Connecticut 2021 Regular Session

Connecticut House Bill HB06446 Compare Versions

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Version 2 (New)

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7		-	General Assembly Substitute Bill No. 6446
	4	+	LCO No. 3112 1 of 51
	5	+
	6	+	General Assembly Governor's Bill No. 6446
8	7		January Session, 2021
	8	+	LCO No. 3112
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	10	+
	11	+	Referred to Committee on HUMAN SERVICES
	12	+
	13	+
	14	+	Introduced by:
	15	+	Request of the Governor Pursuant
	16	+	to Joint Rule 9
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14	22		AN ACT CONCERNING TH E GOVERNOR'S BUDGET
15	23		RECOMMENDATIONS FOR HUMAN SERVICES.
16	24		Be it enacted by the Senate and House of Representatives in General
17	25		Assembly convened:
18	26
19		-	Section 1. Section 17b-265 of the general statutes is repealed and the 1
20		-	following is substituted in lieu thereof (Effective July 1, 2021): 2
21		-	(a) In accordance with 42 USC 1396k, the Department of Social 3
22		-	Services shall be subrogated to any right of recovery or indemnification 4
23		-	that an applicant or recipient of medical assistance or any legally liable 5
24		-	relative of such applicant or recipient has against an insurer or other 6
25		-	legally liable third party including, but not limited to, a self-insured 7
26		-	plan, group health plan, as defined in Section 607(1) of the Employee 8
27		-	Retirement Income Security Act of 1974, service benefit plan, managed 9
28		-	care organization, health care center, pharmacy benefit manager, dental 10
29		-	benefit manager, third-party administrator or other party that is, by 11
30		-	statute, contract or agreement, legally responsible for payment of a 12
31		-	claim for a health care item or service, for the cost of all health care items 13
32		-	or services furnished to the applicant or recipient, including, but not 14
33		-	limited to, hospitalization, pharmaceutical services, physician services, 15
34		-	nursing services, behavioral health services, long-term care services and 16
35		-	other medical services, not to exceed the amount expended by the 17
36		-	department for such care and treatment of the applicant or recipient. In 18 Substitute Bill No. 6446
	27	+	Section 1. Subsection (b) of section 17b-104 of the general statutes is 1
	28	+	repealed and the following is substituted in lieu thereof (Effective July 1, 2
	29	+	2021): 3
	30	+	(b) On July 1, 2007, and annually thereafter, the commissioner shall 4
	31	+	increase the payment standards over those of the previous fiscal year 5
	32	+	under the temporary family assistance program and the state-6
	33	+	administered general assistance program by the percentage increase, if 7
	34	+	any, in the most recent calendar year average in the consumer price 8
	35	+	index for urban consumers over the average for the previous calendar 9
	36	+	year, provided the annual increase, if any, shall not exceed five per cent, 10
	37	+	except that the payment standards for the fiscal years ending June 30, 11
	38	+	2010, June 30, 2011, June 30, 2012, June 30, 2013, June 30, 2016, June 30, 12
	39	+	2017, June 30, 2018, June 30, 2019, June 30, 2020, [and] June 30, 2021, June 13
	40	+	30, 2022, and June 30, 2023, shall not be increased. 14 Governor's Bill No. 6446
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43		-	the case of such a recipient who is an enrollee in a care management 19
44		-	organization under a Medicaid care management contract with the state 20
45		-	or a legally liable relative of such an enrollee, the department shall be 21
46		-	subrogated to any right of recovery or indemnification which the 22
47		-	enrollee or legally liable relative has against such a private insurer or 23
48		-	other third party for the medical costs incurred by the care management 24
49		-	organization on behalf of an enrollee. 25
50		-	(b) An applicant or recipient or legally liable relative, by the act of the 26
51		-	applicant's or recipient's receiving medical assistance, shall be deemed 27
52		-	to have made a subrogation assignment and an assignment of claim for 28
53		-	benefits to the department. The department shall inform an applicant of 29
54		-	such assignments at the time of application. Any entitlements from a 30
55		-	contractual agreement with an applicant or recipient, legally liable 31
56		-	relative or a state or federal program for such medical services, not to 32
57		-	exceed the amount expended by the department, shall be so assigned. 33
58		-	Such entitlements shall be directly reimbursable to the department by 34
59		-	third party payors. The Department of Social Services may assign its 35
60		-	right to subrogation or its entitlement to benefits to a designee or a 36
61		-	health care provider participating in the Medicaid program and 37
62		-	providing services to an applicant or recipient, in order to assist the 38
63		-	provider in obtaining payment for such services. In accordance with 39
64		-	subsection (b) of section 38a-472, a provider that has received an 40
65		-	assignment from the department shall notify the recipient's health 41
66		-	insurer or other legally liable third party including, but not limited to, a 42
67		-	self-insured plan, group health plan, as defined in Section 607(1) of the 43
68		-	Employee Retirement Income Security Act of 1974, service benefit plan, 44
69		-	managed care organization, health care center, pharmacy benefit 45
70		-	manager, dental benefit manager, third-party administrator or other 46
71		-	party that is, by statute, contract or agreement, legally responsible for 47
72		-	payment of a claim for a health care item or service, of the assignment 48
73		-	upon rendition of services to the applicant or recipient. Failure to so 49
74		-	notify the health insurer or other legally liable third party shall render 50
75		-	the provider ineligible for payment from the department. The provider 51
76		-	shall notify the department of any request by the applicant or recipient 52 Substitute Bill No. 6446
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	45	+
	46	+	Sec. 2. Subsection (a) of section 17b-106 of the general statutes is 15
	47	+	repealed and the following is substituted in lieu thereof (Effective July 1, 16
	48	+	2021): 17
	49	+	(a) On July 1, 1989, and annually thereafter, the commissioner shall 18
	50	+	increase the adult payment standards over those of the previous fiscal 19
	51	+	year for the state supplement to the federal Supplemental Security 20
	52	+	Income Program by the percentage increase, if any, in the most recent 21
	53	+	calendar year average in the consumer price index for urban consumers 22
	54	+	over the average for the previous calendar year, provided the annual 23
	55	+	increase, if any, shall not exceed five per cent, except that the adult 24
	56	+	payment standards for the fiscal years ending June 30, 1993, June 30, 25
	57	+	1994, June 30, 1995, June 30, 1996, June 30, 1997, June 30, 1998, June 30, 26
	58	+	1999, June 30, 2000, June 30, 2001, June 30, 2002, June 30, 2003, June 30, 27
	59	+	2004, June 30, 2005, June 30, 2006, June 30, 2007, June 30, 2008, June 30, 28
	60	+	2009, June 30, 2010, June 30, 2011, June 30, 2012, June 30, 2013, June 30, 29
	61	+	2016, June 30, 2017, June 30, 2018, June 30, 2019, June 30, 2020, [and] June 30
	62	+	30, 2021, June 30, 2022, and June 30, 2023, shall not be increased. 31
	63	+	Effective October 1, 1991, the coverage of excess utility costs for 32
	64	+	recipients of the state supplement to the federal Supplemental Security 33
	65	+	Income Program is eliminated. Notwithstanding the provisions of this 34
	66	+	section, the commissioner may increase the personal needs allowance 35
	67	+	component of the adult payment standard as necessary to meet federal 36
	68	+	maintenance of effort requirements. 37
	69	+	Sec. 3. Section 17b-256f of the general statutes is repealed and the 38
	70	+	following is substituted in lieu thereof (Effective August 1, 2022): 39
	71	+	The Commissioner of Social Services shall increase income disregards 40
	72	+	used to determine eligibility by the Department of Social Services for the 41
	73	+	federal Qualified Medicare Beneficiary, the Specified Low-Income 42
	74	+	Medicare Beneficiary and the Qualifying Individual programs, 43
	75	+	administered in accordance with the provisions of 42 USC 1396d(p), by 44
	76	+	such amounts that shall result in persons with income that is (1) less 45
	77	+	than two hundred eleven per cent of the federal poverty level qualifying 46
	78	+	for the Qualified Medicare Beneficiary program, (2) at or above two 47 Governor's Bill No. 6446
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83		-	or legally liable relative or representative of such applicant or recipient 53
84		-	for billing information. This subsection shall not be construed to affect 54
85		-	the right of an applicant or recipient to maintain an independent cause 55
86		-	of action against such third party tortfeasor. 56
87		-	(c) Claims for recovery or indemnification submitted by the 57
88		-	department, or the department's designee, shall not be denied solely on 58
89		-	the basis of the date of the submission of the claim, the type or format of 59
90		-	the claim, the lack of prior authorization or the failure to present proper 60
91		-	documentation at the point-of-service that is the basis of the claim, if (1) 61
92		-	the claim is submitted by the state within the three-year period 62
93		-	beginning on the date on which the item or service was furnished; and 63
94		-	(2) any action by the state to enforce its rights with respect to such claim 64
95		-	is commenced within six years of the state's submission of the claim. 65
96		-	(d) When a recipient of medical assistance has personal health 66
97		-	insurance in force covering care or other benefits provided under such 67
98		-	program, payment or part-payment of the premium for such insurance 68
99		-	may be made when deemed appropriate by the Commissioner of Social 69
100		-	Services. [Effective January 1, 1992, the] The commissioner shall limit 70
101		-	reimbursement to medical assistance providers for coinsurance and 71
102		-	deductible payments under Title XVIII of the Social Security Act to 72
103		-	assure that the combined Medicare and Medicaid payment to the 73
104		-	provider shall not exceed the maximum allowable under the Medicaid 74
105		-	program fee schedules. 75
106		-	(e) No self-insured plan, group health plan, as defined in Section 76
107		-	607(1) of the Employee Retirement Income Security Act of 1974, service 77
108		-	benefit plan, managed care plan, or any plan offered or administered by 78
109		-	a health care center, pharmacy benefit manager, dental benefit manager, 79
110		-	third-party administrator or other party that is, by statute, contract or 80
111		-	agreement, legally responsible for payment of a claim for a health care 81
112		-	item or service, shall contain any provision that has the effect of denying 82
113		-	or limiting enrollment benefits or excluding coverage because services 83
114		-	are rendered to an insured or beneficiary who is eligible for or who 84
115		-	received medical assistance under this chapter. No insurer, as defined 85 Substitute Bill No. 6446
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	83	+
	84	+	hundred eleven per cent of the federal poverty level but less than two 48
	85	+	hundred thirty-one per cent of the federal poverty level qualifying for 49
	86	+	the Specified Low-Income Medicare Beneficiary program, and (3) at or 50
	87	+	above two hundred thirty-one per cent of the federal poverty level but 51
	88	+	less than two hundred forty-six per cent of the federal poverty level 52
	89	+	qualifying for the Qualifying Individual program. The commissioner 53
	90	+	shall [not] apply an asset test for eligibility under the Medicare Savings 54
	91	+	Program. Eligible persons shall have countable assets less than or equal 55
	92	+	to two times the amount of allowable assets for Medicare Savings 56
	93	+	Programs as identified by the Centers for Medicare and Medicaid 57
	94	+	Services. The commissioner shall not consider as income Aid and 58
	95	+	Attendance pension benefits granted to a veteran, as defined in section 59
	96	+	27-103, or the surviving spouse of such veteran. The Commissioner of 60
	97	+	Social Services, pursuant to section 17b-10, may implement policies and 61
	98	+	procedures to administer the provisions of this section while in the 62
	99	+	process of adopting such policies and procedures in regulation form, 63
	100	+	provided the commissioner prints notice of the intent to adopt the 64
	101	+	regulations on the department's Internet web site and the eRegulations 65
	102	+	System not later than twenty days after the date of implementation. 66
	103	+	Such policies and procedures shall be valid until the time final 67
	104	+	regulations are adopted. 68
	105	+	Sec. 4. Section 17b-265 of the general statutes is repealed and the 69
	106	+	following is substituted in lieu thereof (Effective July 1, 2021): 70
	107	+	(a) In accordance with 42 USC 1396k, the Department of Social 71
	108	+	Services shall be subrogated to any right of recovery or indemnification 72
	109	+	that an applicant or recipient of medical assistance or any legally liable 73
	110	+	relative of such applicant or recipient has against an insurer or other 74
	111	+	legally liable third party including, but not limited to, a self-insured 75
	112	+	plan, group health plan, as defined in Section 607(1) of the Employee 76
	113	+	Retirement Income Security Act of 1974, service benefit plan, managed 77
	114	+	care organization, health care center, pharmacy benefit manager, dental 78
	115	+	benefit manager, third-party administrator or other party that is, by 79
	116	+	statute, contract or agreement, legally responsible for payment of a 80
	117	+	claim for a health care item or service, for the cost of all health care items 81 Governor's Bill No. 6446
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122		-	in section 38a-497a, shall impose requirements on the state Medicaid 86
123		-	agency, which has been assigned the rights of an individual eligible for 87
124		-	Medicaid and covered for health benefits from an insurer, that differ 88
125		-	from requirements applicable to an agent or assignee of another 89
126		-	individual so covered. 90
127		-	(f) The Commissioner of Social Services shall not pay for any services 91
128		-	provided under this chapter if the individual eligible for medical 92
129		-	assistance has coverage for the services under an accident or health 93
130		-	insurance policy. 94
131		-	(g) An insurer or other legally liable third party, upon receipt of a 95
132		-	claim submitted by the department or the department's designee, in 96
133		-	accordance with the requirements of subsection (c) of this section, for 97
134		-	payment of a health care item or service covered under a state medical 98
135		-	assistance program administered by the department, shall, not later 99
136		-	than ninety days after receipt of the claim or not later than ninety days 100
137		-	after the effective date of this section, whichever is later, (1) make 101
138		-	payment on the claim, (2) request information necessary to determine 102
139		-	its legal obligation to pay the claim, or (3) issue a written reason for 103
140		-	denial of the claim. Failure to pay, request information necessary to 104
141		-	determine legal obligation to pay or issue a written reason for denial of 105
142		-	a claim not later than one hundred twenty days after receipt of the claim, 106
143		-	or not later than one hundred twenty days after the effective date of this 107
144		-	section, whichever is later, creates an uncontestable obligation to pay 108
145		-	the claim. The provisions of this subsection shall apply to all claims, 109
146		-	including claims submitted by the department or the department's 110
147		-	designee prior to July 1, 2021. 111
148		-	(h) On and after July 1, 2021, an insurer or other legally liable third 112
149		-	party who has reimbursed the department for a health care item or 113
150		-	service paid for and covered under a state medical assistance program 114
151		-	administered by the department shall, upon determining it is not liable 115
152		-	and at risk for cost of the health care item or service, request any refund 116
153		-	from the department not later than twelve months from the date of its 117
154		-	reimbursement to the department. 118 Substitute Bill No. 6446
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	122	+
	123	+	or services furnished to the applicant or recipient, including, but not 82
	124	+	limited to, hospitalization, pharmaceutical services, physician services, 83
	125	+	nursing services, behavioral health services, long-term care services and 84
	126	+	other medical services, not to exceed the amount expended by the 85
	127	+	department for such care and treatment of the applicant or recipient. In 86
	128	+	the case of such a recipient who is an enrollee in a care management 87
	129	+	organization under a Medicaid care management contract with the state 88
	130	+	or a legally liable relative of such an enrollee, the department shall be 89
	131	+	subrogated to any right of recovery or indemnification which the 90
	132	+	enrollee or legally liable relative has against such a private insurer or 91
	133	+	other third party for the medical costs incurred by the care management 92
	134	+	organization on behalf of an enrollee. 93
	135	+	(b) An applicant or recipient or legally liable relative, by the act of the 94
	136	+	applicant's or recipient's receiving medical assistance, shall be deemed 95
	137	+	to have made a subrogation assignment and an assignment of claim for 96
	138	+	benefits to the department. The department shall inform an applicant of 97
	139	+	such assignments at the time of application. Any entitlements from a 98
	140	+	contractual agreement with an applicant or recipient, legally liable 99
	141	+	relative or a state or federal program for such medical services, not to 100
	142	+	exceed the amount expended by the department, shall be so assigned. 101
	143	+	Such entitlements shall be directly reimbursable to the department by 102
	144	+	third party payors. The Department of Social Services may assign its 103
	145	+	right to subrogation or its entitlement to benefits to a designee or a 104
	146	+	health care provider participating in the Medicaid program and 105
	147	+	providing services to an applicant or recipient, in order to assist the 106
	148	+	provider in obtaining payment for such services. In accordance with 107
	149	+	subsection (b) of section 38a-472, a provider that has received an 108
	150	+	assignment from the department shall notify the recipient's health 109
	151	+	insurer or other legally liable third party including, but not limited to, a 110
	152	+	self-insured plan, group health plan, as defined in Section 607(1) of the 111
	153	+	Employee Retirement Income Security Act of 1974, service benefit plan, 112
	154	+	managed care organization, health care center, pharmacy benefit 113
	155	+	manager, dental benefit manager, third-party administrator or other 114
	156	+	party that is, by statute, contract or agreement, legally responsible for 115 Governor's Bill No. 6446
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161		-	Sec. 2. Section 17b-340d of the general statutes is repealed and the 119
162		-	following is substituted in lieu thereof (Effective October 1, 2021): 120
163		-	(a) The Commissioner of Social Services [may] shall implement an 121
164		-	acuity-based methodology for Medicaid reimbursement of nursing 122
165		-	home services. [In the course of developing such a system, the 123
166		-	commissioner shall review the skilled nursing facility prospective 124
167		-	payment system developed by the Centers for Medicare and Medicaid 125
168		-	Services, as well as other methodologies used nationally, and shall 126
169		-	consider recommendations from the nursing home industry. ] 127
170		-	Notwithstanding the provisions of section 17b-340, as amended by this 128
171		-	act, beginning on October 1, 2021, and ending on June 30, 2022, and each 129
172		-	fiscal year ending on June thirtieth thereafter, the Commissioner of 130
173		-	Social Services shall establish Medicaid rates paid to nursing home 131
174		-	facilities based on cost years ending on September thirtieth in 132
175		-	accordance with the following: 133
176		-	(1) Case-mix adjustments to the direct care component shall be made 134
177		-	or phased in effective October 1, 2021, and updated every quarter 135
178		-	thereafter. The transition to acuity-based reimbursement shall be cost 136
179		-	neutral and based on cost reports for the fiscal year ending June 30, 2018. 137
180		-	(2) Geographic peer groupings of facilities shall be established by the 138
181		-	Department of Social Services pursuant to regulations adopted in 139
182		-	accordance with subsection (b) of this section. 140
183		-	(3) Allowable costs shall be divided into the following five cost 141
184		-	components: (A) Direct costs, which shall include salaries for nursing 142
185		-	personnel, related fringe benefits and nursing pool costs; (B) indirect 143
186		-	costs, which shall include professional fees, dietary expenses, 144
187		-	housekeeping expenses, laundry expenses, supplies related to patient 145
188		-	care, salaries for indirect care personnel and related fringe benefits; (C) 146
189		-	fair rent, which shall be defined in regulations adopted in accordance 147
190		-	with subsection (b) of this section; (D) capital-related costs, which shall 148
191		-	include property taxes, insurance expenses, equipment leases and 149
192		-	equipment depreciation; and (E) administrative and general costs, 150 Substitute Bill No. 6446
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	161	+
	162	+	payment of a claim for a health care item or service, of the assignment 116
	163	+	upon rendition of services to the applicant or recipient. Failure to so 117
	164	+	notify the health insurer or other legally liable third party shall render 118
	165	+	the provider ineligible for payment from the department. The provider 119
	166	+	shall notify the department of any request by the applicant or recipient 120
	167	+	or legally liable relative or representative of such applicant or recipient 121
	168	+	for billing information. This subsection shall not be construed to affect 122
	169	+	the right of an applicant or recipient to maintain an independent cause 123
	170	+	of action against such third party tortfeasor. 124
	171	+	(c) Claims for recovery or indemnification submitted by the 125
	172	+	department, or the department's designee, shall not be denied solely on 126
	173	+	the basis of the date of the submission of the claim, the type or format of 127
	174	+	the claim, the lack of prior authorization or the failure to present proper 128
	175	+	documentation at the point-of-service that is the basis of the claim, if (1) 129
	176	+	the claim is submitted by the state within the three-year period 130
	177	+	beginning on the date on which the item or service was furnished; and 131
	178	+	(2) any action by the state to enforce its rights with respect to such claim 132
	179	+	is commenced within six years of the state's submission of the claim. 133
	180	+	(d) When a recipient of medical assistance has personal health 134
	181	+	insurance in force covering care or other benefits provided under such 135
	182	+	program, payment or part-payment of the premium for such insurance 136
	183	+	may be made when deemed appropriate by the Commissioner of Social 137
	184	+	Services. [Effective January 1, 1992, the] The commissioner shall limit 138
	185	+	reimbursement to medical assistance providers for coinsurance and 139
	186	+	deductible payments under Title XVIII of the Social Security Act to 140
	187	+	assure that the combined Medicare and Medicaid payment to the 141
	188	+	provider shall not exceed the maximum allowable under the Medicaid 142
	189	+	program fee schedules. 143
	190	+	(e) No self-insured plan, group health plan, as defined in Section 144
	191	+	607(1) of the Employee Retirement Income Security Act of 1974, service 145
	192	+	benefit plan, managed care plan, or any plan offered or administered by 146
	193	+	a health care center, pharmacy benefit manager, dental benefit manager, 147
	194	+	third-party administrator or other party that is, by statute, contract or 148 Governor's Bill No. 6446
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199		-	which shall include maintenance and operation of plant expenses, 151
200		-	salaries for administrative and maintenance personnel and related 152
201		-	fringe benefits. For (i) direct costs, the maximum cost shall be equal to 153
202		-	one hundred thirty-five per cent of the median allowable cost of that 154
203		-	peer grouping; (ii) indirect costs, the maximum cost shall be equal to one 155
204		-	hundred fifteen per cent of the state-wide median allowable cost; (iii) 156
205		-	fair rent, the amount shall be calculated utilizing the amount approved 157
206		-	pursuant to section 17b-353; (iv) capital-related costs, there shall be no 158
207		-	maximum; and (v) administrative and general costs, the maximum shall 159
208		-	be equal to the state-wide median allowable cost. 160
209		-	(4) For the period beginning on October 1, 2021, and ending on June 161
210		-	30, 2022, the commissioner may, in the commissioner's discretion and 162
211		-	within available appropriations, provide pro rata fair rent increases to 163
212		-	facilities which have documented fair rent additions placed in service in 164
213		-	the cost report year ending on September 30, 2019, that are not otherwise 165
214		-	included in the rates issued. 166
215		-	(5) There shall be no increase to rates based on inflation or any 167
216		-	inflationary factor for the period beginning on October 1, 2021, and 168
217		-	ending on June 30, 2023. 169
218		-	(6) For purposes of computing minimum allowable patient days, 170
219		-	utilization of a facility's certified beds shall be determined at a minimum 171
220		-	of ninety per cent of capacity, except for new facilities and facilities 172
221		-	which are certified for additional beds which may be permitted a lower 173
222		-	occupancy rate for the first three months of operation after the effective 174
223		-	date of licensure. 175
224		-	(7) Rates determined under this section shall comply with federal 176
225		-	laws and regulations. 177
226		-	(b) The Commissioner of Social Services may implement policies as 178
227		-	necessary to carry out the provisions of this section while in the process 179
228		-	of adopting the policies as regulations, provided that prior to 180
229		-	implementation the policies are posted (1) on the eRegulations System 181 Substitute Bill No. 6446
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	199	+
	200	+	agreement, legally responsible for payment of a claim for a health care 149
	201	+	item or service, shall contain any provision that has the effect of denying 150
	202	+	or limiting enrollment benefits or excluding coverage because services 151
	203	+	are rendered to an insured or beneficiary who is eligible for or who 152
	204	+	received medical assistance under this chapter. No insurer, as defined 153
	205	+	in section 38a-497a, shall impose requirements on the state Medicaid 154
	206	+	agency, which has been assigned the rights of an individual eligible for 155
	207	+	Medicaid and covered for health benefits from an insurer, that differ 156
	208	+	from requirements applicable to an agent or assignee of another 157
	209	+	individual so covered. 158
	210	+	(f) The Commissioner of Social Services shall not pay for any services 159
	211	+	provided under this chapter if the individual eligible for medical 160
	212	+	assistance has coverage for the services under an accident or health 161
	213	+	insurance policy. 162
	214	+	(g) An insurer or other legally liable third party, upon receipt of a 163
	215	+	claim submitted by the department or the department's designee, in 164
	216	+	accordance with the requirements of subsection (c) of this section, for 165
	217	+	payment of a health care item or service covered under a state medical 166
	218	+	assistance program administered by the department, shall, not later 167
	219	+	than ninety days after receipt of the claim, or not later than ninety days 168
	220	+	after the effective date of this section, whichever is later, (1) make 169
	221	+	payment on the claim, (2) request information necessary to determine 170
	222	+	its legal obligation to pay the claim, or (3) issue a written reason for 171
	223	+	denial of the claim. Failure to pay, request information necessary to 172
	224	+	determine legal obligation to pay or issue a written reason for denial of 173
	225	+	a claim not later than one hundred twenty days after receipt of the claim, 174
	226	+	or not later than one hundred twenty days after the effective date of this 175
	227	+	section, whichever is later, creates an uncontestable obligation to pay 176
	228	+	the claim. The provisions of this subsection shall apply to all claims, 177
	229	+	including claims submitted by the department or the department's 178
	230	+	designee prior to July 1, 2021. 179
	231	+	(h) On and after July 1, 2021, an insurer or other legally liable third 180
	232	+	party who has reimbursed the department for a health care item or 181 Governor's Bill No. 6446
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236		-	established pursuant to section 4-173b and (2) the Department of Social 182
237		-	Services' Internet web site. 183
238		-	Sec. 3. Section 17b-340 of the general statutes is repealed and the 184
239		-	following is substituted in lieu thereof (Effective July 1, 2021): 185
240		-	(a) For purposes of this subsection, (1) a "related party" includes, but 186
241		-	is not limited to, any company related to a chronic and convalescent 187
242		-	nursing home through family association, common ownership, control 188
243		-	or business association with any of the owners, operators or officials of 189
244		-	such nursing home; (2) "company" means any person, partnership, 190
245		-	association, holding company, limited liability company or corporation; 191
246		-	(3) "family association" means a relationship by birth, marriage or 192
247		-	domestic partnership; and (4) "profit and loss statement" means the 193
248		-	most recent annual statement on profits and losses finalized by a related 194
249		-	party before the annual report mandated under this subsection. The 195
250		-	rates to be paid by or for persons aided or cared for by the state or any 196
251		-	town in this state to licensed chronic and convalescent nursing homes, 197
252		-	to chronic disease hospitals associated with chronic and convalescent 198
253		-	nursing homes, to rest homes with nursing supervision, to licensed 199
254		-	residential care homes, as defined by section 19a-490, and to residential 200
255		-	facilities for persons with intellectual disability that are licensed 201
256		-	pursuant to section 17a-227 and certified to participate in the Title XIX 202
257		-	Medicaid program as intermediate care facilities for individuals with 203
258		-	intellectual disabilities, for room, board and services specified in 204
259		-	licensing regulations issued by the licensing agency shall be determined 205
260		-	annually, except as otherwise provided in this subsection [, after a 206
261		-	public hearing,] by the Commissioner of Social Services, to be effective 207
262		-	July first of each year except as otherwise provided in this subsection. 208
263		-	Such rates shall be determined on a basis of a reasonable payment for 209
264		-	such necessary services, which basis shall take into account as a factor 210
265		-	the costs of such services. Cost of such services shall include reasonable 211
266		-	costs mandated by collective bargaining agreements with certified 212
267		-	collective bargaining agents or other agreements between the employer 213
268		-	and employees, provided "employees" shall not include persons 214 Substitute Bill No. 6446
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	237	+
	238	+	service paid for and covered under a state medical assistance program 182
	239	+	administered by the department, shall, upon determining it is not liable 183
	240	+	and at risk for cost of the health care item or service, request any refund 184
	241	+	from the department not later than twelve months from the date of its 185
	242	+	reimbursement to the department. 186
	243	+	Sec. 5. Section 17b-244 of the general statutes is repealed and the 187
	244	+	following is substituted in lieu thereof (Effective July 1, 2021): 188
	245	+	(a) The room and board component of the rates to be paid by the state 189
	246	+	to private facilities and facilities operated by regional education service 190
	247	+	centers which are licensed to provide residential care pursuant to 191
	248	+	section 17a-227, but not certified to participate in the Title XIX Medicaid 192
	249	+	program as intermediate care facilities for individuals with intellectual 193
	250	+	disabilities, shall be determined annually by the Commissioner of Social 194
	251	+	Services, except that rates effective April 30, 1989, shall remain in effect 195
	252	+	through October 31, 1989. Any facility with real property other than 196
	253	+	land placed in service prior to July 1, 1991, shall, for the fiscal year 197
	254	+	ending June 30, 1995, receive a rate of return on real property equal to 198
	255	+	the average of the rates of return applied to real property other than land 199
	256	+	placed in service for the five years preceding July 1, 1993. For the fiscal 200
	257	+	year ending June 30, 1996, and any succeeding fiscal year, the rate of 201
	258	+	return on real property for property items shall be revised every five 202
	259	+	years. The commissioner shall, upon submission of a request by such 203
	260	+	facility, allow actual debt service, comprised of principal and interest, 204
	261	+	on the loan or loans in lieu of property costs allowed pursuant to section 205
	262	+	17-313b-5 of the regulations of Connecticut state agencies, whether 206
	263	+	actual debt service is higher or lower than such allowed property costs, 207
	264	+	provided such debt service terms and amounts are reasonable in 208
	265	+	relation to the useful life and the base value of the property. In the case 209
	266	+	of facilities financed through the Connecticut Housing Finance 210
	267	+	Authority, the commissioner shall allow actual debt service, comprised 211
	268	+	of principal, interest and a reasonable repair and replacement reserve 212
	269	+	on the loan or loans in lieu of property costs allowed pursuant to section 213
	270	+	17-313b-5 of the regulations of Connecticut state agencies, whether 214
	271	+	actual debt service is higher or lower than such allowed property costs, 215 Governor's Bill No. 6446
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275		-	employed as managers or chief administrators or required to be licensed 215
276		-	as nursing home administrators, and compensation for services 216
277		-	rendered by proprietors at prevailing wage rates, as determined by 217
278		-	application of principles of accounting as prescribed by said 218
279		-	commissioner. Cost of such services shall not include amounts paid by 219
280		-	the facilities to employees as salary, or to attorneys or consultants as 220
281		-	fees, where the responsibility of the employees, attorneys, or consultants 221
282		-	is to persuade or seek to persuade the other employees of the facility to 222
283		-	support or oppose unionization. Nothing in this subsection shall 223
284		-	prohibit inclusion of amounts paid for legal counsel related to the 224
285		-	negotiation of collective bargaining agreements, the settlement of 225
286		-	grievances or normal administration of labor relations. The 226
287		-	commissioner may, in the commissioner's discretion, allow the inclusion 227
288		-	of extraordinary and unanticipated costs of providing services that were 228
289		-	incurred to avoid an immediate negative impact on the health and safety 229
290		-	of patients. The commissioner may, in the commissioner's discretion, 230
291		-	based upon review of a facility's costs, direct care staff to patient ratio 231
292		-	and any other related information, revise a facility's rate for any 232
293		-	increases or decreases to total licensed capacity of more than ten beds or 233
294		-	changes to its number of licensed rest home with nursing supervision 234
295		-	beds and chronic and convalescent nursing home beds. The 235
296		-	commissioner may, in the commissioner's discretion, revise the rate of a 236
297		-	facility that is closing. An interim rate issued for the period during 237
298		-	which a facility is closing shall be based on a review of facility costs, the 238
299		-	expected duration of the close-down period, the anticipated impact on 239
300		-	Medicaid costs, available appropriations and the relationship of the rate 240
301		-	requested by the facility to the average Medicaid rate for a close-down 241
302		-	period. The commissioner may so revise a facility's rate established for 242
303		-	the fiscal year ending June 30, 1993, and thereafter for any bed increases, 243
304		-	decreases or changes in licensure effective after October 1, 1989. 244
305		-	Effective July 1, 1991, in facilities that have both a chronic and 245
306		-	convalescent nursing home and a rest home with nursing supervision, 246
307		-	the rate for the rest home with nursing supervision shall not exceed such 247
308		-	facility's rate for its chronic and convalescent nursing home. All such 248
309		-	facilities for which rates are determined under this subsection shall 249 Substitute Bill No. 6446
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	277	+	provided such debt service terms and amounts are determined by the 216
	278	+	commissioner at the time the loan is entered into to be reasonable in 217
	279	+	relation to the useful life and base value of the property. The 218
	280	+	commissioner may allow fees associated with mortgage refinancing 219
	281	+	provided such refinancing will result in state reimbursement savings, 220
	282	+	after comparing costs over the terms of the existing proposed loans. For 221
	283	+	the fiscal year ending June 30, 1992, the inflation factor used to 222
	284	+	determine rates shall be one-half of the gross national product 223
	285	+	percentage increase for the period between the midpoint of the cost year 224
	286	+	through the midpoint of the rate year. For fiscal year ending June 30, 225
	287	+	1993, the inflation factor used to determine rates shall be two-thirds of 226
	288	+	the gross national product percentage increase from the midpoint of the 227
	289	+	cost year to the midpoint of the rate year. For the fiscal years ending 228
	290	+	June 30, 1996, and June 30, 1997, no inflation factor shall be applied in 229
	291	+	determining rates. The Commissioner of Social Services shall prescribe 230
	292	+	uniform forms on which such facilities shall report their costs. Such rates 231
	293	+	shall be determined on the basis of a reasonable payment for necessary 232
	294	+	services. Any increase in grants, gifts, fund-raising or endowment 233
	295	+	income used for the payment of operating costs by a private facility in 234
	296	+	the fiscal year ending June 30, 1992, shall be excluded by the 235
	297	+	commissioner from the income of the facility in determining the rates to 236
	298	+	be paid to the facility for the fiscal year ending June 30, 1993, provided 237
	299	+	any operating costs funded by such increase shall not obligate the state 238
	300	+	to increase expenditures in subsequent fiscal years. Nothing contained 239
	301	+	in this section shall authorize a payment by the state to any such facility 240
	302	+	in excess of the charges made by the facility for comparable services to 241
	303	+	the general public. The service component of the rates to be paid by the 242
	304	+	state to private facilities and facilities operated by regional education 243
	305	+	service centers which are licensed to provide residential care pursuant 244
	306	+	to section 17a-227, but not certified to participate in the Title XIX 245
	307	+	Medicaid programs as intermediate care facilities for individuals with 246
	308	+	intellectual disabilities, shall be determined annually by the 247
	309	+	Commissioner of Developmental Services in accordance with section 248
	310	+	17b-244a. For the fiscal year ending June 30, 2008, no facility shall receive 249
	311	+	a rate that is more than two per cent greater than the rate in effect for 250 Governor's Bill No. 6446
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316		-	report on a fiscal year basis ending on September thirtieth. Such report 250
317		-	shall be submitted to the commissioner by February fifteenth. Each for-251
318		-	profit chronic and convalescent nursing home that receives state 252
319		-	funding pursuant to this section shall include in such annual report a 253
320		-	profit and loss statement from each related party that receives from such 254
321		-	chronic and convalescent nursing home fifty thousand dollars or more 255
322		-	per year for goods, fees and services. No cause of action or liability shall 256
323		-	arise against the state, the Department of Social Services, any state 257
324		-	official or agent for failure to take action based on the information 258
325		-	required to be reported under this subsection. The commissioner may 259
326		-	reduce the rate in effect for a facility that fails to submit a complete and 260
327		-	accurate report on or before February fifteenth by an amount not to 261
328		-	exceed ten per cent of such rate. If a licensed residential care home fails 262
329		-	to submit a complete and accurate report, the department shall notify 263
330		-	such home of the failure and the home shall have thirty days from the 264
331		-	date the notice was issued to submit a complete and accurate report. If 265
332		-	a licensed residential care home fails to submit a complete and accurate 266
333		-	report not later than thirty days after the date of notice, such home may 267
334		-	not receive a retroactive rate increase, in the commissioner's discretion. 268
335		-	The commissioner shall, annually, on or before April first, report the 269
336		-	data contained in the reports of such facilities [to the joint standing 270
337		-	committee of the General Assembly having cognizance of matters 271
338		-	relating to appropriations and the budgets of state agencies] on the 272
339		-	department's Internet web site. For the cost reporting year commencing 273
340		-	October 1, 1985, and for subsequent cost reporting years, facilities shall 274
341		-	report the cost of using the services of any nursing pool employee by 275
342		-	separating said cost into two categories, the portion of the cost equal to 276
343		-	the salary of the employee for whom the nursing pool employee is 277
344		-	substituting shall be considered a nursing cost and any cost in excess of 278
345		-	such salary shall be further divided so that seventy-five per cent of the 279
346		-	excess cost shall be considered an administrative or general cost and 280
347		-	twenty-five per cent of the excess cost shall be considered a nursing cost, 281
348		-	provided if the total nursing pool costs of a facility for any cost year are 282
349		-	equal to or exceed fifteen per cent of the total nursing expenditures of 283
350		-	the facility for such cost year, no portion of nursing pool costs in excess 284 Substitute Bill No. 6446
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	317	+	the facility on June 30, 2007, except any facility that would have been 251
	318	+	issued a lower rate effective July 1, 2007, due to interim rate status or 252
	319	+	agreement with the department, shall be issued such lower rate effective 253
	320	+	July 1, 2007. For the fiscal year ending June 30, 2009, no facility shall 254
	321	+	receive a rate that is more than two per cent greater than the rate in effect 255
	322	+	for the facility on June 30, 2008, except any facility that would have been 256
	323	+	issued a lower rate effective July 1, 2008, due to interim rate status or 257
	324	+	agreement with the department, shall be issued such lower rate effective 258
	325	+	July 1, 2008. For the fiscal years ending June 30, 2010, and June 30, 2011, 259
	326	+	rates in effect for the period ending June 30, 2009, shall remain in effect 260
	327	+	until June 30, 2011, except that (1) the rate paid to a facility may be higher 261
	328	+	than the rate paid to the facility for the period ending June 30, 2009, if a 262
	329	+	capital improvement required by the Commissioner of Developmental 263
	330	+	Services for the health or safety of the residents was made to the facility 264
	331	+	during the fiscal years ending June 30, 2010, or June 30, 2011, and (2) any 265
	332	+	facility that would have been issued a lower rate for the fiscal year 266
	333	+	ending June 30, 2010, or June 30, 2011, due to interim rate status or 267
	334	+	agreement with the department, shall be issued such lower rate. For the 268
	335	+	fiscal year ending June 30, 2012, rates in effect for the period ending June 269
	336	+	30, 2011, shall remain in effect until June 30, 2012, except that (A) the 270
	337	+	rate paid to a facility may be higher than the rate paid to the facility for 271
	338	+	the period ending June 30, 2011, if a capital improvement required by 272
	339	+	the Commissioner of Developmental Services for the health or safety of 273
	340	+	the residents was made to the facility during the fiscal year ending June 274
	341	+	30, 2012, and (B) any facility that would have been issued a lower rate 275
	342	+	for the fiscal year ending June 30, 2012, due to interim rate status or 276
	343	+	agreement with the department, shall be issued such lower rate. Any 277
	344	+	facility that has a significant decrease in land and building costs shall 278
	345	+	receive a reduced rate to reflect such decrease in land and building costs. 279
	346	+	The rate paid to a facility may be increased if a capital improvement 280
	347	+	approved by the Department of Developmental Services, in consultation 281
	348	+	with the Department of Social Services, for the health or safety of the 282
	349	+	residents was made to the facility during the fiscal year ending June 30, 283
	350	+	2014, or June 30, 2015, only to the extent such increases are within 284
	351	+	available appropriations. For the fiscal years ending June 30, 2016, and 285 Governor's Bill No. 6446
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357		-	of fifteen per cent shall be classified as administrative or general costs. 285
358		-	The commissioner, in determining such rates, shall also take into 286
359		-	account the classification of patients or boarders according to special 287
360		-	care requirements or classification of the facility according to such 288
361		-	factors as facilities and services and such other factors as the 289
362		-	commissioner deems reasonable, including anticipated fluctuations in 290
363		-	the cost of providing such services. The commissioner may establish a 291
364		-	separate rate for a facility or a portion of a facility for traumatic brain 292
365		-	injury patients who require extensive care but not acute general hospital 293
366		-	care. Such separate rate shall reflect the special care requirements of 294
367		-	such patients. If changes in federal or state laws, regulations or 295
368		-	standards adopted subsequent to June 30, 1985, result in increased costs 296
369		-	or expenditures in an amount exceeding one-half of one per cent of 297
370		-	allowable costs for the most recent cost reporting year, the 298
371		-	commissioner shall adjust rates and provide payment for any such 299
372		-	increased reasonable costs or expenditures within a reasonable period 300
373		-	of time retroactive to the date of enforcement. Nothing in this section 301
374		-	shall be construed to require the Department of Social Services to adjust 302
375		-	rates and provide payment for any increases in costs resulting from an 303
376		-	inspection of a facility by the Department of Public Health. Such 304
377		-	assistance as the commissioner requires from other state agencies or 305
378		-	departments in determining rates shall be made available to the 306
379		-	commissioner at the commissioner's request. Payment of the rates 307
380		-	established pursuant to this section shall be conditioned on the 308
381		-	establishment by such facilities of admissions procedures that conform 309
382		-	with this section, section 19a-533 and all other applicable provisions of 310
383		-	the law and the provision of equality of treatment to all persons in such 311
384		-	facilities. The established rates shall be the maximum amount 312
385		-	chargeable by such facilities for care of such beneficiaries, and the 313
386		-	acceptance by or on behalf of any such facility of any additional 314
387		-	compensation for care of any such beneficiary from any other person or 315
388		-	source shall constitute the offense of aiding a beneficiary to obtain aid 316
389		-	to which the beneficiary is not entitled and shall be punishable in the 317
390		-	same manner as is provided in subsection (b) of section 17b-97. [For the 318
391		-	fiscal year ending June 30, 1992, rates for licensed residential care homes 319 Substitute Bill No. 6446
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	357	+	June 30, 2017, rates shall not exceed those in effect for the period ending 286
	358	+	June 30, 2015, except the rate paid to a facility may be higher than the 287
	359	+	rate paid to the facility for the period ending June 30, 2015, if a capital 288
	360	+	improvement approved by the Department of Developmental Services, 289
	361	+	in consultation with the Department of Social Services, for the health or 290
	362	+	safety of the residents was made to the facility during the fiscal year 291
	363	+	ending June 30, 2016, or June 30, 2017, to the extent such rate increases 292
	364	+	are within available appropriations. For the fiscal years ending June 30, 293
	365	+	2016, and June 30, 2017, and each succeeding fiscal year, any facility that 294
	366	+	would have been issued a lower rate, due to interim rate status, a change 295
	367	+	in allowable fair rent or agreement with the department, shall be issued 296
	368	+	such lower rate. For the fiscal years ending June 30, 2018, and June 30, 297
	369	+	2019, rates shall not exceed those in effect for the period ending June 30, 298
	370	+	2017, except the rate paid to a facility may be higher than the rate paid 299
	371	+	to the facility for the period ending June 30, 2017, if a capital 300
	372	+	improvement approved by the Department of Developmental Services, 301
	373	+	in consultation with the Department of Social Services, for the health or 302
	374	+	safety of the residents was made to the facility during the fiscal year 303
	375	+	ending June 30, 2018, or June 30, 2019, to the extent such rate increases 304
	376	+	are within available appropriations. For the fiscal years ending June 30, 305
	377	+	2020, and June 30, 2021, rates shall not exceed those in effect for the fiscal 306
	378	+	year ending June 30, 2019, except the rate paid to a facility may be higher 307
	379	+	than the rate paid to the facility for the fiscal year ending June 30, 2019, 308
	380	+	if a capital improvement approved by the Department of 309
	381	+	Developmental Services, in consultation with the Department of Social 310
	382	+	Services, for the health or safety of the residents was made to the facility 311
	383	+	during the fiscal year ending June 30, 2020, or June 30, 2021, to the extent 312
	384	+	such rate increases are within available appropriations. For the fiscal 313
	385	+	years ending June 30, 2022, and June 30, 2023, rates shall not exceed 314
	386	+	those in effect for the fiscal year ending June 30, 2021, except the rate 315
	387	+	paid to a facility may be higher than the rate paid to the facility for the 316
	388	+	fiscal year ending June 30, 2021, if a capital improvement approved by 317
	389	+	the Department of Developmental Services, in consultation with the 318
	390	+	Department of Social Services, for the health or safety of the residents 319
	391	+	was made to the facility during the fiscal year ending June 30, 2022, or 320 Governor's Bill No. 6446
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398		-	and intermediate care facilities for individuals with intellectual 320
399		-	disabilities may receive an increase not to exceed the most recent annual 321
400		-	increase in the Regional Data Resources Incorporated McGraw-Hill 322
401		-	Health Care Costs: Consumer Price Index (all urban)-All Items. Rates 323
402		-	for newly certified intermediate care facilities for individuals with 324
403		-	intellectual disabilities shall not exceed one hundred fifty per cent of the 325
404		-	median rate of rates in effect on January 31, 1991, for intermediate care 326
405		-	facilities for individuals with intellectual disabilities certified prior to 327
406		-	February 1, 1991.] Notwithstanding any provision of this section, the 328
407		-	Commissioner of Social Services may, within available appropriations, 329
408		-	provide an interim rate increase for a licensed chronic and convalescent 330
409		-	nursing home or a rest home with nursing supervision for rate periods 331
410		-	no earlier than April 1, 2004, only if the commissioner determines that 332
411		-	the increase is necessary to avoid the filing of a petition for relief under 333
412		-	Title 11 of the United States Code; imposition of receivership pursuant 334
413		-	to sections 19a-542 and 19a-543; or substantial deterioration of the 335
414		-	facility's financial condition that may be expected to adversely affect 336
415		-	resident care and the continued operation of the facility, and the 337
416		-	commissioner determines that the continued operation of the facility is 338
417		-	in the best interest of the state. The commissioner shall consider any 339
418		-	requests for interim rate increases on file with the department from 340
419		-	March 30, 2004, and those submitted subsequently for rate periods no 341
420		-	earlier than April 1, 2004. When reviewing an interim rate increase 342
421		-	request the commissioner shall, at a minimum, consider: (A) Existing 343
422		-	chronic and convalescent nursing home or rest home with nursing 344
423		-	supervision utilization in the area and projected bed need; (B) physical 345
424		-	plant long-term viability and the ability of the owner or purchaser to 346
425		-	implement any necessary property improvements; (C) licensure and 347
426		-	certification compliance history; (D) reasonableness of actual and 348
427		-	projected expenses; and (E) the ability of the facility to meet wage and 349
428		-	benefit costs. No interim rate shall be increased pursuant to this 350
429		-	subsection in excess of one hundred fifteen per cent of the median rate 351
430		-	for the facility's peer grouping, established pursuant to subdivision (2) 352
431		-	of subsection (f) of this section, unless recommended by the 353
432		-	commissioner and approved by the Secretary of the Office of Policy and 354 Substitute Bill No. 6446
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	397	+	June 30, 2023, to the extent such rate increases are within available 321
	398	+	appropriations. 322
	399	+	(b) Notwithstanding the provisions of subsection (a) of this section, 323
	400	+	state rates of payment for the fiscal years ending June 30, 2018, June 30, 324
	401	+	2019, June 30, 2020, [and] June 30, 2021, June 30, 2022, and June 30, 2023, 325
	402	+	for residential care homes and community living arrangements that 326
	403	+	receive the flat rate for residential services under section 17-311-54 of the 327
	404	+	regulations of Connecticut state agencies shall be set in accordance with 328
	405	+	section [298 of public act 19-117] 6 of this act. 329
	406	+	(c) The Commissioner of Social Services and the Commissioner of 330
	407	+	Developmental Services shall adopt regulations in accordance with the 331
	408	+	provisions of chapter 54 to implement the provisions of this section. 332
	409	+	Sec. 6. (Effective July 1, 2021) Notwithstanding subsection (a) of section 333
	410	+	17b-244 of the general statutes, as amended by this act, and subsections 334
	411	+	(a) to (i), inclusive, of section 17b-340 of the general statutes or any other 335
	412	+	provision of the general statutes, or regulation adopted thereunder, the 336
	413	+	state rates of payments in effect for the fiscal year ending June 30, 2016, 337
	414	+	for residential care homes, community living arrangements and 338
	415	+	community companion homes that receive the flat rate for residential 339
	416	+	services under section 17-311-54 of the regulations of Connecticut state 340
	417	+	agencies shall remain in effect until June 30, 2023. 341
	418	+	Sec. 7. Section 17b-340d of the general statutes is repealed and the 342
	419	+	following is substituted in lieu thereof (Effective July 1, 2021): 343
	420	+	(a) The Commissioner of Social Services [may] shall implement an 344
	421	+	acuity-based methodology for Medicaid reimbursement of nursing 345
	422	+	home services. [In the course of developing such a system, the 346
	423	+	commissioner shall review the skilled nursing facility prospective 347
	424	+	payment system developed by the Centers for Medicare and Medicaid 348
	425	+	Services, as well as other methodologies used nationally, and shall 349
	426	+	consider recommendations from the nursing home industry. ] 350
	427	+	Notwithstanding section 17b-340, as amended by this act, for the fiscal 351
	428	+	year ending June 30, 2022, and annually thereafter, the Commissioner of 352 Governor's Bill No. 6446
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439		-	~~Management after consultation with the commissioner~~. ~~Such median 355~~
440		-	~~rates shall be published by the Department of Social Services not later 356~~
441		-	~~than April first of each year.~~ ~~In the event that a facility granted an 357~~
442		-	~~interim rate increase pursuant to this section is sold or otherwise 358~~
443		-	~~conveyed for value to an unrelated entity less than five years after~~ the ~~359~~
444		-	~~effective date of such rate increase,~~ the ~~rate increase~~ shall be ~~deemed 360~~
445		-	~~rescinded~~ and ~~the department shall recover an amount equal to the 361~~
446		-	~~difference between payments made for all affected rate periods and 362~~
447		-	~~payments that would have been made if~~ the ~~interim rate increase was 363~~
448		-	~~not granted.~~ The ~~commissioner may seek recovery of such payments 364~~
449		-	~~from any facility with common ownership. With the approval~~ of ~~the 365~~
450		-	~~Secretary~~ of ~~the Office of Policy and Management, the commissioner 366~~
451		-	~~may waive recovery and rescission of~~ the ~~interim rate for good cause 367~~
452		-	~~shown that is not inconsistent with this section~~, ~~including, but not 368~~
453		-	~~limited to~~, ~~transfers to family members that were made for no value.~~ ~~The 369~~
454		-	~~commissioner~~ shall ~~provide written quarterly reports to the joint 370~~
455		-	~~standing committees of the General Assembly having cognizance of 371~~
456		-	~~matters relating to aging~~, ~~human services~~ and ~~appropriations and the 372~~
457		-	~~budgets of state agencies~~, ~~that identify each facility requesting an 373~~
458		-	~~interim rate increase, the amount~~ of ~~the requested rate increase for each 374~~
459		-	~~facility~~, ~~the action taken by the commissioner~~ and ~~the secretary pursuant 375~~
460		-	~~to this subsection,~~ and ~~estimates of the additional cost to the state for 376~~
461		-	~~each approved interim rate increase. Nothing in this subsection~~ shall ~~377~~
462		-	~~prohibit the commissioner from increasing the rate of a licensed chronic 378~~
463		-	~~and convalescent nursing home or a rest home with nursing supervision 379~~
464		-	~~for~~ allowable ~~costs associated with facility capital improvements or 380~~
465		-	~~increasing~~ the ~~rate in case of a sale of a licensed chronic and convalescent 381~~
466		-	~~nursing home or a rest home with nursing supervision [,~~ ~~pursuant to 382~~
467		-	~~subdivision (15) of subsection (f) of this section,] if receivership has been 383~~
468		-	~~imposed on such home.~~ ~~384~~
469		-	(b) [The ~~Commissioner of Social Services~~ shall ~~adopt regulations in 385~~
470		-	~~accordance with~~ the ~~provisions of chapter 54 to specify other~~ allowable ~~386~~
471		-	~~services.~~ For ~~purposes of this section~~, ~~other allowable services means 387~~
472		-	~~those services required by any medical assistance beneficiary residing 388 Substitute~~ Bill No. 6446
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	433	+
	434	+	Social Services shall establish Medicaid rates paid to nursing home 353
	435	+	facilities based on cost years ending on September thirtieth in 354
	436	+	accordance with the following: 355
	437	+	(1) Case-mix adjustments to the direct care component shall be made 356
	438	+	or phased in effective beginning July 1, 2021, and updated every quarter 357
	439	+	thereafter. The transition to acuity-based reimbursement shall be cost 358
	440	+	neutral and based on cost reports for the fiscal year ending June 30, 2018. 359
	441	+	(2) Geographic peer groupings of facilities shall be established by the 360
	442	+	Department of Social Services pursuant to regulations adopted in 361
	443	+	accordance with subsection (b) of this section. 362
	444	+	(3) Allowable costs shall be divided into the following five cost 363
	445	+	components: (A) Direct costs, which shall include salaries for nursing 364
	446	+	personnel, related fringe benefits and nursing pool costs; (B) indirect 365
	447	+	costs, which shall include professional fees, dietary expenses, 366
	448	+	housekeeping expenses, laundry expenses, supplies related to patient 367
	449	+	care, salaries for indirect care personnel and related fringe benefits; (C) 368
	450	+	fair rent, which shall be defined in regulations adopted in accordance 369
	451	+	with subsection (b) of this section; (D) capital-related costs, which shall 370
	452	+	include property taxes, insurance expenses, equipment leases and 371
	453	+	equipment depreciation; and (E) administrative and general costs, 372
	454	+	which shall include maintenance and operation of plant expenses, 373
	455	+	salaries for administrative and maintenance personnel and related 374
	456	+	fringe benefits. For (i) direct costs, the maximum cost shall be equal to 375
	457	+	one hundred thirty-five per cent of the median allowable cost of that 376
	458	+	peer grouping; (ii) indirect costs, the maximum cost shall be equal to one 377
	459	+	hundred fifteen per cent of the state-wide median allowable cost; (iii) 378
	460	+	fair rent, the amount shall be calculated utilizing the amount approved 379
	461	+	pursuant to section 17b-353; (iv) capital-related costs, there shall be no 380
	462	+	maximum; and (v) administrative and general costs, the maximum shall 381
	463	+	be equal to the state-wide median allowable cost. 382
	464	+	(4) For the fiscal year ending June 30, 2022, the commissioner may, in 383
	465	+	the commissioner's discretion and within available appropriations, 384 Governor's Bill No. 6446
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479		-	~~in such home or hospital which are not already covered in the rate set 389~~
480		-	~~by the commissioner in accordance with the provisions of subsection (a) 390~~
481		-	~~of this section]~~ ~~The Commissioner of Social Services may implement 391~~
482		-	~~policies and procedures as necessary to carry out~~ the ~~provisions of this 392~~
483		-	~~section while~~ in the ~~process of adopting the policies and procedures as 393~~
484		-	~~regulations, provided notice of intent~~ to ~~adopt the regulations is 394~~
485		-	~~published in accordance with~~ the ~~provisions of section 17b-10~~ ~~not later 395~~
486		-	~~than twenty days after the date of implementation~~. ~~396~~
487		-	(c) ~~No facility subject to the requirements~~ of ~~this section shall accept 397~~
488		-	~~payment in excess~~ of ~~the rate set by the commissioner pursuant to 398~~
489		-	~~subsection (a)~~ of ~~this section~~ for ~~any medical assistance patient from this 399~~
490		-	~~or any other state.~~ ~~No facility shall accept payment in excess of the 400~~
491		-	~~reasonable and necessary costs~~ of ~~other allowable services as specified 401~~
492		-	~~by the commissioner pursuant to the regulations adopted under 402~~
493		-	~~subsection~~ (b) of this section ~~for any public assistance patient from this 403~~
494		-	~~or any other state~~. ~~Notwithstanding the provisions of this subsection, 404~~
495		-	the commissioner may ~~authorize a facility to accept payment in excess 405~~
496		-	of the ~~rate paid for a medical assistance patient~~ in ~~this state for a patient 406~~
497		-	~~who receives medical assistance from another state.~~ ~~407~~
498		-	~~(d) In any instance where~~ the ~~Commissioner of Social Services finds 408~~
499		-	~~that a facility subject~~ to the ~~requirements~~ of ~~this section is accepting 409~~
500		-	~~payment for a medical assistance beneficiary in violation of subsection 410~~
501		-	~~(c)~~ of ~~this section,~~ the ~~commissioner shall proceed to recover through the 411~~
502		-	~~rate set for the facility any sum~~ in ~~excess of the stipulated per diem and 412~~
503		-	~~other allowable costs, as provided~~ for ~~in regulations adopted pursuant 413~~
504		-	to ~~subsections (a)~~ and ~~(b) of this section. The commissioner shall make 414~~
505		-	~~the recovery prospectively at the time of the next annual rate 415~~
506		-	~~redetermination. 416~~
507		-	(e) ~~Except as provided in this subsection~~, ~~the provisions of 417~~
508		-	~~subsections (c) and (d) of this section shall not apply to any facility 418~~
509		-	~~subject to the requirements of this section~~, ~~which on October 1, 1981, (1) 419~~
510		-	~~was accepting payments from~~ the ~~commissioner in accordance with the 420~~
511		-	~~provisions of subsection (~~a~~) of this section, (2) was accepting medical 421 Substitute~~ Bill No. 6446
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	470	+
	471	+	provide pro rata fair rent increases to facilities which have documented 385
	472	+	fair rent additions placed in service in the cost report year ending 386
	473	+	September 30, 2019, that are not otherwise included in the rates issued. 387
	474	+	(5) There shall be no increase to rates based on inflation or any 388
	475	+	inflationary factor for the fiscal years ending June 30, 2022, and June 30, 389
	476	+	2023. 390
	477	+	(6) For purposes of computing minimum allowable patient days, 391
	478	+	utilization of a facility's certified beds shall be determined at a minimum 392
	479	+	of ninety per cent of capacity, except for new facilities and facilities 393
	480	+	which are certified for additional beds which may be permitted a lower 394
	481	+	occupancy rate for the first three months of operation after the effective 395
	482	+	date of licensure. 396
	483	+	(7) Rates determined under this section shall comply with federal 397
	484	+	laws and regulations. 398
	485	+	(b) The Commissioner of Social Services may implement policies as 399
	486	+	necessary to carry out the provisions of this section while in the process 400
	487	+	of adopting the policies as regulations, provided that prior to 401
	488	+	implementation the policies are posted (1) on the eRegulations System 402
	489	+	established pursuant to section 4-173b and (2) the Department of Social 403
	490	+	Services' Internet web site. 404
	491	+	Sec. 8. Section 17b-340 of the general statutes is repealed and the 405
	492	+	following is substituted in lieu thereof (Effective July 1, 2021): 406
	493	+	(a) For purposes of this subsection, (1) a "related party" includes, but 407
	494	+	is not limited to, any company related to a chronic and convalescent 408
	495	+	nursing home through family association, common ownership, control 409
	496	+	or business association with any of the owners, operators or officials of 410
	497	+	such nursing home; (2) "company" means any person, partnership, 411
	498	+	association, holding company, limited liability company or corporation; 412
	499	+	(3) "family association" means a relationship by birth, marriage or 413
	500	+	domestic partnership; and (4) "profit and loss statement" means the 414
	501	+	most recent annual statement on profits and losses finalized by a related 415 Governor's Bill No. 6446
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518		-	assistance payments from another state for at least twenty per cent of its 422
519		-	patients, and (3) had not notified the commissioner of any intent to 423
520		-	terminate its provider agreement, in accordance with section 17b-271, 424
521		-	provided no patient residing in any such facility on May 22, 1984, shall 425
522		-	be removed from such facility for purposes of meeting the requirements 426
523		-	of this subsection. If the commissioner finds that the number of beds 427
524		-	available to medical assistance patients from this state in any such 428
525		-	facility is less than fifteen per cent the provisions of subsections (c) and 429
526		-	(d) of this section shall apply to that number of beds which is less than 430
527		-	said percentage. 431
528		-	(f) For the fiscal years ending on or before June 30, 2021, and for the 432
529		-	period beginning on July 1, 2021, and ending on September 30, 2021, 433
530		-	rates for nursing home facilities shall be set in accordance with this 434
531		-	subsection. On and after October 1, 2021, such rates shall be set in 435
532		-	accordance with section 17b-340d, as amended by this act. For the fiscal 436
533		-	year ending June 30, 1992, the rates paid by or for persons aided or cared 437
534		-	for by the state or any town in this state to facilities for room, board and 438
535		-	services specified in licensing regulations issued by the licensing 439
536		-	agency, except intermediate care facilities for individuals with 440
537		-	intellectual disabilities and residential care homes, shall be based on the 441
538		-	cost year ending September 30, 1989. For the fiscal years ending June 30, 442
539		-	1993, and June 30, 1994, such rates shall be based on the cost year ending 443
540		-	September 30, 1990. Such rates shall be determined by the 444
541		-	Commissioner of Social Services in accordance with this section and the 445
542		-	regulations of Connecticut state agencies promulgated by the 446
543		-	commissioner and in effect on April 1, 1991, except that: 447
544		-	(1) Allowable costs shall be divided into the following five cost 448
545		-	components: (A) Direct costs, which shall include salaries for nursing 449
546		-	personnel, related fringe benefits and nursing pool costs; (B) indirect 450
547		-	costs, which shall include professional fees, dietary expenses, 451
548		-	housekeeping expenses, laundry expenses, supplies related to patient 452
549		-	care, salaries for indirect care personnel and related fringe benefits; (C) 453
550		-	fair rent, which shall be defined in accordance with subsection (f) of 454 Substitute Bill No. 6446
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	506	+
	507	+	party before the annual report mandated under this subsection. The 416
	508	+	rates to be paid by or for persons aided or cared for by the state or any 417
	509	+	town in this state to licensed chronic and convalescent nursing homes, 418
	510	+	to chronic disease hospitals associated with chronic and convalescent 419
	511	+	nursing homes, to rest homes with nursing supervision, to licensed 420
	512	+	residential care homes, as defined by section 19a-490, and to residential 421
	513	+	facilities for persons with intellectual disability that are licensed 422
	514	+	pursuant to section 17a-227 and certified to participate in the Title XIX 423
	515	+	Medicaid program as intermediate care facilities for individuals with 424
	516	+	intellectual disabilities, for room, board and services specified in 425
	517	+	licensing regulations issued by the licensing agency shall be determined 426
	518	+	annually, except as otherwise provided in this subsection [, after a 427
	519	+	public hearing,] by the Commissioner of Social Services, to be effective 428
	520	+	July first of each year except as otherwise provided in this subsection. 429
	521	+	Such rates shall be determined on a basis of a reasonable payment for 430
	522	+	such necessary services, which basis shall take into account as a factor 431
	523	+	the costs of such services. Cost of such services shall include reasonable 432
	524	+	costs mandated by collective bargaining agreements with certified 433
	525	+	collective bargaining agents or other agreements between the employer 434
	526	+	and employees, provided "employees" shall not include persons 435
	527	+	employed as managers or chief administrators or required to be licensed 436
	528	+	as nursing home administrators, and compensation for services 437
	529	+	rendered by proprietors at prevailing wage rates, as determined by 438
	530	+	application of principles of accounting as prescribed by said 439
	531	+	commissioner. Cost of such services shall not include amounts paid by 440
	532	+	the facilities to employees as salary, or to attorneys or consultants as 441
	533	+	fees, where the responsibility of the employees, attorneys, or consultants 442
	534	+	is to persuade or seek to persuade the other employees of the facility to 443
	535	+	support or oppose unionization. Nothing in this subsection shall 444
	536	+	prohibit inclusion of amounts paid for legal counsel related to the 445
	537	+	negotiation of collective bargaining agreements, the settlement of 446
	538	+	grievances or normal administration of labor relations. The 447
	539	+	commissioner may, in the commissioner's discretion, allow the inclusion 448
	540	+	of extraordinary and unanticipated costs of providing services that were 449
	541	+	incurred to avoid an immediate negative impact on the health and safety 450 Governor's Bill No. 6446
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557		-	section 17-311-52 of the regulations of Connecticut state agencies; (D) 455
558		-	capital-related costs, which shall include property taxes, insurance 456
559		-	expenses, equipment leases and equipment depreciation; and (E) 457
560		-	administrative and general costs, which shall include (i) maintenance 458
561		-	and operation of plant expenses, (ii) salaries for administrative and 459
562		-	maintenance personnel, and (iii) related fringe benefits. The 460
563		-	commissioner may provide a rate adjustment for nonemergency 461
564		-	transportation services required by nursing facility residents. Such 462
565		-	adjustment shall be a fixed amount determined annually by the 463
566		-	commissioner based upon a review of costs and other associated 464
567		-	information. Allowable costs shall not include costs for ancillary 465
568		-	services payable under Part B of the Medicare program. 466
569		-	(2) Two geographic peer groupings of facilities shall be established 467
570		-	for each level of care, as defined by the Department of Social Services 468
571		-	for the determination of rates, for the purpose of determining allowable 469
572		-	direct costs. One peer grouping shall be comprised of those facilities 470
573		-	located in Fairfield County. The other peer grouping shall be comprised 471
574		-	of facilities located in all other counties. 472
575		-	(3) For the fiscal year ending June 30, 1992, per diem maximum 473
576		-	allowable costs for each cost component shall be as follows: For direct 474
577		-	costs, the maximum shall be equal to one hundred forty per cent of the 475
578		-	median allowable cost of that peer grouping; for indirect costs, the 476
579		-	maximum shall be equal to one hundred thirty per cent of the state-wide 477
580		-	median allowable cost; for fair rent, the amount shall be calculated 478
581		-	utilizing the amount approved by the Office of Health Care Access 479
582		-	pursuant to section 19a-638; for capital-related costs, there shall be no 480
583		-	maximum; and for administrative and general costs, the maximum shall 481
584		-	be equal to one hundred twenty-five per cent of the state-wide median 482
585		-	allowable cost. For the fiscal year ending June 30, 1993, per diem 483
586		-	maximum allowable costs for each cost component shall be as follows: 484
587		-	For direct costs, the maximum shall be equal to one hundred forty per 485
588		-	cent of the median allowable cost of that peer grouping; for indirect 486
589		-	costs, the maximum shall be equal to one hundred twenty-five per cent 487 Substitute Bill No. 6446
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	546	+
	547	+	of patients. The commissioner may, in the commissioner's discretion, 451
	548	+	based upon review of a facility's costs, direct care staff to patient ratio 452
	549	+	and any other related information, revise a facility's rate for any 453
	550	+	increases or decreases to total licensed capacity of more than ten beds or 454
	551	+	changes to its number of licensed rest home with nursing supervision 455
	552	+	beds and chronic and convalescent nursing home beds. The 456
	553	+	commissioner may, in the commissioner's discretion, revise the rate of a 457
	554	+	facility that is closing. An interim rate issued for the period during 458
	555	+	which a facility is closing shall be based on a review of facility costs, the 459
	556	+	expected duration of the close-down period, the anticipated impact on 460
	557	+	Medicaid costs, available appropriations and the relationship of the rate 461
	558	+	requested by the facility to the average Medicaid rate for a close-down 462
	559	+	period. The commissioner may so revise a facility's rate established for 463
	560	+	the fiscal year ending June 30, 1993, and thereafter for any bed increases, 464
	561	+	decreases or changes in licensure effective after October 1, 1989. 465
	562	+	Effective July 1, 1991, in facilities that have both a chronic and 466
	563	+	convalescent nursing home and a rest home with nursing supervision, 467
	564	+	the rate for the rest home with nursing supervision shall not exceed such 468
	565	+	facility's rate for its chronic and convalescent nursing home. All such 469
	566	+	facilities for which rates are determined under this subsection shall 470
	567	+	report on a fiscal year basis ending on September thirtieth. Such report 471
	568	+	shall be submitted to the commissioner by February fifteenth. Each for-472
	569	+	profit chronic and convalescent nursing home that receives state 473
	570	+	funding pursuant to this section shall include in such annual report a 474
	571	+	profit and loss statement from each related party that receives from such 475
	572	+	chronic and convalescent nursing home fifty thousand dollars or more 476
	573	+	per year for goods, fees and services. No cause of action or liability shall 477
	574	+	arise against the state, the Department of Social Services, any state 478
	575	+	official or agent for failure to take action based on the information 479
	576	+	required to be reported under this subsection. The commissioner may 480
	577	+	reduce the rate in effect for a facility that fails to submit a complete and 481
	578	+	accurate report on or before February fifteenth by an amount not to 482
	579	+	exceed ten per cent of such rate. If a licensed residential care home fails 483
	580	+	to submit a complete and accurate report, the department shall notify 484
	581	+	such home of the failure and the home shall have thirty days from the 485 Governor's Bill No. 6446
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596		-	of the state-wide median allowable cost; for fair rent, the amount shall 488
597		-	be calculated utilizing the amount approved by the Office of Health 489
598		-	Care Access pursuant to section 19a-638; for capital-related costs, there 490
599		-	shall be no maximum; and for administrative and general costs the 491
600		-	maximum shall be equal to one hundred fifteen per cent of the state-492
601		-	wide median allowable cost. For the fiscal year ending June 30, 1994, per 493
602		-	diem maximum allowable costs for each cost component shall be as 494
603		-	follows: For direct costs, the maximum shall be equal to one hundred 495
604		-	thirty-five per cent of the median allowable cost of that peer grouping; 496
605		-	for indirect costs, the maximum shall be equal to one hundred twenty 497
606		-	per cent of the state-wide median allowable cost; for fair rent, the 498
607		-	amount shall be calculated utilizing the amount approved by the Office 499
608		-	of Health Care Access pursuant to section 19a-638; for capital-related 500
609		-	costs, there shall be no maximum; and for administrative and general 501
610		-	costs the maximum shall be equal to one hundred ten per cent of the 502
611		-	state-wide median allowable cost. For the fiscal year ending June 30, 503
612		-	1995, per diem maximum allowable costs for each cost component shall 504
613		-	be as follows: For direct costs, the maximum shall be equal to one 505
614		-	hundred thirty-five per cent of the median allowable cost of that peer 506
615		-	grouping; for indirect costs, the maximum shall be equal to one hundred 507
616		-	twenty per cent of the state-wide median allowable cost; for fair rent, 508
617		-	the amount shall be calculated utilizing the amount approved by the 509
618		-	Office of Health Care Access pursuant to section 19a-638; for capital-510
619		-	related costs, there shall be no maximum; and for administrative and 511
620		-	general costs the maximum shall be equal to one hundred five per cent 512
621		-	of the state-wide median allowable cost. For the fiscal year ending June 513
622		-	30, 1996, and any succeeding fiscal year, except for the fiscal years 514
623		-	ending June 30, 2000, and June 30, 2001, for facilities with an interim rate 515
624		-	in one or both periods, per diem maximum allowable costs for each cost 516
625		-	component shall be as follows: For direct costs, the maximum shall be 517
626		-	equal to one hundred thirty-five per cent of the median allowable cost 518
627		-	of that peer grouping; for indirect costs, the maximum shall be equal to 519
628		-	one hundred fifteen per cent of the state-wide median allowable cost; 520
629		-	for fair rent, the amount shall be calculated utilizing the amount 521
630		-	approved pursuant to section 19a-638; for capital-related costs, there 522 Substitute Bill No. 6446
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	586	+
	587	+	date the notice was issued to submit a complete and accurate report. If 486
	588	+	a licensed residential care home fails to submit a complete and accurate 487
	589	+	report not later than thirty days after the date of notice, such home may 488
	590	+	not receive a retroactive rate increase, in the commissioner's discretion. 489
	591	+	The commissioner shall, annually, on or before April first, report the 490
	592	+	data contained in the reports of such facilities [to the joint standing 491
	593	+	committee of the General Assembly having cognizance of matters 492
	594	+	relating to appropriations and the budgets of state agencies] on the 493
	595	+	department's Internet web site. For the cost reporting year commencing 494
	596	+	October 1, 1985, and for subsequent cost reporting years, facilities shall 495
	597	+	report the cost of using the services of any nursing pool employee by 496
	598	+	separating said cost into two categories, the portion of the cost equal to 497
	599	+	the salary of the employee for whom the nursing pool employee is 498
	600	+	substituting shall be considered a nursing cost and any cost in excess of 499
	601	+	such salary shall be further divided so that seventy-five per cent of the 500
	602	+	excess cost shall be considered an administrative or general cost and 501
	603	+	twenty-five per cent of the excess cost shall be considered a nursing cost, 502
	604	+	provided if the total nursing pool costs of a facility for any cost year are 503
	605	+	equal to or exceed fifteen per cent of the total nursing expenditures of 504
	606	+	the facility for such cost year, no portion of nursing pool costs in excess 505
	607	+	of fifteen per cent shall be classified as administrative or general costs. 506
	608	+	The commissioner, in determining such rates, shall also take into 507
	609	+	account the classification of patients or boarders according to special 508
	610	+	care requirements or classification of the facility according to such 509
	611	+	factors as facilities and services and such other factors as the 510
	612	+	commissioner deems reasonable, including anticipated fluctuations in 511
	613	+	the cost of providing such services. The commissioner may establish a 512
	614	+	separate rate for a facility or a portion of a facility for traumatic brain 513
	615	+	injury patients who require extensive care but not acute general hospital 514
	616	+	care. Such separate rate shall reflect the special care requirements of 515
	617	+	such patients. If changes in federal or state laws, regulations or 516
	618	+	standards adopted subsequent to June 30, 1985, result in increased costs 517
	619	+	or expenditures in an amount exceeding one-half of one per cent of 518
	620	+	allowable costs for the most recent cost reporting year, the 519
	621	+	commissioner shall adjust rates and provide payment for any such 520 Governor's Bill No. 6446
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636	624
637		-	shall be no maximum; and for administrative and general costs the 523
638		-	maximum shall be equal to the state-wide median allowable cost. For 524
639		-	the fiscal years ending June 30, 2000, and June 30, 2001, for facilities with 525
640		-	an interim rate in one or both periods, per diem maximum allowable 526
641		-	costs for each cost component shall be as follows: For direct costs, the 527
642		-	maximum shall be equal to one hundred forty-five per cent of the 528
643		-	median allowable cost of that peer grouping; for indirect costs, the 529
644		-	maximum shall be equal to one hundred twenty-five per cent of the 530
645		-	state-wide median allowable cost; for fair rent, the amount shall be 531
646		-	calculated utilizing the amount approved pursuant to section 19a-638; 532
647		-	for capital-related costs, there shall be no maximum; and for 533
648		-	administrative and general costs, the maximum shall be equal to the 534
649		-	state-wide median allowable cost and such medians shall be based upon 535
650		-	the same cost year used to set rates for facilities with prospective rates. 536
651		-	Costs in excess of the maximum amounts established under this 537
652		-	subsection shall not be recognized as allowable costs, except that the 538
653		-	Commissioner of Social Services (A) may allow costs in excess of 539
654		-	maximum amounts for any facility with patient days covered by 540
655		-	Medicare, including days requiring coinsurance, in excess of twelve per 541
656		-	cent of annual patient days which also has patient days covered by 542
657		-	Medicaid in excess of fifty per cent of annual patient days; (B) may 543
658		-	establish a pilot program whereby costs in excess of maximum amounts 544
659		-	shall be allowed for beds in a nursing home which has a managed care 545
660		-	program and is affiliated with a hospital licensed under chapter 368v; 546
661		-	and (C) may establish rates whereby allowable costs may exceed such 547
662		-	maximum amounts for beds approved on or after July 1, 1991, which are 548
663		-	restricted to use by patients with acquired immune deficiency syndrome 549
664		-	or traumatic brain injury. 550
665		-	(4) For the fiscal year ending June 30, 1992, (A) no facility shall receive 551
666		-	a rate that is less than the rate it received for the rate year ending June 552
667		-	30, 1991; (B) no facility whose rate, if determined pursuant to this 553
668		-	subsection, would exceed one hundred twenty per cent of the state-wide 554
669		-	median rate, as determined pursuant to this subsection, shall receive a 555
670		-	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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	626	+
	627	+	increased reasonable costs or expenditures within a reasonable period 521
	628	+	of time retroactive to the date of enforcement. Nothing in this section 522
	629	+	shall be construed to require the Department of Social Services to adjust 523
	630	+	rates and provide payment for any increases in costs resulting from an 524
	631	+	inspection of a facility by the Department of Public Health. Such 525
	632	+	assistance as the commissioner requires from other state agencies or 526
	633	+	departments in determining rates shall be made available to the 527
	634	+	commissioner at the commissioner's request. Payment of the rates 528
	635	+	established pursuant to this section shall be conditioned on the 529
	636	+	establishment by such facilities of admissions procedures that conform 530
	637	+	with this section, section 19a-533 and all other applicable provisions of 531
	638	+	the law and the provision of equality of treatment to all persons in such 532
	639	+	facilities. The established rates shall be the maximum amount 533
	640	+	chargeable by such facilities for care of such beneficiaries, and the 534
	641	+	acceptance by or on behalf of any such facility of any additional 535
	642	+	compensation for care of any such beneficiary from any other person or 536
	643	+	source shall constitute the offense of aiding a beneficiary to obtain aid 537
	644	+	to which the beneficiary is not entitled and shall be punishable in the 538
	645	+	same manner as is provided in subsection (b) of section 17b-97. [For the 539
	646	+	fiscal year ending June 30, 1992, rates for licensed residential care homes 540
	647	+	and intermediate care facilities for individuals with intellectual 541
	648	+	disabilities may receive an increase not to exceed the most recent annual 542
	649	+	increase in the Regional Data Resources Incorporated McGraw-Hill 543
	650	+	Health Care Costs: Consumer Price Index (all urban)-All Items. Rates 544
	651	+	for newly certified intermediate care facilities for individuals with 545
	652	+	intellectual disabilities shall not exceed one hundred fifty per cent of the 546
	653	+	median rate of rates in effect on January 31, 1991, for intermediate care 547
	654	+	facilities for individuals with intellectual disabilities certified prior to 548
	655	+	February 1, 1991.] Notwithstanding any provision of this section, the 549
	656	+	Commissioner of Social Services may, within available appropriations, 550
	657	+	provide an interim rate increase for a licensed chronic and convalescent 551
	658	+	nursing home or a rest home with nursing supervision for rate periods 552
	659	+	no earlier than April 1, 2004, only if the commissioner determines that 553
	660	+	the increase is necessary to avoid the filing of a petition for relief under 554
	661	+	Title 11 of the United States Code; imposition of receivership pursuant 555 Governor's Bill No. 6446
671	662
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677		-	the rate year ending June 30, 1991; and (C) no facility whose rate, if 557
678		-	determined pursuant to this subsection, would be less than one hundred 558
679		-	twenty per cent of the state-wide median rate, as determined pursuant 559
680		-	to this subsection, shall receive a rate which is six and one-half per cent 560
681		-	more than the rate it received for the rate year ending June 30, 1991. For 561
682		-	the fiscal year ending June 30, 1993, no facility shall receive a rate that is 562
683		-	less than the rate it received for the rate year ending June 30, 1992, or six 563
684		-	per cent more than the rate it received for the rate year ending June 30, 564
685		-	1992. For the fiscal year ending June 30, 1994, no facility shall receive a 565
686		-	rate that is less than the rate it received for the rate year ending June 30, 566
687		-	1993, or six per cent more than the rate it received for the rate year 567
688		-	ending June 30, 1993. For the fiscal year ending June 30, 1995, no facility 568
689		-	shall receive a rate that is more than five per cent less than the rate it 569
690		-	received for the rate year ending June 30, 1994, or six per cent more than 570
691		-	the rate it received for the rate year ending June 30, 1994. For the fiscal 571
692		-	years ending June 30, 1996, and June 30, 1997, no facility shall receive a 572
693		-	rate that is more than three per cent more than the rate it received for 573
694		-	the prior rate year. For the fiscal year ending June 30, 1998, a facility shall 574
695		-	receive a rate increase that is not more than two per cent more than the 575
696		-	rate that the facility received in the prior year. For the fiscal year ending 576
697		-	June 30, 1999, a facility shall receive a rate increase that is not more than 577
698		-	three per cent more than the rate that the facility received in the prior 578
699		-	year and that is not less than one per cent more than the rate that the 579
700		-	facility received in the prior year, exclusive of rate increases associated 580
701		-	with a wage, benefit and staffing enhancement rate adjustment added 581
702		-	for the period from April 1, 1999, to June 30, 1999, inclusive. For the fiscal 582
703		-	year ending June 30, 2000, each facility, except a facility with an interim 583
704		-	rate or replaced interim rate for the fiscal year ending June 30, 1999, and 584
705		-	a facility having a certificate of need or other agreement specifying rate 585
706		-	adjustments for the fiscal year ending June 30, 2000, shall receive a rate 586
707		-	increase equal to one per cent applied to the rate the facility received for 587
708		-	the fiscal year ending June 30, 1999, exclusive of the facility's wage, 588
709		-	benefit and staffing enhancement rate adjustment. For the fiscal year 589
710		-	ending June 30, 2000, no facility with an interim rate, replaced interim 590
711		-	rate or scheduled rate adjustment specified in a certificate of need or 591 Substitute Bill No. 6446
	665	+	LCO No. 3112 18 of 51
	666	+
	667	+	to sections 19a-542 and 19a-543; or substantial deterioration of the 556
	668	+	facility's financial condition that may be expected to adversely affect 557
	669	+	resident care and the continued operation of the facility, and the 558
	670	+	commissioner determines that the continued operation of the facility is 559
	671	+	in the best interest of the state. The commissioner shall consider any 560
	672	+	requests for interim rate increases on file with the department from 561
	673	+	March 30, 2004, and those submitted subsequently for rate periods no 562
	674	+	earlier than April 1, 2004. When reviewing an interim rate increase 563
	675	+	request the commissioner shall, at a minimum, consider: (A) Existing 564
	676	+	chronic and convalescent nursing home or rest home with nursing 565
	677	+	supervision utilization in the area and projected bed need; (B) physical 566
	678	+	plant long-term viability and the ability of the owner or purchaser to 567
	679	+	implement any necessary property improvements; (C) licensure and 568
	680	+	certification compliance history; (D) reasonableness of actual and 569
	681	+	projected expenses; and (E) the ability of the facility to meet wage and 570
	682	+	benefit costs. No interim rate shall be increased pursuant to this 571
	683	+	subsection in excess of one hundred fifteen per cent of the median rate 572
	684	+	for the facility's peer grouping, established pursuant to subdivision (2) 573
	685	+	of subsection (f) of this section, unless recommended by the 574
	686	+	commissioner and approved by the Secretary of the Office of Policy and 575
	687	+	Management after consultation with the commissioner. Such median 576
	688	+	rates shall be published by the Department of Social Services not later 577
	689	+	than April first of each year. In the event that a facility granted an 578
	690	+	interim rate increase pursuant to this section is sold or otherwise 579
	691	+	conveyed for value to an unrelated entity less than five years after the 580
	692	+	effective date of such rate increase, the rate increase shall be deemed 581
	693	+	rescinded and the department shall recover an amount equal to the 582
	694	+	difference between payments made for all affected rate periods and 583
	695	+	payments that would have been made if the interim rate increase was 584
	696	+	not granted. The commissioner may seek recovery of such payments 585
	697	+	from any facility with common ownership. With the approval of the 586
	698	+	Secretary of the Office of Policy and Management, the commissioner 587
	699	+	may waive recovery and rescission of the interim rate for good cause 588
	700	+	shown that is not inconsistent with this section, including, but not 589
	701	+	limited to, transfers to family members that were made for no value. The 590 Governor's Bill No. 6446
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717	704
718		-	other agreement for the fiscal year ending June 30, 2000, shall receive a 592
719		-	rate increase that is more than one per cent more than the rate the facility 593
720		-	received in the fiscal year ending June 30, 1999. For the fiscal year ending 594
721		-	June 30, 2001, each facility, except a facility with an interim rate or 595
722		-	replaced interim rate for the fiscal year ending June 30, 2000, and a 596
723		-	facility having a certificate of need or other agreement specifying rate 597
724		-	adjustments for the fiscal year ending June 30, 2001, shall receive a rate 598
725		-	increase equal to two per cent applied to the rate the facility received for 599
726		-	the fiscal year ending June 30, 2000, subject to verification of wage 600
727		-	enhancement adjustments pursuant to subdivision (14) of this 601
728		-	subsection. For the fiscal year ending June 30, 2001, no facility with an 602
729		-	interim rate, replaced interim rate or scheduled rate adjustment 603
730		-	specified in a certificate of need or other agreement for the fiscal year 604
731		-	ending June 30, 2001, shall receive a rate increase that is more than two 605
732		-	per cent more than the rate the facility received for the fiscal year ending 606
733		-	June 30, 2000. For the fiscal year ending June 30, 2002, each facility shall 607
734		-	receive a rate that is two and one-half per cent more than the rate the 608
735		-	facility received in the prior fiscal year. For the fiscal year ending June 609
736		-	30, 2003, each facility shall receive a rate that is two per cent more than 610
737		-	the rate the facility received in the prior fiscal year, except that such 611
738		-	increase shall be effective January 1, 2003, and such facility rate in effect 612
739		-	for the fiscal year ending June 30, 2002, shall be paid for services 613
740		-	provided until December 31, 2002, except any facility that would have 614
741		-	been issued a lower rate effective July 1, 2002, than for the fiscal year 615
742		-	ending June 30, 2002, due to interim rate status or agreement with the 616
743		-	department shall be issued such lower rate effective July 1, 2002, and 617
744		-	have such rate increased two per cent effective June 1, 2003. For the fiscal 618
745		-	year ending June 30, 2004, rates in effect for the period ending June 30, 619
746		-	2003, shall remain in effect, except any facility that would have been 620
747		-	issued a lower rate effective July 1, 2003, than for the fiscal year ending 621
748		-	June 30, 2003, due to interim rate status or agreement with the 622
749		-	department shall be issued such lower rate effective July 1, 2003. For the 623
750		-	fiscal year ending June 30, 2005, rates in effect for the period ending June 624
751		-	30, 2004, shall remain in effect until December 31, 2004, except any 625
752		-	facility that would have been issued a lower rate effective July 1, 2004, 626 Substitute Bill No. 6446
	705	+	LCO No. 3112 19 of 51
	706	+
	707	+	commissioner shall provide written quarterly reports to the joint 591
	708	+	standing committees of the General Assembly having cognizance of 592
	709	+	matters relating to aging, human services and appropriations and the 593
	710	+	budgets of state agencies, that identify each facility requesting an 594
	711	+	interim rate increase, the amount of the requested rate increase for each 595
	712	+	facility, the action taken by the commissioner and the secretary pursuant 596
	713	+	to this subsection, and estimates of the additional cost to the state for 597
	714	+	each approved interim rate increase. Nothing in this subsection shall 598
	715	+	prohibit the commissioner from increasing the rate of a licensed chronic 599
	716	+	and convalescent nursing home or a rest home with nursing supervision 600
	717	+	for allowable costs associated with facility capital improvements or 601
	718	+	increasing the rate in case of a sale of a licensed chronic and convalescent 602
	719	+	nursing home or a rest home with nursing supervision [, pursuant to 603
	720	+	subdivision (15) of subsection (f) of this section,] if receivership has been 604
	721	+	imposed on such home. 605
	722	+	(b) [The Commissioner of Social Services shall adopt regulations in 606
	723	+	accordance with the provisions of chapter 54 to specify other allowable 607
	724	+	services. For purposes of this section, other allowable services means 608
	725	+	those services required by any medical assistance beneficiary residing 609
	726	+	in such home or hospital which are not already covered in the rate set 610
	727	+	by the commissioner in accordance with the provisions of subsection (a) 611
	728	+	of this section] The Commissioner of Social Services may implement 612
	729	+	policies and procedures as necessary to carry out the provisions of this 613
	730	+	section while in the process of adopting the policies and procedures as 614
	731	+	regulations, provided notice of intent to adopt the regulations is 615
	732	+	published in accordance with the provisions of section 17b-10 not later 616
	733	+	than twenty days after the date of implementation. 617
	734	+	(c) No facility subject to the requirements of this section shall accept 618
	735	+	payment in excess of the rate set by the commissioner pursuant to 619
	736	+	subsection (a) of this section for any medical assistance patient from this 620
	737	+	or any other state. No facility shall accept payment in excess of the 621
	738	+	reasonable and necessary costs of other allowable services as specified 622
	739	+	by the commissioner pursuant to the regulations adopted under 623
	740	+	subsection (b) of this section for any public assistance patient from this 624 Governor's Bill No. 6446
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758	743
759		-	~~than for the fiscal year ending June 30,~~ ~~2004, due to interim rate status 627~~
760		-	~~or agreement with the department shall be issued such lower rate 628~~
761		-	~~effective July 1~~, ~~2004. Effective January 1, 2005, each facility shall receive 629~~
762		-	a ~~rate that is one per cent greater than the rate~~ in ~~effect December 31, 630~~
763		-	~~2004. Effective upon receipt~~ of ~~all~~ the ~~necessary federal approvals to 631~~
764		-	~~secure federal financial participation matching funds associated with 632~~
765		-	~~the rate increase provided~~ in ~~this subdivision,~~ ~~but in no event earlier 633~~
766		-	~~than July 1,~~ ~~2005, and provided~~ the ~~user fee imposed under~~ section ~~17b-634~~
767		-	~~320 is required to be collected,~~ for ~~the fiscal year ending June 30,~~ ~~2006, 635~~
768		-	the ~~department~~ shall ~~compute~~ the ~~rate for each facility based upon its 636~~
769		-	~~2003 cost report filing or a subsequent cost year filing~~ for ~~facilities 637~~
770		-	~~having an interim rate for the period ending June 30, 2005~~, as provided ~~638~~
771		-	~~under section 17-311-55~~ of the ~~regulations of Connecticut state agencies. 639~~
772		-	~~For each facility not having an interim~~ rate ~~for the period ending June 640~~
773		-	~~30, 2005,~~ ~~the rate for the period ending June 30, 2006, shall be determined 641~~
774		-	~~beginning with~~ the ~~higher~~ of ~~the computed rate based upon its 2003 cost 642~~
775		-	~~report filing or the rate in effect for the period ending June 30,~~ ~~2005. Such 643~~
776		-	~~rate shall then be increased by eleven dollars and eighty cents per day 644~~
777		-	~~except that~~ in ~~no event shall~~ the ~~rate for the period ending June 30, 2006, 645~~
778		-	~~be thirty-two~~ ~~dollars more than the rate in effect for the period ending 646~~
779		-	~~June 30,~~ ~~2005, and~~ for ~~any facility with a rate below one hundred ninety-647~~
780		-	~~five dollars per day for~~ the ~~period ending June 30,~~ ~~2005, such rate for the 648~~
781		-	~~period ending June 30~~, ~~2006~~, ~~shall not be greater than two hundred 649~~
782		-	~~seventeen dollars and forty-three~~ ~~cents per day and for~~ any facility ~~with 650~~
783		-	~~a rate equal to or greater than one hundred ninety-five~~ ~~dollars per day 651~~
784		-	~~for~~ the ~~period ending June 30, 2005, such rate for~~ the ~~period ending June 652~~
785		-	~~30, 2006,~~ ~~shall not exceed the rate~~ in ~~effect for the period ending June 30, 653~~
786		-	~~2005, increased by eleven and one-half~~ per cent~~. For each facility with 654~~
787		-	~~an interim rate for the period ending June 30,~~ ~~2005, the interim 655~~
788		-	~~replacement rate for the period ending June 30, 2006, shall not exceed 656~~
789		-	~~the rate in effect~~ for the ~~period~~ ending June 30, ~~2005~~, ~~increased by eleven 657~~
790		-	~~dollars and eighty cents per day plus the per day cost of the user fee 658~~
791		-	~~payments made pursuant to section 17b-320~~ ~~divided by annual resident 659~~
792		-	~~service days~~, ~~except~~ for ~~any facility with an interim rate below one 660~~
793		-	~~hundred ninety-five~~ ~~dollars per day~~ for the ~~period ending June 30, 2005, 661 Substitute~~ Bill No. 6446
	744	+	LCO No. 3112 20 of 51
	745	+
	746	+	or any other state. Notwithstanding the provisions of this subsection, 625
	747	+	the commissioner may authorize a facility to accept payment in excess 626
	748	+	of the rate paid for a medical assistance patient in this state for a patient 627
	749	+	who receives medical assistance from another state. 628
	750	+	(d) In any instance where the Commissioner of Social Services finds 629
	751	+	that a facility subject to the requirements of this section is accepting 630
	752	+	payment for a medical assistance beneficiary in violation of subsection 631
	753	+	(c) of this section, the commissioner shall proceed to recover through the 632
	754	+	rate set for the facility any sum in excess of the stipulated per diem and 633
	755	+	other allowable costs, as provided for in regulations adopted pursuant 634
	756	+	to subsections (a) and (b) of this section. The commissioner shall make 635
	757	+	the recovery prospectively at the time of the next annual rate 636
	758	+	redetermination. 637
	759	+	(e) Except as provided in this subsection, the provisions of 638
	760	+	subsections (c) and (d) of this section shall not apply to any facility 639
	761	+	subject to the requirements of this section, which on October 1, 1981, (1) 640
	762	+	was accepting payments from the commissioner in accordance with the 641
	763	+	provisions of subsection (a) of this section, (2) was accepting medical 642
	764	+	assistance payments from another state for at least twenty per cent of its 643
	765	+	patients, and (3) had not notified the commissioner of any intent to 644
	766	+	terminate its provider agreement, in accordance with section 17b-271, 645
	767	+	provided no patient residing in any such facility on May 22, 1984, shall 646
	768	+	be removed from such facility for purposes of meeting the requirements 647
	769	+	of this subsection. If the commissioner finds that the number of beds 648
	770	+	available to medical assistance patients from this state in any such 649
	771	+	facility is less than fifteen per cent the provisions of subsections (c) and 650
	772	+	(d) of this section shall apply to that number of beds which is less than 651
	773	+	said percentage. 652
	774	+	(f) For the fiscal years ending on or before June 30, 2021, rates for 653
	775	+	nursing home facilities shall be set in accordance with this subsection. 654
	776	+	On and after July 1, 2021, such rates shall be set in accordance with 655
	777	+	section 17b-340d, as amended by this act. For the fiscal year ending June 656
	778	+	30, 1992, the rates paid by or for persons aided or cared for by the state 657 Governor's Bill No. 6446
794	779
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799	781
800		-	the interim replacement rate for the period ending June 30, 2006, shall 662
801		-	not be greater than two hundred seventeen dollars and forty-three cents 663
802		-	per day and for any facility with an interim rate equal to or greater than 664
803		-	one hundred ninety-five dollars per day for the period ending June 30, 665
804		-	2005, the interim replacement rate for the period ending June 30, 2006, 666
805		-	shall not exceed the rate in effect for the period ending June 30, 2005, 667
806		-	increased by eleven and one-half per cent. Such July 1, 2005, rate 668
807		-	adjustments shall remain in effect unless (i) the federal financial 669
808		-	participation matching funds associated with the rate increase are no 670
809		-	longer available; or (ii) the user fee created pursuant to section 17b-320 671
810		-	is not in effect. For the fiscal year ending June 30, 2007, each facility shall 672
811		-	receive a rate that is three per cent greater than the rate in effect for the 673
812		-	period ending June 30, 2006, except any facility that would have been 674
813		-	issued a lower rate effective July 1, 2006, than for the rate period ending 675
814		-	June 30, 2006, due to interim rate status or agreement with the 676
815		-	department, shall be issued such lower rate effective July 1, 2006. For the 677
816		-	fiscal year ending June 30, 2008, each facility shall receive a rate that is 678
817		-	two and nine-tenths per cent greater than the rate in effect for the period 679
818		-	ending June 30, 2007, except any facility that would have been issued a 680
819		-	lower rate effective July 1, 2007, than for the rate period ending June 30, 681
820		-	2007, due to interim rate status or agreement with the department, shall 682
821		-	be issued such lower rate effective July 1, 2007. For the fiscal year ending 683
822		-	June 30, 2009, rates in effect for the period ending June 30, 2008, shall 684
823		-	remain in effect until June 30, 2009, except any facility that would have 685
824		-	been issued a lower rate for the fiscal year ending June 30, 2009, due to 686
825		-	interim rate status or agreement with the department shall be issued 687
826		-	such lower rate. For the fiscal years ending June 30, 2010, and June 30, 688
827		-	2011, rates in effect for the period ending June 30, 2009, shall remain in 689
828		-	effect until June 30, 2011, except any facility that would have been issued 690
829		-	a lower rate for the fiscal year ending June 30, 2010, or the fiscal year 691
830		-	ending June 30, 2011, due to interim rate status or agreement with the 692
831		-	department, shall be issued such lower rate. For the fiscal years ending 693
832		-	June 30, 2012, and June 30, 2013, rates in effect for the period ending June 694
833		-	30, 2011, shall remain in effect until June 30, 2013, except any facility that 695
834		-	would have been issued a lower rate for the fiscal year ending June 30, 696 Substitute Bill No. 6446
	782	+	LCO No. 3112 21 of 51
	783	+
	784	+	or any town in this state to facilities for room, board and services 658
	785	+	specified in licensing regulations issued by the licensing agency, except 659
	786	+	intermediate care facilities for individuals with intellectual disabilities 660
	787	+	and residential care homes, shall be based on the cost year ending 661
	788	+	September 30, 1989. For the fiscal years ending June 30, 1993, and June 662
	789	+	30, 1994, such rates shall be based on the cost year ending September 30, 663
	790	+	1990. Such rates shall be determined by the Commissioner of Social 664
	791	+	Services in accordance with this section and the regulations of 665
	792	+	Connecticut state agencies promulgated by the commissioner and in 666
	793	+	effect on April 1, 1991, except that: 667
	794	+	(1) Allowable costs shall be divided into the following five cost 668
	795	+	components: (A) Direct costs, which shall include salaries for nursing 669
	796	+	personnel, related fringe benefits and nursing pool costs; (B) indirect 670
	797	+	costs, which shall include professional fees, dietary expenses, 671
	798	+	housekeeping expenses, laundry expenses, supplies related to patient 672
	799	+	care, salaries for indirect care personnel and related fringe benefits; (C) 673
	800	+	fair rent, which shall be defined in accordance with subsection (f) of 674
	801	+	section 17-311-52 of the regulations of Connecticut state agencies; (D) 675
	802	+	capital-related costs, which shall include property taxes, insurance 676
	803	+	expenses, equipment leases and equipment depreciation; and (E) 677
	804	+	administrative and general costs, which shall include (i) maintenance 678
	805	+	and operation of plant expenses, (ii) salaries for administrative and 679
	806	+	maintenance personnel, and (iii) related fringe benefits. The 680
	807	+	commissioner may provide a rate adjustment for nonemergency 681
	808	+	transportation services required by nursing facility residents. Such 682
	809	+	adjustment shall be a fixed amount determined annually by the 683
	810	+	commissioner based upon a review of costs and other associated 684
	811	+	information. Allowable costs shall not include costs for ancillary 685
	812	+	services payable under Part B of the Medicare program. 686
	813	+	(2) Two geographic peer groupings of facilities shall be established 687
	814	+	for each level of care, as defined by the Department of Social Services 688
	815	+	for the determination of rates, for the purpose of determining allowable 689
	816	+	direct costs. One peer grouping shall be comprised of those facilities 690
	817	+	located in Fairfield County. The other peer grouping shall be comprised 691 Governor's Bill No. 6446
835	818
836	819
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839		-	22 of 44
840	820
841		-	2012, or the fiscal year ending June 30, 2013, due to interim rate status 697
842		-	or agreement with the department, shall be issued such lower rate. For 698
843		-	the fiscal year ending June 30, 2014, the department shall determine 699
844		-	facility rates based upon 2011 cost report filings subject to the provisions 700
845		-	of this section and applicable regulations except: (I) A ninety per cent 701
846		-	minimum occupancy standard shall be applied; (II) no facility shall 702
847		-	receive a rate that is higher than the rate in effect on June 30, 2013; and 703
848		-	(III) no facility shall receive a rate that is more than four per cent lower 704
849		-	than the rate in effect on June 30, 2013, except that any facility that would 705
850		-	have been issued a lower rate effective July 1, 2013, than for the rate 706
851		-	period ending June 30, 2013, due to interim rate status or agreement 707
852		-	with the department, shall be issued such lower rate effective July 1, 708
853		-	2013. For the fiscal year ending June 30, 2015, rates in effect for the 709
854		-	period ending June 30, 2014, shall remain in effect until June 30, 2015, 710
855		-	except any facility that would have been issued a lower rate effective 711
856		-	July 1, 2014, than for the rate period ending June 30, 2014, due to interim 712
857		-	rate status or agreement with the department, shall be issued such lower 713
858		-	rate effective July 1, 2014. For the fiscal years ending June 30, 2016, and 714
859		-	June 30, 2017, rates shall not exceed those in effect for the period ending 715
860		-	June 30, 2015, except the rate paid to a facility may be higher than the 716
861		-	rate paid to the facility for the period ending June 30, 2015, if the 717
862		-	commissioner provides, within available appropriations, pro rata fair 718
863		-	rent increases, which may, at the discretion of the commissioner, include 719
864		-	increases for facilities which have undergone a material change in 720
865		-	circumstances related to fair rent additions or moveable equipment 721
866		-	placed in service in cost report years ending September 30, 2014, and 722
867		-	September 30, 2015, and not otherwise included in rates issued. For the 723
868		-	fiscal years ending June 30, 2016, and June 30, 2017, and each succeeding 724
869		-	fiscal year, any facility that would have been issued a lower rate, due to 725
870		-	interim rate status or agreement with the department, shall be issued 726
871		-	such lower rate. For the fiscal year ending June 30, 2018, facilities that 727
872		-	received a rate decrease due to the expiration of a 2015 fair rent asset 728
873		-	shall receive a rate increase of an equivalent amount effective July 1, 729
874		-	2017. For the fiscal year ending June 30, 2018, the department shall 730
875		-	determine facility rates based upon 2016 cost report filings subject to the 731 Substitute Bill No. 6446
	821	+	LCO No. 3112 22 of 51
	822	+
	823	+	of facilities located in all other counties. 692
	824	+	(3) For the fiscal year ending June 30, 1992, per diem maximum 693
	825	+	allowable costs for each cost component shall be as follows: For direct 694
	826	+	costs, the maximum shall be equal to one hundred forty per cent of the 695
	827	+	median allowable cost of that peer grouping; for indirect costs, the 696
	828	+	maximum shall be equal to one hundred thirty per cent of the state-wide 697
	829	+	median allowable cost; for fair rent, the amount shall be calculated 698
	830	+	utilizing the amount approved by the Office of Health Care Access 699
	831	+	pursuant to section 19a-638; for capital-related costs, there shall be no 700
	832	+	maximum; and for administrative and general costs, the maximum shall 701
	833	+	be equal to one hundred twenty-five per cent of the state-wide median 702
	834	+	allowable cost. For the fiscal year ending June 30, 1993, per diem 703
	835	+	maximum allowable costs for each cost component shall be as follows: 704
	836	+	For direct costs, the maximum shall be equal to one hundred forty per 705
	837	+	cent of the median allowable cost of that peer grouping; for indirect 706
	838	+	costs, the maximum shall be equal to one hundred twenty-five per cent 707
	839	+	of the state-wide median allowable cost; for fair rent, the amount shall 708
	840	+	be calculated utilizing the amount approved by the Office of Health 709
	841	+	Care Access pursuant to section 19a-638; for capital-related costs, there 710
	842	+	shall be no maximum; and for administrative and general costs the 711
	843	+	maximum shall be equal to one hundred fifteen per cent of the state-712
	844	+	wide median allowable cost. For the fiscal year ending June 30, 1994, per 713
	845	+	diem maximum allowable costs for each cost component shall be as 714
	846	+	follows: For direct costs, the maximum shall be equal to one hundred 715
	847	+	thirty-five per cent of the median allowable cost of that peer grouping; 716
	848	+	for indirect costs, the maximum shall be equal to one hundred twenty 717
	849	+	per cent of the state-wide median allowable cost; for fair rent, the 718
	850	+	amount shall be calculated utilizing the amount approved by the Office 719
	851	+	of Health Care Access pursuant to section 19a-638; for capital-related 720
	852	+	costs, there shall be no maximum; and for administrative and general 721
	853	+	costs the maximum shall be equal to one hundred ten per cent of the 722
	854	+	state-wide median allowable cost. For the fiscal year ending June 30, 723
	855	+	1995, per diem maximum allowable costs for each cost component shall 724
	856	+	be as follows: For direct costs, the maximum shall be equal to one 725 Governor's Bill No. 6446
876	857
877	858
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881	859
882		-	provisions of this section and applicable regulations, provided no 732
883		-	facility shall receive a rate that is higher than the rate in effect on 733
884		-	December 31, 2016, and no facility shall receive a rate that is more than 734
885		-	two per cent lower than the rate in effect on December 31, 2016. For the 735
886		-	fiscal year ending June 30, 2019, no facility shall receive a rate that is 736
887		-	higher than the rate in effect on June 30, 2018, except the rate paid to a 737
888		-	facility may be higher than the rate paid to the facility for the period 738
889		-	ending June 30, 2018, if the commissioner provides, within available 739
890		-	appropriations, pro rata fair rent increases, which may, at the discretion 740
891		-	of the commissioner, include increases for facilities which have 741
892		-	undergone a material change in circumstances related to fair rent 742
893		-	additions or moveable equipment placed in service in the cost report 743
894		-	year ending September 30, 2017, and not otherwise included in rates 744
895		-	issued. For the fiscal year ending June 30, 2020, the department shall 745
896		-	determine facility rates based upon 2018 cost report filings subject to the 746
897		-	provisions of this section, adjusted to reflect any rate increases provided 747
898		-	after the cost report year ending September 30, 2018, and applicable 748
899		-	regulations, provided no facility shall receive a rate that is higher than 749
900		-	the rate in effect on June 30, 2019, except the rate paid to a facility may 750
901		-	be higher than the rate paid to the facility for the fiscal year ending June 751
902		-	30, 2019, if the commissioner provides, within available appropriations, 752
903		-	pro rata fair rent increases, which may, at the discretion of the 753
904		-	commissioner, include increases for facilities which have undergone a 754
905		-	material change in circumstances related to fair rent additions in the cost 755
906		-	report year ending September 30, 2018, and are not otherwise included 756
907		-	in rates issued. For the fiscal year ending June 30, 2020, no facility shall 757
908		-	receive a rate that is more than two per cent lower than the rate in effect 758
909		-	on June 30, 2019, unless the facility has an occupancy level of less than 759
910		-	seventy per cent, as reported in the 2018 cost report, or an overall rating 760
911		-	on Medicare's Nursing Home Compare of one star for the three most 761
912		-	recent reporting periods as of July 1, 2019, unless the facility is under an 762
913		-	interim rate due to new ownership. For the fiscal year ending June 30, 763
914		-	2021, no facility shall receive a rate that is higher than the rate in effect 764
915		-	on June 30, 2020, except the rate paid to a facility may be higher than the 765
916		-	rate paid to the facility for the fiscal year ending June 30, 2020, if the 766 Substitute Bill No. 6446
	860	+	LCO No. 3112 23 of 51
	861	+
	862	+	hundred thirty-five per cent of the median allowable cost of that peer 726
	863	+	grouping; for indirect costs, the maximum shall be equal to one hundred 727
	864	+	twenty per cent of the state-wide median allowable cost; for fair rent, 728
	865	+	the amount shall be calculated utilizing the amount approved by the 729
	866	+	Office of Health Care Access pursuant to section 19a-638; for capital-730
	867	+	related costs, there shall be no maximum; and for administrative and 731
	868	+	general costs the maximum shall be equal to one hundred five per cent 732
	869	+	of the state-wide median allowable cost. For the fiscal year ending June 733
	870	+	30, 1996, and any succeeding fiscal year, except for the fiscal years 734
	871	+	ending June 30, 2000, and June 30, 2001, for facilities with an interim rate 735
	872	+	in one or both periods, per diem maximum allowable costs for each cost 736
	873	+	component shall be as follows: For direct costs, the maximum shall be 737
	874	+	equal to one hundred thirty-five per cent of the median allowable cost 738
	875	+	of that peer grouping; for indirect costs, the maximum shall be equal to 739
	876	+	one hundred fifteen per cent of the state-wide median allowable cost; 740
	877	+	for fair rent, the amount shall be calculated utilizing the amount 741
	878	+	approved pursuant to section 19a-638; for capital-related costs, there 742
	879	+	shall be no maximum; and for administrative and general costs the 743
	880	+	maximum shall be equal to the state-wide median allowable cost. For 744
	881	+	the fiscal years ending June 30, 2000, and June 30, 2001, for facilities with 745
	882	+	an interim rate in one or both periods, per diem maximum allowable 746
	883	+	costs for each cost component shall be as follows: For direct costs, the 747
	884	+	maximum shall be equal to one hundred forty-five per cent of the 748
	885	+	median allowable cost of that peer grouping; for indirect costs, the 749
	886	+	maximum shall be equal to one hundred twenty-five per cent of the 750
	887	+	state-wide median allowable cost; for fair rent, the amount shall be 751
	888	+	calculated utilizing the amount approved pursuant to section 19a-638; 752
	889	+	for capital-related costs, there shall be no maximum; and for 753
	890	+	administrative and general costs, the maximum shall be equal to the 754
	891	+	state-wide median allowable cost and such medians shall be based upon 755
	892	+	the same cost year used to set rates for facilities with prospective rates. 756
	893	+	Costs in excess of the maximum amounts established under this 757
	894	+	subsection shall not be recognized as allowable costs, except that the 758
	895	+	Commissioner of Social Services (A) may allow costs in excess of 759
	896	+	maximum amounts for any facility with patient days covered by 760 Governor's Bill No. 6446
917	897
918	898
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922	899
923		-	commissioner provides, within available appropriations, pro rata fair 767
924		-	rent increases, which may, at the discretion of the commissioner, include 768
925		-	increases for facilities which have undergone a material change in 769
926		-	circumstances related to fair rent additions in the cost report year 770
927		-	ending September 30, 2019, and are not otherwise included in rates 771
928		-	issued. The Commissioner of Social Services shall add fair rent increases 772
929		-	to any other rate increases established pursuant to this subdivision for a 773
930		-	facility which has undergone a material change in circumstances related 774
931		-	to fair rent, except for the fiscal years ending June 30, 2010, June 30, 2011, 775
932		-	and June 30, 2012, such fair rent increases shall only be provided to 776
933		-	facilities with an approved certificate of need pursuant to section 17b-777
934		-	352, 17b-353, 17b-354 or 17b-355. For the fiscal year ending June 30, 2013, 778
935		-	the commissioner may, within available appropriations, provide pro 779
936		-	rata fair rent increases for facilities which have undergone a material 780
937		-	change in circumstances related to fair rent additions placed in service 781
938		-	in cost report years ending September 30, 2008, to September 30, 2011, 782
939		-	inclusive, and not otherwise included in rates issued. For the fiscal years 783
940		-	ending June 30, 2014, and June 30, 2015, the commissioner may, within 784
941		-	available appropriations, provide pro rata fair rent increases, which may 785
942		-	include moveable equipment at the discretion of the commissioner, for 786
943		-	facilities which have undergone a material change in circumstances 787
944		-	related to fair rent additions or moveable equipment placed in service 788
945		-	in cost report years ending September 30, 2012, and September 30, 2013, 789
946		-	and not otherwise included in rates issued. The commissioner shall add 790
947		-	fair rent increases associated with an approved certificate of need 791
948		-	pursuant to section 17b-352, 17b-353, 17b-354 or 17b-355. Interim rates 792
949		-	may take into account reasonable costs incurred by a facility, including 793
950		-	wages and benefits. Notwithstanding the provisions of this section, the 794
951		-	Commissioner of Social Services may, subject to available 795
952		-	appropriations, increase or decrease rates issued to licensed chronic and 796
953		-	convalescent nursing homes and licensed rest homes with nursing 797
954		-	supervision. Notwithstanding any provision of this section, the 798
955		-	Commissioner of Social Services shall, effective July 1, 2015, within 799
956		-	available appropriations, adjust facility rates in accordance with the 800
957		-	application of standard accounting principles as prescribed by the 801 Substitute Bill No. 6446
	900	+	LCO No. 3112 24 of 51
	901	+
	902	+	Medicare, including days requiring coinsurance, in excess of twelve per 761
	903	+	cent of annual patient days which also has patient days covered by 762
	904	+	Medicaid in excess of fifty per cent of annual patient days; (B) may 763
	905	+	establish a pilot program whereby costs in excess of maximum amounts 764
	906	+	shall be allowed for beds in a nursing home which has a managed care 765
	907	+	program and is affiliated with a hospital licensed under chapter 368v; 766
	908	+	and (C) may establish rates whereby allowable costs may exceed such 767
	909	+	maximum amounts for beds approved on or after July 1, 1991, which are 768
	910	+	restricted to use by patients with acquired immune deficiency syndrome 769
	911	+	or traumatic brain injury. 770
	912	+	(4) For the fiscal year ending June 30, 1992, (A) no facility shall receive 771
	913	+	a rate that is less than the rate it received for the rate year ending June 772
	914	+	30, 1991; (B) no facility whose rate, if determined pursuant to this 773
	915	+	subsection, would exceed one hundred twenty per cent of the state-wide 774
	916	+	median rate, as determined pursuant to this subsection, shall receive a 775
	917	+	rate which is five and one-half per cent more than the rate it received for 776
	918	+	the rate year ending June 30, 1991; and (C) no facility whose rate, if 777
	919	+	determined pursuant to this subsection, would be less than one hundred 778
	920	+	twenty per cent of the state-wide median rate, as determined pursuant 779
	921	+	to this subsection, shall receive a rate which is six and one-half per cent 780
	922	+	more than the rate it received for the rate year ending June 30, 1991. For 781
	923	+	the fiscal year ending June 30, 1993, no facility shall receive a rate that is 782
	924	+	less than the rate it received for the rate year ending June 30, 1992, or six 783
	925	+	per cent more than the rate it received for the rate year ending June 30, 784
	926	+	1992. For the fiscal year ending June 30, 1994, no facility shall receive a 785
	927	+	rate that is less than the rate it received for the rate year ending June 30, 786
	928	+	1993, or six per cent more than the rate it received for the rate year 787
	929	+	ending June 30, 1993. For the fiscal year ending June 30, 1995, no facility 788
	930	+	shall receive a rate that is more than five per cent less than the rate it 789
	931	+	received for the rate year ending June 30, 1994, or six per cent more than 790
	932	+	the rate it received for the rate year ending June 30, 1994. For the fiscal 791
	933	+	years ending June 30, 1996, and June 30, 1997, no facility shall receive a 792
	934	+	rate that is more than three per cent more than the rate it received for 793
	935	+	the prior rate year. For the fiscal year ending June 30, 1998, a facility shall 794 Governor's Bill No. 6446
958	936
959	937
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963	938
964		-	commissioner, for each facility subject to subsection (a) of this section. 802
965		-	Such adjustment shall provide a pro-rata increase based on direct and 803
966		-	indirect care employee salaries reported in the 2014 annual cost report, 804
967		-	and adjusted to reflect subsequent salary increases, to reflect reasonable 805
968		-	costs mandated by collective bargaining agreements with certified 806
969		-	collective bargaining agents, or otherwise provided by a facility to its 807
970		-	employees. For purposes of this subsection, "employee" shall not 808
971		-	include a person employed as a facility's manager, chief administrator, 809
972		-	a person required to be licensed as a nursing home administrator or any 810
973		-	individual who receives compensation for services pursuant to a 811
974		-	contractual arrangement and who is not directly employed by the 812
975		-	facility. The commissioner may establish an upper limit for reasonable 813
976		-	costs associated with salary adjustments beyond which the adjustment 814
977		-	shall not apply. Nothing in this section shall require the commissioner 815
978		-	to distribute such adjustments in a way that jeopardizes anticipated 816
979		-	federal reimbursement. Facilities that receive such adjustment but do 817
980		-	not provide increases in employee salaries as described in this 818
981		-	subsection on or before July 31, 2015, may be subject to a rate decrease 819
982		-	in the same amount as the adjustment by the commissioner. Of the 820
983		-	amount appropriated for this purpose, no more than nine million 821
984		-	dollars shall go to increases based on reasonable costs mandated by 822
985		-	collective bargaining agreements. Notwithstanding the provisions of 823
986		-	this subsection, effective July 1, 2019, October 1, 2020, and January 1, 824
987		-	2021, the commissioner shall, within available appropriations, increase 825
988		-	rates for the purpose of wage and benefit enhancements for facility 826
989		-	employees. The commissioner shall adjust the rate paid to the facility in 827
990		-	the form of a rate adjustment to reflect any rate increases paid after the 828
991		-	cost report year ending September 30, 2018. Facilities that receive a rate 829
992		-	adjustment for the purpose of wage and benefit enhancements but do 830
993		-	not provide increases in employee salaries as described in this 831
994		-	subsection on or before September 30, 2019, October 31, 2020, and 832
995		-	January 31, 2021, respectively, may be subject to a rate decrease in the 833
996		-	same amount as the adjustment by the commissioner. 834
997		-	(5) For the purpose of determining allowable fair rent, a facility with 835 Substitute Bill No. 6446
	939	+	LCO No. 3112 25 of 51
	940	+
	941	+	receive a rate increase that is not more than two per cent more than the 795
	942	+	rate that the facility received in the prior year. For the fiscal year ending 796
	943	+	June 30, 1999, a facility shall receive a rate increase that is not more than 797
	944	+	three per cent more than the rate that the facility received in the prior 798
	945	+	year and that is not less than one per cent more than the rate that the 799
	946	+	facility received in the prior year, exclusive of rate increases associated 800
	947	+	with a wage, benefit and staffing enhancement rate adjustment added 801
	948	+	for the period from April 1, 1999, to June 30, 1999, inclusive. For the fiscal 802
	949	+	year ending June 30, 2000, each facility, except a facility with an interim 803
	950	+	rate or replaced interim rate for the fiscal year ending June 30, 1999, and 804
	951	+	a facility having a certificate of need or other agreement specifying rate 805
	952	+	adjustments for the fiscal year ending June 30, 2000, shall receive a rate 806
	953	+	increase equal to one per cent applied to the rate the facility received for 807
	954	+	the fiscal year ending June 30, 1999, exclusive of the facility's wage, 808
	955	+	benefit and staffing enhancement rate adjustment. For the fiscal year 809
	956	+	ending June 30, 2000, no facility with an interim rate, replaced interim 810
	957	+	rate or scheduled rate adjustment specified in a certificate of need or 811
	958	+	other agreement for the fiscal year ending June 30, 2000, shall receive a 812
	959	+	rate increase that is more than one per cent more than the rate the facility 813
	960	+	received in the fiscal year ending June 30, 1999. For the fiscal year ending 814
	961	+	June 30, 2001, each facility, except a facility with an interim rate or 815
	962	+	replaced interim rate for the fiscal year ending June 30, 2000, and a 816
	963	+	facility having a certificate of need or other agreement specifying rate 817
	964	+	adjustments for the fiscal year ending June 30, 2001, shall receive a rate 818
	965	+	increase equal to two per cent applied to the rate the facility received for 819
	966	+	the fiscal year ending June 30, 2000, subject to verification of wage 820
	967	+	enhancement adjustments pursuant to subdivision (14) of this 821
	968	+	subsection. For the fiscal year ending June 30, 2001, no facility with an 822
	969	+	interim rate, replaced interim rate or scheduled rate adjustment 823
	970	+	specified in a certificate of need or other agreement for the fiscal year 824
	971	+	ending June 30, 2001, shall receive a rate increase that is more than two 825
	972	+	per cent more than the rate the facility received for the fiscal year ending 826
	973	+	June 30, 2000. For the fiscal year ending June 30, 2002, each facility shall 827
	974	+	receive a rate that is two and one-half per cent more than the rate the 828
	975	+	facility received in the prior fiscal year. For the fiscal year ending June 829 Governor's Bill No. 6446
998	976
999	977
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1003	978
1004		-	allowable fair rent less than the twenty-fifth percentile of the state-wide 836
1005		-	allowable fair rent shall be reimbursed as having allowable fair rent 837
1006		-	equal to the twenty-fifth percentile of the state-wide allowable fair rent, 838
1007		-	provided for the fiscal years ending June 30, 1996, and June 30, 1997, the 839
1008		-	reimbursement may not exceed the twenty-fifth percentile of the state-840
1009		-	wide allowable fair rent for the fiscal year ending June 30, 1995. On and 841
1010		-	after July 1, 1998, the Commissioner of Social Services may allow 842
1011		-	minimum fair rent as the basis upon which reimbursement associated 843
1012		-	with improvements to real property is added. Beginning with the fiscal 844
1013		-	year ending June 30, 1996, any facility with a rate of return on real 845
1014		-	property other than land in excess of eleven per cent shall have such 846
1015		-	allowance revised to eleven per cent. Any facility or its related realty 847
1016		-	affiliate which finances or refinances debt through bonds issued by the 848
1017		-	State of Connecticut Health and Education Facilities Authority shall 849
1018		-	report the terms and conditions of such financing or refinancing to the 850
1019		-	Commissioner of Social Services within thirty days of completing such 851
1020		-	financing or refinancing. The Commissioner of Social Services may 852
1021		-	revise the facility's fair rent component of its rate to reflect any financial 853
1022		-	benefit the facility or its related realty affiliate received as a result of such 854
1023		-	financing or refinancing, including but not limited to, reductions in the 855
1024		-	amount of debt service payments or period of debt repayment. The 856
1025		-	commissioner shall allow actual debt service costs for bonds issued by 857
1026		-	the State of Connecticut Health and Educational Facilities Authority if 858
1027		-	such costs do not exceed property costs allowed pursuant to subsection 859
1028		-	(f) of section 17-311-52 of the regulations of Connecticut state agencies, 860
1029		-	provided the commissioner may allow higher debt service costs for such 861
1030		-	bonds for good cause. For facilities which first open on or after October 862
1031		-	1, 1992, the commissioner shall determine allowable fair rent for real 863
1032		-	property other than land based on the rate of return for the cost year in 864
1033		-	which such bonds were issued. The financial benefit resulting from a 865
1034		-	facility financing or refinancing debt through such bonds shall be shared 866
1035		-	between the state and the facility to an extent determined by the 867
1036		-	commissioner on a case-by-case basis and shall be reflected in an 868
1037		-	adjustment to the facility's allowable fair rent. 869 Substitute Bill No. 6446
	979	+	LCO No. 3112 26 of 51
	980	+
	981	+	30, 2003, each facility shall receive a rate that is two per cent more than 830
	982	+	the rate the facility received in the prior fiscal year, except that such 831
	983	+	increase shall be effective January 1, 2003, and such facility rate in effect 832
	984	+	for the fiscal year ending June 30, 2002, shall be paid for services 833
	985	+	provided until December 31, 2002, except any facility that would have 834
	986	+	been issued a lower rate effective July 1, 2002, than for the fiscal year 835
	987	+	ending June 30, 2002, due to interim rate status or agreement with the 836
	988	+	department shall be issued such lower rate effective July 1, 2002, and 837
	989	+	have such rate increased two per cent effective June 1, 2003. For the fiscal 838
	990	+	year ending June 30, 2004, rates in effect for the period ending June 30, 839
	991	+	2003, shall remain in effect, except any facility that would have been 840
	992	+	issued a lower rate effective July 1, 2003, than for the fiscal year ending 841
	993	+	June 30, 2003, due to interim rate status or agreement with the 842
	994	+	department shall be issued such lower rate effective July 1, 2003. For the 843
	995	+	fiscal year ending June 30, 2005, rates in effect for the period ending June 844
	996	+	30, 2004, shall remain in effect until December 31, 2004, except any 845
	997	+	facility that would have been issued a lower rate effective July 1, 2004, 846
	998	+	than for the fiscal year ending June 30, 2004, due to interim rate status 847
	999	+	or agreement with the department shall be issued such lower rate 848
	1000	+	effective July 1, 2004. Effective January 1, 2005, each facility shall receive 849
	1001	+	a rate that is one per cent greater than the rate in effect December 31, 850
	1002	+	2004. Effective upon receipt of all the necessary federal approvals to 851
	1003	+	secure federal financial participation matching funds associated with 852
	1004	+	the rate increase provided in this subdivision, but in no event earlier 853
	1005	+	than July 1, 2005, and provided the user fee imposed under section 17b-854
	1006	+	320 is required to be collected, for the fiscal year ending June 30, 2006, 855
	1007	+	the department shall compute the rate for each facility based upon its 856
	1008	+	2003 cost report filing or a subsequent cost year filing for facilities 857
	1009	+	having an interim rate for the period ending June 30, 2005, as provided 858
	1010	+	under section 17-311-55 of the regulations of Connecticut state agencies. 859
	1011	+	For each facility not having an interim rate for the period ending June 860
	1012	+	30, 2005, the rate for the period ending June 30, 2006, shall be determined 861
	1013	+	beginning with the higher of the computed rate based upon its 2003 cost 862
	1014	+	report filing or the rate in effect for the period ending June 30, 2005. Such 863
	1015	+	rate shall then be increased by eleven dollars and eighty cents per day 864 Governor's Bill No. 6446
1038	1016
1039	1017
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1043	1018
1044		-	(6) A facility shall receive cost efficiency adjustments for indirect costs 870
1045		-	and for administrative and general costs if such costs are below the 871
1046		-	state-wide median costs. The cost efficiency adjustments shall equal 872
1047		-	twenty-five per cent of the difference between allowable reported costs 873
1048		-	and the applicable median allowable cost established pursuant to this 874
1049		-	subdivision. 875
1050		-	(7) For the fiscal year ending June 30, 1992, allowable operating costs, 876
1051		-	excluding fair rent, shall be inflated using the Regional Data Resources 877
1052		-	Incorporated McGraw-Hill Health Care Costs: Consumer Price Index 878
1053		-	(all urban)-All Items minus one and one-half per cent. For the fiscal year 879
1054		-	ending June 30, 1993, allowable operating costs, excluding fair rent, shall 880
1055		-	be inflated using the Regional Data Resources Incorporated McGraw-881
1056		-	Hill Health Care Costs: Consumer Price Index (all urban)-All Items 882
1057		-	minus one and three-quarters per cent. For the fiscal years ending June 883
1058		-	30, 1994, and June 30, 1995, allowable operating costs, excluding fair 884
1059		-	rent, shall be inflated using the Regional Data Resources Incorporated 885
1060		-	McGraw-Hill Health Care Costs: Consumer Price Index (all urban)-All 886
1061		-	Items minus two per cent. For the fiscal year ending June 30, 1996, 887
1062		-	allowable operating costs, excluding fair rent, shall be inflated using the 888
1063		-	Regional Data Resources Incorporated McGraw-Hill Health Care Costs: 889
1064		-	Consumer Price Index (all urban)-All Items minus two and one-half per 890
1065		-	cent. For the fiscal year ending June 30, 1997, allowable operating costs, 891
1066		-	excluding fair rent, shall be inflated using the Regional Data Resources 892
1067		-	Incorporated McGraw-Hill Health Care Costs: Consumer Price Index 893
1068		-	(all urban)-All Items minus three and one-half per cent. For the fiscal 894
1069		-	year ending June 30, 1992, and any succeeding fiscal year, allowable fair 895
1070		-	rent shall be those reported in the annual report of long-term care 896
1071		-	facilities for the cost year ending the immediately preceding September 897
1072		-	thirtieth. The inflation index to be used pursuant to this subsection shall 898
1073		-	be computed to reflect inflation between the midpoint of the cost year 899
1074		-	through the midpoint of the rate year. The Department of Social Services 900
1075		-	shall study methods of reimbursement for fair rent and shall report its 901
1076		-	findings and recommendations to the joint standing committee of the 902
1077		-	General Assembly having cognizance of matters relating to human 903 Substitute Bill No. 6446
	1019	+	LCO No. 3112 27 of 51
	1020	+
	1021	+	except that in no event shall the rate for the period ending June 30, 2006, 865
	1022	+	be thirty-two dollars more than the rate in effect for the period ending 866
	1023	+	June 30, 2005, and for any facility with a rate below one hundred ninety-867
	1024	+	five dollars per day for the period ending June 30, 2005, such rate for the 868
	1025	+	period ending June 30, 2006, shall not be greater than two hundred 869
	1026	+	seventeen dollars and forty-three cents per day and for any facility with 870
	1027	+	a rate equal to or greater than one hundred ninety-five dollars per day 871
	1028	+	for the period ending June 30, 2005, such rate for the period ending June 872
	1029	+	30, 2006, shall not exceed the rate in effect for the period ending June 30, 873
	1030	+	2005, increased by eleven and one-half per cent. For each facility with 874
	1031	+	an interim rate for the period ending June 30, 2005, the interim 875
	1032	+	replacement rate for the period ending June 30, 2006, shall not exceed 876
	1033	+	the rate in effect for the period ending June 30, 2005, increased by eleven 877
	1034	+	dollars and eighty cents per day plus the per day cost of the user fee 878
	1035	+	payments made pursuant to section 17b-320 divided by annual resident 879
	1036	+	service days, except for any facility with an interim rate below one 880
	1037	+	hundred ninety-five dollars per day for the period ending June 30, 2005, 881
	1038	+	the interim replacement rate for the period ending June 30, 2006, shall 882
	1039	+	not be greater than two hundred seventeen dollars and forty-three cents 883
	1040	+	per day and for any facility with an interim rate equal to or greater than 884
	1041	+	one hundred ninety-five dollars per day for the period ending June 30, 885
	1042	+	2005, the interim replacement rate for the period ending June 30, 2006, 886
	1043	+	shall not exceed the rate in effect for the period ending June 30, 2005, 887
	1044	+	increased by eleven and one-half per cent. Such July 1, 2005, rate 888
	1045	+	adjustments shall remain in effect unless (i) the federal financial 889
	1046	+	participation matching funds associated with the rate increase are no 890
	1047	+	longer available; or (ii) the user fee created pursuant to section 17b-320 891
	1048	+	is not in effect. For the fiscal year ending June 30, 2007, each facility shall 892
	1049	+	receive a rate that is three per cent greater than the rate in effect for the 893
	1050	+	period ending June 30, 2006, except any facility that would have been 894
	1051	+	issued a lower rate effective July 1, 2006, than for the rate period ending 895
	1052	+	June 30, 2006, due to interim rate status or agreement with the 896
	1053	+	department, shall be issued such lower rate effective July 1, 2006. For the 897
	1054	+	fiscal year ending June 30, 2008, each facility shall receive a rate that is 898
	1055	+	two and nine-tenths per cent greater than the rate in effect for the period 899 Governor's Bill No. 6446
1078	1056
1079	1057
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1083	1058
1084		-	services on or before January 15, 1993. 904
1085		-	(8) On and after July 1, 1994, costs shall be rebased no more frequently 905
1086		-	than every two years and no less frequently than every four years, as 906
1087		-	determined by the commissioner. The commissioner shall determine 907
1088		-	whether and to what extent a change in ownership of a facility shall 908
1089		-	occasion the rebasing of the facility's costs. 909
1090		-	(9) The method of establishing rates for new facilities shall be 910
1091		-	determined by the commissioner in accordance with the provisions of 911
1092		-	this subsection until September 30, 2021. 912
1093		-	(10) Rates determined under this section shall comply with federal 913
1094		-	laws and regulations. 914
1095		-	(11) Notwithstanding the provisions of this subsection, interim rates 915
1096		-	issued for facilities on and after July 1, 1991, shall be subject to applicable 916
1097		-	fiscal year cost component limitations established pursuant to 917
1098		-	subdivision (3) of this subsection. 918
1099		-	(12) A chronic and convalescent nursing home having an ownership 919
1100		-	affiliation with and operated at the same location as a chronic disease 920
1101		-	hospital may request that the commissioner approve an exception to 921
1102		-	applicable rate-setting provisions for chronic and convalescent nursing 922
1103		-	homes and establish a rate for the fiscal years ending June 30, 1992, and 923
1104		-	June 30, 1993, in accordance with regulations in effect June 30, 1991. Any 924
1105		-	such rate shall not exceed one hundred sixty-five per cent of the median 925
1106		-	rate established for chronic and convalescent nursing homes established 926
1107		-	under this section for the applicable fiscal year. 927
1108		-	(13) For the fiscal year ending June 30, 2014, and any succeeding fiscal 928
1109		-	year, for purposes of computing minimum allowable patient days, 929
1110		-	utilization of a facility's certified beds shall be determined at a minimum 930
1111		-	of ninety per cent of capacity, except for new facilities and facilities 931
1112		-	which are certified for additional beds which may be permitted a lower 932
1113		-	occupancy rate for the first three months of operation after the effective 933
1114		-	date of licensure. 934 Substitute Bill No. 6446
	1059	+	LCO No. 3112 28 of 51
	1060	+
	1061	+	ending June 30, 2007, except any facility that would have been issued a 900
	1062	+	lower rate effective July 1, 2007, than for the rate period ending June 30, 901
	1063	+	2007, due to interim rate status or agreement with the department, shall 902
	1064	+	be issued such lower rate effective July 1, 2007. For the fiscal year ending 903
	1065	+	June 30, 2009, rates in effect for the period ending June 30, 2008, shall 904
	1066	+	remain in effect until June 30, 2009, except any facility that would have 905
	1067	+	been issued a lower rate for the fiscal year ending June 30, 2009, due to 906
	1068	+	interim rate status or agreement with the department shall be issued 907
	1069	+	such lower rate. For the fiscal years ending June 30, 2010, and June 30, 908
	1070	+	2011, rates in effect for the period ending June 30, 2009, shall remain in 909
	1071	+	effect until June 30, 2011, except any facility that would have been issued 910
	1072	+	a lower rate for the fiscal year ending June 30, 2010, or the fiscal year 911
	1073	+	ending June 30, 2011, due to interim rate status or agreement with the 912
	1074	+	department, shall be issued such lower rate. For the fiscal years ending 913
	1075	+	June 30, 2012, and June 30, 2013, rates in effect for the period ending June 914
	1076	+	30, 2011, shall remain in effect until June 30, 2013, except any facility that 915
	1077	+	would have been issued a lower rate for the fiscal year ending June 30, 916
	1078	+	2012, or the fiscal year ending June 30, 2013, due to interim rate status 917
	1079	+	or agreement with the department, shall be issued such lower rate. For 918
	1080	+	the fiscal year ending June 30, 2014, the department shall determine 919
	1081	+	facility rates based upon 2011 cost report filings subject to the provisions 920
	1082	+	of this section and applicable regulations except: (I) A ninety per cent 921
	1083	+	minimum occupancy standard shall be applied; (II) no facility shall 922
	1084	+	receive a rate that is higher than the rate in effect on June 30, 2013; and 923
	1085	+	(III) no facility shall receive a rate that is more than four per cent lower 924
	1086	+	than the rate in effect on June 30, 2013, except that any facility that would 925
	1087	+	have been issued a lower rate effective July 1, 2013, than for the rate 926
	1088	+	period ending June 30, 2013, due to interim rate status or agreement 927
	1089	+	with the department, shall be issued such lower rate effective July 1, 928
	1090	+	2013. For the fiscal year ending June 30, 2015, rates in effect for the 929
	1091	+	period ending June 30, 2014, shall remain in effect until June 30, 2015, 930
	1092	+	except any facility that would have been issued a lower rate effective 931
	1093	+	July 1, 2014, than for the rate period ending June 30, 2014, due to interim 932
	1094	+	rate status or agreement with the department, shall be issued such lower 933
	1095	+	rate effective July 1, 2014. For the fiscal years ending June 30, 2016, and 934 Governor's Bill No. 6446
1115	1096
1116	1097
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1119		-	29 of 44
1120	1098
1121		-	(14) The Commissioner of Social Services shall adjust facility rates 935
1122		-	from April 1, 1999, to June 30, 1999, inclusive, by a per diem amount 936
1123		-	representing each facility's allocation of funds appropriated for the 937
1124		-	purpose of wage, benefit and staffing enhancement. A facility's per diem 938
1125		-	allocation of such funding shall be computed as follows: (A) The 939
1126		-	facility's direct and indirect component salary, wage, nursing pool and 940
1127		-	allocated fringe benefit costs as filed for the 1998 cost report period 941
1128		-	deemed allowable in accordance with this section and applicable 942
1129		-	regulations without application of cost component maximums specified 943
1130		-	in subdivision (3) of this subsection shall be totalled; (B) such total shall 944
1131		-	be multiplied by the facility's Medicaid utilization based on the 1998 cost 945
1132		-	report; (C) the resulting amount for the facility shall be divided by the 946
1133		-	sum of the calculations specified in subparagraphs (A) and (B) of this 947
1134		-	subdivision for all facilities to determine the facility's percentage share 948
1135		-	of appropriated wage, benefit and staffing enhancement funding; (D) 949
1136		-	the facility's percentage share shall be multiplied by the amount of 950
1137		-	appropriated wage, benefit and staffing enhancement funding to 951
1138		-	determine the facility's allocated amount; and (E) such allocated amount 952
1139		-	shall be divided by the number of days of care paid for by Medicaid on 953
1140		-	an annual basis including days for reserved beds specified in the 1998 954
1141		-	cost report to determine the per diem wage and benefit rate adjustment 955
1142		-	amount. The commissioner may adjust a facility's reported 1998 cost and 956
1143		-	utilization data for the purposes of determining a facility's share of 957
1144		-	wage, benefit and staffing enhancement funding when reported 1998 958
1145		-	information is not substantially representative of estimated cost and 959
1146		-	utilization data for the fiscal year ending June 30, 2000, due to special 960
1147		-	circumstances during the 1998 cost report period including change of 961
1148		-	ownership with a part year cost filing or reductions in facility capacity 962
1149		-	due to facility renovation projects. Upon completion of the calculation 963
1150		-	of the allocation of wage, benefit and staffing enhancement funding, the 964
1151		-	commissioner shall not adjust the allocations due to revisions submitted 965
1152		-	to previously filed 1998 annual cost reports. In the event that a facility's 966
1153		-	rate for the fiscal year ending June 30, 1999, is an interim rate or the rate 967
1154		-	includes an increase adjustment due to a rate request to the 968
1155		-	commissioner or other reasons, the commissioner may reduce or 969 Substitute Bill No. 6446
	1099	+	LCO No. 3112 29 of 51
	1100	+
	1101	+	June 30, 2017, rates shall not exceed those in effect for the period ending 935
	1102	+	June 30, 2015, except the rate paid to a facility may be higher than the 936
	1103	+	rate paid to the facility for the period ending June 30, 2015, if the 937
	1104	+	commissioner provides, within available appropriations, pro rata fair 938
	1105	+	rent increases, which may, at the discretion of the commissioner, include 939
	1106	+	increases for facilities which have undergone a material change in 940
	1107	+	circumstances related to fair rent additions or moveable equipment 941
	1108	+	placed in service in cost report years ending September 30, 2014, and 942
	1109	+	September 30, 2015, and not otherwise included in rates issued. For the 943
	1110	+	fiscal years ending June 30, 2016, and June 30, 2017, and each succeeding 944
	1111	+	fiscal year, any facility that would have been issued a lower rate, due to 945
	1112	+	interim rate status or agreement with the department, shall be issued 946
	1113	+	such lower rate. For the fiscal year ending June 30, 2018, facilities that 947
	1114	+	received a rate decrease due to the expiration of a 2015 fair rent asset 948
	1115	+	shall receive a rate increase of an equivalent amount effective July 1, 949
	1116	+	2017. For the fiscal year ending June 30, 2018, the department shall 950
	1117	+	determine facility rates based upon 2016 cost report filings subject to the 951
	1118	+	provisions of this section and applicable regulations, provided no 952
	1119	+	facility shall receive a rate that is higher than the rate in effect on 953
	1120	+	December 31, 2016, and no facility shall receive a rate that is more than 954
	1121	+	two per cent lower than the rate in effect on December 31, 2016. For the 955
	1122	+	fiscal year ending June 30, 2019, no facility shall receive a rate that is 956
	1123	+	higher than the rate in effect on June 30, 2018, except the rate paid to a 957
	1124	+	facility may be higher than the rate paid to the facility for the period 958
	1125	+	ending June 30, 2018, if the commissioner provides, within available 959
	1126	+	appropriations, pro rata fair rent increases, which may, at the discretion 960
	1127	+	of the commissioner, include increases for facilities which have 961
	1128	+	undergone a material change in circumstances related to fair rent 962
	1129	+	additions or moveable equipment placed in service in the cost report 963
	1130	+	year ending September 30, 2017, and not otherwise included in rates 964
	1131	+	issued. For the fiscal year ending June 30, 2020, the department shall 965
	1132	+	determine facility rates based upon 2018 cost report filings subject to the 966
	1133	+	provisions of this section, adjusted to reflect any rate increases provided 967
	1134	+	after the cost report year ending September 30, 2018, and applicable 968
	1135	+	regulations, provided no facility shall receive a rate that is higher than 969 Governor's Bill No. 6446
1156	1136
1157	1137
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1160		-	30 of 44
1161	1138
1162		-	withhold the per diem wage, benefit and staffing enhancement 970
1163		-	allocation computed for the facility. Any enhancement allocations not 971
1164		-	applied to facility rates shall not be reallocated to other facilities and 972
1165		-	such unallocated amounts shall be available for the costs associated with 973
1166		-	interim rates and other Medicaid expenditures. The wage, benefit and 974
1167		-	staffing enhancement per diem adjustment for the period from April 1, 975
1168		-	1999, to June 30, 1999, inclusive, shall also be applied to rates for the 976
1169		-	fiscal years ending June 30, 2000, and June 30, 2001, except that the 977
1170		-	commissioner may increase or decrease the adjustment to account for 978
1171		-	changes in facility capacity or operations. Any facility accepting a rate 979
1172		-	adjustment for wage, benefit and staffing enhancements shall apply 980
1173		-	payments made as a result of such rate adjustment for increased 981
1174		-	allowable employee wage rates and benefits and additional direct and 982
1175		-	indirect component staffing. Adjustment funding shall not be applied to 983
1176		-	wage and salary increases provided to the administrator, assistant 984
1177		-	administrator, owners or related party employees. Enhancement 985
1178		-	payments may be applied to increases in costs associated with staffing 986
1179		-	purchased from staffing agencies provided such costs are deemed 987
1180		-	necessary and reasonable by the commissioner. The commissioner shall 988
1181		-	compare expenditures for wages, benefits and staffing for the 1998 cost 989
1182		-	report period to such expenditures in the 1999, 2000 and 2001 cost report 990
1183		-	periods to verify whether a facility has applied additional payments to 991
1184		-	specified enhancements. In the event that the commissioner determines 992
1185		-	that a facility did not apply additional payments to specified 993
1186		-	enhancements, the commissioner shall recover such amounts from the 994
1187		-	facility through rate adjustments or other means. The commissioner 995
1188		-	may require facilities to file cost reporting forms, in addition to the 996
1189		-	annual cost report, as may be necessary, to verify the appropriate 997
1190		-	application of wage, benefit and staffing enhancement rate adjustment 998
1191		-	payments. For the purposes of this subdivision, "Medicaid utilization" 999
1192		-	means the number of days of care paid for by Medicaid on an annual 1000
1193		-	basis including days for reserved beds as a percentage of total resident 1001
1194		-	days. 1002
1195		-	[(15) The interim rate established to become effective upon sale of any 1003 Substitute Bill No. 6446
	1139	+	LCO No. 3112 30 of 51
	1140	+
	1141	+	the rate in effect on June 30, 2019, except the rate paid to a facility may 970
	1142	+	be higher than the rate paid to the facility for the fiscal year ending June 971
	1143	+	30, 2019, if the commissioner provides, within available appropriations, 972
	1144	+	pro rata fair rent increases, which may, at the discretion of the 973
	1145	+	commissioner, include increases for facilities which have undergone a 974
	1146	+	material change in circumstances related to fair rent additions in the cost 975
	1147	+	report year ending September 30, 2018, and are not otherwise included 976
	1148	+	in rates issued. For the fiscal year ending June 30, 2020, no facility shall 977
	1149	+	receive a rate that is more than two per cent lower than the rate in effect 978
	1150	+	on June 30, 2019, unless the facility has an occupancy level of less than 979
	1151	+	seventy per cent, as reported in the 2018 cost report, or an overall rating 980
	1152	+	on Medicare's Nursing Home Compare of one star for the three most 981
	1153	+	recent reporting periods as of July 1, 2019, unless the facility is under an 982
	1154	+	interim rate due to new ownership. For the fiscal year ending June 30, 983
	1155	+	2021, no facility shall receive a rate that is higher than the rate in effect 984
	1156	+	on June 30, 2020, except the rate paid to a facility may be higher than the 985
	1157	+	rate paid to the facility for the fiscal year ending June 30, 2020, if the 986
	1158	+	commissioner provides, within available appropriations, pro rata fair 987
	1159	+	rent increases, which may, at the discretion of the commissioner, include 988
	1160	+	increases for facilities which have undergone a material change in 989
	1161	+	circumstances related to fair rent additions in the cost report year 990
	1162	+	ending September 30, 2019, and are not otherwise included in rates 991
	1163	+	issued. The Commissioner of Social Services shall add fair rent increases 992
	1164	+	to any other rate increases established pursuant to this subdivision for a 993
	1165	+	facility which has undergone a material change in circumstances related 994
	1166	+	to fair rent, except for the fiscal years ending June 30, 2010, June 30, 2011, 995
	1167	+	and June 30, 2012, such fair rent increases shall only be provided to 996
	1168	+	facilities with an approved certificate of need pursuant to section 17b-997
	1169	+	352, 17b-353, 17b-354 or 17b-355. For the fiscal year ending June 30, 2013, 998
	1170	+	the commissioner may, within available appropriations, provide pro 999
	1171	+	rata fair rent increases for facilities which have undergone a material 1000
	1172	+	change in circumstances related to fair rent additions placed in service 1001
	1173	+	in cost report years ending September 30, 2008, to September 30, 2011, 1002
	1174	+	inclusive, and not otherwise included in rates issued. For the fiscal years 1003
	1175	+	ending June 30, 2014, and June 30, 2015, the commissioner may, within 1004 Governor's Bill No. 6446
1196	1176
1197	1177
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1200		-	31 of 44
1201	1178
1202		-	licensed chronic and convalescent home or rest home with nursing 1004
1203		-	supervision for which a receivership has been imposed pursuant to 1005
1204		-	sections 19a-541 to 19a-549, inclusive, shall not exceed the rate in effect 1006
1205		-	for the facility at the time of the imposition of the receivership, subject 1007
1206		-	to any annual increases permitted by this section; provided the 1008
1207		-	Commissioner of Social Services may, in the commissioner's discretion, 1009
1208		-	and after consultation with the receiver, establish an increased rate for 1010
1209		-	the facility if the commissioner with approval of the Secretary of the 1011
1210		-	Office of Policy and Management determines that such higher rate is 1012
1211		-	needed to keep the facility open and to ensure the health, safety and 1013
1212		-	welfare of the residents at such facility.] 1014
1213		-	(g) The established interim rate to become effective upon sale of any 1015
1214		-	licensed chronic and convalescent home or rest home with nursing 1016
1215		-	supervision for which a receivership has been imposed pursuant to 1017
1216		-	sections 19a-541 to 19a-549, inclusive, shall not exceed the rate in effect 1018
1217		-	for the facility at the time of the imposition of the receivership, subject 1019
1218		-	to any annual increases permitted by this section, provided the 1020
1219		-	Commissioner of Social Services may, in the commissioner's discretion 1021
1220		-	and after consultation with the receiver, establish an increased rate for 1022
1221		-	the facility if the commissioner, with the approval of the Secretary of the 1023
1222		-	Office of Policy and Management, determines that such higher rate is 1024
1223		-	needed to keep the facility open and to ensure the health, safety and 1025
1224		-	welfare of the residents at such facility. 1026
1225		-	[(g)] (h) For the fiscal year ending June 30, 1993, any intermediate care 1027
1226		-	facility for individuals with intellectual disabilities with an operating 1028
1227		-	cost component of its rate in excess of one hundred forty per cent of the 1029
1228		-	median of operating cost components of rates in effect January 1, 1992, 1030
1229		-	shall not receive an operating cost component increase. For the fiscal 1031
1230		-	year ending June 30, 1993, any intermediate care facility for individuals 1032
1231		-	with intellectual disabilities with an operating cost component of its rate 1033
1232		-	that is less than one hundred forty per cent of the median of operating 1034
1233		-	cost components of rates in effect January 1, 1992, shall have an 1035
1234		-	allowance for real wage growth equal to thirty per cent of the increase 1036 Substitute Bill No. 6446
	1179	+	LCO No. 3112 31 of 51
	1180	+
	1181	+	available appropriations, provide pro rata fair rent increases, which may 1005
	1182	+	include moveable equipment at the discretion of the commissioner, for 1006
	1183	+	facilities which have undergone a material change in circumstances 1007
	1184	+	related to fair rent additions or moveable equipment placed in service 1008
	1185	+	in cost report years ending September 30, 2012, and September 30, 2013, 1009
	1186	+	and not otherwise included in rates issued. The commissioner shall add 1010
	1187	+	fair rent increases associated with an approved certificate of need 1011
	1188	+	pursuant to section 17b-352, 17b-353, 17b-354 or 17b-355. Interim rates 1012
	1189	+	may take into account reasonable costs incurred by a facility, including 1013
	1190	+	wages and benefits. Notwithstanding the provisions of this section, the 1014
	1191	+	Commissioner of Social Services may, subject to available 1015
	1192	+	appropriations, increase or decrease rates issued to licensed chronic and 1016
	1193	+	convalescent nursing homes and licensed rest homes with nursing 1017
	1194	+	supervision. Notwithstanding any provision of this section, the 1018
	1195	+	Commissioner of Social Services shall, effective July 1, 2015, within 1019
	1196	+	available appropriations, adjust facility rates in accordance with the 1020
	1197	+	application of standard accounting principles as prescribed by the 1021
	1198	+	commissioner, for each facility subject to subsection (a) of this section. 1022
	1199	+	Such adjustment shall provide a pro-rata increase based on direct and 1023
	1200	+	indirect care employee salaries reported in the 2014 annual cost report, 1024
	1201	+	and adjusted to reflect subsequent salary increases, to reflect reasonable 1025
	1202	+	costs mandated by collective bargaining agreements with certified 1026
	1203	+	collective bargaining agents, or otherwise provided by a facility to its 1027
	1204	+	employees. For purposes of this subsection, "employee" shall not 1028
	1205	+	include a person employed as a facility's manager, chief administrator, 1029
	1206	+	a person required to be licensed as a nursing home administrator or any 1030
	1207	+	individual who receives compensation for services pursuant to a 1031
	1208	+	contractual arrangement and who is not directly employed by the 1032
	1209	+	facility. The commissioner may establish an upper limit for reasonable 1033
	1210	+	costs associated with salary adjustments beyond which the adjustment 1034
	1211	+	shall not apply. Nothing in this section shall require the commissioner 1035
	1212	+	to distribute such adjustments in a way that jeopardizes anticipated 1036
	1213	+	federal reimbursement. Facilities that receive such adjustment but do 1037
	1214	+	not provide increases in employee salaries as described in this 1038
	1215	+	subsection on or before July 31, 2015, may be subject to a rate decrease 1039 Governor's Bill No. 6446
1235	1216
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1240	1218
1241		-	determined in accordance with subsection (q) of section 17-311-52 of the 1037
1242		-	regulations of Connecticut state agencies, provided such operating cost 1038
1243		-	component shall not exceed one hundred forty per cent of the median 1039
1244		-	of operating cost components in effect January 1, 1992. Any facility with 1040
1245		-	real property other than land placed in service prior to October 1, 1991, 1041
1246		-	shall, for the fiscal year ending June 30, 1995, receive a rate of return on 1042
1247		-	real property equal to the average of the rates of return applied to real 1043
1248		-	property other than land placed in service for the five years preceding 1044
1249		-	October 1, 1993. For the fiscal year ending June 30, 1996, and any 1045
1250		-	succeeding fiscal year, the rate of return on real property for property 1046
1251		-	items shall be revised every five years. The commissioner shall, upon 1047
1252		-	submission of a request, allow actual debt service, comprised of 1048
1253		-	principal and interest, in excess of property costs allowed pursuant to 1049
1254		-	section 17-311-52 of the regulations of Connecticut state agencies, 1050
1255		-	provided such debt service terms and amounts are reasonable in 1051
1256		-	relation to the useful life and the base value of the property. For the fiscal 1052
1257		-	year ending June 30, 1995, and any succeeding fiscal year, the inflation 1053
1258		-	adjustment made in accordance with subsection (p) of section 17-311-52 1054
1259		-	of the regulations of Connecticut state agencies shall not be applied to 1055
1260		-	real property costs. For the fiscal year ending June 30, 1996, and any 1056
1261		-	succeeding fiscal year, the allowance for real wage growth, as 1057
1262		-	determined in accordance with subsection (q) of section 17-311-52 of the 1058
1263		-	regulations of Connecticut state agencies, shall not be applied. For the 1059
1264		-	fiscal year ending June 30, 1996, and any succeeding fiscal year, no rate 1060
1265		-	shall exceed three hundred seventy-five dollars per day unless the 1061
1266		-	commissioner, in consultation with the Commissioner of 1062
1267		-	Developmental Services, determines after a review of program and 1063
1268		-	management costs, that a rate in excess of this amount is necessary for 1064
1269		-	care and treatment of facility residents. For the fiscal year ending June 1065
1270		-	30, 2002, rate period, the Commissioner of Social Services shall increase 1066
1271		-	the inflation adjustment for rates made in accordance with subsection 1067
1272		-	(p) of section 17-311-52 of the regulations of Connecticut state agencies 1068
1273		-	to update allowable fiscal year 2000 costs to include a three and one-half 1069
1274		-	per cent inflation factor. For the fiscal year ending June 30, 2003, rate 1070
1275		-	period, the commissioner shall increase the inflation adjustment for 1071 Substitute Bill No. 6446
	1219	+	LCO No. 3112 32 of 51
	1220	+
	1221	+	in the same amount as the adjustment by the commissioner. Of the 1040
	1222	+	amount appropriated for this purpose, no more than nine million 1041
	1223	+	dollars shall go to increases based on reasonable costs mandated by 1042
	1224	+	collective bargaining agreements. Notwithstanding the provisions of 1043
	1225	+	this subsection, effective July 1, 2019, October 1, 2020, and January 1, 1044
	1226	+	2021, the commissioner shall, within available appropriations, increase 1045
	1227	+	rates for the purpose of wage and benefit enhancements for facility 1046
	1228	+	employees. The commissioner shall adjust the rate paid to the facility in 1047
	1229	+	the form of a rate adjustment to reflect any rate increases paid after the 1048
	1230	+	cost report year ending September 30, 2018. Facilities that receive a rate 1049
	1231	+	adjustment for the purpose of wage and benefit enhancements but do 1050
	1232	+	not provide increases in employee salaries as described in this 1051
	1233	+	subsection on or before September 30, 2019, October 31, 2020, and 1052
	1234	+	January 31, 2021, respectively, may be subject to a rate decrease in the 1053
	1235	+	same amount as the adjustment by the commissioner. 1054
	1236	+	(5) For the purpose of determining allowable fair rent, a facility with 1055
	1237	+	allowable fair rent less than the twenty-fifth percentile of the state-wide 1056
	1238	+	allowable fair rent shall be reimbursed as having allowable fair rent 1057
	1239	+	equal to the twenty-fifth percentile of the state-wide allowable fair rent, 1058
	1240	+	provided for the fiscal years ending June 30, 1996, and June 30, 1997, the 1059
	1241	+	reimbursement may not exceed the twenty-fifth percentile of the state-1060
	1242	+	wide allowable fair rent for the fiscal year ending June 30, 1995. On and 1061
	1243	+	after July 1, 1998, the Commissioner of Social Services may allow 1062
	1244	+	minimum fair rent as the basis upon which reimbursement associated 1063
	1245	+	with improvements to real property is added. Beginning with the fiscal 1064
	1246	+	year ending June 30, 1996, any facility with a rate of return on real 1065
	1247	+	property other than land in excess of eleven per cent shall have such 1066
	1248	+	allowance revised to eleven per cent. Any facility or its related realty 1067
	1249	+	affiliate which finances or refinances debt through bonds issued by the 1068
	1250	+	State of Connecticut Health and Education Facilities Authority shall 1069
	1251	+	report the terms and conditions of such financing or refinancing to the 1070
	1252	+	Commissioner of Social Services within thirty days of completing such 1071
	1253	+	financing or refinancing. The Commissioner of Social Services may 1072
	1254	+	revise the facility's fair rent component of its rate to reflect any financial 1073 Governor's Bill No. 6446
1276	1255
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1281	1257
1282		-	rates made in accordance with subsection (p) of section 17-311-52 of the 1072
1283		-	regulations of Connecticut state agencies to update allowable fiscal year 1073
1284		-	2001 costs to include a one and one-half per cent inflation factor, except 1074
1285		-	that such increase shall be effective November 1, 2002, and such facility 1075
1286		-	rate in effect for the fiscal year ending June 30, 2002, shall be paid for 1076
1287		-	services provided until October 31, 2002, except any facility that would 1077
1288		-	have been issued a lower rate effective July 1, 2002, than for the fiscal 1078
1289		-	year ending June 30, 2002, due to interim rate status or agreement with 1079
1290		-	the department shall be issued such lower rate effective July 1, 2002, and 1080
1291		-	have such rate updated effective November 1, 2002, in accordance with 1081
1292		-	applicable statutes and regulations. For the fiscal year ending June 30, 1082
1293		-	2004, rates in effect for the period ending June 30, 2003, shall remain in 1083
1294		-	effect, except any facility that would have been issued a lower rate 1084
1295		-	effective July 1, 2003, than for the fiscal year ending June 30, 2003, due 1085
1296		-	to interim rate status or agreement with the department shall be issued 1086
1297		-	such lower rate effective July 1, 2003. For the fiscal year ending June 30, 1087
1298		-	2005, rates in effect for the period ending June 30, 2004, shall remain in 1088
1299		-	effect until September 30, 2004. Effective October 1, 2004, each facility 1089
1300		-	shall receive a rate that is five per cent greater than the rate in effect 1090
1301		-	September 30, 2004. Effective upon receipt of all the necessary federal 1091
1302		-	approvals to secure federal financial participation matching funds 1092
1303		-	associated with the rate increase provided in subdivision (4) of 1093
1304		-	subsection (f) of this section, but in no event earlier than October 1, 2005, 1094
1305		-	and provided the user fee imposed under section 17b-320 is required to 1095
1306		-	be collected, each facility shall receive a rate that is four per cent more 1096
1307		-	than the rate the facility received in the prior fiscal year, except any 1097
1308		-	facility that would have been issued a lower rate effective October 1, 1098
1309		-	2005, than for the fiscal year ending June 30, 2005, due to interim rate 1099
1310		-	status or agreement with the department, shall be issued such lower rate 1100
1311		-	effective October 1, 2005. Such rate increase shall remain in effect unless: 1101
1312		-	(1) The federal financial participation matching funds associated with 1102
1313		-	the rate increase are no longer available; or (2) the user fee created 1103
1314		-	pursuant to section 17b-320 is not in effect. For the fiscal year ending 1104
1315		-	June 30, 2007, rates in effect for the period ending June 30, 2006, shall 1105
1316		-	remain in effect until September 30, 2006, except any facility that would 1106 Substitute Bill No. 6446
	1258	+	LCO No. 3112 33 of 51
	1259	+
	1260	+	benefit the facility or its related realty affiliate received as a result of such 1074
	1261	+	financing or refinancing, including but not limited to, reductions in the 1075
	1262	+	amount of debt service payments or period of debt repayment. The 1076
	1263	+	commissioner shall allow actual debt service costs for bonds issued by 1077
	1264	+	the State of Connecticut Health and Educational Facilities Authority if 1078
	1265	+	such costs do not exceed property costs allowed pursuant to subsection 1079
	1266	+	(f) of section 17-311-52 of the regulations of Connecticut state agencies, 1080
	1267	+	provided the commissioner may allow higher debt service costs for such 1081
	1268	+	bonds for good cause. For facilities which first open on or after October 1082
	1269	+	1, 1992, the commissioner shall determine allowable fair rent for real 1083
	1270	+	property other than land based on the rate of return for the cost year in 1084
	1271	+	which such bonds were issued. The financial benefit resulting from a 1085
	1272	+	facility financing or refinancing debt through such bonds shall be shared 1086
	1273	+	between the state and the facility to an extent determined by the 1087
	1274	+	commissioner on a case-by-case basis and shall be reflected in an 1088
	1275	+	adjustment to the facility's allowable fair rent. 1089
	1276	+	(6) A facility shall receive cost efficiency adjustments for indirect costs 1090
	1277	+	and for administrative and general costs if such costs are below the 1091
	1278	+	state-wide median costs. The cost efficiency adjustments shall equal 1092
	1279	+	twenty-five per cent of the difference between allowable reported costs 1093
	1280	+	and the applicable median allowable cost established pursuant to this 1094
	1281	+	subdivision. 1095
	1282	+	(7) For the fiscal year ending June 30, 1992, allowable operating costs, 1096
	1283	+	excluding fair rent, shall be inflated using the Regional Data Resources 1097
	1284	+	Incorporated McGraw-Hill Health Care Costs: Consumer Price Index 1098
	1285	+	(all urban)-All Items minus one and one-half per cent. For the fiscal year 1099
	1286	+	ending June 30, 1993, allowable operating costs, excluding fair rent, shall 1100
	1287	+	be inflated using the Regional Data Resources Incorporated McGraw-1101
	1288	+	Hill Health Care Costs: Consumer Price Index (all urban)-All Items 1102
	1289	+	minus one and three-quarters per cent. For the fiscal years ending June 1103
	1290	+	30, 1994, and June 30, 1995, allowable operating costs, excluding fair 1104
	1291	+	rent, shall be inflated using the Regional Data Resources Incorporated 1105
	1292	+	McGraw-Hill Health Care Costs: Consumer Price Index (all urban)-All 1106
	1293	+	Items minus two per cent. For the fiscal year ending June 30, 1996, 1107 Governor's Bill No. 6446
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1322	1296
1323		-	have been issued a lower rate effective July 1, 2006, than for the fiscal 1107
1324		-	year ending June 30, 2006, due to interim rate status or agreement with 1108
1325		-	the department, shall be issued such lower rate effective July 1, 2006. 1109
1326		-	Effective October 1, 2006, no facility shall receive a rate that is more than 1110
1327		-	three per cent greater than the rate in effect for the facility on September 1111
1328		-	30, 2006, except any facility that would have been issued a lower rate 1112
1329		-	effective October 1, 2006, due to interim rate status or agreement with 1113
1330		-	the department, shall be issued such lower rate effective October 1, 2006. 1114
1331		-	For the fiscal year ending June 30, 2008, each facility shall receive a rate 1115
1332		-	that is two and nine-tenths per cent greater than the rate in effect for the 1116
1333		-	period ending June 30, 2007, except any facility that would have been 1117
1334		-	issued a lower rate effective July 1, 2007, than for the rate period ending 1118
1335		-	June 30, 2007, due to interim rate status, or agreement with the 1119
1336		-	department, shall be issued such lower rate effective July 1, 2007. For the 1120
1337		-	fiscal year ending June 30, 2009, rates in effect for the period ending June 1121
1338		-	30, 2008, shall remain in effect until June 30, 2009, except any facility that 1122
1339		-	would have been issued a lower rate for the fiscal year ending June 30, 1123
1340		-	2009, due to interim rate status or agreement with the department, shall 1124
1341		-	be issued such lower rate. For the fiscal years ending June 30, 2010, and 1125
1342		-	June 30, 2011, rates in effect for the period ending June 30, 2009, shall 1126
1343		-	remain in effect until June 30, 2011, except any facility that would have 1127
1344		-	been issued a lower rate for the fiscal year ending June 30, 2010, or the 1128
1345		-	fiscal year ending June 30, 2011, due to interim rate status or agreement 1129
1346		-	with the department, shall be issued such lower rate. For the fiscal year 1130
1347		-	ending June 30, 2012, rates in effect for the period ending June 30, 2011, 1131
1348		-	shall remain in effect until June 30, 2012, except any facility that would 1132
1349		-	have been issued a lower rate for the fiscal year ending June 30, 2012, 1133
1350		-	due to interim rate status or agreement with the department, shall be 1134
1351		-	issued such lower rate. For the fiscal years ending June 30, 2014, and 1135
1352		-	June 30, 2015, rates shall not exceed those in effect for the period ending 1136
1353		-	June 30, 2013, except the rate paid to a facility may be higher than the 1137
1354		-	rate paid to the facility for the period ending June 30, 2013, if a capital 1138
1355		-	improvement approved by the Department of Developmental Services, 1139
1356		-	in consultation with the Department of Social Services, for the health or 1140
1357		-	safety of the residents was made to the facility during the fiscal year 1141 Substitute Bill No. 6446
	1297	+	LCO No. 3112 34 of 51
	1298	+
	1299	+	allowable operating costs, excluding fair rent, shall be inflated using the 1108
	1300	+	Regional Data Resources Incorporated McGraw-Hill Health Care Costs: 1109
	1301	+	Consumer Price Index (all urban)-All Items minus two and one-half per 1110
	1302	+	cent. For the fiscal year ending June 30, 1997, allowable operating costs, 1111
	1303	+	excluding fair rent, shall be inflated using the Regional Data Resources 1112
	1304	+	Incorporated McGraw-Hill Health Care Costs: Consumer Price Index 1113
	1305	+	(all urban)-All Items minus three and one-half per cent. For the fiscal 1114
	1306	+	year ending June 30, 1992, and any succeeding fiscal year, allowable fair 1115
	1307	+	rent shall be those reported in the annual report of long-term care 1116
	1308	+	facilities for the cost year ending the immediately preceding September 1117
	1309	+	thirtieth. The inflation index to be used pursuant to this subsection shall 1118
	1310	+	be computed to reflect inflation between the midpoint of the cost year 1119
	1311	+	through the midpoint of the rate year. The Department of Social Services 1120
	1312	+	shall study methods of reimbursement for fair rent and shall report its 1121
	1313	+	findings and recommendations to the joint standing committee of the 1122
	1314	+	General Assembly having cognizance of matters relating to human 1123
	1315	+	services on or before January 15, 1993. 1124
	1316	+	(8) On and after July 1, 1994, costs shall be rebased no more frequently 1125
	1317	+	than every two years and no less frequently than every four years, as 1126
	1318	+	determined by the commissioner. The commissioner shall determine 1127
	1319	+	whether and to what extent a change in ownership of a facility shall 1128
	1320	+	occasion the rebasing of the facility's costs. 1129
	1321	+	(9) The method of establishing rates for new facilities shall be 1130
	1322	+	determined by the commissioner in accordance with the provisions of 1131
	1323	+	this subsection until June 30, 2021. 1132
	1324	+	(10) Rates determined under this section shall comply with federal 1133
	1325	+	laws and regulations. 1134
	1326	+	(11) Notwithstanding the provisions of this subsection, interim rates 1135
	1327	+	issued for facilities on and after July 1, 1991, shall be subject to applicable 1136
	1328	+	fiscal year cost component limitations established pursuant to 1137
	1329	+	subdivision (3) of this subsection. 1138
	1330	+	(12) A chronic and convalescent nursing home having an ownership 1139 Governor's Bill No. 6446
1358	1331
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1363	1333
1364		-	ending June 30, 2014, or June 30, 2015, to the extent such rate increases 1142
1365		-	are within available appropriations. Any facility that would have been 1143
1366		-	issued a lower rate for the fiscal year ending June 30, 2014, or the fiscal 1144
1367		-	year ending June 30, 2015, due to interim rate status or agreement with 1145
1368		-	the department, shall be issued such lower rate. For the fiscal years 1146
1369		-	ending June 30, 2016, and June 30, 2017, rates shall not exceed those in 1147
1370		-	effect for the period ending June 30, 2015, except the rate paid to a 1148
1371		-	facility may be higher than the rate paid to the facility for the period 1149
1372		-	ending June 30, 2015, if a capital improvement approved by the 1150
1373		-	Department of Developmental Services, in consultation with the 1151
1374		-	Department of Social Services, for the health or safety of the residents 1152
1375		-	was made to the facility during the fiscal year ending June 30, 2016, or 1153
1376		-	June 30, 2017, to the extent such rate increases are within available 1154
1377		-	appropriations. For the fiscal years ending June 30, 2016, and June 30, 1155
1378		-	2017, and each succeeding fiscal year, any facility that would have been 1156
1379		-	issued a lower rate, due to interim rate status, a change in allowable fair 1157
1380		-	rent or agreement with the department, shall be issued such lower rate. 1158
1381		-	For the fiscal years ending June 30, 2018, and June 30, 2019, rates shall 1159
1382		-	not exceed those in effect for the period ending June 30, 2017, except the 1160
1383		-	rate paid to a facility may be higher than the rate paid to the facility for 1161
1384		-	the period ending June 30, 2017, if a capital improvement approved by 1162
1385		-	the Department of Developmental Services, in consultation with the 1163
1386		-	Department of Social Services, for the health or safety of the residents 1164
1387		-	was made to the facility during the fiscal year ending June 30, 2018, or 1165
1388		-	June 30, 2019, only to the extent such rate increases are within available 1166
1389		-	appropriations. For the fiscal years ending June 30, 2020, and June 30, 1167
1390		-	2021, rates shall not exceed those in effect for the fiscal year ending June 1168
1391		-	30, 2019, except the rate paid to a facility may be higher than the rate 1169
1392		-	paid to the facility for the fiscal year ending June 30, 2019, if a capital 1170
1393		-	improvement approved by the Department of Developmental Services, 1171
1394		-	in consultation with the Department of Social Services, for the health or 1172
1395		-	safety of the residents was made to the facility during the fiscal year 1173
1396		-	ending June 30, 2020, or June 30, 2021, only to the extent such rate 1174
1397		-	increases are within available appropriations. Any facility that has a 1175
1398		-	significant decrease in land and building costs shall receive a reduced 1176 Substitute Bill No. 6446
	1334	+	LCO No. 3112 35 of 51
	1335	+
	1336	+	affiliation with and operated at the same location as a chronic disease 1140
	1337	+	hospital may request that the commissioner approve an exception to 1141
	1338	+	applicable rate-setting provisions for chronic and convalescent nursing 1142
	1339	+	homes and establish a rate for the fiscal years ending June 30, 1992, and 1143
	1340	+	June 30, 1993, in accordance with regulations in effect June 30, 1991. Any 1144
	1341	+	such rate shall not exceed one hundred sixty-five per cent of the median 1145
	1342	+	rate established for chronic and convalescent nursing homes established 1146
	1343	+	under this section for the applicable fiscal year. 1147
	1344	+	(13) For the fiscal year ending June 30, 2014, and any succeeding fiscal 1148
	1345	+	year, for purposes of computing minimum allowable patient days, 1149
	1346	+	utilization of a facility's certified beds shall be determined at a minimum 1150
	1347	+	of ninety per cent of capacity, except for new facilities and facilities 1151
	1348	+	which are certified for additional beds which may be permitted a lower 1152
	1349	+	occupancy rate for the first three months of operation after the effective 1153
	1350	+	date of licensure. 1154
	1351	+	(14) The Commissioner of Social Services shall adjust facility rates 1155
	1352	+	from April 1, 1999, to June 30, 1999, inclusive, by a per diem amount 1156
	1353	+	representing each facility's allocation of funds appropriated for the 1157
	1354	+	purpose of wage, benefit and staffing enhancement. A facility's per diem 1158
	1355	+	allocation of such funding shall be computed as follows: (A) The 1159
	1356	+	facility's direct and indirect component salary, wage, nursing pool and 1160
	1357	+	allocated fringe benefit costs as filed for the 1998 cost report period 1161
	1358	+	deemed allowable in accordance with this section and applicable 1162
	1359	+	regulations without application of cost component maximums specified 1163
	1360	+	in subdivision (3) of this subsection shall be totalled; (B) such total shall 1164
	1361	+	be multiplied by the facility's Medicaid utilization based on the 1998 cost 1165
	1362	+	report; (C) the resulting amount for the facility shall be divided by the 1166
	1363	+	sum of the calculations specified in subparagraphs (A) and (B) of this 1167
	1364	+	subdivision for all facilities to determine the facility's percentage share 1168
	1365	+	of appropriated wage, benefit and staffing enhancement funding; (D) 1169
	1366	+	the facility's percentage share shall be multiplied by the amount of 1170
	1367	+	appropriated wage, benefit and staffing enhancement funding to 1171
	1368	+	determine the facility's allocated amount; and (E) such allocated amount 1172
	1369	+	shall be divided by the number of days of care paid for by Medicaid on 1173 Governor's Bill No. 6446
1399	1370
1400	1371
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1404	1372
1405		-	rate to reflect such decrease in land and building costs. For the fiscal 1177
1406		-	years ending June 30, 2012, June 30, 2013, June 30, 2014, June 30, 2015, 1178
1407		-	June 30, 2016, June 30, 2017, June 30, 2018, June 30, 2019, June 30, 2020, 1179
1408		-	[and] June 30, 2021, June 30, 2022, and June 30, 2023, the Commissioner 1180
1409		-	of Social Services may provide fair rent increases to any facility that has 1181
1410		-	undergone a material change in circumstances related to fair rent and 1182
1411		-	has an approved certificate of need pursuant to section 17b-352, 17b-353, 1183
1412		-	17b-354 or 17b-355. Notwithstanding the provisions of this section, the 1184
1413		-	Commissioner of Social Services may, within available appropriations, 1185
1414		-	increase or decrease rates issued to intermediate care facilities for 1186
1415		-	individuals with intellectual disabilities to reflect a reduction in 1187
1416		-	available appropriations as provided in subsection (a) of this section. 1188
1417		-	For the fiscal years ending June 30, 2014, and June 30, 2015, the 1189
1418		-	commissioner shall not consider rebasing in determining rates. 1190
1419		-	[(h) (1)] (i) For the fiscal year ending June 30, 1993, any residential 1191
1420		-	care home with an operating cost component of its rate in excess of one 1192
1421		-	hundred thirty per cent of the median of operating cost components of 1193
1422		-	rates in effect January 1, 1992, shall not receive an operating cost 1194
1423		-	component increase. For the fiscal year ending June 30, 1993, any 1195
1424		-	residential care home with an operating cost component of its rate that 1196
1425		-	is less than one hundred thirty per cent of the median of operating cost 1197
1426		-	components of rates in effect January 1, 1992, shall have an allowance 1198
1427		-	for real wage growth equal to sixty-five per cent of the increase 1199
1428		-	determined in accordance with subsection (q) of section 17-311-52 of the 1200
1429		-	regulations of Connecticut state agencies, provided such operating cost 1201
1430		-	component shall not exceed one hundred thirty per cent of the median 1202
1431		-	of operating cost components in effect January 1, 1992. Beginning with 1203
1432		-	the fiscal year ending June 30, 1993, for the purpose of determining 1204
1433		-	allowable fair rent, a residential care home with allowable fair rent less 1205
1434		-	than the twenty-fifth percentile of the state-wide allowable fair rent shall 1206
1435		-	be reimbursed as having allowable fair rent equal to the twenty-fifth 1207
1436		-	percentile of the state-wide allowable fair rent. Beginning with the fiscal 1208
1437		-	year ending June 30, 1997, a residential care home with allowable fair 1209
1438		-	rent less than three dollars and ten cents per day shall be reimbursed as 1210 Substitute Bill No. 6446
	1373	+	LCO No. 3112 36 of 51
	1374	+
	1375	+	an annual basis including days for reserved beds specified in the 1998 1174
	1376	+	cost report to determine the per diem wage and benefit rate adjustment 1175
	1377	+	amount. The commissioner may adjust a facility's reported 1998 cost and 1176
	1378	+	utilization data for the purposes of determining a facility's share of 1177
	1379	+	wage, benefit and staffing enhancement funding when reported 1998 1178
	1380	+	information is not substantially representative of estimated cost and 1179
	1381	+	utilization data for the fiscal year ending June 30, 2000, due to special 1180
	1382	+	circumstances during the 1998 cost report period including change of 1181
	1383	+	ownership with a part year cost filing or reductions in facility capacity 1182
	1384	+	due to facility renovation projects. Upon completion of the calculation 1183
	1385	+	of the allocation of wage, benefit and staffing enhancement funding, the 1184
	1386	+	commissioner shall not adjust the allocations due to revisions submitted 1185
	1387	+	to previously filed 1998 annual cost reports. In the event that a facility's 1186
	1388	+	rate for the fiscal year ending June 30, 1999, is an interim rate or the rate 1187
	1389	+	includes an increase adjustment due to a rate request to the 1188
	1390	+	commissioner or other reasons, the commissioner may reduce or 1189
	1391	+	withhold the per diem wage, benefit and staffing enhancement 1190
	1392	+	allocation computed for the facility. Any enhancement allocations not 1191
	1393	+	applied to facility rates shall not be reallocated to other facilities and 1192
	1394	+	such unallocated amounts shall be available for the costs associated with 1193
	1395	+	interim rates and other Medicaid expenditures. The wage, benefit and 1194
	1396	+	staffing enhancement per diem adjustment for the period from April 1, 1195
	1397	+	1999, to June 30, 1999, inclusive, shall also be applied to rates for the 1196
	1398	+	fiscal years ending June 30, 2000, and June 30, 2001, except that the 1197
	1399	+	commissioner may increase or decrease the adjustment to account for 1198
	1400	+	changes in facility capacity or operations. Any facility accepting a rate 1199
	1401	+	adjustment for wage, benefit and staffing enhancements shall apply 1200
	1402	+	payments made as a result of such rate adjustment for increased 1201
	1403	+	allowable employee wage rates and benefits and additional direct and 1202
	1404	+	indirect component staffing. Adjustment funding shall not be applied to 1203
	1405	+	wage and salary increases provided to the administrator, assistant 1204
	1406	+	administrator, owners or related party employees. Enhancement 1205
	1407	+	payments may be applied to increases in costs associated with staffing 1206
	1408	+	purchased from staffing agencies provided such costs are deemed 1207
	1409	+	necessary and reasonable by the commissioner. The commissioner shall 1208 Governor's Bill No. 6446
1439	1410
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1444	1412
1445		-	having allowable fair rent equal to three dollars and ten cents per day. 1211
1446		-	Property additions placed in service during the cost year ending 1212
1447		-	September 30, 1996, or any succeeding cost year shall receive a fair rent 1213
1448		-	allowance for such additions as an addition to three dollars and ten 1214
1449		-	cents per day if the fair rent for the facility for property placed in service 1215
1450		-	prior to September 30, 1995, is less than or equal to three dollars and ten 1216
1451		-	cents per day. Beginning with the fiscal year ending June 30, 2016, a 1217
1452		-	residential care home shall be reimbursed the greater of the allowable 1218
1453		-	accumulated fair rent reimbursement associated with real property 1219
1454		-	additions and land as calculated on a per day basis or three dollars and 1220
1455		-	ten cents per day if the allowable reimbursement associated with real 1221
1456		-	property additions and land is less than three dollars and ten cents per 1222
1457		-	day. For the fiscal year ending June 30, 1996, and any succeeding fiscal 1223
1458		-	year, the allowance for real wage growth, as determined in accordance 1224
1459		-	with subsection (q) of section 17-311-52 of the regulations of Connecticut 1225
1460		-	state agencies, shall not be applied. For the fiscal year ending June 30, 1226
1461		-	1996, and any succeeding fiscal year, the inflation adjustment made in 1227
1462		-	accordance with subsection (p) of section 17-311-52 of the regulations of 1228
1463		-	Connecticut state agencies shall not be applied to real property costs. 1229
1464		-	Beginning with the fiscal year ending June 30, 1997, minimum allowable 1230
1465		-	patient days for rate computation purposes for a residential care home 1231
1466		-	with twenty-five beds or less shall be eighty-five per cent of licensed 1232
1467		-	capacity. Beginning with the fiscal year ending June 30, 2002, for the 1233
1468		-	purposes of determining the allowable salary of an administrator of a 1234
1469		-	residential care home with sixty beds or less the department shall revise 1235
1470		-	the allowable base salary to thirty-seven thousand dollars to be annually 1236
1471		-	inflated thereafter in accordance with section 17-311-52 of the 1237
1472		-	regulations of Connecticut state agencies. The rates for the fiscal year 1238
1473		-	ending June 30, 2002, shall be based upon the increased allowable salary 1239
1474		-	of an administrator, regardless of whether such amount was expended 1240
1475		-	in the 2000 cost report period upon which the rates are based. Beginning 1241
1476		-	with the fiscal year ending June 30, 2000, and until the fiscal year ending 1242
1477		-	June 30, 2009, inclusive, the inflation adjustment for rates made in 1243
1478		-	accordance with subsection (p) of section 17-311-52 of the regulations of 1244
1479		-	Connecticut state agencies shall be increased by two per cent, and 1245 Substitute Bill No. 6446
	1413	+	LCO No. 3112 37 of 51
	1414	+
	1415	+	compare expenditures for wages, benefits and staffing for the 1998 cost 1209
	1416	+	report period to such expenditures in the 1999, 2000 and 2001 cost report 1210
	1417	+	periods to verify whether a facility has applied additional payments to 1211
	1418	+	specified enhancements. In the event that the commissioner determines 1212
	1419	+	that a facility did not apply additional payments to specified 1213
	1420	+	enhancements, the commissioner shall recover such amounts from the 1214
	1421	+	facility through rate adjustments or other means. The commissioner 1215
	1422	+	may require facilities to file cost reporting forms, in addition to the 1216
	1423	+	annual cost report, as may be necessary, to verify the appropriate 1217
	1424	+	application of wage, benefit and staffing enhancement rate adjustment 1218
	1425	+	payments. For the purposes of this subdivision, "Medicaid utilization" 1219
	1426	+	means the number of days of care paid for by Medicaid on an annual 1220
	1427	+	basis including days for reserved beds as a percentage of total resident 1221
	1428	+	days. 1222
	1429	+	[(15) The interim rate established to become effective upon sale of any 1223
	1430	+	licensed chronic and convalescent home or rest home with nursing 1224
	1431	+	supervision for which a receivership has been imposed pursuant to 1225
	1432	+	sections 19a-541 to 19a-549, inclusive, shall not exceed the rate in effect 1226
	1433	+	for the facility at the time of the imposition of the receivership, subject 1227
	1434	+	to any annual increases permitted by this section; provided the 1228
	1435	+	Commissioner of Social Services may, in the commissioner's discretion, 1229
	1436	+	and after consultation with the receiver, establish an increased rate for 1230
	1437	+	the facility if the commissioner with approval of the Secretary of the 1231
	1438	+	Office of Policy and Management determines that such higher rate is 1232
	1439	+	needed to keep the facility open and to ensure the health, safety and 1233
	1440	+	welfare of the residents at such facility.] 1234
	1441	+	(g) The established interim rate to become effective upon sale of any 1235
	1442	+	licensed chronic and convalescent home or rest home with nursing 1236
	1443	+	supervision for which a receivership has been imposed pursuant to 1237
	1444	+	sections 19a-541 to 19a-549, inclusive, shall not exceed the rate in effect 1238
	1445	+	for the facility at the time of the imposition of the receivership, subject 1239
	1446	+	to any annual increases permitted by this section, provided the 1240
	1447	+	Commissioner of Social Services may, in the commissioner's discretion 1241
	1448	+	and after consultation with the receiver, establish an increased rate for 1242 Governor's Bill No. 6446
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1485	1451
1486		-	beginning with the fiscal year ending June 30, 2002, the inflation 1246
1487		-	adjustment for rates made in accordance with subsection (c) of said 1247
1488		-	section shall be increased by one per cent. Beginning with the fiscal year 1248
1489		-	ending June 30, 1999, for the purpose of determining the allowable 1249
1490		-	salary of a related party, the department shall revise the maximum 1250
1491		-	salary to twenty-seven thousand eight hundred fifty-six dollars to be 1251
1492		-	annually inflated thereafter in accordance with section 17-311-52 of the 1252
1493		-	regulations of Connecticut state agencies and beginning with the fiscal 1253
1494		-	year ending June 30, 2001, such allowable salary shall be computed on 1254
1495		-	an hourly basis and the maximum number of hours allowed for a related 1255
1496		-	party other than the proprietor shall be increased from forty hours to 1256
1497		-	forty-eight hours per work week. For the fiscal year ending June 30, 1257
1498		-	2005, each facility shall receive a rate that is two and one-quarter per 1258
1499		-	cent more than the rate the facility received in the prior fiscal year, 1259
1500		-	except any facility that would have been issued a lower rate effective 1260
1501		-	July 1, 2004, than for the fiscal year ending June 30, 2004, due to interim 1261
1502		-	rate status or agreement with the department shall be issued such lower 1262
1503		-	rate effective July 1, 2004. Effective upon receipt of all the necessary 1263
1504		-	federal approvals to secure federal financial participation matching 1264
1505		-	funds associated with the rate increase provided in subdivision (4) of 1265
1506		-	subsection (f) of this section, but in no event earlier than October 1, 2005, 1266
1507		-	and provided the user fee imposed under section 17b-320 is required to 1267
1508		-	be collected, each facility shall receive a rate that is determined in 1268
1509		-	accordance with applicable law and subject to appropriations, except 1269
1510		-	any facility that would have been issued a lower rate effective October 1270
1511		-	1, 2005, than for the fiscal year ending June 30, 2005, due to interim rate 1271
1512		-	status or agreement with the department, shall be issued such lower rate 1272
1513		-	effective October 1, 2005. Such rate increase shall remain in effect unless: 1273
1514		-	[(A)] (1) The federal financial participation matching funds associated 1274
1515		-	with the rate increase are no longer available; or [(B)] (2) the user fee 1275
1516		-	created pursuant to section 17b-320 is not in effect. For the fiscal year 1276
1517		-	ending June 30, 2007, rates in effect for the period ending June 30, 2006, 1277
1518		-	shall remain in effect until September 30, 2006, except any facility that 1278
1519		-	would have been issued a lower rate effective July 1, 2006, than for the 1279
1520		-	fiscal year ending June 30, 2006, due to interim rate status or agreement 1280 Substitute Bill No. 6446
	1452	+	LCO No. 3112 38 of 51
	1453	+
	1454	+	the facility if the commissioner, with the approval of the Secretary of the 1243
	1455	+	Office of Policy and Management, determines that such higher rate is 1244
	1456	+	needed to keep the facility open and to ensure the health, safety and 1245
	1457	+	welfare of the residents at such facility. 1246
	1458	+	[(g)] (h) For the fiscal year ending June 30, 1993, any intermediate care 1247
	1459	+	facility for individuals with intellectual disabilities with an operating 1248
	1460	+	cost component of its rate in excess of one hundred forty per cent of the 1249
	1461	+	median of operating cost components of rates in effect January 1, 1992, 1250
	1462	+	shall not receive an operating cost component increase. For the fiscal 1251
	1463	+	year ending June 30, 1993, any intermediate care facility for individuals 1252
	1464	+	with intellectual disabilities with an operating cost component of its rate 1253
	1465	+	that is less than one hundred forty per cent of the median of operating 1254
	1466	+	cost components of rates in effect January 1, 1992, shall have an 1255
	1467	+	allowance for real wage growth equal to thirty per cent of the increase 1256
	1468	+	determined in accordance with subsection (q) of section 17-311-52 of the 1257
	1469	+	regulations of Connecticut state agencies, provided such operating cost 1258
	1470	+	component shall not exceed one hundred forty per cent of the median 1259
	1471	+	of operating cost components in effect January 1, 1992. Any facility with 1260
	1472	+	real property other than land placed in service prior to October 1, 1991, 1261
	1473	+	shall, for the fiscal year ending June 30, 1995, receive a rate of return on 1262
	1474	+	real property equal to the average of the rates of return applied to real 1263
	1475	+	property other than land placed in service for the five years preceding 1264
	1476	+	October 1, 1993. For the fiscal year ending June 30, 1996, and any 1265
	1477	+	succeeding fiscal year, the rate of return on real property for property 1266
	1478	+	items shall be revised every five years. The commissioner shall, upon 1267
	1479	+	submission of a request, allow actual debt service, comprised of 1268
	1480	+	principal and interest, in excess of property costs allowed pursuant to 1269
	1481	+	section 17-311-52 of the regulations of Connecticut state agencies, 1270
	1482	+	provided such debt service terms and amounts are reasonable in 1271
	1483	+	relation to the useful life and the base value of the property. For the fiscal 1272
	1484	+	year ending June 30, 1995, and any succeeding fiscal year, the inflation 1273
	1485	+	adjustment made in accordance with subsection (p) of section 17-311-52 1274
	1486	+	of the regulations of Connecticut state agencies shall not be applied to 1275
	1487	+	real property costs. For the fiscal year ending June 30, 1996, and any 1276 Governor's Bill No. 6446
1521	1488
1522	1489
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1526	1490
1527		-	with the department, shall be issued such lower rate effective July 1, 1281
1528		-	2006. Effective October 1, 2006, no facility shall receive a rate that is more 1282
1529		-	than four per cent greater than the rate in effect for the facility on 1283
1530		-	September 30, 2006, except for any facility that would have been issued 1284
1531		-	a lower rate effective October 1, 2006, due to interim rate status or 1285
1532		-	agreement with the department, shall be issued such lower rate effective 1286
1533		-	October 1, 2006. For the fiscal years ending June 30, 2010, and June 30, 1287
1534		-	2011, rates in effect for the period ending June 30, 2009, shall remain in 1288
1535		-	effect until June 30, 2011, except any facility that would have been issued 1289
1536		-	a lower rate for the fiscal year ending June 30, 2010, or the fiscal year 1290
1537		-	ending June 30, 2011, due to interim rate status or agreement with the 1291
1538		-	department, shall be issued such lower rate, except [(i)] (A) any facility 1292
1539		-	that would have been issued a lower rate for the fiscal year ending June 1293
1540		-	30, 2010, or the fiscal year ending June 30, 2011, due to interim rate status 1294
1541		-	or agreement with the Commissioner of Social Services shall be issued 1295
1542		-	such lower rate; and [(ii)] (B) the commissioner may increase a facility's 1296
1543		-	rate for reasonable costs associated with such facility's compliance with 1297
1544		-	the provisions of section 19a-495a concerning the administration of 1298
1545		-	medication by unlicensed personnel. For the fiscal year ending June 30, 1299
1546		-	2012, rates in effect for the period ending June 30, 2011, shall remain in 1300
1547		-	effect until June 30, 2012, except that [(I)] (i) any facility that would have 1301
1548		-	been issued a lower rate for the fiscal year ending June 30, 2012, due to 1302
1549		-	interim rate status or agreement with the Commissioner of Social 1303
1550		-	Services shall be issued such lower rate; and [(II)] (ii) the commissioner 1304
1551		-	may increase a facility's rate for reasonable costs associated with such 1305
1552		-	facility's compliance with the provisions of section 19a-495a concerning 1306
1553		-	the administration of medication by unlicensed personnel. For the fiscal 1307
1554		-	year ending June 30, 2013, the Commissioner of Social Services may, 1308
1555		-	within available appropriations, provide a rate increase to a residential 1309
1556		-	care home. Any facility that would have been issued a lower rate for the 1310
1557		-	fiscal year ending June 30, 2013, due to interim rate status or agreement 1311
1558		-	with the Commissioner of Social Services shall be issued such lower 1312
1559		-	rate. For the fiscal years ending June 30, 2012, and June 30, 2013, the 1313
1560		-	Commissioner of Social Services may provide fair rent increases to any 1314
1561		-	facility that has undergone a material change in circumstances related 1315 Substitute Bill No. 6446
	1491	+	LCO No. 3112 39 of 51
	1492	+
	1493	+	succeeding fiscal year, the allowance for real wage growth, as 1277
	1494	+	determined in accordance with subsection (q) of section 17-311-52 of the 1278
	1495	+	regulations of Connecticut state agencies, shall not be applied. For the 1279
	1496	+	fiscal year ending June 30, 1996, and any succeeding fiscal year, no rate 1280
	1497	+	shall exceed three hundred seventy-five dollars per day unless the 1281
	1498	+	commissioner, in consultation with the Commissioner of 1282
	1499	+	Developmental Services, determines after a review of program and 1283
	1500	+	management costs, that a rate in excess of this amount is necessary for 1284
	1501	+	care and treatment of facility residents. For the fiscal year ending June 1285
	1502	+	30, 2002, rate period, the Commissioner of Social Services shall increase 1286
	1503	+	the inflation adjustment for rates made in accordance with subsection 1287
	1504	+	(p) of section 17-311-52 of the regulations of Connecticut state agencies 1288
	1505	+	to update allowable fiscal year 2000 costs to include a three and one-half 1289
	1506	+	per cent inflation factor. For the fiscal year ending June 30, 2003, rate 1290
	1507	+	period, the commissioner shall increase the inflation adjustment for 1291
	1508	+	rates made in accordance with subsection (p) of section 17-311-52 of the 1292
	1509	+	regulations of Connecticut state agencies to update allowable fiscal year 1293
	1510	+	2001 costs to include a one and one-half per cent inflation factor, except 1294
	1511	+	that such increase shall be effective November 1, 2002, and such facility 1295
	1512	+	rate in effect for the fiscal year ending June 30, 2002, shall be paid for 1296
	1513	+	services provided until October 31, 2002, except any facility that would 1297
	1514	+	have been issued a lower rate effective July 1, 2002, than for the fiscal 1298
	1515	+	year ending June 30, 2002, due to interim rate status or agreement with 1299
	1516	+	the department shall be issued such lower rate effective July 1, 2002, and 1300
	1517	+	have such rate updated effective November 1, 2002, in accordance with 1301
	1518	+	applicable statutes and regulations. For the fiscal year ending June 30, 1302
	1519	+	2004, rates in effect for the period ending June 30, 2003, shall remain in 1303
	1520	+	effect, except any facility that would have been issued a lower rate 1304
	1521	+	effective July 1, 2003, than for the fiscal year ending June 30, 2003, due 1305
	1522	+	to interim rate status or agreement with the department shall be issued 1306
	1523	+	such lower rate effective July 1, 2003. For the fiscal year ending June 30, 1307
	1524	+	2005, rates in effect for the period ending June 30, 2004, shall remain in 1308
	1525	+	effect until September 30, 2004. Effective October 1, 2004, each facility 1309
	1526	+	shall receive a rate that is five per cent greater than the rate in effect 1310
	1527	+	September 30, 2004. Effective upon receipt of all the necessary federal 1311 Governor's Bill No. 6446
1562	1528
1563	1529
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1566		-	40 of 44
1567	1530
1568		-	to fair rent and has an approved certificate of need pursuant to section 1316
1569		-	17b-352, 17b-353, 17b-354 or 17b-355. For the fiscal years ending June 30, 1317
1570		-	2014, and June 30, 2015, for those facilities that have a calculated rate 1318
1571		-	greater than the rate in effect for the fiscal year ending June 30, 2013, the 1319
1572		-	commissioner may increase facility rates based upon available 1320
1573		-	appropriations up to a stop gain as determined by the commissioner. 1321
1574		-	No facility shall be issued a rate that is lower than the rate in effect on 1322
1575		-	June 30, 2013, except that any facility that would have been issued a 1323
1576		-	lower rate for the fiscal year ending June 30, 2014, or the fiscal year 1324
1577		-	ending June 30, 2015, due to interim rate status or agreement with the 1325
1578		-	commissioner, shall be issued such lower rate. For the fiscal year ending 1326
1579		-	June 30, 2014, and each fiscal year thereafter, a residential care home 1327
1580		-	shall receive a rate increase for any capital improvement made during 1328
1581		-	the fiscal year for the health and safety of residents and approved by the 1329
1582		-	Department of Social Services, provided such rate increase is within 1330
1583		-	available appropriations. For the fiscal year ending June 30, 2015, and 1331
1584		-	each succeeding fiscal year thereafter, costs of less than ten thousand 1332
1585		-	dollars that are incurred by a facility and are associated with any land, 1333
1586		-	building or nonmovable equipment repair or improvement that are 1334
1587		-	reported in the cost year used to establish the facility's rate shall not be 1335
1588		-	capitalized for a period of more than five years for rate-setting purposes. 1336
1589		-	For the fiscal year ending June 30, 2015, subject to available 1337
1590		-	appropriations, the commissioner may, at the commissioner's 1338
1591		-	discretion: Increase the inflation cost limitation under subsection (c) of 1339
1592		-	section 17-311-52 of the regulations of Connecticut state agencies, 1340
1593		-	provided such inflation allowance factor does not exceed a maximum of 1341
1594		-	five per cent; establish a minimum rate of return applied to real property 1342
1595		-	of five per cent inclusive of assets placed in service during cost year 1343
1596		-	2013; waive the standard rate of return under subsection (f) of section 1344
1597		-	17-311-52 of the regulations of Connecticut state agencies for ownership 1345
1598		-	changes or health and safety improvements that exceed one hundred 1346
1599		-	thousand dollars and that are required under a consent order from the 1347
1600		-	Department of Public Health; and waive the rate of return adjustment 1348
1601		-	under subsection (f) of section 17-311-52 of the regulations of 1349
1602		-	Connecticut state agencies to avoid financial hardship. For the fiscal 1350 Substitute Bill No. 6446
	1531	+	LCO No. 3112 40 of 51
	1532	+
	1533	+	approvals to secure federal financial participation matching funds 1312
	1534	+	associated with the rate increase provided in subdivision (4) of 1313
	1535	+	subsection (f) of this section, but in no event earlier than October 1, 2005, 1314
	1536	+	and provided the user fee imposed under section 17b-320 is required to 1315
	1537	+	be collected, each facility shall receive a rate that is four per cent more 1316
	1538	+	than the rate the facility received in the prior fiscal year, except any 1317
	1539	+	facility that would have been issued a lower rate effective October 1, 1318
	1540	+	2005, than for the fiscal year ending June 30, 2005, due to interim rate 1319
	1541	+	status or agreement with the department, shall be issued such lower rate 1320
	1542	+	effective October 1, 2005. Such rate increase shall remain in effect unless: 1321
	1543	+	(1) The federal financial participation matching funds associated with 1322
	1544	+	the rate increase are no longer available; or (2) the user fee created 1323
	1545	+	pursuant to section 17b-320 is not in effect. For the fiscal year ending 1324
	1546	+	June 30, 2007, rates in effect for the period ending June 30, 2006, shall 1325
	1547	+	remain in effect until September 30, 2006, except any facility that would 1326
	1548	+	have been issued a lower rate effective July 1, 2006, than for the fiscal 1327
	1549	+	year ending June 30, 2006, due to interim rate status or agreement with 1328
	1550	+	the department, shall be issued such lower rate effective July 1, 2006. 1329
	1551	+	Effective October 1, 2006, no facility shall receive a rate that is more than 1330
	1552	+	three per cent greater than the rate in effect for the facility on September 1331
	1553	+	30, 2006, except any facility that would have been issued a lower rate 1332
	1554	+	effective October 1, 2006, due to interim rate status or agreement with 1333
	1555	+	the department, shall be issued such lower rate effective October 1, 2006. 1334
	1556	+	For the fiscal year ending June 30, 2008, each facility shall receive a rate 1335
	1557	+	that is two and nine-tenths per cent greater than the rate in effect for the 1336
	1558	+	period ending June 30, 2007, except any facility that would have been 1337
	1559	+	issued a lower rate effective July 1, 2007, than for the rate period ending 1338
	1560	+	June 30, 2007, due to interim rate status, or agreement with the 1339
	1561	+	department, shall be issued such lower rate effective July 1, 2007. For the 1340
	1562	+	fiscal year ending June 30, 2009, rates in effect for the period ending June 1341
	1563	+	30, 2008, shall remain in effect until June 30, 2009, except any facility that 1342
	1564	+	would have been issued a lower rate for the fiscal year ending June 30, 1343
	1565	+	2009, due to interim rate status or agreement with the department, shall 1344
	1566	+	be issued such lower rate. For the fiscal years ending June 30, 2010, and 1345
	1567	+	June 30, 2011, rates in effect for the period ending June 30, 2009, shall 1346 Governor's Bill No. 6446
1603	1568
1604	1569
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1607		-	41 of 44
1608	1570
1609		-	years ending June 30, 2016, and June 30, 2017, rates shall not exceed 1351
1610		-	those in effect for the period ending June 30, 2015, except the 1352
1611		-	commissioner may, in the commissioner's discretion and within 1353
1612		-	available appropriations, provide pro rata fair rent increases to facilities 1354
1613		-	which have documented fair rent additions placed in service in cost 1355
1614		-	report years ending September 30, 2014, and September 30, 2015, that 1356
1615		-	are not otherwise included in rates issued. For the fiscal years ending 1357
1616		-	June 30, 2016, and June 30, 2017, and each succeeding fiscal year, any 1358
1617		-	facility that would have been issued a lower rate, due to interim rate 1359
1618		-	status, a change in allowable fair rent or agreement with the department, 1360
1619		-	shall be issued such lower rate. For the fiscal year ending June 30, 2018, 1361
1620		-	rates shall not exceed those in effect for the period ending June 30, 2017, 1362
1621		-	except the commissioner may, in the commissioner's discretion and 1363
1622		-	within available appropriations, provide pro rata fair rent increases to 1364
1623		-	facilities which have documented fair rent additions placed in service in 1365
1624		-	the cost report year ending September 30, 2016, that are not otherwise 1366
1625		-	included in rates issued. For the fiscal year ending June 30, 2019, rates 1367
1626		-	shall not exceed those in effect for the period ending June 30, 2018, 1368
1627		-	except the commissioner may, in the commissioner's discretion and 1369
1628		-	within available appropriations, provide pro rata fair rent increases to 1370
1629		-	facilities which have documented fair rent additions placed in service in 1371
1630		-	the cost report year ending September 30, 2017, that are not otherwise 1372
1631		-	included in rates issued. For the fiscal year ending June 30, 2020, rates 1373
1632		-	shall not exceed those in effect for the fiscal year ending June 30, 2019, 1374
1633		-	except the commissioner may, in the commissioner's discretion and 1375
1634		-	within available appropriations, provide pro rata fair rent increases to 1376
1635		-	facilities which have documented fair rent additions placed in service in 1377
1636		-	the cost report year ending September 30, 2018, that are not otherwise 1378
1637		-	included in rates issued. For the fiscal year ending June 30, 2021, rates 1379
1638		-	shall not exceed those in effect for the fiscal year ending June 30, 2020, 1380
1639		-	except the commissioner may, in the commissioner's discretion and 1381
1640		-	within available appropriations, provide pro rata fair rent increases to 1382
1641		-	facilities which have documented fair rent additions placed in service in 1383
1642		-	the cost report year ending September 30, 2019, that are not otherwise 1384
1643		-	included in rates issued. For the fiscal year ending June 30, 2022, the 1385 Substitute Bill No. 6446
	1571	+	LCO No. 3112 41 of 51
	1572	+
	1573	+	remain in effect until June 30, 2011, except any facility that would have 1347
	1574	+	been issued a lower rate for the fiscal year ending June 30, 2010, or the 1348
	1575	+	fiscal year ending June 30, 2011, due to interim rate status or agreement 1349
	1576	+	with the department, shall be issued such lower rate. For the fiscal year 1350
	1577	+	ending June 30, 2012, rates in effect for the period ending June 30, 2011, 1351
	1578	+	shall remain in effect until June 30, 2012, except any facility that would 1352
	1579	+	have been issued a lower rate for the fiscal year ending June 30, 2012, 1353
	1580	+	due to interim rate status or agreement with the department, shall be 1354
	1581	+	issued such lower rate. For the fiscal years ending June 30, 2014, and 1355
	1582	+	June 30, 2015, rates shall not exceed those in effect for the period ending 1356
	1583	+	June 30, 2013, except the rate paid to a facility may be higher than the 1357
	1584	+	rate paid to the facility for the period ending June 30, 2013, if a capital 1358
	1585	+	improvement approved by the Department of Developmental Services, 1359
	1586	+	in consultation with the Department of Social Services, for the health or 1360
	1587	+	safety of the residents was made to the facility during the fiscal year 1361
	1588	+	ending June 30, 2014, or June 30, 2015, to the extent such rate increases 1362
	1589	+	are within available appropriations. Any facility that would have been 1363
	1590	+	issued a lower rate for the fiscal year ending June 30, 2014, or the fiscal 1364
	1591	+	year ending June 30, 2015, due to interim rate status or agreement with 1365
	1592	+	the department, shall be issued such lower rate. For the fiscal years 1366
	1593	+	ending June 30, 2016, and June 30, 2017, rates shall not exceed those in 1367
	1594	+	effect for the period ending June 30, 2015, except the rate paid to a 1368
	1595	+	facility may be higher than the rate paid to the facility for the period 1369
	1596	+	ending June 30, 2015, if a capital improvement approved by the 1370
	1597	+	Department of Developmental Services, in consultation with the 1371
	1598	+	Department of Social Services, for the health or safety of the residents 1372
	1599	+	was made to the facility during the fiscal year ending June 30, 2016, or 1373
	1600	+	June 30, 2017, to the extent such rate increases are within available 1374
	1601	+	appropriations. For the fiscal years ending June 30, 2016, and June 30, 1375
	1602	+	2017, and each succeeding fiscal year, any facility that would have been 1376
	1603	+	issued a lower rate, due to interim rate status, a change in allowable fair 1377
	1604	+	rent or agreement with the department, shall be issued such lower rate. 1378
	1605	+	For the fiscal years ending June 30, 2018, and June 30, 2019, rates shall 1379
	1606	+	not exceed those in effect for the period ending June 30, 2017, except the 1380
	1607	+	rate paid to a facility may be higher than the rate paid to the facility for 1381 Governor's Bill No. 6446
1644	1608
1645	1609
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1648		-	42 of 44
1649	1610
1650		-	commissioner may, in the commissioner's discretion and within 1386
1651		-	available appropriations, provide pro rata fair rent increases to facilities 1387
1652		-	which have documented fair rent additions placed in service in the cost 1388
1653		-	report year ending September 30, 2020, that are not otherwise included 1389
1654		-	in rates issued. For the fiscal year ending June 30, 2023, the 1390
1655		-	commissioner may, in the commissioner's discretion and within 1391
1656		-	available appropriations, provide pro rata fair rent increases to facilities 1392
1657		-	which have documented fair rent additions placed in service in the cost 1393
1658		-	report year ending September 30, 2021, that are not otherwise included 1394
1659		-	in rates issued. 1395
1660		-	[(2) The commissioner shall, upon determining that a loan to be 1396
1661		-	issued to a residential care home by the Connecticut Housing Finance 1397
1662		-	Authority is reasonable in relation to the useful life and property cost 1398
1663		-	allowance pursuant to section 17-311-52 of the regulations of 1399
1664		-	Connecticut state agencies, allow actual debt service, comprised of 1400
1665		-	principal, interest and a repair and replacement reserve on the loan, in 1401
1666		-	lieu of allowed property costs whether actual debt service is higher or 1402
1667		-	lower than such allowed property costs. 1403
1668		-	(i) Notwithstanding the provisions of this section, the Commissioner 1404
1669		-	of Social Services shall establish a fee schedule for payments to be made 1405
1670		-	to chronic disease hospitals associated with chronic and convalescent 1406
1671		-	nursing homes to be effective on and after July 1, 1995. The fee schedule 1407
1672		-	may be adjusted annually beginning July 1, 1997, to reflect necessary 1408
1673		-	increases in the cost of services.] 1409
1674		-	(j) Notwithstanding the provisions of this section, state rates of 1410
1675		-	payment for the fiscal years ending June 30, 2018, June 30, 2019, June 30, 1411
1676		-	2020, and June 30, 2021, for residential care homes and community 1412
1677		-	living arrangements that receive the flat rate for residential services 1413
1678		-	under section 17-311-54 of the regulations of Connecticut state agencies 1414
1679		-	shall be set in accordance with section 298 of public act 19-117. 1415
1680		-	Sec. 4. Subsection (a) of section 19a-507 of the general statutes is 1416
1681		-	repealed and the following is substituted in lieu thereof (Effective July 1, 1417 Substitute Bill No. 6446
	1611	+	LCO No. 3112 42 of 51
	1612	+
	1613	+	the period ending June 30, 2017, if a capital improvement approved by 1382
	1614	+	the Department of Developmental Services, in consultation with the 1383
	1615	+	Department of Social Services, for the health or safety of the residents 1384
	1616	+	was made to the facility during the fiscal year ending June 30, 2018, or 1385
	1617	+	June 30, 2019, only to the extent such rate increases are within available 1386
	1618	+	appropriations. For the fiscal years ending June 30, 2020, and June 30, 1387
	1619	+	2021, rates shall not exceed those in effect for the fiscal year ending June 1388
	1620	+	30, 2019, except the rate paid to a facility may be higher than the rate 1389
	1621	+	paid to the facility for the fiscal year ending June 30, 2019, if a capital 1390
	1622	+	improvement approved by the Department of Developmental Services, 1391
	1623	+	in consultation with the Department of Social Services, for the health or 1392
	1624	+	safety of the residents was made to the facility during the fiscal year 1393
	1625	+	ending June 30, 2020, or June 30, 2021, only to the extent such rate 1394
	1626	+	increases are within available appropriations. For the fiscal years ending 1395
	1627	+	June 30, 2022, and June 30, 2023, rates shall not exceed those in effect for 1396
	1628	+	the fiscal year ending June 30, 2021, except the rate paid to a facility may 1397
	1629	+	be higher than the rate paid to the facility for the fiscal year ending June 1398
	1630	+	30, 2021, if a capital improvement approved by the Department of 1399
	1631	+	Developmental Services, in consultation with the Department of Social 1400
	1632	+	Services, for the health or safety of the residents was made to the facility 1401
	1633	+	during the fiscal year ending June 30, 2022, or June 30, 2023, only to the 1402
	1634	+	extent such rate increases are within available appropriations. Any 1403
	1635	+	facility that has a significant decrease in land and building costs shall 1404
	1636	+	receive a reduced rate to reflect such decrease in land and building costs. 1405
	1637	+	For the fiscal years ending June 30, 2012, June 30, 2013, June 30, 2014, 1406
	1638	+	June 30, 2015, June 30, 2016, June 30, 2017, June 30, 2018, June 30, 2019, 1407
	1639	+	June 30, 2020, [and] June 30, 2021, June 30, 2022, and June 30, 2023, the 1408
	1640	+	Commissioner of Social Services may provide fair rent increases to any 1409
	1641	+	facility that has undergone a material change in circumstances related 1410
	1642	+	to fair rent and has an approved certificate of need pursuant to section 1411
	1643	+	17b-352, 17b-353, 17b-354 or 17b-355. Notwithstanding the provisions of 1412
	1644	+	this section, the Commissioner of Social Services may, within available 1413
	1645	+	appropriations, increase or decrease rates issued to intermediate care 1414
	1646	+	facilities for individuals with intellectual disabilities to reflect a 1415
	1647	+	reduction in available appropriations as provided in subsection (a) of 1416 Governor's Bill No. 6446
1682	1648
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1686		-	43 of 44
1687	1650
1688		-	2021): 1418
1689		-	(a) Notwithstanding the provisions of chapter 368z, New Horizons, 1419
1690		-	Inc., a nonprofit, nonsectarian organization, or a subsidiary 1420
1691		-	organization controlled by New Horizons, Inc., is authorized to 1421
1692		-	construct and operate an independent living facility for severely 1422
1693		-	physically disabled adults, in the town of Farmington, provided such 1423
1694		-	facility shall be constructed in accordance with applicable building 1424
1695		-	codes. The Farmington Housing Authority, or any issuer acting on 1425
1696		-	behalf of said authority, subject to the provisions of this section, may 1426
1697		-	issue tax-exempt revenue bonds on a competitive or negotiated basis for 1427
1698		-	the purpose of providing construction and permanent mortgage 1428
1699		-	financing for the facility in accordance with Section 103 of the Internal 1429
1700		-	Revenue Code. Prior to the issuance of such bonds, plans for the 1430
1701		-	construction of the facility shall be submitted to and approved by the 1431
1702		-	Health Systems Planning Unit of the Office of Health Strategy. The unit 1432
1703		-	shall approve or disapprove such plans within thirty days of receipt 1433
1704		-	thereof. If the plans are disapproved they may be resubmitted. Failure 1434
1705		-	of the unit to act on the plans within such thirty-day period shall be 1435
1706		-	deemed approval thereof. The payments to residents of the facility who 1436
1707		-	are eligible for assistance under the state supplement program for room 1437
1708		-	and board and necessary services, shall be determined annually to be 1438
1709		-	effective July first of each year. Such payments shall be determined on a 1439
1710		-	basis of a reasonable payment for necessary services, which basis shall 1440
1711		-	take into account as a factor the costs of providing those services and 1441
1712		-	such other factors as the commissioner deems reasonable, including 1442
1713		-	anticipated fluctuations in the cost of providing services. Such payments 1443
1714		-	shall be calculated in accordance with the manner in which rates are 1444
1715		-	calculated pursuant to subsection [(h)] (i) of section 17b-340, as amended 1445
1716		-	by this act, and the cost-related reimbursement system pursuant to said 1446
1717		-	section except that efficiency incentives shall not be granted. The 1447
1718		-	commissioner may adjust such rates to account for the availability of 1448
1719		-	personal care services for residents under the Medicaid program. The 1449
1720		-	commissioner shall, upon submission of a request, allow actual debt 1450
1721		-	service, comprised of principal and interest, in excess of property costs 1451 Substitute Bill No. 6446
	1651	+	LCO No. 3112 43 of 51
	1652	+
	1653	+	this section. For the fiscal years ending June 30, 2014, and June 30, 2015, 1417
	1654	+	the commissioner shall not consider rebasing in determining rates. 1418
	1655	+	[(h) (1)] (i) For the fiscal year ending June 30, 1993, any residential 1419
	1656	+	care home with an operating cost component of its rate in excess of one 1420
	1657	+	hundred thirty per cent of the median of operating cost components of 1421
	1658	+	rates in effect January 1, 1992, shall not receive an operating cost 1422
	1659	+	component increase. For the fiscal year ending June 30, 1993, any 1423
	1660	+	residential care home with an operating cost component of its rate that 1424
	1661	+	is less than one hundred thirty per cent of the median of operating cost 1425
	1662	+	components of rates in effect January 1, 1992, shall have an allowance 1426
	1663	+	for real wage growth equal to sixty-five per cent of the increase 1427
	1664	+	determined in accordance with subsection (q) of section 17-311-52 of the 1428
	1665	+	regulations of Connecticut state agencies, provided such operating cost 1429
	1666	+	component shall not exceed one hundred thirty per cent of the median 1430
	1667	+	of operating cost components in effect January 1, 1992. Beginning with 1431
	1668	+	the fiscal year ending June 30, 1993, for the purpose of determining 1432
	1669	+	allowable fair rent, a residential care home with allowable fair rent less 1433
	1670	+	than the twenty-fifth percentile of the state-wide allowable fair rent shall 1434
	1671	+	be reimbursed as having allowable fair rent equal to the twenty-fifth 1435
	1672	+	percentile of the state-wide allowable fair rent. Beginning with the fiscal 1436
	1673	+	year ending June 30, 1997, a residential care home with allowable fair 1437
	1674	+	rent less than three dollars and ten cents per day shall be reimbursed as 1438
	1675	+	having allowable fair rent equal to three dollars and ten cents per day. 1439
	1676	+	Property additions placed in service during the cost year ending 1440
	1677	+	September 30, 1996, or any succeeding cost year shall receive a fair rent 1441
	1678	+	allowance for such additions as an addition to three dollars and ten 1442
	1679	+	cents per day if the fair rent for the facility for property placed in service 1443
	1680	+	prior to September 30, 1995, is less than or equal to three dollars and ten 1444
	1681	+	cents per day. Beginning with the fiscal year ending June 30, 2016, a 1445
	1682	+	residential care home shall be reimbursed the greater of the allowable 1446
	1683	+	accumulated fair rent reimbursement associated with real property 1447
	1684	+	additions and land as calculated on a per day basis or three dollars and 1448
	1685	+	ten cents per day if the allowable reimbursement associated with real 1449
	1686	+	property additions and land is less than three dollars and ten cents per 1450 Governor's Bill No. 6446
1722	1687
1723	1688
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1726		-	44 of 44
1727	1689
1728		-	allowed pursuant to section 17-313b-5 of the regulations of Connecticut 1452
1729		-	state agencies, provided such debt service terms and amounts are 1453
1730		-	reasonable in relation to the useful life and the base value of the 1454
1731		-	property. The cost basis for such payment shall be subject to audit, and 1455
1732		-	a recomputation of the rate shall be made based upon such audit. The 1456
1733		-	facility shall report on a fiscal year ending on the thirtieth day of 1457
1734		-	September on forms provided by the commissioner. The required report 1458
1735		-	shall be received by the commissioner no later than December thirty-1459
1736		-	first of each year. The Department of Social Services may use its existing 1460
1737		-	utilization review procedures to monitor utilization of the facility. If the 1461
1738		-	facility is aggrieved by any decision of the commissioner, the facility 1462
1739		-	may, within ten days, after written notice thereof from the 1463
1740		-	commissioner, obtain by written request to the commissioner, a hearing 1464
1741		-	on all items of aggrievement. If the facility is aggrieved by the decision 1465
1742		-	of the commissioner after such hearing, the facility may appeal to the 1466
1743		-	Superior Court in accordance with the provisions of section 4-183. 1467
	1690	+	LCO No. 3112 44 of 51
	1691	+
	1692	+	day. For the fiscal year ending June 30, 1996, and any succeeding fiscal 1451
	1693	+	year, the allowance for real wage growth, as determined in accordance 1452
	1694	+	with subsection (q) of section 17-311-52 of the regulations of Connecticut 1453
	1695	+	state agencies, shall not be applied. For the fiscal year ending June 30, 1454
	1696	+	1996, and any succeeding fiscal year, the inflation adjustment made in 1455
	1697	+	accordance with subsection (p) of section 17-311-52 of the regulations of 1456
	1698	+	Connecticut state agencies shall not be applied to real property costs. 1457
	1699	+	Beginning with the fiscal year ending June 30, 1997, minimum allowable 1458
	1700	+	patient days for rate computation purposes for a residential care home 1459
	1701	+	with twenty-five beds or less shall be eighty-five per cent of licensed 1460
	1702	+	capacity. Beginning with the fiscal year ending June 30, 2002, for the 1461
	1703	+	purposes of determining the allowable salary of an administrator of a 1462
	1704	+	residential care home with sixty beds or less the department shall revise 1463
	1705	+	the allowable base salary to thirty-seven thousand dollars to be annually 1464
	1706	+	inflated thereafter in accordance with section 17-311-52 of the 1465
	1707	+	regulations of Connecticut state agencies. The rates for the fiscal year 1466
	1708	+	ending June 30, 2002, shall be based upon the increased allowable salary 1467
	1709	+	of an administrator, regardless of whether such amount was expended 1468
	1710	+	in the 2000 cost report period upon which the rates are based. Beginning 1469
	1711	+	with the fiscal year ending June 30, 2000, and until the fiscal year ending 1470
	1712	+	June 30, 2009, inclusive, the inflation adjustment for rates made in 1471
	1713	+	accordance with subsection (p) of section 17-311-52 of the regulations of 1472
	1714	+	Connecticut state agencies shall be increased by two per cent, and 1473
	1715	+	beginning with the fiscal year ending June 30, 2002, the inflation 1474
	1716	+	adjustment for rates made in accordance with subsection (c) of said 1475
	1717	+	section shall be increased by one per cent. Beginning with the fiscal year 1476
	1718	+	ending June 30, 1999, for the purpose of determining the allowable 1477
	1719	+	salary of a related party, the department shall revise the maximum 1478
	1720	+	salary to twenty-seven thousand eight hundred fifty-six dollars to be 1479
	1721	+	annually inflated thereafter in accordance with section 17-311-52 of the 1480
	1722	+	regulations of Connecticut state agencies and beginning with the fiscal 1481
	1723	+	year ending June 30, 2001, such allowable salary shall be computed on 1482
	1724	+	an hourly basis and the maximum number of hours allowed for a related 1483
	1725	+	party other than the proprietor shall be increased from forty hours to 1484
	1726	+	forty-eight hours per work week. For the fiscal year ending June 30, 1485 Governor's Bill No. 6446
	1727	+
	1728	+
	1729	+
	1730	+	LCO No. 3112 45 of 51
	1731	+
	1732	+	2005, each facility shall receive a rate that is two and one-quarter per 1486
	1733	+	cent more than the rate the facility received in the prior fiscal year, 1487
	1734	+	except any facility that would have been issued a lower rate effective 1488
	1735	+	July 1, 2004, than for the fiscal year ending June 30, 2004, due to interim 1489
	1736	+	rate status or agreement with the department shall be issued such lower 1490
	1737	+	rate effective July 1, 2004. Effective upon receipt of all the necessary 1491
	1738	+	federal approvals to secure federal financial participation matching 1492
	1739	+	funds associated with the rate increase provided in subdivision (4) of 1493
	1740	+	subsection (f) of this section, but in no event earlier than October 1, 2005, 1494
	1741	+	and provided the user fee imposed under section 17b-320 is required to 1495
	1742	+	be collected, each facility shall receive a rate that is determined in 1496
	1743	+	accordance with applicable law and subject to appropriations, except 1497
	1744	+	any facility that would have been issued a lower rate effective October 1498
	1745	+	1, 2005, than for the fiscal year ending June 30, 2005, due to interim rate 1499
	1746	+	status or agreement with the department, shall be issued such lower rate 1500
	1747	+	effective October 1, 2005. Such rate increase shall remain in effect unless: 1501
	1748	+	[(A)] (1) The federal financial participation matching funds associated 1502
	1749	+	with the rate increase are no longer available; or [(B)] (2) the user fee 1503
	1750	+	created pursuant to section 17b-320 is not in effect. For the fiscal year 1504
	1751	+	ending June 30, 2007, rates in effect for the period ending June 30, 2006, 1505
	1752	+	shall remain in effect until September 30, 2006, except any facility that 1506
	1753	+	would have been issued a lower rate effective July 1, 2006, than for the 1507
	1754	+	fiscal year ending June 30, 2006, due to interim rate status or agreement 1508
	1755	+	with the department, shall be issued such lower rate effective July 1, 1509
	1756	+	2006. Effective October 1, 2006, no facility shall receive a rate that is more 1510
	1757	+	than four per cent greater than the rate in effect for the facility on 1511
	1758	+	September 30, 2006, except for any facility that would have been issued 1512
	1759	+	a lower rate effective October 1, 2006, due to interim rate status or 1513
	1760	+	agreement with the department, shall be issued such lower rate effective 1514
	1761	+	October 1, 2006. For the fiscal years ending June 30, 2010, and June 30, 1515
	1762	+	2011, rates in effect for the period ending June 30, 2009, shall remain in 1516
	1763	+	effect until June 30, 2011, except any facility that would have been issued 1517
	1764	+	a lower rate for the fiscal year ending June 30, 2010, or the fiscal year 1518
	1765	+	ending June 30, 2011, due to interim rate status or agreement with the 1519
	1766	+	department, shall be issued such lower rate, except [(i)] (A) any facility 1520 Governor's Bill No. 6446
	1767	+
	1768	+
	1769	+
	1770	+	LCO No. 3112 46 of 51
	1771	+
	1772	+	that would have been issued a lower rate for the fiscal year ending June 1521
	1773	+	30, 2010, or the fiscal year ending June 30, 2011, due to interim rate status 1522
	1774	+	or agreement with the Commissioner of Social Services shall be issued 1523
	1775	+	such lower rate; and [(ii)] (B) the commissioner may increase a facility's 1524
	1776	+	rate for reasonable costs associated with such facility's compliance with 1525
	1777	+	the provisions of section 19a-495a concerning the administration of 1526
	1778	+	medication by unlicensed personnel. For the fiscal year ending June 30, 1527
	1779	+	2012, rates in effect for the period ending June 30, 2011, shall remain in 1528
	1780	+	effect until June 30, 2012, except that [(I)] (i) any facility that would have 1529
	1781	+	been issued a lower rate for the fiscal year ending June 30, 2012, due to 1530
	1782	+	interim rate status or agreement with the Commissioner of Social 1531
	1783	+	Services shall be issued such lower rate; and [(II)] (ii) the commissioner 1532
	1784	+	may increase a facility's rate for reasonable costs associated with such 1533
	1785	+	facility's compliance with the provisions of section 19a-495a concerning 1534
	1786	+	the administration of medication by unlicensed personnel. For the fiscal 1535
	1787	+	year ending June 30, 2013, the Commissioner of Social Services may, 1536
	1788	+	within available appropriations, provide a rate increase to a residential 1537
	1789	+	care home. Any facility that would have been issued a lower rate for the 1538
	1790	+	fiscal year ending June 30, 2013, due to interim rate status or agreement 1539
	1791	+	with the Commissioner of Social Services shall be issued such lower 1540
	1792	+	rate. For the fiscal years ending June 30, 2012, and June 30, 2013, the 1541
	1793	+	Commissioner of Social Services may provide fair rent increases to any 1542
	1794	+	facility that has undergone a material change in circumstances related 1543
	1795	+	to fair rent and has an approved certificate of need pursuant to section 1544
	1796	+	17b-352, 17b-353, 17b-354 or 17b-355. For the fiscal years ending June 30, 1545
	1797	+	2014, and June 30, 2015, for those facilities that have a calculated rate 1546
	1798	+	greater than the rate in effect for the fiscal year ending June 30, 2013, the 1547
	1799	+	commissioner may increase facility rates based upon available 1548
	1800	+	appropriations up to a stop gain as determined by the commissioner. 1549
	1801	+	No facility shall be issued a rate that is lower than the rate in effect on 1550
	1802	+	June 30, 2013, except that any facility that would have been issued a 1551
	1803	+	lower rate for the fiscal year ending June 30, 2014, or the fiscal year 1552
	1804	+	ending June 30, 2015, due to interim rate status or agreement with the 1553
	1805	+	commissioner, shall be issued such lower rate. For the fiscal year ending 1554
	1806	+	June 30, 2014, and each fiscal year thereafter, a residential care home 1555 Governor's Bill No. 6446
	1807	+
	1808	+
	1809	+
	1810	+	LCO No. 3112 47 of 51
	1811	+
	1812	+	shall receive a rate increase for any capital improvement made during 1556
	1813	+	the fiscal year for the health and safety of residents and approved by the 1557
	1814	+	Department of Social Services, provided such rate increase is within 1558
	1815	+	available appropriations. For the fiscal year ending June 30, 2015, and 1559
	1816	+	each succeeding fiscal year thereafter, costs of less than ten thousand 1560
	1817	+	dollars that are incurred by a facility and are associated with any land, 1561
	1818	+	building or nonmovable equipment repair or improvement that are 1562
	1819	+	reported in the cost year used to establish the facility's rate shall not be 1563
	1820	+	capitalized for a period of more than five years for rate-setting purposes. 1564
	1821	+	For the fiscal year ending June 30, 2015, subject to available 1565
	1822	+	appropriations, the commissioner may, at the commissioner's 1566
	1823	+	discretion: Increase the inflation cost limitation under subsection (c) of 1567
	1824	+	section 17-311-52 of the regulations of Connecticut state agencies, 1568
	1825	+	provided such inflation allowance factor does not exceed a maximum of 1569
	1826	+	five per cent; establish a minimum rate of return applied to real property 1570
	1827	+	of five per cent inclusive of assets placed in service during cost year 1571
	1828	+	2013; waive the standard rate of return under subsection (f) of section 1572
	1829	+	17-311-52 of the regulations of Connecticut state agencies for ownership 1573
	1830	+	changes or health and safety improvements that exceed one hundred 1574
	1831	+	thousand dollars and that are required under a consent order from the 1575
	1832	+	Department of Public Health; and waive the rate of return adjustment 1576
	1833	+	under subsection (f) of section 17-311-52 of the regulations of 1577
	1834	+	Connecticut state agencies to avoid financial hardship. For the fiscal 1578
	1835	+	years ending June 30, 2016, and June 30, 2017, rates shall not exceed 1579
	1836	+	those in effect for the period ending June 30, 2015, except the 1580
	1837	+	commissioner may, in the commissioner's discretion and within 1581
	1838	+	available appropriations, provide pro rata fair rent increases to facilities 1582
	1839	+	which have documented fair rent additions placed in service in cost 1583
	1840	+	report years ending September 30, 2014, and September 30, 2015, that 1584
	1841	+	are not otherwise included in rates issued. For the fiscal years ending 1585
	1842	+	June 30, 2016, and June 30, 2017, and each succeeding fiscal year, any 1586
	1843	+	facility that would have been issued a lower rate, due to interim rate 1587
	1844	+	status, a change in allowable fair rent or agreement with the department, 1588
	1845	+	shall be issued such lower rate. For the fiscal year ending June 30, 2018, 1589
	1846	+	rates shall not exceed those in effect for the period ending June 30, 2017, 1590 Governor's Bill No. 6446
	1847	+
	1848	+
	1849	+
	1850	+	LCO No. 3112 48 of 51
	1851	+
	1852	+	except the commissioner may, in the commissioner's discretion and 1591
	1853	+	within available appropriations, provide pro rata fair rent increases to 1592
	1854	+	facilities which have documented fair rent additions placed in service in 1593
	1855	+	the cost report year ending September 30, 2016, that are not otherwise 1594
	1856	+	included in rates issued. For the fiscal year ending June 30, 2019, rates 1595
	1857	+	shall not exceed those in effect for the period ending June 30, 2018, 1596
	1858	+	except the commissioner may, in the commissioner's discretion and 1597
	1859	+	within available appropriations, provide pro rata fair rent increases to 1598
	1860	+	facilities which have documented fair rent additions placed in service in 1599
	1861	+	the cost report year ending September 30, 2017, that are not otherwise 1600
	1862	+	included in rates issued. For the fiscal year ending June 30, 2020, rates 1601
	1863	+	shall not exceed those in effect for the fiscal year ending June 30, 2019, 1602
	1864	+	except the commissioner may, in the commissioner's discretion and 1603
	1865	+	within available appropriations, provide pro rata fair rent increases to 1604
	1866	+	facilities which have documented fair rent additions placed in service in 1605
	1867	+	the cost report year ending September 30, 2018, that are not otherwise 1606
	1868	+	included in rates issued. For the fiscal year ending June 30, 2021, rates 1607
	1869	+	shall not exceed those in effect for the fiscal year ending June 30, 2020, 1608
	1870	+	except the commissioner may, in the commissioner's discretion and 1609
	1871	+	within available appropriations, provide pro rata fair rent increases to 1610
	1872	+	facilities which have documented fair rent additions placed in service in 1611
	1873	+	the cost report year ending September 30, 2019, that are not otherwise 1612
	1874	+	included in rates issued. For the fiscal year ending June 30, 2022, rates 1613
	1875	+	shall not exceed those in effect for the fiscal year ending June 30, 2021, 1614
	1876	+	except the commissioner may, in the commissioner's discretion and 1615
	1877	+	within available appropriations, provide pro rata fair rent increases to 1616
	1878	+	facilities which have documented fair rent additions placed in service in 1617
	1879	+	the cost report year ending September 30, 2020, that are not otherwise 1618
	1880	+	included in rates issued. For the fiscal year ending June 30, 2023, rates 1619
	1881	+	shall not exceed those in effect for the fiscal year ending June 30, 2022, 1620
	1882	+	except the commissioner may, in the commissioner's discretion and 1621
	1883	+	within available appropriations, provide pro rata fair rent increases to 1622
	1884	+	facilities which have documented fair rent additions placed in service in 1623
	1885	+	the cost report year ending September 30, 2021, that are not otherwise 1624
	1886	+	included in rates issued. 1625 Governor's Bill No. 6446
	1887	+
	1888	+
	1889	+
	1890	+	LCO No. 3112 49 of 51
	1891	+
	1892	+	[(2) The commissioner shall, upon determining that a loan to be 1626
	1893	+	issued to a residential care home by the Connecticut Housing Finance 1627
	1894	+	Authority is reasonable in relation to the useful life and property cost 1628
	1895	+	allowance pursuant to section 17-311-52 of the regulations of 1629
	1896	+	Connecticut state agencies, allow actual debt service, comprised of 1630
	1897	+	principal, interest and a repair and replacement reserve on the loan, in 1631
	1898	+	lieu of allowed property costs whether actual debt service is higher or 1632
	1899	+	lower than such allowed property costs. 1633
	1900	+	(i) Notwithstanding the provisions of this section, the Commissioner 1634
	1901	+	of Social Services shall establish a fee schedule for payments to be made 1635
	1902	+	to chronic disease hospitals associated with chronic and convalescent 1636
	1903	+	nursing homes to be effective on and after July 1, 1995. The fee schedule 1637
	1904	+	may be adjusted annually beginning July 1, 1997, to reflect necessary 1638
	1905	+	increases in the cost of services.] 1639
	1906	+	(j) Notwithstanding the provisions of this section, state rates of 1640
	1907	+	payment for the fiscal years ending June 30, 2018, June 30, 2019, June 30, 1641
	1908	+	2020, [and] June 30, 2021, June 30, 2022, and June 30, 2023, for residential 1642
	1909	+	care homes and community living arrangements that receive the flat rate 1643
	1910	+	for residential services under section 17-311-54 of the regulations of 1644
	1911	+	Connecticut state agencies shall be set in accordance with section [298 of 1645
	1912	+	public act 19-117] 6 of this act. 1646
	1913	+	Sec. 9. Subsection (a) of section 19a-507 of the general statutes is 1647
	1914	+	repealed and the following is substituted in lieu thereof (Effective July 1, 1648
	1915	+	2021): 1649
	1916	+	(a) Notwithstanding the provisions of chapter 368z, New Horizons, 1650
	1917	+	Inc., a nonprofit, nonsectarian organization, or a subsidiary 1651
	1918	+	organization controlled by New Horizons, Inc., is authorized to 1652
	1919	+	construct and operate an independent living facility for severely 1653
	1920	+	physically disabled adults, in the town of Farmington, provided such 1654
	1921	+	facility shall be constructed in accordance with applicable building 1655
	1922	+	codes. The Farmington Housing Authority, or any issuer acting on 1656
	1923	+	behalf of said authority, subject to the provisions of this section, may 1657 Governor's Bill No. 6446
	1924	+
	1925	+
	1926	+
	1927	+	LCO No. 3112 50 of 51
	1928	+
	1929	+	issue tax-exempt revenue bonds on a competitive or negotiated basis for 1658
	1930	+	the purpose of providing construction and permanent mortgage 1659
	1931	+	financing for the facility in accordance with Section 103 of the Internal 1660
	1932	+	Revenue Code. Prior to the issuance of such bonds, plans for the 1661
	1933	+	construction of the facility shall be submitted to and approved by the 1662
	1934	+	Health Systems Planning Unit of the Office of Health Strategy. The unit 1663
	1935	+	shall approve or disapprove such plans within thirty days of receipt 1664
	1936	+	thereof. If the plans are disapproved they may be resubmitted. Failure 1665
	1937	+	of the unit to act on the plans within such thirty-day period shall be 1666
	1938	+	deemed approval thereof. The payments to residents of the facility who 1667
	1939	+	are eligible for assistance under the state supplement program for room 1668
	1940	+	and board and necessary services, shall be determined annually to be 1669
	1941	+	effective July first of each year. Such payments shall be determined on a 1670
	1942	+	basis of a reasonable payment for necessary services, which basis shall 1671
	1943	+	take into account as a factor the costs of providing those services and 1672
	1944	+	such other factors as the commissioner deems reasonable, including 1673
	1945	+	anticipated fluctuations in the cost of providing services. Such payments 1674
	1946	+	shall be calculated in accordance with the manner in which rates are 1675
	1947	+	calculated pursuant to subsection [(h)] (i) of section 17b-340, as amended 1676
	1948	+	by this act, and the cost-related reimbursement system pursuant to said 1677
	1949	+	section except that efficiency incentives shall not be granted. The 1678
	1950	+	commissioner may adjust such rates to account for the availability of 1679
	1951	+	personal care services for residents under the Medicaid program. The 1680
	1952	+	commissioner shall, upon submission of a request, allow actual debt 1681
	1953	+	service, comprised of principal and interest, in excess of property costs 1682
	1954	+	allowed pursuant to section 17-313b-5 of the regulations of Connecticut 1683
	1955	+	state agencies, provided such debt service terms and amounts are 1684
	1956	+	reasonable in relation to the useful life and the base value of the 1685
	1957	+	property. The cost basis for such payment shall be subject to audit, and 1686
	1958	+	a recomputation of the rate shall be made based upon such audit. The 1687
	1959	+	facility shall report on a fiscal year ending on the thirtieth day of 1688
	1960	+	September on forms provided by the commissioner. The required report 1689
	1961	+	shall be received by the commissioner no later than December thirty-1690
	1962	+	first of each year. The Department of Social Services may use its existing 1691
	1963	+	utilization review procedures to monitor utilization of the facility. If the 1692 Governor's Bill No. 6446
	1964	+
	1965	+
	1966	+
	1967	+	LCO No. 3112 51 of 51
	1968	+
	1969	+	facility is aggrieved by any decision of the commissioner, the facility 1693
	1970	+	may, within ten days, after written notice thereof from the 1694
	1971	+	commissioner, obtain by written request to the commissioner, a hearing 1695
	1972	+	on all items of aggrievement. If the facility is aggrieved by the decision 1696
	1973	+	of the commissioner after such hearing, the facility may appeal to the 1697
	1974	+	Superior Court in accordance with the provisions of section 4-183.1698
1744	1975		This act shall take effect as follows and shall amend the following
1745	1976		sections:
1746	1977
1747		-	Section 1 July 1, 2021 17b-265
1748		-	Sec. 2 October 1, 2021 17b-340d
1749		-	Sec. 3 July 1, 2021 17b-340
1750		-	Sec. 4 July 1, 2021 19a-507(a)
	1978	+	Section 1 July 1, 2021 17b-104(b)
	1979	+	Sec. 2 July 1, 2021 17b-106(a)
	1980	+	Sec. 3 August 1, 2022 17b-256f
	1981	+	Sec. 4 July 1, 2021 17b-265
	1982	+	Sec. 5 July 1, 2021 17b-244
	1983	+	Sec. 6 July 1, 2021 New section
	1984	+	Sec. 7 July 1, 2021 17b-340d
	1985	+	Sec. 8 July 1, 2021 17b-340
	1986	+	Sec. 9 July 1, 2021 19a-507(a)
1751	1987
1752		-	HS Joint Favorable Subst.
	1988	+	Statement of Purpose:
	1989	+	To implement the Governor's budget recommendations for human
	1990	+	services.
	1991	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	1992	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	1993	+	underlined.]
1753	1994