Connecticut 2019 Regular Session

Connecticut Senate Bill SB01066 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	LCO No. 5938 1 of 11
4	4
5	5	General Assembly Raised Bill No. 1066
6	6	January Session, 2019
7	7	LCO No. 5938
8	8
9	9
10	10	Referred to Committee on HUMAN SERVICES
11	11
12	12
13	13	Introduced by:
14	14	(HS)
15	15
16	16
17	17
18	18
19	19	AN ACT PROVIDING A VOICE FOR NURSING HOME RESIDEN TS
20	20	SUBJECT TO TRANSFER DUE TO NURSING HOME CLOSURES OR
21	21	RECEIVERSHIPS.
22	22	Be it enacted by the Senate and House of Representatives in General
23	23	Assembly convened:
24	24
25	25	Section 1. Subdivision (5) of subsection (b) of section 17a-408 of the 1
26	26	general statutes is repealed and the following is substituted in lieu 2
27	27	thereof (Effective July 1, 2019): 3
28	28	(5) (A) Represent the interests of the residents, [and of] including, 4
29	29	but not limited to, appearing (i) as a party representing nursing home 5
30	30	residents pursuant to section 19a-542, as amended by this act, (ii) at 6
31	31	any public hearing related to a nursing home closure scheduled 7
32	32	pursuant to section 17b-353, as amended by this act, or (iii) at a 8
33	33	receivership hearing scheduled pursuant to section 19a-545, as 9
34	34	amended by this act, (B) represent applicants in relation to issues 10
35	35	concerning applications to long-term care facilities [,] and before 11
36	36	governmental agencies, and (C) seek administrative, legal and other 12
37	37	remedies to protect the health, safety, welfare and rights of the 13
38	38	residents; 14 Raised Bill No. 1066
39	39
40	40
41	41
42	42	LCO No. 5938 2 of 11
43	43
44	44	Sec. 2. Subsection (d) of section 17b-353 of the general statutes is 15
45	45	repealed and the following is substituted in lieu thereof (Effective July 16
46	46	1, 2019): 17
47	47	(d) Except as provided in this subsection, no facility shall be allowed 18
48	48	to close or decrease substantially its total bed capacity until such time 19
49	49	as a public hearing has been held in accordance with the provisions of 20
50	50	this subsection and the Commissioner of Social Services has approved 21
51	51	the facility's request unless such decrease is associated with a census 22
52	52	reduction. The commissioner may impose a civil penalty of not more 23
53	53	than five thousand dollars on any facility that fails to comply with the 24
54	54	provisions of this subsection. Penalty payments received by the 25
55	55	commissioner pursuant to this subsection shall be deposited in the 26
56	56	special fund established by the department pursuant to subsection (c) 27
57	57	of section 17b-357 and used for the purposes specified in said 28
58	58	subsection (c). The commissioner or the commissioner's designee shall 29
59	59	hold a public hearing upon the earliest occurrence of: (1) Receipt of 30
60	60	any letter of intent submitted by a facility to the department, or (2) 31
61	61	receipt of any certificate of need application. Such hearing shall be held 32
62	62	at the facility for which the letter of intent or certificate of need 33
63	63	application was submitted not later than thirty days after the date on 34
64	64	which such letter or application was received by the commissioner. 35
65	65	The commissioner or the commissioner's designee shall provide both 36
66	66	the facility, the Office of the Long-Term Care Ombudsman and the 37
67	67	public with notice of the date of the hearing not less than fourteen days 38
68	68	in advance of such date. Notice to the facility shall be by certified mail 39
69	69	and notice to the public shall be by publication in a newspaper having 40
70	70	a substantial circulation in the area served by the facility. The Long-41
71	71	Term Care Ombudsman, or the Long -Term Care Ombudsman's 42
72	72	designee, upon request of any facility resident, shall represent the 43
73	73	facility resident at such hearing. The provisions of this subsection shall 44
74	74	not apply to any certificate of need approval requested for the 45
75	75	relocation of a facility, or a portion of a facility's licensed beds, to a 46
76	76	new or replacement facility. 47
77	77	Sec. 3. Subsection (c) of section 19a-535 of the general statutes is 48 Raised Bill No. 1066
78	78
79	79
80	80
81	81	LCO No. 5938 3 of 11
82	82
83	83	repealed and the following is substituted in lieu thereof (Effective July 49
84	84	1, 2019): 50
85	85	(c) (1) [Before effecting any transfer or discharge of a resident from 51
86	86	the facility] Except as provided in subsection (h) of this section, or in 52
87	87	the event of an "emergency" as defined in section 19a-541, before 53
88	88	effecting any transfer or discharge of a resident from the facility, 54
89	89	including any transfer sought pursuant to a receivership proceeding 55
90	90	held in accordance with the provisions of sections 19a-541 to 19a-549a, 56
91	91	inclusive, the facility shall notify, in writing, the resident and the 57
92	92	resident's guardian or conservator, if any, or legally liable relative or 58
93	93	other responsible party if known, and the Long-Term Care 59
94	94	Ombudsman of the proposed transfer or discharge, the reasons 60
95	95	therefor, the effective date of the proposed transfer or discharge, the 61
96	96	location to which the resident is to be transferred or discharged, the 62
97	97	right to appeal the proposed transfer or discharge and the procedures 63
98	98	for initiating such an appeal as determined by the Department of 64
99	99	Social Services, the date by which an appeal must be initiated in order 65
100	100	to preserve the resident's right to an appeal hearing and the date by 66
101	101	which an appeal must be initiated in order to stay the proposed 67
102	102	transfer or discharge and the possibility of an exception to the date by 68
103	103	which an appeal must be initiated in order to stay the proposed 69
104	104	transfer or discharge for good cause, that the resident may represent 70
105	105	himself or herself or be represented by legal counsel, a relative, a 71
106	106	friend or other spokesperson, and information as to bed hold and 72
107	107	nursing home readmission policy when required in accordance with 73
108	108	section 19a-537. The notice shall also include the name, mailing 74
109	109	address and telephone number of the State Long -Term Care 75
110	110	Ombudsman. If the resident is, or the facility alleges a resident is, 76
111	111	mentally ill or developmentally disabled, the notice shall include the 77
112	112	name, mailing address and telephone number of the nonprofit entity 78
113	113	designated by the Governor in accordance with section 46a-10b to 79
114	114	serve as the Connecticut protection and advocacy system. The notice 80
115	115	shall be given at least thirty days and no more than sixty days prior to 81
116	116	the resident's proposed transfer or discharge, except where the health 82 Raised Bill No. 1066
117	117
118	118
119	119
120	120	LCO No. 5938 4 of 11
121	121
122	122	or safety of individuals in the facility are endangered, or where the 83
123	123	resident's health improves sufficiently to allow a more immediate 84
124	124	transfer or discharge, or where immediate transfer or discharge is 85
125	125	necessitated by urgent medical needs or where a resident has not 86
126	126	resided in the facility for thirty days, in which cases notice shall be 87
127	127	given as many days before the transfer or discharge as practicable. 88
128	128	(2) [The] Except as provided in subsection (h) of this section, or in 89
129	129	the event of an "emergency" as defined in section 19a-541, the resident 90
130	130	may initiate an appeal pursuant to this section by submitting a written 91
131	131	request to the Commissioner of Social Services not later than sixty 92
132	132	calendar days after the facility issues the notice of the proposed 93
133	133	transfer or discharge. [, except as provided in subsection (h) of this 94
134	134	section.] In order to stay a proposed transfer or discharge, the resident 95
135	135	must initiate an appeal not later than twenty days after the date the 96
136	136	resident receives the notice of the proposed transfer or discharge from 97
137	137	the facility unless the resident demonstrates good cause for failing to 98
138	138	initiate such appeal within the twenty-day period. 99
139	139	Sec. 4. Subsection (b) of section 19a-542 of the general statutes is 100
140	140	repealed and the following is substituted in lieu thereof (Effective July 101
141	141	1, 2019): 102
142	142	(b) A resident of a nursing home facility or residential care home for 103
143	143	which an application to appoint a receiver has been filed, or such 104
144	144	resident's legally liable relative, conservator or guardian, and the 105
145	145	Long-Term Care Ombudsman, or the Long-Term Care Ombudsman's 106
146	146	designee, may appear as a party to the proceedings. 107
147	147	Sec. 5. Subsection (a) of section 19a-545 of the general statutes is 108
148	148	repealed and the following is substituted in lieu thereof (Effective July 109
149	149	1, 2019): 110
150	150	(a) A receiver appointed pursuant to the provisions of sections 19a-111
151	151	541 to 19a-549, inclusive, in operating a nursing home facility or 112
152	152	residential care home, shall have the same powers as a receiver of a 113
153	153	corporation under section 52-507, except as provided in subsection (c) 114 Raised Bill No. 1066
154	154
155	155
156	156
157	157	LCO No. 5938 5 of 11
158	158
159	159	of this section and shall exercise such powers to remedy the conditions 115
160	160	that constituted grounds for the imposition of receivership, assure 116
161	161	adequate health care for the residents and preserve the assets and 117
162	162	property of the owner. If such facility or home is placed in receivership 118
163	163	it shall be the duty of the receiver to notify each resident and each 119
164	164	resident's guardian or conservator, if any, or legally liable relative or 120
165	165	other responsible party, if known, and the Long-Term Care 121
166	166	Ombudsman. Such receiver may correct or eliminate any deficiency in 122
167	167	the structure or furnishings of such facility or home that endangers the 123
168	168	safety or health of the residents while they remain in such facility or 124
169	169	home, provided the total cost of correction does not exceed three 125
170	170	thousand dollars. The court may order expenditures for this purpose 126
171	171	in excess of three thousand dollars on application from such receiver. 127
172	172	[If any resident is transferred or discharged] Except in an emergency, 128
173	173	as defined in section 19a-541, if any resident is scheduled for 129
174	174	involuntary transfer or discharge as a result of the receivership such 130
175	175	receiver shall provide for: (1) [Transportation] A hearing not less than 131
176	176	thirty days before such transfer or discharge at which such resident, 132
177	177	such resident's guardian, conservator, other legally liable relative or 133
178	178	responsible party and the Long-Term Care Ombudsman or the Long-134
179	179	Term Care Ombudsman's designee may testify and offer evidence on 135
180	180	whether such transfer or discharge plan is necessary and mitigates 136
181	181	transfer trauma as required pursuant to this subsection; (2) 137
182	182	transportation of the resident and such resident's belongings and 138
183	183	medical records to the place where such resident is being transferred 139
184	184	or discharged; [(2)] (3) aid in locating an alternative placement and 140
185	185	discharge planning in accordance with section 19a-535, as amended by 141
186	186	this act; [(3)] (4) preparation for transfer to mitigate transfer trauma, 142
187	187	including but not limited to, participation by the resident or the 143
188	188	resident's guardian, conservator, other legally liable relative or 144
189	189	responsible party in the selection of the resident's alternative 145
190	190	placement, explanation of alternative placements and orientation 146
191	191	concerning the placement chosen by the resident or the resident's 147
192	192	guardian; and [(4)] (5) custodial care of all property or assets of 148
193	193	residents that are in the possession of an owner of such facility or 149 Raised Bill No. 1066
194	194
195	195
196	196
197	197	LCO No. 5938 6 of 11
198	198
199	199	home. The Long-Term Care Ombudsman shall, at the request of a 150
200	200	resident subject to any nonemergency involuntary transfer or 151
201	201	discharge, or at the request of such resident's guardian, conservator or 152
202	202	other legally liable relative or responsible party, represent the resident 153
203	203	at any hearing scheduled pursuant to subdivision (1) of this 154
204	204	subsection. The receiver shall preserve all property, assets and records 155
205	205	of residents that the receiver has custody of and shall provide for the 156
206	206	prompt transfer of the property, assets and records to the alternative 157
207	207	placement of any transferred resident. In no event may the receiver 158
208	208	transfer all residents and close such facility or home without a court 159
209	209	order and without complying with the notice and discharge plan 160
210	210	requirements for each resident in accordance with section 19a-535, as 161
211	211	amended by this act. 162
212	212	Sec. 6. Subsection (b) of section 19a-550 of the general statutes is 163
213	213	repealed and the following is substituted in lieu thereof (Effective July 164
214	214	1, 2019): 165
215	215	(b) There is established a patients' bill of rights for any person 166
216	216	admitted as a patient to any nursing home facility, residential care 167
217	217	home or chronic disease hospital. The patients' bill of rights shall be 168
218	218	implemented in accordance with the provisions of Sections 1919(b), 169
219	219	1919(c), 1919(c)(2), 1919(c)(2)(D) and 1919(c)(2)(E) of the Social Security 170
220	220	Act. The patients' bill of rights shall provide that each such patient: (1) 171
221	221	Is fully informed, as evidenced by the patient's written 172
222	222	acknowledgment, prior to or at the time of admission and during the 173
223	223	patient's stay, of the rights set forth in this section and of all rules and 174
224	224	regulations governing patient conduct and responsibilities; (2) is fully 175
225	225	informed, prior to or at the time of admission and during the patient's 176
226	226	stay, of services available in such facility or chronic disease hospital, 177
227	227	and of related charges including any charges for services not covered 178
228	228	under Titles XVIII or XIX of the Social Security Act, or not covered by 179
229	229	basic per diem rate; (3) in such facility or hospital is entitled to choose 180
230	230	the patient's own physician or advanced practice registered nurse and 181
231	231	is fully informed, by a physician or an advanced practice registered 182
232	232	nurse, of the patient's medical condition unless medically 183 Raised Bill No. 1066
233	233
234	234
235	235
236	236	LCO No. 5938 7 of 11
237	237
238	238	contraindicated, as documented by the physician or advanced practice 184
239	239	registered nurse in the patient's medical record, and is afforded the 185
240	240	opportunity to participate in the planning of the patient's medical 186
241	241	treatment and to refuse to participate in experimental research; (4) in a 187
242	242	residential care home or a chronic disease hospital is transferred from 188
243	243	one room to another within such home or chronic disease hospital only 189
244	244	for medical reasons, or for the patient's welfare or that of other 190
245	245	patients, as documented in the patient's medical record and such 191
246	246	record shall include documentation of action taken to minimize any 192
247	247	disruptive effects of such transfer, except a patient who is a Medicaid 193
248	248	recipient may be transferred from a private room to a nonprivate 194
249	249	room, provided no patient may be involuntarily transferred from one 195
250	250	room to another within such home or chronic disease hospital if (A) it 196
251	251	is medically established that the move will subject the patient to a 197
252	252	reasonable likelihood of serious physical injury or harm, or (B) the 198
253	253	patient has a prior established medical history of psychiatric problems 199
254	254	and there is psychiatric testimony that as a consequence of the 200
255	255	proposed move there will be exacerbation of the psychiatric problem 201
256	256	that would last over a significant period of time and require 202
257	257	psychiatric intervention; and in the case of an involuntary transfer 203
258	258	from one room to another within such home or chronic disease 204
259	259	hospital, the patient and, if known, the patient's legally liable relative, 205
260	260	guardian or conservator or a person designated by the patient in 206
261	261	accordance with section 1-56r, is given not less than thirty days' and 207
262	262	not more than sixty days' written notice to ensure orderly transfer 208
263	263	from one room to another within such home or chronic disease 209
264	264	hospital, except where the health, safety or welfare of other patients is 210
265	265	endangered or where immediate transfer from one room to another 211
266	266	within such home or chronic disease hospital is necessitated by urgent 212
267	267	medical need of the patient or where a patient has resided in such 213
268	268	home or chronic disease hospital for less than thirty days, in which 214
269	269	case notice shall be given as many days before the transfer as 215
270	270	practicable; (5) is encouraged and assisted, throughout the patient's 216
271	271	period of stay, to exercise the patient's rights as a patient and as a 217
272	272	citizen, and to this end, has the right to be fully informed about 218 Raised Bill No. 1066
273	273
274	274
275	275
276	276	LCO No. 5938 8 of 11
277	277
278	278	patients' rights by state or federally funded patient advocacy 219
279	279	programs, and may voice grievances and recommend changes in 220
280	280	policies and services to nursing home facility, residential care home or 221
281	281	chronic disease hospital staff or to outside representatives of the 222
282	282	patient's choice, free from restraint, interference, coercion, 223
283	283	discrimination or reprisal; (6) shall have prompt efforts made by such 224
284	284	nursing home facility, residential care home or chronic disease hospital 225
285	285	to resolve grievances the patient may have, including those with 226
286	286	respect to the behavior of other patients; (7) may manage the patient's 227
287	287	personal financial affairs, and is given a quarterly accounting of 228
288	288	financial transactions made on the patient's behalf; (8) is free from 229
289	289	mental and physical abuse, corporal punishment, involuntary 230
290	290	seclusion and any physical or chemical restraints imposed for 231
291	291	purposes of discipline or convenience and not required to treat the 232
292	292	patient's medical symptoms. Physical or chemical restraints may be 233
293	293	imposed only to ensure the physical safety of the patient or other 234
294	294	patients and only upon the written order of a physician or an 235
295	295	advanced practice registered nurse that specifies the type of restraint 236
296	296	and the duration and circumstances under which the restraints are to 237
297	297	be used, except in emergencies until a specific order can be obtained; 238
298	298	(9) is assured confidential treatment of the patient's personal and 239
299	299	medical records, and may approve or refuse their release to any 240
300	300	individual outside the facility, except in case of the patient's transfer to 241
301	301	another health care institution or as required by law or third-party 242
302	302	payment contract; (10) receives quality care and services with 243
303	303	reasonable accommodation of individual needs and preferences, 244
304	304	except where the health or safety of the individual would be 245
305	305	endangered, and is treated with consideration, respect, and full 246
306	306	recognition of the patient's dignity and individuality, including 247
307	307	privacy in treatment and in care for the patient's personal needs; (11) is 248
308	308	not required to perform services for the nursing home facility, 249
309	309	residential care home or chronic disease hospital that are not included 250
310	310	for therapeutic purposes in the patient's plan of care; (12) may 251
311	311	associate and communicate privately with persons of the patient's 252
312	312	choice, including other patients, send and receive the patient's 253 Raised Bill No. 1066
313	313
314	314
315	315
316	316	LCO No. 5938 9 of 11
317	317
318	318	personal mail unopened and make and receive telephone calls 254
319	319	privately, unless medically contraindicated, as documented by the 255
320	320	patient's physician or advanced practice registered nurse in the 256
321	321	patient's medical record, and receives adequate notice before the 257
322	322	patient's room or roommate in such facility, home or chronic disease 258
323	323	hospital is changed; (13) is entitled to organize and participate in 259
324	324	patient groups in such facility, home or chronic disease hospital and to 260
325	325	participate in social, religious and community activities that do not 261
326	326	interfere with the rights of other patients, unless medically 262
327	327	contraindicated, as documented by the patient's physician or advanced 263
328	328	practice registered nurse in the patient's medical records; (14) may 264
329	329	retain and use the patient's personal clothing and possessions unless to 265
330	330	do so would infringe upon rights of other patients or unless medically 266
331	331	contraindicated, as documented by the patient's physician or advanced 267
332	332	practice registered nurse in the patient's medical record; (15) is assured 268
333	333	privacy for visits by the patient's spouse or a person designated by the 269
334	334	patient in accordance with section 1-56r and, if the patient is married 270
335	335	and both the patient and the patient's spouse are inpatients in the 271
336	336	facility, they are permitted to share a room, unless medically 272
337	337	contraindicated, as documented by the attending physician or 273
338	338	advanced practice registered nurse in the medical record; (16) is fully 274
339	339	informed of the availability of and may examine all current state, local 275
340	340	and federal inspection reports and plans of correction; (17) may 276
341	341	organize, maintain and participate in a patient-run resident council, as 277
342	342	a means of fostering communication among residents and between 278
343	343	residents and staff, encouraging resident independence and 279
344	344	addressing the basic rights of nursing home facility, residential care 280
345	345	home and chronic disease hospital patients and residents, free from 281
346	346	administrative interference or reprisal; (18) is entitled to the opinion of 282
347	347	two physicians concerning the need for surgery, except in an 283
348	348	emergency situation, prior to such surgery being performed; (19) is 284
349	349	entitled to have the patient's family or a person designated by the 285
350	350	patient in accordance with section 1-56r meet in such facility, 286
351	351	residential care home or chronic disease hospital with the families of 287
352	352	other patients in the facility to the extent such facility, residential care 288 Raised Bill No. 1066
353	353
354	354
355	355
356	356	LCO No. 5938 10 of 11
357	357
358	358	home or chronic disease hospital has existing meeting space available 289
359	359	that meets applicable building and fire codes; (20) is entitled to file a 290
360	360	complaint with the Department of Social Services and the Department 291
361	361	of Public Health regarding patient abuse, neglect or misappropriation 292
362	362	of patient property; (21) is entitled to have psychopharmacologic drugs 293
363	363	administered only on orders of a physician or an advanced practice 294
364	364	registered nurse and only as part of a written plan of care developed in 295
365	365	accordance with Section 1919(b)(2) of the Social Security Act and 296
366	366	designed to eliminate or modify the symptoms for which the drugs are 297
367	367	prescribed and only if, at least annually, an independent external 298
368	368	consultant reviews the appropriateness of the drug plan; (22) is 299
369	369	entitled to be transferred or discharged from the facility only pursuant 300
370	370	to section 19a-535, as amended by this act, 19a-535a or 19a-535b, as 301
371	371	applicable, and, in the case of any nonemergency involuntary transfer 302
372	372	or discharge as a result of a nursing home receivership, only after the 303
373	373	patient or the patient's designated representative has been afforded a 304
374	374	right to a hearing, in accordance with section 19a-545, as amended by 305
375	375	this act; (23) is entitled to be treated equally with other patients with 306
376	376	regard to transfer, discharge and the provision of all services 307
377	377	regardless of the source of payment; (24) shall not be required to waive 308
378	378	any rights to benefits under Medicare or Medicaid or to give oral or 309
379	379	written assurance that the patient is not eligible for, or will not apply 310
380	380	for benefits under Medicare or Medicaid; (25) is entitled to be provided 311
381	381	information by the nursing home facility or chronic disease hospital as 312
382	382	to how to apply for Medicare or Medicaid benefits and how to receive 313
383	383	refunds for previous payments covered by such benefits; (26) is 314
384	384	entitled to receive a copy of any Medicare or Medicaid application 315
385	385	completed by a nursing home facility, residential care home or chronic 316
386	386	disease hospital on behalf of the patient or to designate that a family 317
387	387	member, or other representative of the patient, receive a copy of any 318
388	388	such application; (27) on or after October 1, 1990, shall not be required 319
389	389	to give a third-party guarantee of payment to the facility as a condition 320
390	390	of admission to, or continued stay in, such facility; (28) is entitled to 321
391	391	have such facility not charge, solicit, accept or receive any gift, money, 322
392	392	donation, third-party guarantee or other consideration as a 323 Raised Bill No. 1066
393	393
394	394
395	395
396	396	LCO No. 5938 11 of 11
397	397
398	398	precondition of admission or expediting the admission of the 324
399	399	individual to such facility or as a requirement for the individual's 325
400	400	continued stay in such facility; and (29) shall not be required to deposit 326
401	401	the patient's personal funds in such facility, home or chronic disease 327
402	402	hospital. 328
403	403	This act shall take effect as follows and shall amend the following
404	404	sections:
405	405
406	406	Section 1 July 1, 2019 17a-408(b)(5)
407	407	Sec. 2 July 1, 2019 17b-353(d)
408	408	Sec. 3 July 1, 2019 19a-535(c)
409	409	Sec. 4 July 1, 2019 19a-542(b)
410	410	Sec. 5 July 1, 2019 19a-545(a)
411	411	Sec. 6 July 1, 2019 19a-550(b)
412	412
413	413	Statement of Purpose:
414	414	To give nursing home residents subject to involuntary transfer or
415	415	discharge due to a nursing home closure or receivership a greater
416	416	voice.
417	417	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
418	418	except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
419	419	not underlined.]
420	420