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OLR Bill Analysis
HB 5781 (as amended by House "A")*
AN ACT CONCERNING A STUDY OF THE NEEDS OF SENIOR
CITIZENS.
TABLE OF CONTENTS:
SUMMARY:
§§ 1-3 — INVOLUNTARY TRANSFER OR DISCHARGE
NOTIFICATION
Requires nursing homes to notify the Long-Term Care ombudsman about an involuntary
transfer or discharge on the same day the resident is notified; failure to do so invalidates
the transfer
§§ 4 & 5 — MANAGED RESIDENTIAL COMMUNITIES FAMILY
COUNCILS
Requires managed residential communities to encourage and help establish family
councils by January 1, 2024
§ 6 — DEMENTIA SERVICES COORDINATOR
Establishes a dementia services coordinator position within the Department of Aging and
Disability Services
§ 7 — NURSING HOME FACILITY COST REPORTING
REQUIREMENTS
Requires nursing homes to submit annual narrative cost expenditures summaries to DSS;
requires the DSS commissioner to create a uniform narrative summary form for nursing
homes to use; subjects nursing homes that do not comply with the reporting requirements
to a fine of up to $10,000
§ 8 — NURSING HOME PRIVATE EQUITY OWNERS HIP
Requires nursing home licensure applicants to disclose any private equity company or real
estate investment trust that owns any part of the home and give DPH the owner’s audited
and certified financial statements
§ 9 — RELATED PARTY INCOME REPORTING
Requires chronic and convalescent nursing homes that receive Medicaid funding to
annually report a profit and loss statement from each related party that receives at least
$30,000 of income from the home
§ 10 — MEDICAID RATE SETTING GUIDEBOOK FOR NURSING
HOMES
Requires the DSS commissioner to develop and post online a guidebook that explains in
plain language the Medicaid nursing home rate setting process 2023HB-05781-R010845-BA.DOCX
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§ 11 — TRANSITION PLAN FOR HOMEMAKER -COMPANION
AGENCY OVERSIGHT
Requires OPM to develop a plan and proposed timeline to transfer homemaker-companion
agency oversight from DCP to DPH; the plan must also include recommendations on
training standards and appropriate use of the term “care” to describe homemaker-
companion services
§ 12 — HOMEMAKER -COMPANION AGENCY REGISTRATION
REVOCATION
Adds failure to give a consumer written notice that the agency provides nonmedical care
to a list of violations for which DCP may revoke, suspend, or refuse to issue or renew a
homemaker-companion agency’s registration; requires DCP to revoke a homemaker-
companion agency’s registration if the agency is found to have violated any revokable
provisions three times in a calendar year
§ 13 — HOMEMAKER -COMPANION AGENCY CONTRA CTS &
SERVICE PLANS
Requires homemaker-companion agencies to develop a service plan or contract in
consultation with the consumer; the service plan or contract must include (1) a person-
centered plan of care, (2) anticipated oversight by the agency of the employee assigned to
the consumer, and (3) how often the person who oversees the agency’s employee and the
consumer will meet
§§ 13 & 14 — HOMEMAKER-COMPANION AGENCY CONSUMER
COMPLAINTS
Requires DCP to post on its website a guide detailing the process for consumers to file
complaints against a homemaker-companion agency; requires agencies to give consumers
a printed copy of this guide with their contract or service plan
§§ 15-17 — HOMEMAKER -COMPANION AGENCY AD VERTISING
AND SCOPE OF SERVICES
Requires every homemaker-companion agency to create a brochure and maintain a website
detailing the services it provides; allows a homemaker-companion agency to (1) use the
word “care” in its business name and advertising and (2) advertise having employees
trained to provide services to people with memory difficulties, if certain requirements are
met; requires a homemaker-companion agency to give consumers written notice that the
agency provides nonmedical care and obtain the consumer’s signature on this notice before
providing services
SUMMARY:
This bill addresses nursing home transparency and reporting
requirements, expands supports for people with dementia, and
implements the recommendations of the Homemaker -Companion
Agency Task Force, as described in the section-by-section analysis
below.
*House Amendment “A” replaces the underlying bill which would 2023HB-05781-R010845-BA.DOCX
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have required the Commission on Women, Children, Seniors, Equity
and Opportunity executive director to consult with the Aging and
Disability Services commissioner to study the needs of senior citizens in
the state.
EFFECTIVE DATE: Upon passage, unless noted otherwise below.
§§ 1-3 — INVOLUNTARY TRANSFER OR DISCHAR GE
NOTIFICATION
Requires nursing homes to notify the Long-Term Care ombudsman about an involuntary
transfer or discharge on the same day the resident is notified; failure to do so invalidates
the transfer
This bill requires nursing homes to notify the Long-Term Care
Ombudsman about a resident’s involuntary transfer or discharge on the
same day the nursing home notifies the resident. The ombudsman must
prescribe how to provide the notification.
By law, nursing homes must give residents and their representatives
written notification about a discharge or transfer at least 30 days in
advance, including information on the appeals process and the
ombudsman’s contact information. Under the bill, nursing homes must
also notify the ombudsman on the same date if the transfer or discharge
is involuntary. Current law grants the ombudsman access to a long-term
care resident’s medical and social records. The bill specifies that this
includes access to discharge plans.
The bill also requires the facility to affirm to the resident being
transferred or discharged and his or her representative that notice was
given to the ombudsman. If a nursing home fails to notify the
ombudsman, the involuntary transfer or discharge is invalidated and
cannot go forward.
Background — Related Bill
sSB 930 (File 99), reported favorably by the Aging Committee and
passed by the Senate as amended by Senate Amendment “A,” has
similar provisions on notifying the ombudsman but does not require the
facility to affirm to the resident that the ombudsman has been notified
(§§ 1 & 2). 2023HB-05781-R010845-BA.DOCX
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Background — Involuntary Transfers and Discharges
Under federal and state law, nursing homes cannot transfer or
discharge a resident unless the (1) facility cannot provide the resident
adequate care; (2) resident’s health has improved to the point that he or
she no longer needs the home’s services; (3) health or safety of people in
the facility are endangered; (4) resident failed to pay for care after
reasonable notice; or (5) facility closes (42 C.F.R. § 483.15(c), CGS § 19a-
535(b)).
§§ 4 & 5 — MANAGED RESIDENTIAL COMMUNITI ES FAMILY
COUNCILS
Requires managed residential communities to encourage and help establish family
councils by January 1, 2024
The bill requires managed residential communities (MRCs) that offer
assisted living services to encourage and help establish family councils
by January 1, 2024. Under the bill, family councils are self-determined,
independent groups of family members and friends who (1) advocate
for an MRC’s residents’ needs and interests and (2) facilitate open
communication between the MRC administration, residents, and
residents’ family and friends. A resident’s family member or friend
cannot participate in a council without the resident’s consent unless the
resident lives in a dementia special care unit.
Background — Related Bill
sSB 902 (File 78), reported favorably by the Aging Committee, has
identical provisions on family councils.
sSB 930 (File 99), reported favorably by the Aging Committee and
passed by the Senate as amended by Senate Amendment “A,” has
identical provisions (§§ 501 & 502).
§ 6 — DEMENTIA SERVICES COORDINATOR
Establishes a dementia services coordinator position within the Department of Aging and
Disability Services
This bill establishes a dementia services coordinator within the
Department of Aging and Disability Services (ADS). The coordinator’s
duties include: 2023HB-05781-R010845-BA.DOCX
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1. coordinating dementia services across state agencies,
2. assessing and analyzing dementia-related data collected by the
state,
3. evaluating state-funded dementia services,
4. identifying and supporting the development of dementia-
specific training programs, and
5. other relevant duties the ADS commissioner determines.
EFFECTIVE DATE: October 1, 2023
Background — Related Bill
sSB 1024 (File 80), reported favorably by the Aging Committee,
contains identical provisions.
§ 7 — NURSING HOME F ACILITY COST REPORTI NG
REQUIREMENTS
Requires nursing homes to submit annual narrative cost expenditures summaries to DSS;
requires the DSS commissioner to create a uniform narrative summary form for nursing
homes to use; subjects nursing homes that do not comply with the reporting requirements
to a fine of up to $10,000
Beginning with the current cost reporting year, the bill requires
nursing homes to annually submit narrative summaries of cost
expenditures to the Department of Social Services (DSS) commissioner,
alongside their statutorily required cost reports. The summaries must
include (1) profit and loss statements for the preceding three cost report
years; (2) total revenue; (3) total expenditures; (4) total assets; (5) total
liabilities; (6) short-term debt; (7) long-term debt; and (8) cash flows
from investing, operating, and financing activities. The bill requires the
DSS commissioner to develop and post on the agency’s website a
uniform narrative summary form for nursing homes to use to comply.
Starting by January 1, 2024, the DSS commissioner must annually post
these cost reports and summaries for each nursing home in a
conspicuous place on the agency’s website.
The bill requires a nursing home that fails to comply with this
reporting requirement to be fined up to $10,000. Before imposing a 2023HB-05781-R010845-BA.DOCX
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penalty, the social services commissioner must notify the nursing home
about the violation and allow it to request a review. The home must
request a review within 15 days after receiving the notice, and DSS
cannot impose the penalty while the review is pending.
Under the bill, the penalty may be imposed even if the nursing
home’s ownership changes after the violation takes place, as long as DSS
issued the notice about the violation before the change in ownership
became effective and the record of the notice is readily available in a
central registry maintained by DSS. Payments made for these penalties
must be deposited in the General Fund and credited to the Medicaid
account.
EFFECTIVE DATE: July 1, 2023
Background — Related Bill
sHB 6678 (File 74), reported favorably by the Aging Committee and
passed by the House as amended by House Amendment “A” (File 670),
has similar provisions but does not require the DSS commissioner to
develop a uniform narrative summary form (§ 1).
§ 8 — NURSING HOME PRIVATE EQUITY OWNERSHIP
Requires nursing home licensure applicants to disclose any private equity company or real
estate investment trust that owns any part of the home and give DPH the owner’s audited
and certified financial statements
The bill expands the information that nursing home licensure
applicants must give to the Department of Public Health (DPH) to
include (1) information on any private equity company or real estate
investment trust (REIT) that owns any part of the home and (2) the
owner’s audited and certified financial statements. If a private equity
company or REIT owns any part of the home, then it must give DPH the
same information the federal government requires when providers
apply for and maintain enrollment in Medicare. The audited and
certified financial statements must include a balance sheet from the end
of the most recent fiscal year and income statements from the most
recent fiscal year (or an applicable shorter period if the owner has not
existed for a full fiscal year). Existing law, unchanged by the bill, allows
the DPH commissioner to require an applicant to submit additional 2023HB-05781-R010845-BA.DOCX
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information, including these statements.
EFFECTIVE DATE: July 1, 2023
Background — Related Bill
sHB 6678 (File 74), reported favorably by the Aging Committee and
passed by the House as amended by House Amendment “A” (File 670),
has similar provisions but with different reporting requirements (§ 2).
§ 9 — RELATED PARTY INCOME REPORTING
Requires chronic and convalescent nursing homes that receive Medicaid funding to
annually report a profit and loss statement from each related party that receives at least
$30,000 of income from the home
The bill broadens certain reporting requirements for chronic and
convalescent nursing homes that receive Medicaid funding. Current law
requires these types of for-profit homes to include in their annual
reports a profit and loss statement from each related party (i.e., a
company related to the home through family association, common
ownership, control, or business association with the home’s owners or
operators) that receives at least $50,000 of income from the home per
year. The bill extends the requirement to all of these types of nursing
homes, not just for-profits, and lowers the requirement's income
threshold from $50,000 to $30,000.
EFFECTIVE DATE: July 1, 2023
Background — Related Bill
sHB 6678 (File 74), reported favorably by the Aging Committee and
passed by the House as amended by House Amendment “A” (File 670),
has similar provisions but a different income limit (§ 3).
§ 10 — MEDICAID RATE SETTING GUIDEBOOK F OR NURSING
HOMES
Requires the DSS commissioner to develop and post online a guidebook that explains in
plain language the Medicaid nursing home rate setting process
The bill requires the DSS commissioner to develop a guidebook that
at least includes a glossary and a plain language (1) description of the
Medicaid nursing home rate setting process and (2) explanation of terms
related to it. The commissioner must post the guidebook in a 2023HB-05781-R010845-BA.DOCX
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conspicuous place on the agency’s website by July 1, 2024, and may
update it as needed.
Background — Related Bill
sHB 6678 (File 74), reported favorably by the Aging Committee and
passed by the House as amended by House Amendment “A” (File 670),
has identical provisions (§ 4).
§ 11 — TRANSITION PLAN FO R HOMEMAKER -COMPANION
AGENCY OVERSIGHT
Requires OPM to develop a plan and proposed timeline to transfer homemaker-companion
agency oversight from DCP to DPH; the plan must also include recommendations on
training standards and appropriate use of the term “care” to describe homemaker-
companion services
The bill requires the Office of Policy and Management (OPM)
secretary to develop a plan and proposed timeline to transfer
homemaker-companion agency registration and oversight
responsibilities from the Department of Consumer Protection (DCP) to
DPH. The plan must also include recommendations on training
standards that (1) exemplify best practices for providing homemaker-
companion services; (2) provide instruction and specialized training
benchmarks for caring for clients with Alzheimer’s disease, dementia,
and related conditions; and (3) ensure a high level of care for
homemaker-companion agency clients. It may also evaluate and make
recommendations on the appropriate use of the term “care” to describe
services homemaker-companion agencies provide, and any limitations
on using the term to ensure consumer clarity.
The secretary must prepare the plan in consultation with the DCP
and DPH commissioners and report on it to the Aging, General Law,
and Public Health committees by August 1, 2024.
Background — Related Bill
sSB 1025 (File 104), reported favorably by the Aging Committee and
passed by the Senate as amended by Senate “A,” has identical
provisions (§ 1).
§ 12 — HOMEMAKER -COMPANION AGENCY REGIST RATION
REVOCATION 2023HB-05781-R010845-BA.DOCX
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Adds failure to give a consumer written notice that the agency provides nonmedical care
to a list of violations for which DCP may revoke, suspend, or refuse to issue or renew a
homemaker-companion agency’s registration; requires DCP to revoke a homemaker-
companion agency’s registration if the agency is found to have violated any revokable
provisions three times in a calendar year
Current law generally allows the DCP commissioner to revoke,
suspend, or refuse to issue or renew a homemaker-companion agency’s
registration for (1) conduct that misleads or defrauds the public or
commissioner, (2) engaging in misleading advertising, (3) failing to give
a consumer a notice of legal liabilities under certain circumstances, or
(4) failing to complete background checks on prospective employees
and maintain the materials from them. The bill also allows the
commissioner to do this if an agency fails to give a consumer written
notice, or obtain and maintain the consumer’s signed copy of this notice,
that the agency provides nonmedical care, as required by the bill (see §
17).
In addition, the bill requires the DCP commissioner to revoke a
homemaker-companion agency’s registration if the agency is found,
through an administrative hearing, to have violated any of these
provisions three times in a calendar year.
Background — Related Bill
sSB 1025 (File 104), reported favorably by the Aging Committee and
passed by the Senate as amended by Senate “A,” has identical
provisions (§ 2).
§ 13 — HOMEMAKER -COMPANION AGENCY CONTRA CTS &
SERVICE PLANS
Requires homemaker-companion agencies to develop a service plan or contract in
consultation with the consumer; the service plan or contract must include (1) a person-
centered plan of care, (2) anticipated oversight by the agency of the employee assigned to
the consumer, and (3) how often the person who oversees the agency’s employee and the
consumer will meet
Current law requires homemaker-companion agencies to give
consumers a written contract or service plan detailing the anticipated
scope, type, frequency, duration, and cost of services provided by the
agency within seven days of beginning services.
The bill additionally requires the agencies to develop this plan or 2023HB-05781-R010845-BA.DOCX
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contract in consultation with the consumer and expands the information
that must be in it to include:
1. a person-centered plan of care and services;
2. the anticipated scope, type, and frequency of oversight by the
agency over the employee assigned to the consumer; and
3. how often the person who oversees the agency’s employee and
the consumer will meet.
EFFECTIVE DATE: October 1, 2023
Background — Related Bill
sSB 1025 (File 104), reported favorably by the Aging Committee and
passed by the Senate as amended by Senate “A,” contains identical
provisions (§ 5).
§§ 13 & 14 — HOMEMAKER-COMPANION AGENCY CONSUMER
COMPLAINTS
Requires DCP to post on its website a guide detailing the process for consumers to file
complaints against a homemaker-companion agency; requires agencies to give consumers
a printed copy of this guide with their contract or service plan
The bill requires the DCP commissioner, by October 1, 2023, to post
on DCP’s website a guide detailing the process for homemaker-
companion agency consumers to file complaints against an agency. It
requires the agencies to also give consumers a printed copy of this guide
when they give them the written contract or service plan as described
above.
EFFECTIVE DATE: Upon passage, except the requirement that
consumers are given a printed copy of the guide is effective October 1,
2023.
Background — Related Bill
sSB 1025 (File 104), reported favorably by the Aging Committee and
passed by the Senate as amended by Senate “A,” has identical
provisions (§§ 5 & 6). 2023HB-05781-R010845-BA.DOCX
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§§ 15-17 — HOMEMAKER -COMPANION AGENCY AD VERTISING
AND SCOPE OF SERVICE S
Requires every homemaker-companion agency to create a brochure and maintain a website
detailing the services it provides; allows a homemaker-companion agency to (1) use the
word “care” in its business name and advertising and (2) advertise having employees
trained to provide services to people with memory difficulties, if certain requirements are
met; requires a homemaker-companion agency to give consumers written notice that the
agency provides nonmedical care and obtain the consumer’s signature on this notice before
providing services
Brochure and Website (§ 15)
The bill requires every homemaker-companion agency, by January 1,
2024, to (a) create a printed consumer brochure and maintain a website
detailing the services it provides and (b) give the brochure or website
address when a consumer requests it.
Advertising (§ 16)
Under the bill, a homemaker-companion agency may use the term
“care” in its business name and advertising, as long as, starting October
1, 2023, any advertising meets certain conditions. Specifically, it must (1)
prominently display in plain font and contrasting colors at the top of the
ad, the clear and conspicuous words: “(agency’s name) solely provides
nonmedical care,” or audibly convey these words in an audio
advertisement at the same speed as the rest of the audio, and (2) not use
any words, such as those related to medical or health care licensure or
services, to describe services beyond the scope of those a homemaker-
companion agency is authorized to provide. The requirement to display
the disclaimer at the top of the ad applies to each page of the agency's
web site, social media posts, print media, and audio-visual
advertisements. A violation of this provision constitutes untruthful or
misleading advertising.
The bill allows a homemaker-companion agency to use in its
advertising any words deemed appropriate by the DCP commissioner
to accurately describe having employees trained to provide services to
people with memory difficulties, as long as the agency details the type
and number of hours of training these employees received. A violation
of this provision also constitutes untruthful or misleading advertising.
Notice (§ 17) 2023HB-05781-R010845-BA.DOCX
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The bill requires a homemaker-companion agency, before providing
services, to (1) give consumers written notice that the agency provides
nonmedical care and (2) obtain the consumer’s signature on this notice.
The agency must keep the signed notice until the consumer no longer
receives services from the agency and make a copy of the signed notice
available to the DCP commissioner upon request.
Background — Related Bill
sSB 1025 (File 104), reported favorably by the Aging Committee and
passed by the Senate as amended by Senate “A,” has similar provisions
but the advertising requirements are different (§§ 7-9 & 501).
COMMITTEE ACTION
Aging Committee
Joint Favorable
Yea 12 Nay 3 (02/28/2023)