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General Assembly Raised Bill No. 989
January Session, 2023
LCO No. 4040
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT CONCERNING NURSING HOMES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-522a of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective from passage): 2
(a) On and after July 1, 2024, each chronic and convalescent nursing 3
home and rest home with nursing supervision shall have an air 4
conditioning system in all resident rooms. Not later than January 1, 5
2025, each chronic and convalescent nursing home and rest home with 6
nursing supervision shall submit a report to the Department of Public 7
Health attesting to its compliance with this subsection or its plan to 8
comply with the requirements of this subsection. 9
(b) A chronic and convalescent nursing home or a rest home with 10
nursing supervision may maintain temperatures in resident rooms and 11
other areas used by residents at such facilities at levels that are lower 12
than minimum temperature standards prescribed in the Public Health 13
Code provided temperature levels at such facilities comply with the 14
comfortable and safe temperature standards prescribed under federal 15 Raised Bill No. 989
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law pursuant to 42 CFR 483.15(h)(6). In accordance with section 19a-36, 16
the Commissioner of Public Health shall amend the Public Health Code 17
in conformity with the provisions of this section. 18
(c) The provisions of this section shall not apply to residential care 19
homes, as defined in section 19a-490. 20
Sec. 2. (NEW) (Effective from passage) (a) There is established, within 21
the Connecticut Health and Educational Facilities Authority, a 22
revolving loan account for the purpose of providing financial assistance 23
to owners of chronic and convalescent nursing homes or rest homes 24
with nursing supervision, licensed pursuant to chapter 368v of the 25
general statutes, for costs incurred to install air conditioning systems 26
required by subsection (a) of section 19a-522a of the general statutes, as 27
amended by this act. 28
(b) The revolving loan account shall contain any moneys provided or 29
required by law to be deposited in the account. The authority may 30
accept contributions from any source, public or private, for deposit in 31
the account for purposes of the loan program. 32
(c) Loans made pursuant to this section shall have such terms and 33
conditions and shall be subject to such eligibility, loan approval, credit 34
and other underwriting requirements and criteria as are determined by 35
the authority to be reasonable in light of the purpose of the loan 36
program. 37
(d) On or before January 1, 2025, and biannually thereafter so long as 38
the loan program remains active, the authority shall submit to the joint 39
standing committees of the General Assembly having cognizance of 40
matters relating to aging, human services and public health a report, in 41
accordance with section 11-4a of the general statutes, setting forth the 42
following information: (1) A list of the loans made under the program, 43
a general description of the terms and conditions of such loans and the 44
repayment history; (2) an assessment of the impact of such loans on 45
compliance with the requirements of section 19a-522a of the general 46
statutes, as amended by this act; (3) the need for additional funding for 47 Raised Bill No. 989
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the loan program authorized by this section; and (4) such other 48
information as the authority deems relevant to evaluating the success of 49
the loan program in meeting its objectives. 50
(e) In connection with the making and administration of loans 51
pursuant to this section, the authority shall have and may exercise such 52
powers as are necessary or appropriate to carry out the purposes of this 53
section, including the same powers expressly granted to the authority 54
in section 10a-180 of the general statutes with respect to other loans. 55
(f) No loan may be made pursuant to this section after June 30, 2025, 56
and any moneys then remaining in, or thereafter received to the credit 57
of, the account established in subsection (b) of this section may be 58
withdrawn by the authority from such account and used for other 59
purposes of the authority, subject to specific restrictions governing any 60
contribution to such account pursuant to subsection (b) of this section. 61
(g) The authority shall adopt written procedures, in accordance with 62
section 1-121 of the general statutes, to carry out the provisions of this 63
section. 64
Sec. 3. Subsection (c) of section 19a-535 of the general statutes is 65
repealed and the following is substituted in lieu thereof (Effective from 66
passage): 67
(c) (1) Before effecting any transfer or discharge of a resident from the 68
facility, the facility shall notify, in writing, the resident and the resident's 69
guardian or conservator, if any, or legally liable relative or other 70
responsible party if known, of the proposed transfer or discharge, the 71
reasons therefor, the effective date of the proposed transfer or discharge, 72
the location to which the resident is to be transferred or discharged, the 73
right to appeal the proposed transfer or discharge and the procedures 74
for initiating such an appeal as determined by the Department of Social 75
Services, the date by which an appeal must be initiated in order to 76
preserve the resident's right to an appeal hearing and the date by which 77
an appeal must be initiated in order to stay the proposed transfer or 78
discharge and the possibility of an exception to the date by which an 79 Raised Bill No. 989
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appeal must be initiated in order to stay the proposed transfer or 80
discharge for good cause, that the resident may represent himself or 81
herself or be represented by legal counsel, a relative, a friend or other 82
spokesperson, and information as to bed hold and nursing home 83
readmission policy when required in accordance with section 19a-537. 84
The notice shall also include the name, mailing address and telephone 85
number of the State Long-Term Care Ombudsman. If the resident is, or 86
the facility alleges a resident is, mentally ill or developmentally 87
disabled, the notice shall include the name, mailing address and 88
telephone number of the nonprofit entity designated by the Governor in 89
accordance with section 46a-10b to serve as the Connecticut protection 90
and advocacy system. The notice shall be given at least thirty days and 91
no more than sixty days prior to the resident's proposed transfer or 92
discharge, except where the health or safety of individuals in the facility 93
are endangered, or where the resident's health improves sufficiently to 94
allow a more immediate transfer or discharge, or where immediate 95
transfer or discharge is necessitated by urgent medical needs or where 96
a resident has not resided in the facility for thirty days, in which cases 97
notice shall be given as many days before the transfer or discharge as 98
practicable. 99
(2) The resident may initiate an appeal pursuant to this section by 100
submitting a written request to the Commissioner of Social Services not 101
later than sixty calendar days after the facility issues the notice of the 102
proposed transfer or discharge, except as provided in subsection (h) of 103
this section. In order to stay a proposed transfer or discharge, the 104
resident must initiate an appeal not later than twenty days after the date 105
the resident receives the notice of the proposed transfer or discharge 106
from the facility unless the resident demonstrates good cause for failing 107
to initiate such appeal within the twenty-day period. 108
(3) On the date that the facility provides notice of a proposed 109
involuntary transfer or discharge of a resident pursuant to the 110
provisions of subdivision (1) of this subsection, the facility shall notify 111
the State Ombudsman, appointed pursuant to section 17a-405, in a 112
manner prescribed by the State Ombudsman, of such proposed 113 Raised Bill No. 989
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involuntary transfer or discharge. Failure to provide notice to the State 114
Ombudsman pursuant to the provisions of this subdivision shall 115
invalidate any notice of the proposed involuntary transfer or discharge 116
of a resident submitted pursuant to the provisions of subdivision (1) of 117
this subsection. 118
Sec. 4. (NEW) (Effective July 1, 2023) (a) Any nursing home facility, as 119
defined in section 19a-490 of the general statutes, with available vehicles 120
equipped to transport nonambulatory residents, may provide 121
nonemergency transportation of such residents to the homes of such 122
residents' family members, provided: (1) Such family members live 123
within fifteen miles of the nursing home facility, and (2) such 124
transportation is approved not less than five business days in advance 125
by a physician or physician's assistant, licensed pursuant to chapter 370 126
of the general statutes, or an advanced practice registered nurse licensed 127
pursuant to chapter 378 of the general statutes. 128
(b) The Commissioner of Social Services, within availab le 129
appropriations, shall establish a grant program to fund such 130
nonemergency transportation. The commissioner shall prescribe forms 131
and procedures for a nursing home facility to apply for a grant through 132
the program. 133
Sec. 5. Section 19a-533 of the general statutes is repealed and the 134
following is substituted in lieu thereof (Effective July 1, 2023): 135
(a) As used in this section, (1) "nursing home" means any chronic and 136
convalescent facility or any rest home with nursing supervision, as 137
defined in section 19a-521, which has a provider agreement with the 138
state to provide services to recipients of funds obtained through Title 139
XIX of the Social Security Amendments of 1965; and (2) "indigent 140
person" means any person who is eligible for or who is receiving 141
medical assistance benefits from the state. 142
(b) A nursing home which receives payment from the state for 143
rendering care to indigent persons shall include the following wording 144
in a conspicuous place on all applications for admission in at least 145 Raised Bill No. 989
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twelve-point bold type: 146
"As soon as you substantially complete and return this admissions 147
form to the facility, we will accept your application and place your name 148
on our waiting list for admission to the facility. Your name will only be 149
placed on our waiting list after you substantially complete and return 150
the written application form to us. Your name will be removed from the 151
waiting list if the facility is unable to reach you to confirm interest in 152
admission to the facility for a period of not less than thirty days after 153
you have been on the waiting list for a period of not less than ninety 154
days." A nursing home shall not be required to maintain a list of 155
inquiries from prospective residents who have not yet submitted a 156
substantially completed application for admission accepted by the 157
nursing home, nor to provide any such person with a receipt of their 158
inquiry. 159
(1) [Be] A nursing home shall be prohibited from discriminating 160
against indigent persons who apply for admission to such facility on the 161
basis of source of payment. Except as otherwise provided by law, all 162
applicants for admission to such facility shall be admitted in the order 163
in which such applicants apply for admission. A nursing home may 164
provide applications for admission to prospective residents by mail, 165
electronic transmission or Internet web site posting. Each nursing home 166
shall [(A) provide a receipt to each applicant for admission to its facility 167
who requests placement on a waiting list stating the date and time of 168
such request and (B) maintain a dated list of such applications which 169
shall be] maintain a waiting list in the order in which a substantially 170
completed application is accepted by such home with the documented 171
date of acceptance. A nursing home may maintain the waiting list in 172
either a written paper document or in an electronic format, and such list 173
shall not be required to be kept in a single, bound volume. The waiting 174
list shall be made available at all times to any applicant, his bona fide 175
representative, authorized personnel from the Departments of Public 176
Health and Social Services and such other state agencies or other bodies 177
established by state statute whose statutory duties necessitate access to 178
such lists. A nursing home may make a dated notation to the list either 179 Raised Bill No. 989
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in a written paper document or electronically. If a nursing home desires 180
to remove the name of an applicant who is unresponsive to facility 181
telephone calls, [and] letters or other means of communication from its 182
waiting list, the nursing home may, no sooner than ninety days after 183
initial placement of the person's name on the waiting list, inquire by 184
[letter] either letter delivered by United States mail or electronic mail to 185
such applicant, and any one person if designated by such applicant, 186
whether the applicant [desires continuation of his] wants to keep the 187
applicant's name on the waiting list. If the applicant does not respond 188
and an additional thirty days pass, the facility may remove such 189
applicant's name from its waiting list. A nursing home may annually 190
send a waiting list placement continuation letter by either letter 191
delivered by United States mail or electronic mail to all [persons] 192
applicants on the waiting list for at least ninety days to inquire as to 193
whether such [person desires continuation of his name] applicant wants 194
to remain on the waiting list, provided such letter shall also be sent to 195
any one person if designated by such applicant. If such person does not 196
respond and at least thirty days pass, the facility may remove the 197
person's name from its waiting list. Indigent persons shall be placed on 198
any waiting list for admission to a facility and shall be admitted to the 199
facility as vacancies become available, in the same manner as self-pay 200
applicants, except as provided in subsections (f) and (g) of this section; 201
(2) [Post] A nursing home shall post in a conspicuous place a notice 202
informing applicants for admission that the facility is prohibited by 203
statute from discriminating against indigent applicants for admission 204
on the basis of source of payment. Such notice shall advise applicants 205
for admission of the remedies available under this section and shall list 206
the name, address and telephone number of the ombudsman who 207
serves the region in which the facility is located; 208
(3) [Be] A nursing home shall be prohibited from requiring that an 209
indigent person pay any sum of money or furnish any other 210
consideration, including but not limited to the furnishing of an 211
agreement by the relative, conservator or other responsible party of an 212
indigent person which obligates such party to pay for care rendered to 213 Raised Bill No. 989
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an indigent person as a condition for admission of such indigent person; 214
(4) [Record in the patient roster, maintained pursuant to the Public 215
Health Code, or in a separate roster maintained for this purpose, the] A 216
nursing home shall make available, upon request, the number of 217
patients who are Medicare, Medicaid and private pay patients [on each 218
day. Such numbers shall be recorded daily and made available, upon 219
request,] to the state or regional ombudsman. 220
(c) Upon the receipt of a complaint concerning a violation of this 221
section, the Department of Social Services shall conduct an investigation 222
into such complaint. 223
(d) The Department of Social Services is authorized to decrease the 224
daily reimbursement rate to a nursing home for one year for a violation 225
of this section which occurred during the twelve-month period covered 226
by the cost report upon which the per diem rate is calculated. The per 227
diem rate shall be reduced by one-quarter of one per cent for an initial 228
violation of this section and one per cent for each additional violation. 229
(e) Prior to imposing any sanction, the Department of Social Services 230
shall notify the nursing home of the alleged violation and the 231
accompanying sanction, and shall permit such facility to request an 232
administrative hearing, in accordance with sections 4-176e to 4-181a, 233
inclusive. A facility shall request such hearing within fifteen days of 234
receipt of the notice of violation from the Department of Social Services. 235
The department shall stay the imposition of any sanction pending the 236
outcome of the administrative hearing. 237
(f) A nursing home with a number of self-pay residents equal to or 238
less than thirty per cent of its total number of residents shall not be 239
required to admit an indigent person on a waiting list for admission 240
when a vacancy becomes available during the subsequent six months, 241
provided no bed may be held open for more than thirty days. Each such 242
nursing home meeting the conditions for such waiver shall on a 243
quarterly basis notify the Commissioner of Social Services and the 244
regional nursing home ombudsman office of the date on which such six-245 Raised Bill No. 989
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month period of waiver began. 246
(g) A nursing home shall not be required to admit an indigent person 247
on a waiting list for admission when a vacancy becomes available if the 248
vacancy is in a private room. 249
(h) Notwithstanding the provisions of this section, a nursing home 250
may, without regard to the order of its waiting list, admit an applicant 251
who (1) seeks to transfer from a nursing home that is closing, or (2) seeks 252
to transfer from a nursing home in which the applicant was placed 253
following the closure of the nursing home where such applicant 254
previously resided or, in the case of a nursing home placed in 255
receivership, the anticipated closure of the nursing home where such 256
applicant previously resided, provided (A) the transfer occurs not later 257
than sixty days following the date that such applicant was transferred 258
from the nursing home where he or she previously resided, and (B) the 259
applicant submitted an application to the nursing home to which he or 260
she seeks admission at the time of the applicant's transfer from the 261
nursing home where he or she previously resided. 262
Sec. 6. (NEW) (Effective July 1, 2023) (a) Beginning with the cost report 263
year ending on September 30, 2023, and annually thereafter, each 264
nursing home facility, as defined in section 19a-490 of the general 265
statutes, shall submit to the Commissioner of Social Services narrative 266
summaries of expenditures in addition to the cost reports required 267
pursuant to section 17b-340 of the general statutes. The summaries shall 268
include the percentage of Medicaid funding allocated to the five cost 269
components of allowable costs described in section 17b-340d of the 270
general statutes and include expenditures for each allowable cost 271
component by the nursing home and any related party, as defined in 272
section 17b-340 of the general statutes. 273
(b) Not later than January 1, 2024, and annually thereafter, the 274
Commissioner of Social Services shall post in a conspicuous area on the 275
department's Internet web site a link to (1) the annual cost reports and 276
the summaries provided by each nursing home facility, (2) comparisons 277 Raised Bill No. 989
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between individual nursing homes by expenditures, and (3) a summary 278
of the average reported expenditures by facility for each category. Any 279
cost report forms utilized by the department shall include a glossary and 280
explanation of the terms used and a description of the categories being 281
reported on, including, but not limited to, plain language explanation of 282
formulas used to determine maximum costs for the five allowable cost 283
components described in section 17b-340d of the general statutes. 284
(c) Any nursing home facility that violates or fails to comply with the 285
provisions of this section shall be fined not more than ten thousand 286
dollars for each incident of noncompliance. The Commissioner of Social 287
Services may offset payments due a facility to collect the penalty. Prior 288
to imposing any penalty pursuant to this subsection, the commissioner 289
shall notify the nursing home facility of the alleged violation and the 290
accompanying penalty and shall permit such facility to request that the 291
department review its findings. A facility shall request such review not 292
later than fifteen days after receipt of the notice of violation from the 293
department. The department shall stay the imposition of any penalty 294
pending the outcome of the review. The commissioner may impose a 295
penalty upon a facility pursuant to this subsection regardless of whether 296
a change in ownership of the facility has taken place since the time of 297
the violation, provided the department issued notice of the alleged 298
violation and the accompanying penalty prior to the effective date of the 299
change in ownership and record of such notice is readily available in a 300
central registry maintained by the department. Payments of fines 301
received pursuant to this subsection shall be deposited in the General 302
Fund and credited to the Medicaid account. 303
Sec. 7. Section 19a-491a of the general statutes is repealed and the 304
following is substituted in lieu thereof (Effective July 1, 2023): 305
(a) A person seeking a license to establish, conduct, operate or 306
maintain a nursing home shall provide the Department of Public Health 307
with the following information: 308
(1) (A) The name and business address of the owner and a statement 309 Raised Bill No. 989
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of whether the owner is an individual, partnership, corporation or other 310
legal entity; (B) the names of the officers, directors, trustees, or 311
managing and general partners of the owner, the names of persons 312
having a ten per cent or greater ownership interest in the owner, and a 313
description of each such person's occupation with the owner; [and] (C) 314
if the owner is a corporation which is incorporated in another state, a 315
certificate of good standing from the secretary of state of the state of 316
incorporation; and (D) if a private equity fund owns any portion of the 317
business, the name of the fund's investment advisor and a copy of the 318
most recent quarterly statement provided to the private fund's 319
investors, including information regarding fees, expenses and 320
performance of the fund; 321
(2) A description of the relevant business experience of the owner and 322
of the administrator of the nursing home and evidence that the 323
administrator has a license issued pursuant to section 19a-514; 324
(3) Affidavits signed by the owner, any of the persons described in 325
subdivision (1) of this subsection, the administrator, assistant 326
administrator, the medical director, the director of nursing and assistant 327
director of nursing disclosing any matter in which such person has been 328
convicted of a felony, as defined in section 53a-25, or has pleaded nolo 329
contendere to a felony charge, or has been held liable or enjoined in a 330
civil action by final judgment, if the felony or civil action involved fraud, 331
embezzlement, fraudulent conversion or misappropriation of property; 332
or is subject to an injunction or restrictive or remedial order of a court of 333
record at the time of application, within the past five years has had any 334
state or federal license or permit suspended or revoked as a result of an 335
action brought by a governmental agency or department, arising out of 336
or relating to health care business activity, including, but not limited to, 337
actions affecting the operation of a nursing home, retirement home, 338
residential care home or any facility subject to sections 17b-520 to 17b-339
535, inclusive, or a similar statute in another state or country; 340
(4) (A) A statement as to whether or not the owner is, or is affiliated 341
with, a religious, charitable or other nonprofit organization; (B) the 342 Raised Bill No. 989
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extent of the affiliation, if any; (C) the extent to which the affiliate 343
organization will be responsible for the financial obligations of the 344
owner; and (D) the provision of the Internal Revenue Code of 1986, or 345
any subsequent corresponding internal revenue code of the United 346
States, as from time to time amended, if any, under which the owner or 347
affiliate is exempt from the payment of income tax; 348
(5) The location and a description of other health care facilities of the 349
owner, existing or proposed, and, if proposed, the estimated completion 350
date or dates and whether or not construction has begun; [and] 351
(6) Audited and certified financial statements of the owner, including 352
(A) a balance sheet as of the end of the most recent fiscal year, and (B) 353
income statements for the most recent fiscal year of the owner or such 354
shorter period of time as the owner shall have been in existence; and 355
[(6)] (7) If the operation of the nursing home has not yet commenced, 356
a statement of the anticipated source and application of the funds used 357
or to be used in the purchase or construction of the home, including: 358
(A) An estimate of such costs as financing expense, legal expense, 359
land costs, marketing costs and other similar costs which the owner 360
expects to incur or become obligated for prior to the commencement of 361
operations; and 362
(B) A description of any mortgage loan or any other financing 363
intended to be used for the financing of the nursing home, including the 364
anticipated terms and costs of such financing. 365
[(b) In addition to the information provided pursuant to subsection 366
(a) of this section, the commissioner may reasonably require an 367
applicant for a nursing home license or renewal of a nursing home 368
license to submit additional information. Such information may include 369
audited and certified financial statements of the owner, including, (1) a 370
balance sheet as of the end of the most recent fiscal year, and (2) income 371
statements for the most recent fiscal year of the owner or such shorter 372
period of time as the owner shall have been in existence.] 373 Raised Bill No. 989
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[(c)] (b) No person acting individually or jointly with any other 374
person shall establish, conduct, operate or maintain a nursing home 375
without maintaining professional liability insurance or other indemnity 376
against liability for professional malpractice. The amount of insurance 377
which such person shall maintain as insurance or indemnity against 378
claims for injury or death for professional malpractice shall be not less 379
than one million dollars for one person, per occurrence, with an 380
aggregate of not less than three million dollars. The requirements of this 381
subsection shall not apply to any person who establishes, conducts, 382
operates or maintains a residential care home. 383
[(d)] (c) A person seeking to renew a nursing home license shall 384
furnish the department with any information required under this 385
section that was not previously submitted and with satisfactory written 386
proof that the owner of the nursing home consents to such renewal, if 387
the owner is different from the person seeking renewal, and shall 388
provide data on any change in the information submitted. The 389
commissioner shall refuse to issue or renew a nursing home license if 390
the person seeking renewal fails to provide the information required 391
under this section. Upon such refusal, the commissioner shall grant such 392
license to the holder of the certificate of need, provided such holder 393
meets all requirements for such licensure. If such holder does not meet 394
such requirements, the commissioner shall proceed in accordance with 395
sections 19a-541 to 19a-549, inclusive. If the commissioner is considering 396
a license renewal application pursuant to an order of the commissioner, 397
the procedures in this subsection shall apply to such consideration. 398
Sec. 8. Subsection (a) of section 17b-340 of the general statutes is 399
repealed and the following is substituted in lieu thereof (Effective July 1, 400
2023): 401
(a) For purposes of this subsection, (1) a "related party" includes, but 402
is not limited to, any company related to a chronic and convalescent 403
nursing home through family association, common ownership, control 404
or business association with any of the owners, operators or officials of 405
such nursing home; (2) "company" means any person, partnership, 406 Raised Bill No. 989
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association, holding company, limited liability company or corporation; 407
(3) "family association" means a relationship by birth, marriage or 408
domestic partnership; and (4) "profit and loss statement" means the 409
most recent annual statement on profits and losses finalized by a related 410
party before the annual report mandated under this subsection. The 411
rates to be paid by or for persons aided or cared for by the state or any 412
town in this state to licensed chronic and convalescent nursing homes, 413
to chronic disease hospitals associated with chronic and convalescent 414
nursing homes, to rest homes with nursing supervision, to licensed 415
residential care homes, as defined by section 19a-490, and to residential 416
facilities for persons with intellectual disability that are licensed 417
pursuant to section 17a-227 and certified to participate in the Title XIX 418
Medicaid program as intermediate care facilities for individuals with 419
intellectual disabilities, for room, board and services specified in 420
licensing regulations issued by the licensing agency shall be determined 421
annually, except as otherwise provided in this subsection by the 422
Commissioner of Social Services, to be effective July first of each year 423
except as otherwise provided in this subsection. Such rates shall be 424
determined on a basis of a reasonable payment for such necessary 425
services, which basis shall take into account as a factor the costs of such 426
services. Cost of such services shall include reasonable costs mandated 427
by collective bargaining agreements with certified collective bargaining 428
agents or other agreements between the employer and employees, 429
provided "employees" shall not include persons employed as managers 430
or chief administrators or required to be licensed as nursing home 431
administrators, and compensation for services rendered by proprietors 432
at prevailing wage rates, as determined by application of principles of 433
accounting as prescribed by said commissioner. Cost of such services 434
shall not include amounts paid by the facilities to employees as salary, 435
or to attorneys or consultants as fees, where the responsibility of the 436
employees, attorneys, or consultants is to persuade or seek to persuade 437
the other employees of the facility to support or oppose unionization. 438
Nothing in this subsection shall prohibit inclusion of amounts paid for 439
legal counsel related to the negotiation of collective bargaining 440
agreements, the settlement of grievances or normal administration of 441 Raised Bill No. 989
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labor relations. The commissioner may, in the commissioner's 442
discretion, allow the inclusion of extraordinary and unanticipated costs 443
of providing services that were incurred to avoid an immediate negative 444
impact on the health and safety of patients. The commissioner may, in 445
the commissioner's discretion, based upon review of a facility's costs, 446
direct care staff to patient ratio and any other related information, revise 447
a facility's rate for any increases or decreases to total licensed capacity 448
of more than ten beds or changes to its number of licensed rest home 449
with nursing supervision beds and chronic and convalescent nursing 450
home beds. The commissioner may, in the commissioner's discretion, 451
revise the rate of a facility that is closing. An interim rate issued for the 452
period during which a facility is closing shall be based on a review of 453
facility costs, the expected duration of the close-down period, the 454
anticipated impact on Medicaid costs, available appropriations and the 455
relationship of the rate requested by the facility to the average Medicaid 456
rate for a close-down period. The commissioner may so revise a facility's 457
rate established for the fiscal year ending June 30, 1993, and thereafter 458
for any bed increases, decreases or changes in licensure effective after 459
October 1, 1989. Effective July 1, 1991, in facilities that have both a 460
chronic and convalescent nursing home and a rest home with nursing 461
supervision, the rate for the rest home with nursing supervision shall 462
not exceed such facility's rate for its chronic and convalescent nursing 463
home. All such facilities for which rates are determined under this 464
subsection shall report on a fiscal year basis ending on September 465
thirtieth. Such report shall be submitted to the commissioner by 466
February fifteenth. Each for-profit chronic and convalescent nursing 467
home that receives state funding pursuant to this section shall include 468
in such annual report a profit and loss statement from each related party 469
that receives from such chronic and convalescent nursing home [fifty 470
thousand dollars or more per year] any amount of income for goods, 471
fees and services. No cause of action or liability shall arise against the 472
state, the Department of Social Services, any state official or agent for 473
failure to take action based on the information required to be reported 474
under this subsection. The commissioner may reduce the rate in effect 475
for a facility that fails to submit a complete and accurate report on or 476 Raised Bill No. 989
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before February fifteenth by an amount not to exceed ten per cent of 477
such rate. If a licensed residential care home fails to submit a complete 478
and accurate report, the department shall notify such home of the failure 479
and the home shall have thirty days from the date the notice was issued 480
to submit a complete and accurate report. If a licensed residential care 481
home fails to submit a complete and accurate report not later than thirty 482
days after the date of notice, such home may not receive a retroactive 483
rate increase, in the commissioner's discretion. The commissioner shall, 484
annually, on or before April first, report the data contained in the reports 485
of such facilities on the department's Internet web site. For the cost 486
reporting year commencing October 1, 1985, and for subsequent cost 487
reporting years, facilities shall report the cost of using the services of any 488
nursing personnel supplied by a temporary nursing services agency by 489
separating said cost into two categories, the portion of the cost equal to 490
the salary of the employee for whom the nursing personnel supplied by 491
a temporary nursing services agency is substituting shall be considered 492
a nursing cost and any cost in excess of such salary shall be further 493
divided so that seventy-five per cent of the excess cost shall be 494
considered an administrative or general cost and twenty-five per cent of 495
the excess cost shall be considered a nursing cost, provided if the total 496
costs of a facility for nursing personnel supplied by a temporary nursing 497
services agency in any cost year are equal to or exceed fifteen per cent 498
of the total nursing expenditures of the facility for such cost year, no 499
portion of such costs in excess of fifteen per cent shall be classified as 500
administrative or general costs. The commissioner, in determining such 501
rates, shall also take into account the classification of patients or 502
boarders according to special care requirements or classification of the 503
facility according to such factors as facilities and services and such other 504
factors as the commissioner deems reasonable, including anticipated 505
fluctuations in the cost of providing such services. The commissioner 506
may establish a separate rate for a facility or a portion of a facility for 507
traumatic brain injury patients who require extensive care but not acute 508
general hospital care. Such separate rate shall reflect the special care 509
requirements of such patients. If changes in federal or state laws, 510
regulations or standards adopted subsequent to June 30, 1985, result in 511 Raised Bill No. 989
LCO No. 4040 17 of 21
increased costs or expenditures in an amount exceeding one-half of one 512
per cent of allowable costs for the most recent cost reporting year, the 513
commissioner shall adjust rates and provide payment for any such 514
increased reasonable costs or expenditures within a reasonable period 515
of time retroactive to the date of enforcement. Nothing in this section 516
shall be construed to require the Department of Social Services to adjust 517
rates and provide payment for any increases in costs resulting from an 518
inspection of a facility by the Department of Public Health. Such 519
assistance as the commissioner requires from other state agencies or 520
departments in determining rates shall be made available to the 521
commissioner at the commissioner's request. Payment of the rates 522
established pursuant to this section shall be conditioned on the 523
establishment by such facilities of admissions procedures that conform 524
with this section, section 19a-533, as amended by this act, and all other 525
applicable provisions of the law and the provision of equality of 526
treatment to all persons in such facilities. The established rates shall be 527
the maximum amount chargeable by such facilities for care of such 528
beneficiaries, and the acceptance by or on behalf of any such facility of 529
any additional compensation for care of any such beneficiary from any 530
other person or source shall constitute the offense of aiding a beneficiary 531
to obtain aid to which the beneficiary is not entitled and shall be 532
punishable in the same manner as is provided in subsection (b) of 533
section 17b-97. Notwithstanding any provision of this section, the 534
Commissioner of Social Services may, within available appropriations, 535
provide an interim rate increase for a licensed chronic and convalescent 536
nursing home or a rest home with nursing supervision for rate periods 537
no earlier than April 1, 2004, only if the commissioner determines that 538
the increase is necessary to avoid the filing of a petition for relief under 539
Title 11 of the United States Code; imposition of receivership pursuant 540
to sections 19a-542 and 19a-543; or substantial deterioration of the 541
facility's financial condition that may be expected to adversely affect 542
resident care and the continued operation of the facility, and the 543
commissioner determines that the continued operation of the facility is 544
in the best interest of the state. The commissioner shall consider any 545
requests for interim rate increases on file with the department from 546 Raised Bill No. 989
LCO No. 4040 18 of 21
March 30, 2004, and those submitted subsequently for rate periods no 547
earlier than April 1, 2004. When reviewing an interim rate increase 548
request the commissioner shall, at a minimum, consider: (A) Existing 549
chronic and convalescent nursing home or rest home with nursing 550
supervision utilization in the area and projected bed need; (B) physical 551
plant long-term viability and the ability of the owner or purchaser to 552
implement any necessary property improvements; (C) licensure and 553
certification compliance history; (D) reasonableness of actual and 554
projected expenses; and (E) the ability of the facility to meet wage and 555
benefit costs. No interim rate shall be increased pursuant to this 556
subsection in excess of one hundred fifteen per cent of the median rate 557
for the facility's peer grouping, established pursuant to subdivision (2) 558
of subsection (f) of this section, unless recommended by the 559
commissioner and approved by the Secretary of the Office of Policy and 560
Management after consultation with the commissioner. Such median 561
rates shall be published by the Department of Social Services not later 562
than April first of each year. In the event that a facility granted an 563
interim rate increase pursuant to this section is sold or otherwise 564
conveyed for value to an unrelated entity less than five years after the 565
effective date of such rate increase, the rate increase shall be deemed 566
rescinded and the department shall recover an amount equal to the 567
difference between payments made for all affected rate periods and 568
payments that would have been made if the interim rate increase was 569
not granted. The commissioner may seek recovery of such payments 570
from any facility with common ownership. With the approval of the 571
Secretary of the Office of Policy and Management, the commissioner 572
may waive recovery and rescission of the interim rate for good cause 573
shown that is not inconsistent with this section, including, but not 574
limited to, transfers to family members that were made for no value. The 575
commissioner shall provide written quarterly reports to the joint 576
standing committees of the General Assembly having cognizance of 577
matters relating to aging, human services and appropriations and the 578
budgets of state agencies, that identify each facility requesting an 579
interim rate increase, the amount of the requested rate increase for each 580
facility, the action taken by the commissioner and the secretary pursuant 581 Raised Bill No. 989
LCO No. 4040 19 of 21
to this subsection, and estimates of the additional cost to the state for 582
each approved interim rate increase. Nothing in this subsection shall 583
prohibit the commissioner from increasing the rate of a licensed chronic 584
and convalescent nursing home or a rest home with nursing supervision 585
for allowable costs associated with facility capital improvements or 586
increasing the rate in case of a sale of a licensed chronic and convalescent 587
nursing home or a rest home with nursing supervision if receivership 588
has been imposed on such home. For purposes of this section, 589
"temporary nursing services agency" and "nursing personnel" have the 590
same meaning as provided in section 19a-118. 591
Sec. 9. (NEW) (Effective July 1, 2023) (a) On or before January 1, 2024, 592
the Department of Public Health shall (1) establish minimum staffing 593
level requirements for nursing home facilities of at least four and one-594
tenth hours of direct care per resident, including three-quarter hours of 595
care by a registered nurse, fifty-four hundredth hours of care by a 596
licensed practical nurse and two and eighty-one hundredth hours of 597
care by a certified nurse's assistant, and (2) modify staffing level 598
requirements for social work and recreational staff of nursing homes 599
such that the requirements (A) for social work are one full-time social 600
worker per sixty residents, and (B) for recreational staff are higher than 601
the requirements prior to January 1, 2022, as deemed appropriate by the 602
Commissioner of Public Health. 603
(b) The commissioner shall adopt regulations in accordance with the 604
provisions of chapter 54 to implement the provisions of this section. 605
Sec. 10. Section 19a-562h of the general statutes is repealed and the 606
following is substituted in lieu thereof (Effective October 1, 2023): 607
(a) [If] On or before January 1, 2024, if the Commissioner of Public 608
Health finds that a nursing home facility has substantially failed to 609
comply with a nursing home facility staffing level requirement 610
established pursuant to [the regulations of Connecticut state agencies 611
the commissioner may (1) take any disciplinary action against the 612
nursing home facility permitted under section 19a-494, and (2) issue or 613 Raised Bill No. 989
LCO No. 4040 20 of 21
cause to be issued a citation to the licensee of such nursing home facility 614
pursuant to the provisions of section 19a-524] section 9 of this act, such 615
violation shall be considered a class B violation pursuant to section 19a-616
527. 617
(b) A nursing home shall pay any civil penalty imposed as a result of 618
the violation not later than seven days after the violation from 619
management fees or funds assigned for administrative and general 620
costs. 621
[(b)] (c) A citation of a nursing home facility staffing level 622
requirement set forth in the regulations of Connecticut state agencies 623
shall be prominently posted in the nursing home facility and included 624
in the listing prepared by the Department of Public Health pursuant to 625
the provisions of section 19a-540. 626
(d) The Commissioner of Public Health shall adopt regulations, in 627
accordance with chapter 54, to implement the provisions of this section.628
This act shall take effect as follows and shall amend the following
sections:
Section 1 from passage 19a-522a
Sec. 2 from passage New section
Sec. 3 from passage 19a-535(c)
Sec. 4 July 1, 2023 New section
Sec. 5 July 1, 2023 19a-533
Sec. 6 July 1, 2023 New section
Sec. 7 July 1, 2023 19a-491a
Sec. 8 July 1, 2023 17b-340(a)
Sec. 9 July 1, 2023 New section
Sec. 10 October 1, 2023 19a-562h
Statement of Purpose:
To (1) require air conditioning in each room at a nursing home, (2)
require notification of the State Ombudsman when a nursing home
plans to involuntarily transfer or discharge a patient, (3) establish a
grant program for transportation of nonambulatory nursing home
residents to homes of family members, (4) make changes in waiting list Raised Bill No. 989
LCO No. 4040 21 of 21
requirements for nursing homes, (5) require transparent cost reporting
by nursing homes, (6) establish minimum nursing home staffing levels,
and (7) impose stricter penalties for violations.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]