House Bill No. 5781
Public Act No. 23-48
AN ACT CONCERNING NOTICE OF A PROPOSED INVOLUNTARY
TRANSFER OR DISCHARGE OF A NURSING FACILITY RESIDENT,
FAMILY COUNCILS IN MANAGED RESIDENTIAL COMMUNITIES,
COORDINATION OF DEMENTIA SERVICES, NURSING HOME
TRANSPARENCY AND HOMEMAKER -COMPANION AGENCIES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsection (c) of section 19a-535 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective from
passage):
(c) (1) Before effecting any transfer or discharge of a resident from the
facility, the facility shall notify, in writing, the resident and the resident's
guardian or conservator, if any, or legally liable relative or other
responsible party if known, of the proposed transfer or discharge, the
reasons therefor, the effective date of the proposed transfer or discharge,
the location to which the resident is to be transferred or discharged, the
right to appeal the proposed transfer or discharge and the procedures
for initiating such an appeal as determined by the Department of Social
Services, the date by which an appeal must be initiated in order to
preserve the resident's right to an appeal hearing and the date by which
an appeal must be initiated in order to stay the proposed transfer or
discharge and the possibility of an exception to the date by which an
appeal must be initiated in order to stay the proposed transfer or House Bill No. 5781
Public Act No. 23-48 2 of 23
discharge for good cause, that the resident may represent himself or
herself or be represented by legal counsel, a relative, a friend or other
spokesperson, an affirmation by the facility that notice of the proposed
transfer or discharge has been provided to the State Long-Term Care
Ombudsman, in accordance with the provisions of subdivision (3) of
this subsection, and information as to bed hold and nursing home
readmission policy when required in accordance with section 19a-537.
The notice shall also include the name, mailing address and telephone
number of the State Long-Term Care Ombudsman. If the resident is, or
the facility alleges a resident is, mentally ill or developmentally
disabled, the notice shall include the name, mailing address and
telephone number of the nonprofit entity designated by the Governor in
accordance with section 46a-10b to serve as the Connecticut protection
and advocacy system. The notice shall be given at least thirty days and
no more than sixty days prior to the resident's proposed transfer or
discharge, except where the health or safety of individuals in the facility
are endangered, or where the resident's health improves sufficiently to
allow a more immediate transfer or discharge, or where immediate
transfer or discharge is necessitated by urgent medical needs or where
a resident has not resided in the facility for thirty days, in which cases
notice shall be given as many days before the transfer or discharge as
practicable.
(2) The resident may initiate an appeal pursuant to this section by
submitting a written request to the Commissioner of Social Services not
later than sixty calendar days after the facility issues the notice of the
proposed transfer or discharge, except as provided in subsection (h) of
this section. In order to stay a proposed transfer or discharge, the
resident must initiate an appeal not later than twenty days after the date
the resident receives the notice of the proposed transfer or discharge
from the facility unless the resident demonstrates good cause for failing
to initiate such appeal within the twenty-day period. House Bill No. 5781
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(3) On the date that the facility provides notice of a proposed
involuntary transfer or discharge of a resident pursuant to the
provisions of subdivision (1) of this subsection, the facility shall notify
the State Ombudsman, appointed pursuant to section 17a-870, in a
manner prescribed by the State Ombudsman, of such proposed
involuntary transfer or discharge. Failure to provide notice to the State
Ombudsman pursuant to the provisions of this subdivision shall
invalidate any notice of the proposed involuntary transfer or discharge
of a resident submitted pursuant to the provisions of subdivision (1) of
this subsection.
Sec. 2. Subsection (a) of section 17a-878 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective from
passage):
(a) The State Ombudsman and representatives of the office shall have:
(1) Access to long-term care facilities and residents;
(2) Appropriate access to review the medical and social records of a
resident, including, but not limited to, the discharge plan developed
pursuant to subsection (e) of section 19a-535, if (A) the representative of
the office has the permission of the resident, or the legal representative
of the resident, (B) the resident is unable to consent to the review and
has no legal representative, or (C) access to the records is necessary to
investigate a complaint and a resident representative refuses to give
permission, a representative of the office has reasonable cause to believe
that the resident representative is not acting in the best interests of the
resident, and the representative of the office obtains the approval of the
ombudsman;
(3) Access to the administrative records, policies and documents, to
which the residents have, or the general public has access, of long-term
care facilities; and House Bill No. 5781
Public Act No. 23-48 4 of 23
(4) Access to and, on request, copies of all licensing and certification
records maintained by the state with respect to long-term care facilities.
Sec. 3. Subsection (k) of section 19a-535 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective from
passage):
(k) [A] Except as otherwise provided pursuant to subdivision (3) of
subsection (c) of this section, a facility shall electronically report each
involuntary transfer or discharge to the State Ombudsman, appointed
pursuant to section [17a-405] 17a-870, (1) in a manner prescribed by the
State Ombudsman, and (2) on an Internet web site portal maintained by
the State Ombudsman in accordance with patient privacy provisions of
the Health Insurance Portability and Accountability Act of 1996, P.L.
104-191, as amended from time to time.
Sec. 4. Section 19a-693 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective October 1, 2023):
As used in this section and sections 19a-694 to 19a-701, inclusive, as
amended by this act:
(1) "Activities of daily living" means activities or tasks that are
essential for a person's healthful and safe existence, including, but not
limited to, bathing, dressing, grooming, eating, meal preparation,
shopping, housekeeping, transfers, bowel and bladder care, laundry,
communication, self-administration of medication and ambulation.
(2) "Assisted living services" means nursing services and assistance
with activities of daily living provided to residents living within (A) a
managed residential community having supportive services that
encourage persons primarily fifty-five years of age or older to maintain
a maximum level of independence, or (B) an elderly housing complex
receiving assistance and funding through the United States Department
of Housing and Urban Development's Assisted Living Conversion House Bill No. 5781
Public Act No. 23-48 5 of 23
Program.
(3) "Assisted living services agency" means an entity, licensed by the
Department of Public Health pursuant to chapter 368v that provides,
among other things, nursing services and assistance with activities of
daily living to a population that is chronic and stable.
(4) "Managed residential community" means a for-profit or not-for-
profit facility consisting of private residential units that provides a
managed group living environment consisting of housing and services
for persons who are primarily fifty-five years of age or older. "Managed
residential community" does not include any state-funded congregate
housing facilities.
(5) "Department" means the Department of Public Health.
(6) "Family council" means an independent, self-determining group
of family members and friends who (A) advocate for the needs and
interests of the residents of a managed residential community that offers
assisted living services, and (B) facilitate open communication between
the managed residential community administration, the residents and
family and friends of the residents.
[(6)] (7) "Private residential unit" means a private living environment
designed for use and occupancy by a resident within a managed
residential community that includes a full bathroom and access to
facilities and equipment for the preparation and storage of food.
[(7)] (8) "Resident" means a person residing in a private residential
unit of a managed residential community pursuant to the terms of a
written agreement for occupancy of such unit.
Sec. 5. Section 19a-694 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective October 1, 2023): House Bill No. 5781
Public Act No. 23-48 6 of 23
(a) All managed residential communities operating in the state shall:
(1) Provide a written residency agreement to each resident in
accordance with section 19a-700;
(2) Afford residents the ability to access services provided by an
assisted living services agency. Such services shall be provided in
accordance with a service plan developed in accordance with section
19a-699;
(3) Upon the request of a resident, arrange, in conjunction with the
assisted living services agency, for the provision of ancillary medical
services on behalf of a resident, including physician and dental services,
pharmacy services, restorative physical therapies, podiatry services,
hospice care and home health agency services, provided the ancillary
medical services are not administered by employees of the managed
residential community, unless the resident chooses to receive such
services;
(4) Provide a formally established security program for the protection
and safety of residents that is designed to protect residents from
intruders;
(5) Afford residents the rights and privileges guaranteed under title
47a;
(6) Comply with the provisions of subsection (c) of section 19-13-D105
of the regulations of Connecticut state agencies; [and]
(7) Assist a resident who has a long-term care insurance policy with
preparing and submitting claims for benefits to the insurer, provided
such resident has executed a written authorization requesting and
directing the insurer to (A) disclose information to the managed
residential community relevant to such resident's eligibility for an
insurance benefit or payment, and (B) provide a copy of the acceptance House Bill No. 5781
Public Act No. 23-48 7 of 23
or declination of a claim for benefits to the managed residential
community at the same time such acceptance or declination is made to
such resident; and
(8) On or before January 1, 2024, encourage and assist in the
establishment of a family council in managed residential communities
offering assisted living services. Such family council shall not allow a
family member or friend of a resident who is not a resident of a dementia
special care unit to participate in the family council without the consent
of such resident.
(b) No managed residential community shall control or manage the
financial affairs or personal property of any resident, except as provided
for in subdivision (7) of subsection (a) of this section.
Sec. 6. (NEW) (Effective October 1, 2023) There shall be within the
Department of Aging and Disability Services a dementia services
coordinator. The dementia services coordinator shall (1) coordinate
dementia services across state agencies, (2) assess and analyze
dementia-related data collected by the state, (3) evaluate state-funded
dementia services, (4) identify and support the development of
dementia-specific training programs, and (5) perform any other relevant
duties to support individuals with dementia in the state, as determined
by the Commissioner of Aging and Disability Services.
Sec. 7. (NEW) (Effective July 1, 2023) (a) Beginning with the cost report
year ending on September 30, 2023, and annually thereafter, each
nursing home facility, as defined in section 19a-490 of the general
statutes, shall submit to the Commissioner of Social Services narrative
summaries of expenditures in addition to the cost reports required
pursuant to section 17b-340 of the general statutes, as amended by this
act. The summaries shall include profit and loss statements for the
preceding three cost report years, total revenue, total expenditures, total
assets, total liabilities, short-term debt, long-term debt and cash flows House Bill No. 5781
Public Act No. 23-48 8 of 23
from investing, operating and financing activities. The Commissioner of
Social Services shall develop a uniform narrative summary form to be
used by nursing home facilities for the purposes of complying with the
provisions of this subsection and post such form on the department's
Internet web site.
(b) Not later than January 1, 2024, and annually thereafter, the
Commissioner of Social Services shall post in a conspicuous area on the
Internet web site of the Department of Social Services a link to the
annual cost reports and the summaries provided by each nursing home
facility.
(c) Any nursing home facility that violates or fails to comply with the
provisions of this section shall be fined not more than ten thousand
dollars for each incident of noncompliance. Prior to imposing any
penalty pursuant to this subsection, the commissioner shall notify the
nursing home facility of the alleged violation and the accompanying
penalty and shall permit such facility to request that the department
review its findings. A facility shall request such review not later than
fifteen days after receipt of the notice of violation from the department.
The department shall stay the imposition of any penalty pending the
outcome of the review. The commissioner may impose a penalty upon
a facility pursuant to this subsection regardless of whether a change in
ownership of the facility has taken place since the time of the violation,
provided the department issued notice of the alleged violation and the
accompanying penalty prior to the effective date of the change in
ownership and record of such notice is readily available in a central
registry maintained by the department. Payments of fines received
pursuant to this subsection shall be deposited in the General Fund and
credited to the Medicaid account.
Sec. 8. Section 19a-491a of the general statutes is repealed and the
following is substituted in lieu thereof (Effective July 1, 2023): House Bill No. 5781
Public Act No. 23-48 9 of 23
(a) A person seeking a license to establish, conduct, operate or
maintain a nursing home shall provide the Department of Public Health
with the following information:
(1) (A) The name and business address of the owner and a statement
of whether the owner is an individual, partnership, corporation or other
legal entity; (B) the names of the officers, directors, trustees, or
managing and general partners of the owner, the names of persons
having a ten per cent or greater ownership interest in the owner, and a
description of each such person's occupation with the owner; [and] (C)
if the owner is a corporation which is incorporated in another state, a
certificate of good standing from the secretary of state of the state of
incorporation; and (D) if a private equity company or real estate
investment trust owns any portion of the business, any information
regarding such company or trust required to be disclosed (i) on federal
Form CMS-855a, and (ii) in accordance with 42 CFR 424.516 or 42 CFR
455.104, as amended from time to time;
(2) A description of the relevant business experience of the owner and
of the administrator of the nursing home and evidence that the
administrator has a license issued pursuant to section 19a-514;
(3) Affidavits signed by the owner, any of the persons described in
subdivision (1) of this subsection, the administrator, assistant
administrator, the medical director, the director of nursing and assistant
director of nursing disclosing any matter in which such person has been
convicted of a felony, as defined in section 53a-25, or has pleaded nolo
contendere to a felony charge, or has been held liable or enjoined in a
civil action by final judgment, if the felony or civil action involved fraud,
embezzlement, fraudulent conversion or misappropriation of property;
or is subject to an injunction or restrictive or remedial order of a court of
record at the time of application, within the past five years has had any
state or federal license or permit suspended or revoked as a result of an
action brought by a governmental agency or department, arising out of House Bill No. 5781
Public Act No. 23-48 10 of 23
or relating to health care business activity, including, but not limited to,
actions affecting the operation of a nursing home, retirement home,
residential care home or any facility subject to sections 17b-520 to 17b-
535, inclusive, or a similar statute in another state or country;
(4) (A) A statement as to whether or not the owner is, or is affiliated
with, a religious, charitable or other nonprofit organization; (B) the
extent of the affiliation, if any; (C) the extent to which the affiliate
organization will be responsible for the financial obligations of the
owner; and (D) the provision of the Internal Revenue Code of 1986, or
any subsequent corresponding internal revenue code of the United
States, as from time to time amended, if any, under which the owner or
affiliate is exempt from the payment of income tax;
(5) The location and a description of other health care facilities of the
owner, existing or proposed, and, if proposed, the estimated completion
date or dates and whether or not construction has begun; [and]
(6) Audited and certified financial statements of the owner, including
(A) a balance sheet as of the end of the most recent fiscal year, and (B)
income statements for the most recent fiscal year of the owner or such
shorter period of time as the owner shall have been in existence; and
[(6)] (7) If the operation of the nursing home has not yet commenced,
a statement of the anticipated source and application of the funds used
or to be used in the purchase or construction of the home, including:
(A) An estimate of such costs as financing expense, legal expense,
land costs, marketing costs and other similar costs which the owner
expects to incur or become obligated for prior to the commencement of
operations; and
(B) A description of any mortgage loan or any other financing
intended to be used for the financing of the nursing home, including the
anticipated terms and costs of such financing. House Bill No. 5781
Public Act No. 23-48 11 of 23
(b) In addition to the information provided pursuant to subsection (a)
of this section, the commissioner may reasonably require an applicant
for a nursing home license or renewal of a nursing home license to
submit additional information. Such information may include audited
and certified financial statements of the owner, including, (1) a balance
sheet as of the end of the most recent fiscal year, and (2) income
statements for the most recent fiscal year of the owner or such shorter
period of time as the owner shall have been in existence.
(c) No person acting individually or jointly with any other person
shall establish, conduct, operate or maintain a nursing home without
maintaining professional liability insurance or other indemnity against
liability for professional malpractice. The amount of insurance which
such person shall maintain as insurance or indemnity against claims for
injury or death for professional malpractice shall be not less than one
million dollars for one person, per occurrence, with an aggregate of not
less than three million dollars. The requirements of this subsection shall
not apply to any person who establishes, conducts, operates or
maintains a residential care home.
(d) A person seeking to renew a nursing home license shall furnish
the department with any information required under this section that
was not previously submitted and with satisfactory written proof that
the owner of the nursing home consents to such renewal, if the owner is
different from the person seeking renewal, and shall provide data on
any change in the information submitted. The commissioner shall refuse
to issue or renew a nursing home license if the person seeking renewal
fails to provide the information required under this section. Upon such
refusal, the commissioner shall grant such license to the holder of the
certificate of need, provided such holder meets all requirements for such
licensure. If such holder does not meet such requirements, the
commissioner shall proceed in accordance with sections 19a-541 to 19a-
549, inclusive. If the commissioner is considering a license renewal House Bill No. 5781
Public Act No. 23-48 12 of 23
application pursuant to an order of the commissioner, the procedures in
this subsection shall apply to such consideration.
Sec. 9. Subsection (a) of section 17b-340 of the general statutes is
repealed and the following is substituted in lieu thereof (Effective July 1,
2023):
(a) For purposes of this subsection, (1) a "related party" includes, but
is not limited to, any company related to a chronic and convalescent
nursing home through family association, common ownership, control
or business association with any of the owners, operators or officials of
such nursing home; (2) "company" means any person, partnership,
association, holding company, limited liability company or corporation;
(3) "family association" means a relationship by birth, marriage or
domestic partnership; and (4) "profit and loss statement" means the
most recent annual statement on profits and losses finalized by a related
party before the annual report mandated under this subsection. The
rates to be paid by or for persons aided or cared for by the state or any
town in this state to licensed chronic and convalescent nursing homes,
to chronic disease hospitals associated with chronic and convalescent
nursing homes, to rest homes with nursing supervision, to licensed
residential care homes, as defined by section 19a-490, and to residential
facilities for persons with intellectual disability that are licensed
pursuant to section 17a-227 and certified to participate in the Title XIX
Medicaid program as intermediate care facilities for individuals with
intellectual disabilities, for room, board and services specified in
licensing regulations issued by the licensing agency shall be determined
annually, except as otherwise provided in this subsection by the
Commissioner of Social Services, to be effective July first of each year
except as otherwise provided in this subsection. Such rates shall be
determined on a basis of a reasonable payment for such necessary
services, which basis shall take into account as a factor the costs of such
services. Cost of such services shall include reasonable costs mandated House Bill No. 5781
Public Act No. 23-48 13 of 23
by collective bargaining agreements with certified collective bargaining
agents or other agreements between the employer and employees,
provided "employees" shall not include persons employed as managers
or chief administrators or required to be licensed as nursing home
administrators, and compensation for services rendered by proprietors
at prevailing wage rates, as determined by application of principles of
accounting as prescribed by said commissioner. Cost of such services
shall not include amounts paid by the facilities to employees as salary,
or to attorneys or consultants as fees, where the responsibility of the
employees, attorneys, or consultants is to persuade or seek to persuade
the other employees of the facility to support or oppose unionization.
Nothing in this subsection shall prohibit inclusion of amounts paid for
legal counsel related to the negotiation of collective bargaining
agreements, the settlement of grievances or normal administration of
labor relations. The commissioner may, in the commissioner's
discretion, allow the inclusion of extraordinary and unanticipated costs
of providing services that were incurred to avoid an immediate negative
impact on the health and safety of patients. The commissioner may, in
the commissioner's discretion, based upon review of a facility's costs,
direct care staff to patient ratio and any other related information, revise
a facility's rate for any increases or decreases to total licensed capacity
of more than ten beds or changes to its number of licensed rest home
with nursing supervision beds and chronic and convalescent nursing
home beds. The commissioner may, in the commissioner's discretion,
revise the rate of a facility that is closing. An interim rate issued for the
period during which a facility is closing shall be based on a review of
facility costs, the expected duration of the close-down period, the
anticipated impact on Medicaid costs, available appropriations and the
relationship of the rate requested by the facility to the average Medicaid
rate for a close-down period. The commissioner may so revise a facility's
rate established for the fiscal year ending June 30, 1993, and thereafter
for any bed increases, decreases or changes in licensure effective after
October 1, 1989. Effective July 1, 1991, in facilities that have both a House Bill No. 5781
Public Act No. 23-48 14 of 23
chronic and convalescent nursing home and a rest home with nursing
supervision, the rate for the rest home with nursing supervision shall
not exceed such facility's rate for its chronic and convalescent nursing
home. All such facilities for which rates are determined under this
subsection shall report on a fiscal year basis ending on September
thirtieth. Such report shall be submitted to the commissioner by
February fifteenth. Each [for-profit] chronic and convalescent nursing
home that receives state funding pursuant to this section shall include
in such annual report a profit and loss statement from each related party
that receives from such chronic and convalescent nursing home [fifty]
thirty thousand dollars or more per year for goods, fees and services.
No cause of action or liability shall arise against the state, the
Department of Social Services, any state official or agent for failure to
take action based on the information required to be reported under this
subsection. The commissioner may reduce the rate in effect for a facility
that fails to submit a complete and accurate report on or before February
fifteenth by an amount not to exceed ten per cent of such rate. If a
licensed residential care home fails to submit a complete and accurate
report, the department shall notify such home of the failure and the
home shall have thirty days from the date the notice was issued to
submit a complete and accurate report. If a licensed residential care
home fails to submit a complete and accurate report not later than thirty
days after the date of notice, such home may not receive a retroactive
rate increase, in the commissioner's discretion. The commissioner shall,
annually, on or before April first, report the data contained in the reports
of such facilities on the department's Internet web site. For the cost
reporting year commencing October 1, 1985, and for subsequent cost
reporting years, facilities shall report the cost of using the services of any
nursing personnel supplied by a temporary nursing services agency by
separating said cost into two categories, the portion of the cost equal to
the salary of the employee for whom the nursing personnel supplied by
a temporary nursing services agency is substituting shall be considered
a nursing cost and any cost in excess of such salary shall be further House Bill No. 5781
Public Act No. 23-48 15 of 23
divided so that seventy-five per cent of the excess cost shall be
considered an administrative or general cost and twenty-five per cent of
the excess cost shall be considered a nursing cost, provided if the total
costs of a facility for nursing personnel supplied by a temporary nursing
services agency in any cost year are equal to or exceed fifteen per cent
of the total nursing expenditures of the facility for such cost year, no
portion of such costs in excess of fifteen per cent shall be classified as
administrative or general costs. The commissioner, in determining such
rates, shall also take into account the classification of patients or
boarders according to special care requirements or classification of the
facility according to such factors as facilities and services and such other
factors as the commissioner deems reasonable, including anticipated
fluctuations in the cost of providing such services. The commissioner
may establish a separate rate for a facility or a portion of a facility for
traumatic brain injury patients who require extensive care but not acute
general hospital care. Such separate rate shall reflect the special care
requirements of such patients. If changes in federal or state laws,
regulations or standards adopted subsequent to June 30, 1985, result in
increased costs or expenditures in an amount exceeding one-half of one
per cent of allowable costs for the most recent cost reporting year, the
commissioner shall adjust rates and provide payment for any such
increased reasonable costs or expenditures within a reasonable period
of time retroactive to the date of enforcement. Nothing in this section
shall be construed to require the Department of Social Services to adjust
rates and provide payment for any increases in costs resulting from an
inspection of a facility by the Department of Public Health. Such
assistance as the commissioner requires from other state agencies or
departments in determining rates shall be made available to the
commissioner at the commissioner's request. Payment of the rates
established pursuant to this section shall be conditioned on the
establishment by such facilities of admissions procedures that conform
with this section, section 19a-533 and all other applicable provisions of
the law and the provision of equality of treatment to all persons in such House Bill No. 5781
Public Act No. 23-48 16 of 23
facilities. The established rates shall be the maximum amount
chargeable by such facilities for care of such beneficiaries, and the
acceptance by or on behalf of any such facility of any additional
compensation for care of any such beneficiary from any other person or
source shall constitute the offense of aiding a beneficiary to obtain aid
to which the beneficiary is not entitled and shall be punishable in the
same manner as is provided in subsection (b) of section 17b-97.
Notwithstanding any provision of this section, the Commissioner of
Social Services may, within available appropriations, provide an interim
rate increase for a licensed chronic and convalescent nursing home or a
rest home with nursing supervision for rate periods no earlier than April
1, 2004, only if the commissioner determines that the increase is
necessary to avoid the filing of a petition for relief under Title 11 of the
United States Code; imposition of receivership pursuant to sections 19a-
542 and 19a-543; or substantial deterioration of the facility's financial
condition that may be expected to adversely affect resident care and the
continued operation of the facility, and the commissioner determines
that the continued operation of the facility is in the best interest of the
state. The commissioner shall consider any requests for interim rate
increases on file with the department from March 30, 2004, and those
submitted subsequently for rate periods no earlier than April 1, 2004.
When reviewing an interim rate increase request the commissioner
shall, at a minimum, consider: (A) Existing chronic and convalescent
nursing home or rest home with nursing supervision utilization in the
area and projected bed need; (B) physical plant long-term viability and
the ability of the owner or purchaser to implement any necessary
property improvements; (C) licensure and certification compliance
history; (D) reasonableness of actual and projected expenses; and (E) the
ability of the facility to meet wage and benefit costs. No interim rate
shall be increased pursuant to this subsection in excess of one hundred
fifteen per cent of the median rate for the facility's peer grouping,
established pursuant to subdivision (2) of subsection (f) of this section,
unless recommended by the commissioner and approved by the House Bill No. 5781
Public Act No. 23-48 17 of 23
Secretary of the Office of Policy and Management after consultation
with the commissioner. Such median rates shall be published by the
Department of Social Services not later than April first of each year. In
the event that a facility granted an interim rate increase pursuant to this
section is sold or otherwise conveyed for value to an unrelated entity
less than five years after the effective date of such rate increase, the rate
increase shall be deemed rescinded and the department shall recover an
amount equal to the difference between payments made for all affected
rate periods and payments that would have been made if the interim
rate increase was not granted. The commissioner may seek recovery of
such payments from any facility with common ownership. With the
approval of the Secretary of the Office of Policy and Management, the
commissioner may waive recovery and rescission of the interim rate for
good cause shown that is not inconsistent with this section, including,
but not limited to, transfers to family members that were made for no
value. The commissioner shall provide written quarterly reports to the
joint standing committees of the General Assembly having cognizance
of matters relating to aging, human services and appropriations and the
budgets of state agencies, that identify each facility requesting an
interim rate increase, the amount of the requested rate increase for each
facility, the action taken by the commissioner and the secretary pursuant
to this subsection, and estimates of the additional cost to the state for
each approved interim rate increase. Nothing in this subsection shall
prohibit the commissioner from increasing the rate of a licensed chronic
and convalescent nursing home or a rest home with nursing supervision
for allowable costs associated with facility capital improvements or
increasing the rate in case of a sale of a licensed chronic and convalescent
nursing home or a rest home with nursing supervision if receivership
has been imposed on such home. For purposes of this section,
"temporary nursing services agency" and "nursing personnel" have the
same meaning as provided in section 19a-118.
Sec. 10. (NEW) (Effective from passage) The Commissioner of Social House Bill No. 5781
Public Act No. 23-48 18 of 23
Services shall develop a guidebook that includes, but need not be
limited to, a glossary and plain language explanation of the terms
relating to and a description of the Medicaid nursing home rate setting
process. Not later than July 1, 2024, the commissioner shall post the
guidebook in a conspicuous area on the Internet web site of the
Department of Social Services. The commissioner may update the
guidebook as deemed necessary.
Sec. 11. (Effective from passage) The Secretary of the Office of Policy
and Management, in consultation with the Commissioners of Consumer
Protection and Public Health, shall develop a plan to transfer the
responsibility for registration and oversight of homemaker-companion
agencies, as defined in section 20-670 of the general statutes from the
Department of Consumer Protection to the Department of Public
Health. Such plan shall (1) provide a timeline for the proposed
transition, and (2) include recommendations on appropriate training
standards that (A) exemplify best practices for providing homemaker
and companion services, as defined in section 20-670 of the general
statutes, (B) provide instruction and specialized training benchmarks
for the care of clients with Alzheimer's disease, dementia and other
related conditions, and (C) ensure a high quality of care for homemaker-
companion agency clients and may evaluate and make
recommendations on the appropriate use of the term "care" in
describing the services provided by homemaker-companion agencies
and any limitations on the use of such term to ensure consumer clarity.
Not later than August 1, 2024, the secretary shall report, in accordance
with section 11-4a of the general statutes, on such plan to the joint
standing committees of the General Assembly having cognizance of
matters relating to aging, general law and public health.
Sec. 12. Section 20-675 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective from passage):
(a) The Commissioner of Consumer Protection may revoke, suspend House Bill No. 5781
Public Act No. 23-48 19 of 23
or refuse to issue or renew any certificate of registration as a
homemaker-companion agency or place an agency on probation or issue
a letter of reprimand for: (1) Conduct by the agency, or by an employee
of the agency while in the course of employment, of a character likely to
mislead, deceive or defraud the public or the commissioner; (2)
engaging in any untruthful or misleading advertising; (3) failure of such
agency that acts as a registry to comply with the notice requirements of
section 20-679a; [or] (4) failing to perform a comprehensive background
check of a prospective employee or maintain a copy of materials
obtained during a comprehensive background check, as required by
section 20-678; or (5) failing to provide a written notice, obtain a signed
notice or maintain a copy of a signed notice, as required by section 17 of
this act.
(b) The commissioner shall revoke a certificate of registration if a
homemaker-companion agency is found to have violated, after an
administrative hearing conducted in accordance with chapter 54, the
provisions of subdivisions (1) to (5), inclusive, of subsection (a) of this
section three times in one calendar year.
[(b)] (c) The commissioner shall not revoke or suspend any certificate
of registration except upon notice and hearing in accordance with
chapter 54.
Sec. 13. Section 20-679 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective October 1, 2023):
(a) Not later than seven calendar days after the date on which a
homemaker-companion agency commences providing homemaker
services or companion services, such agency shall provide the person
who receives the services, or the authorized representative of such
person, with a written contract or service plan. The written contract or
service plan shall be developed in consultation with such person or
authorized representative and include (1) a person-centered plan of care House Bill No. 5781
Public Act No. 23-48 20 of 23
and services that prescribes the anticipated scope, type, frequency,
duration and cost of the services provided by the agency, (2) the
anticipated scope, type and frequency of oversight of an employee
assigned to such person by the homemaker-companion agency, and (3)
a predetermined frequency of meetings between the person who
oversees such employee and the person who receives the services, or the
authorized representative of such person. In addition, any contract or
service plan provided by a homemaker-companion agency to a person
receiving services shall also provide conspicuous notice, in boldface
type [(1)] (A) of the person's right to request changes to, or review of the
contract or service plan, [(2)] (B) of the employees of such agency who,
pursuant to section 20-678 are required to submit to a comprehensive
background check, [(3)] (C) that upon the request of such person or an
authorized representative of such person, such agency shall provide
such person or representative of such person with written notice that a
comprehensive background check, as required pursuant to section 20-
678, was performed for all employees of such agency performing
services for such person, [(4)] (D) that such agency's records are
available for inspection or audit by the Department of Consumer
Protection, [(5)] (E) that the agency is not able to guarantee the extent to
which its services will be covered under any insurance plan, and [(6)]
(F) that such contract or service plan may be cancelled at any time by
the client if such contract or service plan does not contain a specific
period of duration. On the date that a homemaker-companion agency
provides such contract or service plan to such person, the agency shall
also provide a printed copy of the guide that details the process by
which such person, or such person's authorized representative, may file
a complaint against such agency, posted on the Department of
Consumer Protection's Internet web site pursuant to section 14 of this
act. No contract or service plan for the provision of homemaker or
companion services shall be valid against the person who receives the
services or the authorized representative of such person, unless the
contract or service plan has been signed by a duly authorized House Bill No. 5781
Public Act No. 23-48 21 of 23
representative of the homemaker-companion agency and the person
who receives the services or the authorized representative of such
person. The requirements of this section shall not apply to homemaker
services or companion services provided under the Connecticut home-
care program for the elderly administered by the Department of Social
Services in accordance with section 17b-342. A written contract or
service plan between a homemaker-companion agency and a person
receiving services or the authorized representative of such person shall
not be enforceable against such person receiving services or authorized
representative unless such written contract or service plan contains all
of the requirements of this section.
(b) Nothing in this section shall preclude a homemaker-companion
agency that has complied with [subdivisions (1) to (6)] subparagraphs
(A) to (F), inclusive, of subsection (a) of this section from the recovery of
payment for work performed based on the reasonable value of services
which were requested by the person receiving services, provided the
court determines that it would be inequitable to deny such recovery.
Sec. 14. (NEW) (Effective from passage) Not later than October 1, 2023,
the Commissioner of Consumer Protection shall post a guide that details
the process by which a person who receives homemaker services or
companion services, as defined in section 20-670 of the general statutes
or the authorized representative of such person, may file a complaint
against a homemaker-companion agency, as defined in section 20-670 of
the general statutes on its Internet web site.
Sec. 15. (NEW) (Effective from passage) On and after January 1, 2024,
each homemaker-companion agency, as defined in section 20-670 of the
general statutes shall have a printed consumer brochure and maintain
an Internet web site detailing the homemaker and companion services
offered by such agency and provide such brochure or the address of
such Internet web site upon the request of consumers. House Bill No. 5781
Public Act No. 23-48 22 of 23
Sec. 16. Section 20-677 of the general statutes is amended by adding
subsection (g) as follows (Effective from passage):
(NEW) (g) A homemaker-companion agency may include in its
business name and advertising the term "care" if such term is used in
reference to such agency's provision of homemaker services, provided,
on and after October 1, 2023, any such advertising (1) shall prominently
and clearly display in plain font with distinctly contrasting colors at the
top of such advertising, including, but not limited to, each page of the
agency's Internet web site, social media posts, print media and audio-
visual advertisements, the clear and conspicuous words: "(Insert name
of homemaker-companion agency) solely provides nonmedical care.",
or, if such advertising is an audio advertisement, such words shall be
audibly conveyed at the same speed and manner as the rest of such
audio advertisement, and (2) shall not include any words that indicate
or suggest that such agency provides any services beyond the scope of
services authorized under this chapter, including, but not limited to,
words relating to medical or health care licensure or services. A
homemaker-companion agency may include in its advertising words
that accurately describe, as determined by the commissioner, that such
agency has employees who are trained to provide homemaker services
to individuals experiencing memory difficulties, provided the agency
details the type of training and number of hours each employee was
trained to provide such services. A violation of the provisions of this
subsection shall constitute untruthful or misleading advertising for the
purposes of subsection (a) of section 20-675, as amended by this act.
Sec. 17. (NEW) (Effective from passage) Each homemaker-companion
agency, prior to providing homemaker services or companion services,
shall (1) provide the person who receives the services, or the authorized
representative of such person, with a written notice that the agency
provides nonmedical care, and (2) obtain the signature of such person
or representative on the written notice. The agency shall maintain a House Bill No. 5781
Public Act No. 23-48 23 of 23
paper or electronic copy of such signed notice until such time that the
person who receives the services ceases receiving services from the
agency and make such copy available for inspection upon the request of
the Commissioner of Consumer Protection.