CT
Connecticut Senate Bill SB00989

Connecticut 2023 Regular Session

Connecticut Senate Bill SB00989 Compare Versions

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7+General Assembly Substitute Bill No. 989
8+January Session, 2023
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4-Substitute Senate Bill No. 989
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6-Public Act No. 23-186
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9-AN ACT CONCERNING NONPROFIT PROVIDER RETENTION OF
10-CONTRACT SAVINGS, COMMUNITY HEALTH WORKER MEDICAID
11-REIMBURSEMENT AND STUDIES OF MEDICAID RATES OF
12-REIMBURSEMENT, NURSING HOME TRANSPORTATION AND
13-NURSING HOME WAITING LISTS.
14+AN ACT CONCERNING NURSING HOME AIR CONDITIONING, COST
15+REPORTING TRANSPARENCY, WAITING LIST REQUIREMENTS,
16+INVOLUNTARY PATIENT TRANSFER NOTICES AND
17+TRANSPORTATION FOR RESIDENT SOCIAL VISITS.
1418 Be it enacted by the Senate and House of Representatives in General
1519 Assembly convened:
1620
17-Section 1. (Effective from passage) (a) Within available appropriations,
18-the Commissioner of Social Services shall conduct a two-part study of
19-Medicaid rates of reimbursement beginning with (1) an examination of
20-such rates for physician specialists, dentists and behavioral health
21-providers followed by (2) a review of the reimbursement system for all
22-other aspects of the Medicaid program, including, but not limited to,
23-ambulance services, the encounter-based reimbursement model for
24-federally qualified health centers and reimbursement rates for specialty
25-hospitals, complex nursing care and methadone maintenance.
26-(b) The rate reimbursement study shall include, but need not be
27-limited to: (1) A comparison of the state's Medicaid rates with Medicaid
28-rates provided by neighboring states; and (2) a comparison of the state's
29-Medicaid rates with Medicare rates and cost-of-living increases
30-provided under Medicare compared to the state Medicaid program.
31-(c) The commissioner shall file interim reports, in accordance with the Substitute Senate Bill No. 989
21+Section 1. Section 19a-522a of the general statutes is repealed and the 1
22+following is substituted in lieu thereof (Effective from passage): 2
23+(a) On and after July 1, 2024, the Department of Public Health shall 3
24+conduct a review of each nursing home facility, as defined in section 4
25+19a-490, to determine which such facilities have air conditioning in all 5
26+resident rooms. For those facilities that do not have air conditioning in 6
27+all resident rooms, each such facility shall report to the Department of 7
28+Public Health in a time and manner prescribed by the Commissioner of 8
29+Public Health: 9
30+(1) Whether and how such facility is able to adequately control the 10
31+climate in resident rooms during hot weather; 11
32+(2) What air conditioning system options are feasible for installation 12
33+at such facility; 13
34+(3) The cost and physical plant needs involved in providing air 14
35+conditioning in each resident room; and 15 Substitute Bill No. 989
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35-provisions of section 11-4a of the general statutes, (1) not later than
36-February 1, 2024, on the aspects of the study conducted pursuant to
37-subdivision (1) of subsection (a) of this section; and (2) not later than
38-January 1, 2025, on the aspects of the study conducted pursuant to
39-subdivision (2) of subsection (a) of this section with the joint standing
40-committees of the General Assembly having cognizance of matters
41-relating to appropriations and the budgets of state agencies and human
42-services. Nothing in this section shall be construed to impact Medicaid
43-rates of reimbursement for the fiscal years ending June 30, 2024, and
44-June 30, 2025.
45-Sec. 2. (NEW) (Effective July 1, 2023) (a) As used in this section, (1)
46-"private provider organization" and "purchase of service contract" each
47-have the same meanings as provided in section 4-70b of the general
48-statutes; (2) "health and human services" means services provided under
49-contract with a state agency that directly support the health, safety and
50-welfare of residents, including, but not limited to, those residents who
51-may have conditions that include, but are not limited to, behavioral
52-health disorders, intellectual disabilities, developmental disabilities,
53-physical disabilities and autism spectrum disorder; (3) "attempt to
54-recover or otherwise offset" means efforts to recoup savings at the end
55-of each fiscal year; and (4) "state agency" means the Departments of
56-Developmental Services, Mental Health and Addiction Services, Social
57-Services and Children and Families.
58-(b) Subject to the provisions of subsection (c) of this section, each state
59-agency that contracts with a nonprofit private provider organization for
60-health and human services shall allow such nonprofit organization that
61-otherwise meets contractual requirements, including, but not limited to,
62-its contractual obligations regarding services provided and clients
63-served, to retain any savings from a purchase of service contract at the
64-end of each fiscal year. No state agency shall attempt to recover or
65-otherwise offset funds retained by such nonprofit organization from the Substitute Senate Bill No. 989
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42+(4) Other impediments to providing air conditioning in each resident 16
43+room. 17
44+(b) Not later than January 1, 2025, the Department of Public Health 18
45+shall submit a report, in accordance with the provisions of section 11-4a, 19
46+to the joint standing committees of the General Assembly having 20
47+cognizance of matters relating to aging, human services and public 21
48+health on (1) the number of such facilities without air conditioning in all 22
49+resident rooms, (2) how many such facilities are able to adequately 23
50+control the temperature and humidity levels in resident rooms, (3) the 24
51+overall costs for nursing home facilities without air conditioning in 25
52+every resident room to provide air conditioning in such rooms, and (4) 26
53+any impediments to providing air conditioning in all resident rooms at 27
54+specific nursing homes. 28
55+(c) On or before January 1, 2026, each nursing home facility shall 29
56+provide air conditioning in every resident room. 30
57+(d) A chronic and convalescent nursing home or a rest home with 31
58+nursing supervision may maintain temperatures in resident rooms and 32
59+other areas used by residents at such facilities at levels that are lower 33
60+than minimum temperature standards prescribed in the Public Health 34
61+Code provided temperature levels at such facilities comply with the 35
62+comfortable and safe temperature standards prescribed under federal 36
63+law pursuant to 42 CFR 483.15(h)(6). In accordance with section 19a-36, 37
64+the Commissioner of Public Health shall amend the Public Health Code 38
65+in conformity with the provisions of this section. 39
66+(e) The provisions of this section shall not apply to residential care 40
67+homes, as defined in section 19a-490. 41
68+Sec. 2. (NEW) (Effective from passage) (a) There is established, within 42
69+the Connecticut Health and Educational Facilities Authority, a 43
70+revolving loan account for the purpose of providing financial assistance 44
71+to an owner of a nursing home facility, as defined in section 19a-490 of 45
72+the general statutes, for costs incurred to install an air conditioning 46 Substitute Bill No. 989
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69-contracted cost for services.
70-(c) Any nonprofit private provider organization allowed to retain
71-savings under this section shall submit an application to the contracting
72-state agency on how savings are planned to be reinvested and report to
73-the contracting state agency on how savings will be reinvested to
74-strengthen quality, invest in deferred maintenance and make asset
75-improvements. The commissioner of each state agency shall prescribe
76-the form and manner of such application form and the frequency of such
77-reports. The commissioner of each state agency shall review an
78-application submitted pursuant to this subsection and respond to a
79-nonprofit private provider organization not later than ninety days after
80-receiving such application from such provider organization. Retained
81-funds may only be used for the purposes of strengthening quality,
82-investing in deferred maintenance and making asset improvements. The
83-commissioner of each state agency shall approve, disapprove or modify
84-any application for funds in accordance with the allowable uses in this
85-subsection. Nonprofit private provider organizations providing health
86-and human services shall be permitted to expend retained funds on
87-programs that are funded by the same state agency.
88-(d) Notwithstanding any provisions to the contrary in this section, a
89-state agency shall not allow a nonprofit private provider organization
90-to retain surplus funds from the contracted cost of services under a
91-contract funded in whole, or in part, with federal funds when allowing
92-such organization to retain such funds would jeopardize federal
93-funding or reimbursement for such contract or when such allowance is
94-prohibited by federal law or regulations.
95-(e) The Commissioner of Social Services, in consultation with the
96-Secretary of the Office of Policy and Management and the
97-Commissioners of Children and Families, Mental Health and Addiction
98-Services and Developmental Services, may undertake a study of the
99-contracting and billing practices of such nonprofit private provider Substitute Senate Bill No. 989
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103-organizations to ensure compliance with all Medicaid waivers and
104-Medicaid state plan amendments. Any study started under this
105-subsection shall be completed not later than December 31, 2024.
106-(f) Notwithstanding the provisions of subsections (a) to (e), inclusive,
107-of this section, the Commissioner of Developmental Services, in
108-consultation with the Secretary of the Office of Policy and Management,
109-may extend the provisions of this section to other private provider
110-organizations with which the Department of Developmental Services
111-contracts, provided they meet all of the requirements set forth in this
112-section, including, but not limited to, meeting all terms and conditions
113-of their contracts for services with the Department of Developmental
114-Services.
115-Sec. 3. Section 4-216 of the general statutes is repealed and the
116-following is substituted in lieu thereof (Effective July 1, 2023):
117-(a) No state agency may execute a personal service agreement having
118-a cost of more than fifty thousand dollars or a term of more than one
119-year, without the approval of the secretary. A state agency may apply
120-for an approval by submitting the following information to the
121-secretary: (1) A description of the services to be purchased and the need
122-for such services; (2) an estimate of the cost of the services and the term
123-of the agreement; (3) whether the services are to be on-going; (4)
124-whether the state agency has contracted out for such services during the
125-preceding two years and, if so, the name of the contractor, term of the
126-agreement with such contractor and the amount paid to the contractor;
127-(5) whether any other state agency has the resources to provide the
128-services; (6) whether the agency intends to purchase the services by
129-competitive negotiation and, if not, why; and (7) whether it is possible
130-to purchase the services on a cooperative basis with other state agencies.
131-The secretary shall approve or disapprove an application within fifteen
132-business days after receiving it and any necessary supporting
133-information, provided if the secretary does not act within such Substitute Senate Bill No. 989
79+system in each resident room. 47
80+(b) The revolving loan account shall contain any moneys provided or 48
81+required by law to be deposited in the account. The authority may 49
82+accept contributions from any source, public or private, for deposit in 50
83+the account for purposes of the loan program. 51
84+(c) Loans made pursuant to this section shall have such terms and 52
85+conditions and shall be subject to such eligibility, loan approval, credit 53
86+and other underwriting requirements and criteria as are determined by 54
87+the authority to be reasonable in light of the purpose of the loan 55
88+program. 56
89+(d) On or before January 1, 2026, the authority shall submit to the joint 57
90+standing committees of the General Assembly having cognizance of 58
91+matters relating to aging, human services and public health a report, in 59
92+accordance with section 11-4a of the general statutes, setting forth the 60
93+following information: (1) A list of the loans made under the program, 61
94+a general description of the terms and conditions of such loans and the 62
95+repayment history; (2) an assessment of the impact of such loans on 63
96+compliance with any requirements for nursing home facilities to 64
97+provide an air conditioning system in each resident room; (3) the need 65
98+for additional funding for the loan program authorized by this section; 66
99+and (4) such other information as the authority deems relevant to 67
100+evaluating the success of the loan program in meeting its objectives. 68
101+(e) In connection with the making and administration of loans 69
102+pursuant to this section, the authority shall have and may exercise such 70
103+powers as are necessary or appropriate to carry out the purposes of this 71
104+section, including the same powers expressly granted to the authority 72
105+in section 10a-180 of the general statutes with respect to other loans. 73
106+(f) No new loan may be made pursuant to this section after January 74
107+1, 2026, and any moneys then remaining in, or thereafter received to the 75
108+credit of, the account established in subsection (b) of this section may be 76
109+withdrawn by the authority from such account and used for other 77 Substitute Bill No. 989
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137-fifteen-day period the application shall be deemed to have been
138-approved. The secretary shall immediately notify the Auditors of Public
139-Accounts of any application which the secretary receives for approval
140-of a personal services agreement for audit services and give said
141-auditors an opportunity to review the application during such fifteen-
142-day period and advise the secretary as to whether such audit services
143-are necessary and, if so, could be provided by said auditors.
144-(b) Each personal service agreement having a cost of more than fifty
145-thousand dollars or a term of more than one year shall be based on
146-competitive negotiation or competitive quotations, unless the state
147-agency purchasing the personal services applies to the secretary for a
148-waiver from such requirement and the secretary grants the waiver in
149-accordance with the guidelines adopted under section 4-215.
150-[(c) The secretary shall establish an incentive program for nonprofit
151-providers of human services that shall (1) allow providers who
152-otherwise meet contractual requirements to retain any savings realized
153-by the providers from the contracted cost for services, and (2) provide
154-that future contracted amounts from the state for the same types of
155-services are not reduced solely to reflect savings achieved in previous
156-contracts by such providers. For purposes of this subsection, "nonprofit
157-providers of human services" includes, but is not limited to, nonprofit
158-providers of services to persons with intellectual, physical or mental
159-disabilities or autism spectrum disorder. Any nonprofit provider of
160-human services allowed to retain savings under the incentive program
161-shall submit a report to the secretary on how excess funds were
162-reinvested to strengthen quality, invest in deferred maintenance and
163-make asset improvements.]
164-Sec. 4. (NEW) (Effective from passage) (a) For purposes of this section,
165-"certified community health worker" has the same meaning as provided
166-in section 20-195ttt of the general statutes. The Commissioner of Social
167-Services shall design and implement a program to provide Medicaid Substitute Senate Bill No. 989
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116+purposes of the authority, subject to specific restrictions governing any 78
117+contribution to such account pursuant to subsection (b) of this section. 79
118+(g) The authority shall adopt written procedures, in accordance with 80
119+section 1-121 of the general statutes, to carry out the provisions of this 81
120+section. 82
121+Sec. 3. Subsection (c) of section 19a-535 of the general statutes is 83
122+repealed and the following is substituted in lieu thereof (Effective from 84
123+passage): 85
124+(c) (1) Before effecting any transfer or discharge of a resident from the 86
125+facility, the facility shall notify, in writing, the resident and the resident's 87
126+guardian or conservator, if any, or legally liable relative or other 88
127+responsible party if known, of the proposed transfer or discharge, the 89
128+reasons therefor, the effective date of the proposed transfer or discharge, 90
129+the location to which the resident is to be transferred or discharged, the 91
130+right to appeal the proposed transfer or discharge and the procedures 92
131+for initiating such an appeal as determined by the Department of Social 93
132+Services, the date by which an appeal must be initiated in order to 94
133+preserve the resident's right to an appeal hearing and the date by which 95
134+an appeal must be initiated in order to stay the proposed transfer or 96
135+discharge and the possibility of an exception to the date by which an 97
136+appeal must be initiated in order to stay the proposed transfer or 98
137+discharge for good cause, that the resident may represent himself or 99
138+herself or be represented by legal counsel, a relative, a friend or other 100
139+spokesperson, and information as to bed hold and nursing home 101
140+readmission policy when required in accordance with section 19a-537. 102
141+The notice shall also include the name, mailing address and telephone 103
142+number of the State [Long-Term Care] Ombudsman. If the resident is, 104
143+or the facility alleges a resident is, mentally ill or developmentally 105
144+disabled, the notice shall include the name, mailing address and 106
145+telephone number of the nonprofit entity designated by the Governor in 107
146+accordance with section 46a-10b to serve as the Connecticut protection 108
147+and advocacy system. The notice shall be given at least thirty days and 109
148+no more than sixty days prior to the resident's proposed transfer or 110 Substitute Bill No. 989
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171-reimbursement to certified community health workers for services
172-provided to HUSKY Health program members, including, but not
173-limited to: (1) Coordination of medical, oral and behavioral health care
174-services and social supports; (2) connection to and navigation of health
175-systems and services; (3) prenatal, birth, lactation and postpartum
176-supports; and (4) health promotion, coaching and self-management
177-education.
178-(b) The Commissioner of Social Services and the commissioner's
179-designees shall consult with certified community health workers,
180-Medicaid beneficiaries and advocates, including, but not limited to,
181-advocates for persons with physical, mental and developmental
182-disabilities, and others throughout the design and implementation of
183-the certified community health worker reimbursement program in a
184-manner that (1) is inclusive of community-based and clinic-based
185-certified community health workers; (2) is representative of medical
186-assistance program member demographics; and (3) helps shape the
187-reimbursement program's design and implementation. The
188-commissioner, in consultation with community health workers,
189-Medicaid beneficiaries and such advocates, shall explore options for the
190-reimbursement program's design that ensures access to such
191-community health workers, encourages workforce growth to support
192-such access and averts the risk of creating financial incentives for other
193-providers to limit access to such community health workers.
194-(c) Not later than January 1, 2024, and annually thereafter until the
195-reimbursement program is fully implemented, the Commissioner of
196-Social Services shall submit a report, in accordance with the provisions
197-of section 11-4a of the general statutes, to the joint standing committee
198-of the General Assembly having cognizance of matters relating to
199-human services and the Council on Medical Assistance Program
200-Oversight. The initial report shall be submitted not less than six months
201-prior to the implementation of the reimbursement program. The reports Substitute Senate Bill No. 989
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205-shall contain an update on the certified community health worker
206-reimbursement program design, including, but not limited to (1) an
207-analysis regarding the program elements designed to ensure access to
208-such services, promote workforce growth and avert the risk of creating
209-financial incentives for other providers to limit access to such
210-community health workers, and (2) an evaluation of any impact of the
211-program on health outcomes and health equity.
212-Sec. 5. (Effective July 1, 2023) (a) Any nursing home facility, as defined
213-in section 19a-490 of the general statutes, with available vehicles
214-equipped to transport nonambulatory residents, may provide
215-nonemergency transportation of such residents to the homes of such
216-residents' family members, provided: (1) Such family members live
217-within fifteen miles of the nursing home facility, and (2) such
218-transportation is approved not less than five business days in advance
219-by a physician or physician's assistant, licensed pursuant to chapter 370
220-of the general statutes, or an advanced practice registered nurse licensed
221-pursuant to chapter 378 of the general statutes. Nothing in this section
222-shall be construed to authorize or require any payment or
223-reimbursement to a nursing home facility for such nonemergency
224-transportation services.
225-(b) The Commissioner of Social Services shall evaluate whether the
226-need for such transportation would qualify as a health-related social
227-need and file a report not later than October 1, 2023, with the Council on
228-Medical Assistance Program Oversight on such evaluation and
229-potential federal funding that may be available for such transportation.
230-For purposes of this subsection, "health-related social need" means a
231-health need deriving from an adverse social condition that contributes
232-to poor health and health disparities, including, but not limited to, the
233-need for reliable transportation.
234-Sec. 6. (Effective from passage) (a) The State Ombudsman, appointed
235-pursuant to section 17a-870 of the general statutes, and the Substitute Senate Bill No. 989
155+discharge, except where the health or safety of individuals in the facility 111
156+are endangered, or where the resident's health improves sufficiently to 112
157+allow a more immediate transfer or discharge, or where immediate 113
158+transfer or discharge is necessitated by urgent medical needs or where 114
159+a resident has not resided in the facility for thirty days, in which cases 115
160+notice shall be given as many days before the transfer or discharge as 116
161+practicable. 117
162+(2) The resident may initiate an appeal pursuant to this section by 118
163+submitting a written request to the Commissioner of Social Services not 119
164+later than sixty calendar days after the facility issues the notice of the 120
165+proposed transfer or discharge, except as provided in subsection (h) of 121
166+this section. In order to stay a proposed transfer or discharge, the 122
167+resident must initiate an appeal not later than twenty days after the date 123
168+the resident receives the notice of the proposed transfer or discharge 124
169+from the facility unless the resident demonstrates good cause for failing 125
170+to initiate such appeal within the twenty-day period. 126
171+(3) On the date that the facility provides notice of a proposed 127
172+involuntary transfer or discharge of a resident pursuant to the 128
173+provisions of subdivision (1) of this subsection, the facility shall notify 129
174+the State Ombudsman, appointed pursuant to section 17a-870, in a 130
175+manner prescribed by the State Ombudsman, of such proposed 131
176+involuntary transfer or discharge. Failure to provide notice to the State 132
177+Ombudsman pursuant to the provisions of this subdivision shall 133
178+invalidate any notice of the proposed involuntary transfer or discharge 134
179+of a resident submitted pursuant to the provisions of subdivision (1) of 135
180+this subsection. 136
181+Sec. 4. Subsection (k) of section 19a-535 of the general statutes is 137
182+repealed and the following is substituted in lieu thereof (Effective from 138
183+passage): 139
184+(k) [A] Except as otherwise provided in subdivision (3) of subsection 140
185+(c) of this section, a facility shall electronically report each involuntary 141
186+transfer or discharge to the State Ombudsman, appointed pursuant to 142 Substitute Bill No. 989
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239-Commissioners of Public Health and Social Services shall convene a
240-working group concerning any revisions necessary to nursing home
241-waiting list requirements as described in section 19a-533 of the general
242-statutes. The working group shall include, but need not be limited to,
243-the State Ombudsman, or the State Ombudsman's designee; the
244-Commissioners of Public Health and Social Services, or their designees;
245-and not fewer than two representatives of the nursing home industry,
246-appointed by the Commissioner of Social Services.
247-(b) The State Ombudsman, or the State Ombudsman's designee, and
248-the Commissioner of Social Services, or the commissioner's designee,
249-shall serve as chairpersons of the working group, which shall meet not
250-less than once monthly. Not later than January 1, 2024, the State
251-Ombudsman and the Commissioners of Public Health and Social
252-Services shall file a report, in accordance with section 11-4a of the
253-general statutes, with the joint standing committees of the General
254-Assembly having cognizance of matters relating to human services and
255-public health with recommendations concerning any changes to the
256-waiting list requirements, including, but not limited to, authorizing
257-nursing homes to maintain waiting lists in electronic form.
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193+section [17a-405] 17a-870, (1) in a manner prescribed by the State 143
194+Ombudsman, and (2) on an Internet web site portal maintained by the 144
195+State Ombudsman in accordance with patient privacy provisions of the 145
196+Health Insurance Portability and Accountability Act of 1996, P.L. 104-146
197+191, as amended from time to time. 147
198+Sec. 5. (NEW) (Effective July 1, 2023) (a) Any nursing home facility, as 148
199+defined in section 19a-490 of the general statutes, with available vehicles 149
200+equipped to transport nonambulatory residents, may provide 150
201+nonemergency transportation of such residents to the homes of such 151
202+residents' family members, provided: (1) Such family members live 152
203+within fifteen miles of the nursing home facility, and (2) such 153
204+transportation is approved not less than five business days in advance 154
205+by a physician or physician's assistant, licensed pursuant to chapter 370 155
206+of the general statutes, or an advanced practice registered nurse licensed 156
207+pursuant to chapter 378 of the general statutes. 157
208+(b) The Commissioner of Social Services, within available 158
209+appropriations, may establish a grant program to fund such 159
210+nonemergency transportation. The commissioner shall prescribe forms 160
211+and procedures for a nursing home facility to apply for a grant through 161
212+any such grant program. The commissioner shall evaluate whether the 162
213+need for such transportation would qualify as a health-related social 163
214+need and file a report not later than October 1, 2023, with the Council on 164
215+Medical Assistance Program Oversight on such evaluation and 165
216+potential federal funding that may be available for such transportation. 166
217+For purposes of this subsection, "health-related social need" means a 167
218+health need deriving from an adverse social condition that contributes 168
219+to poor health and health disparities, including, but not limited to, the 169
220+need for reliable transportation. 170
221+Sec. 6. (Effective from passage) (a) The State Ombudsman, appointed 171
222+pursuant to section 17a-870 of the general statutes, shall convene a 172
223+working group concerning any revisions necessary to nursing home 173
224+waiting list requirements as described in section 19a-533 of the general 174
225+statutes. The working group shall include, but need not be limited to, 175 Substitute Bill No. 989
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232+the State Ombudsman, or the State Ombudsman's designee; not less 176
233+than two representatives of the nursing home industry, appointed by 177
234+the State Ombudsman; the Commissioners of Public Health and Social 178
235+Services, or their designees; and any other member the State 179
236+Ombudsman may appoint. 180
237+(b) The State Ombudsman, or the State Ombudsman's designee, shall 181
238+serve as chairperson of the working group, which shall meet not less 182
239+than once monthly. Not later than January 1, 2024, the State 183
240+Ombudsman shall file a report, in accordance with section 11-4a of the 184
241+general statutes, with the joint standing committees of the General 185
242+Assembly having cognizance of matters relating to human services and 186
243+public health with recommendations concerning any changes to the 187
244+waiting list requirements, including, but not limited to, authorizing 188
245+nursing homes to maintain waiting lists in electronic form. 189
246+Sec. 7. (NEW) (Effective July 1, 2023) (a) As used in this section, 190
247+"allowable costs" has the same meaning as provided in section 17b-340d 191
248+of the general statutes. Beginning with the cost report year ending on 192
249+September 30, 2024, and annually thereafter, each nursing home facility, 193
250+as defined in section 19a-490 of the general statutes, shall submit to the 194
251+Commissioner of Social Services narrative summaries of expenditures 195
252+in addition to the cost reports required pursuant to section 17b-340 of 196
253+the general statutes, as amended by this act. The summaries shall be in 197
254+plain language and include the percentage of Medicaid funding 198
255+allocated to (1) the five cost components of allowable costs, broken 199
256+down to include individual expenditure categories of each cost 200
257+component described in subdivision (4) of subsection (a) of section 17b-201
258+340d of the general statutes, and (2) any related party, as defined in 202
259+section 17b-340 of the general statutes, as amended by this act. 203
260+(b) Not later than January 1, 2025, and annually thereafter, the 204
261+Commissioner of Social Services shall post in a conspicuous area on the 205
262+department's Internet web site a link to (1) the annual cost reports and 206
263+the plain language summaries provided by each nursing home facility, 207
264+(2) comparisons between individual nursing homes by expenditures, 208 Substitute Bill No. 989
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271+and (3) a summary of the average reported expenditures of all reporting 209
272+nursing homes for each category. Any cost report forms utilized by the 210
273+department shall include a glossary and explanation of the terms used 211
274+and a description of the categories being reported on, including, but not 212
275+limited to, plain language explanations of formulas and formula terms 213
276+used to determine maximum costs for direct costs, indirect costs, fair 214
277+rent, capital-related costs and administrative and general costs, as 215
278+described in subdivision (4) of subsection (a) of section 17b-340d of the 216
279+general statutes. 217
280+(c) Any nursing home facility that violates or fails to comply with the 218
281+provisions of this section shall be fined not more than ten thousand 219
282+dollars for each incident of noncompliance. The Commissioner of Social 220
283+Services may offset payments due a facility to collect the penalty. Prior 221
284+to imposing any penalty pursuant to this subsection, the commissioner 222
285+shall notify the nursing home facility of the alleged violation and the 223
286+accompanying penalty and shall permit such facility to request that the 224
287+department review its findings. A facility shall request such review not 225
288+later than fifteen days after receipt of the notice of violation from the 226
289+department. The department shall stay the imposition of any penalty 227
290+pending the outcome of the review. The commissioner may impose a 228
291+penalty upon a facility pursuant to this subsection regardless of whether 229
292+a change in ownership of the facility has taken place since the time of 230
293+the violation, provided the department issued notice of the alleged 231
294+violation and the accompanying penalty prior to the effective date of the 232
295+change in ownership and record of such notice is readily available in a 233
296+central registry maintained by the department. Payments of fines 234
297+received pursuant to this subsection shall be deposited in the General 235
298+Fund and credited to the Medicaid account. 236
299+Sec. 8. Section 19a-491a of the general statutes is repealed and the 237
300+following is substituted in lieu thereof (Effective July 1, 2023): 238
301+(a) A person seeking a license to establish, conduct, operate or 239
302+maintain a nursing home shall provide the Department of Public Health 240
303+with the following information: 241 Substitute Bill No. 989
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310+(1) (A) The name and business address of the owner and a statement 242
311+of whether the owner is an individual, partnership, corporation or other 243
312+legal entity; (B) the names of the officers, directors, trustees, or 244
313+managing and general partners of the owner, the names of persons 245
314+having a ten per cent or greater ownership interest in the owner, and a 246
315+description of each such person's occupation with the owner; [and] (C) 247
316+if the owner is a corporation which is incorporated in another state, a 248
317+certificate of good standing from the secretary of state of the state of 249
318+incorporation; and (D) if a private equity firm owns any portion of the 250
319+business, the name of the private equity fund's investment advisor and 251
320+a copy of the most recent quarterly statement provided to the private 252
321+equity fund's investors, including information regarding fees, expenses 253
322+and performance of the fund; 254
323+(2) A description of the relevant business experience of the owner and 255
324+of the administrator of the nursing home and evidence that the 256
325+administrator has a license issued pursuant to section 19a-514; 257
326+(3) Affidavits signed by the owner, any of the persons described in 258
327+subdivision (1) of this subsection, the administrator, assistant 259
328+administrator, the medical director, the director of nursing and assistant 260
329+director of nursing disclosing any matter in which such person has been 261
330+convicted of a felony, as defined in section 53a-25, or has pleaded nolo 262
331+contendere to a felony charge, or has been held liable or enjoined in a 263
332+civil action by final judgment, if the felony or civil action involved fraud, 264
333+embezzlement, fraudulent conversion or misappropriation of property; 265
334+or is subject to an injunction or restrictive or remedial order of a court of 266
335+record at the time of application, within the past five years has had any 267
336+state or federal license or permit suspended or revoked as a result of an 268
337+action brought by a governmental agency or department, arising out of 269
338+or relating to health care business activity, including, but not limited to, 270
339+actions affecting the operation of a nursing home, retirement home, 271
340+residential care home or any facility subject to sections 17b-520 to 17b-272
341+535, inclusive, or a similar statute in another state or country; 273
342+(4) (A) A statement as to whether or not the owner is, or is affiliated 274 Substitute Bill No. 989
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349+with, a religious, charitable or other nonprofit organization; (B) the 275
350+extent of the affiliation, if any; (C) the extent to which the affiliate 276
351+organization will be responsible for the financial obligations of the 277
352+owner; and (D) the provision of the Internal Revenue Code of 1986, or 278
353+any subsequent corresponding internal revenue code of the United 279
354+States, as from time to time amended, if any, under which the owner or 280
355+affiliate is exempt from the payment of income tax; 281
356+(5) The location and a description of other health care facilities of the 282
357+owner, existing or proposed, and, if proposed, the estimated completion 283
358+date or dates and whether or not construction has begun; [and] 284
359+(6) Audited and certified financial statements of the owner, including 285
360+(A) a balance sheet as of the end of the most recent fiscal year, and (B) 286
361+income statements for the most recent fiscal year of the owner or such 287
362+shorter period of time as the owner shall have been in existence; and 288
363+[(6)] (7) If the operation of the nursing home has not yet commenced, 289
364+a statement of the anticipated source and application of the funds used 290
365+or to be used in the purchase or construction of the home, including: 291
366+(A) An estimate of such costs as financing expense, legal expense, 292
367+land costs, marketing costs and other similar costs which the owner 293
368+expects to incur or become obligated for prior to the commencement of 294
369+operations; and 295
370+(B) A description of any mortgage loan or any other financing 296
371+intended to be used for the financing of the nursing home, including the 297
372+anticipated terms and costs of such financing. 298
373+[(b) In addition to the information provided pursuant to subsection 299
374+(a) of this section, the commissioner may reasonably require an 300
375+applicant for a nursing home license or renewal of a nursing home 301
376+license to submit additional information. Such information may include 302
377+audited and certified financial statements of the owner, including, (1) a 303
378+balance sheet as of the end of the most recent fiscal year, and (2) income 304
379+statements for the most recent fiscal year of the owner or such shorter 305 Substitute Bill No. 989
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386+period of time as the owner shall have been in existence.] 306
387+[(c)] (b) No person acting individually or jointly with any other 307
388+person shall establish, conduct, operate or maintain a nursing home 308
389+without maintaining professional liability insurance or other indemnity 309
390+against liability for professional malpractice. The amount of insurance 310
391+which such person shall maintain as insurance or indemnity against 311
392+claims for injury or death for professional malpractice shall be not less 312
393+than one million dollars for one person, per occurrence, with an 313
394+aggregate of not less than three million dollars. The requirements of this 314
395+subsection shall not apply to any person who establishes, conducts, 315
396+operates or maintains a residential care home. 316
397+[(d)] (c) A person seeking to renew a nursing home license shall 317
398+furnish the department with any information required under this 318
399+section that was not previously submitted and with satisfactory written 319
400+proof that the owner of the nursing home consents to such renewal, if 320
401+the owner is different from the person seeking renewal, and shall 321
402+provide data on any change in the information submitted. The 322
403+commissioner shall refuse to issue or renew a nursing home license if 323
404+the person seeking renewal fails to provide the information required 324
405+under this section. Upon such refusal, the commissioner shall grant such 325
406+license to the holder of the certificate of need, provided such holder 326
407+meets all requirements for such licensure. If such holder does not meet 327
408+such requirements, the commissioner shall proceed in accordance with 328
409+sections 19a-541 to 19a-549, inclusive. If the commissioner is considering 329
410+a license renewal application pursuant to an order of the commissioner, 330
411+the procedures in this subsection shall apply to such consideration. 331
412+Sec. 9. Subsection (a) of section 17b-340 of the general statutes is 332
413+repealed and the following is substituted in lieu thereof (Effective July 1, 333
414+2023): 334
415+(a) For purposes of this subsection, (1) a "related party" includes, but 335
416+is not limited to, any company related to a chronic and convalescent 336
417+nursing home through family association, common ownership, control 337 Substitute Bill No. 989
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424+or business association with any of the owners, operators or officials of 338
425+such nursing home; (2) "company" means any person, partnership, 339
426+association, holding company, limited liability company or corporation; 340
427+(3) "family association" means a relationship by birth, marriage or 341
428+domestic partnership; and (4) "profit and loss statement" means the 342
429+most recent annual statement on profits and losses finalized by a related 343
430+party before the annual report mandated under this subsection. The 344
431+rates to be paid by or for persons aided or cared for by the state or any 345
432+town in this state to licensed chronic and convalescent nursing homes, 346
433+to chronic disease hospitals associated with chronic and convalescent 347
434+nursing homes, to rest homes with nursing supervision, to licensed 348
435+residential care homes, as defined by section 19a-490, and to residential 349
436+facilities for persons with intellectual disability that are licensed 350
437+pursuant to section 17a-227 and certified to participate in the Title XIX 351
438+Medicaid program as intermediate care facilities for individuals with 352
439+intellectual disabilities, for room, board and services specified in 353
440+licensing regulations issued by the licensing agency shall be determined 354
441+annually, except as otherwise provided in this subsection by the 355
442+Commissioner of Social Services, to be effective July first of each year 356
443+except as otherwise provided in this subsection. Such rates shall be 357
444+determined on a basis of a reasonable payment for such necessary 358
445+services, which basis shall take into account as a factor the costs of such 359
446+services. Cost of such services shall include reasonable costs mandated 360
447+by collective bargaining agreements with certified collective bargaining 361
448+agents or other agreements between the employer and employees, 362
449+provided "employees" shall not include persons employed as managers 363
450+or chief administrators or required to be licensed as nursing home 364
451+administrators, and compensation for services rendered by proprietors 365
452+at prevailing wage rates, as determined by application of principles of 366
453+accounting as prescribed by said commissioner. Cost of such services 367
454+shall not include amounts paid by the facilities to employees as salary, 368
455+or to attorneys or consultants as fees, where the responsibility of the 369
456+employees, attorneys, or consultants is to persuade or seek to persuade 370
457+the other employees of the facility to support or oppose unionization. 371
458+Nothing in this subsection shall prohibit inclusion of amounts paid for 372 Substitute Bill No. 989
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465+legal counsel related to the negotiation of collective bargaining 373
466+agreements, the settlement of grievances or normal administration of 374
467+labor relations. The commissioner may, in the commissioner's 375
468+discretion, allow the inclusion of extraordinary and unanticipated costs 376
469+of providing services that were incurred to avoid an immediate negative 377
470+impact on the health and safety of patients. The commissioner may, in 378
471+the commissioner's discretion, based upon review of a facility's costs, 379
472+direct care staff to patient ratio and any other related information, revise 380
473+a facility's rate for any increases or decreases to total licensed capacity 381
474+of more than ten beds or changes to its number of licensed rest home 382
475+with nursing supervision beds and chronic and convalescent nursing 383
476+home beds. The commissioner may, in the commissioner's discretion, 384
477+revise the rate of a facility that is closing. An interim rate issued for the 385
478+period during which a facility is closing shall be based on a review of 386
479+facility costs, the expected duration of the close-down period, the 387
480+anticipated impact on Medicaid costs, available appropriations and the 388
481+relationship of the rate requested by the facility to the average Medicaid 389
482+rate for a close-down period. The commissioner may so revise a facility's 390
483+rate established for the fiscal year ending June 30, 1993, and thereafter 391
484+for any bed increases, decreases or changes in licensure effective after 392
485+October 1, 1989. Effective July 1, 1991, in facilities that have both a 393
486+chronic and convalescent nursing home and a rest home with nursing 394
487+supervision, the rate for the rest home with nursing supervision shall 395
488+not exceed such facility's rate for its chronic and convalescent nursing 396
489+home. All such facilities for which rates are determined under this 397
490+subsection shall report on a fiscal year basis ending on September 398
491+thirtieth. Such report shall be submitted to the commissioner by 399
492+February fifteenth. Each for-profit chronic and convalescent nursing 400
493+home that receives state funding pursuant to this section shall include 401
494+in such annual report a profit and loss statement from each related party 402
495+that receives from such chronic and convalescent nursing home [fifty 403
496+thousand dollars or more per year] any amount of income for goods, 404
497+fees and services. No cause of action or liability shall arise against the 405
498+state, the Department of Social Services, any state official or agent for 406
499+failure to take action based on the information required to be reported 407 Substitute Bill No. 989
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506+under this subsection. The commissioner may reduce the rate in effect 408
507+for a facility that fails to submit a complete and accurate report on or 409
508+before February fifteenth by an amount not to exceed ten per cent of 410
509+such rate. If a licensed residential care home fails to submit a complete 411
510+and accurate report, the department shall notify such home of the failure 412
511+and the home shall have thirty days from the date the notice was issued 413
512+to submit a complete and accurate report. If a licensed residential care 414
513+home fails to submit a complete and accurate report not later than thirty 415
514+days after the date of notice, such home may not receive a retroactive 416
515+rate increase, in the commissioner's discretion. The commissioner shall, 417
516+annually, on or before April first, report the data contained in the reports 418
517+of such facilities on the department's Internet web site. For the cost 419
518+reporting year commencing October 1, 1985, and for subsequent cost 420
519+reporting years, facilities shall report the cost of using the services of any 421
520+nursing personnel supplied by a temporary nursing services agency by 422
521+separating said cost into two categories, the portion of the cost equal to 423
522+the salary of the employee for whom the nursing personnel supplied by 424
523+a temporary nursing services agency is substituting shall be considered 425
524+a nursing cost and any cost in excess of such salary shall be further 426
525+divided so that seventy-five per cent of the excess cost shall be 427
526+considered an administrative or general cost and twenty-five per cent of 428
527+the excess cost shall be considered a nursing cost, provided if the total 429
528+costs of a facility for nursing personnel supplied by a temporary nursing 430
529+services agency in any cost year are equal to or exceed fifteen per cent 431
530+of the total nursing expenditures of the facility for such cost year, no 432
531+portion of such costs in excess of fifteen per cent shall be classified as 433
532+administrative or general costs. The commissioner, in determining such 434
533+rates, shall also take into account the classification of patients or 435
534+boarders according to special care requirements or classification of the 436
535+facility according to such factors as facilities and services and such other 437
536+factors as the commissioner deems reasonable, including anticipated 438
537+fluctuations in the cost of providing such services. The commissioner 439
538+may establish a separate rate for a facility or a portion of a facility for 440
539+traumatic brain injury patients who require extensive care but not acute 441
540+general hospital care. Such separate rate shall reflect the special care 442 Substitute Bill No. 989
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547+requirements of such patients. If changes in federal or state laws, 443
548+regulations or standards adopted subsequent to June 30, 1985, result in 444
549+increased costs or expenditures in an amount exceeding one-half of one 445
550+per cent of allowable costs for the most recent cost reporting year, the 446
551+commissioner shall adjust rates and provide payment for any such 447
552+increased reasonable costs or expenditures within a reasonable period 448
553+of time retroactive to the date of enforcement. Nothing in this section 449
554+shall be construed to require the Department of Social Services to adjust 450
555+rates and provide payment for any increases in costs resulting from an 451
556+inspection of a facility by the Department of Public Health. Such 452
557+assistance as the commissioner requires from other state agencies or 453
558+departments in determining rates shall be made available to the 454
559+commissioner at the commissioner's request. Payment of the rates 455
560+established pursuant to this section shall be conditioned on the 456
561+establishment by such facilities of admissions procedures that conform 457
562+with this section, section 19a-533 and all other applicable provisions of 458
563+the law and the provision of equality of treatment to all persons in such 459
564+facilities. The established rates shall be the maximum amount 460
565+chargeable by such facilities for care of such beneficiaries, and the 461
566+acceptance by or on behalf of any such facility of any additional 462
567+compensation for care of any such beneficiary from any other person or 463
568+source shall constitute the offense of aiding a beneficiary to obtain aid 464
569+to which the beneficiary is not entitled and shall be punishable in the 465
570+same manner as is provided in subsection (b) of section 17b-97. 466
571+Notwithstanding any provision of this section, the Commissioner of 467
572+Social Services may, within available appropriations, provide an interim 468
573+rate increase for a licensed chronic and convalescent nursing home or a 469
574+rest home with nursing supervision for rate periods no earlier than April 470
575+1, 2004, only if the commissioner determines that the increase is 471
576+necessary to avoid the filing of a petition for relief under Title 11 of the 472
577+United States Code; imposition of receivership pursuant to sections 19a-473
578+542 and 19a-543; or substantial deterioration of the facility's financial 474
579+condition that may be expected to adversely affect resident care and the 475
580+continued operation of the facility, and the commissioner determines 476
581+that the continued operation of the facility is in the best interest of the 477 Substitute Bill No. 989
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588+state. The commissioner shall consider any requests for interim rate 478
589+increases on file with the department from March 30, 2004, and those 479
590+submitted subsequently for rate periods no earlier than April 1, 2004. 480
591+When reviewing an interim rate increase request the commissioner 481
592+shall, at a minimum, consider: (A) Existing chronic and convalescent 482
593+nursing home or rest home with nursing supervision utilization in the 483
594+area and projected bed need; (B) physical plant long-term viability and 484
595+the ability of the owner or purchaser to implement any necessary 485
596+property improvements; (C) licensure and certification compliance 486
597+history; (D) reasonableness of actual and projected expenses; and (E) the 487
598+ability of the facility to meet wage and benefit costs. No interim rate 488
599+shall be increased pursuant to this subsection in excess of one hundred 489
600+fifteen per cent of the median rate for the facility's peer grouping, 490
601+established pursuant to subdivision (2) of subsection (f) of this section, 491
602+unless recommended by the commissioner and approved by the 492
603+Secretary of the Office of Policy and Management after consultation 493
604+with the commissioner. Such median rates shall be published by the 494
605+Department of Social Services not later than April first of each year. In 495
606+the event that a facility granted an interim rate increase pursuant to this 496
607+section is sold or otherwise conveyed for value to an unrelated entity 497
608+less than five years after the effective date of such rate increase, the rate 498
609+increase shall be deemed rescinded and the department shall recover an 499
610+amount equal to the difference between payments made for all affected 500
611+rate periods and payments that would have been made if the interim 501
612+rate increase was not granted. The commissioner may seek recovery of 502
613+such payments from any facility with common ownership. With the 503
614+approval of the Secretary of the Office of Policy and Management, the 504
615+commissioner may waive recovery and rescission of the interim rate for 505
616+good cause shown that is not inconsistent with this section, including, 506
617+but not limited to, transfers to family members that were made for no 507
618+value. The commissioner shall provide written quarterly reports to the 508
619+joint standing committees of the General Assembly having cognizance 509
620+of matters relating to aging, human services and appropriations and the 510
621+budgets of state agencies, that identify each facility requesting an 511
622+interim rate increase, the amount of the requested rate increase for each 512 Substitute Bill No. 989
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629+facility, the action taken by the commissioner and the secretary pursuant 513
630+to this subsection, and estimates of the additional cost to the state for 514
631+each approved interim rate increase. Nothing in this subsection shall 515
632+prohibit the commissioner from increasing the rate of a licensed chronic 516
633+and convalescent nursing home or a rest home with nursing supervision 517
634+for allowable costs associated with facility capital improvements or 518
635+increasing the rate in case of a sale of a licensed chronic and convalescent 519
636+nursing home or a rest home with nursing supervision if receivership 520
637+has been imposed on such home. For purposes of this section, 521
638+"temporary nursing services agency" and "nursing personnel" have the 522
639+same meaning as provided in section 19a-118. 523
640+This act shall take effect as follows and shall amend the following
641+sections:
642+
643+Section 1 from passage 19a-522a
644+Sec. 2 from passage New section
645+Sec. 3 from passage 19a-535(c)
646+Sec. 4 from passage 19a-535(k)
647+Sec. 5 July 1, 2023 New section
648+Sec. 6 from passage New section
649+Sec. 7 July 1, 2023 New section
650+Sec. 8 July 1, 2023 19a-491a
651+Sec. 9 July 1, 2023 17b-340(a)
652+
653+
654+HS Joint Favorable Subst.
655+JUD Joint Favorable
258656