of 87
medication administration pursuant to section 19a-492e, as amended 88
by this act. If, by January 1, 2016, the commissioner determines that the 89
rate of savings is not adequate to meet the annualized savings 90
assumed in the budget for the biennium ending June 30, 2017, the 91
department may reduce rates for medication administration as 92
necessary to achieve the savings assumed in the budget. Prior to any 93
rate reduction, the department shall report to the joint standing 94
committees of the General Assembly having cognizance of matters 95
relating to appropriations and the budgets of state agencies and 96
human services provider specific cost and utilization trend data for 97
those patients receiving medication administration. Should the 98
department determine it necessary to reduce medication 99
administration rates under this section, it shall examine the possibility 100
of establishing a separate Medicaid supplemental rate or a pay-for-101
performance program for those providers, as determined by the 102
commissioner, who have established successful nurse delegation 103
programs. 104
(d) The home health services fee schedule established pursuant to 105
subsection (c) of this section shall include rates for psychiatric nurse 106
visits. 107
(e) The Department of Social Services, when processing or auditing 108
claims for reimbursement submitted by home health care agencies and 109
[homemaker-home] home health aide agencies shall, in accordance 110
with the provisions of chapter 15, accept electronic records and records 111
bearing the electronic signature of a licensed physician or licensed 112
practitioner of a healthcare profession that has been submitted to the 113
home health care agency or [homemaker home-health] home health 114
aide agency. 115
(f) If the electronic record or signature that has been transmitted to a 116
home health care agency or [homemaker-home] home health aide 117 Raised Bill No. 919
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agency is illegible or the department is unable to determine the 118
validity of such electronic record or signature, the department shall 119
review additional evidence of the accuracy or validity of the record or 120
signature, including, but not limited to, (1) the original of the record or 121
signature, or (2) a written statement, made under penalty of false 122
statement, from (A) the licensed physician or licensed practitioner of a 123
health care profession who signed such record, or (B) if such licensed 124
physician or licensed practitioner of a health care profession is 125
unavailable, the medical director of the agency verifying the accuracy 126
or validity of such record or signature, and the department shall make 127
a determination whether the electronic record or signature is valid. 128
(g) The Department of Social Services, when auditing claims 129
submitted by home health care agencies and [homemaker-home] home 130
health aide agencies, shall consider any signature from a licensed 131
physician or licensed practitioner of a health care profession that may 132
be required on a plan of care for home health services, to have been 133
provided in timely fashion if (1) the document bearing such signature 134
was signed prior to the time when such agency seeks reimbursement 135
from the department for services provided, and (2) verbal or telephone 136
orders from the licensed physician or licensed practitioner of a health 137
care profession were received prior to the commencement of services 138
covered by the plan of care and such orders were subsequently 139
documented. Nothing in this subsection shall be construed as limiting 140
the powers of the Commissioner of Public Health to enforce the 141
provisions of sections 19-13-D73 and 19-13-D74 of the regulations of 142
Connecticut state agencies and 42 CFR 484.18(c). 143
(h) For purposes of this section, "licensed practitioner of a healthcare 144
profession" has the same meaning as "licensed practitioner" in section 145
21a-244a. 146
Sec. 2. Subsection (a) of section 19a-490 of the general statutes is 147
repealed and the following is substituted in lieu thereof (Effective July 148
1, 2019): 149 Raised Bill No. 919
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(a) "Institution" means a hospital, short-term hospital special 150
hospice, hospice inpatient facility, residential care home, nursing home 151
facility, home health care agency, [homemaker-home] home health 152
aide agency, behavioral health facility, assisted living services agency, 153
substance abuse treatment facility, outpatient surgical facility, 154
outpatient clinic, an infirmary operated by an educational institution 155
for the care of students enrolled in, and faculty and employees of, such 156
institution; a facility engaged in providing services for the prevention, 157
diagnosis, treatment or care of human health conditions, including 158
facilities operated and maintained by any state agency; and a 159
residential facility for persons with intellectual disability licensed 160
pursuant to section 17a-227 and certified to participate in the Title XIX 161
Medicaid program as an intermediate care facility for individuals with 162
intellectual disability. "Institution" does not include any facility for the 163
care and treatment of persons with mental illness or substance use 164
disorder operated or maintained by any state agency, except Whiting 165
Forensic Hospital; 166
Sec. 3. Subsections (d) to (f), inclusive, of section 19a-490 of the 167
general statutes are repealed and the following is substituted in lieu 168
thereof (Effective July 1, 2019): 169
(d) "Home health care agency" means a public or private 170
organization, or a subdivision thereof, engaged in providing 171
professional nursing services and the following services, available 172
twenty-four hours per day, in the patient's home or a substantially 173
equivalent environment: [Homemaker-home] Home health aide 174
services as defined in this section, physical therapy, speech therapy, 175
occupational therapy or medical social services. The agency shall 176
provide professional nursing services and at least one additional 177
service directly and all others directly or through contract. An agency 178
shall be available to enroll new patients seven days a week, twenty-179
four hours per day; 180
(e) ["Homemaker-home health aide agency"] "Home health aide 181
agency" means a public or private organization, except a home health 182 Raised Bill No. 919
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care agency, which provides in the patient's home or a substantially 183
equivalent environment supportive services which may include, but 184
are not limited to, assistance with personal hygiene, dressing, feeding 185
and incidental household tasks essential to achieving adequate 186
household and family management. Such supportive services shall be 187
provided under the supervision of a registered nurse and, if such 188
nurse determines appropriate, shall be provided by a social worker, 189
physical therapist, speech therapist or occupational therapist. Such 190
supervision may be provided directly or through contract; 191
(f) ["Homemaker-home health aide services"] "Home health aide 192
services" as defined in this section shall not include services provided 193
to assist individuals with activities of daily living when such 194
individuals have a disease or condition that is chronic and stable as 195
determined by a physician licensed in the state; [of Connecticut;] 196
Sec. 4. Subsection (k) of section 19a-490 of the general statutes is 197
repealed and the following is substituted in lieu thereof (Effective July 198
1, 2019): 199
(k) "Home health agency" means an agency licensed as a home 200
health care agency or a [homemaker-home] home health aide agency; 201
Sec. 5. Section 19a-490g of the general statutes is repealed and the 202
following is substituted in lieu thereof (Effective July 1, 2019): 203
The Department of Public Health shall develop and produce a 204
consumer guide of bilingual information on home health care agencies 205
and [homemaker-home] home health aide agencies. 206
Sec. 6. Subsections (h) and (i) of section 19a-491 of the general 207
statutes are repealed and the following is substituted in lieu thereof 208
(Effective July 1, 2019): 209
(h) The commissioner may require as a condition of the licensure of 210
home health care agencies and [homemaker-home] home health aide 211
agencies that each agency meet minimum service quality standards. In 212 Raised Bill No. 919
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the event the commissioner requires such agencies to meet minimum 213
service quality standards as a condition of their licensure, the 214
commissioner shall adopt regulations, in accordance with the 215
provisions of chapter 54, to define such minimum service quality 216
standards, which shall (1) allow for training of [homemaker-home] 217
home health aides by adult continuing education, (2) require a 218
registered nurse to visit and assess each patient receiving [homemaker-219
home] home health aide services as often as necessary based on the 220
patient's condition, but not less than once every sixty days, and (3) 221
require the assessment prescribed by subdivision (2) of this subsection 222
to be completed while the [homemaker-home] home health aide is 223
providing services in the patient's home. 224
(i) No person acting individually or jointly with any other person 225
shall establish, conduct, operate or maintain a home health care agency 226
or [homemaker-home] home health aide agency without maintaining 227
professional liability insurance or other indemnity against liability for 228
professional malpractice. The amount of insurance which such person 229
shall maintain as insurance or indemnity against claims for injury or 230
death for professional malpractice shall be not less than one million 231
dollars for one person, per occurrence, with an aggregate of not less 232
than three million dollars. 233
Sec. 7. Section 19a-492d of the general statutes is repealed and the 234
following is substituted in lieu thereof (Effective July 1, 2019): 235
On and after October 1, 2007, a nurse who is employed by an agency 236
licensed by the Department of Public Health as a home health care 237
agency or a [homemaker-home] home health aide agency may 238
administer influenza and pneumococcal vaccines to persons in their 239
homes, after an assessment for contraindications, without a physician's 240
order in accordance with a physician-approved agency policy that 241
includes an anaphylaxis protocol. In the event of an adverse reaction to 242
the vaccine, such nurse may also administer epinephrine or other 243
anaphylaxis medication without a physician's order in accordance with 244
the physician-approved agency policy. For purposes of this section, 245 Raised Bill No. 919
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"nurse" means an advanced practice registered nurse, registered nurse 246
or practical nurse licensed under chapter 378. 247
Sec. 8. Section 19a-492e of the general statutes is repealed and the 248
following is substituted in lieu thereof (Effective July 1, 2019): 249
(a) For purposes of this section "home health care agency" has the 250
same meaning as provided in section 19a-490, as amended by this act. 251
Notwithstanding the provisions of chapter 378, a registered nurse may 252
delegate the administration of medications that are not administered 253
by injection to [homemaker-home] home health aides who have 254
obtained certification and recertification every three years thereafter 255
for medication administration in accordance with regulations adopted 256
pursuant to subsection (b) of this section, unless the prescribing 257
practitioner specifies that a medication shall only be administered by a 258
licensed nurse. Any [homemaker-home] home health aide who 259
obtained certification in the administration of medications on or before 260
June 30, 2015, shall obtain recertification on or before July 1, 2018. 261
(b) (1) The Commissioner of Public Health shall adopt regulations, 262
in accordance with the provisions of chapter 54, to carry out the 263
provisions of this section. Such regulations shall require each home 264
health care agency that serves clients requiring assistance with 265
medication administration to (A) adopt practices that increase and 266
encourage client choice, dignity and independence; (B) establish 267
policies and procedures to ensure that a registered nurse may delegate 268
allowed tasks of nursing care, to include medication administration, to 269
[homemaker-home] home health aides when the registered nurse 270
determines that it is in the best interest of the client and the 271
[homemaker-home] home health aide has been deemed competent to 272
perform the task; (C) designate [homemaker-home] home health aides 273
to obtain certification and recertification for the administration of 274
medication; and (D) ensure that such [homemaker-home] home health 275
aides receive such certification and recertification. 276
(2) The regulations shall establish certification and recertification 277 Raised Bill No. 919
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requirements for medication administration and the criteria to be used 278
by home health care agencies that provide services for clients requiring 279
assistance with medication administration in determining (A) which 280
[homemaker-home] home health aides shall obtain such certification 281
and recertification, and (B) education and skill training requirements, 282
including ongoing training requirements for such certification and 283
recertification. 284
(3) Education and skill training requirements for initial certification 285
and recertification shall include, but not be limited to, initial 286
orientation, training in client rights and identification of the types of 287
medication that may be administered by unlicensed personnel, 288
behavioral management, personal care, nutrition and food safety, and 289
health and safety in general. 290
(c) Each home health care agency shall ensure that, on or before 291
January 1, 2013, delegation of nursing care tasks in the home care 292
setting is allowed within such agency and that policies are adopted to 293
employ [homemaker-home] home health aides for the purposes of 294
allowing nurses to delegate such tasks. 295
(d) A registered nurse licensed pursuant to the provisions of chapter 296
378 who delegates the task of medication administration to a 297
[homemaker-home] home health aide pursuant to this section shall not 298
be subject to disciplinary action based on the performance of the 299
[homemaker-home] home health aide to whom tasks are delegated, 300
unless the [homemaker-home] home health aide is acting pursuant to 301
specific instructions from the registered nurse or the registered nurse 302
fails to leave instructions when the nurse should have done so, 303
provided the registered nurse: (1) Documented in the patient's care 304
plan that the medication administration could be properly and safely 305
performed by the [homemaker-home] home health aide to whom it is 306
delegated, (2) provided initial direction to the [homemaker-home] 307
home health aide, and (3) provided ongoing supervision of the 308
[homemaker-home] home health aide, including the periodic 309
assessment and evaluation of the patient's health and safety related to 310 Raised Bill No. 919
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medication administration. 311
(e) A registered nurse who delegates the provision of nursing care 312
to another person pursuant to this section shall not be subject to an 313
action for civil damages for the performance of the person to whom 314
nursing care is delegated unless the person is acting pursuant to 315
specific instructions from the nurse or the nurse fails to leave 316
instructions when the nurse should have done so. 317
(f) No person may coerce a registered nurse into compromising 318
patient safety by requiring the nurse to delegate the administration of 319
medication if the nurse's assessment of the patient documents a need 320
for a nurse to administer medication and identifies why the need 321
cannot be safely met through utilization of assistive technology or 322
administration of medication by certified [homemaker-home] home 323
health aides. No registered nurse who has made a reasonable 324
determination based on such assessment that delegation may 325
compromise patient safety shall be subject to any employer reprisal or 326
disciplinary action pursuant to chapter 378 for refusing to delegate or 327
refusing to provide the required training for such delegation. The 328
Department of Social Services, in consultation with the Department of 329
Public Health and home health care agencies, shall develop protocols 330
for documentation pursuant to the requirements of this subsection. 331
The Department of Social Services shall notify all licensed home health 332
care agencies of such protocols prior to the implementation of this 333
section. 334
(g) The Commissioner of Public Health may implement policies and 335
procedures necessary to administer the provisions of this section while 336
in the process of adopting such policies and procedures as regulations, 337
provided notice of intent to adopt regulations is published in the 338
Connecticut Law Journal not later than twenty days after the date of 339
implementation. Policies and procedures implemented pursuant to 340
this section shall be valid until the time final regulations are adopted. 341
Sec. 9. Subsection (a) of section 19a-495 of the general statutes is 342 Raised Bill No. 919
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repealed and the following is substituted in lieu thereof (Effective July 343
1, 2019): 344
(a) The Department of Public Health shall, after consultation with 345
the appropriate public and voluntary hospital planning agencies, 346
establish classifications of institutions. The department shall, in the 347
Public Health Code, adopt, amend, promulgate and enforce such 348
regulations based upon reasonable standards of health, safety and 349
comfort of patients and demonstrable need for such institutions, with 350
respect to each classification of institutions to be licensed under 351
sections 19a-490 to 19a-503, inclusive, as amended by this act, 352
including their special facilities, as will further the accomplishment of 353
the purposes of said sections in promoting safe, humane and adequate 354
care and treatment of individuals in institutions. The department shall 355
adopt such regulations, in accordance with chapter 54, concerning 356
home health care agencies and [homemaker-home] home health aide 357
agencies. 358
Sec. 10. Subdivision (2) of subsection (a) of section 19a-905 of the 359
general statutes is repealed and the following is substituted in lieu 360
thereof (Effective July 1, 2019): 361
(2) "Health care facility or institution" means a hospital, nursing 362
home, rest home, home health care agency, [homemaker-home] home 363
health aide agency, emergency medical services organization, assisted 364
living services agency, outpatient surgical facility and an infirmary 365
operated by an educational institution for the care of students enrolled 366
in, and faculty and employees of, such institution. 367
Sec. 11. Subdivision (7) of section 20-670 of the general statutes is 368
repealed and the following is substituted in lieu thereof (Effective July 369
1, 2019): 370
(7) "Homemaker-companion agency" means (A) any public or 371
private organization that employs one or more persons and is engaged 372
in the business of providing companion services or homemaker 373 Raised Bill No. 919
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services, or (B) any registry. "Homemaker-companion agency" shall 374
not include a home health care agency, as defined in subsection (d) of 375
section 19a-490, as amended by this act, or a [homemaker-home] home 376
health aide agency, as defined in subsection (e) of section 19a-490. 377
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2019 17b-242
Sec. 2 July 1, 2019 19a-490(a)
Sec. 3 July 1, 2019 19a-490(d) to (f)
Sec. 4 July 1, 2019 19a-490(k)
Sec. 5 July 1, 2019 19a-490g
Sec. 6 July 1, 2019 19a-491(h) and (i)
Sec. 7 July 1, 2019 19a-492d
Sec. 8 July 1, 2019 19a-492e
Sec. 9 July 1, 2019 19a-495(a)
Sec. 10 July 1, 2019 19a-905(a)(2)
Sec. 11 July 1, 2019 20-670(7)
PH Joint Favorable