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 Section 17b-265 of the general statutes is repealed and the 1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