Researcher: MF Page 1 4/13/23
OLR Bill Analysis
sSB 989
AN ACT CONCERNING NURSING HOME AIR CONDITIONING,
COST REPORTING TRANSPARENCY, WAITING LIST
REQUIREMENTS, INVOLUNTARY PATIENT TRANSFER NOTICES
AND TRANSPORTATION FOR RESIDENT SOCIAL VISITS.
TABLE OF CONTENTS:
§§ 1 & 2 — AIR CONDITIONING IN NURSING HOMES
Requires nursing homes to provide air conditioning in every resident room by January 1,
2026; requires DPH to review and report to the legislature on this topic before the
requirement takes effect; creates a revolving loan account within CHEFA to help nursing
home owners pay to install the resident air conditioning systems
§§ 3 & 4 — INVOLUNTARY TRANSFER NOTICE
Requires nursing homes to notify the Long-Term Care Ombudsman of a resident’s
involuntary transfer or discharge on the same day the nursing home notifies the resident
§ 5 — NURSING HOME TRANSPORTATION FOR N ONAMBULATORY
RESIDENTS
Allows nursing homes to transport residents to their family members’ homes under
certain conditions and requires DSS to establish a grant program and report on
transportation as a health-related social need and potential federal funding for it
§ 6 — NURSING HOME WAITLIST WORKING GROUP
Requires the Long-Term Care Ombudsman to convene a working group to recommend
revisions to nursing home waitlist requirements and report to the Human Services and
Public Health committees by January 1, 2024
§ 7 — NURSING HOME EXPENDITURE SUMMARIES
Requires nursing homes to submit to DSS narrative summaries of certain expenditures
with their annual cost reports, requires DSS to post this information online, and sets a
$10,000 fine for violations
§ 8 — PRIVATE EQUITY OWNERS AND NURSING HOME LICENSURE
Requires applicants for a nursing home license to provide to DPH (1) information on
private equity funds that own any part of the nursing home and (2) the owner’s audited
and certified financial statements
§ 9 — FOR-PROFIT NURSING HOME RELATED PARTY REPORTING
Broadens nursing home related party cost reporting requirements by removing the cost
threshold
2023SB-00989-R000554-BA.DOCX
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§§ 1 & 2 — AIR CONDITIONING IN NURSING HOMES
Requires nursing homes to provide air conditioning in every resident room by January 1,
2026; requires DPH to review and report to the legislature on this topic before the
requirement takes effect; creates a revolving loan account within CHEFA to help nursing
home owners pay to install the resident air conditioning systems
The bill requires nursing homes, by January 1, 2026, to provide air
conditioning in every resident room. (It expressly exempts residential
care homes from the requirement.) Before the requirement takes effect,
the bill requires the Department of Public Health (DPH) to review each
nursing home to determine which homes do not currently do this and
report specified information on these homes to the Aging, Human
Services, and Public Health committees by January 1, 2025.
Additionally, the bill creates a revolving loan account within the
Connecticut Health and Educational Facilities Authority (CHEFA) to
help nursing home owners pay to install the resident air conditioning
systems.
DPH Review and Report
Beginning July 1, 2024, the bill requires DPH to review each nursing
home to determine which homes already have air conditioning in all
resident rooms. Those homes that do not must report the following
information to DPH as the commissioner prescribes:
1. whether and how the nursing home can adequately control the
climate in resident rooms during hot weather,
2. feasible air conditioning system options to install at the nursing
home, and
3. the cost and physical plant needs for providing air conditioning
in each resident room and any other impediments to doing so.
The bill requires DPH to report on this information to the Aging,
Human Services, and Public Health committees by January 1, 2025.
CHEFA Revolving Loan Account
Under the bill, the revolving loan account must contain (1) moneys
provided or required by law to be deposited into it and (2) public or 2023SB-00989-R000554-BA.DOCX
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private contributions CHEFA accepts.
The bill subjects the loans’ terms and conditions to eligibility, loan
approval, credit, and other underwriting requirements and criteria that
CHEFA determines are reasonable given the program’s purpose. To
implement the program, CHEFA may use its existing powers and must
adopt written procedures following notice requirements for quasi-
public agencies.
The bill prohibits CHEFA from issuing new loans to nursing homes
after January 1, 2026, once the air conditioning requirement takes effect.
At that time, it may withdraw any remaining account funds and use
them for other purposes, subject to any restrictions on account
contributions.
By law, CHEFA generally assists higher education institutions,
healthcare institutions, nursing homes, child care or child development
facilities, and qualified nonprofit organizations with construction,
financing or refinancing projects, or in other ways authorized by law
(CGS § 10a-180).
CHEFA Report
The bill requires CHEFA to report the following information to the
Aging, Human Services, and Public Health committees by January 1,
2026:
1. a list of program loans issued and a general description of their
terms, conditions, and repayment history;
2. an assessment of their impact on nursing homes’ compliance
with the bill’s air conditioning requirement;
3. the need for additional program funding; and
4. other information CHEFA deems relevant to evaluate the
program’s success in meeting its objectives.
Background — Nursing Home Minimum Temperature Standards
DPH regulations set minimum temperature requirements of 75 2023SB-00989-R000554-BA.DOCX
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degrees in areas that residents use and at least 70 degrees in all other
occupied areas (Conn. Agencies Regs., 19-13-D8t(d)(4)).
EFFECTIVE DATE: Upon passage
§§ 3 & 4 — INVOLUNTARY TRANSF ER NOTICE
Requires nursing homes to notify the Long-Term Care Ombudsman of a resident’s
involuntary transfer or discharge on the same day the nursing home notifies the resident
By law, nursing homes must give residents and their representatives
written notification about a discharge or transfer at least 30 days in
advance, including information about the appeals process and the
ombudsman’s contact information. Under the bill, nursing homes must
also notify the Long-Term Care Ombudsman on the same date as the
resident notification if the transfer or discharge is involuntary. If the
nursing home fails to do so, the involuntary transfer or discharge is
invalidated and cannot proceed. The ombudsman must prescribe how
to give the notification.
EFFECTIVE DATE: Upon passage
Background — Involuntary Transfers and Discharges
Under federal and state law, nursing homes cannot transfer or
discharge a resident unless the (1) facility cannot provide the resident
adequate care, (2) resident’s health has improved to the point that he or
she no longer needs the home’s services, (3) health or safety of people in
the facility are endangered, (4) resident failed to pay for care after
reasonable notice, or (5) facility closes (42 C.F.R. § 483.15(c), CGS §
19a535(b)).
Background — Related Bill
sSB 930 (File 99), favorably reported by the Aging Committee, has
identical provisions.
§ 5 — NURSING HOME T RANSPORTATION FOR
NONAMBULATORY RESIDE NTS
Allows nursing homes to transport residents to their family members’ homes under
certain conditions and requires DSS to establish a grant program and report on
transportation as a health-related social need and potential federal funding for it
The bill allows nursing homes to transport nonambulatory residents 2023SB-00989-R000554-BA.DOCX
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(i.e., those unable to walk) to their family members’ homes if:
1. a licensed physician, physician’s assistant, or advanced practice
registered nurse approves it at least five business days in
advance;
2. the nursing home has available vehicles equipped to transport
the residents; and
3. the family members live within 15 miles of the nursing home.
The bill also allows the Department of Social Services (DSS)
commissioner, within available appropriations, to establish a grant
program to fund this transportation. If she does so, the commissioner
must establish forms and procedures for nursing homes to apply for a
grant.
Under the bill, the commissioner must also evaluate if (1) the need for
this transportation would qualify as a health-related social need (i.e., a
health need derived from an adverse social condition that contributes to
poor health and health disparities) and (2) there is any available federal
funding for the transportation. She must report on the evaluation to the
Council on Medical Assistance Program Oversight (MAPOC ) by
October 1, 2023.
EFFECTIVE DATE: July 1, 2023
Background — Related Bill
HB 6575 (File 71), favorably reported by the Aging Committee, has
similar provisions, but does not require DSS to report to MAPOC.
§ 6 — NURSING HOME W AITLIST WORKING GROU P
Requires the Long-Term Care Ombudsman to convene a working group to recommend
revisions to nursing home waitlist requirements and report to the Human Services and
Public Health committees by January 1, 2024
The bill requires the Long-Term Care Ombudsman to convene a
working group to recommend revisions to existing law’s nursing home
waitlist requirements (CGS § 19a-533). Working group members must
include the following: 2023SB-00989-R000554-BA.DOCX
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1. the Long-Term Care Ombudsman, or her designee, who serves
as chairperson;
2. at least two nursing home industry representatives, appointed by
the ombudsman;
3. DSS and DPH commissioners, or their designees; and
4. any other member the ombudsman appoints.
The bill requires the working group to meet at least monthly, but does
not specify when it must convene.
Under the bill, the working group must report its recommended
changes to the waiting list requirements (e.g., authorizing nursing
homes to maintain waiting lists electronically) by January 1, 2024, to the
Human Services and Public Health committees.
EFFECTIVE DATE: Upon passage
§ 7 — NURSING HOME EXPENDITURE SUMMARIES
Requires nursing homes to submit to DSS narrative summaries of certain expenditures
with their annual cost reports, requires DSS to post this information online, and sets a
$10,000 fine for violations
Beginning the cost report year ending September 30, 2024, the bill
requires nursing homes to annually submit narrative summaries of cost
expenditures to the DSS commissioner, alongside their statutorily
required cost reports. The summaries must include the percentage of
Medicaid funding allocated to, and expenditures in, (1) direct costs, (2)
indirect costs, (3) fair rent, (4) capital-related costs, and (5)
administrative and general costs. They must also include expenditures
for each allowable cost component by the nursing home and any related
party (see below).
Beginning January 1, 2025, DSS must annually post on the agency’s
website (1) these cost reports and summaries for each nursing home, (2)
comparisons between individual nursing homes by expenditures, and
(3) a summary of the average reported expenditures of all reporting
nursing homes for each category. Any cost report forms DSS uses must 2023SB-00989-R000554-BA.DOCX
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include a glossary, an explanation of the terms used, a description of the
reported categories, and a plain language explanation of the formulas
used to determine costs for the five allowable cost components.
The bill requires a nursing home that fails to comply with this
reporting requirement to be fined up to $10,000. Before imposing a
penalty, the DSS commissioner must notify the nursing home about the
violation and allow it to request a review. The home must request a
review within 15 days after receiving the notice, and DSS cannot impose
the penalty while the review is pending.
Under the bill, the penalty may be imposed even if the nursing
home’s ownership changes after the violation takes place, as long as DSS
issued the notice about the violation before the change in ownership
became effective and the record of the notice is readily available in a
central registry maintained by DSS. The DSS commissioner may collect
the penalty by offsetting payments due to the facility. Payments made
for these penalties must be deposited in the General Fund and credited
to the Medicaid account.
EFFECTIVE DATE: July 1, 2023
Background — Related Bill
sHB 6678 (File 74) (§ 1), favorably reported by the Aging Committee,
has similar provisions with earlier deadlines.
§ 8 — PRIVATE EQUITY OWNERS AND NURSING HOME
LICENSURE
Requires applicants for a nursing home license to provide to DPH (1) information on
private equity funds that own any part of the nursing home and (2) the owner’s audited
and certified financial statements
The bill expands the information the nursing home licensure
applicants must give DPH to include (1) information on any private
equity fund that owns any part of the home, the name of the fund’s
investment advisor, and a copy of the most recent quarterly statement
given to the private fund’s investors and (2) the owner’s audited and
certified financial statements. Under current law, these statements are
only required if requested by DPH. The financial statement must 2023SB-00989-R000554-BA.DOCX
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include a balance sheet from the end of the most recent fiscal year and
income statements from the most recent fiscal year (or an applicable
shorter period if the owner has not existed for a full fiscal year).
EFFECTIVE DATE: July 1, 2023
Background — Related Bill
sHB 6678 (File 74) (§ 2), favorably reported by the Aging Committee,
has identical provisions.
§ 9 — FOR-PROFIT NURSING HOME RELATE D PARTY
REPORTING
Broadens nursing home related party cost reporting requirements by removing the cost
threshold
The bill broadens related party reporting requirements for for-profit
nursing homes that receive Medicaid funding. Current law requires
these nursing homes to include in their annual reports a profit and loss
statement from each related party (i.e., a company related to the home
through family association, common ownership, control, or business
association with the home’s owners or operators) that receives at least
$50,000 of income from the home per year. The bill removes this income
threshold, requiring statements from each related party that received
any income from the home.
EFFECTIVE DATE: July 1, 2023
Background — Related Bill
sHB 6678 (File 74) (§ 3), favorably reported by the Aging Committee,
also removes the income requirement, and further expands the
reporting requirement to nonprofit nursing homes.
COMMITTEE ACTION
Human Services Committee
Joint Favorable Substitute
Yea 20 Nay 1 (03/28/2023)