LCO \\PRDFS1\HCOUSERS\BARRYJN\WS\2021HB-06317-R02-
HB.docx
1 of 10
General Assembly Substitute Bill No. 6317
January Session, 2021
AN ACT PROHIBITING DISCHARGES FROM NURSI NG HOMES AND
RESIDENTIAL CARE HOM ES TO TEMPORARY OR U NSTABLE
HOUSING.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-535 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective from passage): 2
(a) For the purposes of this section: (1) "Facility" means an entity 3
certified as a nursing facility under the Medicaid program or an entity 4
certified as a skilled nursing facility under the Medicare program or 5
with respect to facilities that do not participate in the Medicaid or 6
Medicare programs, a chronic and convalescent nursing home or a rest 7
home with nursing supervision as defined in section 19a-521; (2) 8
"continuing care facility which guarantees life care for its residents" has 9
the same meaning as provided in section 17b-354; (3) "transfer" means 10
the movement of a resident from one facility to another facility or 11
institution, including, but not limited to, a hospital emergency 12
department, if the resident is admitted to the facility or institution or is 13
under the care of the facility or institution for more than twenty-four 14
hours; (4) "discharge" means the movement of a resident from a facility 15
to a noninstitutional setting; (5) "self-pay resident" means a resident who 16
is not receiving state or municipal assistance to pay for the cost of care 17 Substitute Bill No. 6317
LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2021HB-06317-
R02-HB.docx }
2 of 10
at a facility, but shall not include a resident who has filed an application 18
with the Department of Social Services for Medicaid coverage for facility 19
care but has not received an eligibility determination from the 20
department on such application, provided the resident has timely 21
responded to requests by the department for information that is 22
necessary to make such determination; and (6) "emergency" means a 23
situation in which a failure to effect an immediate transfer or discharge 24
of the resident that would endanger the health, safety or welfare of the 25
resident or other residents. 26
(b) A facility shall not transfer or discharge a resident from the facility 27
except to meet the welfare of the resident which cannot be met in the 28
facility, or unless the resident no longer needs the services of the facility 29
due to improved health, the facility is required to transfer the resident 30
pursuant to section 17b-359 or 17b-360, or the health or safety of 31
individuals in the facility is endangered, or in the case of a self-pay 32
resident, for the resident's nonpayment or arrearage of more than fifteen 33
days of the per diem facility room rate, or the facility ceases to operate. 34
In each case the basis for transfer or discharge shall be documented in 35
the resident's medical record by a physician or an advanced practice 36
registered nurse. In each case where the welfare, health or safety of the 37
resident is concerned the documentation shall be by the resident's 38
physician or the resident's advanced practice registered nurse. A facility 39
that is part of a continuing care facility which guarantees life care for its 40
residents may transfer or discharge (1) a self-pay resident who is a 41
member of the continuing care community and who has intentionally 42
transferred assets in a sum that will render the resident unable to pay 43
the costs of facility care in accordance with the contract between the 44
resident and the facility, or (2) a self-pay resident who is not a member 45
of the continuing care community and who has intentionally transferred 46
assets in a sum that will render the resident unable to pay the costs of a 47
total of forty-two months of facility care from the date of initial 48
admission to the facility. 49
(c) (1) Before effecting any transfer or discharge of a resident from the 50 Substitute Bill No. 6317
LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2021HB-06317-
R02-HB.docx }
3 of 10
facility, the facility shall notify, in writing, the resident and the resident's 51
guardian or conservator, if any, or legally liable relative or other 52
responsible party if known, of the proposed transfer or discharge, the 53
reasons therefor, the effective date of the proposed transfer or discharge, 54
the location to which the resident is to be transferred or discharged, the 55
right to appeal the proposed transfer or discharge and the procedures 56
for initiating such an appeal as determined by the Department of Social 57
Services, the date by which an appeal must be initiated in order to 58
preserve the resident's right to an appeal hearing and the date by which 59
an appeal must be initiated in order to stay the proposed transfer or 60
discharge and the possibility of an exception to the date by which an 61
appeal must be initiated in order to stay the proposed transfer or 62
discharge for good cause, that the resident may represent himself or 63
herself or be represented by legal counsel, a relative, a friend or other 64
spokesperson, and information as to bed hold and nursing home 65
readmission policy when required in accordance with section 19a-537. 66
The notice shall also include the name, mailing address and telephone 67
number of the State Long-Term Care Ombudsman. If the resident is, or 68
the facility alleges a resident is, mentally ill or developmentally 69
disabled, the notice shall include the name, mailing address and 70
telephone number of the nonprofit entity designated by the Governor in 71
accordance with section 46a-10b to serve as the Connecticut protection 72
and advocacy system. The notice shall be given at least thirty days and 73
no more than sixty days prior to the resident's proposed transfer or 74
discharge, except where the health or safety of individuals in the facility 75
are endangered, or where the resident's health improves sufficiently to 76
allow a more immediate transfer or discharge, or where immediate 77
transfer or discharge is necessitated by urgent medical needs or where 78
a resident has not resided in the facility for thirty days, in which cases 79
notice shall be given as many days before the transfer or discharge as 80
practicable. 81
(2) The resident may initiate an appeal pursuant to this section by 82
submitting a written request to the Commissioner of Social Services not 83
later than sixty calendar days after the facility issues the notice of the 84 Substitute Bill No. 6317
LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2021HB-06317-
R02-HB.docx }
4 of 10
proposed transfer or discharge, except as provided in subsection [(h)] (i) 85
of this section. In order to stay a proposed transfer or discharge, the 86
resident must initiate an appeal not later than twenty days after the date 87
the resident receives the notice of the proposed transfer or discharge 88
from the facility unless the resident demonstrates good cause for failing 89
to initiate such appeal within the twenty-day period. 90
(d) No resident shall be transferred or discharged from any facility as 91
a result of a change in the resident's status from self-pay or Medicare to 92
Medicaid provided the facility offers services to both categories of 93
residents. Any such resident who wishes to be transferred to another 94
facility that has agreed to accept the resident may do so upon giving at 95
least fifteen days written notice to the administrator of the facility from 96
which the resident is to be transferred and a copy thereof to the 97
appropriate advocate of such resident. The resident's advocate may help 98
the resident complete all administrative procedures relating to a 99
transfer. 100
(e) Except in an emergency or in the case of transfer to a hospital, no 101
resident shall be transferred or discharged from a facility unless a 102
discharge plan has been developed by the personal physician or 103
advanced practice registered nurse of the resident or the medical 104
director in conjunction with the nursing director, social worker or other 105
health care provider. To minimize the disruptive effects of the transfer 106
or discharge on the resident, the person responsible for developing the 107
plan shall consider the feasibility of placement near the resident's 108
relatives, the acceptability of the placement to the resident and the 109
resident's guardian or conservator, if any, or the resident's legally liable 110
relative or other responsible party, if known, and any other relevant 111
factors that affect the resident's adjustment to the move. The plan shall 112
contain a written evaluation of the effects of the transfer or discharge on 113
the resident and a statement of the action taken to minimize such effects. 114
In addition, the plan shall outline the care and kinds of services that the 115
resident shall receive upon transfer or discharge. Not less than thirty 116
days prior to an involuntary transfer or discharge, a copy of the 117 Substitute Bill No. 6317
LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2021HB-06317-
R02-HB.docx }
5 of 10
discharge plan shall be provided to the resident's personal physician or 118
advanced practice registered nurse if the discharge plan was prepared 119
by the medical director, to the resident and the resident's guardian or 120
conservator, if any, or legally liable relative or other responsible party, 121
if known. 122
(f) No resident shall be involuntarily transferred or discharged from 123
a facility to a homeless shelter or to a temporary or unstable housing 124
situation. As used in this subsection, "temporary or unstable housing 125
situation" includes, but is not limited to, any housing (1) in a hotel or 126
motel or similar lodging for less than thirty days, (2) in which the 127
resident does not have a legal right of occupancy, or (3) where, in 128
accordance with the resident's discharge plan, (A) the health needs of 129
the resident cannot be met, or (B) the resident has not designated an 130
available and willing caregiver, as defined in section 19a-535c. 131
[(f)] (g) No resident shall be involuntarily transferred or discharged 132
from a facility if such transfer or discharge is medically contraindicated. 133
[(g)] (h) The facility shall be responsible for assisting the resident in 134
finding appropriate placement. 135
[(h)] (i) (1) Except in the case of an emergency, as provided in 136
subdivision (4) of this subsection, upon receipt of a request for a hearing 137
to appeal any proposed transfer or discharge, the Commissioner of 138
Social Services or the commissioner's designee shall hold a hearing to 139
determine whether the transfer or discharge is being effected in 140
accordance with this section. A hearing shall be convened not less than 141
ten, but not more than thirty days from the date of receipt of such 142
request and a written decision made by the commissioner or the 143
commissioner's designee not later than thirty days after the date of 144
termination of the hearing or not later than sixty days after the date of 145
the hearing request, whichever occurs sooner. The hearing shall be 146
conducted in accordance with chapter 54. In each case the facility shall 147
prove by a preponderance of the evidence that it has complied with the 148
provisions of this section. Except in the case of an emergency or in 149 Substitute Bill No. 6317
LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2021HB-06317-
R02-HB.docx }
6 of 10
circumstances when the resident is not physically present in the facility, 150
whenever the Commissioner of Social Services receives a request for a 151
hearing in response to a notice of proposed transfer or discharge and 152
such notice does not meet the requirements of subsection (c) of this 153
section, the commissioner shall, not later than ten business days after 154
the date of receipt of such notice from the resident or the facility, order 155
the transfer or discharge stayed and return such notice to the facility. 156
Upon receipt of such returned notice, the facility shall issue a revised 157
notice that meets the requirements of subsection (c) of this section. 158
(2) The resident, the resident's guardian, conservator, legally liable 159
relative or other responsible party shall have an opportunity to examine, 160
during regular business hours at least three business days prior to a 161
hearing conducted pursuant to this section, the contents of the resident's 162
file maintained by the facility and all documents and records to be used 163
by the commissioner or the commissioner's designee or the facility at the 164
hearing. The facility shall have an opportunity to examine during 165
regular business hours at least three business days prior to such a 166
hearing, all documents and records to be used by the resident at the 167
hearing. 168
(3) If a hearing conducted pursuant to this section involves medical 169
issues, the commissioner or the commissioner's designee may order an 170
independent medical assessment of the resident at the expense of the 171
Department of Social Services that shall be made part of the hearing 172
record. 173
(4) In an emergency the notice required pursuant to subsection (c) of 174
this section shall be provided as soon as practicable. A resident who is 175
transferred or discharged on an emergency basis or a resident who 176
receives notice of such a transfer or discharge may contest the action by 177
requesting a hearing in writing not later than twenty days after the date 178
of receipt of notice or not later than twenty days after the date of transfer 179
or discharge, whichever is later, unless the resident demonstrates good 180
cause for failing to request a hearing within the twenty-day period. A 181
hearing shall be held in accordance with the requirements of this 182 Substitute Bill No. 6317
LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2021HB-06317-
R02-HB.docx }
7 of 10
subsection not later than fifteen business days after the date of receipt 183
of the request. The commissioner, or the commissioner's designee, shall 184
issue a decision not later than thirty days after the date on which the 185
hearing record is closed. 186
(5) Except in the case of a transfer or discharge effected pursuant to 187
subdivision (4) of this subsection, (A) an involuntary transfer or 188
discharge shall be stayed pending a decision by the commissioner or the 189
commissioner's designee, and (B) if the commissioner or the 190
commissioner's designee determines the transfer or discharge is being 191
effected in accordance with this section, the facility may not transfer or 192
discharge the resident prior to fifteen days from the date of receipt of 193
the decision by the resident and the resident's guardian or conservator, 194
if any, or the resident's legally liable relative or other responsible party 195
if known. 196
(6) If the commissioner, or the commissioner's designee, determines 197
after a hearing held in accordance with this section that the facility has 198
transferred or discharged a resident in violation of this section, the 199
commissioner, or the commissioner's designee, may require the facility 200
to readmit the resident to a bed in a semiprivate room or in a private 201
room, if a private room is medically necessary, regardless of whether or 202
not the resident has accepted placement in another facility pending the 203
issuance of a hearing decision or is awaiting the availability of a bed in 204
the facility from which the resident was transferred or discharged. 205
(7) A copy of a decision of the commissioner or the commissioner's 206
designee shall be sent to the facility and to the resident, the resident's 207
guardian, conservator, if any, legally liable relative or other responsible 208
party, if known. The decision shall be deemed to have been received not 209
later than five days after the date it was mailed, unless the facility, the 210
resident or the resident's guardian, conservator, legally liable relative or 211
other responsible party proves otherwise by a preponderance of the 212
evidence. The Superior Court shall consider an appeal from a decision 213
of the Department of Social Services pursuant to this section as a 214
privileged case in order to dispose of the case with the least possible 215 Substitute Bill No. 6317
LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2021HB-06317-
R02-HB.docx }
8 of 10
delay. 216
[(i)] (j) A resident who receives notice from the Department of Social 217
Services or its agent that the resident is no longer in need of the level of 218
care provided by a facility and that, consequently, the resident's 219
coverage for facility care will end, may request a hearing by the 220
Commissioner of Social Services in accordance with the provisions of 221
section 17b-60. If the resident requests a hearing prior to the date that 222
Medicaid coverage for facility care is to end, Medicaid coverage shall 223
continue pending the outcome of the hearing. If the resident receives a 224
notice of denial of Medicaid coverage from the department or its agent 225
and also receives a notice of discharge from the facility pursuant to 226
subsection (c) of this section and the resident requests a hearing to 227
contest each proposed action, the department may schedule one hearing 228
at which the resident may contest both actions. 229
[(j)] (k) Whenever a facility is discharging a resident to the resident's 230
home in the community, the discharge shall be in accordance with 231
sections 19a-535c and 19a-535d. 232
Sec. 2. Section 19a-535a of the general statutes is repealed and the 233
following is substituted in lieu thereof (Effective from passage): 234
(a) As used in this section, a "facility" means a residential care home, 235
as defined in section 19a-490. 236
(b) A facility shall not transfer or discharge a resident from the facility 237
unless (1) the transfer or discharge is necessary to meet the resident's 238
welfare and the resident's welfare cannot be met in the facility, (2) the 239
transfer or discharge is appropriate because the resident's health has 240
improved sufficiently so the resident no longer needs the services 241
provided by the facility, (3) the health or safety of individuals in the 242
facility is endangered, (4) the resident has failed, after reasonable and 243
appropriate notice, to pay for a stay or a requested service, at the facility 244
or (5) the facility ceases to operate. In the case of an involuntary transfer 245
or discharge the resident and, if known, his legally liable relative, 246 Substitute Bill No. 6317
LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2021HB-06317-
R02-HB.docx }
9 of 10
guardian or conservator shall be given a thirty-day written notification 247
which includes the reason for the transfer or discharge and notice of the 248
right of the resident to appeal a transfer or discharge by the facility 249
pursuant to subsection [(d)] (e) of this section. No resident shall be 250
involuntarily transferred or discharged from a facility if such transfer or 251
discharge presents imminent danger of death. 252
(c) The facility shall be responsible for assisting the resident in finding 253
appropriate placement. A discharge plan, prepared by the facility, 254
which indicates the resident's individual needs shall accompany the 255
patient. 256
(d) No resident shall be involuntarily transferred or discharged from 257
a facility to a homeless shelter or to a temporary or unstable housing 258
situation. As used in this subsection, "temporary or unstable housing 259
situation" includes, but is not limited to, any housing (1) in a hotel or 260
motel or similar lodging for less than thirty days, (2) in which the 261
resident does not have a legal right of occupancy, or (3) where, in 262
accordance with the resident's discharge plan, the health needs of the 263
resident cannot be met. 264
[(d)] (e) (1) For transfers or discharges effected on or after October 1, 265
1989, a resident or his legally liable relative, guardian or conservator 266
who has been notified by a facility, pursuant to subsection (b) of this 267
section, that he will be transferred or discharged from the facility may 268
appeal such transfer or discharge to the Commissioner of Public Health 269
by filing a request for a hearing with the commissioner within ten days 270
of receipt of such notice. Upon receipt of any such request, the 271
commissioner or his designee shall hold a hearing to determine whether 272
the transfer or discharge is being effected in accordance with this 273
section. Such a hearing shall be held within seven business days of 274
receipt of such request and a determination made by the commissioner 275
or his designee within twenty days of the termination of the hearing. 276
The hearing shall be conducted in accordance with chapter 54. 277
(2) In an emergency the facility may request that the commissioner 278 Substitute Bill No. 6317
LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2021HB-06317-
R02-HB.docx }
10 of 10
make a determination as to the need for an immediate transfer or 279
discharge of a resident. Before making such a determination, the 280
commissioner shall notify the resident and, if known, his legally liable 281
relative, guardian or conservator. The commissioner shall issue such a 282
determination no later than seven days after receipt of the request for 283
such determination. If, as a result of such a request, the commissioner or 284
his designee determines that a failure to effect an immediate transfer or 285
discharge would endanger the health, safety or welfare of the resident 286
or other residents, the commissioner or his designee shall order the 287
immediate transfer or discharge of the resident from the facility. A 288
hearing shall be held in accordance with the requirements of 289
subdivision (1) of this subsection within seven business days of the 290
issuance of any determination issued pursuant to this subdivision. 291
(3) Any involuntary transfer or discharge shall be stayed pending a 292
determination by the commissioner or his designee. Notwithstanding 293
any provision of the general statutes, the determination of the 294
commissioner or his designee after a hearing shall be final and binding 295
upon all parties and not subject to any further appeal.296
This act shall take effect as follows and shall amend the following
sections:
Section 1 from passage 19a-535
Sec. 2 from passage 19a-535a
HS Joint Favorable Subst.
PH Joint Favorable