O F F I C E O F L E G I S L A T I V E R E S E A R C H
P U B L I C A C T S U M M A R Y
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PA 22-57—sHB 5313
Aging Committee
Public Health Committee
AN ACT CONCERNING TEMPORARY NURSING SERVICES
AGENCIES, REPORTING OF INVOLUNTARY TRANSFERS AND
DISCHARGES FROM NURSING HOMES AND RESIDENTIAL CARE
HOMES, ELDER ABUSE TRAINING, LEGAL RIGHTS OF LONG -TERM
CARE APPLICANTS AND A STUDY OF MANAGED RESIDENTIAL
COMMUNITY ISSUES
SUMMARY: This act makes various unrelated changes in state laws affecting
long-term care facilities and services. Principally, it does the following:
1. repeals prior 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 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).
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
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The act repeals prior statutes on nursing pools and replaces them with
provisions for “temporary nursing services agencies” with the same requirements.
Under the act, 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 act also makes related technical and conforming changes, 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 act 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 act requires temporary nursing services agencies to
submit to the DPH commissioner annual cost reports in a manner the commissioner
determines, in consultation with the DSS commissioner.
Under the act, 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 act 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)
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The act permits the DPH commissioner to adopt regulations to implement the
act’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 prior law for nursing pools, the act 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 act subjects health care facilities that fail to
do so to DPH disciplinary action (e.g., probation, letter of reprimand, or license
suspension), as under prior law for nursing pools.
The act 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 prior law for nursing pools, the act 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 prior law for nursing pools, the act authorizes the court to assess a
civil penalty of up to $300 per violation against a temporary nursing services
agency that violates the act’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 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 act 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 act, the DSS commissioner must report to the Aging, Human
Services, and Public Health committees by October 1, 2023, on her O L R P U B L I C A C T S U M M A R Y
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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 INVOLUNTA RY TRANSFERS
OR DISCHARGES IN NURSING HOMES AND RCHS
The act 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 act, RCHs must begin reporting this information within six months
after the act’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 days in advance (CGS §§ 19a-535 & 535a). Federal law also requires
nursing homes to give the long-term care ombudsman a copy of the notice (42
C.F.R. § 483.15 (c)(3)(i)).
§ 11 — WORKING GROUP ON MANAGED RESIDENTIAL COMMUNITIES
The act 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 act, working group members must at least include:
1. the long-term care ombudsman, or her designee, and
2. representatives from the Connecticut Assisted Living Association,
Connecticut Association of Health Care Facilities/Connecticut Center for
Assisted Living, and LeadingAge Connecticut (so long as 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.
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Meetings and Staff
The act requires the long-term care ombudsman to schedule the working
group’s first meeting by July 22, 2022. The Aging Committee’s administrative staff
also serve in this capacity for the working group.
Report
The act 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, whichever is later.
§§ 12 & 13 — ELDER ABUSE REPORTER TRAINING
The act 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 act requires DSS to develop an advisory for Medicaid long-term care (LTC)
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 act, DSS must post the advisory on its website by July 1, 2022, and
include the advisory in its applications by September 1, 2023.
BACKGROUND
Mandated Elder Abuse Reporters
Existing law requires doctors, nurses, 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
services (CGS §§ 17a-412 & 17b-451). O L R P U B L I C A C T S U M M A R Y
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