Connecticut 2021 Regular Session

Connecticut House Bill HB06317 Compare Versions

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Version 2 (New)

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5	5		1 of 10
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7	7		General Assembly Substitute Bill No. 6317
8	8		January Session, 2021
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12	12
13	13
14	14		AN ACT PROHIBITING DISCHARGES FROM NURSI NG HOMES AND
15	15		RESIDENTIAL CARE HOM ES TO TEMPORARY OR U NSTABLE
16	16		HOUSING.
17	17		Be it enacted by the Senate and House of Representatives in General
18	18		Assembly convened:
19	19
20	20		Section 1. Section 19a-535 of the general statutes is repealed and the 1
21	21		following is substituted in lieu thereof (Effective from passage): 2
22	22		(a) For the purposes of this section: (1) "Facility" means an entity 3
23	23		certified as a nursing facility under the Medicaid program or an entity 4
24	24		certified as a skilled nursing facility under the Medicare program or 5
25	25		with respect to facilities that do not participate in the Medicaid or 6
26	26		Medicare programs, a chronic and convalescent nursing home or a rest 7
27	27		home with nursing supervision as defined in section 19a-521; (2) 8
28	28		"continuing care facility which guarantees life care for its residents" has 9
29	29		the same meaning as provided in section 17b-354; (3) "transfer" means 10
30	30		the movement of a resident from one facility to another facility or 11
31	31		institution, including, but not limited to, a hospital emergency 12
32	32		department, if the resident is admitted to the facility or institution or is 13
33	33		under the care of the facility or institution for more than twenty-four 14
34	34		hours; (4) "discharge" means the movement of a resident from a facility 15
35	35		to a noninstitutional setting; (5) "self-pay resident" means a resident who 16
36	36		is not receiving state or municipal assistance to pay for the cost of care 17 Substitute Bill No. 6317
37	37
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42	42
43	43		at a facility, but shall not include a resident who has filed an application 18
44	44		with the Department of Social Services for Medicaid coverage for facility 19
45	45		care but has not received an eligibility determination from the 20
46	46		department on such application, provided the resident has timely 21
47	47		responded to requests by the department for information that is 22
48	48		necessary to make such determination; and (6) "emergency" means a 23
49	49		situation in which a failure to effect an immediate transfer or discharge 24
50	50		of the resident that would endanger the health, safety or welfare of the 25
51	51		resident or other residents. 26
52	52		(b) A facility shall not transfer or discharge a resident from the facility 27
53	53		except to meet the welfare of the resident which cannot be met in the 28
54	54		facility, or unless the resident no longer needs the services of the facility 29
55	55		due to improved health, the facility is required to transfer the resident 30
56	56		pursuant to section 17b-359 or 17b-360, or the health or safety of 31
57	57		individuals in the facility is endangered, or in the case of a self-pay 32
58	58		resident, for the resident's nonpayment or arrearage of more than fifteen 33
59	59		days of the per diem facility room rate, or the facility ceases to operate. 34
60	60		In each case the basis for transfer or discharge shall be documented in 35
61	61		the resident's medical record by a physician or an advanced practice 36
62	62		registered nurse. In each case where the welfare, health or safety of the 37
63	63		resident is concerned the documentation shall be by the resident's 38
64	64		physician or the resident's advanced practice registered nurse. A facility 39
65	65		that is part of a continuing care facility which guarantees life care for its 40
66	66		residents may transfer or discharge (1) a self-pay resident who is a 41
67	67		member of the continuing care community and who has intentionally 42
68	68		transferred assets in a sum that will render the resident unable to pay 43
69	69		the costs of facility care in accordance with the contract between the 44
70	70		resident and the facility, or (2) a self-pay resident who is not a member 45
71	71		of the continuing care community and who has intentionally transferred 46
72	72		assets in a sum that will render the resident unable to pay the costs of a 47
73	73		total of forty-two months of facility care from the date of initial 48
74	74		admission to the facility. 49
75	75		(c) (1) Before effecting any transfer or discharge of a resident from the 50 Substitute Bill No. 6317
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81	81
82	82		facility, the facility shall notify, in writing, the resident and the resident's 51
83	83		guardian or conservator, if any, or legally liable relative or other 52
84	84		responsible party if known, of the proposed transfer or discharge, the 53
85	85		reasons therefor, the effective date of the proposed transfer or discharge, 54
86	86		the location to which the resident is to be transferred or discharged, the 55
87	87		right to appeal the proposed transfer or discharge and the procedures 56
88	88		for initiating such an appeal as determined by the Department of Social 57
89	89		Services, the date by which an appeal must be initiated in order to 58
90	90		preserve the resident's right to an appeal hearing and the date by which 59
91	91		an appeal must be initiated in order to stay the proposed transfer or 60
92	92		discharge and the possibility of an exception to the date by which an 61
93	93		appeal must be initiated in order to stay the proposed transfer or 62
94	94		discharge for good cause, that the resident may represent himself or 63
95	95		herself or be represented by legal counsel, a relative, a friend or other 64
96	96		spokesperson, and information as to bed hold and nursing home 65
97	97		readmission policy when required in accordance with section 19a-537. 66
98	98		The notice shall also include the name, mailing address and telephone 67
99	99		number of the State Long-Term Care Ombudsman. If the resident is, or 68
100	100		the facility alleges a resident is, mentally ill or developmentally 69
101	101		disabled, the notice shall include the name, mailing address and 70
102	102		telephone number of the nonprofit entity designated by the Governor in 71
103	103		accordance with section 46a-10b to serve as the Connecticut protection 72
104	104		and advocacy system. The notice shall be given at least thirty days and 73
105	105		no more than sixty days prior to the resident's proposed transfer or 74
106	106		discharge, except where the health or safety of individuals in the facility 75
107	107		are endangered, or where the resident's health improves sufficiently to 76
108	108		allow a more immediate transfer or discharge, or where immediate 77
109	109		transfer or discharge is necessitated by urgent medical needs or where 78
110	110		a resident has not resided in the facility for thirty days, in which cases 79
111	111		notice shall be given as many days before the transfer or discharge as 80
112	112		practicable. 81
113	113		(2) The resident may initiate an appeal pursuant to this section by 82
114	114		submitting a written request to the Commissioner of Social Services not 83
115	115		later than sixty calendar days after the facility issues the notice of the 84 Substitute Bill No. 6317
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122	122		proposed transfer or discharge, except as provided in subsection [(h)] (i) 85
123	123		of this section. In order to stay a proposed transfer or discharge, the 86
124	124		resident must initiate an appeal not later than twenty days after the date 87
125	125		the resident receives the notice of the proposed transfer or discharge 88
126	126		from the facility unless the resident demonstrates good cause for failing 89
127	127		to initiate such appeal within the twenty-day period. 90
128	128		(d) No resident shall be transferred or discharged from any facility as 91
129	129		a result of a change in the resident's status from self-pay or Medicare to 92
130	130		Medicaid provided the facility offers services to both categories of 93
131	131		residents. Any such resident who wishes to be transferred to another 94
132	132		facility that has agreed to accept the resident may do so upon giving at 95
133	133		least fifteen days written notice to the administrator of the facility from 96
134	134		which the resident is to be transferred and a copy thereof to the 97
135	135		appropriate advocate of such resident. The resident's advocate may help 98
136	136		the resident complete all administrative procedures relating to a 99
137	137		transfer. 100
138	138		(e) Except in an emergency or in the case of transfer to a hospital, no 101
139	139		resident shall be transferred or discharged from a facility unless a 102
140	140		discharge plan has been developed by the personal physician or 103
141	141		advanced practice registered nurse of the resident or the medical 104
142	142		director in conjunction with the nursing director, social worker or other 105
143	143		health care provider. To minimize the disruptive effects of the transfer 106
144	144		or discharge on the resident, the person responsible for developing the 107
145	145		plan shall consider the feasibility of placement near the resident's 108
146	146		relatives, the acceptability of the placement to the resident and the 109
147	147		resident's guardian or conservator, if any, or the resident's legally liable 110
148	148		relative or other responsible party, if known, and any other relevant 111
149	149		factors that affect the resident's adjustment to the move. The plan shall 112
150	150		contain a written evaluation of the effects of the transfer or discharge on 113
151	151		the resident and a statement of the action taken to minimize such effects. 114
152	152		In addition, the plan shall outline the care and kinds of services that the 115
153	153		resident shall receive upon transfer or discharge. Not less than thirty 116
154	154		days prior to an involuntary transfer or discharge, a copy of the 117 Substitute Bill No. 6317
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161	161		discharge plan shall be provided to the resident's personal physician or 118
162	162		advanced practice registered nurse if the discharge plan was prepared 119
163	163		by the medical director, to the resident and the resident's guardian or 120
164	164		conservator, if any, or legally liable relative or other responsible party, 121
165	165		if known. 122
166	166		(f) No resident shall be involuntarily transferred or discharged from 123
167	167		a facility to a homeless shelter or to a temporary or unstable housing 124
168	168		situation. As used in this subsection, "temporary or unstable housing 125
169	169		situation" includes, but is not limited to, any housing (1) in a hotel or 126
170	170		motel or similar lodging for less than thirty days, (2) in which the 127
171	171		resident does not have a legal right of occupancy, or (3) where, in 128
172	172		accordance with the resident's discharge plan, (A) the health needs of 129
173	173		the resident cannot be met, or (B) the resident has not designated an 130
174	174		available and willing caregiver, as defined in section 19a-535c. 131
175	175		[(f)] (g) No resident shall be involuntarily transferred or discharged 132
176	176		from a facility if such transfer or discharge is medically contraindicated. 133
177	177		[(g)] (h) The facility shall be responsible for assisting the resident in 134
178	178		finding appropriate placement. 135
179	179		[(h)] (i) (1) Except in the case of an emergency, as provided in 136
180	180		subdivision (4) of this subsection, upon receipt of a request for a hearing 137
181	181		to appeal any proposed transfer or discharge, the Commissioner of 138
182	182		Social Services or the commissioner's designee shall hold a hearing to 139
183	183		determine whether the transfer or discharge is being effected in 140
184	184		accordance with this section. A hearing shall be convened not less than 141
185	185		ten, but not more than thirty days from the date of receipt of such 142
186	186		request and a written decision made by the commissioner or the 143
187	187		commissioner's designee not later than thirty days after the date of 144
188	188		termination of the hearing or not later than sixty days after the date of 145
189	189		the hearing request, whichever occurs sooner. The hearing shall be 146
190	190		conducted in accordance with chapter 54. In each case the facility shall 147
191	191		prove by a preponderance of the evidence that it has complied with the 148
192	192		provisions of this section. Except in the case of an emergency or in 149 Substitute Bill No. 6317
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197	197		6 of 10
198	198
199	199		circumstances when the resident is not physically present in the facility, 150
200	200		whenever the Commissioner of Social Services receives a request for a 151
201	201		hearing in response to a notice of proposed transfer or discharge and 152
202	202		such notice does not meet the requirements of subsection (c) of this 153
203	203		section, the commissioner shall, not later than ten business days after 154
204	204		the date of receipt of such notice from the resident or the facility, order 155
205	205		the transfer or discharge stayed and return such notice to the facility. 156
206	206		Upon receipt of such returned notice, the facility shall issue a revised 157
207	207		notice that meets the requirements of subsection (c) of this section. 158
208	208		(2) The resident, the resident's guardian, conservator, legally liable 159
209	209		relative or other responsible party shall have an opportunity to examine, 160
210	210		during regular business hours at least three business days prior to a 161
211	211		hearing conducted pursuant to this section, the contents of the resident's 162
212	212		file maintained by the facility and all documents and records to be used 163
213	213		by the commissioner or the commissioner's designee or the facility at the 164
214	214		hearing. The facility shall have an opportunity to examine during 165
215	215		regular business hours at least three business days prior to such a 166
216	216		hearing, all documents and records to be used by the resident at the 167
217	217		hearing. 168
218	218		(3) If a hearing conducted pursuant to this section involves medical 169
219	219		issues, the commissioner or the commissioner's designee may order an 170
220	220		independent medical assessment of the resident at the expense of the 171
221	221		Department of Social Services that shall be made part of the hearing 172
222	222		record. 173
223	223		(4) In an emergency the notice required pursuant to subsection (c) of 174
224	224		this section shall be provided as soon as practicable. A resident who is 175
225	225		transferred or discharged on an emergency basis or a resident who 176
226	226		receives notice of such a transfer or discharge may contest the action by 177
227	227		requesting a hearing in writing not later than twenty days after the date 178
228	228		of receipt of notice or not later than twenty days after the date of transfer 179
229	229		or discharge, whichever is later, unless the resident demonstrates good 180
230	230		cause for failing to request a hearing within the twenty-day period. A 181
231	231		hearing shall be held in accordance with the requirements of this 182 Substitute Bill No. 6317
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238	238		subsection not later than fifteen business days after the date of receipt 183
239	239		of the request. The commissioner, or the commissioner's designee, shall 184
240	240		issue a decision not later than thirty days after the date on which the 185
241	241		hearing record is closed. 186
242	242		(5) Except in the case of a transfer or discharge effected pursuant to 187
243	243		subdivision (4) of this subsection, (A) an involuntary transfer or 188
244	244		discharge shall be stayed pending a decision by the commissioner or the 189
245	245		commissioner's designee, and (B) if the commissioner or the 190
246	246		commissioner's designee determines the transfer or discharge is being 191
247	247		effected in accordance with this section, the facility may not transfer or 192
248	248		discharge the resident prior to fifteen days from the date of receipt of 193
249	249		the decision by the resident and the resident's guardian or conservator, 194
250	250		if any, or the resident's legally liable relative or other responsible party 195
251	251		if known. 196
252	252		(6) If the commissioner, or the commissioner's designee, determines 197
253	253		after a hearing held in accordance with this section that the facility has 198
254	254		transferred or discharged a resident in violation of this section, the 199
255	255		commissioner, or the commissioner's designee, may require the facility 200
256	256		to readmit the resident to a bed in a semiprivate room or in a private 201
257	257		room, if a private room is medically necessary, regardless of whether or 202
258	258		not the resident has accepted placement in another facility pending the 203
259	259		issuance of a hearing decision or is awaiting the availability of a bed in 204
260	260		the facility from which the resident was transferred or discharged. 205
261	261		(7) A copy of a decision of the commissioner or the commissioner's 206
262	262		designee shall be sent to the facility and to the resident, the resident's 207
263	263		guardian, conservator, if any, legally liable relative or other responsible 208
264	264		party, if known. The decision shall be deemed to have been received not 209
265	265		later than five days after the date it was mailed, unless the facility, the 210
266	266		resident or the resident's guardian, conservator, legally liable relative or 211
267	267		other responsible party proves otherwise by a preponderance of the 212
268	268		evidence. The Superior Court shall consider an appeal from a decision 213
269	269		of the Department of Social Services pursuant to this section as a 214
270	270		privileged case in order to dispose of the case with the least possible 215 Substitute Bill No. 6317
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277	277		delay. 216
278	278		[(i)] (j) A resident who receives notice from the Department of Social 217
279	279		Services or its agent that the resident is no longer in need of the level of 218
280	280		care provided by a facility and that, consequently, the resident's 219
281	281		coverage for facility care will end, may request a hearing by the 220
282	282		Commissioner of Social Services in accordance with the provisions of 221
283	283		section 17b-60. If the resident requests a hearing prior to the date that 222
284	284		Medicaid coverage for facility care is to end, Medicaid coverage shall 223
285	285		continue pending the outcome of the hearing. If the resident receives a 224
286	286		notice of denial of Medicaid coverage from the department or its agent 225
287	287		and also receives a notice of discharge from the facility pursuant to 226
288	288		subsection (c) of this section and the resident requests a hearing to 227
289	289		contest each proposed action, the department may schedule one hearing 228
290	290		at which the resident may contest both actions. 229
291	291		[(j)] (k) Whenever a facility is discharging a resident to the resident's 230
292	292		home in the community, the discharge shall be in accordance with 231
293	293		sections 19a-535c and 19a-535d. 232
294	294		Sec. 2. Section 19a-535a of the general statutes is repealed and the 233
295	295		following is substituted in lieu thereof (Effective from passage): 234
296	296		(a) As used in this section, a "facility" means a residential care home, 235
297	297		as defined in section 19a-490. 236
298	298		(b) A facility shall not transfer or discharge a resident from the facility 237
299	299		unless (1) the transfer or discharge is necessary to meet the resident's 238
300	300		welfare and the resident's welfare cannot be met in the facility, (2) the 239
301	301		transfer or discharge is appropriate because the resident's health has 240
302	302		improved sufficiently so the resident no longer needs the services 241
303	303		provided by the facility, (3) the health or safety of individuals in the 242
304	304		facility is endangered, (4) the resident has failed, after reasonable and 243
305	305		appropriate notice, to pay for a stay or a requested service, at the facility 244
306	306		or (5) the facility ceases to operate. In the case of an involuntary transfer 245
307	307		or discharge the resident and, if known, his legally liable relative, 246 Substitute Bill No. 6317
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314	314		guardian or conservator shall be given a thirty-day written notification 247
315	315		which includes the reason for the transfer or discharge and notice of the 248
316	316		right of the resident to appeal a transfer or discharge by the facility 249
317	317		pursuant to subsection [(d)] (e) of this section. No resident shall be 250
318	318		involuntarily transferred or discharged from a facility if such transfer or 251
319	319		discharge presents imminent danger of death. 252
320	320		(c) The facility shall be responsible for assisting the resident in finding 253
321	321		appropriate placement. A discharge plan, prepared by the facility, 254
322	322		which indicates the resident's individual needs shall accompany the 255
323	323		patient. 256
324	324		(d) No resident shall be involuntarily transferred or discharged from 257
325	325		a facility to a homeless shelter or to a temporary or unstable housing 258
326	326		situation. As used in this subsection, "temporary or unstable housing 259
327	327		situation" includes, but is not limited to, any housing (1) in a hotel or 260
328	328		motel or similar lodging for less than thirty days, (2) in which the 261
329	329		resident does not have a legal right of occupancy, or (3) where, in 262
330	330		accordance with the resident's discharge plan, the health needs of the 263
331	331		resident cannot be met. 264
332	332		[(d)] (e) (1) For transfers or discharges effected on or after October 1, 265
333	333		1989, a resident or his legally liable relative, guardian or conservator 266
334	334		who has been notified by a facility, pursuant to subsection (b) of this 267
335	335		section, that he will be transferred or discharged from the facility may 268
336	336		appeal such transfer or discharge to the Commissioner of Public Health 269
337	337		by filing a request for a hearing with the commissioner within ten days 270
338	338		of receipt of such notice. Upon receipt of any such request, the 271
339	339		commissioner or his designee shall hold a hearing to determine whether 272
340	340		the transfer or discharge is being effected in accordance with this 273
341	341		section. Such a hearing shall be held within seven business days of 274
342	342		receipt of such request and a determination made by the commissioner 275
343	343		or his designee within twenty days of the termination of the hearing. 276
344	344		The hearing shall be conducted in accordance with chapter 54. 277
345	345		(2) In an emergency the facility may request that the commissioner 278 Substitute Bill No. 6317
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352	352		make a determination as to the need for an immediate transfer or 279
353	353		discharge of a resident. Before making such a determination, the 280
354	354		commissioner shall notify the resident and, if known, his legally liable 281
355	355		relative, guardian or conservator. The commissioner shall issue such a 282
356	356		determination no later than seven days after receipt of the request for 283
357	357		such determination. If, as a result of such a request, the commissioner or 284
358	358		his designee determines that a failure to effect an immediate transfer or 285
359	359		discharge would endanger the health, safety or welfare of the resident 286
360	360		or other residents, the commissioner or his designee shall order the 287
361	361		immediate transfer or discharge of the resident from the facility. A 288
362	362		hearing shall be held in accordance with the requirements of 289
363	363		subdivision (1) of this subsection within seven business days of the 290
364	364		issuance of any determination issued pursuant to this subdivision. 291
365	365		(3) Any involuntary transfer or discharge shall be stayed pending a 292
366	366		determination by the commissioner or his designee. Notwithstanding 293
367	367		any provision of the general statutes, the determination of the 294
368	368		commissioner or his designee after a hearing shall be final and binding 295
369	369		upon all parties and not subject to any further appeal.296
370	370		This act shall take effect as follows and shall amend the following
371	371		sections:
372	372
373	373		Section 1 from passage 19a-535
374	374		Sec. 2 from passage 19a-535a
375	375
	376	+	Statement of Legislative Commissioners:
	377	+	In Sections 1(f)(2) and 1(f)(3), provisions were rewritten for clarity and
	378	+	internal consistency.
376	379
377	380		HS Joint Favorable Subst.
378		-	PH Joint Favorable
379	381