Connecticut House Bill HB06446 Introduced / Bill

                        
 
 
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General Assembly  Governor's Bill No. 6446  
January Session, 2021 
LCO No. 3112 
 
 
Referred to Committee on HUMAN SERVICES  
 
 
Introduced by:  
Request of the Governor Pursuant 
to Joint Rule 9 
  
 
 
 
 
AN ACT CONCERNING TH E GOVERNOR'S BUDGET 
RECOMMENDATIONS FOR HUMAN SERVICES. 
Be it enacted by the Senate and House of Representatives in General 
Assembly convened: 
 
Section 1. Subsection (b) of section 17b-104 of the general statutes is 1 
repealed and the following is substituted in lieu thereof (Effective July 1, 2 
2021): 3 
(b) On July 1, 2007, and annually thereafter, the commissioner shall 4 
increase the payment standards over those of the previous fiscal year 5 
under the temporary family assistance program and the state-6 
administered general assistance program by the percentage increase, if 7 
any, in the most recent calendar year average in the consumer price 8 
index for urban consumers over the average for the previous calendar 9 
year, provided the annual increase, if any, shall not exceed five per cent, 10 
except that the payment standards for the fiscal years ending June 30, 11 
2010, June 30, 2011, June 30, 2012, June 30, 2013, June 30, 2016, June 30, 12 
2017, June 30, 2018, June 30, 2019, June 30, 2020, [and] June 30, 2021, June 13 
30, 2022, and June 30, 2023, shall not be increased. 14  Governor's Bill No.  6446 
 
 
 
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Sec. 2. Subsection (a) of section 17b-106 of the general statutes is 15 
repealed and the following is substituted in lieu thereof (Effective July 1, 16 
2021): 17 
(a) On July 1, 1989, and annually thereafter, the commissioner shall 18 
increase the adult payment standards over those of the previous fiscal 19 
year for the state supplement to the federal Supplemental Security 20 
Income Program by the percentage increase, if any, in the most recent 21 
calendar year average in the consumer price index for urban consumers 22 
over the average for the previous calendar year, provided the annual 23 
increase, if any, shall not exceed five per cent, except that the adult 24 
payment standards for the fiscal years ending June 30, 1993, June 30, 25 
1994, June 30, 1995, June 30, 1996, June 30, 1997, June 30, 1998, June 30, 26 
1999, June 30, 2000, June 30, 2001, June 30, 2002, June 30, 2003, June 30, 27 
2004, June 30, 2005, June 30, 2006, June 30, 2007, June 30, 2008, June 30, 28 
2009, June 30, 2010, June 30, 2011, June 30, 2012, June 30, 2013, June 30, 29 
2016, June 30, 2017, June 30, 2018, June 30, 2019, June 30, 2020, [and] June 30 
30, 2021, June 30, 2022, and June 30, 2023, shall not be increased. 31 
Effective October 1, 1991, the coverage of excess utility costs for 32 
recipients of the state supplement to the federal Supplemental Security 33 
Income Program is eliminated. Notwithstanding the provisions of this 34 
section, the commissioner may increase the personal needs allowance 35 
component of the adult payment standard as necessary to meet federal 36 
maintenance of effort requirements. 37 
Sec. 3. Section 17b-256f of the general statutes is repealed and the 38 
following is substituted in lieu thereof (Effective August 1, 2022): 39 
The Commissioner of Social Services shall increase income disregards 40 
used to determine eligibility by the Department of Social Services for the 41 
federal Qualified Medicare Beneficiary, the Specified Low-Income 42 
Medicare Beneficiary and the Qualifying Individual programs, 43 
administered in accordance with the provisions of 42 USC 1396d(p), by 44 
such amounts that shall result in persons with income that is (1) less 45 
than two hundred eleven per cent of the federal poverty level qualifying 46 
for the Qualified Medicare Beneficiary program, (2) at or above two 47  Governor's Bill No.  6446 
 
 
 
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hundred eleven per cent of the federal poverty level but less than two 48 
hundred thirty-one per cent of the federal poverty level qualifying for 49 
the Specified Low-Income Medicare Beneficiary program, and (3) at or 50 
above two hundred thirty-one per cent of the federal poverty level but 51 
less than two hundred forty-six per cent of the federal poverty level 52 
qualifying for the Qualifying Individual program. The commissioner 53 
shall [not] apply an asset test for eligibility under the Medicare Savings 54 
Program. Eligible persons shall have countable assets less than or equal 55 
to two times the amount of allowable assets for Medicare Savings 56 
Programs as identified by the Centers for Medicare and Medicaid 57 
Services. The commissioner shall not consider as income Aid and 58 
Attendance pension benefits granted to a veteran, as defined in section 59 
27-103, or the surviving spouse of such veteran. The Commissioner of 60 
Social Services, pursuant to section 17b-10, may implement policies and 61 
procedures to administer the provisions of this section while in the 62 
process of adopting such policies and procedures in regulation form, 63 
provided the commissioner prints notice of the intent to adopt the 64 
regulations on the department's Internet web site and the eRegulations 65 
System not later than twenty days after the date of implementation. 66 
Such policies and procedures shall be valid until the time final 67 
regulations are adopted. 68 
Sec. 4. Section 17b-265 of the general statutes is repealed and the 69 
following is substituted in lieu thereof (Effective July 1, 2021): 70 
(a) In accordance with 42 USC 1396k, the Department of Social 71 
Services shall be subrogated to any right of recovery or indemnification 72 
that an applicant or recipient of medical assistance or any legally liable 73 
relative of such applicant or recipient has against an insurer or other 74 
legally liable third party including, but not limited to, a self-insured 75 
plan, group health plan, as defined in Section 607(1) of the Employee 76 
Retirement Income Security Act of 1974, service benefit plan, managed 77 
care organization, health care center, pharmacy benefit manager, dental 78 
benefit manager, third-party administrator or other party that is, by 79 
statute, contract or agreement, legally responsible for payment of a 80 
claim for a health care item or service, for the cost of all health care items 81  Governor's Bill No.  6446 
 
 
 
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or services furnished to the applicant or recipient, including, but not 82 
limited to, hospitalization, pharmaceutical services, physician services, 83 
nursing services, behavioral health services, long-term care services and 84 
other medical services, not to exceed the amount expended by the 85 
department for such care and treatment of the applicant or recipient. In 86 
the case of such a recipient who is an enrollee in a care management 87 
organization under a Medicaid care management contract with the state 88 
or a legally liable relative of such an enrollee, the department shall be 89 
subrogated to any right of recovery or indemnification which the 90 
enrollee or legally liable relative has against such a private insurer or 91 
other third party for the medical costs incurred by the care management 92 
organization on behalf of an enrollee. 93 
(b) An applicant or recipient or legally liable relative, by the act of the 94 
applicant's or recipient's receiving medical assistance, shall be deemed 95 
to have made a subrogation assignment and an assignment of claim for 96 
benefits to the department. The department shall inform an applicant of 97 
such assignments at the time of application. Any entitlements from a 98 
contractual agreement with an applicant or recipient, legally liable 99 
relative or a state or federal program for such medical services, not to 100 
exceed the amount expended by the department, shall be so assigned. 101 
Such entitlements shall be directly reimbursable to the department by 102 
third party payors. The Department of Social Services may assign its 103 
right to subrogation or its entitlement to benefits to a designee or a 104 
health care provider participating in the Medicaid program and 105 
providing services to an applicant or recipient, in order to assist the 106 
provider in obtaining payment for such services. In accordance with 107 
subsection (b) of section 38a-472, a provider that has received an 108 
assignment from the department shall notify the recipient's health 109 
insurer or other legally liable third party including, but not limited to, a 110 
self-insured plan, group health plan, as defined in Section 607(1) of the 111 
Employee Retirement Income Security Act of 1974, service benefit plan, 112 
managed care organization, health care center, pharmacy benefit 113 
manager, dental benefit manager, third-party administrator or other 114 
party that is, by statute, contract or agreement, legally responsible for 115  Governor's Bill No.  6446 
 
 
 
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payment of a claim for a health care item or service, of the assignment 116 
upon rendition of services to the applicant or recipient. Failure to so 117 
notify the health insurer or other legally liable third party shall render 118 
the provider ineligible for payment from the department. The provider 119 
shall notify the department of any request by the applicant or recipient 120 
or legally liable relative or representative of such applicant or recipient 121 
for billing information. This subsection shall not be construed to affect 122 
the right of an applicant or recipient to maintain an independent cause 123 
of action against such third party tortfeasor. 124 
(c) Claims for recovery or indemnification submitted by the 125 
department, or the department's designee, shall not be denied solely on 126 
the basis of the date of the submission of the claim, the type or format of 127 
the claim, the lack of prior authorization or the failure to present proper 128 
documentation at the point-of-service that is the basis of the claim, if (1) 129 
the claim is submitted by the state within the three-year period 130 
beginning on the date on which the item or service was furnished; and 131 
(2) any action by the state to enforce its rights with respect to such claim 132 
is commenced within six years of the state's submission of the claim. 133 
(d) When a recipient of medical assistance has personal health 134 
insurance in force covering care or other benefits provided under such 135 
program, payment or part-payment of the premium for such insurance 136 
may be made when deemed appropriate by the Commissioner of Social 137 
Services. [Effective January 1, 1992, the] The commissioner shall limit 138 
reimbursement to medical assistance providers for coinsurance and 139 
deductible payments under Title XVIII of the Social Security Act to 140 
assure that the combined Medicare and Medicaid payment to the 141 
provider shall not exceed the maximum allowable under the Medicaid 142 
program fee schedules. 143 
(e) No self-insured plan, group health plan, as defined in Section 144 
607(1) of the Employee Retirement Income Security Act of 1974, service 145 
benefit plan, managed care plan, or any plan offered or administered by 146 
a health care center, pharmacy benefit manager, dental benefit manager, 147 
third-party administrator or other party that is, by statute, contract or 148  Governor's Bill No.  6446 
 
 
 
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agreement, legally responsible for payment of a claim for a health care 149 
item or service, shall contain any provision that has the effect of denying 150 
or limiting enrollment benefits or excluding coverage because services 151 
are rendered to an insured or beneficiary who is eligible for or who 152 
received medical assistance under this chapter. No insurer, as defined 153 
in section 38a-497a, shall impose requirements on the state Medicaid 154 
agency, which has been assigned the rights of an individual eligible for 155 
Medicaid and covered for health benefits from an insurer, that differ 156 
from requirements applicable to an agent or assignee of another 157 
individual so covered. 158 
(f) The Commissioner of Social Services shall not pay for any services 159 
provided under this chapter if the individual eligible for medical 160 
assistance has coverage for the services under an accident or health 161 
insurance policy. 162 
(g) An insurer or other legally liable third party, upon receipt of a 163 
claim submitted by the department or the department's designee, in 164 
accordance with the requirements of subsection (c) of this section, for 165 
payment of a health care item or service covered under a state medical 166 
assistance program administered by the department, shall, not later 167 
than ninety days after receipt of the claim, or not later than ninety days 168 
after the effective date of this section, whichever is later, (1) make 169 
payment on the claim, (2) request information necessary to determine 170 
its legal obligation to pay the claim, or (3) issue a written reason for 171 
denial of the claim. Failure to pay, request information necessary to 172 
determine legal obligation to pay or issue a written reason for denial of 173 
a claim not later than one hundred twenty days after receipt of the claim, 174 
or not later than one hundred twenty days after the effective date of this 175 
section, whichever is later, creates an uncontestable obligation to pay 176 
the claim. The provisions of this subsection shall apply to all claims, 177 
including claims submitted by the department or the department's 178 
designee prior to July 1, 2021. 179 
(h) On and after July 1, 2021, an insurer or other legally liable third 180 
party who has reimbursed the department for a health care item or 181  Governor's Bill No.  6446 
 
 
 
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service paid for and covered under a state medical assistance program 182 
administered by the department, shall, upon determining it is not liable 183 
and at risk for cost of the health care item or service, request any refund 184 
from the department not later than twelve months from the date of its 185 
reimbursement to the department. 186 
Sec. 5. Section 17b-244 of the general statutes is repealed and the 187 
following is substituted in lieu thereof (Effective July 1, 2021): 188 
(a) The room and board component of the rates to be paid by the state 189 
to private facilities and facilities operated by regional education service 190 
centers which are licensed to provide residential care pursuant to 191 
section 17a-227, but not certified to participate in the Title XIX Medicaid 192 
program as intermediate care facilities for individuals with intellectual 193 
disabilities, shall be determined annually by the Commissioner of Social 194 
Services, except that rates effective April 30, 1989, shall remain in effect 195 
through October 31, 1989. Any facility with real property other than 196 
land placed in service prior to July 1, 1991, shall, for the fiscal year 197 
ending June 30, 1995, receive a rate of return on real property equal to 198 
the average of the rates of return applied to real property other than land 199 
placed in service for the five years preceding July 1, 1993. For the fiscal 200 
year ending June 30, 1996, and any succeeding fiscal year, the rate of 201 
return on real property for property items shall be revised every five 202 
years. The commissioner shall, upon submission of a request by such 203 
facility, allow actual debt service, comprised of principal and interest, 204 
on the loan or loans in lieu of property costs allowed pursuant to section 205 
17-313b-5 of the regulations of Connecticut state agencies, whether 206 
actual debt service is higher or lower than such allowed property costs, 207 
provided such debt service terms and amounts are reasonable in 208 
relation to the useful life and the base value of the property. In the case 209 
of facilities financed through the Connecticut Housing Finance 210 
Authority, the commissioner shall allow actual debt service, comprised 211 
of principal, interest and a reasonable repair and replacement reserve 212 
on the loan or loans in lieu of property costs allowed pursuant to section 213 
17-313b-5 of the regulations of Connecticut state agencies, whether 214 
actual debt service is higher or lower than such allowed property costs, 215  Governor's Bill No.  6446 
 
 
 
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provided such debt service terms and amounts are determined by the 216 
commissioner at the time the loan is entered into to be reasonable in 217 
relation to the useful life and base value of the property. The 218 
commissioner may allow fees associated with mortgage refinancing 219 
provided such refinancing will result in state reimbursement savings, 220 
after comparing costs over the terms of the existing proposed loans. For 221 
the fiscal year ending June 30, 1992, the inflation factor used to 222 
determine rates shall be one-half of the gross national product 223 
percentage increase for the period between the midpoint of the cost year 224 
through the midpoint of the rate year. For fiscal year ending June 30, 225 
1993, the inflation factor used to determine rates shall be two-thirds of 226 
the gross national product percentage increase from the midpoint of the 227 
cost year to the midpoint of the rate year. For the fiscal years ending 228 
June 30, 1996, and June 30, 1997, no inflation factor shall be applied in 229 
determining rates. The Commissioner of Social Services shall prescribe 230 
uniform forms on which such facilities shall report their costs. Such rates 231 
shall be determined on the basis of a reasonable payment for necessary 232 
services. Any increase in grants, gifts, fund-raising or endowment 233 
income used for the payment of operating costs by a private facility in 234 
the fiscal year ending June 30, 1992, shall be excluded by the 235 
commissioner from the income of the facility in determining the rates to 236 
be paid to the facility for the fiscal year ending June 30, 1993, provided 237 
any operating costs funded by such increase shall not obligate the state 238 
to increase expenditures in subsequent fiscal years. Nothing contained 239 
in this section shall authorize a payment by the state to any such facility 240 
in excess of the charges made by the facility for comparable services to 241 
the general public. The service component of the rates to be paid by the 242 
state to private facilities and facilities operated by regional education 243 
service centers which are licensed to provide residential care pursuant 244 
to section 17a-227, but not certified to participate in the Title XIX 245 
Medicaid programs as intermediate care facilities for individuals with 246 
intellectual disabilities, shall be determined annually by the 247 
Commissioner of Developmental Services in accordance with section 248 
17b-244a. For the fiscal year ending June 30, 2008, no facility shall receive 249 
a rate that is more than two per cent greater than the rate in effect for 250  Governor's Bill No.  6446 
 
 
 
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the facility on June 30, 2007, except any facility that would have been 251 
issued a lower rate effective July 1, 2007, due to interim rate status or 252 
agreement with the department, shall be issued such lower rate effective 253 
July 1, 2007. For the fiscal year ending June 30, 2009, no facility shall 254 
receive a rate that is more than two per cent greater than the rate in effect 255 
for the facility on June 30, 2008, except any facility that would have been 256 
issued a lower rate effective July 1, 2008, due to interim rate status or 257 
agreement with the department, shall be issued such lower rate effective 258 
July 1, 2008. For the fiscal years ending June 30, 2010, and June 30, 2011, 259 
rates in effect for the period ending June 30, 2009, shall remain in effect 260 
until June 30, 2011, except that (1) the rate paid to a facility may be higher 261 
than the rate paid to the facility for the period ending June 30, 2009, if a 262 
capital improvement required by the Commissioner of Developmental 263 
Services for the health or safety of the residents was made to the facility 264 
during the fiscal years ending June 30, 2010, or June 30, 2011, and (2) any 265 
facility that would have been issued a lower rate for the fiscal year 266 
ending June 30, 2010, or June 30, 2011, due to interim rate status or 267 
agreement with the department, shall be issued such lower rate. For the 268 
fiscal year ending June 30, 2012, rates in effect for the period ending June 269 
30, 2011, shall remain in effect until June 30, 2012, except that (A) the 270 
rate paid to a facility may be higher than the rate paid to the facility for 271 
the period ending June 30, 2011, if a capital improvement required by 272 
the Commissioner of Developmental Services for the health or safety of 273 
the residents was made to the facility during the fiscal year ending June 274 
30, 2012, and (B) any facility that would have been issued a lower rate 275 
for the fiscal year ending June 30, 2012, due to interim rate status or 276 
agreement with the department, shall be issued such lower rate. Any 277 
facility that has a significant decrease in land and building costs shall 278 
receive a reduced rate to reflect such decrease in land and building costs. 279 
The rate paid to a facility may be increased if a capital improvement 280 
approved by the Department of Developmental Services, in consultation 281 
with the Department of Social Services, for the health or safety of the 282 
residents was made to the facility during the fiscal year ending June 30, 283 
2014, or June 30, 2015, only to the extent such increases are within 284 
available appropriations. For the fiscal years ending June 30, 2016, and 285  Governor's Bill No.  6446 
 
 
 
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June 30, 2017, rates shall not exceed those in effect for the period ending 286 
June 30, 2015, except the rate paid to a facility may be higher than the 287 
rate paid to the facility for the period ending June 30, 2015, if a capital 288 
improvement approved by the Department of Developmental Services, 289 
in consultation with the Department of Social Services, for the health or 290 
safety of the residents was made to the facility during the fiscal year 291 
ending June 30, 2016, or June 30, 2017, to the extent such rate increases 292 
are within available appropriations. For the fiscal years ending June 30, 293 
2016, and June 30, 2017, and each succeeding fiscal year, any facility that 294 
would have been issued a lower rate, due to interim rate status, a change 295 
in allowable fair rent or agreement with the department, shall be issued 296 
such lower rate. For the fiscal years ending June 30, 2018, and June 30, 297 
2019, rates shall not exceed those in effect for the period ending June 30, 298 
2017, except the rate paid to a facility may be higher than the rate paid 299 
to the facility for the period ending June 30, 2017, if a capital 300 
improvement approved by the Department of Developmental Services, 301 
in consultation with the Department of Social Services, for the health or 302 
safety of the residents was made to the facility during the fiscal year 303 
ending June 30, 2018, or June 30, 2019, to the extent such rate increases 304 
are within available appropriations. For the fiscal years ending June 30, 305 
2020, and June 30, 2021, rates shall not exceed those in effect for the fiscal 306 
year ending June 30, 2019, except the rate paid to a facility may be higher 307 
than the rate paid to the facility for the fiscal year ending June 30, 2019, 308 
if a capital improvement approved by the Department of 309 
Developmental Services, in consultation with the Department of Social 310 
Services, for the health or safety of the residents was made to the facility 311 
during the fiscal year ending June 30, 2020, or June 30, 2021, to the extent 312 
such rate increases are within available appropriations. For the fiscal 313 
years ending June 30, 2022, and June 30, 2023, rates shall not exceed 314 
those in effect for the fiscal year ending June 30, 2021, except the rate 315 
paid to a facility may be higher than the rate paid to the facility for the 316 
fiscal year ending June 30, 2021, if a capital improvement approved by 317 
the Department of Developmental Services, in consultation with the 318 
Department of Social Services, for the health or safety of the residents 319 
was made to the facility during the fiscal year ending June 30, 2022, or 320  Governor's Bill No.  6446 
 
 
 
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June 30, 2023, to the extent such rate increases are within available 321 
appropriations. 322 
(b) Notwithstanding the provisions of subsection (a) of this section, 323 
state rates of payment for the fiscal years ending June 30, 2018, June 30, 324 
2019, June 30, 2020, [and] June 30, 2021, June 30, 2022, and June 30, 2023, 325 
for residential care homes and community living arrangements that 326 
receive the flat rate for residential services under section 17-311-54 of the 327 
regulations of Connecticut state agencies shall be set in accordance with 328 
section [298 of public act 19-117] 6 of this act. 329 
(c) The Commissioner of Social Services and the Commissioner of 330 
Developmental Services shall adopt regulations in accordance with the 331 
provisions of chapter 54 to implement the provisions of this section. 332 
Sec. 6. (Effective July 1, 2021) Notwithstanding subsection (a) of section 333 
17b-244 of the general statutes, as amended by this act, and subsections 334 
(a) to (i), inclusive, of section 17b-340 of the general statutes or any other 335 
provision of the general statutes, or regulation adopted thereunder, the 336 
state rates of payments in effect for the fiscal year ending June 30, 2016, 337 
for residential care homes, community living arrangements and 338 
community companion homes that receive the flat rate for residential 339 
services under section 17-311-54 of the regulations of Connecticut state 340 
agencies shall remain in effect until June 30, 2023. 341 
Sec. 7.  Section 17b-340d of the general statutes is repealed and the 342 
following is substituted in lieu thereof (Effective July 1, 2021): 343 
(a) The Commissioner of Social Services [may] shall implement an 344 
acuity-based methodology for Medicaid reimbursement of nursing 345 
home services. [In the course of developing such a system, the 346 
commissioner shall review the skilled nursing facility prospective 347 
payment system developed by the Centers for Medicare and Medicaid 348 
Services, as well as other methodologies used nationally, and shall 349 
consider recommendations from the nursing home industry. ] 350 
Notwithstanding section 17b-340, as amended by this act, for the fiscal 351 
year ending June 30, 2022, and annually thereafter, the Commissioner of 352  Governor's Bill No.  6446 
 
 
 
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Social Services shall establish Medicaid rates paid to nursing home 353 
facilities based on cost years ending on September thirtieth in 354 
accordance with the following: 355 
(1) Case-mix adjustments to the direct care component shall be made 356 
or phased in effective beginning July 1, 2021, and updated every quarter 357 
thereafter. The transition to acuity-based reimbursement shall be cost 358 
neutral and based on cost reports for the fiscal year ending June 30, 2018. 359 
(2) Geographic peer groupings of facilities shall be established by the 360 
Department of Social Services pursuant to regulations adopted in 361 
accordance with subsection (b) of this section. 362 
(3) Allowable costs shall be divided into the following five cost 363 
components: (A) Direct costs, which shall include salaries for nursing 364 
personnel, related fringe benefits and nursing pool costs; (B) indirect 365 
costs, which shall include professional fees, dietary expenses, 366 
housekeeping expenses, laundry expenses, supplies related to patient 367 
care, salaries for indirect care personnel and related fringe benefits; (C) 368 
fair rent, which shall be defined in regulations adopted in accordance 369 
with subsection (b) of this section; (D) capital-related costs, which shall 370 
include property taxes, insurance expenses, equipment leases and 371 
equipment depreciation; and (E) administrative and general costs, 372 
which shall include maintenance and operation of plant expenses, 373 
salaries for administrative and maintenance personnel and related 374 
fringe benefits. For (i) direct costs, the maximum cost shall be equal to 375 
one hundred thirty-five per cent of the median allowable cost of that 376 
peer grouping; (ii) indirect costs, the maximum cost shall be equal to one 377 
hundred fifteen per cent of the state-wide median allowable cost; (iii) 378 
fair rent, the amount shall be calculated utilizing the amount approved 379 
pursuant to section 17b-353; (iv) capital-related costs, there shall be no 380 
maximum; and (v) administrative and general costs, the maximum shall 381 
be equal to the state-wide median allowable cost. 382 
(4) For the fiscal year ending June 30, 2022, the commissioner may, in 383 
the commissioner's discretion and within available appropriations, 384  Governor's Bill No.  6446 
 
 
 
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provide pro rata fair rent increases to facilities which have documented 385 
fair rent additions placed in service in the cost report year ending 386 
September 30, 2019, that are not otherwise included in the rates issued. 387 
(5) There shall be no increase to rates based on inflation or any 388 
inflationary factor for the fiscal years ending June 30, 2022, and June 30, 389 
2023. 390 
(6) For purposes of computing minimum allowable patient days, 391 
utilization of a facility's certified beds shall be determined at a minimum 392 
of ninety per cent of capacity, except for new facilities and facilities 393 
which are certified for additional beds which may be permitted a lower 394 
occupancy rate for the first three months of operation after the effective 395 
date of licensure. 396 
(7) Rates determined under this section shall comply with federal 397 
laws and regulations. 398 
(b) The Commissioner of Social Services may implement policies as 399 
necessary to carry out the provisions of this section while in the process 400 
of adopting the policies as regulations, provided that prior to 401 
implementation the policies are posted (1) on the eRegulations System 402 
established pursuant to section 4-173b and (2) the Department of Social 403 
Services' Internet web site.  404 
Sec. 8. Section 17b-340 of the general statutes is repealed and the 405 
following is substituted in lieu thereof (Effective July 1, 2021): 406 
(a) For purposes of this subsection, (1) a "related party" includes, but 407 
is not limited to, any company related to a chronic and convalescent 408 
nursing home through family association, common ownership, control 409 
or business association with any of the owners, operators or officials of 410 
such nursing home; (2) "company" means any person, partnership, 411 
association, holding company, limited liability company or corporation; 412 
(3) "family association" means a relationship by birth, marriage or 413 
domestic partnership; and (4) "profit and loss statement" means the 414 
most recent annual statement on profits and losses finalized by a related 415  Governor's Bill No.  6446 
 
 
 
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party before the annual report mandated under this subsection. The 416 
rates to be paid by or for persons aided or cared for by the state or any 417 
town in this state to licensed chronic and convalescent nursing homes, 418 
to chronic disease hospitals associated with chronic and convalescent 419 
nursing homes, to rest homes with nursing supervision, to licensed 420 
residential care homes, as defined by section 19a-490, and to residential 421 
facilities for persons with intellectual disability that are licensed 422 
pursuant to section 17a-227 and certified to participate in the Title XIX 423 
Medicaid program as intermediate care facilities for individuals with 424 
intellectual disabilities, for room, board and services specified in 425 
licensing regulations issued by the licensing agency shall be determined 426 
annually, except as otherwise provided in this subsection [, after a 427 
public hearing,] by the Commissioner of Social Services, to be effective 428 
July first of each year except as otherwise provided in this subsection. 429 
Such rates shall be determined on a basis of a reasonable payment for 430 
such necessary services, which basis shall take into account as a factor 431 
the costs of such services. Cost of such services shall include reasonable 432 
costs mandated by collective bargaining agreements with certified 433 
collective bargaining agents or other agreements between the employer 434 
and employees, provided "employees" shall not include persons 435 
employed as managers or chief administrators or required to be licensed 436 
as nursing home administrators, and compensation for services 437 
rendered by proprietors at prevailing wage rates, as determined by 438 
application of principles of accounting as prescribed by said 439 
commissioner. Cost of such services shall not include amounts paid by 440 
the facilities to employees as salary, or to attorneys or consultants as 441 
fees, where the responsibility of the employees, attorneys, or consultants 442 
is to persuade or seek to persuade the other employees of the facility to 443 
support or oppose unionization. Nothing in this subsection shall 444 
prohibit inclusion of amounts paid for legal counsel related to the 445 
negotiation of collective bargaining agreements, the settlement of 446 
grievances or normal administration of labor relations. The 447 
commissioner may, in the commissioner's discretion, allow the inclusion 448 
of extraordinary and unanticipated costs of providing services that were 449 
incurred to avoid an immediate negative impact on the health and safety 450  Governor's Bill No.  6446 
 
 
 
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of patients. The commissioner may, in the commissioner's discretion, 451 
based upon review of a facility's costs, direct care staff to patient ratio 452 
and any other related information, revise a facility's rate for any 453 
increases or decreases to total licensed capacity of more than ten beds or 454 
changes to its number of licensed rest home with nursing supervision 455 
beds and chronic and convalescent nursing home beds. The 456 
commissioner may, in the commissioner's discretion, revise the rate of a 457 
facility that is closing. An interim rate issued for the period during 458 
which a facility is closing shall be based on a review of facility costs, the 459 
expected duration of the close-down period, the anticipated impact on 460 
Medicaid costs, available appropriations and the relationship of the rate 461 
requested by the facility to the average Medicaid rate for a close-down 462 
period. The commissioner may so revise a facility's rate established for 463 
the fiscal year ending June 30, 1993, and thereafter for any bed increases, 464 
decreases or changes in licensure effective after October 1, 1989. 465 
Effective July 1, 1991, in facilities that have both a chronic and 466 
convalescent nursing home and a rest home with nursing supervision, 467 
the rate for the rest home with nursing supervision shall not exceed such 468 
facility's rate for its chronic and convalescent nursing home. All such 469 
facilities for which rates are determined under this subsection shall 470 
report on a fiscal year basis ending on September thirtieth. Such report 471 
shall be submitted to the commissioner by February fifteenth. Each for-472 
profit chronic and convalescent nursing home that receives state 473 
funding pursuant to this section shall include in such annual report a 474 
profit and loss statement from each related party that receives from such 475 
chronic and convalescent nursing home fifty thousand dollars or more 476 
per year for goods, fees and services. No cause of action or liability shall 477 
arise against the state, the Department of Social Services, any state 478 
official or agent for failure to take action based on the information 479 
required to be reported under this subsection. The commissioner may 480 
reduce the rate in effect for a facility that fails to submit a complete and 481 
accurate report on or before February fifteenth by an amount not to 482 
exceed ten per cent of such rate. If a licensed residential care home fails 483 
to submit a complete and accurate report, the department shall notify 484 
such home of the failure and the home shall have thirty days from the 485  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	16 of 51 
 
date the notice was issued to submit a complete and accurate report. If 486 
a licensed residential care home fails to submit a complete and accurate 487 
report not later than thirty days after the date of notice, such home may 488 
not receive a retroactive rate increase, in the commissioner's discretion. 489 
The commissioner shall, annually, on or before April first, report the 490 
data contained in the reports of such facilities [to the joint standing 491 
committee of the General Assembly having cognizance of matters 492 
relating to appropriations and the budgets of state agencies] on the 493 
department's Internet web site. For the cost reporting year commencing 494 
October 1, 1985, and for subsequent cost reporting years, facilities shall 495 
report the cost of using the services of any nursing pool employee by 496 
separating said cost into two categories, the portion of the cost equal to 497 
the salary of the employee for whom the nursing pool employee is 498 
substituting shall be considered a nursing cost and any cost in excess of 499 
such salary shall be further divided so that seventy-five per cent of the 500 
excess cost shall be considered an administrative or general cost and 501 
twenty-five per cent of the excess cost shall be considered a nursing cost, 502 
provided if the total nursing pool costs of a facility for any cost year are 503 
equal to or exceed fifteen per cent of the total nursing expenditures of 504 
the facility for such cost year, no portion of nursing pool costs in excess 505 
of fifteen per cent shall be classified as administrative or general costs. 506 
The commissioner, in determining such rates, shall also take into 507 
account the classification of patients or boarders according to special 508 
care requirements or classification of the facility according to such 509 
factors as facilities and services and such other factors as the 510 
commissioner deems reasonable, including anticipated fluctuations in 511 
the cost of providing such services. The commissioner may establish a 512 
separate rate for a facility or a portion of a facility for traumatic brain 513 
injury patients who require extensive care but not acute general hospital 514 
care. Such separate rate shall reflect the special care requirements of 515 
such patients. If changes in federal or state laws, regulations or 516 
standards adopted subsequent to June 30, 1985, result in increased costs 517 
or expenditures in an amount exceeding one-half of one per cent of 518 
allowable costs for the most recent cost reporting year, the 519 
commissioner shall adjust rates and provide payment for any such 520  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	17 of 51 
 
increased reasonable costs or expenditures within a reasonable period 521 
of time retroactive to the date of enforcement. Nothing in this section 522 
shall be construed to require the Department of Social Services to adjust 523 
rates and provide payment for any increases in costs resulting from an 524 
inspection of a facility by the Department of Public Health. Such 525 
assistance as the commissioner requires from other state agencies or 526 
departments in determining rates shall be made available to the 527 
commissioner at the commissioner's request. Payment of the rates 528 
established pursuant to this section shall be conditioned on the 529 
establishment by such facilities of admissions procedures that conform 530 
with this section, section 19a-533 and all other applicable provisions of 531 
the law and the provision of equality of treatment to all persons in such 532 
facilities. The established rates shall be the maximum amount 533 
chargeable by such facilities for care of such beneficiaries, and the 534 
acceptance by or on behalf of any such facility of any additional 535 
compensation for care of any such beneficiary from any other person or 536 
source shall constitute the offense of aiding a beneficiary to obtain aid 537 
to which the beneficiary is not entitled and shall be punishable in the 538 
same manner as is provided in subsection (b) of section 17b-97. [For the 539 
fiscal year ending June 30, 1992, rates for licensed residential care homes 540 
and intermediate care facilities for individuals with intellectual 541 
disabilities may receive an increase not to exceed the most recent annual 542 
increase in the Regional Data Resources Incorporated McGraw-Hill 543 
Health Care Costs: Consumer Price Index (all urban)-All Items. Rates 544 
for newly certified intermediate care facilities for individuals with 545 
intellectual disabilities shall not exceed one hundred fifty per cent of the 546 
median rate of rates in effect on January 31, 1991, for intermediate care 547 
facilities for individuals with intellectual disabilities certified prior to 548 
February 1, 1991.] Notwithstanding any provision of this section, the 549 
Commissioner of Social Services may, within available appropriations, 550 
provide an interim rate increase for a licensed chronic and convalescent 551 
nursing home or a rest home with nursing supervision for rate periods 552 
no earlier than April 1, 2004, only if the commissioner determines that 553 
the increase is necessary to avoid the filing of a petition for relief under 554 
Title 11 of the United States Code; imposition of receivership pursuant 555  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	18 of 51 
 
to sections 19a-542 and 19a-543; or substantial deterioration of the 556 
facility's financial condition that may be expected to adversely affect 557 
resident care and the continued operation of the facility, and the 558 
commissioner determines that the continued operation of the facility is 559 
in the best interest of the state. The commissioner shall consider any 560 
requests for interim rate increases on file with the department from 561 
March 30, 2004, and those submitted subsequently for rate periods no 562 
earlier than April 1, 2004. When reviewing an interim rate increase 563 
request the commissioner shall, at a minimum, consider: (A) Existing 564 
chronic and convalescent nursing home or rest home with nursing 565 
supervision utilization in the area and projected bed need; (B) physical 566 
plant long-term viability and the ability of the owner or purchaser to 567 
implement any necessary property improvements; (C) licensure and 568 
certification compliance history; (D) reasonableness of actual and 569 
projected expenses; and (E) the ability of the facility to meet wage and 570 
benefit costs. No interim rate shall be increased pursuant to this 571 
subsection in excess of one hundred fifteen per cent of the median rate 572 
for the facility's peer grouping, established pursuant to subdivision (2) 573 
of subsection (f) of this section, unless recommended by the 574 
commissioner and approved by the Secretary of the Office of Policy and 575 
Management after consultation with the commissioner. Such median 576 
rates shall be published by the Department of Social Services not later 577 
than April first of each year. In the event that a facility granted an 578 
interim rate increase pursuant to this section is sold or otherwise 579 
conveyed for value to an unrelated entity less than five years after the 580 
effective date of such rate increase, the rate increase shall be deemed 581 
rescinded and the department shall recover an amount equal to the 582 
difference between payments made for all affected rate periods and 583 
payments that would have been made if the interim rate increase was 584 
not granted. The commissioner may seek recovery of such payments 585 
from any facility with common ownership. With the approval of the 586 
Secretary of the Office of Policy and Management, the commissioner 587 
may waive recovery and rescission of the interim rate for good cause 588 
shown that is not inconsistent with this section, including, but not 589 
limited to, transfers to family members that were made for no value. The 590  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	19 of 51 
 
commissioner shall provide written quarterly reports to the joint 591 
standing committees of the General Assembly having cognizance of 592 
matters relating to aging, human services and appropriations and the 593 
budgets of state agencies, that identify each facility requesting an 594 
interim rate increase, the amount of the requested rate increase for each 595 
facility, the action taken by the commissioner and the secretary pursuant 596 
to this subsection, and estimates of the additional cost to the state for 597 
each approved interim rate increase. Nothing in this subsection shall 598 
prohibit the commissioner from increasing the rate of a licensed chronic 599 
and convalescent nursing home or a rest home with nursing supervision 600 
for allowable costs associated with facility capital improvements or 601 
increasing the rate in case of a sale of a licensed chronic and convalescent 602 
nursing home or a rest home with nursing supervision [, pursuant to 603 
subdivision (15) of subsection (f) of this section,] if receivership has been 604 
imposed on such home. 605 
(b) [The Commissioner of Social Services shall adopt regulations in 606 
accordance with the provisions of chapter 54 to specify other allowable 607 
services. For purposes of this section, other allowable services means 608 
those services required by any medical assistance beneficiary residing 609 
in such home or hospital which are not already covered in the rate set 610 
by the commissioner in accordance with the provisions of subsection (a) 611 
of this section] The Commissioner of Social Services may implement 612 
policies and procedures as necessary to carry out the provisions of this 613 
section while in the process of adopting the policies and procedures as 614 
regulations, provided notice of intent to adopt the regulations is 615 
published in accordance with the provisions of section 17b-10 not later 616 
than twenty days after the date of implementation. 617 
(c) No facility subject to the requirements of this section shall accept 618 
payment in excess of the rate set by the commissioner pursuant to 619 
subsection (a) of this section for any medical assistance patient from this 620 
or any other state. No facility shall accept payment in excess of the 621 
reasonable and necessary costs of other allowable services as specified 622 
by the commissioner pursuant to the regulations adopted under 623 
subsection (b) of this section for any public assistance patient from this 624  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	20 of 51 
 
or any other state. Notwithstanding the provisions of this subsection, 625 
the commissioner may authorize a facility to accept payment in excess 626 
of the rate paid for a medical assistance patient in this state for a patient 627 
who receives medical assistance from another state. 628 
(d) In any instance where the Commissioner of Social Services finds 629 
that a facility subject to the requirements of this section is accepting 630 
payment for a medical assistance beneficiary in violation of subsection 631 
(c) of this section, the commissioner shall proceed to recover through the 632 
rate set for the facility any sum in excess of the stipulated per diem and 633 
other allowable costs, as provided for in regulations adopted pursuant 634 
to subsections (a) and (b) of this section. The commissioner shall make 635 
the recovery prospectively at the time of the next annual rate 636 
redetermination. 637 
(e) Except as provided in this subsection, the provisions of 638 
subsections (c) and (d) of this section shall not apply to any facility 639 
subject to the requirements of this section, which on October 1, 1981, (1) 640 
was accepting payments from the commissioner in accordance with the 641 
provisions of subsection (a) of this section, (2) was accepting medical 642 
assistance payments from another state for at least twenty per cent of its 643 
patients, and (3) had not notified the commissioner of any intent to 644 
terminate its provider agreement, in accordance with section 17b-271, 645 
provided no patient residing in any such facility on May 22, 1984, shall 646 
be removed from such facility for purposes of meeting the requirements 647 
of this subsection. If the commissioner finds that the number of beds 648 
available to medical assistance patients from this state in any such 649 
facility is less than fifteen per cent the provisions of subsections (c) and 650 
(d) of this section shall apply to that number of beds which is less than 651 
said percentage. 652 
(f) For the fiscal years ending on or before June 30, 2021, rates for 653 
nursing home facilities shall be set in accordance with this subsection. 654 
On and after July 1, 2021, such rates shall be set in accordance with 655 
section 17b-340d, as amended by this act. For the fiscal year ending June 656 
30, 1992, the rates paid by or for persons aided or cared for by the state 657  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	21 of 51 
 
or any town in this state to facilities for room, board and services 658 
specified in licensing regulations issued by the licensing agency, except 659 
intermediate care facilities for individuals with intellectual disabilities 660 
and residential care homes, shall be based on the cost year ending 661 
September 30, 1989. For the fiscal years ending June 30, 1993, and June 662 
30, 1994, such rates shall be based on the cost year ending September 30, 663 
1990. Such rates shall be determined by the Commissioner of Social 664 
Services in accordance with this section and the regulations of 665 
Connecticut state agencies promulgated by the commissioner and in 666 
effect on April 1, 1991, except that: 667 
(1) Allowable costs shall be divided into the following five cost 668 
components: (A) Direct costs, which shall include salaries for nursing 669 
personnel, related fringe benefits and nursing pool costs; (B) indirect 670 
costs, which shall include professional fees, dietary expenses, 671 
housekeeping expenses, laundry expenses, supplies related to patient 672 
care, salaries for indirect care personnel and related fringe benefits; (C) 673 
fair rent, which shall be defined in accordance with subsection (f) of 674 
section 17-311-52 of the regulations of Connecticut state agencies; (D) 675 
capital-related costs, which shall include property taxes, insurance 676 
expenses, equipment leases and equipment depreciation; and (E) 677 
administrative and general costs, which shall include (i) maintenance 678 
and operation of plant expenses, (ii) salaries for administrative and 679 
maintenance personnel, and (iii) related fringe benefits. The 680 
commissioner may provide a rate adjustment for nonemergency 681 
transportation services required by nursing facility residents. Such 682 
adjustment shall be a fixed amount determined annually by the 683 
commissioner based upon a review of costs and other associated 684 
information. Allowable costs shall not include costs for ancillary 685 
services payable under Part B of the Medicare program. 686 
(2) Two geographic peer groupings of facilities shall be established 687 
for each level of care, as defined by the Department of Social Services 688 
for the determination of rates, for the purpose of determining allowable 689 
direct costs. One peer grouping shall be comprised of those facilities 690 
located in Fairfield County. The other peer grouping shall be comprised 691  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	22 of 51 
 
of facilities located in all other counties. 692 
(3) For the fiscal year ending June 30, 1992, per diem maximum 693 
allowable costs for each cost component shall be as follows: For direct 694 
costs, the maximum shall be equal to one hundred forty per cent of the 695 
median allowable cost of that peer grouping; for indirect costs, the 696 
maximum shall be equal to one hundred thirty per cent of the state-wide 697 
median allowable cost; for fair rent, the amount shall be calculated 698 
utilizing the amount approved by the Office of Health Care Access 699 
pursuant to section 19a-638; for capital-related costs, there shall be no 700 
maximum; and for administrative and general costs, the maximum shall 701 
be equal to one hundred twenty-five per cent of the state-wide median 702 
allowable cost. For the fiscal year ending June 30, 1993, per diem 703 
maximum allowable costs for each cost component shall be as follows: 704 
For direct costs, the maximum shall be equal to one hundred forty per 705 
cent of the median allowable cost of that peer grouping; for indirect 706 
costs, the maximum shall be equal to one hundred twenty-five per cent 707 
of the state-wide median allowable cost; for fair rent, the amount shall 708 
be calculated utilizing the amount approved by the Office of Health 709 
Care Access pursuant to section 19a-638; for capital-related costs, there 710 
shall be no maximum; and for administrative and general costs the 711 
maximum shall be equal to one hundred fifteen per cent of the state-712 
wide median allowable cost. For the fiscal year ending June 30, 1994, per 713 
diem maximum allowable costs for each cost component shall be as 714 
follows: For direct costs, the maximum shall be equal to one hundred 715 
thirty-five per cent of the median allowable cost of that peer grouping; 716 
for indirect costs, the maximum shall be equal to one hundred twenty 717 
per cent of the state-wide median allowable cost; for fair rent, the 718 
amount shall be calculated utilizing the amount approved by the Office 719 
of Health Care Access pursuant to section 19a-638; for capital-related 720 
costs, there shall be no maximum; and for administrative and general 721 
costs the maximum shall be equal to one hundred ten per cent of the 722 
state-wide median allowable cost. For the fiscal year ending June 30, 723 
1995, per diem maximum allowable costs for each cost component shall 724 
be as follows: For direct costs, the maximum shall be equal to one 725  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	23 of 51 
 
hundred thirty-five per cent of the median allowable cost of that peer 726 
grouping; for indirect costs, the maximum shall be equal to one hundred 727 
twenty per cent of the state-wide median allowable cost; for fair rent, 728 
the amount shall be calculated utilizing the amount approved by the 729 
Office of Health Care Access pursuant to section 19a-638; for capital-730 
related costs, there shall be no maximum; and for administrative and 731 
general costs the maximum shall be equal to one hundred five per cent 732 
of the state-wide median allowable cost. For the fiscal year ending June 733 
30, 1996, and any succeeding fiscal year, except for the fiscal years 734 
ending June 30, 2000, and June 30, 2001, for facilities with an interim rate 735 
in one or both periods, per diem maximum allowable costs for each cost 736 
component shall be as follows: For direct costs, the maximum shall be 737 
equal to one hundred thirty-five per cent of the median allowable cost 738 
of that peer grouping; for indirect costs, the maximum shall be equal to 739 
one hundred fifteen per cent of the state-wide median allowable cost; 740 
for fair rent, the amount shall be calculated utilizing the amount 741 
approved pursuant to section 19a-638; for capital-related costs, there 742 
shall be no maximum; and for administrative and general costs the 743 
maximum shall be equal to the state-wide median allowable cost. For 744 
the fiscal years ending June 30, 2000, and June 30, 2001, for facilities with 745 
an interim rate in one or both periods, per diem maximum allowable 746 
costs for each cost component shall be as follows: For direct costs, the 747 
maximum shall be equal to one hundred forty-five per cent of the 748 
median allowable cost of that peer grouping; for indirect costs, the 749 
maximum shall be equal to one hundred twenty-five per cent of the 750 
state-wide median allowable cost; for fair rent, the amount shall be 751 
calculated utilizing the amount approved pursuant to section 19a-638; 752 
for capital-related costs, there shall be no maximum; and for 753 
administrative and general costs, the maximum shall be equal to the 754 
state-wide median allowable cost and such medians shall be based upon 755 
the same cost year used to set rates for facilities with prospective rates. 756 
Costs in excess of the maximum amounts established under this 757 
subsection shall not be recognized as allowable costs, except that the 758 
Commissioner of Social Services (A) may allow costs in excess of 759 
maximum amounts for any facility with patient days covered by 760  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	24 of 51 
 
Medicare, including days requiring coinsurance, in excess of twelve per 761 
cent of annual patient days which also has patient days covered by 762 
Medicaid in excess of fifty per cent of annual patient days; (B) may 763 
establish a pilot program whereby costs in excess of maximum amounts 764 
shall be allowed for beds in a nursing home which has a managed care 765 
program and is affiliated with a hospital licensed under chapter 368v; 766 
and (C) may establish rates whereby allowable costs may exceed such 767 
maximum amounts for beds approved on or after July 1, 1991, which are 768 
restricted to use by patients with acquired immune deficiency syndrome 769 
or traumatic brain injury. 770 
(4) For the fiscal year ending June 30, 1992, (A) no facility shall receive 771 
a rate that is less than the rate it received for the rate year ending June 772 
30, 1991; (B) no facility whose rate, if determined pursuant to this 773 
subsection, would exceed one hundred twenty per cent of the state-wide 774 
median rate, as determined pursuant to this subsection, shall receive a 775 
rate which is five and one-half per cent more than the rate it received for 776 
the rate year ending June 30, 1991; and (C) no facility whose rate, if 777 
determined pursuant to this subsection, would be less than one hundred 778 
twenty per cent of the state-wide median rate, as determined pursuant 779 
to this subsection, shall receive a rate which is six and one-half per cent 780 
more than the rate it received for the rate year ending June 30, 1991. For 781 
the fiscal year ending June 30, 1993, no facility shall receive a rate that is 782 
less than the rate it received for the rate year ending June 30, 1992, or six 783 
per cent more than the rate it received for the rate year ending June 30, 784 
1992. For the fiscal year ending June 30, 1994, no facility shall receive a 785 
rate that is less than the rate it received for the rate year ending June 30, 786 
1993, or six per cent more than the rate it received for the rate year 787 
ending June 30, 1993. For the fiscal year ending June 30, 1995, no facility 788 
shall receive a rate that is more than five per cent less than the rate it 789 
received for the rate year ending June 30, 1994, or six per cent more than 790 
the rate it received for the rate year ending June 30, 1994. For the fiscal 791 
years ending June 30, 1996, and June 30, 1997, no facility shall receive a 792 
rate that is more than three per cent more than the rate it received for 793 
the prior rate year. For the fiscal year ending June 30, 1998, a facility shall 794  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	25 of 51 
 
receive a rate increase that is not more than two per cent more than the 795 
rate that the facility received in the prior year. For the fiscal year ending 796 
June 30, 1999, a facility shall receive a rate increase that is not more than 797 
three per cent more than the rate that the facility received in the prior 798 
year and that is not less than one per cent more than the rate that the 799 
facility received in the prior year, exclusive of rate increases associated 800 
with a wage, benefit and staffing enhancement rate adjustment added 801 
for the period from April 1, 1999, to June 30, 1999, inclusive. For the fiscal 802 
year ending June 30, 2000, each facility, except a facility with an interim 803 
rate or replaced interim rate for the fiscal year ending June 30, 1999, and 804 
a facility having a certificate of need or other agreement specifying rate 805 
adjustments for the fiscal year ending June 30, 2000, shall receive a rate 806 
increase equal to one per cent applied to the rate the facility received for 807 
the fiscal year ending June 30, 1999, exclusive of the facility's wage, 808 
benefit and staffing enhancement rate adjustment. For the fiscal year 809 
ending June 30, 2000, no facility with an interim rate, replaced interim 810 
rate or scheduled rate adjustment specified in a certificate of need or 811 
other agreement for the fiscal year ending June 30, 2000, shall receive a 812 
rate increase that is more than one per cent more than the rate the facility 813 
received in the fiscal year ending June 30, 1999. For the fiscal year ending 814 
June 30, 2001, each facility, except a facility with an interim rate or 815 
replaced interim rate for the fiscal year ending June 30, 2000, and a 816 
facility having a certificate of need or other agreement specifying rate 817 
adjustments for the fiscal year ending June 30, 2001, shall receive a rate 818 
increase equal to two per cent applied to the rate the facility received for 819 
the fiscal year ending June 30, 2000, subject to verification of wage 820 
enhancement adjustments pursuant to subdivision (14) of this 821 
subsection. For the fiscal year ending June 30, 2001, no facility with an 822 
interim rate, replaced interim rate or scheduled rate adjustment 823 
specified in a certificate of need or other agreement for the fiscal year 824 
ending June 30, 2001, shall receive a rate increase that is more than two 825 
per cent more than the rate the facility received for the fiscal year ending 826 
June 30, 2000. For the fiscal year ending June 30, 2002, each facility shall 827 
receive a rate that is two and one-half per cent more than the rate the 828 
facility received in the prior fiscal year. For the fiscal year ending June 829  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	26 of 51 
 
30, 2003, each facility shall receive a rate that is two per cent more than 830 
the rate the facility received in the prior fiscal year, except that such 831 
increase shall be effective January 1, 2003, and such facility rate in effect 832 
for the fiscal year ending June 30, 2002, shall be paid for services 833 
provided until December 31, 2002, except any facility that would have 834 
been issued a lower rate effective July 1, 2002, than for the fiscal year 835 
ending June 30, 2002, due to interim rate status or agreement with the 836 
department shall be issued such lower rate effective July 1, 2002, and 837 
have such rate increased two per cent effective June 1, 2003. For the fiscal 838 
year ending June 30, 2004, rates in effect for the period ending June 30, 839 
2003, shall remain in effect, except any facility that would have been 840 
issued a lower rate effective July 1, 2003, than for the fiscal year ending 841 
June 30, 2003, due to interim rate status or agreement with the 842 
department shall be issued such lower rate effective July 1, 2003. For the 843 
fiscal year ending June 30, 2005, rates in effect for the period ending June 844 
30, 2004, shall remain in effect until December 31, 2004, except any 845 
facility that would have been issued a lower rate effective July 1, 2004, 846 
than for the fiscal year ending June 30, 2004, due to interim rate status 847 
or agreement with the department shall be issued such lower rate 848 
effective July 1, 2004. Effective January 1, 2005, each facility shall receive 849 
a rate that is one per cent greater than the rate in effect December 31, 850 
2004. Effective upon receipt of all the necessary federal approvals to 851 
secure federal financial participation matching funds associated with 852 
the rate increase provided in this subdivision, but in no event earlier 853 
than July 1, 2005, and provided the user fee imposed under section 17b-854 
320 is required to be collected, for the fiscal year ending June 30, 2006, 855 
the department shall compute the rate for each facility based upon its 856 
2003 cost report filing or a subsequent cost year filing for facilities 857 
having an interim rate for the period ending June 30, 2005, as provided 858 
under section 17-311-55 of the regulations of Connecticut state agencies. 859 
For each facility not having an interim rate for the period ending June 860 
30, 2005, the rate for the period ending June 30, 2006, shall be determined 861 
beginning with the higher of the computed rate based upon its 2003 cost 862 
report filing or the rate in effect for the period ending June 30, 2005. Such 863 
rate shall then be increased by eleven dollars and eighty cents per day 864  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	27 of 51 
 
except that in no event shall the rate for the period ending June 30, 2006, 865 
be thirty-two dollars more than the rate in effect for the period ending 866 
June 30, 2005, and for any facility with a rate below one hundred ninety-867 
five dollars per day for the period ending June 30, 2005, such rate for the 868 
period ending June 30, 2006, shall not be greater than two hundred 869 
seventeen dollars and forty-three cents per day and for any facility with 870 
a rate equal to or greater than one hundred ninety-five dollars per day 871 
for the period ending June 30, 2005, such rate for the period ending June 872 
30, 2006, shall not exceed the rate in effect for the period ending June 30, 873 
2005, increased by eleven and one-half per cent. For each facility with 874 
an interim rate for the period ending June 30, 2005, the interim 875 
replacement rate for the period ending June 30, 2006, shall not exceed 876 
the rate in effect for the period ending June 30, 2005, increased by eleven 877 
dollars and eighty cents per day plus the per day cost of the user fee 878 
payments made pursuant to section 17b-320 divided by annual resident 879 
service days, except for any facility with an interim rate below one 880 
hundred ninety-five dollars per day for the period ending June 30, 2005, 881 
the interim replacement rate for the period ending June 30, 2006, shall 882 
not be greater than two hundred seventeen dollars and forty-three cents 883 
per day and for any facility with an interim rate equal to or greater than 884 
one hundred ninety-five dollars per day for the period ending June 30, 885 
2005, the interim replacement rate for the period ending June 30, 2006, 886 
shall not exceed the rate in effect for the period ending June 30, 2005, 887 
increased by eleven and one-half per cent. Such July 1, 2005, rate 888 
adjustments shall remain in effect unless (i) the federal financial 889 
participation matching funds associated with the rate increase are no 890 
longer available; or (ii) the user fee created pursuant to section 17b-320 891 
is not in effect. For the fiscal year ending June 30, 2007, each facility shall 892 
receive a rate that is three per cent greater than the rate in effect for the 893 
period ending June 30, 2006, except any facility that would have been 894 
issued a lower rate effective July 1, 2006, than for the rate period ending 895 
June 30, 2006, due to interim rate status or agreement with the 896 
department, shall be issued such lower rate effective July 1, 2006. For the 897 
fiscal year ending June 30, 2008, each facility shall receive a rate that is 898 
two and nine-tenths per cent greater than the rate in effect for the period 899  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	28 of 51 
 
ending June 30, 2007, except any facility that would have been issued a 900 
lower rate effective July 1, 2007, than for the rate period ending June 30, 901 
2007, due to interim rate status or agreement with the department, shall 902 
be issued such lower rate effective July 1, 2007. For the fiscal year ending 903 
June 30, 2009, rates in effect for the period ending June 30, 2008, shall 904 
remain in effect until June 30, 2009, except any facility that would have 905 
been issued a lower rate for the fiscal year ending June 30, 2009, due to 906 
interim rate status or agreement with the department shall be issued 907 
such lower rate. For the fiscal years ending June 30, 2010, and June 30, 908 
2011, rates in effect for the period ending June 30, 2009, shall remain in 909 
effect until June 30, 2011, except any facility that would have been issued 910 
a lower rate for the fiscal year ending June 30, 2010, or the fiscal year 911 
ending June 30, 2011, due to interim rate status or agreement with the 912 
department, shall be issued such lower rate. For the fiscal years ending 913 
June 30, 2012, and June 30, 2013, rates in effect for the period ending June 914 
30, 2011, shall remain in effect until June 30, 2013, except any facility that 915 
would have been issued a lower rate for the fiscal year ending June 30, 916 
2012, or the fiscal year ending June 30, 2013, due to interim rate status 917 
or agreement with the department, shall be issued such lower rate. For 918 
the fiscal year ending June 30, 2014, the department shall determine 919 
facility rates based upon 2011 cost report filings subject to the provisions 920 
of this section and applicable regulations except: (I) A ninety per cent 921 
minimum occupancy standard shall be applied; (II) no facility shall 922 
receive a rate that is higher than the rate in effect on June 30, 2013; and 923 
(III) no facility shall receive a rate that is more than four per cent lower 924 
than the rate in effect on June 30, 2013, except that any facility that would 925 
have been issued a lower rate effective July 1, 2013, than for the rate 926 
period ending June 30, 2013, due to interim rate status or agreement 927 
with the department, shall be issued such lower rate effective July 1, 928 
2013. For the fiscal year ending June 30, 2015, rates in effect for the 929 
period ending June 30, 2014, shall remain in effect until June 30, 2015, 930 
except any facility that would have been issued a lower rate effective 931 
July 1, 2014, than for the rate period ending June 30, 2014, due to interim 932 
rate status or agreement with the department, shall be issued such lower 933 
rate effective July 1, 2014. For the fiscal years ending June 30, 2016, and 934  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	29 of 51 
 
June 30, 2017, rates shall not exceed those in effect for the period ending 935 
June 30, 2015, except the rate paid to a facility may be higher than the 936 
rate paid to the facility for the period ending June 30, 2015, if the 937 
commissioner provides, within available appropriations, pro rata fair 938 
rent increases, which may, at the discretion of the commissioner, include 939 
increases for facilities which have undergone a material change in 940 
circumstances related to fair rent additions or moveable equipment 941 
placed in service in cost report years ending September 30, 2014, and 942 
September 30, 2015, and not otherwise included in rates issued. For the 943 
fiscal years ending June 30, 2016, and June 30, 2017, and each succeeding 944 
fiscal year, any facility that would have been issued a lower rate, due to 945 
interim rate status or agreement with the department, shall be issued 946 
such lower rate. For the fiscal year ending June 30, 2018, facilities that 947 
received a rate decrease due to the expiration of a 2015 fair rent asset 948 
shall receive a rate increase of an equivalent amount effective July 1, 949 
2017. For the fiscal year ending June 30, 2018, the department shall 950 
determine facility rates based upon 2016 cost report filings subject to the 951 
provisions of this section and applicable regulations, provided no 952 
facility shall receive a rate that is higher than the rate in effect on 953 
December 31, 2016, and no facility shall receive a rate that is more than 954 
two per cent lower than the rate in effect on December 31, 2016. For the 955 
fiscal year ending June 30, 2019, no facility shall receive a rate that is 956 
higher than the rate in effect on June 30, 2018, except the rate paid to a 957 
facility may be higher than the rate paid to the facility for the period 958 
ending June 30, 2018, if the commissioner provides, within available 959 
appropriations, pro rata fair rent increases, which may, at the discretion 960 
of the commissioner, include increases for facilities which have 961 
undergone a material change in circumstances related to fair rent 962 
additions or moveable equipment placed in service in the cost report 963 
year ending September 30, 2017, and not otherwise included in rates 964 
issued. For the fiscal year ending June 30, 2020, the department shall 965 
determine facility rates based upon 2018 cost report filings subject to the 966 
provisions of this section, adjusted to reflect any rate increases provided 967 
after the cost report year ending September 30, 2018, and applicable 968 
regulations, provided no facility shall receive a rate that is higher than 969  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	30 of 51 
 
the rate in effect on June 30, 2019, except the rate paid to a facility may 970 
be higher than the rate paid to the facility for the fiscal year ending June 971 
30, 2019, if the commissioner provides, within available appropriations, 972 
pro rata fair rent increases, which may, at the discretion of the 973 
commissioner, include increases for facilities which have undergone a 974 
material change in circumstances related to fair rent additions in the cost 975 
report year ending September 30, 2018, and are not otherwise included 976 
in rates issued. For the fiscal year ending June 30, 2020, no facility shall 977 
receive a rate that is more than two per cent lower than the rate in effect 978 
on June 30, 2019, unless the facility has an occupancy level of less than 979 
seventy per cent, as reported in the 2018 cost report, or an overall rating 980 
on Medicare's Nursing Home Compare of one star for the three most 981 
recent reporting periods as of July 1, 2019, unless the facility is under an 982 
interim rate due to new ownership. For the fiscal year ending June 30, 983 
2021, no facility shall receive a rate that is higher than the rate in effect 984 
on June 30, 2020, except the rate paid to a facility may be higher than the 985 
rate paid to the facility for the fiscal year ending June 30, 2020, if the 986 
commissioner provides, within available appropriations, pro rata fair 987 
rent increases, which may, at the discretion of the commissioner, include 988 
increases for facilities which have undergone a material change in 989 
circumstances related to fair rent additions in the cost report year 990 
ending September 30, 2019, and are not otherwise included in rates 991 
issued. The Commissioner of Social Services shall add fair rent increases 992 
to any other rate increases established pursuant to this subdivision for a 993 
facility which has undergone a material change in circumstances related 994 
to fair rent, except for the fiscal years ending June 30, 2010, June 30, 2011, 995 
and June 30, 2012, such fair rent increases shall only be provided to 996 
facilities with an approved certificate of need pursuant to section 17b-997 
352, 17b-353, 17b-354 or 17b-355. For the fiscal year ending June 30, 2013, 998 
the commissioner may, within available appropriations, provide pro 999 
rata fair rent increases for facilities which have undergone a material 1000 
change in circumstances related to fair rent additions placed in service 1001 
in cost report years ending September 30, 2008, to September 30, 2011, 1002 
inclusive, and not otherwise included in rates issued. For the fiscal years 1003 
ending June 30, 2014, and June 30, 2015, the commissioner may, within 1004  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	31 of 51 
 
available appropriations, provide pro rata fair rent increases, which may 1005 
include moveable equipment at the discretion of the commissioner, for 1006 
facilities which have undergone a material change in circumstances 1007 
related to fair rent additions or moveable equipment placed in service 1008 
in cost report years ending September 30, 2012, and September 30, 2013, 1009 
and not otherwise included in rates issued. The commissioner shall add 1010 
fair rent increases associated with an approved certificate of need 1011 
pursuant to section 17b-352, 17b-353, 17b-354 or 17b-355. Interim rates 1012 
may take into account reasonable costs incurred by a facility, including 1013 
wages and benefits. Notwithstanding the provisions of this section, the 1014 
Commissioner of Social Services may, subject to available 1015 
appropriations, increase or decrease rates issued to licensed chronic and 1016 
convalescent nursing homes and licensed rest homes with nursing 1017 
supervision. Notwithstanding any provision of this section, the 1018 
Commissioner of Social Services shall, effective July 1, 2015, within 1019 
available appropriations, adjust facility rates in accordance with the 1020 
application of standard accounting principles as prescribed by the 1021 
commissioner, for each facility subject to subsection (a) of this section. 1022 
Such adjustment shall provide a pro-rata increase based on direct and 1023 
indirect care employee salaries reported in the 2014 annual cost report, 1024 
and adjusted to reflect subsequent salary increases, to reflect reasonable 1025 
costs mandated by collective bargaining agreements with certified 1026 
collective bargaining agents, or otherwise provided by a facility to its 1027 
employees. For purposes of this subsection, "employee" shall not 1028 
include a person employed as a facility's manager, chief administrator, 1029 
a person required to be licensed as a nursing home administrator or any 1030 
individual who receives compensation for services pursuant to a 1031 
contractual arrangement and who is not directly employed by the 1032 
facility. The commissioner may establish an upper limit for reasonable 1033 
costs associated with salary adjustments beyond which the adjustment 1034 
shall not apply. Nothing in this section shall require the commissioner 1035 
to distribute such adjustments in a way that jeopardizes anticipated 1036 
federal reimbursement. Facilities that receive such adjustment but do 1037 
not provide increases in employee salaries as described in this 1038 
subsection on or before July 31, 2015, may be subject to a rate decrease 1039  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	32 of 51 
 
in the same amount as the adjustment by the commissioner. Of the 1040 
amount appropriated for this purpose, no more than nine million 1041 
dollars shall go to increases based on reasonable costs mandated by 1042 
collective bargaining agreements. Notwithstanding the provisions of 1043 
this subsection, effective July 1, 2019, October 1, 2020, and January 1, 1044 
2021, the commissioner shall, within available appropriations, increase 1045 
rates for the purpose of wage and benefit enhancements for facility 1046 
employees. The commissioner shall adjust the rate paid to the facility in 1047 
the form of a rate adjustment to reflect any rate increases paid after the 1048 
cost report year ending September 30, 2018. Facilities that receive a rate 1049 
adjustment for the purpose of wage and benefit enhancements but do 1050 
not provide increases in employee salaries as described in this 1051 
subsection on or before September 30, 2019, October 31, 2020, and 1052 
January 31, 2021, respectively, may be subject to a rate decrease in the 1053 
same amount as the adjustment by the commissioner. 1054 
(5) For the purpose of determining allowable fair rent, a facility with 1055 
allowable fair rent less than the twenty-fifth percentile of the state-wide 1056 
allowable fair rent shall be reimbursed as having allowable fair rent 1057 
equal to the twenty-fifth percentile of the state-wide allowable fair rent, 1058 
provided for the fiscal years ending June 30, 1996, and June 30, 1997, the 1059 
reimbursement may not exceed the twenty-fifth percentile of the state-1060 
wide allowable fair rent for the fiscal year ending June 30, 1995. On and 1061 
after July 1, 1998, the Commissioner of Social Services may allow 1062 
minimum fair rent as the basis upon which reimbursement associated 1063 
with improvements to real property is added. Beginning with the fiscal 1064 
year ending June 30, 1996, any facility with a rate of return on real 1065 
property other than land in excess of eleven per cent shall have such 1066 
allowance revised to eleven per cent. Any facility or its related realty 1067 
affiliate which finances or refinances debt through bonds issued by the 1068 
State of Connecticut Health and Education Facilities Authority shall 1069 
report the terms and conditions of such financing or refinancing to the 1070 
Commissioner of Social Services within thirty days of completing such 1071 
financing or refinancing. The Commissioner of Social Services may 1072 
revise the facility's fair rent component of its rate to reflect any financial 1073  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	33 of 51 
 
benefit the facility or its related realty affiliate received as a result of such 1074 
financing or refinancing, including but not limited to, reductions in the 1075 
amount of debt service payments or period of debt repayment. The 1076 
commissioner shall allow actual debt service costs for bonds issued by 1077 
the State of Connecticut Health and Educational Facilities Authority if 1078 
such costs do not exceed property costs allowed pursuant to subsection 1079 
(f) of section 17-311-52 of the regulations of Connecticut state agencies, 1080 
provided the commissioner may allow higher debt service costs for such 1081 
bonds for good cause. For facilities which first open on or after October 1082 
1, 1992, the commissioner shall determine allowable fair rent for real 1083 
property other than land based on the rate of return for the cost year in 1084 
which such bonds were issued. The financial benefit resulting from a 1085 
facility financing or refinancing debt through such bonds shall be shared 1086 
between the state and the facility to an extent determined by the 1087 
commissioner on a case-by-case basis and shall be reflected in an 1088 
adjustment to the facility's allowable fair rent. 1089 
(6) A facility shall receive cost efficiency adjustments for indirect costs 1090 
and for administrative and general costs if such costs are below the 1091 
state-wide median costs. The cost efficiency adjustments shall equal 1092 
twenty-five per cent of the difference between allowable reported costs 1093 
and the applicable median allowable cost established pursuant to this 1094 
subdivision. 1095 
(7) For the fiscal year ending June 30, 1992, allowable operating costs, 1096 
excluding fair rent, shall be inflated using the Regional Data Resources 1097 
Incorporated McGraw-Hill Health Care Costs: Consumer Price Index 1098 
(all urban)-All Items minus one and one-half per cent. For the fiscal year 1099 
ending June 30, 1993, allowable operating costs, excluding fair rent, shall 1100 
be inflated using the Regional Data Resources Incorporated McGraw-1101 
Hill Health Care Costs: Consumer Price Index (all urban)-All Items 1102 
minus one and three-quarters per cent. For the fiscal years ending June 1103 
30, 1994, and June 30, 1995, allowable operating costs, excluding fair 1104 
rent, shall be inflated using the Regional Data Resources Incorporated 1105 
McGraw-Hill Health Care Costs: Consumer Price Index (all urban)-All 1106 
Items minus two per cent. For the fiscal year ending June 30, 1996, 1107  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	34 of 51 
 
allowable operating costs, excluding fair rent, shall be inflated using the 1108 
Regional Data Resources Incorporated McGraw-Hill Health Care Costs: 1109 
Consumer Price Index (all urban)-All Items minus two and one-half per 1110 
cent. For the fiscal year ending June 30, 1997, allowable operating costs, 1111 
excluding fair rent, shall be inflated using the Regional Data Resources 1112 
Incorporated McGraw-Hill Health Care Costs: Consumer Price Index 1113 
(all urban)-All Items minus three and one-half per cent. For the fiscal 1114 
year ending June 30, 1992, and any succeeding fiscal year, allowable fair 1115 
rent shall be those reported in the annual report of long-term care 1116 
facilities for the cost year ending the immediately preceding September 1117 
thirtieth. The inflation index to be used pursuant to this subsection shall 1118 
be computed to reflect inflation between the midpoint of the cost year 1119 
through the midpoint of the rate year. The Department of Social Services 1120 
shall study methods of reimbursement for fair rent and shall report its 1121 
findings and recommendations to the joint standing committee of the 1122 
General Assembly having cognizance of matters relating to human 1123 
services on or before January 15, 1993. 1124 
(8) On and after July 1, 1994, costs shall be rebased no more frequently 1125 
than every two years and no less frequently than every four years, as 1126 
determined by the commissioner. The commissioner shall determine 1127 
whether and to what extent a change in ownership of a facility shall 1128 
occasion the rebasing of the facility's costs. 1129 
(9) The method of establishing rates for new facilities shall be 1130 
determined by the commissioner in accordance with the provisions of 1131 
this subsection until June 30, 2021. 1132 
(10) Rates determined under this section shall comply with federal 1133 
laws and regulations. 1134 
(11) Notwithstanding the provisions of this subsection, interim rates 1135 
issued for facilities on and after July 1, 1991, shall be subject to applicable 1136 
fiscal year cost component limitations established pursuant to 1137 
subdivision (3) of this subsection. 1138 
(12) A chronic and convalescent nursing home having an ownership 1139  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	35 of 51 
 
affiliation with and operated at the same location as a chronic disease 1140 
hospital may request that the commissioner approve an exception to 1141 
applicable rate-setting provisions for chronic and convalescent nursing 1142 
homes and establish a rate for the fiscal years ending June 30, 1992, and 1143 
June 30, 1993, in accordance with regulations in effect June 30, 1991. Any 1144 
such rate shall not exceed one hundred sixty-five per cent of the median 1145 
rate established for chronic and convalescent nursing homes established 1146 
under this section for the applicable fiscal year. 1147 
(13) For the fiscal year ending June 30, 2014, and any succeeding fiscal 1148 
year, for purposes of computing minimum allowable patient days, 1149 
utilization of a facility's certified beds shall be determined at a minimum 1150 
of ninety per cent of capacity, except for new facilities and facilities 1151 
which are certified for additional beds which may be permitted a lower 1152 
occupancy rate for the first three months of operation after the effective 1153 
date of licensure. 1154 
(14) The Commissioner of Social Services shall adjust facility rates 1155 
from April 1, 1999, to June 30, 1999, inclusive, by a per diem amount 1156 
representing each facility's allocation of funds appropriated for the 1157 
purpose of wage, benefit and staffing enhancement. A facility's per diem 1158 
allocation of such funding shall be computed as follows: (A) The 1159 
facility's direct and indirect component salary, wage, nursing pool and 1160 
allocated fringe benefit costs as filed for the 1998 cost report period 1161 
deemed allowable in accordance with this section and applicable 1162 
regulations without application of cost component maximums specified 1163 
in subdivision (3) of this subsection shall be totalled; (B) such total shall 1164 
be multiplied by the facility's Medicaid utilization based on the 1998 cost 1165 
report; (C) the resulting amount for the facility shall be divided by the 1166 
sum of the calculations specified in subparagraphs (A) and (B) of this 1167 
subdivision for all facilities to determine the facility's percentage share 1168 
of appropriated wage, benefit and staffing enhancement funding; (D) 1169 
the facility's percentage share shall be multiplied by the amount of 1170 
appropriated wage, benefit and staffing enhancement funding to 1171 
determine the facility's allocated amount; and (E) such allocated amount 1172 
shall be divided by the number of days of care paid for by Medicaid on 1173  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	36 of 51 
 
an annual basis including days for reserved beds specified in the 1998 1174 
cost report to determine the per diem wage and benefit rate adjustment 1175 
amount. The commissioner may adjust a facility's reported 1998 cost and 1176 
utilization data for the purposes of determining a facility's share of 1177 
wage, benefit and staffing enhancement funding when reported 1998 1178 
information is not substantially representative of estimated cost and 1179 
utilization data for the fiscal year ending June 30, 2000, due to special 1180 
circumstances during the 1998 cost report period including change of 1181 
ownership with a part year cost filing or reductions in facility capacity 1182 
due to facility renovation projects. Upon completion of the calculation 1183 
of the allocation of wage, benefit and staffing enhancement funding, the 1184 
commissioner shall not adjust the allocations due to revisions submitted 1185 
to previously filed 1998 annual cost reports. In the event that a facility's 1186 
rate for the fiscal year ending June 30, 1999, is an interim rate or the rate 1187 
includes an increase adjustment due to a rate request to the 1188 
commissioner or other reasons, the commissioner may reduce or 1189 
withhold the per diem wage, benefit and staffing enhancement 1190 
allocation computed for the facility. Any enhancement allocations not 1191 
applied to facility rates shall not be reallocated to other facilities and 1192 
such unallocated amounts shall be available for the costs associated with 1193 
interim rates and other Medicaid expenditures. The wage, benefit and 1194 
staffing enhancement per diem adjustment for the period from April 1, 1195 
1999, to June 30, 1999, inclusive, shall also be applied to rates for the 1196 
fiscal years ending June 30, 2000, and June 30, 2001, except that the 1197 
commissioner may increase or decrease the adjustment to account for 1198 
changes in facility capacity or operations. Any facility accepting a rate 1199 
adjustment for wage, benefit and staffing enhancements shall apply 1200 
payments made as a result of such rate adjustment for increased 1201 
allowable employee wage rates and benefits and additional direct and 1202 
indirect component staffing. Adjustment funding shall not be applied to 1203 
wage and salary increases provided to the administrator, assistant 1204 
administrator, owners or related party employees. Enhancement 1205 
payments may be applied to increases in costs associated with staffing 1206 
purchased from staffing agencies provided such costs are deemed 1207 
necessary and reasonable by the commissioner. The commissioner shall 1208  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	37 of 51 
 
compare expenditures for wages, benefits and staffing for the 1998 cost 1209 
report period to such expenditures in the 1999, 2000 and 2001 cost report 1210 
periods to verify whether a facility has applied additional payments to 1211 
specified enhancements. In the event that the commissioner determines 1212 
that a facility did not apply additional payments to specified 1213 
enhancements, the commissioner shall recover such amounts from the 1214 
facility through rate adjustments or other means. The commissioner 1215 
may require facilities to file cost reporting forms, in addition to the 1216 
annual cost report, as may be necessary, to verify the appropriate 1217 
application of wage, benefit and staffing enhancement rate adjustment 1218 
payments. For the purposes of this subdivision, "Medicaid utilization" 1219 
means the number of days of care paid for by Medicaid on an annual 1220 
basis including days for reserved beds as a percentage of total resident 1221 
days. 1222 
[(15) The interim rate established to become effective upon sale of any 1223 
licensed chronic and convalescent home or rest home with nursing 1224 
supervision for which a receivership has been imposed pursuant to 1225 
sections 19a-541 to 19a-549, inclusive, shall not exceed the rate in effect 1226 
for the facility at the time of the imposition of the receivership, subject 1227 
to any annual increases permitted by this section; provided the 1228 
Commissioner of Social Services may, in the commissioner's discretion, 1229 
and after consultation with the receiver, establish an increased rate for 1230 
the facility if the commissioner with approval of the Secretary of the 1231 
Office of Policy and Management determines that such higher rate is 1232 
needed to keep the facility open and to ensure the health, safety and 1233 
welfare of the residents at such facility.] 1234 
(g) The established interim rate to become effective upon sale of any 1235 
licensed chronic and convalescent home or rest home with nursing 1236 
supervision for which a receivership has been imposed pursuant to 1237 
sections 19a-541 to 19a-549, inclusive, shall not exceed the rate in effect 1238 
for the facility at the time of the imposition of the receivership, subject 1239 
to any annual increases permitted by this section, provided the 1240 
Commissioner of Social Services may, in the commissioner's discretion 1241 
and after consultation with the receiver, establish an increased rate for 1242  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	38 of 51 
 
the facility if the commissioner, with the approval of the Secretary of the 1243 
Office of Policy and Management, determines that such higher rate is 1244 
needed to keep the facility open and to ensure the health, safety and 1245 
welfare of the residents at such facility. 1246 
[(g)] (h) For the fiscal year ending June 30, 1993, any intermediate care 1247 
facility for individuals with intellectual disabilities with an operating 1248 
cost component of its rate in excess of one hundred forty per cent of the 1249 
median of operating cost components of rates in effect January 1, 1992, 1250 
shall not receive an operating cost component increase. For the fiscal 1251 
year ending June 30, 1993, any intermediate care facility for individuals 1252 
with intellectual disabilities with an operating cost component of its rate 1253 
that is less than one hundred forty per cent of the median of operating 1254 
cost components of rates in effect January 1, 1992, shall have an 1255 
allowance for real wage growth equal to thirty per cent of the increase 1256 
determined in accordance with subsection (q) of section 17-311-52 of the 1257 
regulations of Connecticut state agencies, provided such operating cost 1258 
component shall not exceed one hundred forty per cent of the median 1259 
of operating cost components in effect January 1, 1992. Any facility with 1260 
real property other than land placed in service prior to October 1, 1991, 1261 
shall, for the fiscal year ending June 30, 1995, receive a rate of return on 1262 
real property equal to the average of the rates of return applied to real 1263 
property other than land placed in service for the five years preceding 1264 
October 1, 1993. For the fiscal year ending June 30, 1996, and any 1265 
succeeding fiscal year, the rate of return on real property for property 1266 
items shall be revised every five years. The commissioner shall, upon 1267 
submission of a request, allow actual debt service, comprised of 1268 
principal and interest, in excess of property costs allowed pursuant to 1269 
section 17-311-52 of the regulations of Connecticut state agencies, 1270 
provided such debt service terms and amounts are reasonable in 1271 
relation to the useful life and the base value of the property. For the fiscal 1272 
year ending June 30, 1995, and any succeeding fiscal year, the inflation 1273 
adjustment made in accordance with subsection (p) of section 17-311-52 1274 
of the regulations of Connecticut state agencies shall not be applied to 1275 
real property costs. For the fiscal year ending June 30, 1996, and any 1276  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	39 of 51 
 
succeeding fiscal year, the allowance for real wage growth, as 1277 
determined in accordance with subsection (q) of section 17-311-52 of the 1278 
regulations of Connecticut state agencies, shall not be applied. For the 1279 
fiscal year ending June 30, 1996, and any succeeding fiscal year, no rate 1280 
shall exceed three hundred seventy-five dollars per day unless the 1281 
commissioner, in consultation with the Commissioner of 1282 
Developmental Services, determines after a review of program and 1283 
management costs, that a rate in excess of this amount is necessary for 1284 
care and treatment of facility residents. For the fiscal year ending June 1285 
30, 2002, rate period, the Commissioner of Social Services shall increase 1286 
the inflation adjustment for rates made in accordance with subsection 1287 
(p) of section 17-311-52 of the regulations of Connecticut state agencies 1288 
to update allowable fiscal year 2000 costs to include a three and one-half 1289 
per cent inflation factor. For the fiscal year ending June 30, 2003, rate 1290 
period, the commissioner shall increase the inflation adjustment for 1291 
rates made in accordance with subsection (p) of section 17-311-52 of the 1292 
regulations of Connecticut state agencies to update allowable fiscal year 1293 
2001 costs to include a one and one-half per cent inflation factor, except 1294 
that such increase shall be effective November 1, 2002, and such facility 1295 
rate in effect for the fiscal year ending June 30, 2002, shall be paid for 1296 
services provided until October 31, 2002, except any facility that would 1297 
have been issued a lower rate effective July 1, 2002, than for the fiscal 1298 
year ending June 30, 2002, due to interim rate status or agreement with 1299 
the department shall be issued such lower rate effective July 1, 2002, and 1300 
have such rate updated effective November 1, 2002, in accordance with 1301 
applicable statutes and regulations. For the fiscal year ending June 30, 1302 
2004, rates in effect for the period ending June 30, 2003, shall remain in 1303 
effect, except any facility that would have been issued a lower rate 1304 
effective July 1, 2003, than for the fiscal year ending June 30, 2003, due 1305 
to interim rate status or agreement with the department shall be issued 1306 
such lower rate effective July 1, 2003. For the fiscal year ending June 30, 1307 
2005, rates in effect for the period ending June 30, 2004, shall remain in 1308 
effect until September 30, 2004. Effective October 1, 2004, each facility 1309 
shall receive a rate that is five per cent greater than the rate in effect 1310 
September 30, 2004. Effective upon receipt of all the necessary federal 1311  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	40 of 51 
 
approvals to secure federal financial participation matching funds 1312 
associated with the rate increase provided in subdivision (4) of 1313 
subsection (f) of this section, but in no event earlier than October 1, 2005, 1314 
and provided the user fee imposed under section 17b-320 is required to 1315 
be collected, each facility shall receive a rate that is four per cent more 1316 
than the rate the facility received in the prior fiscal year, except any 1317 
facility that would have been issued a lower rate effective October 1, 1318 
2005, than for the fiscal year ending June 30, 2005, due to interim rate 1319 
status or agreement with the department, shall be issued such lower rate 1320 
effective October 1, 2005. Such rate increase shall remain in effect unless: 1321 
(1) The federal financial participation matching funds associated with 1322 
the rate increase are no longer available; or (2) the user fee created 1323 
pursuant to section 17b-320 is not in effect. For the fiscal year ending 1324 
June 30, 2007, rates in effect for the period ending June 30, 2006, shall 1325 
remain in effect until September 30, 2006, except any facility that would 1326 
have been issued a lower rate effective July 1, 2006, than for the fiscal 1327 
year ending June 30, 2006, due to interim rate status or agreement with 1328 
the department, shall be issued such lower rate effective July 1, 2006. 1329 
Effective October 1, 2006, no facility shall receive a rate that is more than 1330 
three per cent greater than the rate in effect for the facility on September 1331 
30, 2006, except any facility that would have been issued a lower rate 1332 
effective October 1, 2006, due to interim rate status or agreement with 1333 
the department, shall be issued such lower rate effective October 1, 2006. 1334 
For the fiscal year ending June 30, 2008, each facility shall receive a rate 1335 
that is two and nine-tenths per cent greater than the rate in effect for the 1336 
period ending June 30, 2007, except any facility that would have been 1337 
issued a lower rate effective July 1, 2007, than for the rate period ending 1338 
June 30, 2007, due to interim rate status, or agreement with the 1339 
department, shall be issued such lower rate effective July 1, 2007. For the 1340 
fiscal year ending June 30, 2009, rates in effect for the period ending June 1341 
30, 2008, shall remain in effect until June 30, 2009, except any facility that 1342 
would have been issued a lower rate for the fiscal year ending June 30, 1343 
2009, due to interim rate status or agreement with the department, shall 1344 
be issued such lower rate. For the fiscal years ending June 30, 2010, and 1345 
June 30, 2011, rates in effect for the period ending June 30, 2009, shall 1346  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	41 of 51 
 
remain in effect until June 30, 2011, except any facility that would have 1347 
been issued a lower rate for the fiscal year ending June 30, 2010, or the 1348 
fiscal year ending June 30, 2011, due to interim rate status or agreement 1349 
with the department, shall be issued such lower rate. For the fiscal year 1350 
ending June 30, 2012, rates in effect for the period ending June 30, 2011, 1351 
shall remain in effect until June 30, 2012, except any facility that would 1352 
have been issued a lower rate for the fiscal year ending June 30, 2012, 1353 
due to interim rate status or agreement with the department, shall be 1354 
issued such lower rate. For the fiscal years ending June 30, 2014, and 1355 
June 30, 2015, rates shall not exceed those in effect for the period ending 1356 
June 30, 2013, except the rate paid to a facility may be higher than the 1357 
rate paid to the facility for the period ending June 30, 2013, if a capital 1358 
improvement approved by the Department of Developmental Services, 1359 
in consultation with the Department of Social Services, for the health or 1360 
safety of the residents was made to the facility during the fiscal year 1361 
ending June 30, 2014, or June 30, 2015, to the extent such rate increases 1362 
are within available appropriations. Any facility that would have been 1363 
issued a lower rate for the fiscal year ending June 30, 2014, or the fiscal 1364 
year ending June 30, 2015, due to interim rate status or agreement with 1365 
the department, shall be issued such lower rate. For the fiscal years 1366 
ending June 30, 2016, and June 30, 2017, rates shall not exceed those in 1367 
effect for the period ending June 30, 2015, except the rate paid to a 1368 
facility may be higher than the rate paid to the facility for the period 1369 
ending June 30, 2015, if a capital improvement approved by the 1370 
Department of Developmental Services, in consultation with the 1371 
Department of Social Services, for the health or safety of the residents 1372 
was made to the facility during the fiscal year ending June 30, 2016, or 1373 
June 30, 2017, to the extent such rate increases are within available 1374 
appropriations. For the fiscal years ending June 30, 2016, and June 30, 1375 
2017, and each succeeding fiscal year, any facility that would have been 1376 
issued a lower rate, due to interim rate status, a change in allowable fair 1377 
rent or agreement with the department, shall be issued such lower rate. 1378 
For the fiscal years ending June 30, 2018, and June 30, 2019, rates shall 1379 
not exceed those in effect for the period ending June 30, 2017, except the 1380 
rate paid to a facility may be higher than the rate paid to the facility for 1381  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	42 of 51 
 
the period ending June 30, 2017, if a capital improvement approved by 1382 
the Department of Developmental Services, in consultation with the 1383 
Department of Social Services, for the health or safety of the residents 1384 
was made to the facility during the fiscal year ending June 30, 2018, or 1385 
June 30, 2019, only to the extent such rate increases are within available 1386 
appropriations. For the fiscal years ending June 30, 2020, and June 30, 1387 
2021, rates shall not exceed those in effect for the fiscal year ending June 1388 
30, 2019, except the rate paid to a facility may be higher than the rate 1389 
paid to the facility for the fiscal year ending June 30, 2019, if a capital 1390 
improvement approved by the Department of Developmental Services, 1391 
in consultation with the Department of Social Services, for the health or 1392 
safety of the residents was made to the facility during the fiscal year 1393 
ending June 30, 2020, or June 30, 2021, only to the extent such rate 1394 
increases are within available appropriations. For the fiscal years ending 1395 
June 30, 2022, and June 30, 2023, rates shall not exceed those in effect for 1396 
the fiscal year ending June 30, 2021, except the rate paid to a facility may 1397 
be higher than the rate paid to the facility for the fiscal year ending June 1398 
30, 2021, if a capital improvement approved by the Department of 1399 
Developmental Services, in consultation with the Department of Social 1400 
Services, for the health or safety of the residents was made to the facility 1401 
during the fiscal year ending June 30, 2022, or June 30, 2023, only to the 1402 
extent such rate increases are within available appropriations. Any 1403 
facility that has a significant decrease in land and building costs shall 1404 
receive a reduced rate to reflect such decrease in land and building costs. 1405 
For the fiscal years ending June 30, 2012, June 30, 2013, June 30, 2014, 1406 
June 30, 2015, June 30, 2016, June 30, 2017, June 30, 2018, June 30, 2019, 1407 
June 30, 2020, [and] June 30, 2021, June 30, 2022, and June 30, 2023, the 1408 
Commissioner of Social Services may provide fair rent increases to any 1409 
facility that has undergone a material change in circumstances related 1410 
to fair rent and has an approved certificate of need pursuant to section 1411 
17b-352, 17b-353, 17b-354 or 17b-355. Notwithstanding the provisions of 1412 
this section, the Commissioner of Social Services may, within available 1413 
appropriations, increase or decrease rates issued to intermediate care 1414 
facilities for individuals with intellectual disabilities to reflect a 1415 
reduction in available appropriations as provided in subsection (a) of 1416  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	43 of 51 
 
this section. For the fiscal years ending June 30, 2014, and June 30, 2015, 1417 
the commissioner shall not consider rebasing in determining rates. 1418 
[(h) (1)] (i) For the fiscal year ending June 30, 1993, any residential 1419 
care home with an operating cost component of its rate in excess of one 1420 
hundred thirty per cent of the median of operating cost components of 1421 
rates in effect January 1, 1992, shall not receive an operating cost 1422 
component increase. For the fiscal year ending June 30, 1993, any 1423 
residential care home with an operating cost component of its rate that 1424 
is less than one hundred thirty per cent of the median of operating cost 1425 
components of rates in effect January 1, 1992, shall have an allowance 1426 
for real wage growth equal to sixty-five per cent of the increase 1427 
determined in accordance with subsection (q) of section 17-311-52 of the 1428 
regulations of Connecticut state agencies, provided such operating cost 1429 
component shall not exceed one hundred thirty per cent of the median 1430 
of operating cost components in effect January 1, 1992. Beginning with 1431 
the fiscal year ending June 30, 1993, for the purpose of determining 1432 
allowable fair rent, a residential care home with allowable fair rent less 1433 
than the twenty-fifth percentile of the state-wide allowable fair rent shall 1434 
be reimbursed as having allowable fair rent equal to the twenty-fifth 1435 
percentile of the state-wide allowable fair rent. Beginning with the fiscal 1436 
year ending June 30, 1997, a residential care home with allowable fair 1437 
rent less than three dollars and ten cents per day shall be reimbursed as 1438 
having allowable fair rent equal to three dollars and ten cents per day. 1439 
Property additions placed in service during the cost year ending 1440 
September 30, 1996, or any succeeding cost year shall receive a fair rent 1441 
allowance for such additions as an addition to three dollars and ten 1442 
cents per day if the fair rent for the facility for property placed in service 1443 
prior to September 30, 1995, is less than or equal to three dollars and ten 1444 
cents per day. Beginning with the fiscal year ending June 30, 2016, a 1445 
residential care home shall be reimbursed the greater of the allowable 1446 
accumulated fair rent reimbursement associated with real property 1447 
additions and land as calculated on a per day basis or three dollars and 1448 
ten cents per day if the allowable reimbursement associated with real 1449 
property additions and land is less than three dollars and ten cents per 1450  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	44 of 51 
 
day. For the fiscal year ending June 30, 1996, and any succeeding fiscal 1451 
year, the allowance for real wage growth, as determined in accordance 1452 
with subsection (q) of section 17-311-52 of the regulations of Connecticut 1453 
state agencies, shall not be applied. For the fiscal year ending June 30, 1454 
1996, and any succeeding fiscal year, the inflation adjustment made in 1455 
accordance with subsection (p) of section 17-311-52 of the regulations of 1456 
Connecticut state agencies shall not be applied to real property costs. 1457 
Beginning with the fiscal year ending June 30, 1997, minimum allowable 1458 
patient days for rate computation purposes for a residential care home 1459 
with twenty-five beds or less shall be eighty-five per cent of licensed 1460 
capacity. Beginning with the fiscal year ending June 30, 2002, for the 1461 
purposes of determining the allowable salary of an administrator of a 1462 
residential care home with sixty beds or less the department shall revise 1463 
the allowable base salary to thirty-seven thousand dollars to be annually 1464 
inflated thereafter in accordance with section 17-311-52 of the 1465 
regulations of Connecticut state agencies. The rates for the fiscal year 1466 
ending June 30, 2002, shall be based upon the increased allowable salary 1467 
of an administrator, regardless of whether such amount was expended 1468 
in the 2000 cost report period upon which the rates are based. Beginning 1469 
with the fiscal year ending June 30, 2000, and until the fiscal year ending 1470 
June 30, 2009, inclusive, the inflation adjustment for rates made in 1471 
accordance with subsection (p) of section 17-311-52 of the regulations of 1472 
Connecticut state agencies shall be increased by two per cent, and 1473 
beginning with the fiscal year ending June 30, 2002, the inflation 1474 
adjustment for rates made in accordance with subsection (c) of said 1475 
section shall be increased by one per cent. Beginning with the fiscal year 1476 
ending June 30, 1999, for the purpose of determining the allowable 1477 
salary of a related party, the department shall revise the maximum 1478 
salary to twenty-seven thousand eight hundred fifty-six dollars to be 1479 
annually inflated thereafter in accordance with section 17-311-52 of the 1480 
regulations of Connecticut state agencies and beginning with the fiscal 1481 
year ending June 30, 2001, such allowable salary shall be computed on 1482 
an hourly basis and the maximum number of hours allowed for a related 1483 
party other than the proprietor shall be increased from forty hours to 1484 
forty-eight hours per work week. For the fiscal year ending June 30, 1485  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	45 of 51 
 
2005, each facility shall receive a rate that is two and one-quarter per 1486 
cent more than the rate the facility received in the prior fiscal year, 1487 
except any facility that would have been issued a lower rate effective 1488 
July 1, 2004, than for the fiscal year ending June 30, 2004, due to interim 1489 
rate status or agreement with the department shall be issued such lower 1490 
rate effective July 1, 2004. Effective upon receipt of all the necessary 1491 
federal approvals to secure federal financial participation matching 1492 
funds associated with the rate increase provided in subdivision (4) of 1493 
subsection (f) of this section, but in no event earlier than October 1, 2005, 1494 
and provided the user fee imposed under section 17b-320 is required to 1495 
be collected, each facility shall receive a rate that is determined in 1496 
accordance with applicable law and subject to appropriations, except 1497 
any facility that would have been issued a lower rate effective October 1498 
1, 2005, than for the fiscal year ending June 30, 2005, due to interim rate 1499 
status or agreement with the department, shall be issued such lower rate 1500 
effective October 1, 2005. Such rate increase shall remain in effect unless: 1501 
[(A)] (1) The federal financial participation matching funds associated 1502 
with the rate increase are no longer available; or [(B)] (2) the user fee 1503 
created pursuant to section 17b-320 is not in effect. For the fiscal year 1504 
ending June 30, 2007, rates in effect for the period ending June 30, 2006, 1505 
shall remain in effect until September 30, 2006, except any facility that 1506 
would have been issued a lower rate effective July 1, 2006, than for the 1507 
fiscal year ending June 30, 2006, due to interim rate status or agreement 1508 
with the department, shall be issued such lower rate effective July 1, 1509 
2006. Effective October 1, 2006, no facility shall receive a rate that is more 1510 
than four per cent greater than the rate in effect for the facility on 1511 
September 30, 2006, except for any facility that would have been issued 1512 
a lower rate effective October 1, 2006, due to interim rate status or 1513 
agreement with the department, shall be issued such lower rate effective 1514 
October 1, 2006. For the fiscal years ending June 30, 2010, and June 30, 1515 
2011, rates in effect for the period ending June 30, 2009, shall remain in 1516 
effect until June 30, 2011, except any facility that would have been issued 1517 
a lower rate for the fiscal year ending June 30, 2010, or the fiscal year 1518 
ending June 30, 2011, due to interim rate status or agreement with the 1519 
department, shall be issued such lower rate, except [(i)] (A) any facility 1520  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	46 of 51 
 
that would have been issued a lower rate for the fiscal year ending June 1521 
30, 2010, or the fiscal year ending June 30, 2011, due to interim rate status 1522 
or agreement with the Commissioner of Social Services shall be issued 1523 
such lower rate; and [(ii)] (B) the commissioner may increase a facility's 1524 
rate for reasonable costs associated with such facility's compliance with 1525 
the provisions of section 19a-495a concerning the administration of 1526 
medication by unlicensed personnel. For the fiscal year ending June 30, 1527 
2012, rates in effect for the period ending June 30, 2011, shall remain in 1528 
effect until June 30, 2012, except that [(I)] (i) any facility that would have 1529 
been issued a lower rate for the fiscal year ending June 30, 2012, due to 1530 
interim rate status or agreement with the Commissioner of Social 1531 
Services shall be issued such lower rate; and [(II)] (ii) the commissioner 1532 
may increase a facility's rate for reasonable costs associated with such 1533 
facility's compliance with the provisions of section 19a-495a concerning 1534 
the administration of medication by unlicensed personnel. For the fiscal 1535 
year ending June 30, 2013, the Commissioner of Social Services may, 1536 
within available appropriations, provide a rate increase to a residential 1537 
care home. Any facility that would have been issued a lower rate for the 1538 
fiscal year ending June 30, 2013, due to interim rate status or agreement 1539 
with the Commissioner of Social Services shall be issued such lower 1540 
rate. For the fiscal years ending June 30, 2012, and June 30, 2013, the 1541 
Commissioner of Social Services may provide fair rent increases to any 1542 
facility that has undergone a material change in circumstances related 1543 
to fair rent and has an approved certificate of need pursuant to section 1544 
17b-352, 17b-353, 17b-354 or 17b-355. For the fiscal years ending June 30, 1545 
2014, and June 30, 2015, for those facilities that have a calculated rate 1546 
greater than the rate in effect for the fiscal year ending June 30, 2013, the 1547 
commissioner may increase facility rates based upon available 1548 
appropriations up to a stop gain as determined by the commissioner. 1549 
No facility shall be issued a rate that is lower than the rate in effect on 1550 
June 30, 2013, except that any facility that would have been issued a 1551 
lower rate for the fiscal year ending June 30, 2014, or the fiscal year 1552 
ending June 30, 2015, due to interim rate status or agreement with the 1553 
commissioner, shall be issued such lower rate. For the fiscal year ending 1554 
June 30, 2014, and each fiscal year thereafter, a residential care home 1555  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	47 of 51 
 
shall receive a rate increase for any capital improvement made during 1556 
the fiscal year for the health and safety of residents and approved by the 1557 
Department of Social Services, provided such rate increase is within 1558 
available appropriations. For the fiscal year ending June 30, 2015, and 1559 
each succeeding fiscal year thereafter, costs of less than ten thousand 1560 
dollars that are incurred by a facility and are associated with any land, 1561 
building or nonmovable equipment repair or improvement that are 1562 
reported in the cost year used to establish the facility's rate shall not be 1563 
capitalized for a period of more than five years for rate-setting purposes. 1564 
For the fiscal year ending June 30, 2015, subject to available 1565 
appropriations, the commissioner may, at the commissioner's 1566 
discretion: Increase the inflation cost limitation under subsection (c) of 1567 
section 17-311-52 of the regulations of Connecticut state agencies, 1568 
provided such inflation allowance factor does not exceed a maximum of 1569 
five per cent; establish a minimum rate of return applied to real property 1570 
of five per cent inclusive of assets placed in service during cost year 1571 
2013; waive the standard rate of return under subsection (f) of section 1572 
17-311-52 of the regulations of Connecticut state agencies for ownership 1573 
changes or health and safety improvements that exceed one hundred 1574 
thousand dollars and that are required under a consent order from the 1575 
Department of Public Health; and waive the rate of return adjustment 1576 
under subsection (f) of section 17-311-52 of the regulations of 1577 
Connecticut state agencies to avoid financial hardship. For the fiscal 1578 
years ending June 30, 2016, and June 30, 2017, rates shall not exceed 1579 
those in effect for the period ending June 30, 2015, except the 1580 
commissioner may, in the commissioner's discretion and within 1581 
available appropriations, provide pro rata fair rent increases to facilities 1582 
which have documented fair rent additions placed in service in cost 1583 
report years ending September 30, 2014, and September 30, 2015, that 1584 
are not otherwise included in rates issued. For the fiscal years ending 1585 
June 30, 2016, and June 30, 2017, and each succeeding fiscal year, any 1586 
facility that would have been issued a lower rate, due to interim rate 1587 
status, a change in allowable fair rent or agreement with the department, 1588 
shall be issued such lower rate. For the fiscal year ending June 30, 2018, 1589 
rates shall not exceed those in effect for the period ending June 30, 2017, 1590  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	48 of 51 
 
except the commissioner may, in the commissioner's discretion and 1591 
within available appropriations, provide pro rata fair rent increases to 1592 
facilities which have documented fair rent additions placed in service in 1593 
the cost report year ending September 30, 2016, that are not otherwise 1594 
included in rates issued. For the fiscal year ending June 30, 2019, rates 1595 
shall not exceed those in effect for the period ending June 30, 2018, 1596 
except the commissioner may, in the commissioner's discretion and 1597 
within available appropriations, provide pro rata fair rent increases to 1598 
facilities which have documented fair rent additions placed in service in 1599 
the cost report year ending September 30, 2017, that are not otherwise 1600 
included in rates issued. For the fiscal year ending June 30, 2020, rates 1601 
shall not exceed those in effect for the fiscal year ending June 30, 2019, 1602 
except the commissioner may, in the commissioner's discretion and 1603 
within available appropriations, provide pro rata fair rent increases to 1604 
facilities which have documented fair rent additions placed in service in 1605 
the cost report year ending September 30, 2018, that are not otherwise 1606 
included in rates issued. For the fiscal year ending June 30, 2021, rates 1607 
shall not exceed those in effect for the fiscal year ending June 30, 2020, 1608 
except the commissioner may, in the commissioner's discretion and 1609 
within available appropriations, provide pro rata fair rent increases to 1610 
facilities which have documented fair rent additions placed in service in 1611 
the cost report year ending September 30, 2019, that are not otherwise 1612 
included in rates issued. For the fiscal year ending June 30, 2022, rates 1613 
shall not exceed those in effect for the fiscal year ending June 30, 2021, 1614 
except the commissioner may, in the commissioner's discretion and 1615 
within available appropriations, provide pro rata fair rent increases to 1616 
facilities which have documented fair rent additions placed in service in 1617 
the cost report year ending September 30, 2020, that are not otherwise 1618 
included in rates issued. For the fiscal year ending June 30, 2023, rates 1619 
shall not exceed those in effect for the fiscal year ending June 30, 2022, 1620 
except the commissioner may, in the commissioner's discretion and 1621 
within available appropriations, provide pro rata fair rent increases to 1622 
facilities which have documented fair rent additions placed in service in 1623 
the cost report year ending September 30, 2021, that are not otherwise 1624 
included in rates issued. 1625  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	49 of 51 
 
[(2) The commissioner shall, upon determining that a loan to be 1626 
issued to a residential care home by the Connecticut Housing Finance 1627 
Authority is reasonable in relation to the useful life and property cost 1628 
allowance pursuant to section 17-311-52 of the regulations of 1629 
Connecticut state agencies, allow actual debt service, comprised of 1630 
principal, interest and a repair and replacement reserve on the loan, in 1631 
lieu of allowed property costs whether actual debt service is higher or 1632 
lower than such allowed property costs. 1633 
(i) Notwithstanding the provisions of this section, the Commissioner 1634 
of Social Services shall establish a fee schedule for payments to be made 1635 
to chronic disease hospitals associated with chronic and convalescent 1636 
nursing homes to be effective on and after July 1, 1995. The fee schedule 1637 
may be adjusted annually beginning July 1, 1997, to reflect necessary 1638 
increases in the cost of services.] 1639 
(j) Notwithstanding the provisions of this section, state rates of 1640 
payment for the fiscal years ending June 30, 2018, June 30, 2019, June 30, 1641 
2020, [and] June 30, 2021, June 30, 2022, and June 30, 2023, for residential 1642 
care homes and community living arrangements that receive the flat rate 1643 
for residential services under section 17-311-54 of the regulations of 1644 
Connecticut state agencies shall be set in accordance with section [298 of 1645 
public act 19-117] 6 of this act. 1646 
Sec. 9. Subsection (a) of section 19a-507 of the general statutes is 1647 
repealed and the following is substituted in lieu thereof (Effective July 1, 1648 
2021): 1649 
(a) Notwithstanding the provisions of chapter 368z, New Horizons, 1650 
Inc., a nonprofit, nonsectarian organization, or a subsidiary 1651 
organization controlled by New Horizons, Inc., is authorized to 1652 
construct and operate an independent living facility for severely 1653 
physically disabled adults, in the town of Farmington, provided such 1654 
facility shall be constructed in accordance with applicable building 1655 
codes. The Farmington Housing Authority, or any issuer acting on 1656 
behalf of said authority, subject to the provisions of this section, may 1657  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	50 of 51 
 
issue tax-exempt revenue bonds on a competitive or negotiated basis for 1658 
the purpose of providing construction and permanent mortgage 1659 
financing for the facility in accordance with Section 103 of the Internal 1660 
Revenue Code. Prior to the issuance of such bonds, plans for the 1661 
construction of the facility shall be submitted to and approved by the 1662 
Health Systems Planning Unit of the Office of Health Strategy. The unit 1663 
shall approve or disapprove such plans within thirty days of receipt 1664 
thereof. If the plans are disapproved they may be resubmitted. Failure 1665 
of the unit to act on the plans within such thirty-day period shall be 1666 
deemed approval thereof. The payments to residents of the facility who 1667 
are eligible for assistance under the state supplement program for room 1668 
and board and necessary services, shall be determined annually to be 1669 
effective July first of each year. Such payments shall be determined on a 1670 
basis of a reasonable payment for necessary services, which basis shall 1671 
take into account as a factor the costs of providing those services and 1672 
such other factors as the commissioner deems reasonable, including 1673 
anticipated fluctuations in the cost of providing services. Such payments 1674 
shall be calculated in accordance with the manner in which rates are 1675 
calculated pursuant to subsection [(h)] (i) of section 17b-340, as amended 1676 
by this act, and the cost-related reimbursement system pursuant to said 1677 
section except that efficiency incentives shall not be granted. The 1678 
commissioner may adjust such rates to account for the availability of 1679 
personal care services for residents under the Medicaid program. The 1680 
commissioner shall, upon submission of a request, allow actual debt 1681 
service, comprised of principal and interest, in excess of property costs 1682 
allowed pursuant to section 17-313b-5 of the regulations of Connecticut 1683 
state agencies, provided such debt service terms and amounts are 1684 
reasonable in relation to the useful life and the base value of the 1685 
property. The cost basis for such payment shall be subject to audit, and 1686 
a recomputation of the rate shall be made based upon such audit. The 1687 
facility shall report on a fiscal year ending on the thirtieth day of 1688 
September on forms provided by the commissioner. The required report 1689 
shall be received by the commissioner no later than December thirty-1690 
first of each year. The Department of Social Services may use its existing 1691 
utilization review procedures to monitor utilization of the facility. If the 1692  Governor's Bill No.  6446 
 
 
 
LCO No. 3112   	51 of 51 
 
facility is aggrieved by any decision of the commissioner, the facility 1693 
may, within ten days, after written notice thereof from the 1694 
commissioner, obtain by written request to the commissioner, a hearing 1695 
on all items of aggrievement. If the facility is aggrieved by the decision 1696 
of the commissioner after such hearing, the facility may appeal to the 1697 
Superior Court in accordance with the provisions of section 4-183.1698 
This act shall take effect as follows and shall amend the following 
sections: 
 
Section 1 July 1, 2021 17b-104(b) 
Sec. 2 July 1, 2021 17b-106(a) 
Sec. 3 August 1, 2022 17b-256f 
Sec. 4 July 1, 2021 17b-265 
Sec. 5 July 1, 2021 17b-244 
Sec. 6 July 1, 2021 New section 
Sec. 7 July 1, 2021 17b-340d 
Sec. 8 July 1, 2021 17b-340 
Sec. 9 July 1, 2021 19a-507(a) 
 
Statement of Purpose:   
To implement the Governor's budget recommendations for human 
services. 
[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.]