Connecticut 2023 Regular Session

Connecticut House Bill HB05781 Compare Versions

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Version 2 (New)

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	7	+	General Assembly Raised Bill No. 5781
	8	+	January Session, 2023
	9	+	LCO No. 2261
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	11	+
	12	+	Referred to Committee on AGING
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	14	+
	15	+	Introduced by:
	16	+	(AGE)
1	17
2	18
3	19
4		-	House Bill No. 5781
5		-
6		-	Public Act No. 23-48
7		-
8		-
9		-	AN ACT CONCERNING NOTICE OF A PROPOSED INVOLUNTARY
10		-	TRANSFER OR DISCHARGE OF A NURSING FACILITY RESIDENT,
11		-	FAMILY COUNCILS IN MANAGED RESIDENTIAL COMMUNITIES,
12		-	COORDINATION OF DEMENTIA SERVICES, NURSING HOME
13		-	TRANSPARENCY AND HOMEMAKER -COMPANION AGENCIES.
	20	+	AN ACT CONCERNING A STUDY OF THE NEEDS OF SENIOR
	21	+	CITIZENS.
14	22		Be it enacted by the Senate and House of Representatives in General
15	23		Assembly convened:
16	24
17		-	Section 1. Subsection (c) of section 19a-535 of the general statutes is
18		-	repealed and the following is substituted in lieu thereof (Effective from
19		-	passage):
20		-	(c) (1) Before effecting any transfer or discharge of a resident from the
21		-	facility, the facility shall notify, in writing, the resident and the resident's
22		-	guardian or conservator, if any, or legally liable relative or other
23		-	responsible party if known, of the proposed transfer or discharge, the
24		-	reasons therefor, the effective date of the proposed transfer or discharge,
25		-	the location to which the resident is to be transferred or discharged, the
26		-	right to appeal the proposed transfer or discharge and the procedures
27		-	for initiating such an appeal as determined by the Department of Social
28		-	Services, the date by which an appeal must be initiated in order to
29		-	preserve the resident's right to an appeal hearing and the date by which
30		-	an appeal must be initiated in order to stay the proposed transfer or
31		-	discharge and the possibility of an exception to the date by which an
32		-	appeal must be initiated in order to stay the proposed transfer or House Bill No. 5781
	25	+	Section 1. (Effective from passage) (a) The executive director of the 1
	26	+	Commission on Women, Children, Seniors, Equity and Opportunity, 2
	27	+	in consultation with the Commissioner of Aging and Disability 3
	28	+	Services, shall study the needs of senior citizens in the state in order to 4
	29	+	ensure the adequate allocation of resources. 5
	30	+	(b) The study shall include, but not be limited to, the needs of senior 6
	31	+	citizens for (1) long-term care, (2) transportation, (3) housing 7
	32	+	assistance, (4) nutritional assistance, and (5) opportunities for 8
	33	+	socialization. 9
	34	+	(c) The executive director shall report the results of the study, in 10
	35	+	accordance with the provisions of section 11-4a of the general statutes, 11
	36	+	to the joint standing committee of the General Assembly having 12
	37	+	cognizance of matters relating to aging not later than January 1, 2024. 13 Bill No. 5781
33	38
34		-	Public Act No. 23-48 2 of 23
35	39
36		-	discharge for good cause, that the resident may represent himself or
37		-	herself or be represented by legal counsel, a relative, a friend or other
38		-	spokesperson, an affirmation by the facility that notice of the proposed
39		-	transfer or discharge has been provided to the State Long-Term Care
40		-	Ombudsman, in accordance with the provisions of subdivision (3) of
41		-	this subsection, and information as to bed hold and nursing home
42		-	readmission policy when required in accordance with section 19a-537.
43		-	The notice shall also include the name, mailing address and telephone
44		-	number of the State Long-Term Care Ombudsman. If the resident is, or
45		-	the facility alleges a resident is, mentally ill or developmentally
46		-	disabled, the notice shall include the name, mailing address and
47		-	telephone number of the nonprofit entity designated by the Governor in
48		-	accordance with section 46a-10b to serve as the Connecticut protection
49		-	and advocacy system. The notice shall be given at least thirty days and
50		-	no more than sixty days prior to the resident's proposed transfer or
51		-	discharge, except where the health or safety of individuals in the facility
52		-	are endangered, or where the resident's health improves sufficiently to
53		-	allow a more immediate transfer or discharge, or where immediate
54		-	transfer or discharge is necessitated by urgent medical needs or where
55		-	a resident has not resided in the facility for thirty days, in which cases
56		-	notice shall be given as many days before the transfer or discharge as
57		-	practicable.
58		-	(2) The resident may initiate an appeal pursuant to this section by
59		-	submitting a written request to the Commissioner of Social Services not
60		-	later than sixty calendar days after the facility issues the notice of the
61		-	proposed transfer or discharge, except as provided in subsection (h) of
62		-	this section. In order to stay a proposed transfer or discharge, the
63		-	resident must initiate an appeal not later than twenty days after the date
64		-	the resident receives the notice of the proposed transfer or discharge
65		-	from the facility unless the resident demonstrates good cause for failing
66		-	to initiate such appeal within the twenty-day period. House Bill No. 5781
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67	43
68		-	Public Act No. 23-48 3 of 23
	44	+	This act shall take effect as follows and shall amend the following
	45	+	sections:
69	46
70		-	(3) On the date that the facility provides notice of a proposed
71		-	involuntary transfer or discharge of a resident pursuant to the
72		-	provisions of subdivision (1) of this subsection, the facility shall notify
73		-	the State Ombudsman, appointed pursuant to section 17a-870, in a
74		-	manner prescribed by the State Ombudsman, of such proposed
75		-	involuntary transfer or discharge. Failure to provide notice to the State
76		-	Ombudsman pursuant to the provisions of this subdivision shall
77		-	invalidate any notice of the proposed involuntary transfer or discharge
78		-	of a resident submitted pursuant to the provisions of subdivision (1) of
79		-	this subsection.
80		-	Sec. 2. Subsection (a) of section 17a-878 of the general statutes is
81		-	repealed and the following is substituted in lieu thereof (Effective from
82		-	passage):
83		-	(a) The State Ombudsman and representatives of the office shall have:
84		-	(1) Access to long-term care facilities and residents;
85		-	(2) Appropriate access to review the medical and social records of a
86		-	resident, including, but not limited to, the discharge plan developed
87		-	pursuant to subsection (e) of section 19a-535, if (A) the representative of
88		-	the office has the permission of the resident, or the legal representative
89		-	of the resident, (B) the resident is unable to consent to the review and
90		-	has no legal representative, or (C) access to the records is necessary to
91		-	investigate a complaint and a resident representative refuses to give
92		-	permission, a representative of the office has reasonable cause to believe
93		-	that the resident representative is not acting in the best interests of the
94		-	resident, and the representative of the office obtains the approval of the
95		-	ombudsman;
96		-	(3) Access to the administrative records, policies and documents, to
97		-	which the residents have, or the general public has access, of long-term
98		-	care facilities; and House Bill No. 5781
	47	+	Section 1 from passage New section
99	48
100		-	Public Act No. 23-48 4 of 23
101	49
102		-	(4) Access to and, on request, copies of all licensing and certification
103		-	records maintained by the state with respect to long-term care facilities.
104		-	Sec. 3. Subsection (k) of section 19a-535 of the general statutes is
105		-	repealed and the following is substituted in lieu thereof (Effective from
106		-	passage):
107		-	(k) [A] Except as otherwise provided pursuant to subdivision (3) of
108		-	subsection (c) of this section, a facility shall electronically report each
109		-	involuntary transfer or discharge to the State Ombudsman, appointed
110		-	pursuant to section [17a-405] 17a-870, (1) in a manner prescribed by the
111		-	State Ombudsman, and (2) on an Internet web site portal maintained by
112		-	the State Ombudsman in accordance with patient privacy provisions of
113		-	the Health Insurance Portability and Accountability Act of 1996, P.L.
114		-	104-191, as amended from time to time.
115		-	Sec. 4. Section 19a-693 of the general statutes is repealed and the
116		-	following is substituted in lieu thereof (Effective October 1, 2023):
117		-	As used in this section and sections 19a-694 to 19a-701, inclusive, as
118		-	amended by this act:
119		-	(1) "Activities of daily living" means activities or tasks that are
120		-	essential for a person's healthful and safe existence, including, but not
121		-	limited to, bathing, dressing, grooming, eating, meal preparation,
122		-	shopping, housekeeping, transfers, bowel and bladder care, laundry,
123		-	communication, self-administration of medication and ambulation.
124		-	(2) "Assisted living services" means nursing services and assistance
125		-	with activities of daily living provided to residents living within (A) a
126		-	managed residential community having supportive services that
127		-	encourage persons primarily fifty-five years of age or older to maintain
128		-	a maximum level of independence, or (B) an elderly housing complex
129		-	receiving assistance and funding through the United States Department
130		-	of Housing and Urban Development's Assisted Living Conversion House Bill No. 5781
131		-
132		-	Public Act No. 23-48 5 of 23
133		-
134		-	Program.
135		-	(3) "Assisted living services agency" means an entity, licensed by the
136		-	Department of Public Health pursuant to chapter 368v that provides,
137		-	among other things, nursing services and assistance with activities of
138		-	daily living to a population that is chronic and stable.
139		-	(4) "Managed residential community" means a for-profit or not-for-
140		-	profit facility consisting of private residential units that provides a
141		-	managed group living environment consisting of housing and services
142		-	for persons who are primarily fifty-five years of age or older. "Managed
143		-	residential community" does not include any state-funded congregate
144		-	housing facilities.
145		-	(5) "Department" means the Department of Public Health.
146		-	(6) "Family council" means an independent, self-determining group
147		-	of family members and friends who (A) advocate for the needs and
148		-	interests of the residents of a managed residential community that offers
149		-	assisted living services, and (B) facilitate open communication between
150		-	the managed residential community administration, the residents and
151		-	family and friends of the residents.
152		-	[(6)] (7) "Private residential unit" means a private living environment
153		-	designed for use and occupancy by a resident within a managed
154		-	residential community that includes a full bathroom and access to
155		-	facilities and equipment for the preparation and storage of food.
156		-	[(7)] (8) "Resident" means a person residing in a private residential
157		-	unit of a managed residential community pursuant to the terms of a
158		-	written agreement for occupancy of such unit.
159		-	Sec. 5. Section 19a-694 of the general statutes is repealed and the
160		-	following is substituted in lieu thereof (Effective October 1, 2023): House Bill No. 5781
161		-
162		-	Public Act No. 23-48 6 of 23
163		-
164		-	(a) All managed residential communities operating in the state shall:
165		-	(1) Provide a written residency agreement to each resident in
166		-	accordance with section 19a-700;
167		-	(2) Afford residents the ability to access services provided by an
168		-	assisted living services agency. Such services shall be provided in
169		-	accordance with a service plan developed in accordance with section
170		-	19a-699;
171		-	(3) Upon the request of a resident, arrange, in conjunction with the
172		-	assisted living services agency, for the provision of ancillary medical
173		-	services on behalf of a resident, including physician and dental services,
174		-	pharmacy services, restorative physical therapies, podiatry services,
175		-	hospice care and home health agency services, provided the ancillary
176		-	medical services are not administered by employees of the managed
177		-	residential community, unless the resident chooses to receive such
178		-	services;
179		-	(4) Provide a formally established security program for the protection
180		-	and safety of residents that is designed to protect residents from
181		-	intruders;
182		-	(5) Afford residents the rights and privileges guaranteed under title
183		-	47a;
184		-	(6) Comply with the provisions of subsection (c) of section 19-13-D105
185		-	of the regulations of Connecticut state agencies; [and]
186		-	(7) Assist a resident who has a long-term care insurance policy with
187		-	preparing and submitting claims for benefits to the insurer, provided
188		-	such resident has executed a written authorization requesting and
189		-	directing the insurer to (A) disclose information to the managed
190		-	residential community relevant to such resident's eligibility for an
191		-	insurance benefit or payment, and (B) provide a copy of the acceptance House Bill No. 5781
192		-
193		-	Public Act No. 23-48 7 of 23
194		-
195		-	or declination of a claim for benefits to the managed residential
196		-	community at the same time such acceptance or declination is made to
197		-	such resident; and
198		-	(8) On or before January 1, 2024, encourage and assist in the
199		-	establishment of a family council in managed residential communities
200		-	offering assisted living services. Such family council shall not allow a
201		-	family member or friend of a resident who is not a resident of a dementia
202		-	special care unit to participate in the family council without the consent
203		-	of such resident.
204		-	(b) No managed residential community shall control or manage the
205		-	financial affairs or personal property of any resident, except as provided
206		-	for in subdivision (7) of subsection (a) of this section.
207		-	Sec. 6. (NEW) (Effective October 1, 2023) There shall be within the
208		-	Department of Aging and Disability Services a dementia services
209		-	coordinator. The dementia services coordinator shall (1) coordinate
210		-	dementia services across state agencies, (2) assess and analyze
211		-	dementia-related data collected by the state, (3) evaluate state-funded
212		-	dementia services, (4) identify and support the development of
213		-	dementia-specific training programs, and (5) perform any other relevant
214		-	duties to support individuals with dementia in the state, as determined
215		-	by the Commissioner of Aging and Disability Services.
216		-	Sec. 7. (NEW) (Effective July 1, 2023) (a) Beginning with the cost report
217		-	year ending on September 30, 2023, and annually thereafter, each
218		-	nursing home facility, as defined in section 19a-490 of the general
219		-	statutes, shall submit to the Commissioner of Social Services narrative
220		-	summaries of expenditures in addition to the cost reports required
221		-	pursuant to section 17b-340 of the general statutes, as amended by this
222		-	act. The summaries shall include profit and loss statements for the
223		-	preceding three cost report years, total revenue, total expenditures, total
224		-	assets, total liabilities, short-term debt, long-term debt and cash flows House Bill No. 5781
225		-
226		-	Public Act No. 23-48 8 of 23
227		-
228		-	from investing, operating and financing activities. The Commissioner of
229		-	Social Services shall develop a uniform narrative summary form to be
230		-	used by nursing home facilities for the purposes of complying with the
231		-	provisions of this subsection and post such form on the department's
232		-	Internet web site.
233		-	(b) Not later than January 1, 2024, and annually thereafter, the
234		-	Commissioner of Social Services shall post in a conspicuous area on the
235		-	Internet web site of the Department of Social Services a link to the
236		-	annual cost reports and the summaries provided by each nursing home
237		-	facility.
238		-	(c) Any nursing home facility that violates or fails to comply with the
239		-	provisions of this section shall be fined not more than ten thousand
240		-	dollars for each incident of noncompliance. Prior to imposing any
241		-	penalty pursuant to this subsection, the commissioner shall notify the
242		-	nursing home facility of the alleged violation and the accompanying
243		-	penalty and shall permit such facility to request that the department
244		-	review its findings. A facility shall request such review not later than
245		-	fifteen days after receipt of the notice of violation from the department.
246		-	The department shall stay the imposition of any penalty pending the
247		-	outcome of the review. The commissioner may impose a penalty upon
248		-	a facility pursuant to this subsection regardless of whether a change in
249		-	ownership of the facility has taken place since the time of the violation,
250		-	provided the department issued notice of the alleged violation and the
251		-	accompanying penalty prior to the effective date of the change in
252		-	ownership and record of such notice is readily available in a central
253		-	registry maintained by the department. Payments of fines received
254		-	pursuant to this subsection shall be deposited in the General Fund and
255		-	credited to the Medicaid account.
256		-	Sec. 8. Section 19a-491a of the general statutes is repealed and the
257		-	following is substituted in lieu thereof (Effective July 1, 2023): House Bill No. 5781
258		-
259		-	Public Act No. 23-48 9 of 23
260		-
261		-	(a) A person seeking a license to establish, conduct, operate or
262		-	maintain a nursing home shall provide the Department of Public Health
263		-	with the following information:
264		-	(1) (A) The name and business address of the owner and a statement
265		-	of whether the owner is an individual, partnership, corporation or other
266		-	legal entity; (B) the names of the officers, directors, trustees, or
267		-	managing and general partners of the owner, the names of persons
268		-	having a ten per cent or greater ownership interest in the owner, and a
269		-	description of each such person's occupation with the owner; [and] (C)
270		-	if the owner is a corporation which is incorporated in another state, a
271		-	certificate of good standing from the secretary of state of the state of
272		-	incorporation; and (D) if a private equity company or real estate
273		-	investment trust owns any portion of the business, any information
274		-	regarding such company or trust required to be disclosed (i) on federal
275		-	Form CMS-855a, and (ii) in accordance with 42 CFR 424.516 or 42 CFR
276		-	455.104, as amended from time to time;
277		-	(2) A description of the relevant business experience of the owner and
278		-	of the administrator of the nursing home and evidence that the
279		-	administrator has a license issued pursuant to section 19a-514;
280		-	(3) Affidavits signed by the owner, any of the persons described in
281		-	subdivision (1) of this subsection, the administrator, assistant
282		-	administrator, the medical director, the director of nursing and assistant
283		-	director of nursing disclosing any matter in which such person has been
284		-	convicted of a felony, as defined in section 53a-25, or has pleaded nolo
285		-	contendere to a felony charge, or has been held liable or enjoined in a
286		-	civil action by final judgment, if the felony or civil action involved fraud,
287		-	embezzlement, fraudulent conversion or misappropriation of property;
288		-	or is subject to an injunction or restrictive or remedial order of a court of
289		-	record at the time of application, within the past five years has had any
290		-	state or federal license or permit suspended or revoked as a result of an
291		-	action brought by a governmental agency or department, arising out of House Bill No. 5781
292		-
293		-	Public Act No. 23-48 10 of 23
294		-
295		-	or relating to health care business activity, including, but not limited to,
296		-	actions affecting the operation of a nursing home, retirement home,
297		-	residential care home or any facility subject to sections 17b-520 to 17b-
298		-	535, inclusive, or a similar statute in another state or country;
299		-	(4) (A) A statement as to whether or not the owner is, or is affiliated
300		-	with, a religious, charitable or other nonprofit organization; (B) the
301		-	extent of the affiliation, if any; (C) the extent to which the affiliate
302		-	organization will be responsible for the financial obligations of the
303		-	owner; and (D) the provision of the Internal Revenue Code of 1986, or
304		-	any subsequent corresponding internal revenue code of the United
305		-	States, as from time to time amended, if any, under which the owner or
306		-	affiliate is exempt from the payment of income tax;
307		-	(5) The location and a description of other health care facilities of the
308		-	owner, existing or proposed, and, if proposed, the estimated completion
309		-	date or dates and whether or not construction has begun; [and]
310		-	(6) Audited and certified financial statements of the owner, including
311		-	(A) a balance sheet as of the end of the most recent fiscal year, and (B)
312		-	income statements for the most recent fiscal year of the owner or such
313		-	shorter period of time as the owner shall have been in existence; and
314		-	[(6)] (7) If the operation of the nursing home has not yet commenced,
315		-	a statement of the anticipated source and application of the funds used
316		-	or to be used in the purchase or construction of the home, including:
317		-	(A) An estimate of such costs as financing expense, legal expense,
318		-	land costs, marketing costs and other similar costs which the owner
319		-	expects to incur or become obligated for prior to the commencement of
320		-	operations; and
321		-	(B) A description of any mortgage loan or any other financing
322		-	intended to be used for the financing of the nursing home, including the
323		-	anticipated terms and costs of such financing. House Bill No. 5781
324		-
325		-	Public Act No. 23-48 11 of 23
326		-
327		-	(b) In addition to the information provided pursuant to subsection (a)
328		-	of this section, the commissioner may reasonably require an applicant
329		-	for a nursing home license or renewal of a nursing home license to
330		-	submit additional information. Such information may include audited
331		-	and certified financial statements of the owner, including, (1) a balance
332		-	sheet as of the end of the most recent fiscal year, and (2) income
333		-	statements for the most recent fiscal year of the owner or such shorter
334		-	period of time as the owner shall have been in existence.
335		-	(c) No person acting individually or jointly with any other person
336		-	shall establish, conduct, operate or maintain a nursing home without
337		-	maintaining professional liability insurance or other indemnity against
338		-	liability for professional malpractice. The amount of insurance which
339		-	such person shall maintain as insurance or indemnity against claims for
340		-	injury or death for professional malpractice shall be not less than one
341		-	million dollars for one person, per occurrence, with an aggregate of not
342		-	less than three million dollars. The requirements of this subsection shall
343		-	not apply to any person who establishes, conducts, operates or
344		-	maintains a residential care home.
345		-	(d) A person seeking to renew a nursing home license shall furnish
346		-	the department with any information required under this section that
347		-	was not previously submitted and with satisfactory written proof that
348		-	the owner of the nursing home consents to such renewal, if the owner is
349		-	different from the person seeking renewal, and shall provide data on
350		-	any change in the information submitted. The commissioner shall refuse
351		-	to issue or renew a nursing home license if the person seeking renewal
352		-	fails to provide the information required under this section. Upon such
353		-	refusal, the commissioner shall grant such license to the holder of the
354		-	certificate of need, provided such holder meets all requirements for such
355		-	licensure. If such holder does not meet such requirements, the
356		-	commissioner shall proceed in accordance with sections 19a-541 to 19a-
357		-	549, inclusive. If the commissioner is considering a license renewal House Bill No. 5781
358		-
359		-	Public Act No. 23-48 12 of 23
360		-
361		-	application pursuant to an order of the commissioner, the procedures in
362		-	this subsection shall apply to such consideration.
363		-	Sec. 9. Subsection (a) of section 17b-340 of the general statutes is
364		-	repealed and the following is substituted in lieu thereof (Effective July 1,
365		-	2023):
366		-	(a) For purposes of this subsection, (1) a "related party" includes, but
367		-	is not limited to, any company related to a chronic and convalescent
368		-	nursing home through family association, common ownership, control
369		-	or business association with any of the owners, operators or officials of
370		-	such nursing home; (2) "company" means any person, partnership,
371		-	association, holding company, limited liability company or corporation;
372		-	(3) "family association" means a relationship by birth, marriage or
373		-	domestic partnership; and (4) "profit and loss statement" means the
374		-	most recent annual statement on profits and losses finalized by a related
375		-	party before the annual report mandated under this subsection. The
376		-	rates to be paid by or for persons aided or cared for by the state or any
377		-	town in this state to licensed chronic and convalescent nursing homes,
378		-	to chronic disease hospitals associated with chronic and convalescent
379		-	nursing homes, to rest homes with nursing supervision, to licensed
380		-	residential care homes, as defined by section 19a-490, and to residential
381		-	facilities for persons with intellectual disability that are licensed
382		-	pursuant to section 17a-227 and certified to participate in the Title XIX
383		-	Medicaid program as intermediate care facilities for individuals with
384		-	intellectual disabilities, for room, board and services specified in
385		-	licensing regulations issued by the licensing agency shall be determined
386		-	annually, except as otherwise provided in this subsection by the
387		-	Commissioner of Social Services, to be effective July first of each year
388		-	except as otherwise provided in this subsection. Such rates shall be
389		-	determined on a basis of a reasonable payment for such necessary
390		-	services, which basis shall take into account as a factor the costs of such
391		-	services. Cost of such services shall include reasonable costs mandated House Bill No. 5781
392		-
393		-	Public Act No. 23-48 13 of 23
394		-
395		-	by collective bargaining agreements with certified collective bargaining
396		-	agents or other agreements between the employer and employees,
397		-	provided "employees" shall not include persons employed as managers
398		-	or chief administrators or required to be licensed as nursing home
399		-	administrators, and compensation for services rendered by proprietors
400		-	at prevailing wage rates, as determined by application of principles of
401		-	accounting as prescribed by said commissioner. Cost of such services
402		-	shall not include amounts paid by the facilities to employees as salary,
403		-	or to attorneys or consultants as fees, where the responsibility of the
404		-	employees, attorneys, or consultants is to persuade or seek to persuade
405		-	the other employees of the facility to support or oppose unionization.
406		-	Nothing in this subsection shall prohibit inclusion of amounts paid for
407		-	legal counsel related to the negotiation of collective bargaining
408		-	agreements, the settlement of grievances or normal administration of
409		-	labor relations. The commissioner may, in the commissioner's
410		-	discretion, allow the inclusion of extraordinary and unanticipated costs
411		-	of providing services that were incurred to avoid an immediate negative
412		-	impact on the health and safety of patients. The commissioner may, in
413		-	the commissioner's discretion, based upon review of a facility's costs,
414		-	direct care staff to patient ratio and any other related information, revise
415		-	a facility's rate for any increases or decreases to total licensed capacity
416		-	of more than ten beds or changes to its number of licensed rest home
417		-	with nursing supervision beds and chronic and convalescent nursing
418		-	home beds. The commissioner may, in the commissioner's discretion,
419		-	revise the rate of a facility that is closing. An interim rate issued for the
420		-	period during which a facility is closing shall be based on a review of
421		-	facility costs, the expected duration of the close-down period, the
422		-	anticipated impact on Medicaid costs, available appropriations and the
423		-	relationship of the rate requested by the facility to the average Medicaid
424		-	rate for a close-down period. The commissioner may so revise a facility's
425		-	rate established for the fiscal year ending June 30, 1993, and thereafter
426		-	for any bed increases, decreases or changes in licensure effective after
427		-	October 1, 1989. Effective July 1, 1991, in facilities that have both a House Bill No. 5781
428		-
429		-	Public Act No. 23-48 14 of 23
430		-
431		-	chronic and convalescent nursing home and a rest home with nursing
432		-	supervision, the rate for the rest home with nursing supervision shall
433		-	not exceed such facility's rate for its chronic and convalescent nursing
434		-	home. All such facilities for which rates are determined under this
435		-	subsection shall report on a fiscal year basis ending on September
436		-	thirtieth. Such report shall be submitted to the commissioner by
437		-	February fifteenth. Each [for-profit] chronic and convalescent nursing
438		-	home that receives state funding pursuant to this section shall include
439		-	in such annual report a profit and loss statement from each related party
440		-	that receives from such chronic and convalescent nursing home [fifty]
441		-	thirty thousand dollars or more per year for goods, fees and services.
442		-	No cause of action or liability shall arise against the state, the
443		-	Department of Social Services, any state official or agent for failure to
444		-	take action based on the information required to be reported under this
445		-	subsection. The commissioner may reduce the rate in effect for a facility
446		-	that fails to submit a complete and accurate report on or before February
447		-	fifteenth by an amount not to exceed ten per cent of such rate. If a
448		-	licensed residential care home fails to submit a complete and accurate
449		-	report, the department shall notify such home of the failure and the
450		-	home shall have thirty days from the date the notice was issued to
451		-	submit a complete and accurate report. If a licensed residential care
452		-	home fails to submit a complete and accurate report not later than thirty
453		-	days after the date of notice, such home may not receive a retroactive
454		-	rate increase, in the commissioner's discretion. The commissioner shall,
455		-	annually, on or before April first, report the data contained in the reports
456		-	of such facilities on the department's Internet web site. For the cost
457		-	reporting year commencing October 1, 1985, and for subsequent cost
458		-	reporting years, facilities shall report the cost of using the services of any
459		-	nursing personnel supplied by a temporary nursing services agency by
460		-	separating said cost into two categories, the portion of the cost equal to
461		-	the salary of the employee for whom the nursing personnel supplied by
462		-	a temporary nursing services agency is substituting shall be considered
463		-	a nursing cost and any cost in excess of such salary shall be further House Bill No. 5781
464		-
465		-	Public Act No. 23-48 15 of 23
466		-
467		-	divided so that seventy-five per cent of the excess cost shall be
468		-	considered an administrative or general cost and twenty-five per cent of
469		-	the excess cost shall be considered a nursing cost, provided if the total
470		-	costs of a facility for nursing personnel supplied by a temporary nursing
471		-	services agency in any cost year are equal to or exceed fifteen per cent
472		-	of the total nursing expenditures of the facility for such cost year, no
473		-	portion of such costs in excess of fifteen per cent shall be classified as
474		-	administrative or general costs. The commissioner, in determining such
475		-	rates, shall also take into account the classification of patients or
476		-	boarders according to special care requirements or classification of the
477		-	facility according to such factors as facilities and services and such other
478		-	factors as the commissioner deems reasonable, including anticipated
479		-	fluctuations in the cost of providing such services. The commissioner
480		-	may establish a separate rate for a facility or a portion of a facility for
481		-	traumatic brain injury patients who require extensive care but not acute
482		-	general hospital care. Such separate rate shall reflect the special care
483		-	requirements of such patients. If changes in federal or state laws,
484		-	regulations or standards adopted subsequent to June 30, 1985, result in
485		-	increased costs or expenditures in an amount exceeding one-half of one
486		-	per cent of allowable costs for the most recent cost reporting year, the
487		-	commissioner shall adjust rates and provide payment for any such
488		-	increased reasonable costs or expenditures within a reasonable period
489		-	of time retroactive to the date of enforcement. Nothing in this section
490		-	shall be construed to require the Department of Social Services to adjust
491		-	rates and provide payment for any increases in costs resulting from an
492		-	inspection of a facility by the Department of Public Health. Such
493		-	assistance as the commissioner requires from other state agencies or
494		-	departments in determining rates shall be made available to the
495		-	commissioner at the commissioner's request. Payment of the rates
496		-	established pursuant to this section shall be conditioned on the
497		-	establishment by such facilities of admissions procedures that conform
498		-	with this section, section 19a-533 and all other applicable provisions of
499		-	the law and the provision of equality of treatment to all persons in such House Bill No. 5781
500		-
501		-	Public Act No. 23-48 16 of 23
502		-
503		-	facilities. The established rates shall be the maximum amount
504		-	chargeable by such facilities for care of such beneficiaries, and the
505		-	acceptance by or on behalf of any such facility of any additional
506		-	compensation for care of any such beneficiary from any other person or
507		-	source shall constitute the offense of aiding a beneficiary to obtain aid
508		-	to which the beneficiary is not entitled and shall be punishable in the
509		-	same manner as is provided in subsection (b) of section 17b-97.
510		-	Notwithstanding any provision of this section, the Commissioner of
511		-	Social Services may, within available appropriations, provide an interim
512		-	rate increase for a licensed chronic and convalescent nursing home or a
513		-	rest home with nursing supervision for rate periods no earlier than April
514		-	1, 2004, only if the commissioner determines that the increase is
515		-	necessary to avoid the filing of a petition for relief under Title 11 of the
516		-	United States Code; imposition of receivership pursuant to sections 19a-
517		-	542 and 19a-543; or substantial deterioration of the facility's financial
518		-	condition that may be expected to adversely affect resident care and the
519		-	continued operation of the facility, and the commissioner determines
520		-	that the continued operation of the facility is in the best interest of the
521		-	state. The commissioner shall consider any requests for interim rate
522		-	increases on file with the department from March 30, 2004, and those
523		-	submitted subsequently for rate periods no earlier than April 1, 2004.
524		-	When reviewing an interim rate increase request the commissioner
525		-	shall, at a minimum, consider: (A) Existing chronic and convalescent
526		-	nursing home or rest home with nursing supervision utilization in the
527		-	area and projected bed need; (B) physical plant long-term viability and
528		-	the ability of the owner or purchaser to implement any necessary
529		-	property improvements; (C) licensure and certification compliance
530		-	history; (D) reasonableness of actual and projected expenses; and (E) the
531		-	ability of the facility to meet wage and benefit costs. No interim rate
532		-	shall be increased pursuant to this subsection in excess of one hundred
533		-	fifteen per cent of the median rate for the facility's peer grouping,
534		-	established pursuant to subdivision (2) of subsection (f) of this section,
535		-	unless recommended by the commissioner and approved by the House Bill No. 5781
536		-
537		-	Public Act No. 23-48 17 of 23
538		-
539		-	Secretary of the Office of Policy and Management after consultation
540		-	with the commissioner. Such median rates shall be published by the
541		-	Department of Social Services not later than April first of each year. In
542		-	the event that a facility granted an interim rate increase pursuant to this
543		-	section is sold or otherwise conveyed for value to an unrelated entity
544		-	less than five years after the effective date of such rate increase, the rate
545		-	increase shall be deemed rescinded and the department shall recover an
546		-	amount equal to the difference between payments made for all affected
547		-	rate periods and payments that would have been made if the interim
548		-	rate increase was not granted. The commissioner may seek recovery of
549		-	such payments from any facility with common ownership. With the
550		-	approval of the Secretary of the Office of Policy and Management, the
551		-	commissioner may waive recovery and rescission of the interim rate for
552		-	good cause shown that is not inconsistent with this section, including,
553		-	but not limited to, transfers to family members that were made for no
554		-	value. The commissioner shall provide written quarterly reports to the
555		-	joint standing committees of the General Assembly having cognizance
556		-	of matters relating to aging, human services and appropriations and the
557		-	budgets of state agencies, that identify each facility requesting an
558		-	interim rate increase, the amount of the requested rate increase for each
559		-	facility, the action taken by the commissioner and the secretary pursuant
560		-	to this subsection, and estimates of the additional cost to the state for
561		-	each approved interim rate increase. Nothing in this subsection shall
562		-	prohibit the commissioner from increasing the rate of a licensed chronic
563		-	and convalescent nursing home or a rest home with nursing supervision
564		-	for allowable costs associated with facility capital improvements or
565		-	increasing the rate in case of a sale of a licensed chronic and convalescent
566		-	nursing home or a rest home with nursing supervision if receivership
567		-	has been imposed on such home. For purposes of this section,
568		-	"temporary nursing services agency" and "nursing personnel" have the
569		-	same meaning as provided in section 19a-118.
570		-	Sec. 10. (NEW) (Effective from passage) The Commissioner of Social House Bill No. 5781
571		-
572		-	Public Act No. 23-48 18 of 23
573		-
574		-	Services shall develop a guidebook that includes, but need not be
575		-	limited to, a glossary and plain language explanation of the terms
576		-	relating to and a description of the Medicaid nursing home rate setting
577		-	process. Not later than July 1, 2024, the commissioner shall post the
578		-	guidebook in a conspicuous area on the Internet web site of the
579		-	Department of Social Services. The commissioner may update the
580		-	guidebook as deemed necessary.
581		-	Sec. 11. (Effective from passage) The Secretary of the Office of Policy
582		-	and Management, in consultation with the Commissioners of Consumer
583		-	Protection and Public Health, shall develop a plan to transfer the
584		-	responsibility for registration and oversight of homemaker-companion
585		-	agencies, as defined in section 20-670 of the general statutes from the
586		-	Department of Consumer Protection to the Department of Public
587		-	Health. Such plan shall (1) provide a timeline for the proposed
588		-	transition, and (2) include recommendations on appropriate training
589		-	standards that (A) exemplify best practices for providing homemaker
590		-	and companion services, as defined in section 20-670 of the general
591		-	statutes, (B) provide instruction and specialized training benchmarks
592		-	for the care of clients with Alzheimer's disease, dementia and other
593		-	related conditions, and (C) ensure a high quality of care for homemaker-
594		-	companion agency clients and may evaluate and make
595		-	recommendations on the appropriate use of the term "care" in
596		-	describing the services provided by homemaker-companion agencies
597		-	and any limitations on the use of such term to ensure consumer clarity.
598		-	Not later than August 1, 2024, the secretary shall report, in accordance
599		-	with section 11-4a of the general statutes, on such plan to the joint
600		-	standing committees of the General Assembly having cognizance of
601		-	matters relating to aging, general law and public health.
602		-	Sec. 12. Section 20-675 of the general statutes is repealed and the
603		-	following is substituted in lieu thereof (Effective from passage):
604		-	(a) The Commissioner of Consumer Protection may revoke, suspend House Bill No. 5781
605		-
606		-	Public Act No. 23-48 19 of 23
607		-
608		-	or refuse to issue or renew any certificate of registration as a
609		-	homemaker-companion agency or place an agency on probation or issue
610		-	a letter of reprimand for: (1) Conduct by the agency, or by an employee
611		-	of the agency while in the course of employment, of a character likely to
612		-	mislead, deceive or defraud the public or the commissioner; (2)
613		-	engaging in any untruthful or misleading advertising; (3) failure of such
614		-	agency that acts as a registry to comply with the notice requirements of
615		-	section 20-679a; [or] (4) failing to perform a comprehensive background
616		-	check of a prospective employee or maintain a copy of materials
617		-	obtained during a comprehensive background check, as required by
618		-	section 20-678; or (5) failing to provide a written notice, obtain a signed
619		-	notice or maintain a copy of a signed notice, as required by section 17 of
620		-	this act.
621		-	(b) The commissioner shall revoke a certificate of registration if a
622		-	homemaker-companion agency is found to have violated, after an
623		-	administrative hearing conducted in accordance with chapter 54, the
624		-	provisions of subdivisions (1) to (5), inclusive, of subsection (a) of this
625		-	section three times in one calendar year.
626		-	[(b)] (c) The commissioner shall not revoke or suspend any certificate
627		-	of registration except upon notice and hearing in accordance with
628		-	chapter 54.
629		-	Sec. 13. Section 20-679 of the general statutes is repealed and the
630		-	following is substituted in lieu thereof (Effective October 1, 2023):
631		-	(a) Not later than seven calendar days after the date on which a
632		-	homemaker-companion agency commences providing homemaker
633		-	services or companion services, such agency shall provide the person
634		-	who receives the services, or the authorized representative of such
635		-	person, with a written contract or service plan. The written contract or
636		-	service plan shall be developed in consultation with such person or
637		-	authorized representative and include (1) a person-centered plan of care House Bill No. 5781
638		-
639		-	Public Act No. 23-48 20 of 23
640		-
641		-	and services that prescribes the anticipated scope, type, frequency,
642		-	duration and cost of the services provided by the agency, (2) the
643		-	anticipated scope, type and frequency of oversight of an employee
644		-	assigned to such person by the homemaker-companion agency, and (3)
645		-	a predetermined frequency of meetings between the person who
646		-	oversees such employee and the person who receives the services, or the
647		-	authorized representative of such person. In addition, any contract or
648		-	service plan provided by a homemaker-companion agency to a person
649		-	receiving services shall also provide conspicuous notice, in boldface
650		-	type [(1)] (A) of the person's right to request changes to, or review of the
651		-	contract or service plan, [(2)] (B) of the employees of such agency who,
652		-	pursuant to section 20-678 are required to submit to a comprehensive
653		-	background check, [(3)] (C) that upon the request of such person or an
654		-	authorized representative of such person, such agency shall provide
655		-	such person or representative of such person with written notice that a
656		-	comprehensive background check, as required pursuant to section 20-
657		-	678, was performed for all employees of such agency performing
658		-	services for such person, [(4)] (D) that such agency's records are
659		-	available for inspection or audit by the Department of Consumer
660		-	Protection, [(5)] (E) that the agency is not able to guarantee the extent to
661		-	which its services will be covered under any insurance plan, and [(6)]
662		-	(F) that such contract or service plan may be cancelled at any time by
663		-	the client if such contract or service plan does not contain a specific
664		-	period of duration. On the date that a homemaker-companion agency
665		-	provides such contract or service plan to such person, the agency shall
666		-	also provide a printed copy of the guide that details the process by
667		-	which such person, or such person's authorized representative, may file
668		-	a complaint against such agency, posted on the Department of
669		-	Consumer Protection's Internet web site pursuant to section 14 of this
670		-	act. No contract or service plan for the provision of homemaker or
671		-	companion services shall be valid against the person who receives the
672		-	services or the authorized representative of such person, unless the
673		-	contract or service plan has been signed by a duly authorized House Bill No. 5781
674		-
675		-	Public Act No. 23-48 21 of 23
676		-
677		-	representative of the homemaker-companion agency and the person
678		-	who receives the services or the authorized representative of such
679		-	person. The requirements of this section shall not apply to homemaker
680		-	services or companion services provided under the Connecticut home-
681		-	care program for the elderly administered by the Department of Social
682		-	Services in accordance with section 17b-342. A written contract or
683		-	service plan between a homemaker-companion agency and a person
684		-	receiving services or the authorized representative of such person shall
685		-	not be enforceable against such person receiving services or authorized
686		-	representative unless such written contract or service plan contains all
687		-	of the requirements of this section.
688		-	(b) Nothing in this section shall preclude a homemaker-companion
689		-	agency that has complied with [subdivisions (1) to (6)] subparagraphs
690		-	(A) to (F), inclusive, of subsection (a) of this section from the recovery of
691		-	payment for work performed based on the reasonable value of services
692		-	which were requested by the person receiving services, provided the
693		-	court determines that it would be inequitable to deny such recovery.
694		-	Sec. 14. (NEW) (Effective from passage) Not later than October 1, 2023,
695		-	the Commissioner of Consumer Protection shall post a guide that details
696		-	the process by which a person who receives homemaker services or
697		-	companion services, as defined in section 20-670 of the general statutes
698		-	or the authorized representative of such person, may file a complaint
699		-	against a homemaker-companion agency, as defined in section 20-670 of
700		-	the general statutes on its Internet web site.
701		-	Sec. 15. (NEW) (Effective from passage) On and after January 1, 2024,
702		-	each homemaker-companion agency, as defined in section 20-670 of the
703		-	general statutes shall have a printed consumer brochure and maintain
704		-	an Internet web site detailing the homemaker and companion services
705		-	offered by such agency and provide such brochure or the address of
706		-	such Internet web site upon the request of consumers. House Bill No. 5781
707		-
708		-	Public Act No. 23-48 22 of 23
709		-
710		-	Sec. 16. Section 20-677 of the general statutes is amended by adding
711		-	subsection (g) as follows (Effective from passage):
712		-	(NEW) (g) A homemaker-companion agency may include in its
713		-	business name and advertising the term "care" if such term is used in
714		-	reference to such agency's provision of homemaker services, provided,
715		-	on and after October 1, 2023, any such advertising (1) shall prominently
716		-	and clearly display in plain font with distinctly contrasting colors at the
717		-	top of such advertising, including, but not limited to, each page of the
718		-	agency's Internet web site, social media posts, print media and audio-
719		-	visual advertisements, the clear and conspicuous words: "(Insert name
720		-	of homemaker-companion agency) solely provides nonmedical care.",
721		-	or, if such advertising is an audio advertisement, such words shall be
722		-	audibly conveyed at the same speed and manner as the rest of such
723		-	audio advertisement, and (2) shall not include any words that indicate
724		-	or suggest that such agency provides any services beyond the scope of
725		-	services authorized under this chapter, including, but not limited to,
726		-	words relating to medical or health care licensure or services. A
727		-	homemaker-companion agency may include in its advertising words
728		-	that accurately describe, as determined by the commissioner, that such
729		-	agency has employees who are trained to provide homemaker services
730		-	to individuals experiencing memory difficulties, provided the agency
731		-	details the type of training and number of hours each employee was
732		-	trained to provide such services. A violation of the provisions of this
733		-	subsection shall constitute untruthful or misleading advertising for the
734		-	purposes of subsection (a) of section 20-675, as amended by this act.
735		-	Sec. 17. (NEW) (Effective from passage) Each homemaker-companion
736		-	agency, prior to providing homemaker services or companion services,
737		-	shall (1) provide the person who receives the services, or the authorized
738		-	representative of such person, with a written notice that the agency
739		-	provides nonmedical care, and (2) obtain the signature of such person
740		-	or representative on the written notice. The agency shall maintain a House Bill No. 5781
741		-
742		-	Public Act No. 23-48 23 of 23
743		-
744		-	paper or electronic copy of such signed notice until such time that the
745		-	person who receives the services ceases receiving services from the
746		-	agency and make such copy available for inspection upon the request of
747		-	the Commissioner of Consumer Protection.
	50	+	AGE Joint Favorable
748	51