Connecticut 2022 Regular Session

Connecticut House Bill HB05313 Compare Versions

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Version 2 (New)

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	7	+	General Assembly Substitute Bill No. 5313
	8	+	February Session, 2022
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4		-	Substitute House Bill No. 5313
5		-
6		-	Public Act No. 22-57
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9		-	AN ACT CONCERNING TEMPORARY NURSING SERVICES
10		-	AGENCIES, REPORTING OF INVOLUNTARY TRANSFERS AND
11		-	DISCHARGES FROM NURSING HOMES AND RESIDENTIAL CARE
12		-	HOMES, ELDER ABUSE TRAINING, LEGAL RIGHTS OF LONG -
13		-	TERM CARE APPLICANTS AND A STUDY OF MANAGED
14		-	RESIDENTIAL COMMUNITY ISSUES.
	14	+	AN ACT CONCERNING REGISTRATION OF TEMPORARY NURSING
	15	+	SERVICES AGENCIES AND MAXIMUM RATES FOR TEMPORARY
	16	+	NURSING SERVICES AT NURSING HOME FACILITIES.
15	17		Be it enacted by the Senate and House of Representatives in General
16	18		Assembly convened:
17	19
18		-	Section 1. (NEW) (Effective July 1, 2022) (a) As used in this section and
19		-	sections 2 and 3 of this act, (1) "health care facility" means a hospital,
20		-	nursing home facility or residential care home as those terms are defined
21		-	in section 19a-490 of the general statutes; (2) "nursing personnel" means
22		-	an advanced practice registered nurse, a licensed practical nurse or a
23		-	registered nurse licensed or issued a temporary permit to practice
24		-	pursuant to chapter 378 of the general statutes, or a nurse's aide
25		-	registered pursuant to chapter 378a of the general statutes; (3)
26		-	"temporary nursing services" means services provided to a health care
27		-	facility on a per diem or other temporary basis; and (4) "temporary
28		-	nursing services agency" means any person, firm, corporation, limited
29		-	liability company, partnership or association that is engaged for hire in
30		-	the business of providing temporary nursing services to a health care
31		-	facility but does not include an individual who offers only his or her
32		-	own temporary nursing services. Substitute House Bill No. 5313
	20	+	Section 1. (NEW) (Effective July 1, 2022) (a) As used in this section and 1
	21	+	sections 2 and 3 of this act, (1) "health care facility" means a hospital, 2
	22	+	residential care home or nursing home facility as those terms are defined 3
	23	+	in section 19a-490 of the general statutes; (2) "fixed-term nursing 4
	24	+	services" means services provided under contract for not less than 5
	25	+	ninety consecutive days exclusively to a health care facility by nursing 6
	26	+	personnel (A) whose permanent residence is at least two hundred miles 7
	27	+	from the health care facility, and (B) who establish a temporary 8
	28	+	residence and incur expenses for temporary accommodations paid for 9
	29	+	by a temporary nursing services agency to provide such services; (3) 10
	30	+	"nursing personnel" means an advanced practice registered nurse, a 11
	31	+	licensed practical nurse or a registered nurse licensed or issued a 12
	32	+	temporary permit to practice pursuant to chapter 378 of the general 13
	33	+	statutes or a nurse's aide registered pursuant to chapter 378a of the 14
	34	+	general statutes; (4) "temporary nursing services" means services 15
	35	+	provided to a health care facility on a per diem or other temporary basis 16
	36	+	but does not include fixed-term nursing services; and (5) "temporary 17
	37	+	nursing services agency" means any person, firm, corporation, limited 18 Substitute Bill No. 5313
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34		-	Public Act No. 22-57 2 of 16
35	39
36		-	(b) Not later than October 1, 2022, the Commissioner of Public Health
37		-	shall develop a system for a temporary nursing services agency that
38		-	provides services in the state to register annually with the Department
39		-	of Public Health. The commissioner may assess an annual registration
40		-	fee of not more than seven hundred fifty dollars.
41		-	(c) Not later than January 1, 2023, no temporary nursing services
42		-	agency shall provide temporary nursing services in the state unless it is
43		-	registered pursuant to subsection (b) of this section.
44		-	(d) The Commissioner of Public Health shall establish requirements
45		-	for a temporary nursing services agency, including, but not limited to,
46		-	minimum qualifications for nursing personnel provided by such
47		-	agency.
48		-	(e) Beginning not later than July 1, 2023, each temporary nursing
49		-	services agency shall submit, in a form and manner prescribed by the
50		-	Commissioner of Public Health, in consultation with the Commissioner
51		-	of Social Services, an annual cost report for the previous calendar year.
52		-	Such report shall be filed with the Commissioner of Public Health and
53		-	may include, but shall not be limited to, (1) itemized revenues and costs
54		-	for each such agency; (2) average number of nursing personnel
55		-	employed by such agency; (3) average fees charged by such agency by
56		-	type of nursing personnel and type of health care facility; (4) the states
57		-	of the permanent residences of nursing personnel supplied by the
58		-	agency to health care facilities in the state, aggregated by type of nursing
59		-	personnel; and (5) any other information prescribed by the
60		-	Commissioner of Public Health. Each such agency shall make available
61		-	records, books, reports and other data relating to its operation at the
62		-	request of the Commissioner of Public Health, or the commissioner's
63		-	designee. Records provided by a temporary nursing services agency
64		-	pursuant to this subsection shall not be considered public records
65		-	subject to disclosure pursuant to section 1-210 of the general statutes. Substitute House Bill No. 5313
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67		-	Public Act No. 22-57 3 of 16
	44	+	liability company, partnership or association that is engaged for hire in 19
	45	+	the business of procuring or providing temporary nursing services to a 20
	46	+	health care facility but does not include (A) a health care facility or 21
	47	+	subsidiary thereof that supplies nursing personnel to its own facility 22
	48	+	only and does not charge a fee to such facility, or (B) an individual who 23
	49	+	offers only his or her own temporary nursing services. 24
	50	+	(b) Not later than October 1, 2022, the Commissioner of Public Health 25
	51	+	shall develop a system for a temporary nursing services agency that 26
	52	+	provides services in the state to register annually with the Department 27
	53	+	of Public Health. The commissioner may assess an annual registration 28
	54	+	fee of not more than seven hundred fifty dollars. 29
	55	+	(c) Not later than January 1, 2023, no temporary nursing services 30
	56	+	agency shall provide temporary nursing services in the state unless it is 31
	57	+	registered pursuant to subsection (b) of this section. 32
	58	+	(d) The Commissioner of Public Health shall adopt regulations, in 33
	59	+	accordance with the provisions of chapter 54 of the general statutes, to 34
	60	+	establish requirements for a temporary nursing services agency, 35
	61	+	including, but not limited to: (1) Minimum qualifications for nursing 36
	62	+	personnel provided by such agency, and (2) an annual cost report for 37
	63	+	the previous calendar year to be filed by such agency not later than 38
	64	+	January fifteenth with the commissioner. Such report shall detail (A) 39
	65	+	revenues and costs in the state, (B) average fees charged by such agency 40
	66	+	to a health care facility in the state by type of nursing personnel, and (C) 41
	67	+	the states of the permanent residences of nursing personnel supplied by 42
	68	+	the agency to health care facilities in the state, aggregated by type of 43
	69	+	nursing personnel. Each such agency shall make available records, 44
	70	+	books, reports and other data relating to its operation at the request of 45
	71	+	the commissioner or the commissioner's designee. 46
	72	+	Sec. 2. (NEW) (Effective July 1, 2022) (a) A temporary nursing services 47
	73	+	agency shall enter into a written agreement with each health care facility 48
	74	+	to which the agency assigns its nursing personnel. The agreement shall 49
	75	+	contain an assurance that assigned nursing personnel have appropriate 50 Substitute Bill No. 5313
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69		-	(f) The Commissioner of Public Health may adopt regulations in
70		-	accordance with chapter 54 of the general statutes to implement the
71		-	provisions of this section. The commissioner may adopt policies and
72		-	procedures to implement the provisions of this section in advance of
73		-	adopting regulations, provided notice of intent to adopt such
74		-	regulations is posted on the eRegulations System not later than twenty
75		-	days after adoption of such policies and procedures.
76		-	Sec. 2. (NEW) (Effective July 1, 2022) (a) A temporary nursing services
77		-	agency shall enter into a written agreement with each health care facility
78		-	to which the agency assigns its nursing personnel. Any such agreement
79		-	entered into, amended or renewed on and after July 1, 2022, shall
80		-	contain an assurance that assigned nursing personnel have appropriate
81		-	credentials. Such agreement shall be on file at such temporary nursing
82		-	services agency and such health care facility not later than fourteen days
83		-	from the date of assignment of nursing personnel by such agency to the
84		-	health care facility.
85		-	(b) Any health care facility that fails to have the written agreement
86		-	described in subsection (a) of this section on file may be subject to
87		-	disciplinary action in accordance with the provisions of chapter 368v of
88		-	the general statutes and any applicable licensing regulations.
89		-	(c) Notwithstanding the provisions of subsections (a) and (b) of this
90		-	section, no health care facility or subsidiary thereof that supplies
91		-	temporary nursing services only to its own facility and does not charge
92		-	a fee to such facility shall be subject to the provisions of this section.
93		-	Sec. 3. (NEW) (Effective July 1, 2022) (a) Any person aggrieved by any
94		-	action of a temporary nursing services agency may petition the superior
95		-	court for the judicial district in which the agency's temporary nursing
96		-	services were rendered for relief, including temporary and permanent
97		-	injunctions, or may bring a civil action for damages. Substitute House Bill No. 5313
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101		-	(b) Any temporary nursing services agency that violates any
102		-	provision of section 1 or 2 of this act may be assessed a civil penalty by
103		-	the court not to exceed three hundred dollars for each offense. Each
104		-	violation shall be a separate and distinct offense and, in the case of a
105		-	continuing violation, each day of continuance thereof shall be deemed
106		-	to be a separate and distinct offense. The Commissioner of Public Health
107		-	may request the Attorney General to bring a civil action in the superior
108		-	court for the judicial district of Hartford for injunctive relief to restrain
109		-	any further violation of section 1 or 2 of this act. The Superior Court may
110		-	grant such relief upon notice and hearing.
111		-	Sec. 4. (Effective July 1, 2022) (a) As used in this section, (1) "nursing
112		-	home facility" has the same meaning as provided in section 19a-490 of
113		-	the general statutes, and (2) "nursing personnel", "temporary nursing
114		-	services" and "temporary nursing services agency" have the same
115		-	meanings as provided in section 1 of this act. The Commissioner of
116		-	Social Services, in consultation with the Commissioner of Public Health,
117		-	shall evaluate the rates charged by a temporary nursing services agency
118		-	to a nursing home facility for temporary nursing services to determine
119		-	whether and what changes may be needed in the regulation of such
120		-	rates to ensure that a nursing home facility has adequate nursing
121		-	personnel.
122		-	(b) Not later than October 1, 2023, the Commissioner of Social
123		-	Services shall submit a report, in accordance with the provisions of
124		-	section 11-4a of the general statutes, to the joint standing committees of
125		-	the General Assembly having cognizance of matters relating to aging,
126		-	human services and public health with recommendations based on the
127		-	cost reports submitted by temporary nursing services agencies pursuant
128		-	to section 1 of this act. The commissioner's report may include, but need
129		-	not be limited to (1) what, if any, changes are needed in the regulation
130		-	of rates charged by such agencies, and (2) how best to ensure, within
131		-	available appropriations, that a nursing home facility is able to maintain Substitute House Bill No. 5313
	82	+	credentials. The agreement shall be on file at both the temporary nursing 51
	83	+	services agency and the health care facility not later than fourteen days 52
	84	+	from the date of assignment. 53
	85	+	(b) Any health care facility that fails to have the agreement described 54
	86	+	in subsection (a) of this section on file may be subject to disciplinary 55
	87	+	action in accordance with the provisions of chapter 368v of the general 56
	88	+	statutes and any applicable licensing regulations. 57
	89	+	Sec. 3. (NEW) (Effective July 1, 2022) (a) Any person aggrieved by any 58
	90	+	action of a temporary nursing services agency may petition the superior 59
	91	+	court for the judicial district in which the agency's temporary nursing 60
	92	+	services were rendered for relief, including temporary and permanent 61
	93	+	injunctions, or may bring a civil action for damages. 62
	94	+	(b) Any temporary nursing services agency that violates any 63
	95	+	provision of section 1 or 2 of this act may be assessed a civil penalty by 64
	96	+	the court not to exceed three hundred dollars for each offense. Each 65
	97	+	violation shall be a separate and distinct offense and, in the case of a 66
	98	+	continuing violation, each day of continuance thereof shall be deemed 67
	99	+	to be a separate and distinct offense. The Commissioner of Public Health 68
	100	+	may request the Attorney General to bring a civil action in the superior 69
	101	+	court for the judicial district of Hartford for injunctive relief to restrain 70
	102	+	any further violation of section 1 or 2 of this act. The Superior Court shall 71
	103	+	grant such relief upon notice and hearing. 72
	104	+	Sec. 4. (NEW) (Effective July 1, 2022) (a) As used in this section, 73
	105	+	"temporary nursing services agency", "fixed-term nursing services" and 74
	106	+	"nursing personnel" have the same meaning as provided in section 1 of 75
	107	+	this act and "nursing home facility" has the same meaning as provided 76
	108	+	in section 19a-490 of the general statutes. Not later than January 1, 2023, 77
	109	+	the Commissioner of Social Services, in consultation with the 78
	110	+	Commissioner of Public Health, shall establish maximum rates a 79
	111	+	temporary nursing services agency may charge a nursing home facility 80
	112	+	in the state by type of nursing personnel provided by such agency. The 81
	113	+	rates shall include an allowance for wages, payroll taxes, workers' 82 Substitute Bill No. 5313
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133		-	Public Act No. 22-57 5 of 16
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135		-	adequate nursing personnel during a public health emergency declared
136		-	pursuant to section 19a-131a of the general statutes.
137		-	Sec. 5. Subsection (a) of section 17b-340 of the 2022 supplement to the
138		-	general statutes is repealed and the following is substituted in lieu
139		-	thereof (Effective July 1, 2022):
140		-	(a) For purposes of this subsection, (1) a "related party" includes, but
141		-	is not limited to, any company related to a chronic and convalescent
142		-	nursing home through family association, common ownership, control
143		-	or business association with any of the owners, operators or officials of
144		-	such nursing home; (2) "company" means any person, partnership,
145		-	association, holding company, limited liability company or corporation;
146		-	(3) "family association" means a relationship by birth, marriage or
147		-	domestic partnership; and (4) "profit and loss statement" means the
148		-	most recent annual statement on profits and losses finalized by a related
149		-	party before the annual report mandated under this subsection. The
150		-	rates to be paid by or for persons aided or cared for by the state or any
151		-	town in this state to licensed chronic and convalescent nursing homes,
152		-	to chronic disease hospitals associated with chronic and convalescent
153		-	nursing homes, to rest homes with nursing supervision, to licensed
154		-	residential care homes, as defined by section 19a-490, and to residential
155		-	facilities for persons with intellectual disability that are licensed
156		-	pursuant to section 17a-227 and certified to participate in the Title XIX
157		-	Medicaid program as intermediate care facilities for individuals with
158		-	intellectual disabilities, for room, board and services specified in
159		-	licensing regulations issued by the licensing agency shall be determined
160		-	annually, except as otherwise provided in this subsection by the
161		-	Commissioner of Social Services, to be effective July first of each year
162		-	except as otherwise provided in this subsection. Such rates shall be
163		-	determined on a basis of a reasonable payment for such necessary
164		-	services, which basis shall take into account as a factor the costs of such
165		-	services. Cost of such services shall include reasonable costs mandated Substitute House Bill No. 5313
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	120	+	compensation insurance, training and fringe benefits, which shall be 83
	121	+	based upon median wages, payroll taxes and fringe benefits paid to 84
	122	+	permanent staff nursing personnel of the same type at nursing home 85
	123	+	facilities in the same geographic region. 86
	124	+	(b) The Commissioner of Social Services shall include in the rates an 87
	125	+	allowance for reasonable administrative expenses and a reasonable 88
	126	+	profit factor for a temporary nursing services agency, as determined by 89
	127	+	the commissioner, but in no event shall the profit factor exceed fifteen 90
	128	+	per cent. The commissioner may set higher rates for certain fixed-term 91
	129	+	nursing services personnel who work exclusively at a nursing home 92
	130	+	facility under a contract with such facility for a period of not less than 93
	131	+	ninety days. 94
	132	+	(c) The Commissioner of Social Services may adopt regulations in 95
	133	+	accordance with the provisions of chapter 54 of the general statutes to 96
	134	+	implement the provisions of this section. Beginning January 15, 2024, 97
	135	+	temporary nursing services agencies shall submit to the commissioner 98
	136	+	annual cost reports, which may be subject to audit, that include data on 99
	137	+	average fees charged by such agencies to nursing home facilities in the 100
	138	+	state by type of nursing personnel such agencies supply to such facilities 101
	139	+	and wages paid and benefits provided to such nursing personnel. The 102
	140	+	commissioner shall consider such reports and annual nursing home 103
	141	+	facility cost reports, provided by such facilities to the commissioner 104
	142	+	pursuant to section 17b-340 of the general statutes, as amended by this 105
	143	+	act, when adjusting maximum rates temporary nursing services 106
	144	+	agencies may charge such facilities for nursing personnel. 107
	145	+	Sec. 5. Subsection (a) of section 17b-340 of the 2022 supplement to the 108
	146	+	general statutes is repealed and the following is substituted in lieu 109
	147	+	thereof (Effective July 1, 2022): 110
	148	+	(a) For purposes of this subsection, (1) a "related party" includes, but 111
	149	+	is not limited to, any company related to a chronic and convalescent 112
	150	+	nursing home through family association, common ownership, control 113
	151	+	or business association with any of the owners, operators or officials of 114 Substitute Bill No. 5313
168	152
169		-	by collective bargaining agreements with certified collective bargaining
170		-	agents or other agreements between the employer and employees,
171		-	provided "employees" shall not include persons employed as managers
172		-	or chief administrators or required to be licensed as nursing home
173		-	administrators, and compensation for services rendered by proprietors
174		-	at prevailing wage rates, as determined by application of principles of
175		-	accounting as prescribed by said commissioner. Cost of such services
176		-	shall not include amounts paid by the facilities to employees as salary,
177		-	or to attorneys or consultants as fees, where the responsibility of the
178		-	employees, attorneys, or consultants is to persuade or seek to persuade
179		-	the other employees of the facility to support or oppose unionization.
180		-	Nothing in this subsection shall prohibit inclusion of amounts paid for
181		-	legal counsel related to the negotiation of collective bargaining
182		-	agreements, the settlement of grievances or normal administration of
183		-	labor relations. The commissioner may, in the commissioner's
184		-	discretion, allow the inclusion of extraordinary and unanticipated costs
185		-	of providing services that were incurred to avoid an immediate negative
186		-	impact on the health and safety of patients. The commissioner may, in
187		-	the commissioner's discretion, based upon review of a facility's costs,
188		-	direct care staff to patient ratio and any other related information, revise
189		-	a facility's rate for any increases or decreases to total licensed capacity
190		-	of more than ten beds or changes to its number of licensed rest home
191		-	with nursing supervision beds and chronic and convalescent nursing
192		-	home beds. The commissioner may, in the commissioner's discretion,
193		-	revise the rate of a facility that is closing. An interim rate issued for the
194		-	period during which a facility is closing shall be based on a review of
195		-	facility costs, the expected duration of the close-down period, the
196		-	anticipated impact on Medicaid costs, available appropriations and the
197		-	relationship of the rate requested by the facility to the average Medicaid
198		-	rate for a close-down period. The commissioner may so revise a facility's
199		-	rate established for the fiscal year ending June 30, 1993, and thereafter
200		-	for any bed increases, decreases or changes in licensure effective after
201		-	October 1, 1989. Effective July 1, 1991, in facilities that have both a Substitute House Bill No. 5313
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205		-	chronic and convalescent nursing home and a rest home with nursing
206		-	supervision, the rate for the rest home with nursing supervision shall
207		-	not exceed such facility's rate for its chronic and convalescent nursing
208		-	home. All such facilities for which rates are determined under this
209		-	subsection shall report on a fiscal year basis ending on September
210		-	thirtieth. Such report shall be submitted to the commissioner by
211		-	February fifteenth. Each for-profit chronic and convalescent nursing
212		-	home that receives state funding pursuant to this section shall include
213		-	in such annual report a profit and loss statement from each related party
214		-	that receives from such chronic and convalescent nursing home fifty
215		-	thousand dollars or more per year for goods, fees and services. No cause
216		-	of action or liability shall arise against the state, the Department of Social
217		-	Services, any state official or agent for failure to take action based on the
218		-	information required to be reported under this subsection. The
219		-	commissioner may reduce the rate in effect for a facility that fails to
220		-	submit a complete and accurate report on or before February fifteenth
221		-	by an amount not to exceed ten per cent of such rate. If a licensed
222		-	residential care home fails to submit a complete and accurate report, the
223		-	department shall notify such home of the failure and the home shall
224		-	have thirty days from the date the notice was issued to submit a
225		-	complete and accurate report. If a licensed residential care home fails to
226		-	submit a complete and accurate report not later than thirty days after
227		-	the date of notice, such home may not receive a retroactive rate increase,
228		-	in the commissioner's discretion. The commissioner shall, annually, on
229		-	or before April first, report the data contained in the reports of such
230		-	facilities on the department's Internet web site. For the cost reporting
231		-	year commencing October 1, 1985, and for subsequent cost reporting
232		-	years, facilities shall report the cost of using the services of any [nursing
233		-	pool employee] nursing personnel supplied by a temporary nursing
234		-	services agency by separating said cost into two categories, the portion
235		-	of the cost equal to the salary of the employee for whom the [nursing
236		-	pool employee] nursing personnel supplied by a temporary nursing
237		-	services agency is substituting shall be considered a nursing cost and Substitute House Bill No. 5313
	158	+	such nursing home; (2) "company" means any person, partnership, 115
	159	+	association, holding company, limited liability company or corporation; 116
	160	+	(3) "family association" means a relationship by birth, marriage or 117
	161	+	domestic partnership; and (4) "profit and loss statement" means the 118
	162	+	most recent annual statement on profits and losses finalized by a related 119
	163	+	party before the annual report mandated under this subsection. The 120
	164	+	rates to be paid by or for persons aided or cared for by the state or any 121
	165	+	town in this state to licensed chronic and convalescent nursing homes, 122
	166	+	to chronic disease hospitals associated with chronic and convalescent 123
	167	+	nursing homes, to rest homes with nursing supervision, to licensed 124
	168	+	residential care homes, as defined by section 19a-490, and to residential 125
	169	+	facilities for persons with intellectual disability that are licensed 126
	170	+	pursuant to section 17a-227 and certified to participate in the Title XIX 127
	171	+	Medicaid program as intermediate care facilities for individuals with 128
	172	+	intellectual disabilities, for room, board and services specified in 129
	173	+	licensing regulations issued by the licensing agency shall be determined 130
	174	+	annually, except as otherwise provided in this subsection by the 131
	175	+	Commissioner of Social Services, to be effective July first of each year 132
	176	+	except as otherwise provided in this subsection. Such rates shall be 133
	177	+	determined on a basis of a reasonable payment for such necessary 134
	178	+	services, which basis shall take into account as a factor the costs of such 135
	179	+	services. Cost of such services shall include reasonable costs mandated 136
	180	+	by collective bargaining agreements with certified collective bargaining 137
	181	+	agents or other agreements between the employer and employees, 138
	182	+	provided "employees" shall not include persons employed as managers 139
	183	+	or chief administrators or required to be licensed as nursing home 140
	184	+	administrators, and compensation for services rendered by proprietors 141
	185	+	at prevailing wage rates, as determined by application of principles of 142
	186	+	accounting as prescribed by said commissioner. Cost of such services 143
	187	+	shall not include amounts paid by the facilities to employees as salary, 144
	188	+	or to attorneys or consultants as fees, where the responsibility of the 145
	189	+	employees, attorneys, or consultants is to persuade or seek to persuade 146
	190	+	the other employees of the facility to support or oppose unionization. 147
	191	+	Nothing in this subsection shall prohibit inclusion of amounts paid for 148
	192	+	legal counsel related to the negotiation of collective bargaining 149 Substitute Bill No. 5313
238	193
239		-	Public Act No. 22-57 8 of 16
240	194
241		-	any cost in excess of such salary shall be further divided so that seventy-
242		-	five per cent of the excess cost shall be considered an administrative or
243		-	general cost and twenty-five per cent of the excess cost shall be
244		-	considered a nursing cost, provided if the total [nursing pool] costs of a
245		-	facility for nursing personnel supplied by a temporary nursing services
246		-	agency in any cost year are equal to or exceed fifteen per cent of the total
247		-	nursing expenditures of the facility for such cost year, no portion of
248		-	[nursing pool] such costs in excess of fifteen per cent shall be classified
249		-	as administrative or general costs. The commissioner, in determining
250		-	such rates, shall also take into account the classification of patients or
251		-	boarders according to special care requirements or classification of the
252		-	facility according to such factors as facilities and services and such other
253		-	factors as the commissioner deems reasonable, including anticipated
254		-	fluctuations in the cost of providing such services. The commissioner
255		-	may establish a separate rate for a facility or a portion of a facility for
256		-	traumatic brain injury patients who require extensive care but not acute
257		-	general hospital care. Such separate rate shall reflect the special care
258		-	requirements of such patients. If changes in federal or state laws,
259		-	regulations or standards adopted subsequent to June 30, 1985, result in
260		-	increased costs or expenditures in an amount exceeding one-half of one
261		-	per cent of allowable costs for the most recent cost reporting year, the
262		-	commissioner shall adjust rates and provide payment for any such
263		-	increased reasonable costs or expenditures within a reasonable period
264		-	of time retroactive to the date of enforcement. Nothing in this section
265		-	shall be construed to require the Department of Social Services to adjust
266		-	rates and provide payment for any increases in costs resulting from an
267		-	inspection of a facility by the Department of Public Health. Such
268		-	assistance as the commissioner requires from other state agencies or
269		-	departments in determining rates shall be made available to the
270		-	commissioner at the commissioner's request. Payment of the rates
271		-	established pursuant to this section shall be conditioned on the
272		-	establishment by such facilities of admissions procedures that conform
273		-	with this section, section 19a-533 and all other applicable provisions of Substitute House Bill No. 5313
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274	198
275		-	Public Act No. 22-57 9 of 16
	199	+	agreements, the settlement of grievances or normal administration of 150
	200	+	labor relations. The commissioner may, in the commissioner's 151
	201	+	discretion, allow the inclusion of extraordinary and unanticipated costs 152
	202	+	of providing services that were incurred to avoid an immediate negative 153
	203	+	impact on the health and safety of patients. The commissioner may, in 154
	204	+	the commissioner's discretion, based upon review of a facility's costs, 155
	205	+	direct care staff to patient ratio and any other related information, revise 156
	206	+	a facility's rate for any increases or decreases to total licensed capacity 157
	207	+	of more than ten beds or changes to its number of licensed rest home 158
	208	+	with nursing supervision beds and chronic and convalescent nursing 159
	209	+	home beds. The commissioner may, in the commissioner's discretion, 160
	210	+	revise the rate of a facility that is closing. An interim rate issued for the 161
	211	+	period during which a facility is closing shall be based on a review of 162
	212	+	facility costs, the expected duration of the close-down period, the 163
	213	+	anticipated impact on Medicaid costs, available appropriations and the 164
	214	+	relationship of the rate requested by the facility to the average Medicaid 165
	215	+	rate for a close-down period. The commissioner may so revise a facility's 166
	216	+	rate established for the fiscal year ending June 30, 1993, and thereafter 167
	217	+	for any bed increases, decreases or changes in licensure effective after 168
	218	+	October 1, 1989. Effective July 1, 1991, in facilities that have both a 169
	219	+	chronic and convalescent nursing home and a rest home with nursing 170
	220	+	supervision, the rate for the rest home with nursing supervision shall 171
	221	+	not exceed such facility's rate for its chronic and convalescent nursing 172
	222	+	home. All such facilities for which rates are determined under this 173
	223	+	subsection shall report on a fiscal year basis ending on September 174
	224	+	thirtieth. Such report shall be submitted to the commissioner by 175
	225	+	February fifteenth. Each for-profit chronic and convalescent nursing 176
	226	+	home that receives state funding pursuant to this section shall include 177
	227	+	in such annual report a profit and loss statement from each related party 178
	228	+	that receives from such chronic and convalescent nursing home fifty 179
	229	+	thousand dollars or more per year for goods, fees and services. No cause 180
	230	+	of action or liability shall arise against the state, the Department of Social 181
	231	+	Services, any state official or agent for failure to take action based on the 182
	232	+	information required to be reported under this subsection. The 183
	233	+	commissioner may reduce the rate in effect for a facility that fails to 184 Substitute Bill No. 5313
276	234
277		-	the law and the provision of equality of treatment to all persons in such
278		-	facilities. The established rates shall be the maximum amount
279		-	chargeable by such facilities for care of such beneficiaries, and the
280		-	acceptance by or on behalf of any such facility of any additional
281		-	compensation for care of any such beneficiary from any other person or
282		-	source shall constitute the offense of aiding a beneficiary to obtain aid
283		-	to which the beneficiary is not entitled and shall be punishable in the
284		-	same manner as is provided in subsection (b) of section 17b-97.
285		-	Notwithstanding any provision of this section, the Commissioner of
286		-	Social Services may, within available appropriations, provide an interim
287		-	rate increase for a licensed chronic and convalescent nursing home or a
288		-	rest home with nursing supervision for rate periods no earlier than April
289		-	1, 2004, only if the commissioner determines that the increase is
290		-	necessary to avoid the filing of a petition for relief under Title 11 of the
291		-	United States Code; imposition of receivership pursuant to sections 19a-
292		-	542 and 19a-543; or substantial deterioration of the facility's financial
293		-	condition that may be expected to adversely affect resident care and the
294		-	continued operation of the facility, and the commissioner determines
295		-	that the continued operation of the facility is in the best interest of the
296		-	state. The commissioner shall consider any requests for interim rate
297		-	increases on file with the department from March 30, 2004, and those
298		-	submitted subsequently for rate periods no earlier than April 1, 2004.
299		-	When reviewing an interim rate increase request the commissioner
300		-	shall, at a minimum, consider: (A) Existing chronic and convalescent
301		-	nursing home or rest home with nursing supervision utilization in the
302		-	area and projected bed need; (B) physical plant long-term viability and
303		-	the ability of the owner or purchaser to implement any necessary
304		-	property improvements; (C) licensure and certification compliance
305		-	history; (D) reasonableness of actual and projected expenses; and (E) the
306		-	ability of the facility to meet wage and benefit costs. No interim rate
307		-	shall be increased pursuant to this subsection in excess of one hundred
308		-	fifteen per cent of the median rate for the facility's peer grouping,
309		-	established pursuant to subdivision (2) of subsection (f) of this section, Substitute House Bill No. 5313
310	235
311		-	Public Act No. 22-57 10 of 16
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312	239
313		-	unless recommended by the commissioner and approved by the
314		-	Secretary of the Office of Policy and Management after consultation
315		-	with the commissioner. Such median rates shall be published by the
316		-	Department of Social Services not later than April first of each year. In
317		-	the event that a facility granted an interim rate increase pursuant to this
318		-	section is sold or otherwise conveyed for value to an unrelated entity
319		-	less than five years after the effective date of such rate increase, the rate
320		-	increase shall be deemed rescinded and the department shall recover an
321		-	amount equal to the difference between payments made for all affected
322		-	rate periods and payments that would have been made if the interim
323		-	rate increase was not granted. The commissioner may seek recovery of
324		-	such payments from any facility with common ownership. With the
325		-	approval of the Secretary of the Office of Policy and Management, the
326		-	commissioner may waive recovery and rescission of the interim rate for
327		-	good cause shown that is not inconsistent with this section, including,
328		-	but not limited to, transfers to family members that were made for no
329		-	value. The commissioner shall provide written quarterly reports to the
330		-	joint standing committees of the General Assembly having cognizance
331		-	of matters relating to aging, human services and appropriations and the
332		-	budgets of state agencies, that identify each facility requesting an
333		-	interim rate increase, the amount of the requested rate increase for each
334		-	facility, the action taken by the commissioner and the secretary pursuant
335		-	to this subsection, and estimates of the additional cost to the state for
336		-	each approved interim rate increase. Nothing in this subsection shall
337		-	prohibit the commissioner from increasing the rate of a licensed chronic
338		-	and convalescent nursing home or a rest home with nursing supervision
339		-	for allowable costs associated with facility capital improvements or
340		-	increasing the rate in case of a sale of a licensed chronic and convalescent
341		-	nursing home or a rest home with nursing supervision if receivership
342		-	has been imposed on such home. For purposes of this section,
343		-	"temporary nursing services agency" and "nursing personnel" have the
344		-	same meaning as provided in section 1 of this act. Substitute House Bill No. 5313
	240	+	submit a complete and accurate report on or before February fifteenth 185
	241	+	by an amount not to exceed ten per cent of such rate. If a licensed 186
	242	+	residential care home fails to submit a complete and accurate report, the 187
	243	+	department shall notify such home of the failure and the home shall 188
	244	+	have thirty days from the date the notice was issued to submit a 189
	245	+	complete and accurate report. If a licensed residential care home fails to 190
	246	+	submit a complete and accurate report not later than thirty days after 191
	247	+	the date of notice, such home may not receive a retroactive rate increase, 192
	248	+	in the commissioner's discretion. The commissioner shall, annually, on 193
	249	+	or before April first, report the data contained in the reports of such 194
	250	+	facilities on the department's Internet web site. For the cost reporting 195
	251	+	year commencing October 1, 1985, and for subsequent cost reporting 196
	252	+	years, facilities shall report the cost of using the services of any [nursing 197
	253	+	pool employee] nursing personnel supplied by a temporary nursing 198
	254	+	services agency by separating said cost into two categories, the portion 199
	255	+	of the cost equal to the salary of the employee for whom the [nursing 200
	256	+	pool employee] nursing personnel supplied by a temporary nursing 201
	257	+	services agency is substituting shall be considered a nursing cost and 202
	258	+	any cost in excess of such salary shall be further divided so that seventy-203
	259	+	five per cent of the excess cost shall be considered an administrative or 204
	260	+	general cost and twenty-five per cent of the excess cost shall be 205
	261	+	considered a nursing cost, provided if the total [nursing pool] costs of a 206
	262	+	facility for nursing personnel supplied by a temporary nursing services 207
	263	+	agency in any cost year are equal to or exceed fifteen per cent of the total 208
	264	+	nursing expenditures of the facility for such cost year, no portion of 209
	265	+	[nursing pool] such costs in excess of fifteen per cent shall be classified 210
	266	+	as administrative or general costs. The commissioner, in determining 211
	267	+	such rates, shall also take into account the classification of patients or 212
	268	+	boarders according to special care requirements or classification of the 213
	269	+	facility according to such factors as facilities and services and such other 214
	270	+	factors as the commissioner deems reasonable, including anticipated 215
	271	+	fluctuations in the cost of providing such services. The commissioner 216
	272	+	may establish a separate rate for a facility or a portion of a facility for 217
	273	+	traumatic brain injury patients who require extensive care but not acute 218
	274	+	general hospital care. Such separate rate shall reflect the special care 219 Substitute Bill No. 5313
345	275
346		-	Public Act No. 22-57 11 of 16
347	276
348		-	Sec. 6. Subdivision (1) of subsection (f) of section 17b-340 of the 2022
349		-	supplement to the general statutes is repealed and the following is
350		-	substituted in lieu thereof (Effective July 1, 2022):
351		-	(1) Allowable costs shall be divided into the following five cost
352		-	components: (A) Direct costs, which shall include salaries for nursing
353		-	personnel, related fringe benefits and [nursing pool] costs for nursing
354		-	personnel supplied by a temporary nursing services agency; (B) indirect
355		-	costs, which shall include professional fees, dietary expenses,
356		-	housekeeping expenses, laundry expenses, supplies related to patient
357		-	care, salaries for indirect care personnel and related fringe benefits; (C)
358		-	fair rent, which shall be defined in accordance with subsection (f) of
359		-	section 17-311-52 of the regulations of Connecticut state agencies; (D)
360		-	capital-related costs, which shall include property taxes, insurance
361		-	expenses, equipment leases and equipment depreciation; and (E)
362		-	administrative and general costs, which shall include (i) maintenance
363		-	and operation of plant expenses, (ii) salaries for administrative and
364		-	maintenance personnel, and (iii) related fringe benefits. The
365		-	commissioner may provide a rate adjustment for nonemergency
366		-	transportation services required by nursing facility residents. Such
367		-	adjustment shall be a fixed amount determined annually by the
368		-	commissioner based upon a review of costs and other associated
369		-	information. Allowable costs shall not include costs for ancillary
370		-	services payable under Part B of the Medicare program.
371		-	Sec. 7. Subdivision (4) of subsection (a) of section 17b-340d of the 2022
372		-	supplement to the general statutes is repealed and the following is
373		-	substituted in lieu thereof (Effective July 1, 2022):
374		-	(4) Allowable costs shall be divided into the following five cost
375		-	components: (A) Direct costs, which shall include salaries for nursing
376		-	personnel, related fringe benefits and [nursing pool] costs for nursing
377		-	personnel supplied by a temporary nursing services agency; (B) indirect
378		-	costs, which shall include professional fees, dietary expenses, Substitute House Bill No. 5313
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379	280
380		-	Public Act No. 22-57 12 of 16
	281	+	requirements of such patients. If changes in federal or state laws, 220
	282	+	regulations or standards adopted subsequent to June 30, 1985, result in 221
	283	+	increased costs or expenditures in an amount exceeding one-half of one 222
	284	+	per cent of allowable costs for the most recent cost reporting year, the 223
	285	+	commissioner shall adjust rates and provide payment for any such 224
	286	+	increased reasonable costs or expenditures within a reasonable period 225
	287	+	of time retroactive to the date of enforcement. Nothing in this section 226
	288	+	shall be construed to require the Department of Social Services to adjust 227
	289	+	rates and provide payment for any increases in costs resulting from an 228
	290	+	inspection of a facility by the Department of Public Health. Such 229
	291	+	assistance as the commissioner requires from other state agencies or 230
	292	+	departments in determining rates shall be made available to the 231
	293	+	commissioner at the commissioner's request. Payment of the rates 232
	294	+	established pursuant to this section shall be conditioned on the 233
	295	+	establishment by such facilities of admissions procedures that conform 234
	296	+	with this section, section 19a-533 and all other applicable provisions of 235
	297	+	the law and the provision of equality of treatment to all persons in such 236
	298	+	facilities. The established rates shall be the maximum amount 237
	299	+	chargeable by such facilities for care of such beneficiaries, and the 238
	300	+	acceptance by or on behalf of any such facility of any additional 239
	301	+	compensation for care of any such beneficiary from any other person or 240
	302	+	source shall constitute the offense of aiding a beneficiary to obtain aid 241
	303	+	to which the beneficiary is not entitled and shall be punishable in the 242
	304	+	same manner as is provided in subsection (b) of section 17b-97. 243
	305	+	Notwithstanding any provision of this section, the Commissioner of 244
	306	+	Social Services may, within available appropriations, provide an interim 245
	307	+	rate increase for a licensed chronic and convalescent nursing home or a 246
	308	+	rest home with nursing supervision for rate periods no earlier than April 247
	309	+	1, 2004, only if the commissioner determines that the increase is 248
	310	+	necessary to avoid the filing of a petition for relief under Title 11 of the 249
	311	+	United States Code; imposition of receivership pursuant to sections 19a-250
	312	+	542 and 19a-543; or substantial deterioration of the facility's financial 251
	313	+	condition that may be expected to adversely affect resident care and the 252
	314	+	continued operation of the facility, and the commissioner determines 253
	315	+	that the continued operation of the facility is in the best interest of the 254 Substitute Bill No. 5313
381	316
382		-	housekeeping expenses, laundry expenses, supplies related to patient
383		-	care, salaries for indirect care personnel and related fringe benefits; (C)
384		-	fair rent, which shall be defined in regulations adopted in accordance
385		-	with subsection (b) of this section; (D) capital-related costs, which shall
386		-	include property taxes, insurance expenses, equipment leases and
387		-	equipment depreciation; and (E) administrative and general costs,
388		-	which shall include maintenance and operation of plant expenses,
389		-	salaries for administrative and maintenance personnel and related
390		-	fringe benefits. For (i) direct costs, the maximum cost shall be equal to
391		-	one hundred thirty-five per cent of the median allowable cost of that
392		-	peer grouping; (ii) indirect costs, the maximum cost shall be equal to one
393		-	hundred fifteen per cent of the state-wide median allowable cost; (iii)
394		-	fair rent, the amount shall be calculated utilizing the amount approved
395		-	pursuant to section 17b-353; (iv) capital-related costs, there shall be no
396		-	maximum; and (v) administrative and general costs, the maximum shall
397		-	be equal to the state-wide median allowable cost. For purposes of this
398		-	subdivision, "temporary nursing services agency" and "nursing
399		-	personnel" have the same meaning as provided in section 1 of this act.
400		-	Sec. 8. Subsection (a) of section 51-344a of the 2022 supplement to the
401		-	general statutes is repealed and the following is substituted in lieu
402		-	thereof (Effective July 1, 2022):
403		-	(a) Whenever the term "judicial district of Hartford-New Britain" or
404		-	"judicial district of Hartford-New Britain at Hartford" is used or referred
405		-	to in the following sections of the general statutes, it shall be deemed to
406		-	mean or refer to the judicial district of Hartford on and after September
407		-	1, 1998: Sections 1-205, 1-206, 2-48, 3-21a, 3-62d, 3-70a, 3-71a, 4-61, 4-160,
408		-	4-164, 4-177b, 4-180, 4-183, 4-197, 5-202, 5-276a, 8-30g, 9-7a, 9-7b, 9-369b,
409		-	10-153e, 12-208, 12-237, 12-268l, 12-312, 12-330m, 12-405k, 12-422, 12-448,
410		-	12-454, 12-456, 12-463, 12-489, 12-522, 12-554, 12-565, 12-572, 12-586f, 12-
411		-	597, 12-730, 13b-34, 13b-235, 13b-315, 13b-375, 14-57, 14-66, 14-67u, 14-
412		-	110, 14-195, 14-311, 14-311c, 14-324, 14-331, 15-125, 15-126, 16-41, 16a-5, Substitute House Bill No. 5313
413	317
414		-	Public Act No. 22-57 13 of 16
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415	321
416		-	17b-60, 17b-100, 17b-238, 17b-531, 19a-85, 19a-86, [19a-123d,] 19a-425,
417		-	19a-498, 19a-517, 19a-526, 19a-633, 20-12f, 20-13e, 20-29, 20-40, 20-45, 20-
418		-	59, 20-73a, 20-86f, 20-99, 20-114, 20-133, 20-154, 20-156, 20-162p, 20-192,
419		-	20-195p, 20-202, 20-206c, 20-227, 20-238, 20-247, 20-263, 20-271, 20-307,
420		-	20-341f, 20-363, 20-373, 20-404, 20-414, 21a-55, 21a-190i, 22-7, 22-228, 22-
421		-	248, 22-254, 22-320d, 22-326a, 22-344b, 22-386, 22a-6b, 22a-7, 22a-16, 22a-
422		-	30, 22a-34, 22a-53, 22a-60, 22a-62, 22a-63, 22a-66h, 22a-106a, 22a-119,
423		-	22a-180, 22a-182a, 22a-184, 22a-220a, 22a-220d, 22a-225, 22a-226, 22a-
424		-	226c, 22a-227, 22a-250, 22a-255l, 22a-276, 22a-310, 22a-342a, 22a-344, 22a-
425		-	361a, 22a-374, 22a-376, 22a-408, 22a-430, 22a-432, 22a-438, 22a-449f, 22a-
426		-	449g, 22a-459, 23-5e, 23-65m, 25-32e, 25-36, 28-5, 29-143j, 29-158, 29-161z,
427		-	29-323, 30-8, 31-109, 31-249b, 31-266, 31-266a, 31-270, 31-273, 31-284, 31-
428		-	285, 31-339, 31-355a, 31-379, 35-3c, 35-42, 36a-186, 36a-187, 36a-471a, 36a-
429		-	494, 36a-587, 36a-647, 36a-684, 36a-718, 36a-807, 36b-26, 36b-27, 36b-30,
430		-	36b-50, 36b-71, 36b-72, 36b-74, 36b-76, 38a-41, 38a-52, 38a-134, 38a-139,
431		-	38a-140, 38a-147, 38a-150, 38a-185, 38a-209, 38a-225, 38a-226b, 38a-241,
432		-	38a-337, 38a-470, 38a-620, 38a-657, 38a-687, 38a-774, 38a-776, 38a-817,
433		-	38a-843, 38a-868, 38a-906, 38a-994, 42-103c, 42-110d, 42-110k, 42-110p,
434		-	42-182, 46a-56, 46a-100, 47a-21, 49-73, 51-44a, 51-81b, 51-194, 52-146j, 53-
435		-	392d and 54-211a.
436		-	Sec. 9. Section 19a-535 of the 2022 supplement to the general statutes
437		-	is amended by adding subsection (k) as follows (Effective July 1, 2022):
438		-	(NEW) (k) A facility shall electronically report each involuntary
439		-	transfer or discharge to the State Ombudsman, appointed pursuant to
440		-	section 17a-405, (1) in a manner prescribed by the State Ombudsman,
441		-	and (2) on an Internet web site portal maintained by the State
442		-	Ombudsman in accordance with patient privacy provisions of the
443		-	Health Insurance Portability and Accountability Act of 1996, P.L. 104-
444		-	191, as amended from time to time.
445		-	Sec. 10. Section 19a-535a of the general statutes is amended by adding
446		-	subsection (e) as follows (Effective from passage): Substitute House Bill No. 5313
	322	+	state. The commissioner shall consider any requests for interim rate 255
	323	+	increases on file with the department from March 30, 2004, and those 256
	324	+	submitted subsequently for rate periods no earlier than April 1, 2004. 257
	325	+	When reviewing an interim rate increase request the commissioner 258
	326	+	shall, at a minimum, consider: (A) Existing chronic and convalescent 259
	327	+	nursing home or rest home with nursing supervision utilization in the 260
	328	+	area and projected bed need; (B) physical plant long-term viability and 261
	329	+	the ability of the owner or purchaser to implement any necessary 262
	330	+	property improvements; (C) licensure and certification compliance 263
	331	+	history; (D) reasonableness of actual and projected expenses; and (E) the 264
	332	+	ability of the facility to meet wage and benefit costs. No interim rate 265
	333	+	shall be increased pursuant to this subsection in excess of one hundred 266
	334	+	fifteen per cent of the median rate for the facility's peer grouping, 267
	335	+	established pursuant to subdivision (2) of subsection (f) of this section, 268
	336	+	unless recommended by the commissioner and approved by the 269
	337	+	Secretary of the Office of Policy and Management after consultation 270
	338	+	with the commissioner. Such median rates shall be published by the 271
	339	+	Department of Social Services not later than April first of each year. In 272
	340	+	the event that a facility granted an interim rate increase pursuant to this 273
	341	+	section is sold or otherwise conveyed for value to an unrelated entity 274
	342	+	less than five years after the effective date of such rate increase, the rate 275
	343	+	increase shall be deemed rescinded and the department shall recover an 276
	344	+	amount equal to the difference between payments made for all affected 277
	345	+	rate periods and payments that would have been made if the interim 278
	346	+	rate increase was not granted. The commissioner may seek recovery of 279
	347	+	such payments from any facility with common ownership. With the 280
	348	+	approval of the Secretary of the Office of Policy and Management, the 281
	349	+	commissioner may waive recovery and rescission of the interim rate for 282
	350	+	good cause shown that is not inconsistent with this section, including, 283
	351	+	but not limited to, transfers to family members that were made for no 284
	352	+	value. The commissioner shall provide written quarterly reports to the 285
	353	+	joint standing committees of the General Assembly having cognizance 286
	354	+	of matters relating to aging, human services and appropriations and the 287
	355	+	budgets of state agencies, that identify each facility requesting an 288
	356	+	interim rate increase, the amount of the requested rate increase for each 289 Substitute Bill No. 5313
447	357
448		-	Public Act No. 22-57 14 of 16
449	358
450		-	(NEW) (e) Not later than six months after the effective date of this
451		-	section, a facility shall electronically report each involuntary transfer or
452		-	discharge (1) in a manner prescribed by the State Ombudsman,
453		-	appointed pursuant to section 17a-405, and (2) on an Internet web site
454		-	portal maintained by the State Ombudsman in accordance with patient
455		-	privacy provisions of the Health Insurance Portability and
456		-	Accountability Act of 1996, P.L. 104-191, as amended from time to time.
457		-	Sec. 11. (Effective from passage) (a) The State Ombudsman, appointed
458		-	pursuant to section 17a-405 of the general statutes, shall appoint and
459		-	convene a working group of not more than eight members to study the
460		-	following issues involving a managed residential community, as
461		-	defined in section 19a-693 of the general statutes, that is not affiliated
462		-	with a facility providing services under a continuing-care contract, as
463		-	defined in section 17b-520 of the general statutes: (1) What notice should
464		-	be provided to residents of managed residential communities of rental
465		-	and other fee increases that exceed certain percentages, and (2) resident
466		-	health transitions and determinations of care levels.
467		-	(b) The working group shall include, but not be limited to, the State
468		-	Ombudsman, or the State Ombudsman's designee, and the following
469		-	members, provided such members are willing and available to serve:
470		-	Representatives of the (1) Connecticut Assisted Living Association, (2)
471		-	Connecticut Association of Health Care Facilities/Connecticut Center
472		-	for Assisted Living, and (3) LeadingAge Connecticut.
473		-	(c) Chairpersons of the working group shall be the State
474		-	Ombudsman, or the State Ombudsman's designee, and another member
475		-	of the working group chosen by members of the group. The State
476		-	Ombudsman shall schedule the first meeting of the working group not
477		-	later than sixty days after the effective date of this section. The
478		-	administrative staff of the joint standing committee of the General
479		-	Assembly having cognizance of matters relating to aging shall serve as
480		-	administrative staff of the working group. Substitute House Bill No. 5313
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481	362
482		-	Public Act No. 22-57 15 of 16
	363	+	facility, the action taken by the commissioner and the secretary pursuant 290
	364	+	to this subsection, and estimates of the additional cost to the state for 291
	365	+	each approved interim rate increase. Nothing in this subsection shall 292
	366	+	prohibit the commissioner from increasing the rate of a licensed chronic 293
	367	+	and convalescent nursing home or a rest home with nursing supervision 294
	368	+	for allowable costs associated with facility capital improvements or 295
	369	+	increasing the rate in case of a sale of a licensed chronic and convalescent 296
	370	+	nursing home or a rest home with nursing supervision if receivership 297
	371	+	has been imposed on such home. For purposes of this section, 298
	372	+	"temporary nursing services agency" and "nursing personnel" have the 299
	373	+	same meaning as provided in section 1 of this act. 300
	374	+	Sec. 6. Subdivision (1) of subsection (f) of section 17b-340 of the 2022 301
	375	+	supplement to the general statutes is repealed and the following is 302
	376	+	substituted in lieu thereof (Effective July 1, 2022): 303
	377	+	(1) Allowable costs shall be divided into the following five cost 304
	378	+	components: (A) Direct costs, which shall include salaries for nursing 305
	379	+	personnel, related fringe benefits and [nursing pool] costs for nursing 306
	380	+	personnel supplied by a temporary nursing services agency; (B) indirect 307
	381	+	costs, which shall include professional fees, dietary expenses, 308
	382	+	housekeeping expenses, laundry expenses, supplies related to patient 309
	383	+	care, salaries for indirect care personnel and related fringe benefits; (C) 310
	384	+	fair rent, which shall be defined in accordance with subsection (f) of 311
	385	+	section 17-311-52 of the regulations of Connecticut state agencies; (D) 312
	386	+	capital-related costs, which shall include property taxes, insurance 313
	387	+	expenses, equipment leases and equipment depreciation; and (E) 314
	388	+	administrative and general costs, which shall include (i) maintenance 315
	389	+	and operation of plant expenses, (ii) salaries for administrative and 316
	390	+	maintenance personnel, and (iii) related fringe benefits. The 317
	391	+	commissioner may provide a rate adjustment for nonemergency 318
	392	+	transportation services required by nursing facility residents. Such 319
	393	+	adjustment shall be a fixed amount determined annually by the 320
	394	+	commissioner based upon a review of costs and other associated 321
	395	+	information. Allowable costs shall not include costs for ancillary 322 Substitute Bill No. 5313
483	396
484		-	(d) Not later than December 31, 2022, the working group shall submit
485		-	a report on its findings and recommendations to the joint standing
486		-	committee of the General Assembly having cognizance of matters
487		-	relating to aging in accordance with the provisions of section 11-4a of
488		-	the general statutes. The working group shall terminate on the date that
489		-	it submits such report or December 31, 2022, whichever is later.
490		-	Sec. 12. Subsection (g) of section 17b-451 of the 2022 supplement to
491		-	the general statutes is repealed and the following is substituted in lieu
492		-	thereof (Effective from passage):
493		-	(g) The Commissioner of Social Services shall develop an educational
494		-	training program to promote and encourage the accurate and prompt
495		-	identification and reporting of abuse, neglect, exploitation and
496		-	abandonment of elderly persons. Such training program shall be made
497		-	available on the Internet web site of the Department of Social Services
498		-	to mandatory reporters and other interested persons. The commissioner
499		-	shall also make such training available in person or otherwise at various
500		-	times and locations throughout the state as determined by the
501		-	commissioner. Except for a mandatory reporter who has received
502		-	training from an institution, organization, agency or facility required to
503		-	provide such training pursuant to subsection (a) of this section, a
504		-	mandatory reporter shall complete the educational training program
505		-	developed by the commissioner, or an alternate program approved by
506		-	the commissioner, not later than December 31, 2022, or not later than
507		-	ninety days after becoming a mandatory reporter.
508		-	Sec. 13. Section 17a-412 of the 2022 supplement to the general statutes
509		-	is amended by adding subsection (i) as follows (Effective from passage):
510		-	(NEW) (i) Any person required to report suspected abuse, neglect,
511		-	exploitation or abandonment pursuant to subsection (a) of this section
512		-	shall complete the educational training program provided by the
513		-	Commissioner of Social Services pursuant to subsection (g) of section Substitute House Bill No. 5313
514	397
515		-	Public Act No. 22-57 16 of 16
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516	401
517		-	17b-451, as amended by this act, or an alternate program approved by
518		-	the commissioner, not later than December 31, 2022, or not later than
519		-	ninety days after beginning employment as a person required to report
520		-	suspected abuse, neglect, exploitation or abandonment pursuant to
521		-	subsection (a) of this section.
522		-	Sec. 14. (NEW) (Effective from passage) (a) The Department of Social
523		-	Services shall develop an advisory for medical assistance applicants for
524		-	long-term medical care and home care concerning their right to seek
525		-	legal assistance. The advisory shall state, at a minimum, that while
526		-	applicants are not required to utilize an attorney, obtaining legal advice
527		-	prior to completing such application for long-term medical care and
528		-	home care may help protect their finances and rights.
529		-	(b) The department shall post the advisory developed pursuant to
530		-	subsection (a) of this section not later than July 1, 2022, on its Internet
531		-	web site and shall include the advisory in such applications for long-
532		-	term medical care and home care not later than September 1, 2023.
533		-	Sec. 15. Sections 19a-123, 19a-123b and 19a-123d of the general
534		-	statutes are repealed. (Effective July 1, 2022)
	402	+	services payable under Part B of the Medicare program. 323
	403	+	Sec. 7. Subdivision (4) of subsection (a) of section 17b-340d of the 2022 324
	404	+	supplement to the general statutes is repealed and the following is 325
	405	+	substituted in lieu thereof (Effective July 1, 2022): 326
	406	+	(4) Allowable costs shall be divided into the following five cost 327
	407	+	components: (A) Direct costs, which shall include salaries for nursing 328
	408	+	personnel, related fringe benefits and [nursing pool] costs for nursing 329
	409	+	personnel supplied by a temporary nursing services agency; (B) indirect 330
	410	+	costs, which shall include professional fees, dietary expenses, 331
	411	+	housekeeping expenses, laundry expenses, supplies related to patient 332
	412	+	care, salaries for indirect care personnel and related fringe benefits; (C) 333
	413	+	fair rent, which shall be defined in regulations adopted in accordance 334
	414	+	with subsection (b) of this section; (D) capital-related costs, which shall 335
	415	+	include property taxes, insurance expenses, equipment leases and 336
	416	+	equipment depreciation; and (E) administrative and general costs, 337
	417	+	which shall include maintenance and operation of plant expenses, 338
	418	+	salaries for administrative and maintenance personnel and related 339
	419	+	fringe benefits. For (i) direct costs, the maximum cost shall be equal to 340
	420	+	one hundred thirty-five per cent of the median allowable cost of that 341
	421	+	peer grouping; (ii) indirect costs, the maximum cost shall be equal to one 342
	422	+	hundred fifteen per cent of the state-wide median allowable cost; (iii) 343
	423	+	fair rent, the amount shall be calculated utilizing the amount approved 344
	424	+	pursuant to section 17b-353; (iv) capital-related costs, there shall be no 345
	425	+	maximum; and (v) administrative and general costs, the maximum shall 346
	426	+	be equal to the state-wide median allowable cost. For purposes of this 347
	427	+	subdivision, "temporary nursing services agency" and "nursing 348
	428	+	personnel" have the same meaning as provided in section 1 of this act. 349
	429	+	Sec. 8. Subsection (a) of section 51-344a of the 2022 supplement to the 350
	430	+	general statutes is repealed and the following is substituted in lieu 351
	431	+	thereof (Effective July 1, 2022): 352
	432	+	(a) Whenever the term "judicial district of Hartford-New Britain" or 353
	433	+	"judicial district of Hartford-New Britain at Hartford" is used or referred 354 Substitute Bill No. 5313
	434	+
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	439	+
	440	+	to in the following sections of the general statutes, it shall be deemed to 355
	441	+	mean or refer to the judicial district of Hartford on and after September 356
	442	+	1, 1998: Sections 1-205, 1-206, 2-48, 3-21a, 3-62d, 3-70a, 3-71a, 4-61, 4-160, 357
	443	+	4-164, 4-177b, 4-180, 4-183, 4-197, 5-202, 5-276a, 8-30g, 9-7a, 9-7b, 9-369b, 358
	444	+	10-153e, 12-208, 12-237, 12-268l, 12-312, 12-330m, 12-405k, 12-422, 12-448, 359
	445	+	12-454, 12-456, 12-463, 12-489, 12-522, 12-554, 12-565, 12-572, 12-586f, 12-360
	446	+	597, 12-730, 13b-34, 13b-235, 13b-315, 13b-375, 14-57, 14-66, 14-67u, 14-361
	447	+	110, 14-195, 14-311, 14-311c, 14-324, 14-331, 15-125, 15-126, 16-41, 16a-5, 362
	448	+	17b-60, 17b-100, 17b-238, 17b-531, 19a-85, 19a-86, [19a-123d,] 19a-425, 363
	449	+	19a-498, 19a-517, 19a-526, 19a-633, 20-12f, 20-13e, 20-29, 20-40, 20-45, 20-364
	450	+	59, 20-73a, 20-86f, 20-99, 20-114, 20-133, 20-154, 20-156, 20-162p, 20-192, 365
	451	+	20-195p, 20-202, 20-206c, 20-227, 20-238, 20-247, 20-263, 20-271, 20-307, 366
	452	+	20-341f, 20-363, 20-373, 20-404, 20-414, 21a-55, 21a-190i, 22-7, 22-228, 22-367
	453	+	248, 22-254, 22-320d, 22-326a, 22-344b, 22-386, 22a-6b, 22a-7, 22a-16, 22a-368
	454	+	30, 22a-34, 22a-53, 22a-60, 22a-62, 22a-63, 22a-66h, 22a-106a, 22a-119, 369
	455	+	22a-180, 22a-182a, 22a-184, 22a-220a, 22a-220d, 22a-225, 22a-226, 22a-370
	456	+	226c, 22a-227, 22a-250, 22a-255l, 22a-276, 22a-310, 22a-342a, 22a-344, 22a-371
	457	+	361a, 22a-374, 22a-376, 22a-408, 22a-430, 22a-432, 22a-438, 22a-449f, 22a-372
	458	+	449g, 22a-459, 23-5e, 23-65m, 25-32e, 25-36, 28-5, 29-143j, 29-158, 29-161z, 373
	459	+	29-323, 30-8, 31-109, 31-249b, 31-266, 31-266a, 31-270, 31-273, 31-284, 31-374
	460	+	285, 31-339, 31-355a, 31-379, 35-3c, 35-42, 36a-186, 36a-187, 36a-471a, 36a-375
	461	+	494, 36a-587, 36a-647, 36a-684, 36a-718, 36a-807, 36b-26, 36b-27, 36b-30, 376
	462	+	36b-50, 36b-71, 36b-72, 36b-74, 36b-76, 38a-41, 38a-52, 38a-134, 38a-139, 377
	463	+	38a-140, 38a-147, 38a-150, 38a-185, 38a-209, 38a-225, 38a-226b, 38a-241, 378
	464	+	38a-337, 38a-470, 38a-620, 38a-657, 38a-687, 38a-774, 38a-776, 38a-817, 379
	465	+	38a-843, 38a-868, 38a-906, 38a-994, 42-103c, 42-110d, 42-110k, 42-110p, 380
	466	+	42-182, 46a-56, 46a-100, 47a-21, 49-73, 51-44a, 51-81b, 51-194, 52-146j, 53-381
	467	+	392d and 54-211a. 382
	468	+	Sec. 9. Sections 19a-123, 19a-123b and 19a-123d of the general statutes 383
	469	+	are repealed. (Effective July 1, 2022) 384
	470	+	This act shall take effect as follows and shall amend the following
	471	+	sections:
	472	+
	473	+	Section 1 July 1, 2022 New section Substitute Bill No. 5313
	474	+
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	479	+
	480	+	Sec. 2 July 1, 2022 New section
	481	+	Sec. 3 July 1, 2022 New section
	482	+	Sec. 4 July 1, 2022 New section
	483	+	Sec. 5 July 1, 2022 17b-340(a)
	484	+	Sec. 6 July 1, 2022 17b-340(f)(1)
	485	+	Sec. 7 July 1, 2022 17b-340d(a)(4)
	486	+	Sec. 8 July 1, 2022 51-344a(a)
	487	+	Sec. 9 July 1, 2022 Repealer section
	488	+
	489	+
	490	+	AGE Joint Favorable Subst.
	491	+	PH Joint Favorable
535	492