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General Assembly Raised Bill No. 1109
January Session, 2023
LCO No. 4741
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT CONCERNING MEDICAID REIMBURSEMENT TO
COMMUNITY LIVING ARRANGEMENTS, INTERMEDIATE CARE
FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES,
RESIDENTIAL CARE HOMES AND NURSING FACILITIES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 17b-244 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective July 1, 2023): 2
(a) The room and board component of the rates to be paid by the state 3
to private facilities and facilities operated by regional education service 4
centers which are licensed to provide residential care pursuant to 5
section 17a-227, but not certified to participate in the Title XIX Medicaid 6
program as intermediate care facilities for individuals with intellectual 7
disabilities, shall be determined annually by the Commissioner of Social 8
Services. [, except that rates effective April 30, 1989, shall remain in effect 9
through October 31, 1989. Any facility with real property other than 10
land placed in service prior to July 1, 1991, shall, for the fiscal year 11
ending June 30, 1995, receive a rate of return on real property equal to 12
the average of the rates of return applied to real property other than land 13
placed in service for the five years preceding July 1, 1993.] For the fiscal 14 Raised Bill No. 1109
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year ending June 30, 1996, and any succeeding fiscal year, the rate of 15
return on real property for property items shall be revised every five 16
years. The commissioner shall, upon submission of a request by such 17
facility, allow actual debt service, comprised of principal and interest, 18
on the loan or loans in lieu of property costs allowed pursuant to section 19
17-313b-5 of the regulations of Connecticut state agencies, whether 20
actual debt service is higher or lower than such allowed property costs, 21
provided such debt service terms and amounts are reasonable in 22
relation to the useful life and the base value of the property. In the case 23
of facilities financed through the Connecticut Housing Finance 24
Authority, the commissioner shall allow actual debt service, comprised 25
of principal, interest and a reasonable repair and replacement reserve 26
on the loan or loans in lieu of property costs allowed pursuant to section 27
17-313b-5 of the regulations of Connecticut state agencies, whether 28
actual debt service is higher or lower than such allowed property costs, 29
provided such debt service terms and amounts are determined by the 30
commissioner at the time the loan is entered into to be reasonable in 31
relation to the useful life and base value of the property. The 32
commissioner may allow fees associated with mortgage refinancing 33
provided such refinancing will result in state reimbursement savings, 34
after comparing costs over the terms of the existing proposed loans. For 35
the fiscal year ending June 30, 1992, the inflation factor used to 36
determine rates shall be one-half of the gross national product 37
percentage increase for the period between the midpoint of the cost year 38
through the midpoint of the rate year. For fiscal year ending June 30, 39
1993, the inflation factor used to determine rates shall be two-thirds of 40
the gross national product percentage increase from the midpoint of the 41
cost year to the midpoint of the rate year. For the fiscal years ending 42
June 30, 1996, and June 30, 1997, no inflation factor shall be applied in 43
determining rates. The Commissioner of Social Services shall prescribe 44
uniform forms on which such facilities shall report their costs. Such rates 45
shall be determined on the basis of a reasonable payment for necessary 46
services. Any increase in grants, gifts, fund-raising or endowment 47
income used for the payment of operating costs by a private facility in 48
the fiscal year ending June 30, 1992, shall be excluded by the 49 Raised Bill No. 1109
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commissioner from the income of the facility in determining the rates to 50
be paid to the facility for the fiscal year ending June 30, 1993, provided 51
any operating costs funded by such increase shall not obligate the state 52
to increase expenditures in subsequent fiscal years. Nothing contained 53
in this section shall authorize a payment by the state to any such facility 54
in excess of the charges made by the facility for comparable services to 55
the general public. The service component of the rates to be paid by the 56
state to private facilities and facilities operated by regional education 57
service centers which are licensed to provide residential care pursuant 58
to section 17a-227, but not certified to participate in the Title XIX 59
Medicaid programs as intermediate care facilities for individuals with 60
intellectual disabilities, shall be determined annually by the 61
Commissioner of Developmental Services in accordance with section 62
17b-244a. For the fiscal year ending June 30, 2008, no facility shall receive 63
a rate that is more than two per cent greater than the rate in effect for 64
the facility on June 30, 2007, except any facility that would have been 65
issued a lower rate effective July 1, 2007, due to interim rate status or 66
agreement with the department, shall be issued such lower rate effective 67
July 1, 2007. For the fiscal year ending June 30, 2009, no facility shall 68
receive a rate that is more than two per cent greater than the rate in effect 69
for the facility on June 30, 2008, except any facility that would have been 70
issued a lower rate effective July 1, 2008, due to interim rate status or 71
agreement with the department, shall be issued such lower rate effective 72
July 1, 2008. For the fiscal years ending June 30, 2010, and June 30, 2011, 73
rates in effect for the period ending June 30, 2009, shall remain in effect 74
until June 30, 2011, except that (1) the rate paid to a facility may be higher 75
than the rate paid to the facility for the period ending June 30, 2009, if a 76
capital improvement required by the Commissioner of Developmental 77
Services for the health or safety of the residents was made to the facility 78
during the fiscal years ending June 30, 2010, or June 30, 2011, and (2) any 79
facility that would have been issued a lower rate for the fiscal year 80
ending June 30, 2010, or June 30, 2011, due to interim rate status or 81
agreement with the department, shall be issued such lower rate. For the 82
fiscal year ending June 30, 2012, rates in effect for the period ending June 83
30, 2011, shall remain in effect until June 30, 2012, except that (A) the 84 Raised Bill No. 1109
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rate paid to a facility may be higher than the rate paid to the facility for 85
the period ending June 30, 2011, if a capital improvement required by 86
the Commissioner of Developmental Services for the health or safety of 87
the residents was made to the facility during the fiscal year ending June 88
30, 2012, and (B) any facility that would have been issued a lower rate 89
for the fiscal year ending June 30, 2012, due to interim rate status or 90
agreement with the department, shall be issued such lower rate. Any 91
facility that has a significant decrease in land and building costs shall 92
receive a reduced rate to reflect such decrease in land and building costs. 93
The rate paid to a facility may be increased if a capital improvement 94
approved by the Department of Developmental Services, in consultation 95
with the Department of Social Services, for the health or safety of the 96
residents was made to the facility during the fiscal year ending June 30, 97
2014, or June 30, 2015, only to the extent such increases are within 98
available appropriations. For the fiscal years ending June 30, 2016, and 99
June 30, 2017, rates shall not exceed those in effect for the period ending 100
June 30, 2015, except the rate paid to a facility may be higher than the 101
rate paid to the facility for the period ending June 30, 2015, if a capital 102
improvement approved by the Department of Developmental Services, 103
in consultation with the Department of Social Services, for the health or 104
safety of the residents was made to the facility during the fiscal year 105
ending June 30, 2016, or June 30, 2017, to the extent such rate increases 106
are within available appropriations. For the fiscal years ending June 30, 107
2016, and June 30, 2017, and each succeeding fiscal year, any facility that 108
would have been issued a lower rate, due to interim rate status, a change 109
in allowable fair rent or agreement with the department, shall be issued 110
such lower rate. For the fiscal years ending June 30, 2018, and June 30, 111
2019, rates shall not exceed those in effect for the period ending June 30, 112
2017, except the rate paid to a facility may be higher than the rate paid 113
to the facility for the period ending June 30, 2017, if a capital 114
improvement approved by the Department of Developmental Services, 115
in consultation with the Department of Social Services, for the health or 116
safety of the residents was made to the facility during the fiscal year 117
ending June 30, 2018, or June 30, 2019, to the extent such rate increases 118
are within available appropriations. For the fiscal years ending June 30, 119 Raised Bill No. 1109
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2020, and June 30, 2021, rates shall not exceed those in effect for the fiscal 120
year ending June 30, 2019, except the rate paid to a facility may be higher 121
than the rate paid to the facility for the fiscal year ending June 30, 2019, 122
if a capital improvement approved by the Department of 123
Developmental Services, in consultation with the Department of Social 124
Services, for the health or safety of the residents was made to the facility 125
during the fiscal year ending June 30, 2020, or June 30, 2021, to the extent 126
such rate increases are within available appropriations. For the fiscal 127
years ending June 30, 2022, and June 30, 2023, rates shall be based upon 128
rates in effect for the fiscal year ending June 30, 2021, inflated by the 129
gross domestic product deflator applicable to each rate year, except the 130
commissioner may, in the commissioner's discretion and within 131
available appropriations, provide pro rata fair rent increases to facilities 132
which have documented fair rent additions placed in service in the cost 133
report years ending September 30, 2020, and September 30, 2021, that 134
are not otherwise included in rates issued, or if a rate adjustment for a 135
capital improvement approved by the Department of Developmental 136
Services, in consultation with the Department of Social Services, for the 137
health or safety of the residents was made to the facility during the fiscal 138
year ending June 30, 2022, or June 30, 2023. 139
(b) Notwithstanding the provisions of subsection (a) of this section, 140
state rates of payment for the fiscal years ending June 30, 2018, June 30, 141
2019, June 30, 2020, and June 30, 2021, for residential care homes and 142
community living arrangements that receive the flat rate for residential 143
services under section 17-311-54 of the regulations of Connecticut state 144
agencies shall be set in accordance with section 298 of public act 19-117. 145
For the fiscal years ending June 30, 2022, and June 30, 2023, rates shall 146
be based upon rates in effect for the fiscal year ending June 30, 2021, 147
inflated by the gross domestic product deflator applicable to each rate 148
year. 149
(c) For the fiscal year ending June 30, 2024, and each subsequent fiscal 150
year, the commissioner may, in the commissioner's discretion and 151
within available appropriations, provide pro rata fair rent increases to 152
facilities which have documented fair rent additions placed in service in 153 Raised Bill No. 1109
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the cost report years that are not otherwise included in rates issued. 154
[(c)] (d) The Commissioner of Social Services and the Commissioner 155
of Developmental Services shall adopt regulations in accordance with 156
the provisions of chapter 54 to implement the provisions of this section. 157
Sec. 2. Subsection (h) of section 17b-340 of the general statutes is 158
repealed and the following is substituted in lieu thereof (Effective July 1, 159
2023): 160
(h) (1) For the fiscal year ending June 30, 1993, any intermediate care 161
facility for individuals with intellectual disabilities with an operating 162
cost component of its rate in excess of one hundred forty per cent of the 163
median of operating cost components of rates in effect January 1, 1992, 164
shall not receive an operating cost component increase. For the fiscal 165
year ending June 30, 1993, any intermediate care facility for individuals 166
with intellectual disabilities with an operating cost component of its rate 167
that is less than one hundred forty per cent of the median of operating 168
cost components of rates in effect January 1, 1992, shall have an 169
allowance for real wage growth equal to thirty per cent of the increase 170
determined in accordance with subsection (q) of section 17-311-52 of the 171
regulations of Connecticut state agencies, provided such operating cost 172
component shall not exceed one hundred forty per cent of the median 173
of operating cost components in effect January 1, 1992. Any facility with 174
real property other than land placed in service prior to October 1, 1991, 175
shall, for the fiscal year ending June 30, 1995, receive a rate of return on 176
real property equal to the average of the rates of return applied to real 177
property other than land placed in service for the five years preceding 178
October 1, 1993. For the fiscal year ending June 30, 1996, and any 179
succeeding fiscal year, the rate of return on real property for property 180
items shall be revised every five years. The commissioner shall, upon 181
submission of a request, allow actual debt service, comprised of 182
principal and interest, in excess of property costs allowed pursuant to 183
section 17-311-52 of the regulations of Connecticut state agencies, 184
provided such debt service terms and amounts are reasonable in 185
relation to the useful life and the base value of the property. For the fiscal 186 Raised Bill No. 1109
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year ending June 30, 1995, and any succeeding fiscal year, the inflation 187
adjustment made in accordance with subsection (p) of section 17-311-52 188
of the regulations of Connecticut state agencies shall not be applied to 189
real property costs. For the fiscal year ending June 30, 1996, and any 190
succeeding fiscal year, the allowance for real wage growth, as 191
determined in accordance with subsection (q) of section 17-311-52 of the 192
regulations of Connecticut state agencies, shall not be applied. For the 193
fiscal year ending June 30, 1996, and any succeeding fiscal year, no rate 194
shall exceed three hundred seventy-five dollars per day unless the 195
commissioner, in consultation with the Commissioner of 196
Developmental Services, determines after a review of program and 197
management costs, that a rate in excess of this amount is necessary for 198
care and treatment of facility residents. For the fiscal year ending June 199
30, 2002, rate period, the Commissioner of Social Services shall increase 200
the inflation adjustment for rates made in accordance with subsection 201
(p) of section 17-311-52 of the regulations of Connecticut state agencies 202
to update allowable fiscal year 2000 costs to include a three and one-half 203
per cent inflation factor. For the fiscal year ending June 30, 2003, rate 204
period, the commissioner shall increase the inflation adjustment for 205
rates made in accordance with subsection (p) of section 17-311-52 of the 206
regulations of Connecticut state agencies to update allowable fiscal year 207
2001 costs to include a one and one-half per cent inflation factor, except 208
that such increase shall be effective November 1, 2002, and such facility 209
rate in effect for the fiscal year ending June 30, 2002, shall be paid for 210
services provided until October 31, 2002, except any facility that would 211
have been issued a lower rate effective July 1, 2002, than for the fiscal 212
year ending June 30, 2002, due to interim rate status or agreement with 213
the department shall be issued such lower rate effective July 1, 2002, and 214
have such rate updated effective November 1, 2002, in accordance with 215
applicable statutes and regulations. For the fiscal year ending June 30, 216
2004, rates in effect for the period ending June 30, 2003, shall remain in 217
effect, except any facility that would have been issued a lower rate 218
effective July 1, 2003, than for the fiscal year ending June 30, 2003, due 219
to interim rate status or agreement with the department shall be issued 220
such lower rate effective July 1, 2003. For the fiscal year ending June 30, 221 Raised Bill No. 1109
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2005, rates in effect for the period ending June 30, 2004, shall remain in 222
effect until September 30, 2004. Effective October 1, 2004, each facility 223
shall receive a rate that is five per cent greater than the rate in effect 224
September 30, 2004. Effective upon receipt of all the necessary federal 225
approvals to secure federal financial participation matching funds 226
associated with the rate increase provided in subdivision (4) of 227
subsection (f) of this section, but in no event earlier than October 1, 2005, 228
and provided the user fee imposed under section 17b-320 is required to 229
be collected, each facility shall receive a rate that is four per cent more 230
than the rate the facility received in the prior fiscal year, except any 231
facility that would have been issued a lower rate effective October 1, 232
2005, than for the fiscal year ending June 30, 2005, due to interim rate 233
status or agreement with the department, shall be issued such lower rate 234
effective October 1, 2005. Such rate increase shall remain in effect unless: 235
(1) The federal financial participation matching funds associated with 236
the rate increase are no longer available; or (2) the user fee created 237
pursuant to section 17b-320 is not in effect. For the fiscal year ending 238
June 30, 2007, rates in effect for the period ending June 30, 2006, shall 239
remain in effect until September 30, 2006, except any facility that would 240
have been issued a lower rate effective July 1, 2006, than for the fiscal 241
year ending June 30, 2006, due to interim rate status or agreement with 242
the department, shall be issued such lower rate effective July 1, 2006. 243
Effective October 1, 2006, no facility shall receive a rate that is more than 244
three per cent greater than the rate in effect for the facility on September 245
30, 2006, except any facility that would have been issued a lower rate 246
effective October 1, 2006, due to interim rate status or agreement with 247
the department, shall be issued such lower rate effective October 1, 2006. 248
For the fiscal year ending June 30, 2008, each facility shall receive a rate 249
that is two and nine-tenths per cent greater than the rate in effect for the 250
period ending June 30, 2007, except any facility that would have been 251
issued a lower rate effective July 1, 2007, than for the rate period ending 252
June 30, 2007, due to interim rate status, or agreement with the 253
department, shall be issued such lower rate effective July 1, 2007. For the 254
fiscal year ending June 30, 2009, rates in effect for the period ending June 255
30, 2008, shall remain in effect until June 30, 2009, except any facility that 256 Raised Bill No. 1109
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would have been issued a lower rate for the fiscal year ending June 30, 257
2009, due to interim rate status or agreement with the department, shall 258
be issued such lower rate. For the fiscal years ending June 30, 2010, and 259
June 30, 2011, rates in effect for the period ending June 30, 2009, shall 260
remain in effect until June 30, 2011, except any facility that would have 261
been issued a lower rate for the fiscal year ending June 30, 2010, or the 262
fiscal year ending June 30, 2011, due to interim rate status or agreement 263
with the department, shall be issued such lower rate. For the fiscal year 264
ending June 30, 2012, rates in effect for the period ending June 30, 2011, 265
shall remain in effect until June 30, 2012, except any facility that would 266
have been issued a lower rate for the fiscal year ending June 30, 2012, 267
due to interim rate status or agreement with the department, shall be 268
issued such lower rate. For the fiscal years ending June 30, 2014, and 269
June 30, 2015, rates shall not exceed those in effect for the period ending 270
June 30, 2013, except the rate paid to a facility may be higher than the 271
rate paid to the facility for the period ending June 30, 2013, if a capital 272
improvement approved by the Department of Developmental Services, 273
in consultation with the Department of Social Services, for the health or 274
safety of the residents was made to the facility during the fiscal year 275
ending June 30, 2014, or June 30, 2015, to the extent such rate increases 276
are within available appropriations. Any facility that would have been 277
issued a lower rate for the fiscal year ending June 30, 2014, or the fiscal 278
year ending June 30, 2015, due to interim rate status or agreement with 279
the department, shall be issued such lower rate. For the fiscal years 280
ending June 30, 2016, and June 30, 2017, rates shall not exceed those in 281
effect for the period ending June 30, 2015, except the rate paid to a 282
facility may be higher than the rate paid to the facility for the period 283
ending June 30, 2015, if a capital improvement approved by the 284
Department of Developmental Services, in consultation with the 285
Department of Social Services, for the health or safety of the residents 286
was made to the facility during the fiscal year ending June 30, 2016, or 287
June 30, 2017, to the extent such rate increases are within available 288
appropriations. For the fiscal years ending June 30, 2016, and June 30, 289
2017, and each succeeding fiscal year, any facility that would have been 290
issued a lower rate, due to interim rate status, a change in allowable fair 291 Raised Bill No. 1109
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rent or agreement with the department, shall be issued such lower rate. 292
For the fiscal years ending June 30, 2018, and June 30, 2019, rates shall 293
not exceed those in effect for the period ending June 30, 2017, except the 294
rate paid to a facility may be higher than the rate paid to the facility for 295
the period ending June 30, 2017, if a capital improvement approved by 296
the Department of Developmental Services, in consultation with the 297
Department of Social Services, for the health or safety of the residents 298
was made to the facility during the fiscal year ending June 30, 2018, or 299
June 30, 2019, only to the extent such rate increases are within available 300
appropriations. For the fiscal years ending June 30, 2020, and June 30, 301
2021, rates shall not exceed those in effect for the fiscal year ending June 302
30, 2019, except the rate paid to a facility may be higher than the rate 303
paid to the facility for the fiscal year ending June 30, 2019, if a capital 304
improvement approved by the Department of Developmental Services, 305
in consultation with the Department of Social Services, for the health or 306
safety of the residents was made to the facility during the fiscal year 307
ending June 30, 2020, or June 30, 2021, only to the extent such rate 308
increases are within available appropriations. For the fiscal year ending 309
June 30, 2022, rates shall not exceed those in effect for the fiscal year 310
ending June 30, 2021, except the commissioner may, in the 311
commissioner's discretion and within available appropriations, provide 312
pro rata fair rent increases to facilities that have documented fair rent 313
additions placed in service in the cost report year ending September 30, 314
2020, that are not otherwise included in rates issued. For the fiscal year 315
ending June 30, 2023, rates shall not exceed those in effect for the fiscal 316
year ending June 30, 2022, except the commissioner may, in the 317
commissioner's discretion and within available appropriations, provide 318
pro rata fair rent increases to facilities which have documented fair rent 319
additions placed in service in the cost report year ending September 30, 320
2021, that are not otherwise included in rates issued. For the fiscal years 321
ending June 30, 2022, and June 30, 2023, a facility may receive a rate 322
increase for a capital improvement approved by the Department of 323
Developmental Services, in consultation with the Department of Social 324
Services, for the health or safety of the residents during the fiscal year 325
ending June 30, 2022, or June 30, 2023, only to the extent such rate 326 Raised Bill No. 1109
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increases are within available appropriations. Any facility that has a 327
significant decrease in land and building costs shall receive a reduced 328
rate to reflect such decrease in land and building costs. For the fiscal 329
years ending June 30, 2012, June 30, 2013, June 30, 2014, June 30, 2015, 330
June 30, 2016, June 30, 2017, June 30, 2018, June 30, 2019, June 30, 2020, 331
June 30, 2021, June 30, 2022, and June 30, 2023, the Commissioner of 332
Social Services may provide fair rent increases to any facility that has 333
undergone a material change in circumstances related to fair rent and 334
has an approved certificate of need pursuant to section 17b-352, 17b-353, 335
17b-354 or 17b-355. Notwithstanding the provisions of this section, the 336
Commissioner of Social Services may, within available appropriations, 337
increase or decrease rates issued to intermediate care facilities for 338
individuals with intellectual disabilities to reflect a reduction in 339
available appropriations as provided in subsection (a) of this section. 340
For the fiscal years ending June 30, 2014, and June 30, 2015, the 341
commissioner shall not consider rebasing in determining rates. 342
Notwithstanding the provisions of this subsection, effective July 1, 2021, 343
and July 1, 2022, the commissioner shall, within available 344
appropriations, increase rates for the purpose of wage and benefit 345
enhancements for employees of intermediate care facilities. Facilities 346
that receive a rate adjustment for the purpose of wage and benefit 347
enhancements but do not provide increases in employee salaries as 348
described in this subsection on or before July 31, 2021, and July 31, 2022, 349
respectively, may be subject to a rate decrease in the same amount as the 350
adjustment by the commissioner. There shall be no increase to rates 351
based on inflation or any inflationary factor for the fiscal years ending 352
June 30, 2022, and June 30, 2023. Notwithstanding any other provisions 353
of the general statutes or regulations adopted thereunder, any 354
subsequent increase to rates based on inflation as authorized for any 355
succeeding fiscal year shall be adjusted as determined by the 356
commissioner. The rate of inflation shall be computed based on the 357
percentage increase, if any, in the most recent calendar year average in 358
the gross domestic product deflator over the average for the previous 359
calendar year. Any increase to rates based on inflation shall be applied 360
prior to the application of any other budget adjustment factors that may 361 Raised Bill No. 1109
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impact such rates. 362
(2) The Commissioner of Social Services shall determine whether and 363
to what extent a change in ownership of a facility shall occasion the 364
rebasing of the facility's costs. There shall be no inflation adjustment 365
during a year in which a facility's rates are rebased. For the fiscal year 366
ending June 30, 2024, and each subsequent fiscal year, the commissioner 367
may, in the commissioner's discretion and within available 368
appropriations, provide pro rata fair rent increases to facilities which 369
have documented fair rent additions placed in service in the cost report 370
years that are not otherwise included in rates issued. 371
Sec. 3. Subsection (i) of section 17b-340 of the general statutes is 372
repealed and the following is substituted in lieu thereof (Effective July 1, 373
2023): 374
(i) For the fiscal year ending June 30, 1993, any residential care home 375
with an operating cost component of its rate in excess of one hundred 376
thirty per cent of the median of operating cost components of rates in 377
effect January 1, 1992, shall not receive an operating cost component 378
increase. For the fiscal year ending June 30, 1993, any residential care 379
home with an operating cost component of its rate that is less than one 380
hundred thirty per cent of the median of operating cost components of 381
rates in effect January 1, 1992, shall have an allowance for real wage 382
growth equal to sixty-five per cent of the increase determined in 383
accordance with subsection (q) of section 17-311-52 of the regulations of 384
Connecticut state agencies, provided such operating cost component 385
shall not exceed one hundred thirty per cent of the median of operating 386
cost components in effect January 1, 1992. Beginning with the fiscal year 387
ending June 30, 1993, for the purpose of determining allowable fair rent, 388
a residential care home with allowable fair rent less than the twenty-389
fifth percentile of the state-wide allowable fair rent shall be reimbursed 390
as having allowable fair rent equal to the twenty-fifth percentile of the 391
state-wide allowable fair rent. Beginning with the fiscal year ending 392
June 30, 1997, a residential care home with allowable fair rent less than 393
three dollars and ten cents per day shall be reimbursed as having 394 Raised Bill No. 1109
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allowable fair rent equal to three dollars and ten cents per day. Property 395
additions placed in service during the cost year ending September 30, 396
1996, or any succeeding cost year shall receive a fair rent allowance for 397
such additions as an addition to three dollars and ten cents per day if 398
the fair rent for the facility for property placed in service prior to 399
September 30, 1995, is less than or equal to three dollars and ten cents 400
per day. Beginning with the fiscal year ending June 30, 2016, a 401
residential care home shall be reimbursed the greater of the allowable 402
accumulated fair rent reimbursement associated with real property 403
additions and land as calculated on a per day basis or three dollars and 404
ten cents per day if the allowable reimbursement associated with real 405
property additions and land is less than three dollars and ten cents per 406
day. For the fiscal year ending June 30, 1996, and any succeeding fiscal 407
year, the allowance for real wage growth, as determined in accordance 408
with subsection (q) of section 17-311-52 of the regulations of Connecticut 409
state agencies, shall not be applied. For the fiscal year ending June 30, 410
1996, and any succeeding fiscal year, the inflation adjustment made in 411
accordance with subsection (p) of section 17-311-52 of the regulations of 412
Connecticut state agencies shall not be applied to real property costs. 413
Beginning with the fiscal year ending June 30, 1997, minimum allowable 414
patient days for rate computation purposes for a residential care home 415
with twenty-five beds or less shall be eighty-five per cent of licensed 416
capacity. Beginning with the fiscal year ending June 30, 2002, for the 417
purposes of determining the allowable salary of an administrator of a 418
residential care home with sixty beds or less the department shall revise 419
the allowable base salary to thirty-seven thousand dollars to be annually 420
inflated thereafter in accordance with section 17-311-52 of the 421
regulations of Connecticut state agencies. The rates for the fiscal year 422
ending June 30, 2002, shall be based upon the increased allowable salary 423
of an administrator, regardless of whether such amount was expended 424
in the 2000 cost report period upon which the rates are based. Beginning 425
with the fiscal year ending June 30, 2000, and until the fiscal year ending 426
June 30, 2009, inclusive, the inflation adjustment for rates made in 427
accordance with subsection (p) of section 17-311-52 of the regulations of 428
Connecticut state agencies shall be increased by two per cent, and 429 Raised Bill No. 1109
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beginning with the fiscal year ending June 30, 2002, the inflation 430
adjustment for rates made in accordance with subsection (c) of said 431
section shall be increased by one per cent. Beginning with the fiscal year 432
ending June 30, 1999, for the purpose of determining the allowable 433
salary of a related party, the department shall revise the maximum 434
salary to twenty-seven thousand eight hundred fifty-six dollars to be 435
annually inflated thereafter in accordance with section 17-311-52 of the 436
regulations of Connecticut state agencies and beginning with the fiscal 437
year ending June 30, 2001, such allowable salary shall be computed on 438
an hourly basis and the maximum number of hours allowed for a related 439
party other than the proprietor shall be increased from forty hours to 440
forty-eight hours per work week. For the fiscal year ending June 30, 441
2005, each facility shall receive a rate that is two and one-quarter per 442
cent more than the rate the facility received in the prior fiscal year, 443
except any facility that would have been issued a lower rate effective 444
July 1, 2004, than for the fiscal year ending June 30, 2004, due to interim 445
rate status or agreement with the department shall be issued such lower 446
rate effective July 1, 2004. Effective upon receipt of all the necessary 447
federal approvals to secure federal financial participation matching 448
funds associated with the rate increase provided in subdivision (4) of 449
subsection (f) of this section, but in no event earlier than October 1, 2005, 450
and provided the user fee imposed under section 17b-320 is required to 451
be collected, each facility shall receive a rate that is determined in 452
accordance with applicable law and subject to appropriations, except 453
any facility that would have been issued a lower rate effective October 454
1, 2005, than for the fiscal year ending June 30, 2005, due to interim rate 455
status or agreement with the department, shall be issued such lower rate 456
effective October 1, 2005. Such rate increase shall remain in effect unless: 457
(1) The federal financial participation matching funds associated with 458
the rate increase are no longer available; or (2) the user fee created 459
pursuant to section 17b-320 is not in effect. For the fiscal year ending 460
June 30, 2007, rates in effect for the period ending June 30, 2006, shall 461
remain in effect until September 30, 2006, except any facility that would 462
have been issued a lower rate effective July 1, 2006, than for the fiscal 463
year ending June 30, 2006, due to interim rate status or agreement with 464 Raised Bill No. 1109
LCO No. 4741 15 of 28
the department, shall be issued such lower rate effective July 1, 2006. 465
Effective October 1, 2006, no facility shall receive a rate that is more than 466
four per cent greater than the rate in effect for the facility on September 467
30, 2006, except for any facility that would have been issued a lower rate 468
effective October 1, 2006, due to interim rate status or agreement with 469
the department, shall be issued such lower rate effective October 1, 2006. 470
For the fiscal years ending June 30, 2010, and June 30, 2011, rates in effect 471
for the period ending June 30, 2009, shall remain in effect until June 30, 472
2011, except any facility that would have been issued a lower rate for 473
the fiscal year ending June 30, 2010, or the fiscal year ending June 30, 474
2011, due to interim rate status or agreement with the department, shall 475
be issued such lower rate, except (A) any facility that would have been 476
issued a lower rate for the fiscal year ending June 30, 2010, or the fiscal 477
year ending June 30, 2011, due to interim rate status or agreement with 478
the Commissioner of Social Services shall be issued such lower rate; and 479
(B) the commissioner may increase a facility's rate for reasonable costs 480
associated with such facility's compliance with the provisions of section 481
19a-495a concerning the administration of medication by unlicensed 482
personnel. For the fiscal year ending June 30, 2012, rates in effect for the 483
period ending June 30, 2011, shall remain in effect until June 30, 2012, 484
except that (i) any facility that would have been issued a lower rate for 485
the fiscal year ending June 30, 2012, due to interim rate status or 486
agreement with the Commissioner of Social Services shall be issued 487
such lower rate; and (ii) the commissioner may increase a facility's rate 488
for reasonable costs associated with such facility's compliance with the 489
provisions of section 19a-495a concerning the administration of 490
medication by unlicensed personnel. For the fiscal year ending June 30, 491
2013, the Commissioner of Social Services may, within available 492
appropriations, provide a rate increase to a residential care home. Any 493
facility that would have been issued a lower rate for the fiscal year 494
ending June 30, 2013, due to interim rate status or agreement with the 495
Commissioner of Social Services shall be issued such lower rate. For the 496
fiscal years ending June 30, 2012, and June 30, 2013, the Commissioner 497
of Social Services may provide fair rent increases to any facility that has 498
undergone a material change in circumstances related to fair rent and 499 Raised Bill No. 1109
LCO No. 4741 16 of 28
has an approved certificate of need pursuant to section 17b-352, 17b-353, 500
17b-354 or 17b-355. For the fiscal years ending June 30, 2014, and June 501
30, 2015, for those facilities that have a calculated rate greater than the 502
rate in effect for the fiscal year ending June 30, 2013, the commissioner 503
may increase facility rates based upon available appropriations up to a 504
stop gain as determined by the commissioner. No facility shall be issued 505
a rate that is lower than the rate in effect on June 30, 2013, except that 506
any facility that would have been issued a lower rate for the fiscal year 507
ending June 30, 2014, or the fiscal year ending June 30, 2015, due to 508
interim rate status or agreement with the commissioner, shall be issued 509
such lower rate. For the fiscal year ending June 30, 2014, and each fiscal 510
year thereafter, a residential care home shall receive a rate increase for 511
any capital improvement made during the fiscal year for the health and 512
safety of residents and approved by the Department of Social Services, 513
provided such rate increase is within available appropriations. For the 514
fiscal year ending June 30, 2015, and each succeeding fiscal year 515
thereafter, costs of less than ten thousand dollars that are incurred by a 516
facility and are associated with any land, building or nonmovable 517
equipment repair or improvement that are reported in the cost year used 518
to establish the facility's rate shall not be capitalized for a period of more 519
than five years for rate-setting purposes. For the fiscal year ending June 520
30, 2015, subject to available appropriations, the commissioner may, at 521
the commissioner's discretion: Increase the inflation cost limitation 522
under subsection (c) of section 17-311-52 of the regulations of 523
Connecticut state agencies, provided such inflation allowance factor 524
does not exceed a maximum of five per cent; establish a minimum rate 525
of return applied to real property of five per cent inclusive of assets 526
placed in service during cost year 2013; waive the standard rate of return 527
under subsection (f) of section 17-311-52 of the regulations of 528
Connecticut state agencies for ownership changes or health and safety 529
improvements that exceed one hundred thousand dollars and that are 530
required under a consent order from the Department of Public Health; 531
and waive the rate of return adjustment under subsection (f) of section 532
17-311-52 of the regulations of Connecticut state agencies to avoid 533
financial hardship. For the fiscal years ending June 30, 2016, and June 534 Raised Bill No. 1109
LCO No. 4741 17 of 28
30, 2017, rates shall not exceed those in effect for the period ending June 535
30, 2015, except the commissioner may, in the commissioner's discretion 536
and within available appropriations, provide pro rata fair rent increases 537
to facilities which have documented fair rent additions placed in service 538
in cost report years ending September 30, 2014, and September 30, 2015, 539
that are not otherwise included in rates issued. For the fiscal years 540
ending June 30, 2016, and June 30, 2017, and each succeeding fiscal year, 541
any facility that would have been issued a lower rate, due to interim rate 542
status, a change in allowable fair rent or agreement with the department, 543
shall be issued such lower rate. For the fiscal year ending June 30, 2018, 544
rates shall not exceed those in effect for the period ending June 30, 2017, 545
except the commissioner may, in the commissioner's discretion and 546
within available appropriations, provide pro rata fair rent increases to 547
facilities which have documented fair rent additions placed in service in 548
the cost report year ending September 30, 2016, that are not otherwise 549
included in rates issued. For the fiscal year ending June 30, 2019, rates 550
shall not exceed those in effect for the period ending June 30, 2018, 551
except the commissioner may, in the commissioner's discretion and 552
within available appropriations, provide pro rata fair rent increases to 553
facilities which have documented fair rent additions placed in service in 554
the cost report year ending September 30, 2017, that are not otherwise 555
included in rates issued. For the fiscal year ending June 30, 2020, rates 556
shall not exceed those in effect for the fiscal year ending June 30, 2019, 557
except the commissioner may, in the commissioner's discretion and 558
within available appropriations, provide pro rata fair rent increases to 559
facilities which have documented fair rent additions placed in service in 560
the cost report year ending September 30, 2018, that are not otherwise 561
included in rates issued. For the fiscal year ending June 30, 2021, rates 562
shall not exceed those in effect for the fiscal year ending June 30, 2020, 563
except the commissioner may, in the commissioner's discretion and 564
within available appropriations, provide pro rata fair rent increases to 565
facilities which have documented fair rent additions placed in service in 566
the cost report year ending September 30, 2019, that are not otherwise 567
included in rates issued. For the fiscal year ending June 30, 2022, the 568
commissioner may, in the commissioner's discretion and within 569 Raised Bill No. 1109
LCO No. 4741 18 of 28
available appropriations, provide pro rata fair rent increases to facilities 570
that have documented fair rent additions placed in service in the cost 571
report year ending September 30, 2020, that are not otherwise included 572
in rates issued. For the fiscal year ending June 30, 2023, the 573
commissioner may, in the commissioner's discretion and within 574
available appropriations, provide pro rata fair rent increases to facilities 575
which have documented fair rent additions placed in service in the cost 576
report year ending September 30, 2021, that are not otherwise included 577
in rates issued. For the fiscal years ending June 30, 2022, and June 30, 578
2023, a facility may receive a rate increase for a capital improvement 579
approved by the Department of Social Services, for the health or safety 580
of the residents during the fiscal year ending June 30, 2022, or June 30, 581
2023, only to the extent such rate increases are within available 582
appropriations. For the fiscal year ending June 30, 2022, and June 30, 583
2023, rates shall be based upon rates in effect for the fiscal year ending 584
June 30, 2021, inflated by the gross domestic product deflator applicable 585
to each rate year, except the commissioner may, in the commissioner's 586
discretion and within available appropriations, provide pro rata fair 587
rent increases to facilities which have documented fair rent additions 588
placed in service in the cost report years ending September 30, 2020, and 589
September 30, 2021, that are not otherwise included in rates issued. 590
Notwithstanding any other provisions of the general statutes or 591
regulations adopted thereunder, any subsequent increase to rates based 592
on inflation as authorized for any succeeding fiscal year shall be 593
adjusted as determined by the commissioner. The rate of inflation shall 594
be computed based on the percentage increase, if any, in the most recent 595
calendar year average in the gross domestic product deflator over the 596
average for the previous calendar year. Any increase to rates based on 597
inflation shall be applied prior to the application of any other budget 598
adjustment factors that may impact such rates. The commissioner shall 599
determine whether and to what extent a change in ownership of a 600
facility shall occasion the rebasing of the facility's costs. There shall be 601
no inflation adjustment during a year in which a facility's rates are 602
rebased. 603 Raised Bill No. 1109
LCO No. 4741 19 of 28
Sec. 4. Subsection (a) of section 17b-340 of the general statutes is 604
repealed and the following is substituted in lieu thereof (Effective from 605
passage): 606
(a) For purposes of this subsection, (1) a "related party" includes, but 607
is not limited to, any company related to a chronic and convalescent 608
nursing home through family association, common ownership, control 609
or business association with any of the owners, operators or officials of 610
such nursing home; (2) "company" means any person, partnership, 611
association, holding company, limited liability company or corporation; 612
(3) "family association" means a relationship by birth, marriage or 613
domestic partnership; and (4) "profit and loss statement" means the 614
most recent annual statement on profits and losses finalized by a related 615
party before the annual report mandated under this subsection. The 616
rates to be paid by or for persons aided or cared for by the state or any 617
town in this state to licensed chronic and convalescent nursing homes, 618
to chronic disease hospitals associated with chronic and convalescent 619
nursing homes, to rest homes with nursing supervision, to licensed 620
residential care homes, as defined by section 19a-490, and to residential 621
facilities for persons with intellectual disability that are licensed 622
pursuant to section 17a-227 and certified to participate in the Title XIX 623
Medicaid program as intermediate care facilities for individuals with 624
intellectual disabilities, for room, board and services specified in 625
licensing regulations issued by the licensing agency shall be determined 626
annually, except as otherwise provided in this subsection by the 627
Commissioner of Social Services, to be effective July first of each year 628
except as otherwise provided in this subsection. Such rates shall be 629
determined on a basis of a reasonable payment for such necessary 630
services, which basis shall take into account as a factor the costs of such 631
services. Cost of such services shall include reasonable costs mandated 632
by collective bargaining agreements with certified collective bargaining 633
agents or other agreements between the employer and employees, 634
provided "employees" shall not include persons employed as managers 635
or chief administrators or required to be licensed as nursing home 636
administrators, and compensation for services rendered by proprietors 637 Raised Bill No. 1109
LCO No. 4741 20 of 28
at prevailing wage rates, as determined by application of principles of 638
accounting as prescribed by said commissioner. Cost of such services 639
shall not include amounts paid by the facilities to employees as salary, 640
or to attorneys or consultants as fees, where the responsibility of the 641
employees, attorneys, or consultants is to persuade or seek to persuade 642
the other employees of the facility to support or oppose unionization. 643
Nothing in this subsection shall prohibit inclusion of amounts paid for 644
legal counsel related to the negotiation of collective bargaining 645
agreements, the settlement of grievances or normal administration of 646
labor relations. The commissioner may, in the commissioner's 647
discretion, allow the inclusion of extraordinary and unanticipated costs 648
of providing services that were incurred to avoid an immediate negative 649
impact on the health and safety of patients. The commissioner may, in 650
the commissioner's discretion, based upon review of a facility's costs, 651
direct care staff to patient ratio and any other related information, revise 652
a facility's rate for any increases or decreases to total licensed capacity 653
of more than ten beds or changes to its number of licensed rest home 654
with nursing supervision beds and chronic and convalescent nursing 655
home beds. The commissioner may, in the commissioner's discretion, 656
revise the rate of a facility that is closing. An interim rate issued for the 657
period during which a facility is closing shall be based on a review of 658
facility costs, the expected duration of the close-down period, the 659
anticipated impact on Medicaid costs, available appropriations and the 660
relationship of the rate requested by the facility to the average Medicaid 661
rate for a close-down period. The commissioner may so revise a facility's 662
rate established for the fiscal year ending June 30, 1993, and thereafter 663
for any bed increases, decreases or changes in licensure effective after 664
October 1, 1989. Effective July 1, 1991, in facilities that have both a 665
chronic and convalescent nursing home and a rest home with nursing 666
supervision, the rate for the rest home with nursing supervision shall 667
not exceed such facility's rate for its chronic and convalescent nursing 668
home. All such facilities for which rates are determined under this 669
subsection shall report on a fiscal year basis ending on September 670
thirtieth. Such report shall be submitted to the commissioner by 671
February fifteenth. Each for-profit chronic and convalescent nursing 672 Raised Bill No. 1109
LCO No. 4741 21 of 28
home that receives state funding pursuant to this section shall include 673
in such annual report a profit and loss statement from each related party 674
that receives from such chronic and convalescent nursing home fifty 675
thousand dollars or more per year for goods, fees and services. No cause 676
of action or liability shall arise against the state, the Department of Social 677
Services, any state official or agent for failure to take action based on the 678
information required to be reported under this subsection. The 679
commissioner may reduce the rate in effect for a facility that fails to 680
submit a complete and accurate report on or before February fifteenth 681
by an amount not to exceed ten per cent of such rate. If a licensed 682
residential care home fails to submit a complete and accurate report, the 683
department shall notify such home of the failure and the home shall 684
have thirty days from the date the notice was issued to submit a 685
complete and accurate report. If a licensed residential care home fails to 686
submit a complete and accurate report not later than thirty days after 687
the date of notice, such home may not receive a retroactive rate increase, 688
in the commissioner's discretion. The commissioner shall, annually, on 689
or before April first, report the data contained in the reports of such 690
facilities on the department's Internet web site. For the cost reporting 691
year commencing October 1, 1985, and for subsequent cost reporting 692
years, facilities shall report the cost of using the services of any nursing 693
personnel supplied by a temporary nursing services agency by 694
separating said cost into two categories, the portion of the cost equal to 695
the salary of the employee for whom the nursing personnel supplied by 696
a temporary nursing services agency is substituting shall be considered 697
a nursing cost and any cost in excess of such salary shall be further 698
divided so that seventy-five per cent of the excess cost shall be 699
considered an administrative or general cost and twenty-five per cent of 700
the excess cost shall be considered a nursing cost, provided if the total 701
costs of a facility for nursing personnel supplied by a temporary nursing 702
services agency in any cost year are equal to or exceed fifteen per cent 703
of the total nursing expenditures of the facility for such cost year, no 704
portion of such costs in excess of fifteen per cent shall be classified as 705
administrative or general costs. The commissioner, in determining such 706
rates, shall also take into account the classification of patients or 707 Raised Bill No. 1109
LCO No. 4741 22 of 28
boarders according to special care requirements or classification of the 708
facility according to such factors as facilities and services and such other 709
factors as the commissioner deems reasonable, including anticipated 710
fluctuations in the cost of providing such services. The commissioner 711
may establish a separate rate for a facility or a portion of a facility for 712
traumatic brain injury patients who require extensive care but not acute 713
general hospital care. Such separate rate shall reflect the special care 714
requirements of such patients. If changes in federal or state laws, 715
regulations or standards adopted subsequent to June 30, 1985, result in 716
increased costs or expenditures in an amount exceeding one-half of one 717
per cent of allowable costs for the most recent cost reporting year, the 718
commissioner shall adjust rates and provide payment for any such 719
increased reasonable costs or expenditures within a reasonable period 720
of time retroactive to the date of enforcement. Nothing in this section 721
shall be construed to require the Department of Social Services to adjust 722
rates and provide payment for any increases in costs resulting from an 723
inspection of a facility by the Department of Public Health. Such 724
assistance as the commissioner requires from other state agencies or 725
departments in determining rates shall be made available to the 726
commissioner at the commissioner's request. Payment of the rates 727
established pursuant to this section shall be conditioned on the 728
establishment by such facilities of admissions procedures that conform 729
with this section, section 19a-533 and all other applicable provisions of 730
the law and the provision of equality of treatment to all persons in such 731
facilities. The established rates shall be the maximum amount 732
chargeable by such facilities for care of such beneficiaries, and the 733
acceptance by or on behalf of any such facility of any additional 734
compensation for care of any such beneficiary from any other person or 735
source shall constitute the offense of aiding a beneficiary to obtain aid 736
to which the beneficiary is not entitled and shall be punishable in the 737
same manner as is provided in subsection (b) of section 17b-97. 738
Notwithstanding any provision of this section, the Commissioner of 739
Social Services may, within available appropriations, provide an interim 740
rate increase for a licensed chronic and convalescent nursing home or a 741
rest home with nursing supervision for rate periods no earlier than April 742 Raised Bill No. 1109
LCO No. 4741 23 of 28
1, 2004, only if the commissioner determines that the increase is 743
necessary to avoid the filing of a petition for relief under Title 11 of the 744
United States Code; imposition of receivership pursuant to sections 19a-745
542 and 19a-543; or substantial deterioration of the facility's financial 746
condition that may be expected to adversely affect resident care and the 747
continued operation of the facility, and the commissioner determines 748
that the continued operation of the facility is in the best interest of the 749
state. The commissioner shall consider any requests for interim rate 750
increases on file with the department from March 30, 2004, and those 751
submitted subsequently for rate periods no earlier than April 1, 2004. 752
When reviewing an interim rate increase request the commissioner 753
shall, at a minimum, consider: (A) Existing chronic and convalescent 754
nursing home or rest home with nursing supervision utilization in the 755
area and projected bed need; (B) physical plant long-term viability and 756
the ability of the owner or purchaser to implement any necessary 757
property improvements; (C) licensure and certification compliance 758
history; (D) reasonableness of actual and projected expenses; and (E) the 759
ability of the facility to meet wage and benefit costs. No interim rate 760
shall be increased pursuant to this subsection in excess of one hundred 761
fifteen per cent of the median rate for the facility's peer grouping, 762
established pursuant to [subdivision (2) of subsection (f) of this section] 763
subdivision (3) of subsection (a) of section 17b-340d, as amended by this 764
act, unless recommended by the commissioner and approved by the 765
Secretary of the Office of Policy and Management after consultation 766
with the commissioner. Such median rates shall be published by the 767
Department of Social Services not later than April first of each year. In 768
the event that a facility granted an interim rate increase pursuant to this 769
section is sold or otherwise conveyed for value to an unrelated entity 770
less than five years after the effective date of such rate increase, the rate 771
increase shall be deemed rescinded and the department shall recover an 772
amount equal to the difference between payments made for all affected 773
rate periods and payments that would have been made if the interim 774
rate increase was not granted. The commissioner may seek recovery of 775
such payments from any facility with common ownership. With the 776
approval of the Secretary of the Office of Policy and Management, the 777 Raised Bill No. 1109
LCO No. 4741 24 of 28
commissioner may waive recovery and rescission of the interim rate for 778
good cause shown that is not inconsistent with this section, including, 779
but not limited to, transfers to family members that were made for no 780
value. The commissioner shall provide written quarterly reports to the 781
joint standing committees of the General Assembly having cognizance 782
of matters relating to aging, human services and appropriations and the 783
budgets of state agencies, that identify each facility requesting an 784
interim rate increase, the amount of the requested rate increase for each 785
facility, the action taken by the commissioner and the secretary pursuant 786
to this subsection, and estimates of the additional cost to the state for 787
each approved interim rate increase. Nothing in this subsection shall 788
prohibit the commissioner from increasing the rate of a licensed chronic 789
and convalescent nursing home or a rest home with nursing supervision 790
for allowable costs associated with facility capital improvements or 791
increasing the rate in case of a sale of a licensed chronic and convalescent 792
nursing home or a rest home with nursing supervision if receivership 793
has been imposed on such home. For purposes of this section, 794
"temporary nursing services agency" and "nursing personnel" have the 795
same meaning as provided in section 19a-118. 796
Sec. 5. Subsection (a) of section 17b-340d of the general statutes is 797
repealed and the following is substituted in lieu thereof (Effective from 798
passage): 799
(a) The Commissioner of Social Services shall implement an acuity-800
based methodology for Medicaid reimbursement of nursing home 801
services effective July 1, 2022. Notwithstanding section 17b-340, as 802
amended by this act, for the fiscal year ending June 30, 2023, and 803
annually thereafter, the Commissioner of Social Services shall establish 804
Medicaid rates paid to nursing home facilities based on cost years 805
ending on September thirtieth in accordance with the following: 806
(1) Case-mix adjustments to the direct care component, which will be 807
based on Minimum Data Set resident assessment data as well as cost 808
data reported for the cost year ending September 30, 2019, shall be made 809
effective beginning July 1, 2022, and updated every quarter thereafter. 810 Raised Bill No. 1109
LCO No. 4741 25 of 28
After modeling such case-mix adjustments, the Commissioner of Social 811
Services shall evaluate impact on a facility by facility basis and, not later 812
than October 1, 2021, (A) make recommendations to the Secretary of the 813
Office of Policy and Management, and (B) submit a report on the 814
recommendations, in accordance with the provisions of section 11-4a, to 815
the joint standing committees of the General Assembly having 816
cognizance of matters relating to appropriations and the budgets of state 817
agencies and human services on any adjustments needed to facilitate the 818
transition to the new methodology on July 1, 2022. This evaluation may 819
include a review of inflationary allowances, case mix and budget 820
adjustment factors and stop loss and stop gain corridors and the ability 821
to make such adjustments within available appropriations. 822
(2) Beginning July 1, 2022, facilities will be required to comply with 823
collection and reporting of quality metrics as specified by the 824
Department of Social Services, after consultation with the nursing home 825
industry, consumers, employees and the Department of Public Health. 826
Rate adjustments based on performance on quality metrics will be 827
phased in, beginning July 1, 2022, with a period of reporting only. 828
(3) Geographic peer groupings of facilities shall be established by the 829
Department of Social Services pursuant to regulations adopted in 830
accordance with subsection (b) of this section. 831
(4) Allowable costs shall be divided into the following five cost 832
components: (A) Direct costs, which shall include salaries for nursing 833
personnel, related fringe benefits and costs for nursing personnel 834
supplied by a temporary nursing services agency; (B) indirect costs, 835
which shall include professional fees, dietary expenses, housekeeping 836
expenses, laundry expenses, supplies related to patient care, salaries for 837
indirect care personnel and related fringe benefits; (C) fair rent, which 838
shall be defined in regulations adopted in accordance with subsection 839
(b) of this section; (D) capital-related costs, which shall include property 840
taxes, insurance expenses, equipment leases and equipment 841
depreciation; and (E) administrative and general costs, which shall 842
include maintenance and operation of plant expenses, salaries for 843 Raised Bill No. 1109
LCO No. 4741 26 of 28
administrative and maintenance personnel and related fringe benefits. 844
For (i) direct costs, the maximum cost shall be equal to one hundred 845
thirty-five per cent of the median allowable cost of that peer grouping; 846
(ii) indirect costs, the maximum cost shall be equal to one hundred 847
fifteen per cent of the state-wide median allowable cost; (iii) fair rent, 848
the amount shall be calculated utilizing the amount approved pursuant 849
to section 17b-353; (iv) capital-related costs, there shall be no maximum; 850
and (v) administrative and general costs, the maximum shall be equal to 851
the state-wide median allowable cost. For purposes of this subdivision, 852
"temporary nursing services agency" and "nursing personnel" have the 853
same meaning as provided in section 19a-118. 854
(5) Costs in excess of the maximum amounts established under this 855
subsection shall not be recognized as allowable costs, except that the 856
commissioner may establish rates whereby allowable costs may exceed 857
such maximum amounts for beds which are restricted to use by patients 858
with acquired immune deficiency syndrome, traumatic brain injury or 859
other specialized services. 860
[(5) For the fiscal year ending] (6) On or after June 30, 2022, the 861
commissioner may, in the commissioner's discretion and within 862
available appropriations, provide pro rata fair rent increases to facilities 863
which have documented fair rent additions placed in service in the most 864
recently filed cost report [year ending September 30, 2020,] that are not 865
otherwise included in the rates issued. 866
(7) For the purpose of determining allowable fair rent, a facility with 867
allowable fair rent less than the twenty-fifth percentile of the state-wide 868
allowable fair rent shall be reimbursed as having allowable fair rent 869
equal to the twenty-fifth percentile of the state-wide allowable fair rent. 870
Any facility with a rate of return on real property other than land in 871
excess of eleven per cent shall have such allowance revised to eleven per 872
cent. Any facility or its related realty affiliate which finances or 873
refinances debt through bonds issued by the Connecticut Health and 874
Education Facilities Authority shall report the terms and conditions of 875
such financing or refinancing to the Commissioner of Social Services not 876 Raised Bill No. 1109
LCO No. 4741 27 of 28
later than thirty days after completing such financing or refinancing. 877
The commissioner may revise the facility's fair rent component of its rate 878
to reflect any financial benefit the facility or its related realty affiliate 879
received as a result of such financing or refinancing. The commissioner 880
shall determine allowable fair rent for real property other than land 881
based on the rate of return for the cost year in which such bonds were 882
issued. The financial benefit resulting from a facility financing or 883
refinancing debt through such bonds shall be shared between the state 884
and the facility to an extent determined by the commissioner on a case-885
by-case basis and shall be reflected in an adjustment to the facility's 886
allowable fair rent. 887
(8) A facility shall receive cost efficiency adjustments for indirect costs 888
and for administrative and general costs if such costs are below the 889
state-wide median costs. The cost efficiency adjustments shall equal 890
twenty-five per cent of the difference between allowable reported costs 891
and the applicable median allowable cost established pursuant to 892
subdivision (4) of this subsection. 893
(9) On and after July 1, 2025, costs shall be rebased no more frequently 894
than every two years and no less frequently than every four years, as 895
determined by the commissioner. There shall be no inflation adjustment 896
during a year in which a facility's rates are rebased. The commissioner 897
shall determine whether and to what extent a change in ownership of a 898
facility shall occasion the rebasing of the facility's costs. 899
(10) The method of establishing rates for new facilities shall be 900
determined by the commissioner in accordance with the provisions of 901
this subsection. 902
[(6)] (11) There shall be no increase to rates based on inflation or any 903
inflationary factor for the fiscal years ending June 30, 2022, and June 30, 904
2023, unless otherwise authorized under subdivision (1) of this 905
subsection. Notwithstanding any other provisions of the general 906
statutes or regulations adopted thereunder, any subsequent increase to 907
rates based on inflation as authorized for any succeeding fiscal year 908 Raised Bill No. 1109
LCO No. 4741 28 of 28
shall be adjusted as determined by the commissioner. The rate of 909
inflation shall be computed based on the percentage increase, if any, in 910
the most recent calendar year average in the gross domestic product 911
deflator over the average for the previous calendar year. Any increase 912
to rates based on inflation shall be applied prior to the application of any 913
other budget adjustment factors that may impact such rates. 914
[(7)] (12) For purposes of computing minimum allowable patient 915
days, utilization of a facility's certified beds shall be determined at a 916
minimum of ninety per cent of capacity, except for facilities that have 917
undergone a change in ownership, new facilities, and facilities which 918
are certified for additional beds which may be permitted a lower 919
occupancy rate for the first three months of operation after the effective 920
date of licensure. 921
[(8)] (13) Rates determined under this section shall comply with 922
federal laws and regulations. 923
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2023 17b-244
Sec. 2 July 1, 2023 17b-340(h)
Sec. 3 July 1, 2023 17b-340(i)
Sec. 4 from passage 17b-340(a)
Sec. 5 from passage 17b-340d(a)
Statement of Purpose:
To adjust Medicaid reimbursement for Community Living
Arrangements, Intermediate Care Facilities for Individuals with
Intellectual Disabilities, residential care homes and nursing facilities.
[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.]