Senate Bill No. 919
Public Act No. 19-97
AN ACT REMOVING THE TERM "HOMEMAKER" IN REFERENCE
TO HOME HEALTH AIDE AGENCIES AND SERVICE S.
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 Section 17b-242 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective July 1, 2019):
(a) The Department of Social Services shall determine the rates to be
paid to home health care agencies and [homemaker-home] home
health aide agencies by the state or any town in the state for persons
aided or cared for by the state or any such town. For the period from
February 1, 1991, to January 31, 1992, inclusive, payment for each
service to the state shall be based upon the rate for such service as
determined by the Office of Health Care Access, except that for those
providers whose Medicaid rates for the year ending January 31, 1991,
exceed the median rate, no increase shall be allowed. For those
providers whose rates for the year ending January 31, 1991, are below
the median rate, increases shall not exceed the lower of the prior rate
increased by the most recent annual increase in the consumer price
index for urban consumers or the median rate. In no case shall any
such rate exceed the eightieth percentile of rates in effect January 31,
1991, nor shall any rate exceed the charge to the general public for
similar services. Rates effective February 1, 1992, shall be based upon Senate Bill No. 919
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rates as determined by the Office of Health Care Access, except that
increases shall not exceed the prior year's rate increased by the most
recent annual increase in the consumer price index for urban
consumers and rates effective February 1, 1992, shall remain in effect
through June 30, 1993. Rates effective July 1, 1993, shall be based upon
rates as determined by the Office of Health Care Access except if the
Medicaid rates for any service for the period ending June 30, 1993,
exceed the median rate for such service, the increase effective July 1,
1993, shall not exceed one per cent. If the Medicaid rate for any service
for the period ending June 30, 1993, is below the median rate, the
increase effective July 1, 1993, shall not exceed the lower of the prior
rate increased by one and one-half times the most recent annual
increase in the consumer price index for urban consumers or the
median rate plus one per cent. The Commissioner of Social Services
shall establish a fee schedule for home health services to be effective on
and after July 1, 1994. The commissioner may annually modify such
fee schedule if such modification is needed to ensure that the
conversion to an administrative services organization is cost neutral to
home health care agencies and [homemaker-home] home health aide
agencies in the aggregate and ensures patient access. Utilization may
be a factor in determining cost neutrality. The commissioner shall
increase the fee schedule for home health services provided under the
Connecticut home-care program for the elderly established under
section 17b-342, effective July 1, 2000, by two per cent over the fee
schedule for home health services for the previous year. The
commissioner may increase any fee payable to a home health care
agency or [homemaker-home] home health aide agency upon the
application of such an agency evidencing extraordinary costs related to
(1) serving persons with AIDS; (2) high-risk maternal and child health
care; (3) escort services; or (4) extended hour services. In no case shall
any rate or fee exceed the charge to the general public for similar
services. A home health care agency or [homemaker-home] home
health aide agency which, due to any material change in Senate Bill No. 919
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circumstances, is aggrieved by a rate determined pursuant to this
subsection may, within ten days of receipt of written notice of such
rate from the Commissioner of Social Services, request in writing a
hearing on all items of aggrievement. The commissioner shall, upon
the receipt of all documentation necessary to evaluate the request,
determine whether there has been such a change in circumstances and
shall conduct a hearing if appropriate. The Commissioner of Social
Services shall adopt regulations, in accordance with chapter 54, to
implement the provisions of this subsection. The commissioner may
implement policies and procedures to carry out the provisions of this
subsection while in the process of adopting regulations, provided
notice of intent to adopt the regulations is published in the Connecticut
Law Journal not later than twenty days after the date of implementing
the policies and procedures. Such policies and procedures shall be
valid for not longer than nine months.
(b) The Department of Social Services shall monitor the rates
charged by home health care agencies and [homemaker-home] home
health aide agencies. Such agencies shall file annual cost reports and
service charge information with the department.
(c) The home health services fee schedule shall include a fee for the
administration of medication, which shall apply when the purpose of a
nurse's visit is limited to the administration of medication.
Administration of medication may include, but is not limited to, blood
pressure checks, glucometer readings, pulse rate checks and similar
indicators of health status. The fee for medication administration shall
include administration of medications while the nurse is present, the
pre-pouring of additional doses that the client will self-administer at a
later time and the teaching of self-administration. The department
shall not pay for medication administration in addition to any other
nursing service at the same visit. The department may establish prior
authorization requirements for this service. Before implementing such Senate Bill No. 919
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change, the Commissioner of Social Services shall consult with the
chairpersons of the joint standing committees of the General Assembly
having cognizance of matters relating to public health and human
services. The commissioner shall monitor Medicaid home health care
savings achieved through the implementation of nurse delegation of
medication administration pursuant to section 19a-492e, as amended
by this act. If, by January 1, 2016, the commissioner determines that the
rate of savings is not adequate to meet the annualized savings
assumed in the budget for the biennium ending June 30, 2017, the
department may reduce rates for medication administration as
necessary to achieve the savings assumed in the budget. Prior to any
rate reduction, the department shall report to the joint standing
committees of the General Assembly having cognizance of matters
relating to appropriations and the budgets of state agencies and
human services provider specific cost and utilization trend data for
those patients receiving medication administration. Should the
department determine it necessary to reduce medication
administration rates under this section, it shall examine the possibility
of establishing a separate Medicaid supplemental rate or a pay-for-
performance program for those providers, as determined by the
commissioner, who have established successful nurse delegation
programs.
(d) The home health services fee schedule established pursuant to
subsection (c) of this section shall include rates for psychiatric nurse
visits.
(e) The Department of Social Services, when processing or auditing
claims for reimbursement submitted by home health care agencies and
[homemaker-home] home health aide agencies shall, in accordance
with the provisions of chapter 15, accept electronic records and records
bearing the electronic signature of a licensed physician or licensed
practitioner of a healthcare profession that has been submitted to the Senate Bill No. 919
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home health care agency or [homemaker home-health] home health
aide agency.
(f) If the electronic record or signature that has been transmitted to a
home health care agency or [homemaker-home] home health aide
agency is illegible or the department is unable to determine the
validity of such electronic record or signature, the department shall
review additional evidence of the accuracy or validity of the record or
signature, including, but not limited to, (1) the original of the record or
signature, or (2) a written statement, made under penalty of false
statement, from (A) the licensed physician or licensed practitioner of a
health care profession who signed such record, or (B) if such licensed
physician or licensed practitioner of a health care profession is
unavailable, the medical director of the agency verifying the accuracy
or validity of such record or signature, and the department shall make
a determination whether the electronic record or signature is valid.
(g) The Department of Social Services, when auditing claims
submitted by home health care agencies and [homemaker-home] home
health aide agencies, shall consider any signature from a licensed
physician or licensed practitioner of a health care profession that may
be required on a plan of care for home health services, to have been
provided in timely fashion if (1) the document bearing such signature
was signed prior to the time when such agency seeks reimbursement
from the department for services provided, and (2) verbal or telephone
orders from the licensed physician or licensed practitioner of a health
care profession were received prior to the commencement of services
covered by the plan of care and such orders were subsequently
documented. Nothing in this subsection shall be construed as limiting
the powers of the Commissioner of Public Health to enforce the
provisions of sections 19-13-D73 and 19-13-D74 of the regulations of
Connecticut state agencies and 42 CFR 484.18(c).
(h) For purposes of this section, "licensed practitioner of a healthcare Senate Bill No. 919
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profession" has the same meaning as "licensed practitioner" in section
21a-244a.
Sec. 2. Subsection (a) of section 19a-490 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective July
1, 2019):
(a) "Institution" means a hospital, short-term hospital special
hospice, hospice inpatient facility, residential care home, nursing home
facility, home health care agency, [homemaker-home] home health
aide agency, behavioral health facility, assisted living services agency,
substance abuse treatment facility, outpatient surgical facility,
outpatient clinic, an infirmary operated by an educational institution
for the care of students enrolled in, and faculty and employees of, such
institution; a facility engaged in providing services for the prevention,
diagnosis, treatment or care of human health conditions, including
facilities operated and maintained by any state agency; and a
residential facility for persons with intellectual disability licensed
pursuant to section 17a-227 and certified to participate in the Title XIX
Medicaid program as an intermediate care facility for individuals with
intellectual disability. "Institution" does not include any facility for the
care and treatment of persons with mental illness or substance use
disorder operated or maintained by any state agency, except Whiting
Forensic Hospital;
Sec. 3. Subsections (d) to (f), inclusive, of section 19a-490 of the
general statutes are repealed and the following is substituted in lieu
thereof (Effective July 1, 2019):
(d) "Home health care agency" means a public or private
organization, or a subdivision thereof, engaged in providing
professional nursing services and the following services, available
twenty-four hours per day, in the patient's home or a substantially
equivalent environment: [Homemaker-home] Home health aide Senate Bill No. 919
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services as defined in this section, physical therapy, speech therapy,
occupational therapy or medical social services. The agency shall
provide professional nursing services and at least one additional
service directly and all others directly or through contract. An agency
shall be available to enroll new patients seven days a week, twenty-
four hours per day;
(e) ["Homemaker-home health aide agency"] "Home health aide
agency" means a public or private organization, except a home health
care agency, which provides in the patient's home or a substantially
equivalent environment supportive services which may include, but
are not limited to, assistance with personal hygiene, dressing, feeding
and incidental household tasks essential to achieving adequate
household and family management. Such supportive services shall be
provided under the supervision of a registered nurse and, if such
nurse determines appropriate, shall be provided by a social worker,
physical therapist, speech therapist or occupational therapist. Such
supervision may be provided directly or through contract;
(f) ["Homemaker-home health aide services"] "Home health aide
services" as defined in this section shall not include services provided
to assist individuals with activities of daily living when such
individuals have a disease or condition that is chronic and stable as
determined by a physician licensed in the state; [of Connecticut;]
Sec. 4. Subsection (k) of section 19a-490 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective July
1, 2019):
(k) "Home health agency" means an agency licensed as a home
health care agency or a [homemaker-home] home health aide agency;
Sec. 5. Section 19a-490g of the general statutes is repealed and the
following is substituted in lieu thereof (Effective July 1, 2019): Senate Bill No. 919
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The Department of Public Health shall develop and produce a
consumer guide of bilingual information on home health care agencies
and [homemaker-home] home health aide agencies.
Sec. 6. Subsections (h) and (i) of section 19a-491 of the general
statutes are repealed and the following is substituted in lieu thereof
(Effective July 1, 2019):
(h) The commissioner may require as a condition of the licensure of
home health care agencies and [homemaker-home] home health aide
agencies that each agency meet minimum service quality standards. In
the event the commissioner requires such agencies to meet minimum
service quality standards as a condition of their licensure, the
commissioner shall adopt regulations, in accordance with the
provisions of chapter 54, to define such minimum service quality
standards, which shall (1) allow for training of [homemaker-home]
home health aides by adult continuing education, (2) require a
registered nurse to visit and assess each patient receiving [homemaker-
home] home health aide services as often as necessary based on the
patient's condition, but not less than once every sixty days, and (3)
require the assessment prescribed by subdivision (2) of this subsection
to be completed while the [homemaker-home] home health aide is
providing services in the patient's home.
(i) No person acting individually or jointly with any other person
shall establish, conduct, operate or maintain a home health care agency
or [homemaker-home] home health aide agency without maintaining
professional liability insurance or other indemnity against liability for
professional malpractice. The amount of insurance which such person
shall maintain as insurance or indemnity against claims for injury or
death for professional malpractice shall be not less than one million
dollars for one person, per occurrence, with an aggregate of not less
than three million dollars. Senate Bill No. 919
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Sec. 7. Section 19a-492d of the general statutes is repealed and the
following is substituted in lieu thereof (Effective July 1, 2019):
On and after October 1, 2007, a nurse who is employed by an agency
licensed by the Department of Public Health as a home health care
agency or a [homemaker-home] home health aide agency may
administer influenza and pneumococcal vaccines to persons in their
homes, after an assessment for contraindications, without a physician's
order in accordance with a physician-approved agency policy that
includes an anaphylaxis protocol. In the event of an adverse reaction to
the vaccine, such nurse may also administer epinephrine or other
anaphylaxis medication without a physician's order in accordance with
the physician-approved agency policy. For purposes of this section,
"nurse" means an advanced practice registered nurse, registered nurse
or practical nurse licensed under chapter 378.
Sec. 8. Section 19a-492e of the general statutes is repealed and the
following is substituted in lieu thereof (Effective July 1, 2019):
(a) For purposes of this section "home health care agency" has the
same meaning as provided in section 19a-490, as amended by this act.
Notwithstanding the provisions of chapter 378, a registered nurse may
delegate the administration of medications that are not administered
by injection to [homemaker-home] home health aides who have
obtained certification and recertification every three years thereafter
for medication administration in accordance with regulations adopted
pursuant to subsection (b) of this section, unless the prescribing
practitioner specifies that a medication shall only be administered by a
licensed nurse. Any [homemaker-home] home health aide who
obtained certification in the administration of medications on or before
June 30, 2015, shall obtain recertification on or before July 1, 2018.
(b) (1) The Commissioner of Public Health shall adopt regulations,
in accordance with the provisions of chapter 54, to carry out the Senate Bill No. 919
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provisions of this section. Such regulations shall require each home
health care agency that serves clients requiring assistance with
medication administration to (A) adopt practices that increase and
encourage client choice, dignity and independence; (B) establish
policies and procedures to ensure that a registered nurse may delegate
allowed tasks of nursing care, to include medication administration, to
[homemaker-home] home health aides when the registered nurse
determines that it is in the best interest of the client and the
[homemaker-home] home health aide has been deemed competent to
perform the task; (C) designate [homemaker-home] home health aides
to obtain certification and recertification for the administration of
medication; and (D) ensure that such [homemaker-home] home health
aides receive such certification and recertification.
(2) The regulations shall establish certification and recertification
requirements for medication administration and the criteria to be used
by home health care agencies that provide services for clients requiring
assistance with medication administration in determining (A) which
[homemaker-home] home health aides shall obtain such certification
and recertification, and (B) education and skill training requirements,
including ongoing training requirements for such certification and
recertification.
(3) Education and skill training requirements for initial certification
and recertification shall include, but not be limited to, initial
orientation, training in client rights and identification of the types of
medication that may be administered by unlicensed personnel,
behavioral management, personal care, nutrition and food safety, and
health and safety in general.
(c) Each home health care agency shall ensure that, on or before
January 1, 2013, delegation of nursing care tasks in the home care
setting is allowed within such agency and that policies are adopted to
employ [homemaker-home] home health aides for the purposes of Senate Bill No. 919
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allowing nurses to delegate such tasks.
(d) A registered nurse licensed pursuant to the provisions of chapter
378 who delegates the task of medication administration to a
[homemaker-home] home health aide pursuant to this section shall not
be subject to disciplinary action based on the performance of the
[homemaker-home] home health aide to whom tasks are delegated,
unless the [homemaker-home] home health aide is acting pursuant to
specific instructions from the registered nurse or the registered nurse
fails to leave instructions when the nurse should have done so,
provided the registered nurse: (1) Documented in the patient's care
plan that the medication administration could be properly and safely
performed by the [homemaker-home] home health aide to whom it is
delegated, (2) provided initial direction to the [homemaker-home]
home health aide, and (3) provided ongoing supervision of the
[homemaker-home] home health aide, including the periodic
assessment and evaluation of the patient's health and safety related to
medication administration.
(e) A registered nurse who delegates the provision of nursing care
to another person pursuant to this section shall not be subject to an
action for civil damages for the performance of the person to whom
nursing care is delegated unless the person is acting pursuant to
specific instructions from the nurse or the nurse fails to leave
instructions when the nurse should have done so.
(f) No person may coerce a registered nurse into compromising
patient safety by requiring the nurse to delegate the administration of
medication if the nurse's assessment of the patient documents a need
for a nurse to administer medication and identifies why the need
cannot be safely met through utilization of assistive technology or
administration of medication by certified [homemaker-home] home
health aides. No registered nurse who has made a reasonable
determination based on such assessment that delegation may Senate Bill No. 919
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compromise patient safety shall be subject to any employer reprisal or
disciplinary action pursuant to chapter 378 for refusing to delegate or
refusing to provide the required training for such delegation. The
Department of Social Services, in consultation with the Department of
Public Health and home health care agencies, shall develop protocols
for documentation pursuant to the requirements of this subsection.
The Department of Social Services shall notify all licensed home health
care agencies of such protocols prior to the implementation of this
section.
(g) The Commissioner of Public Health may implement policies and
procedures necessary to administer the provisions of this section while
in the process of adopting such policies and procedures as regulations,
provided notice of intent to adopt regulations is published in the
Connecticut Law Journal not later than twenty days after the date of
implementation. Policies and procedures implemented pursuant to
this section shall be valid until the time final regulations are adopted.
Sec. 9. Subsection (a) of section 19a-495 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective July
1, 2019):
(a) The Department of Public Health shall, after consultation with
the appropriate public and voluntary hospital planning agencies,
establish classifications of institutions. The department shall, in the
Public Health Code, adopt, amend, promulgate and enforce such
regulations based upon reasonable standards of health, safety and
comfort of patients and demonstrable need for such institutions, with
respect to each classification of institutions to be licensed under
sections 19a-490 to 19a-503, inclusive, as amended by this act,
including their special facilities, as will further the accomplishment of
the purposes of said sections in promoting safe, humane and adequate
care and treatment of individuals in institutions. The department shall
adopt such regulations, in accordance with chapter 54, concerning Senate Bill No. 919
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home health care agencies and [homemaker-home] home health aide
agencies.
Sec. 10. Subdivision (2) of subsection (a) of section 19a-905 of the
general statutes is repealed and the following is substituted in lieu
thereof (Effective July 1, 2019):
(2) "Health care facility or institution" means a hospital, nursing
home, rest home, home health care agency, [homemaker-home] home
health aide agency, emergency medical services organization, assisted
living services agency, outpatient surgical facility and an infirmary
operated by an educational institution for the care of students enrolled
in, and faculty and employees of, such institution.
Sec. 11. Subdivision (7) of section 20-670 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective July
1, 2019):
(7) "Homemaker-companion agency" means (A) any public or
private organization that employs one or more persons and is engaged
in the business of providing companion services or homemaker
services, or (B) any registry. "Homemaker-companion agency" shall
not include a home health care agency, as defined in subsection (d) of
section 19a-490, as amended by this act, or a [homemaker-home] home
health aide agency, as defined in subsection (e) of section 19a-490.