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OLR Bill Analysis
sHB 5313 (as amended by House "A")*
AN ACT CONCERNING REGISTRATION OF TEMPORARY
NURSING SERVICES AGENCIES AND MAXIMUM RATES FOR
TEMPORARY NURSING SERVICES AT NURSING HOME
FACILITIES.
SUMMARY
This bill makes various unrelated changes affecting long-term care
facilities and services. Principally, it:
1. repeals current statutes on nursing pools and replaces them with
provisions for “temporary nursing services agencies” with the
same requirements (§§ 1-8 & 15);
2. requires the Department of Public Health (DPH) commissioner,
by October 1, 2022, to establish an annual registration system for
these agencies and authorizes her to charge an annual
registration fee of up to $750 (§ 1);
3. requires the Department of Social Services (DSS) commissioner
to evaluate rates these agencies charge nursing homes and report
her recommendations to the Aging, Human Services, and Public
Health committees by October 1, 2023 (§ 4);
4. requires nursing homes and residential care homes (RCHs) to
electronically report each involuntary discharge or transfer to the
Long-Term Care Ombudsman and on a website she maintains (§§
9 & 10);
5. requires the Long-Term Care ombudsman to convene a working
group to study specified issues involving managed residential
communities (MRCs) that are not affiliated with continuing care
retirement communities (§ 11);
6. generally requires mandated elder abuse reporters to complete
the DSS elder abuse training program, or another DSS-approved 2022HB-05313-R01-BA.DOCX
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program, by December 31, 2022, or within 90 days after becoming
a mandated elder abuse reporter (§§ 12 & 13); and
7. requires DSS to (a) develop an advisory for Medicaid long-term
care and home care applicants on their right to seek legal
assistance, (b) post the advisory on its website by July 1, 2022, and
(c) include the advisory in its applications by September 1, 2023
(§ 14).
*House Amendment “A” replaces the original bill (File 132). It
primarily (1) allows, rather than requires, DPH to adopt regulations on
temporary nursing services agencies; (2) eliminates the requirement that
DSS set maximum rates for these agencies, instead requiring the
department to study rates these agencies charge nursing homes; and (3)
adds provisions on electronic reporting of nursing home and RCH
involuntary transfers, the MRC working group, mandated elder abuse
reporter training, and an advisory for Medicaid applicants on their legal
rights.
EFFECTIVE DATE: Upon passage, except that provisions on (1)
temporary nursing services agencies and (2) electronically reporting
nursing home involuntary transfers and discharges take effect July 1,
2022.
§§ 1-8 & 15 — TEMPORARY NURSING SERVICES AGENCIES
The bill repeals current statutes on nursing pools and replaces them
with provisions for “temporary nursing services agencies” with the
same requirements. Under the bill, these agencies provide temporary
nursing services to nursing homes, residential care homes, and hospitals
on a per diem or temporary basis.
It requires the DPH commissioner, by October 1, 2022, to establish an
annual registration system for these agencies and authorizes her to
charge an annual registration fee of up to $750. Starting by January 1,
2023, it prohibits temporary nursing services agencies from providing
services in the state unless they obtain DPH registration.
The bill also makes related technical and conforming changes, 2022HB-05313-R01-BA.DOCX
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replacing references to nursing pools with temporary nursing services
agencies in various statutes (§§ 5-8).
Definitions (§ 1)
“Nursing personnel” means advanced practice registered nurses,
licensed practical nurses and registered nurses (including those issued
temporary permits), and nurse’s aides.
A “temporary nursing services agency” is any person, firm,
corporation, limited liability company, partnership, or association that
is hired to provide temporary nursing services to health care facilities.
It excludes individuals who offer only their own temporary nursing
services.
Agency Requirements (§ 1)
The bill requires the DPH commissioner to establish requirements for
temporary nursing services agencies, including minimum qualifications
for nursing personnel the agencies provide to health care facilities.
Annual Cost Reports (§ 1)
Starting July 1, 2023, the bill requires temporary nursing services
agencies to submit to the DPH commissioner annual cost reports in a
manner the commissioner prescribes, in consultation with the DSS
commissioner.
Under the bill, the cost reports must include the (1) agency’s itemized
revenues and costs; (2) average number of nursing personnel the agency
employs; (3) average fees the agencies charge by type of nursing
personnel and health care facility; (4) nursing personnel’s state of
permanent residence, aggregated by the type of nursing personnel; and
(5) any other information the DPH commissioner requires.
The bill also requires agencies to make available to DPH, upon
request, records, books, reports, and other data related to their
operation. Records that agencies provide are not subject to disclosure
under the Freedom of Information Act.
Regulations (§ 1) 2022HB-05313-R01-BA.DOCX
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The bill permits the DPH commissioner to adopt regulations to
implement the bill’s requirements. She may also adopt implementing
policies and procedures while in the process of adopting the regulations,
so long as she posts her intent to adopt regulations in the eRegulations
System within 20 days after adopting the policies and procedures.
Written Agreements (§ 2)
As under current law for nursing pools, the bill requires temporary
nursing services agencies to enter into a written agreement with a health
care facility that ensures that the assigned nursing personnel have
appropriate credentials. The agreement must be on file at both the
agency and facility within 14 days after the nursing personnel’s
assignment.
The bill subjects health care facilities who fail to do so to DPH
disciplinary action (e.g., probation, letter of reprimand, or license
suspension), as under current law for nursing pools.
The bill exempts from the written agreement requirement a health
care facility, or its subsidiary, that supplies temporary nursing services
only to its own facility without charge.
Appeals (§ 3)
As under current law for nursing pools, the bill permits a person
aggrieved by a temporary nursing services agency to petition the
Superior Court for the judicial district where the agency’s services were
provided. The aggrieved person may seek relief, including temporary
and permanent injunctions, or bring a civil action for damages.
Civil Penalties (§ 3)
As under current law for nursing pools, the bill authorizes the court
to assess a civil penalty of up to $300 per violation against a temporary
nursing services agency that violates the bill’s provisions. It specifies
that each violation is a separate and distinct offense, and in the case of a
continuing violation, each day it continues is a separate and distinct
offense.
It also allows the DPH commissioner to request the attorney general 2022HB-05313-R01-BA.DOCX
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to bring a civil action in the Hartford Superior Court for injunctive relief
to restrain any further violation. The Superior Court must grant the
relief after a notice and hearing.
Agency Rates (§4)
The bill requires the DSS commissioner, in consultation with the DPH
commissioner, to evaluate temporary nursing services agency rates
charged to nursing homes to determine whether changes are needed in
regulating these rates to ensure nursing homes have adequate
personnel.
Under the bill, the DSS commissioner must report to the Aging,
Human Services, and Public Health committees by October 1, 2023, on
her recommendations, which must be based on agency cost reports
submitted to DPH (see § 1). The report may include (1) any changes
needed in regulating agency rates and (2) how best to ensure, within
available appropriations, that nursing homes are able to maintain
adequate nursing personnel during a declared public health emergency.
§§ 9 & 10 — ELECTRONIC REPORTING OF INVOLUNTARY
TRANSFERS OR DISCHARGES IN NURSING HOMES AND RCHS
The bill requires nursing homes and RCHs to electronically report
each involuntary discharge or transfer (1) to the Long-Term Care
Ombudsman, in a manner she prescribes, and (2) on a website the
ombudsman maintains in accordance with federal HIPAA privacy
protections.
Under the bill, RCHs must begin reporting this information within
six months after the bill’s passage. (In practice, nursing homes already
do this.)
By law, a nursing home or RCH may involuntarily transfer or
discharge a resident only if the (1) facility cannot provide the resident
adequate care, (2) resident’s health has improved to the point that he or
she no longer needs the home’s services, (3) health or safety of
individuals in the facility are endangered, (4) resident failed to pay for
care after reasonable notice, or (5) facility closes. Residents and their
representatives must be notified in writing of the discharge at least 30 2022HB-05313-R01-BA.DOCX
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days in advance (CGS §§19a-535 and 535a). Federal law also requires
nursing homes to give the Long-Term Care Ombudsman a copy of the
notice (42 CFR §483.15 (c)(3)(i)).
§ 11 — WORKING GROUP ON MANAGED RESIDENTIAL
COMMUNITIES
The bill requires the Long-Term Care Ombudsman to appoint and
convene a working group of up to eight members to study certain issues
involving MRCs that are not affiliated with a facility providing services
to continuing care retirement communities. Specifically, the working
group must study (1) what notice MRCs should provide residents about
rent and other fee increases that exceed certain percentages and (2)
resident health transitions and determinations of care levels.
Membership
Under the bill, working group members must at least include:
1. the Long-Term Care Ombudsman, or her designee, and
2. representatives of the Connecticut Assisted Living Association,
Connecticut Association of Health Care Facilities/Connecticut
Center for Assisted Living, and LeadingAge Connecticut
(provided these members are willing and able to serve).
The working group chairpersons are (1) the Long-Term Care
Ombudsman, or her designee, and (2) another chairperson selected by
the working group from among its members.
Meetings and Staff
The bill requires the Long-Term Care Ombudsman to schedule the
working group’s first meeting within 60 days of the bill’s passage. The
Aging Committee’s administrative staff also serve in this capacity for
the working group.
Report
The bill requires the working group to submit its findings and
recommendations to the Aging Committee by December 31, 2022. The
working group terminates on this date, or when it submits its report, 2022HB-05313-R01-BA.DOCX
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whichever is later.
§§ 12 & 13 — ELDER ABUSE REPORTER TRAINING
The bill generally requires mandated elder abuse reporters to
complete the DSS elder abuse training program, or another DSS-
approved program, by December 31, 2022, or within 90 days after
becoming a mandated elder abuse reporter (see BACKGROUND). The
requirement does not apply to any reporter who has already received
the training from an entity that must provide the training to its
employees. By law, any institution, organization, agency, or facility that
employs people to care for seniors age 60 and older must (1) provide
mandatory training on detecting potential elder abuse and (2) inform
employees of their obligation to report such incidences.
By law, the DSS commissioner must develop a training program on
identifying and reporting elder abuse, neglect, exploitation, and
abandonment and make the program available on the department’s
website and in-person or otherwise throughout the state.
§ 14 — ADVISORY FOR MEDICAID APPLICANTS
The bill requires DSS to develop an advisory for Medicaid long-term
care and home care applicants on their right to seek legal assistance. At
a minimum, it must state that while applicants are not required to use
an attorney, obtaining legal advice before completing their application
may help protect their finances and rights.
Under the bill, DSS must post the advisory on its website by July 1,
2022, and include the advisory in its applications by September 1, 2023.
BACKGROUND
Mandatory Elder Abuse Reporters
Existing law requires doctors, nurses, long-term care (LTC) facility
administrators and staff, other health care personnel, and certain other
professionals to report suspected abuse, neglect, abandonment, or
exploitation of the elderly and LTC facility residents to DSS within 72
hours of suspecting the abuse or face penalties. They must also report to
the department if they suspect an elderly person needs protective 2022HB-05313-R01-BA.DOCX
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services (CGS §§ 17a-412 & 17b-451).
Related Bills
HB 5195 (File 101), favorably reported by the Aging Committee,
contains the same provisions requiring nursing homes to report
involuntary transfers and discharges to the Long-Term Care
Ombudsman.
HB 5196 (File 102), favorably reported by the Aging Committee,
contains the same provisions requiring RCHs to report involuntary
transfers and discharges to the Long-Term Care Ombudsman.
sHB 5314 (File 117), favorably reported by the Aging Committee,
contains the same provisions requiring mandated elder abuse reporters
to complete the DSS elder abuse training program, or another DSS-
approved program, by December 31, 2022, or within 90 days after
becoming a mandated elder abuse reporter.
COMMITTEE ACTION
Aging Committee
Joint Favorable Substitute
Yea 9 Nay 6 (03/10/2022)
Public Health Committee
Joint Favorable
Yea 31 Nay 0 (04/13/2022)