Connecticut 2023 Regular Session

Connecticut House Bill HB06678 Compare Versions

Version 1 (Old)

Version 2 (New)

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7		-	General Assembly ~~Substitute~~ Bill No. 6678
	5	+	General Assembly Raised Bill No. 6678
8	6		January Session, 2023
	7	+	LCO No. 4114
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	10	+	Referred to Committee on AGING
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	12	+
	13	+	Introduced by:
	14	+	(AGE)
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14	19		AN ACT CONCERNING NURSING HOME TRANSPARENCY.
15	20		Be it enacted by the Senate and House of Representatives in General
16	21		Assembly convened:
17	22
18	23		Section 1. (NEW) (Effective July 1, 2023) (a) Beginning with the cost 1
19	24		report year ending on September 30, 2023, and annually thereafter, each 2
20	25		nursing home facility, as defined in section 19a-490 of the general 3
21	26		statutes, shall submit to the Commissioner of Social Services narrative 4
22	27		summaries of expenditures in addition to the cost reports required 5
23	28		pursuant to section 17b-340 of the general statutes, as amended by this 6
24	29		act. The summaries shall include the percentage of Medicaid funding 7
25	30		allocated to the five cost components of allowable costs described in 8
26	31		section 17b-340d of the general statutes and include expenditures for 9
27	32		each allowable cost component by the nursing home and any related 10
28	33		party, as defined in section 17b-340 of the general statutes, as amended 11
29	34		by this act. 12
30	35		(b) Not later than January 1, 2024, and annually thereafter, the 13
31	36		Commissioner of Social Services shall post in a conspicuous area on the 14
32		-	Internet web site of the Department of Social Services a link to (1) the 15
33		-	annual cost reports and the summaries provided by each nursing home 16
34		-	facility, (2) comparisons between individual nursing homes by 17
35		-	expenditures, and (3) a summary of the average reported expenditures 18
36		-	by facility for each category. Any cost report forms utilized by the 19 Substitute Bill No. 6678
	37	+	department's Internet web site a link to (1) the annual cost reports and 15
	38	+	the summaries provided by each nursing home facility, (2) comparisons 16 Raised Bill No. 6678
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43		-	department shall include a glossary and explanation of the terms used 20
44		-	and a description of the categories being reported on, including, but not 21
45		-	limited to, plain language explanation of formulas used to determine 22
46		-	maximum costs for the five allowable cost components described in 23
47		-	section 17b-340d of the general statutes. 24
48		-	(c) Any nursing home facility that violates or fails to comply with the 25
49		-	provisions of this section shall be fined not more than ten thousand 26
50		-	dollars for each incident of noncompliance. The Commissioner of Social 27
51		-	Services may offset payments due a facility to collect the penalty. Prior 28
52		-	to imposing any penalty pursuant to this subsection, the commissioner 29
53		-	shall notify the nursing home facility of the alleged violation and the 30
54		-	accompanying penalty and shall permit such facility to request that the 31
55		-	department review its findings. A facility shall request such review not 32
56		-	later than fifteen days after receipt of the notice of violation from the 33
57		-	department. The department shall stay the imposition of any penalty 34
58		-	pending the outcome of the review. The commissioner may impose a 35
59		-	penalty upon a facility pursuant to this subsection regardless of whether 36
60		-	a change in ownership of the facility has taken place since the time of 37
61		-	the violation, provided the department issued notice of the alleged 38
62		-	violation and the accompanying penalty prior to the effective date of the 39
63		-	change in ownership and record of such notice is readily available in a 40
64		-	central registry maintained by the department. Payments of fines 41
65		-	received pursuant to this subsection shall be deposited in the General 42
66		-	Fund and credited to the Medicaid account. 43
67		-	Sec. 2. Section 19a-491a of the general statutes is repealed and the 44
68		-	following is substituted in lieu thereof (Effective July 1, 2023): 45
69		-	(a) A person seeking a license to establish, conduct, operate or 46
70		-	maintain a nursing home shall provide the Department of Public Health 47
71		-	with the following information: 48
72		-	(1) (A) The name and business address of the owner and a statement 49
73		-	of whether the owner is an individual, partnership, corporation or other 50
74		-	legal entity; (B) the names of the officers, directors, trustees, or 51 Substitute Bill No. 6678
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	43	+
	44	+	between individual nursing homes by expenditures, and (3) a summary 17
	45	+	of the average reported expenditures by facility for each category. Any 18
	46	+	cost report forms utilized by the department shall include a glossary and 19
	47	+	explanation of the terms used and a description of the categories being 20
	48	+	reported on, including, but not limited to, plain language explanation of 21
	49	+	formulas used to determine maximum costs for the five allowable cost 22
	50	+	components described in section 17b-340d of the general statutes. 23
	51	+	(c) Any nursing home facility that violates or fails to comply with the 24
	52	+	provisions of this section shall be fined not more than ten thousand 25
	53	+	dollars for each incident of noncompliance. The Commissioner of Social 26
	54	+	Services may offset payments due a facility to collect the penalty. Prior 27
	55	+	to imposing any penalty pursuant to this subsection, the commissioner 28
	56	+	shall notify the nursing home facility of the alleged violation and the 29
	57	+	accompanying penalty and shall permit such facility to request that the 30
	58	+	department review its findings. A facility shall request such review not 31
	59	+	later than fifteen days after receipt of the notice of violation from the 32
	60	+	department. The department shall stay the imposition of any penalty 33
	61	+	pending the outcome of the review. The commissioner may impose a 34
	62	+	penalty upon a facility pursuant to this subsection regardless of whether 35
	63	+	a change in ownership of the facility has taken place since the time of 36
	64	+	the violation, provided the department issued notice of the alleged 37
	65	+	violation and the accompanying penalty prior to the effective date of the 38
	66	+	change in ownership and record of such notice is readily available in a 39
	67	+	central registry maintained by the department. Payments of fines 40
	68	+	received pursuant to this subsection shall be deposited in the General 41
	69	+	Fund and credited to the Medicaid account. 42
	70	+	Sec. 2. Section 19a-491a of the general statutes is repealed and the 43
	71	+	following is substituted in lieu thereof (Effective July 1, 2023): 44
	72	+	(a) A person seeking a license to establish, conduct, operate or 45
	73	+	maintain a nursing home shall provide the Department of Public Health 46
	74	+	with the following information: 47
	75	+	(1) (A) The name and business address of the owner and a statement 48 Raised Bill No. 6678
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81		-	managing and general partners of the owner, the names of persons 52
82		-	having a ten per cent or greater ownership interest in the owner, and a 53
83		-	description of each such person's occupation with the owner; [and] (C) 54
84		-	if the owner is a corporation which is incorporated in another state, a 55
85		-	certificate of good standing from the secretary of state of the state of 56
86		-	incorporation; and (D) if a private equity fund owns any portion of the 57
87		-	business, the name of the fund's investment advisor and a copy of the 58
88		-	most recent quarterly statement provided to the private fund's 59
89		-	investors, including information regarding fees, expenses and 60
90		-	performance of the fund; 61
91		-	(2) A description of the relevant business experience of the owner and 62
92		-	of the administrator of the nursing home and evidence that the 63
93		-	administrator has a license issued pursuant to section 19a-514; 64
94		-	(3) Affidavits signed by the owner, any of the persons described in 65
95		-	subdivision (1) of this subsection, the administrator, assistant 66
96		-	administrator, the medical director, the director of nursing and assistant 67
97		-	director of nursing disclosing any matter in which such person has been 68
98		-	convicted of a felony, as defined in section 53a-25, or has pleaded nolo 69
99		-	contendere to a felony charge, or has been held liable or enjoined in a 70
100		-	civil action by final judgment, if the felony or civil action involved fraud, 71
101		-	embezzlement, fraudulent conversion or misappropriation of property; 72
102		-	or is subject to an injunction or restrictive or remedial order of a court of 73
103		-	record at the time of application, within the past five years has had any 74
104		-	state or federal license or permit suspended or revoked as a result of an 75
105		-	action brought by a governmental agency or department, arising out of 76
106		-	or relating to health care business activity, including, but not limited to, 77
107		-	actions affecting the operation of a nursing home, retirement home, 78
108		-	residential care home or any facility subject to sections 17b-520 to 17b-79
109		-	535, inclusive, or a similar statute in another state or country; 80
110		-	(4) (A) A statement as to whether or not the owner is, or is affiliated 81
111		-	with, a religious, charitable or other nonprofit organization; (B) the 82
112		-	extent of the affiliation, if any; (C) the extent to which the affiliate 83
113		-	organization will be responsible for the financial obligations of the 84 Substitute Bill No. 6678
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	81	+	of whether the owner is an individual, partnership, corporation or other 49
	82	+	legal entity; (B) the names of the officers, directors, trustees, or 50
	83	+	managing and general partners of the owner, the names of persons 51
	84	+	having a ten per cent or greater ownership interest in the owner, and a 52
	85	+	description of each such person's occupation with the owner; [and] (C) 53
	86	+	if the owner is a corporation which is incorporated in another state, a 54
	87	+	certificate of good standing from the secretary of state of the state of 55
	88	+	incorporation; and (D) if a private equity fund owns any portion of the 56
	89	+	business, the name of the fund's investment advisor and a copy of the 57
	90	+	most recent quarterly statement provided to the private fund's 58
	91	+	investors, including information regarding fees, expenses and 59
	92	+	performance of the fund; 60
	93	+	(2) A description of the relevant business experience of the owner and 61
	94	+	of the administrator of the nursing home and evidence that the 62
	95	+	administrator has a license issued pursuant to section 19a-514; 63
	96	+	(3) Affidavits signed by the owner, any of the persons described in 64
	97	+	subdivision (1) of this subsection, the administrator, assistant 65
	98	+	administrator, the medical director, the director of nursing and assistant 66
	99	+	director of nursing disclosing any matter in which such person has been 67
	100	+	convicted of a felony, as defined in section 53a-25, or has pleaded nolo 68
	101	+	contendere to a felony charge, or has been held liable or enjoined in a 69
	102	+	civil action by final judgment, if the felony or civil action involved fraud, 70
	103	+	embezzlement, fraudulent conversion or misappropriation of property; 71
	104	+	or is subject to an injunction or restrictive or remedial order of a court of 72
	105	+	record at the time of application, within the past five years has had any 73
	106	+	state or federal license or permit suspended or revoked as a result of an 74
	107	+	action brought by a governmental agency or department, arising out of 75
	108	+	or relating to health care business activity, including, but not limited to, 76
	109	+	actions affecting the operation of a nursing home, retirement home, 77
	110	+	residential care home or any facility subject to sections 17b-520 to 17b-78
	111	+	535, inclusive, or a similar statute in another state or country; 79
	112	+	(4) (A) A statement as to whether or not the owner is, or is affiliated 80
	113	+	with, a religious, charitable or other nonprofit organization; (B) the 81 Raised Bill No. 6678
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120		-	owner; and (D) the provision of the Internal Revenue Code of 1986, or 85
121		-	any subsequent corresponding internal revenue code of the United 86
122		-	States, as from time to time amended, if any, under which the owner or 87
123		-	affiliate is exempt from the payment of income tax; 88
124		-	(5) The location and a description of other health care facilities of the 89
125		-	owner, existing or proposed, and, if proposed, the estimated completion 90
126		-	date or dates and whether or not construction has begun; [and] 91
127		-	(6) Audited and certified financial statements of the owner, including 92
128		-	(A) a balance sheet as of the end of the most recent fiscal year, and (B) 93
129		-	income statements for the most recent fiscal year of the owner or such 94
130		-	shorter period of time as the owner shall have been in existence; and 95
131		-	[(6)] (7) If the operation of the nursing home has not yet commenced, 96
132		-	a statement of the anticipated source and application of the funds used 97
133		-	or to be used in the purchase or construction of the home, including: 98
134		-	(A) An estimate of such costs as financing expense, legal expense, 99
135		-	land costs, marketing costs and other similar costs which the owner 100
136		-	expects to incur or become obligated for prior to the commencement of 101
137		-	operations; and 102
138		-	(B) A description of any mortgage loan or any other financing 103
139		-	intended to be used for the financing of the nursing home, including the 104
140		-	anticipated terms and costs of such financing. 105
141		-	[(b) In addition to the information provided pursuant to subsection 106
142		-	(a) of this section, the commissioner may reasonably require an 107
143		-	applicant for a nursing home license or renewal of a nursing home 108
144		-	license to submit additional information. Such information may include 109
145		-	audited and certified financial statements of the owner, including, (1) a 110
146		-	balance sheet as of the end of the most recent fiscal year, and (2) income 111
147		-	statements for the most recent fiscal year of the owner or such shorter 112
148		-	period of time as the owner shall have been in existence.] 113
149		-	[(c)] (b) No person acting individually or jointly with any other 114 Substitute Bill No. 6678
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	119	+	extent of the affiliation, if any; (C) the extent to which the affiliate 82
	120	+	organization will be responsible for the financial obligations of the 83
	121	+	owner; and (D) the provision of the Internal Revenue Code of 1986, or 84
	122	+	any subsequent corresponding internal revenue code of the United 85
	123	+	States, as from time to time amended, if any, under which the owner or 86
	124	+	affiliate is exempt from the payment of income tax; 87
	125	+	(5) The location and a description of other health care facilities of the 88
	126	+	owner, existing or proposed, and, if proposed, the estimated completion 89
	127	+	date or dates and whether or not construction has begun; [and] 90
	128	+	(6) Audited and certified financial statements of the owner, including 91
	129	+	(A) a balance sheet as of the end of the most recent fiscal year, and (B) 92
	130	+	income statements for the most recent fiscal year of the owner or such 93
	131	+	shorter period of time as the owner shall have been in existence; and 94
	132	+	[(6)] (7) If the operation of the nursing home has not yet commenced, 95
	133	+	a statement of the anticipated source and application of the funds used 96
	134	+	or to be used in the purchase or construction of the home, including: 97
	135	+	(A) An estimate of such costs as financing expense, legal expense, 98
	136	+	land costs, marketing costs and other similar costs which the owner 99
	137	+	expects to incur or become obligated for prior to the commencement of 100
	138	+	operations; and 101
	139	+	(B) A description of any mortgage loan or any other financing 102
	140	+	intended to be used for the financing of the nursing home, including the 103
	141	+	anticipated terms and costs of such financing. 104
	142	+	[(b) In addition to the information provided pursuant to subsection 105
	143	+	(a) of this section, the commissioner may reasonably require an 106
	144	+	applicant for a nursing home license or renewal of a nursing home 107
	145	+	license to submit additional information. Such information may include 108
	146	+	audited and certified financial statements of the owner, including, (1) a 109
	147	+	balance sheet as of the end of the most recent fiscal year, and (2) income 110
	148	+	statements for the most recent fiscal year of the owner or such shorter 111
	149	+	period of time as the owner shall have been in existence.] 112 Raised Bill No. 6678
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156		-	person shall establish, conduct, operate or maintain a nursing home 115
157		-	without maintaining professional liability insurance or other indemnity 116
158		-	against liability for professional malpractice. The amount of insurance 117
159		-	which such person shall maintain as insurance or indemnity against 118
160		-	claims for injury or death for professional malpractice shall be not less 119
161		-	than one million dollars for one person, per occurrence, with an 120
162		-	aggregate of not less than three million dollars. The requirements of this 121
163		-	subsection shall not apply to any person who establishes, conducts, 122
164		-	operates or maintains a residential care home. 123
165		-	[(d)] (c) A person seeking to renew a nursing home license shall 124
166		-	furnish the department with any information required under this 125
167		-	section that was not previously submitted and with satisfactory written 126
168		-	proof that the owner of the nursing home consents to such renewal, if 127
169		-	the owner is different from the person seeking renewal, and shall 128
170		-	provide data on any change in the information submitted. The 129
171		-	commissioner shall refuse to issue or renew a nursing home license if 130
172		-	the person seeking renewal fails to provide the information required 131
173		-	under this section. Upon such refusal, the commissioner shall grant such 132
174		-	license to the holder of the certificate of need, provided such holder 133
175		-	meets all requirements for such licensure. If such holder does not meet 134
176		-	such requirements, the commissioner shall proceed in accordance with 135
177		-	sections 19a-541 to 19a-549, inclusive. If the commissioner is considering 136
178		-	a license renewal application pursuant to an order of the commissioner, 137
179		-	the procedures in this subsection shall apply to such consideration. 138
180		-	Sec. 3. Subsection (a) of section 17b-340 of the general statutes is 139
181		-	repealed and the following is substituted in lieu thereof (Effective July 1, 140
182		-	2023): 141
183		-	(a) For purposes of this subsection, (1) a "related party" includes, but 142
184		-	is not limited to, any company related to a chronic and convalescent 143
185		-	nursing home through family association, common ownership, control 144
186		-	or business association with any of the owners, operators or officials of 145
187		-	such nursing home; (2) "company" means any person, partnership, 146
188		-	association, holding company, limited liability company or corporation; 147 Substitute Bill No. 6678
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	154	+
	155	+	[(c)] (b) No person acting individually or jointly with any other 113
	156	+	person shall establish, conduct, operate or maintain a nursing home 114
	157	+	without maintaining professional liability insurance or other indemnity 115
	158	+	against liability for professional malpractice. The amount of insurance 116
	159	+	which such person shall maintain as insurance or indemnity against 117
	160	+	claims for injury or death for professional malpractice shall be not less 118
	161	+	than one million dollars for one person, per occurrence, with an 119
	162	+	aggregate of not less than three million dollars. The requirements of this 120
	163	+	subsection shall not apply to any person who establishes, conducts, 121
	164	+	operates or maintains a residential care home. 122
	165	+	[(d)] (c) A person seeking to renew a nursing home license shall 123
	166	+	furnish the department with any information required under this 124
	167	+	section that was not previously submitted and with satisfactory written 125
	168	+	proof that the owner of the nursing home consents to such renewal, if 126
	169	+	the owner is different from the person seeking renewal, and shall 127
	170	+	provide data on any change in the information submitted. The 128
	171	+	commissioner shall refuse to issue or renew a nursing home license if 129
	172	+	the person seeking renewal fails to provide the information required 130
	173	+	under this section. Upon such refusal, the commissioner shall grant such 131
	174	+	license to the holder of the certificate of need, provided such holder 132
	175	+	meets all requirements for such licensure. If such holder does not meet 133
	176	+	such requirements, the commissioner shall proceed in accordance with 134
	177	+	sections 19a-541 to 19a-549, inclusive. If the commissioner is considering 135
	178	+	a license renewal application pursuant to an order of the commissioner, 136
	179	+	the procedures in this subsection shall apply to such consideration. 137
	180	+	Sec. 3. Subsection (a) of section 17b-340 of the general statutes is 138
	181	+	repealed and the following is substituted in lieu thereof (Effective July 1, 139
	182	+	2023): 140
	183	+	(a) For purposes of this subsection, (1) a "related party" includes, but 141
	184	+	is not limited to, any company related to a chronic and convalescent 142
	185	+	nursing home through family association, common ownership, control 143
	186	+	or business association with any of the owners, operators or officials of 144
	187	+	such nursing home; (2) "company" means any person, partnership, 145 Raised Bill No. 6678
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195		-	(3) "family association" means a relationship by birth, marriage or 148
196		-	domestic partnership; and (4) "profit and loss statement" means the 149
197		-	most recent annual statement on profits and losses finalized by a related 150
198		-	party before the annual report mandated under this subsection. The 151
199		-	rates to be paid by or for persons aided or cared for by the state or any 152
200		-	town in this state to licensed chronic and convalescent nursing homes, 153
201		-	to chronic disease hospitals associated with chronic and convalescent 154
202		-	nursing homes, to rest homes with nursing supervision, to licensed 155
203		-	residential care homes, as defined by section 19a-490, and to residential 156
204		-	facilities for persons with intellectual disability that are licensed 157
205		-	pursuant to section 17a-227 and certified to participate in the Title XIX 158
206		-	Medicaid program as intermediate care facilities for individuals with 159
207		-	intellectual disabilities, for room, board and services specified in 160
208		-	licensing regulations issued by the licensing agency shall be determined 161
209		-	annually, except as otherwise provided in this subsection by the 162
210		-	Commissioner of Social Services, to be effective July first of each year 163
211		-	except as otherwise provided in this subsection. Such rates shall be 164
212		-	determined on a basis of a reasonable payment for such necessary 165
213		-	services, which basis shall take into account as a factor the costs of such 166
214		-	services. Cost of such services shall include reasonable costs mandated 167
215		-	by collective bargaining agreements with certified collective bargaining 168
216		-	agents or other agreements between the employer and employees, 169
217		-	provided "employees" shall not include persons employed as managers 170
218		-	or chief administrators or required to be licensed as nursing home 171
219		-	administrators, and compensation for services rendered by proprietors 172
220		-	at prevailing wage rates, as determined by application of principles of 173
221		-	accounting as prescribed by said commissioner. Cost of such services 174
222		-	shall not include amounts paid by the facilities to employees as salary, 175
223		-	or to attorneys or consultants as fees, where the responsibility of the 176
224		-	employees, attorneys, or consultants is to persuade or seek to persuade 177
225		-	the other employees of the facility to support or oppose unionization. 178
226		-	Nothing in this subsection shall prohibit inclusion of amounts paid for 179
227		-	legal counsel related to the negotiation of collective bargaining 180
228		-	agreements, the settlement of grievances or normal administration of 181
229		-	labor relations. The commissioner may, in the commissioner's 182 Substitute Bill No. 6678
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	192	+
	193	+	association, holding company, limited liability company or corporation; 146
	194	+	(3) "family association" means a relationship by birth, marriage or 147
	195	+	domestic partnership; and (4) "profit and loss statement" means the 148
	196	+	most recent annual statement on profits and losses finalized by a related 149
	197	+	party before the annual report mandated under this subsection. The 150
	198	+	rates to be paid by or for persons aided or cared for by the state or any 151
	199	+	town in this state to licensed chronic and convalescent nursing homes, 152
	200	+	to chronic disease hospitals associated with chronic and convalescent 153
	201	+	nursing homes, to rest homes with nursing supervision, to licensed 154
	202	+	residential care homes, as defined by section 19a-490, and to residential 155
	203	+	facilities for persons with intellectual disability that are licensed 156
	204	+	pursuant to section 17a-227 and certified to participate in the Title XIX 157
	205	+	Medicaid program as intermediate care facilities for individuals with 158
	206	+	intellectual disabilities, for room, board and services specified in 159
	207	+	licensing regulations issued by the licensing agency shall be determined 160
	208	+	annually, except as otherwise provided in this subsection by the 161
	209	+	Commissioner of Social Services, to be effective July first of each year 162
	210	+	except as otherwise provided in this subsection. Such rates shall be 163
	211	+	determined on a basis of a reasonable payment for such necessary 164
	212	+	services, which basis shall take into account as a factor the costs of such 165
	213	+	services. Cost of such services shall include reasonable costs mandated 166
	214	+	by collective bargaining agreements with certified collective bargaining 167
	215	+	agents or other agreements between the employer and employees, 168
	216	+	provided "employees" shall not include persons employed as managers 169
	217	+	or chief administrators or required to be licensed as nursing home 170
	218	+	administrators, and compensation for services rendered by proprietors 171
	219	+	at prevailing wage rates, as determined by application of principles of 172
	220	+	accounting as prescribed by said commissioner. Cost of such services 173
	221	+	shall not include amounts paid by the facilities to employees as salary, 174
	222	+	or to attorneys or consultants as fees, where the responsibility of the 175
	223	+	employees, attorneys, or consultants is to persuade or seek to persuade 176
	224	+	the other employees of the facility to support or oppose unionization. 177
	225	+	Nothing in this subsection shall prohibit inclusion of amounts paid for 178
	226	+	legal counsel related to the negotiation of collective bargaining 179
	227	+	agreements, the settlement of grievances or normal administration of 180 Raised Bill No. 6678
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236		-	discretion, allow the inclusion of extraordinary and unanticipated costs 183
237		-	of providing services that were incurred to avoid an immediate negative 184
238		-	impact on the health and safety of patients. The commissioner may, in 185
239		-	the commissioner's discretion, based upon review of a facility's costs, 186
240		-	direct care staff to patient ratio and any other related information, revise 187
241		-	a facility's rate for any increases or decreases to total licensed capacity 188
242		-	of more than ten beds or changes to its number of licensed rest home 189
243		-	with nursing supervision beds and chronic and convalescent nursing 190
244		-	home beds. The commissioner may, in the commissioner's discretion, 191
245		-	revise the rate of a facility that is closing. An interim rate issued for the 192
246		-	period during which a facility is closing shall be based on a review of 193
247		-	facility costs, the expected duration of the close-down period, the 194
248		-	anticipated impact on Medicaid costs, available appropriations and the 195
249		-	relationship of the rate requested by the facility to the average Medicaid 196
250		-	rate for a close-down period. The commissioner may so revise a facility's 197
251		-	rate established for the fiscal year ending June 30, 1993, and thereafter 198
252		-	for any bed increases, decreases or changes in licensure effective after 199
253		-	October 1, 1989. Effective July 1, 1991, in facilities that have both a 200
254		-	chronic and convalescent nursing home and a rest home with nursing 201
255		-	supervision, the rate for the rest home with nursing supervision shall 202
256		-	not exceed such facility's rate for its chronic and convalescent nursing 203
257		-	home. All such facilities for which rates are determined under this 204
258		-	subsection shall report on a fiscal year basis ending on September 205
259		-	thirtieth. Such report shall be submitted to the commissioner by 206
260		-	February fifteenth. Each [for-profit] chronic and convalescent nursing 207
261		-	home that receives state funding pursuant to this section shall include 208
262		-	in such annual report a profit and loss statement from each related party 209
263		-	that receives from such chronic and convalescent nursing home [fifty 210
264		-	thousand dollars or more per year] any amount of income for goods, 211
265		-	fees and services. No cause of action or liability shall arise against the 212
266		-	state, the Department of Social Services, any state official or agent for 213
267		-	failure to take action based on the information required to be reported 214
268		-	under this subsection. The commissioner may reduce the rate in effect 215
269		-	for a facility that fails to submit a complete and accurate report on or 216
270		-	before February fifteenth by an amount not to exceed ten per cent of 217 Substitute Bill No. 6678
	231	+	LCO No. 4114 7 of 11
	232	+
	233	+	labor relations. The commissioner may, in the commissioner's 181
	234	+	discretion, allow the inclusion of extraordinary and unanticipated costs 182
	235	+	of providing services that were incurred to avoid an immediate negative 183
	236	+	impact on the health and safety of patients. The commissioner may, in 184
	237	+	the commissioner's discretion, based upon review of a facility's costs, 185
	238	+	direct care staff to patient ratio and any other related information, revise 186
	239	+	a facility's rate for any increases or decreases to total licensed capacity 187
	240	+	of more than ten beds or changes to its number of licensed rest home 188
	241	+	with nursing supervision beds and chronic and convalescent nursing 189
	242	+	home beds. The commissioner may, in the commissioner's discretion, 190
	243	+	revise the rate of a facility that is closing. An interim rate issued for the 191
	244	+	period during which a facility is closing shall be based on a review of 192
	245	+	facility costs, the expected duration of the close-down period, the 193
	246	+	anticipated impact on Medicaid costs, available appropriations and the 194
	247	+	relationship of the rate requested by the facility to the average Medicaid 195
	248	+	rate for a close-down period. The commissioner may so revise a facility's 196
	249	+	rate established for the fiscal year ending June 30, 1993, and thereafter 197
	250	+	for any bed increases, decreases or changes in licensure effective after 198
	251	+	October 1, 1989. Effective July 1, 1991, in facilities that have both a 199
	252	+	chronic and convalescent nursing home and a rest home with nursing 200
	253	+	supervision, the rate for the rest home with nursing supervision shall 201
	254	+	not exceed such facility's rate for its chronic and convalescent nursing 202
	255	+	home. All such facilities for which rates are determined under this 203
	256	+	subsection shall report on a fiscal year basis ending on September 204
	257	+	thirtieth. Such report shall be submitted to the commissioner by 205
	258	+	February fifteenth. Each for-profit chronic and convalescent nursing 206
	259	+	home that receives state funding pursuant to this section shall include 207
	260	+	in such annual report a profit and loss statement from each related party 208
	261	+	that receives from such chronic and convalescent nursing home [fifty 209
	262	+	thousand dollars or more per year] any amount of income for goods, 210
	263	+	fees and services. No cause of action or liability shall arise against the 211
	264	+	state, the Department of Social Services, any state official or agent for 212
	265	+	failure to take action based on the information required to be reported 213
	266	+	under this subsection. The commissioner may reduce the rate in effect 214
	267	+	for a facility that fails to submit a complete and accurate report on or 215 Raised Bill No. 6678
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277		-	such rate. If a licensed residential care home fails to submit a complete 218
278		-	and accurate report, the department shall notify such home of the failure 219
279		-	and the home shall have thirty days from the date the notice was issued 220
280		-	to submit a complete and accurate report. If a licensed residential care 221
281		-	home fails to submit a complete and accurate report not later than thirty 222
282		-	days after the date of notice, such home may not receive a retroactive 223
283		-	rate increase, in the commissioner's discretion. The commissioner shall, 224
284		-	annually, on or before April first, report the data contained in the reports 225
285		-	of such facilities on the department's Internet web site. For the cost 226
286		-	reporting year commencing October 1, 1985, and for subsequent cost 227
287		-	reporting years, facilities shall report the cost of using the services of any 228
288		-	nursing personnel supplied by a temporary nursing services agency by 229
289		-	separating said cost into two categories, the portion of the cost equal to 230
290		-	the salary of the employee for whom the nursing personnel supplied by 231
291		-	a temporary nursing services agency is substituting shall be considered 232
292		-	a nursing cost and any cost in excess of such salary shall be further 233
293		-	divided so that seventy-five per cent of the excess cost shall be 234
294		-	considered an administrative or general cost and twenty-five per cent of 235
295		-	the excess cost shall be considered a nursing cost, provided if the total 236
296		-	costs of a facility for nursing personnel supplied by a temporary nursing 237
297		-	services agency in any cost year are equal to or exceed fifteen per cent 238
298		-	of the total nursing expenditures of the facility for such cost year, no 239
299		-	portion of such costs in excess of fifteen per cent shall be classified as 240
300		-	administrative or general costs. The commissioner, in determining such 241
301		-	rates, shall also take into account the classification of patients or 242
302		-	boarders according to special care requirements or classification of the 243
303		-	facility according to such factors as facilities and services and such other 244
304		-	factors as the commissioner deems reasonable, including anticipated 245
305		-	fluctuations in the cost of providing such services. The commissioner 246
306		-	may establish a separate rate for a facility or a portion of a facility for 247
307		-	traumatic brain injury patients who require extensive care but not acute 248
308		-	general hospital care. Such separate rate shall reflect the special care 249
309		-	requirements of such patients. If changes in federal or state laws, 250
310		-	regulations or standards adopted subsequent to June 30, 1985, result in 251
311		-	increased costs or expenditures in an amount exceeding one-half of one 252 Substitute Bill No. 6678
	271	+	LCO No. 4114 8 of 11
	272	+
	273	+	before February fifteenth by an amount not to exceed ten per cent of 216
	274	+	such rate. If a licensed residential care home fails to submit a complete 217
	275	+	and accurate report, the department shall notify such home of the failure 218
	276	+	and the home shall have thirty days from the date the notice was issued 219
	277	+	to submit a complete and accurate report. If a licensed residential care 220
	278	+	home fails to submit a complete and accurate report not later than thirty 221
	279	+	days after the date of notice, such home may not receive a retroactive 222
	280	+	rate increase, in the commissioner's discretion. The commissioner shall, 223
	281	+	annually, on or before April first, report the data contained in the reports 224
	282	+	of such facilities on the department's Internet web site. For the cost 225
	283	+	reporting year commencing October 1, 1985, and for subsequent cost 226
	284	+	reporting years, facilities shall report the cost of using the services of any 227
	285	+	nursing personnel supplied by a temporary nursing services agency by 228
	286	+	separating said cost into two categories, the portion of the cost equal to 229
	287	+	the salary of the employee for whom the nursing personnel supplied by 230
	288	+	a temporary nursing services agency is substituting shall be considered 231
	289	+	a nursing cost and any cost in excess of such salary shall be further 232
	290	+	divided so that seventy-five per cent of the excess cost shall be 233
	291	+	considered an administrative or general cost and twenty-five per cent of 234
	292	+	the excess cost shall be considered a nursing cost, provided if the total 235
	293	+	costs of a facility for nursing personnel supplied by a temporary nursing 236
	294	+	services agency in any cost year are equal to or exceed fifteen per cent 237
	295	+	of the total nursing expenditures of the facility for such cost year, no 238
	296	+	portion of such costs in excess of fifteen per cent shall be classified as 239
	297	+	administrative or general costs. The commissioner, in determining such 240
	298	+	rates, shall also take into account the classification of patients or 241
	299	+	boarders according to special care requirements or classification of the 242
	300	+	facility according to such factors as facilities and services and such other 243
	301	+	factors as the commissioner deems reasonable, including anticipated 244
	302	+	fluctuations in the cost of providing such services. The commissioner 245
	303	+	may establish a separate rate for a facility or a portion of a facility for 246
	304	+	traumatic brain injury patients who require extensive care but not acute 247
	305	+	general hospital care. Such separate rate shall reflect the special care 248
	306	+	requirements of such patients. If changes in federal or state laws, 249
	307	+	regulations or standards adopted subsequent to June 30, 1985, result in 250 Raised Bill No. 6678
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317	310
318		-	per cent of allowable costs for the most recent cost reporting year, the 253
319		-	commissioner shall adjust rates and provide payment for any such 254
320		-	increased reasonable costs or expenditures within a reasonable period 255
321		-	of time retroactive to the date of enforcement. Nothing in this section 256
322		-	shall be construed to require the Department of Social Services to adjust 257
323		-	rates and provide payment for any increases in costs resulting from an 258
324		-	inspection of a facility by the Department of Public Health. Such 259
325		-	assistance as the commissioner requires from other state agencies or 260
326		-	departments in determining rates shall be made available to the 261
327		-	commissioner at the commissioner's request. Payment of the rates 262
328		-	established pursuant to this section shall be conditioned on the 263
329		-	establishment by such facilities of admissions procedures that conform 264
330		-	with this section, section 19a-533 and all other applicable provisions of 265
331		-	the law and the provision of equality of treatment to all persons in such 266
332		-	facilities. The established rates shall be the maximum amount 267
333		-	chargeable by such facilities for care of such beneficiaries, and the 268
334		-	acceptance by or on behalf of any such facility of any additional 269
335		-	compensation for care of any such beneficiary from any other person or 270
336		-	source shall constitute the offense of aiding a beneficiary to obtain aid 271
337		-	to which the beneficiary is not entitled and shall be punishable in the 272
338		-	same manner as is provided in subsection (b) of section 17b-97. 273
339		-	Notwithstanding any provision of this section, the Commissioner of 274
340		-	Social Services may, within available appropriations, provide an interim 275
341		-	rate increase for a licensed chronic and convalescent nursing home or a 276
342		-	rest home with nursing supervision for rate periods no earlier than April 277
343		-	1, 2004, only if the commissioner determines that the increase is 278
344		-	necessary to avoid the filing of a petition for relief under Title 11 of the 279
345		-	United States Code; imposition of receivership pursuant to sections 19a-280
346		-	542 and 19a-543; or substantial deterioration of the facility's financial 281
347		-	condition that may be expected to adversely affect resident care and the 282
348		-	continued operation of the facility, and the commissioner determines 283
349		-	that the continued operation of the facility is in the best interest of the 284
350		-	state. The commissioner shall consider any requests for interim rate 285
351		-	increases on file with the department from March 30, 2004, and those 286
352		-	submitted subsequently for rate periods no earlier than April 1, 2004. 287 Substitute Bill No. 6678
	311	+	LCO No. 4114 9 of 11
	312	+
	313	+	increased costs or expenditures in an amount exceeding one-half of one 251
	314	+	per cent of allowable costs for the most recent cost reporting year, the 252
	315	+	commissioner shall adjust rates and provide payment for any such 253
	316	+	increased reasonable costs or expenditures within a reasonable period 254
	317	+	of time retroactive to the date of enforcement. Nothing in this section 255
	318	+	shall be construed to require the Department of Social Services to adjust 256
	319	+	rates and provide payment for any increases in costs resulting from an 257
	320	+	inspection of a facility by the Department of Public Health. Such 258
	321	+	assistance as the commissioner requires from other state agencies or 259
	322	+	departments in determining rates shall be made available to the 260
	323	+	commissioner at the commissioner's request. Payment of the rates 261
	324	+	established pursuant to this section shall be conditioned on the 262
	325	+	establishment by such facilities of admissions procedures that conform 263
	326	+	with this section, section 19a-533 and all other applicable provisions of 264
	327	+	the law and the provision of equality of treatment to all persons in such 265
	328	+	facilities. The established rates shall be the maximum amount 266
	329	+	chargeable by such facilities for care of such beneficiaries, and the 267
	330	+	acceptance by or on behalf of any such facility of any additional 268
	331	+	compensation for care of any such beneficiary from any other person or 269
	332	+	source shall constitute the offense of aiding a beneficiary to obtain aid 270
	333	+	to which the beneficiary is not entitled and shall be punishable in the 271
	334	+	same manner as is provided in subsection (b) of section 17b-97. 272
	335	+	Notwithstanding any provision of this section, the Commissioner of 273
	336	+	Social Services may, within available appropriations, provide an interim 274
	337	+	rate increase for a licensed chronic and convalescent nursing home or a 275
	338	+	rest home with nursing supervision for rate periods no earlier than April 276
	339	+	1, 2004, only if the commissioner determines that the increase is 277
	340	+	necessary to avoid the filing of a petition for relief under Title 11 of the 278
	341	+	United States Code; imposition of receivership pursuant to sections 19a-279
	342	+	542 and 19a-543; or substantial deterioration of the facility's financial 280
	343	+	condition that may be expected to adversely affect resident care and the 281
	344	+	continued operation of the facility, and the commissioner determines 282
	345	+	that the continued operation of the facility is in the best interest of the 283
	346	+	state. The commissioner shall consider any requests for interim rate 284
	347	+	increases on file with the department from March 30, 2004, and those 285 Raised Bill No. 6678
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359		-	When reviewing an interim rate increase request the commissioner 288
360		-	shall, at a minimum, consider: (A) Existing chronic and convalescent 289
361		-	nursing home or rest home with nursing supervision utilization in the 290
362		-	area and projected bed need; (B) physical plant long-term viability and 291
363		-	the ability of the owner or purchaser to implement any necessary 292
364		-	property improvements; (C) licensure and certification compliance 293
365		-	history; (D) reasonableness of actual and projected expenses; and (E) the 294
366		-	ability of the facility to meet wage and benefit costs. No interim rate 295
367		-	shall be increased pursuant to this subsection in excess of one hundred 296
368		-	fifteen per cent of the median rate for the facility's peer grouping, 297
369		-	established pursuant to subdivision (2) of subsection (f) of this section, 298
370		-	unless recommended by the commissioner and approved by the 299
371		-	Secretary of the Office of Policy and Management after consultation 300
372		-	with the commissioner. Such median rates shall be published by the 301
373		-	Department of Social Services not later than April first of each year. In 302
374		-	the event that a facility granted an interim rate increase pursuant to this 303
375		-	section is sold or otherwise conveyed for value to an unrelated entity 304
376		-	less than five years after the effective date of such rate increase, the rate 305
377		-	increase shall be deemed rescinded and the department shall recover an 306
378		-	amount equal to the difference between payments made for all affected 307
379		-	rate periods and payments that would have been made if the interim 308
380		-	rate increase was not granted. The commissioner may seek recovery of 309
381		-	such payments from any facility with common ownership. With the 310
382		-	approval of the Secretary of the Office of Policy and Management, the 311
383		-	commissioner may waive recovery and rescission of the interim rate for 312
384		-	good cause shown that is not inconsistent with this section, including, 313
385		-	but not limited to, transfers to family members that were made for no 314
386		-	value. The commissioner shall provide written quarterly reports to the 315
387		-	joint standing committees of the General Assembly having cognizance 316
388		-	of matters relating to aging, human services and appropriations and the 317
389		-	budgets of state agencies, that identify each facility requesting an 318
390		-	interim rate increase, the amount of the requested rate increase for each 319
391		-	facility, the action taken by the commissioner and the secretary pursuant 320
392		-	to this subsection, and estimates of the additional cost to the state for 321
393		-	each approved interim rate increase. Nothing in this subsection shall 322 Substitute Bill No. 6678
	351	+	LCO No. 4114 10 of 11
	352	+
	353	+	submitted subsequently for rate periods no earlier than April 1, 2004. 286
	354	+	When reviewing an interim rate increase request the commissioner 287
	355	+	shall, at a minimum, consider: (A) Existing chronic and convalescent 288
	356	+	nursing home or rest home with nursing supervision utilization in the 289
	357	+	area and projected bed need; (B) physical plant long-term viability and 290
	358	+	the ability of the owner or purchaser to implement any necessary 291
	359	+	property improvements; (C) licensure and certification compliance 292
	360	+	history; (D) reasonableness of actual and projected expenses; and (E) the 293
	361	+	ability of the facility to meet wage and benefit costs. No interim rate 294
	362	+	shall be increased pursuant to this subsection in excess of one hundred 295
	363	+	fifteen per cent of the median rate for the facility's peer grouping, 296
	364	+	established pursuant to subdivision (2) of subsection (f) of this section, 297
	365	+	unless recommended by the commissioner and approved by the 298
	366	+	Secretary of the Office of Policy and Management after consultation 299
	367	+	with the commissioner. Such median rates shall be published by the 300
	368	+	Department of Social Services not later than April first of each year. In 301
	369	+	the event that a facility granted an interim rate increase pursuant to this 302
	370	+	section is sold or otherwise conveyed for value to an unrelated entity 303
	371	+	less than five years after the effective date of such rate increase, the rate 304
	372	+	increase shall be deemed rescinded and the department shall recover an 305
	373	+	amount equal to the difference between payments made for all affected 306
	374	+	rate periods and payments that would have been made if the interim 307
	375	+	rate increase was not granted. The commissioner may seek recovery of 308
	376	+	such payments from any facility with common ownership. With the 309
	377	+	approval of the Secretary of the Office of Policy and Management, the 310
	378	+	commissioner may waive recovery and rescission of the interim rate for 311
	379	+	good cause shown that is not inconsistent with this section, including, 312
	380	+	but not limited to, transfers to family members that were made for no 313
	381	+	value. The commissioner shall provide written quarterly reports to the 314
	382	+	joint standing committees of the General Assembly having cognizance 315
	383	+	of matters relating to aging, human services and appropriations and the 316
	384	+	budgets of state agencies, that identify each facility requesting an 317
	385	+	interim rate increase, the amount of the requested rate increase for each 318
	386	+	facility, the action taken by the commissioner and the secretary pursuant 319
	387	+	to this subsection, and estimates of the additional cost to the state for 320 Raised Bill No. 6678
394	388
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400		-	prohibit the commissioner from increasing the rate of a licensed chronic 323
401		-	and convalescent nursing home or a rest home with nursing supervision 324
402		-	for allowable costs associated with facility capital improvements or 325
403		-	increasing the rate in case of a sale of a licensed chronic and convalescent 326
404		-	nursing home or a rest home with nursing supervision if receivership 327
405		-	has been imposed on such home. For purposes of this section, 328
406		-	"temporary nursing services agency" and "nursing personnel" have the 329
407		-	same meaning as provided in section 19a-118. 330
	391	+	LCO No. 4114 11 of 11
	392	+
	393	+	each approved interim rate increase. Nothing in this subsection shall 321
	394	+	prohibit the commissioner from increasing the rate of a licensed chronic 322
	395	+	and convalescent nursing home or a rest home with nursing supervision 323
	396	+	for allowable costs associated with facility capital improvements or 324
	397	+	increasing the rate in case of a sale of a licensed chronic and convalescent 325
	398	+	nursing home or a rest home with nursing supervision if receivership 326
	399	+	has been imposed on such home. For purposes of this section, 327
	400	+	"temporary nursing services agency" and "nursing personnel" have the 328
	401	+	same meaning as provided in section 19a-118. 329
408	402		This act shall take effect as follows and shall amend the following
409	403		sections:
410	404
411	405		Section 1 July 1, 2023 New section
412	406		Sec. 2 July 1, 2023 19a-491a
413	407		Sec. 3 July 1, 2023 17b-340(a)
414	408
415		-	Statement of Legislative Commissioners:
416		-	In Section 1(b), "department's Internet web site" was changed to
417		-	"Internet web site of the Department of Social Services" for clarity.
418		-
419		-	AGE Joint Favorable Subst.
	409	+	Statement of Purpose:
	410	+	To require (1) transparent cost reporting by nursing homes, and (2)
	411	+	disclosure of private equity ownership by applicants for nursing home
	412	+	licensure.
	413	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	414	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	415	+	underlined.]
420	416