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general statutes is repealed and the following is substituted in lieu 2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repealed and the following is substituted in lieu thereof (Effective July 16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