Connecticut House Bill HB06446 Comm Sub / Bill

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 Section 17b-265 of the general statutes is repealed and the 1 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