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General Assembly Substitute Bill No. 1109
January Session, 2023
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 Section 17b-244 of the general statutes is repealed and the 1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 3
state to private facilities and facilities operated by regional education 4
service centers which are licensed to provide residential care pursuant 5
to section 17a-227, but not certified to participate in the Title XIX 6
Medicaid program as intermediate care facilities for individuals with 7
intellectual disabilities, shall be determined annually by the 8
Commissioner of Social Services. [, except that rates effective April 30, 9
1989, shall remain in effect through October 31, 1989. Any facility with 10
real property other than land placed in service prior to July 1, 1991, 11
shall, for the fiscal year ending June 30, 1995, receive a rate of return on 12
real property equal to the average of the rates of return applied to real 13
property other than land placed in service for the five years preceding 14
July 1, 1993.] For the fiscal year ending June 30, 1996, and any 15
succeeding fiscal year, the rate of return on real property for property 16
items shall be revised every five years. The commissioner shall, upon 17 Substitute Bill No. 1109
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submission of a request by such facility, allow actual debt service, 18
comprised of principal and interest, on the loan or loans in lieu of 19
property costs allowed pursuant to section 17-313b-5 of the regulations 20
of Connecticut state agencies, whether actual debt service is higher or 21
lower than such allowed property costs, provided such debt service 22
terms and amounts are reasonable in relation to the useful life and the 23
base value of the property. In the case of facilities financed through the 24
Connecticut Housing Finance Authority, the commissioner shall allow 25
actual debt service, comprised of principal, interest and a reasonable 26
repair and replacement reserve on the loan or loans in lieu of property 27
costs allowed pursuant to section 17-313b-5 of the regulations of 28
Connecticut state agencies, whether actual debt service is higher or 29
lower than such allowed property costs, provided such debt service 30
terms and amounts are determined by the commissioner at the time 31
the loan is entered into to be reasonable in relation to the useful life 32
and base value of the property. The commissioner may allow fees 33
associated with mortgage refinancing provided such refinancing will 34
result in state reimbursement savings, after comparing costs over the 35
terms of the existing proposed loans. For the fiscal year ending June 30, 36
1992, the inflation factor used to determine rates shall be one-half of 37
the gross national product percentage increase for the period between 38
the midpoint of the cost year through the midpoint of the rate year. For 39
fiscal year ending June 30, 1993, the inflation factor used to determine 40
rates shall be two-thirds of the gross national product percentage 41
increase from the midpoint of the cost year to the midpoint of the rate 42
year. For the fiscal years ending June 30, 1996, and June 30, 1997, no 43
inflation factor shall be applied in determining rates. The 44
Commissioner of Social Services shall prescribe uniform forms on 45
which such facilities shall report their costs. Such rates shall be 46
determined on the basis of a reasonable payment for necessary 47
services. Any increase in grants, gifts, fund-raising or endowment 48
income used for the payment of operating costs by a private facility in 49
the fiscal year ending June 30, 1992, shall be excluded by the 50
commissioner from the income of the facility in determining the rates 51
to be paid to the facility for the fiscal year ending June 30, 1993, 52 Substitute Bill No. 1109
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provided any operating costs funded by such increase shall not 53
obligate the state to increase expenditures in subsequent fiscal years. 54
Nothing contained in this section shall authorize a payment by the 55
state to any such facility in excess of the charges made by the facility 56
for comparable services to the general public. The service component 57
of the rates to be paid by the state to private facilities and facilities 58
operated by regional education service centers which are licensed to 59
provide residential care pursuant to section 17a-227, but not certified 60
to participate in the Title XIX Medicaid programs as intermediate care 61
facilities for individuals with intellectual disabilities, shall be 62
determined annually by the Commissioner of Developmental Services 63
in accordance with section 17b-244a. For the fiscal year ending June 30, 64
2008, no facility shall receive a rate that is more than two per cent 65
greater than the rate in effect for the facility on June 30, 2007, except 66
any facility that would have been issued a lower rate effective July 1, 67
2007, due to interim rate status or agreement with the department, 68
shall be issued such lower rate effective July 1, 2007. For the fiscal year 69
ending June 30, 2009, no facility shall receive a rate that is more than 70
two per cent greater than the rate in effect for the facility on June 30, 71
2008, except any facility that would have been issued a lower rate 72
effective July 1, 2008, due to interim rate status or agreement with the 73
department, shall be issued such lower rate effective July 1, 2008. For 74
the fiscal years ending June 30, 2010, and June 30, 2011, rates in effect 75
for the period ending June 30, 2009, shall remain in effect until June 30, 76
2011, except that (1) the rate paid to a facility may be higher than the 77
rate paid to the facility for the period ending June 30, 2009, if a capital 78
improvement required by the Commissioner of Developmental 79
Services for the health or safety of the residents was made to the 80
facility during the fiscal years ending June 30, 2010, or June 30, 2011, 81
and (2) any facility that would have been issued a lower rate for the 82
fiscal year ending June 30, 2010, or June 30, 2011, due to interim rate 83
status or agreement with the department, shall be issued such lower 84
rate. For the fiscal year ending June 30, 2012, rates in effect for the 85
period ending June 30, 2011, shall remain in effect until June 30, 2012, 86
except that (A) the rate paid to a facility may be higher than the rate 87 Substitute Bill No. 1109
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paid to the facility for the period ending June 30, 2011, if a capital 88
improvement required by the Commissioner of Developmental 89
Services for the health or safety of the residents was made to the 90
facility during the fiscal year ending June 30, 2012, and (B) any facility 91
that would have been issued a lower rate for the fiscal year ending 92
June 30, 2012, due to interim rate status or agreement with the 93
department, shall be issued such lower rate. Any facility that has a 94
significant decrease in land and building costs shall receive a reduced 95
rate to reflect such decrease in land and building costs. The rate paid to 96
a facility may be increased if a capital improvement approved by the 97
Department of Developmental Services, in consultation with the 98
Department of Social Services, for the health or safety of the residents 99
was made to the facility during the fiscal year ending June 30, 2014, or 100
June 30, 2015, only to the extent such increases are within available 101
appropriations. For the fiscal years ending June 30, 2016, and June 30, 102
2017, rates shall not exceed those in effect for the period ending June 103
30, 2015, except the rate paid to a facility may be higher than the rate 104
paid to the facility for the period ending June 30, 2015, if a capital 105
improvement approved by the Department of Developmental Services, 106
in consultation with the Department of Social Services, for the health 107
or safety of the residents was made to the facility during the fiscal year 108
ending June 30, 2016, or June 30, 2017, to the extent such rate increases 109
are within available appropriations. For the fiscal years ending June 30, 110
2016, and June 30, 2017, and each succeeding fiscal year, any facility 111
that would have been issued a lower rate, due to interim rate status, a 112
change in allowable fair rent or agreement with the department, shall 113
be issued such lower rate. For the fiscal years ending June 30, 2018, and 114
June 30, 2019, rates shall not exceed those in effect for the period 115
ending June 30, 2017, except the rate paid to a facility may be higher 116
than the rate paid to the facility for the period ending June 30, 2017, if a 117
capital improvement approved by the Department of Developmental 118
Services, in consultation with the Department of Social Services, for the 119
health or safety of the residents was made to the facility during the 120
fiscal year ending June 30, 2018, or June 30, 2019, to the extent such rate 121
increases are within available appropriations. For the fiscal years 122 Substitute Bill No. 1109
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ending June 30, 2020, and June 30, 2021, rates shall not exceed those in 123
effect for the fiscal year ending June 30, 2019, except the rate paid to a 124
facility may be higher than the rate paid to the facility for the fiscal 125
year ending June 30, 2019, if a capital improvement approved by the 126
Department of Developmental Services, in consultation with the 127
Department of Social Services, for the health or safety of the residents 128
was made to the facility during the fiscal year ending June 30, 2020, or 129
June 30, 2021, to the extent such rate increases are within available 130
appropriations. For the fiscal years ending June 30, 2022, and June 30, 131
2023, rates shall be based upon rates in effect for the fiscal year ending 132
June 30, 2021, inflated by the gross domestic product deflator 133
applicable to each rate year, except the commissioner may, in the 134
commissioner's discretion and within available appropriations, 135
provide pro rata fair rent increases to facilities which have 136
documented fair rent additions placed in service in the cost report 137
years ending September 30, 2020, and September 30, 2021, that are not 138
otherwise included in rates issued, or if a rate adjustment for a capital 139
improvement approved by the Department of Developmental Services, 140
in consultation with the Department of Social Services, for the health 141
or safety of the residents was made to the facility during the fiscal year 142
ending June 30, 2022, or June 30, 2023. 143
(b) Notwithstanding the provisions of subsection (a) of this section, 144
state rates of payment for the fiscal years ending June 30, 2018, June 30, 145
2019, June 30, 2020, and June 30, 2021, for residential care homes and 146
community living arrangements that receive the flat rate for residential 147
services under section 17-311-54 of the regulations of Connecticut state 148
agencies shall be set in accordance with section 298 of public act 19-149
117. For the fiscal years ending June 30, 2022, and June 30, 2023, rates 150
shall be based upon rates in effect for the fiscal year ending June 30, 151
2021, inflated by the gross domestic product deflator applicable to each 152
rate year. 153
(c) For the fiscal year ending June 30, 2024, and each subsequent 154
fiscal year, the commissioner may, in the commissioner's discretion 155 Substitute Bill No. 1109
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and within available appropriations, provide pro rata fair rent 156
increases to facilities which have documented fair rent additions 157
placed in service in the cost report years that are not otherwise 158
included in rates issued. 159
[(c)] (d) The Commissioner of Social Services and the Commissioner 160
of Developmental Services shall adopt regulations in accordance with 161
the provisions of chapter 54 to implement the provisions of this 162
section. 163
Sec. 2. Subsection (h) of section 17b-340 of the general statutes is 164
repealed and the following is substituted in lieu thereof (Effective July 165
1, 2023): 166
(h) (1) For the fiscal year ending June 30, 1993, any intermediate care 167
facility for individuals with intellectual disabilities with an operating 168
cost component of its rate in excess of one hundred forty per cent of 169
the median of operating cost components of rates in effect January 1, 170
1992, shall not receive an operating cost component increase. For the 171
fiscal year ending June 30, 1993, any intermediate care facility for 172
individuals with intellectual disabilities with an operating cost 173
component of its rate that is less than one hundred forty per cent of the 174
median of operating cost components of rates in effect January 1, 1992, 175
shall have an allowance for real wage growth equal to thirty per cent 176
of the increase determined in accordance with subsection (q) of section 177
17-311-52 of the regulations of Connecticut state agencies, provided 178
such operating cost component shall not exceed one hundred forty per 179
cent of the median of operating cost components in effect January 1, 180
1992. Any facility with real property other than land placed in service 181
prior to October 1, 1991, shall, for the fiscal year ending June 30, 1995, 182
receive a rate of return on real property equal to the average of the 183
rates of return applied to real property other than land placed in 184
service for the five years preceding October 1, 1993. For the fiscal year 185
ending June 30, 1996, and any succeeding fiscal year, the rate of return 186
on real property for property items shall be revised every five years. 187
The commissioner shall, upon submission of a request, allow actual 188 Substitute Bill No. 1109
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debt service, comprised of principal and interest, in excess of property 189
costs allowed pursuant to section 17-311-52 of the regulations of 190
Connecticut state agencies, provided such debt service terms and 191
amounts are reasonable in relation to the useful life and the base value 192
of the property. For the fiscal year ending June 30, 1995, and any 193
succeeding fiscal year, the inflation adjustment made in accordance 194
with subsection (p) of section 17-311-52 of the regulations of 195
Connecticut state agencies shall not be applied to real property costs. 196
For the fiscal year ending June 30, 1996, and any succeeding fiscal year, 197
the allowance for real wage growth, as determined in accordance with 198
subsection (q) of section 17-311-52 of the regulations of Connecticut 199
state agencies, shall not be applied. For the fiscal year ending June 30, 200
1996, and any succeeding fiscal year, no rate shall exceed three 201
hundred seventy-five dollars per day unless the commissioner, in 202
consultation with the Commissioner of Developmental Services, 203
determines after a review of program and management costs, that a 204
rate in excess of this amount is necessary for care and treatment of 205
facility residents. For the fiscal year ending June 30, 2002, rate period, 206
the Commissioner of Social Services shall increase the inflation 207
adjustment for rates made in accordance with subsection (p) of section 208
17-311-52 of the regulations of Connecticut state agencies to update 209
allowable fiscal year 2000 costs to include a three and one-half per cent 210
inflation factor. For the fiscal year ending June 30, 2003, rate period, the 211
commissioner shall increase the inflation adjustment for rates made in 212
accordance with subsection (p) of section 17-311-52 of the regulations 213
of Connecticut state agencies to update allowable fiscal year 2001 costs 214
to include a one and one-half per cent inflation factor, except that such 215
increase shall be effective November 1, 2002, and such facility rate in 216
effect for the fiscal year ending June 30, 2002, shall be paid for services 217
provided until October 31, 2002, except any facility that would have 218
been issued a lower rate effective July 1, 2002, than for the fiscal year 219
ending June 30, 2002, due to interim rate status or agreement with the 220
department shall be issued such lower rate effective July 1, 2002, and 221
have such rate updated effective November 1, 2002, in accordance with 222
applicable statutes and regulations. For the fiscal year ending June 30, 223 Substitute Bill No. 1109
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2004, rates in effect for the period ending June 30, 2003, shall remain in 224
effect, except any facility that would have been issued a lower rate 225
effective July 1, 2003, than for the fiscal year ending June 30, 2003, due 226
to interim rate status or agreement with the department shall be issued 227
such lower rate effective July 1, 2003. For the fiscal year ending June 228
30, 2005, rates in effect for the period ending June 30, 2004, shall 229
remain in effect until September 30, 2004. Effective October 1, 2004, 230
each facility shall receive a rate that is five per cent greater than the 231
rate in effect September 30, 2004. Effective upon receipt of all the 232
necessary federal approvals to secure federal financial participation 233
matching funds associated with the rate increase provided in 234
subdivision (4) of subsection (f) of this section, but in no event earlier 235
than October 1, 2005, and provided the user fee imposed under section 236
17b-320 is required to be collected, each facility shall receive a rate that 237
is four per cent more than the rate the facility received in the prior 238
fiscal year, except any facility that would have been issued a lower rate 239
effective October 1, 2005, than for the fiscal year ending June 30, 2005, 240
due to interim rate status or agreement with the department, shall be 241
issued such lower rate effective October 1, 2005. Such rate increase 242
shall remain in effect unless: [(1)] (A) The federal financial 243
participation matching funds associated with the rate increase are no 244
longer available; or [(2)] (B) the user fee created pursuant to section 245
17b-320 is not in effect. For the fiscal year ending June 30, 2007, rates in 246
effect for the period ending June 30, 2006, shall remain in effect until 247
September 30, 2006, except any facility that would have been issued a 248
lower rate effective July 1, 2006, than for the fiscal year ending June 30, 249
2006, due to interim rate status or agreement with the department, 250
shall be issued such lower rate effective July 1, 2006. Effective October 251
1, 2006, no facility shall receive a rate that is more than three per cent 252
greater than the rate in effect for the facility on September 30, 2006, 253
except any facility that would have been issued a lower rate effective 254
October 1, 2006, due to interim rate status or agreement with the 255
department, shall be issued such lower rate effective October 1, 2006. 256
For the fiscal year ending June 30, 2008, each facility shall receive a rate 257
that is two and nine-tenths per cent greater than the rate in effect for 258 Substitute Bill No. 1109
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the period ending June 30, 2007, except any facility that would have 259
been issued a lower rate effective July 1, 2007, than for the rate period 260
ending June 30, 2007, due to interim rate status, or agreement with the 261
department, shall be issued such lower rate effective July 1, 2007. For 262
the fiscal year ending June 30, 2009, rates in effect for the period 263
ending June 30, 2008, shall remain in effect until June 30, 2009, except 264
any facility that would have been issued a lower rate for the fiscal year 265
ending June 30, 2009, due to interim rate status or agreement with the 266
department, shall be issued such lower rate. For the fiscal years ending 267
June 30, 2010, and June 30, 2011, rates in effect for the period ending 268
June 30, 2009, shall remain in effect until June 30, 2011, except any 269
facility that would have been issued a lower rate for the fiscal year 270
ending June 30, 2010, or the fiscal year ending June 30, 2011, due to 271
interim rate status or agreement with the department, shall be issued 272
such lower rate. For the fiscal year ending June 30, 2012, rates in effect 273
for the period ending June 30, 2011, shall remain in effect until June 30, 274
2012, except any facility that would have been issued a lower rate for 275
the fiscal year ending June 30, 2012, due to interim rate status or 276
agreement with the department, shall be issued such lower rate. For 277
the fiscal years ending June 30, 2014, and June 30, 2015, rates shall not 278
exceed those in effect for the period ending June 30, 2013, except the 279
rate paid to a facility may be higher than the rate paid to the facility for 280
the period ending June 30, 2013, if a capital improvement approved by 281
the Department of Developmental Services, in consultation with the 282
Department of Social Services, for the health or safety of the residents 283
was made to the facility during the fiscal year ending June 30, 2014, or 284
June 30, 2015, to the extent such rate increases are within available 285
appropriations. Any facility that would have been issued a lower rate 286
for the fiscal year ending June 30, 2014, or the fiscal year ending June 287
30, 2015, due to interim rate status or agreement with the department, 288
shall be issued such lower rate. For the fiscal years ending June 30, 289
2016, and June 30, 2017, rates shall not exceed those in effect for the 290
period ending June 30, 2015, except the rate paid to a facility may be 291
higher than the rate paid to the facility for the period ending June 30, 292
2015, if a capital improvement approved by the Department of 293 Substitute Bill No. 1109
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Developmental Services, in consultation with the Department of Social 294
Services, for the health or safety of the residents was made to the 295
facility during the fiscal year ending June 30, 2016, or June 30, 2017, to 296
the extent such rate increases are within available appropriations. For 297
the fiscal years ending June 30, 2016, and June 30, 2017, and each 298
succeeding fiscal year, any facility that would have been issued a 299
lower rate, due to interim rate status, a change in allowable fair rent or 300
agreement with the department, shall be issued such lower rate. For 301
the fiscal years ending June 30, 2018, and June 30, 2019, rates shall not 302
exceed those in effect for the period ending June 30, 2017, except the 303
rate paid to a facility may be higher than the rate paid to the facility for 304
the period ending June 30, 2017, if a capital improvement approved by 305
the Department of Developmental Services, in consultation with the 306
Department of Social Services, for the health or safety of the residents 307
was made to the facility during the fiscal year ending June 30, 2018, or 308
June 30, 2019, only to the extent such rate increases are within available 309
appropriations. For the fiscal years ending June 30, 2020, and June 30, 310
2021, rates shall not exceed those in effect for the fiscal year ending 311
June 30, 2019, except the rate paid to a facility may be higher than the 312
rate paid to the facility for the fiscal year ending June 30, 2019, if a 313
capital improvement approved by the Department of Developmental 314
Services, in consultation with the Department of Social Services, for the 315
health or safety of the residents was made to the facility during the 316
fiscal year ending June 30, 2020, or June 30, 2021, only to the extent 317
such rate increases are within available appropriations. For the fiscal 318
year ending June 30, 2022, rates shall not exceed those in effect for the 319
fiscal year ending June 30, 2021, except the commissioner may, in the 320
commissioner's discretion and within available appropriations, 321
provide pro rata fair rent increases to facilities that have documented 322
fair rent additions placed in service in the cost report year ending 323
September 30, 2020, that are not otherwise included in rates issued. For 324
the fiscal year ending June 30, 2023, rates shall not exceed those in 325
effect for the fiscal year ending June 30, 2022, except the commissioner 326
may, in the commissioner's discretion and within available 327
appropriations, provide pro rata fair rent increases to facilities which 328 Substitute Bill No. 1109
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have documented fair rent additions placed in service in the cost 329
report year ending September 30, 2021, that are not otherwise included 330
in rates issued. For the fiscal years ending June 30, 2022, and June 30, 331
2023, a facility may receive a rate increase for a capital improvement 332
approved by the Department of Developmental Services, in 333
consultation with the Department of Social Services, for the health or 334
safety of the residents during the fiscal year ending June 30, 2022, or 335
June 30, 2023, only to the extent such rate increases are within available 336
appropriations. Any facility that has a significant decrease in land and 337
building costs shall receive a reduced rate to reflect such decrease in 338
land and building costs. For the fiscal years ending June 30, 2012, June 339
30, 2013, June 30, 2014, June 30, 2015, June 30, 2016, June 30, 2017, June 340
30, 2018, June 30, 2019, June 30, 2020, June 30, 2021, June 30, 2022, and 341
June 30, 2023, the Commissioner of Social Services may provide fair 342
rent increases to any facility that has undergone a material change in 343
circumstances related to fair rent and has an approved certificate of 344
need pursuant to section 17b-352, 17b-353, 17b-354 or 17b-355. 345
Notwithstanding the provisions of this section, the Commissioner of 346
Social Services may, within available appropriations, increase or 347
decrease rates issued to intermediate care facilities for individuals with 348
intellectual disabilities to reflect a reduction in available 349
appropriations as provided in subsection (a) of this section. For the 350
fiscal years ending June 30, 2014, and June 30, 2015, the commissioner 351
shall not consider rebasing in determining rates. Notwithstanding the 352
provisions of this subsection, effective July 1, 2021, and July 1, 2022, the 353
commissioner shall, within available appropriations, increase rates for 354
the purpose of wage and benefit enhancements for employees of 355
intermediate care facilities. Facilities that receive a rate adjustment for 356
the purpose of wage and benefit enhancements but do not provide 357
increases in employee salaries as described in this subsection on or 358
before July 31, 2021, and July 31, 2022, respectively, may be subject to a 359
rate decrease in the same amount as the adjustment by the 360
commissioner. There shall be no increase to rates based on inflation or 361
any inflationary factor for the fiscal years ending June 30, 2022, and 362
June 30, 2023. Notwithstanding any other provisions of the general 363 Substitute Bill No. 1109
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statutes or regulations adopted thereunder, any subsequent increase to 364
rates based on inflation as authorized for any succeeding fiscal year 365
shall be adjusted as determined by the commissioner. The rate of 366
inflation shall be computed based on the percentage increase, if any, in 367
the most recent calendar year average in the gross domestic product 368
deflator over the average for the previous calendar year. Any increase 369
to rates based on inflation shall be applied prior to the application of 370
any other budget adjustment factors that may impact such rates. 371
(2) The Commissioner of Social Services shall determine whether 372
and to what extent a change in ownership of a facility shall occasion 373
the rebasing of the facility's costs. There shall be no inflation 374
adjustment during a year in which a facility's rates are rebased. For the 375
fiscal year ending June 30, 2024, and each subsequent fiscal year, the 376
commissioner may, in the commissioner's discretion and within 377
available appropriations, provide pro rata fair rent increases to 378
facilities which have documented fair rent additions placed in service 379
in the cost report years that are not otherwise included in rates issued. 380
Sec. 3. Subsection (i) of section 17b-340 of the general statutes is 381
repealed and the following is substituted in lieu thereof (Effective July 382
1, 2023): 383
(i) For the fiscal year ending June 30, 1993, any residential care home 384
with an operating cost component of its rate in excess of one hundred 385
thirty per cent of the median of operating cost components of rates in 386
effect January 1, 1992, shall not receive an operating cost component 387
increase. For the fiscal year ending June 30, 1993, any residential care 388
home with an operating cost component of its rate that is less than one 389
hundred thirty per cent of the median of operating cost components of 390
rates in effect January 1, 1992, shall have an allowance for real wage 391
growth equal to sixty-five per cent of the increase determined in 392
accordance with subsection (q) of section 17-311-52 of the regulations 393
of Connecticut state agencies, provided such operating cost component 394
shall not exceed one hundred thirty per cent of the median of 395
operating cost components in effect January 1, 1992. Beginning with 396 Substitute Bill No. 1109
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the fiscal year ending June 30, 1993, for the purpose of determining 397
allowable fair rent, a residential care home with allowable fair rent less 398
than the twenty-fifth percentile of the state-wide allowable fair rent 399
shall be reimbursed as having allowable fair rent equal to the twenty-400
fifth percentile of the state-wide allowable fair rent. Beginning with the 401
fiscal year ending June 30, 1997, a residential care home with allowable 402
fair rent less than three dollars and ten cents per day shall be 403
reimbursed as having allowable fair rent equal to three dollars and ten 404
cents per day. Property additions placed in service during the cost year 405
ending September 30, 1996, or any succeeding cost year shall receive a 406
fair rent allowance for such additions as an addition to three dollars 407
and ten cents per day if the fair rent for the facility for property placed 408
in service prior to September 30, 1995, is less than or equal to three 409
dollars and ten cents per day. Beginning with the fiscal year ending 410
June 30, 2016, a residential care home shall be reimbursed the greater 411
of the allowable accumulated fair rent reimbursement associated with 412
real property additions and land as calculated on a per day basis or 413
three dollars and ten cents per day if the allowable reimbursement 414
associated with real property additions and land is less than three 415
dollars and ten cents per day. For the fiscal year ending June 30, 1996, 416
and any succeeding fiscal year, the allowance for real wage growth, as 417
determined in accordance with subsection (q) of section 17-311-52 of 418
the regulations of Connecticut state agencies, shall not be applied. For 419
the fiscal year ending June 30, 1996, and any succeeding fiscal year, the 420
inflation adjustment made in accordance with subsection (p) of section 421
17-311-52 of the regulations of Connecticut state agencies shall not be 422
applied to real property costs. Beginning with the fiscal year ending 423
June 30, 1997, minimum allowable patient days for rate computation 424
purposes for a residential care home with twenty-five beds or less shall 425
be eighty-five per cent of licensed capacity. Beginning with the fiscal 426
year ending June 30, 2002, for the purposes of determining the 427
allowable salary of an administrator of a residential care home with 428
sixty beds or less the department shall revise the allowable base salary 429
to thirty-seven thousand dollars to be annually inflated thereafter in 430
accordance with section 17-311-52 of the regulations of Connecticut 431 Substitute Bill No. 1109
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state agencies. The rates for the fiscal year ending June 30, 2002, shall 432
be based upon the increased allowable salary of an administrator, 433
regardless of whether such amount was expended in the 2000 cost 434
report period upon which the rates are based. Beginning with the fiscal 435
year ending June 30, 2000, and until the fiscal year ending June 30, 436
2009, inclusive, the inflation adjustment for rates made in accordance 437
with subsection (p) of section 17-311-52 of the regulations of 438
Connecticut state agencies shall be increased by two per cent, and 439
beginning with the fiscal year ending June 30, 2002, the inflation 440
adjustment for rates made in accordance with subsection (c) of said 441
section shall be increased by one per cent. Beginning with the fiscal 442
year ending June 30, 1999, for the purpose of determining the 443
allowable salary of a related party, the department shall revise the 444
maximum salary to twenty-seven thousand eight hundred fifty-six 445
dollars to be annually inflated thereafter in accordance with section 17-446
311-52 of the regulations of Connecticut state agencies and beginning 447
with the fiscal year ending June 30, 2001, such allowable salary shall be 448
computed on an hourly basis and the maximum number of hours 449
allowed for a related party other than the proprietor shall be increased 450
from forty hours to forty-eight hours per work week. For the fiscal 451
year ending June 30, 2005, each facility shall receive a rate that is two 452
and one-quarter per cent more than the rate the facility received in the 453
prior fiscal year, except any facility that would have been issued a 454
lower rate effective July 1, 2004, than for the fiscal year ending June 30, 455
2004, due to interim rate status or agreement with the department shall 456
be issued such lower rate effective July 1, 2004. Effective upon receipt 457
of all the necessary federal approvals to secure federal financial 458
participation matching funds associated with the rate increase 459
provided in subdivision (4) of subsection (f) of this section, but in no 460
event earlier than October 1, 2005, and provided the user fee imposed 461
under section 17b-320 is required to be collected, each facility shall 462
receive a rate that is determined in accordance with applicable law and 463
subject to appropriations, except any facility that would have been 464
issued a lower rate effective October 1, 2005, than for the fiscal year 465
ending June 30, 2005, due to interim rate status or agreement with the 466 Substitute Bill No. 1109
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department, shall be issued such lower rate effective October 1, 2005. 467
Such rate increase shall remain in effect unless: (1) The federal financial 468
participation matching funds associated with the rate increase are no 469
longer available; or (2) the user fee created pursuant to section 17b-320 470
is not in effect. For the fiscal year ending June 30, 2007, rates in effect 471
for the period ending June 30, 2006, shall remain in effect until 472
September 30, 2006, except any facility that would have been issued a 473
lower rate effective July 1, 2006, than for the fiscal year ending June 30, 474
2006, due to interim rate status or agreement with the department, 475
shall be issued such lower rate effective July 1, 2006. Effective October 476
1, 2006, no facility shall receive a rate that is more than four per cent 477
greater than the rate in effect for the facility on September 30, 2006, 478
except for any facility that would have been issued a lower rate 479
effective October 1, 2006, due to interim rate status or agreement with 480
the department, shall be issued such lower rate effective October 1, 481
2006. For the fiscal years ending June 30, 2010, and June 30, 2011, rates 482
in effect for the period ending June 30, 2009, shall remain in effect until 483
June 30, 2011, except any facility that would have been issued a lower 484
rate for the fiscal year ending June 30, 2010, or the fiscal year ending 485
June 30, 2011, due to interim rate status or agreement with the 486
department, shall be issued such lower rate, except (A) any facility that 487
would have been issued a lower rate for the fiscal year ending June 30, 488
2010, or the fiscal year ending June 30, 2011, due to interim rate status 489
or agreement with the Commissioner of Social Services shall be issued 490
such lower rate; and (B) the commissioner may increase a facility's rate 491
for reasonable costs associated with such facility's compliance with the 492
provisions of section 19a-495a concerning the administration of 493
medication by unlicensed personnel. For the fiscal year ending June 30, 494
2012, rates in effect for the period ending June 30, 2011, shall remain in 495
effect until June 30, 2012, except that (i) any facility that would have 496
been issued a lower rate for the fiscal year ending June 30, 2012, due to 497
interim rate status or agreement with the Commissioner of Social 498
Services shall be issued such lower rate; and (ii) the commissioner may 499
increase a facility's rate for reasonable costs associated with such 500
facility's compliance with the provisions of section 19a-495a 501 Substitute Bill No. 1109
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concerning the administration of medication by unlicensed personnel. 502
For the fiscal year ending June 30, 2013, the Commissioner of Social 503
Services may, within available appropriations, provide a rate increase 504
to a residential care home. Any facility that would have been issued a 505
lower rate for the fiscal year ending June 30, 2013, due to interim rate 506
status or agreement with the Commissioner of Social Services shall be 507
issued such lower rate. For the fiscal years ending June 30, 2012, and 508
June 30, 2013, the Commissioner of Social Services may provide fair 509
rent increases to any facility that has undergone a material change in 510
circumstances related to fair rent and has an approved certificate of 511
need pursuant to section 17b-352, 17b-353, 17b-354 or 17b-355. For the 512
fiscal years ending June 30, 2014, and June 30, 2015, for those facilities 513
that have a calculated rate greater than the rate in effect for the fiscal 514
year ending June 30, 2013, the commissioner may increase facility rates 515
based upon available appropriations up to a stop gain as determined 516
by the commissioner. No facility shall be issued a rate that is lower 517
than the rate in effect on June 30, 2013, except that any facility that 518
would have been issued a lower rate for the fiscal year ending June 30, 519
2014, or the fiscal year ending June 30, 2015, due to interim rate status 520
or agreement with the commissioner, shall be issued such lower rate. 521
For the fiscal year ending June 30, 2014, and each fiscal year thereafter, 522
a residential care home shall receive a rate increase for any capital 523
improvement made during the fiscal year for the health and safety of 524
residents and approved by the Department of Social Services, 525
provided such rate increase is within available appropriations. For the 526
fiscal year ending June 30, 2015, and each succeeding fiscal year 527
thereafter, costs of less than ten thousand dollars that are incurred by a 528
facility and are associated with any land, building or nonmovable 529
equipment repair or improvement that are reported in the cost year 530
used to establish the facility's rate shall not be capitalized for a period 531
of more than five years for rate-setting purposes. For the fiscal year 532
ending June 30, 2015, subject to available appropriations, the 533
commissioner may, at the commissioner's discretion: Increase the 534
inflation cost limitation under subsection (c) of section 17-311-52 of the 535
regulations of Connecticut state agencies, provided such inflation 536 Substitute Bill No. 1109
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allowance factor does not exceed a maximum of five per cent; establish 537
a minimum rate of return applied to real property of five per cent 538
inclusive of assets placed in service during cost year 2013; waive the 539
standard rate of return under subsection (f) of section 17-311-52 of the 540
regulations of Connecticut state agencies for ownership changes or 541
health and safety improvements that exceed one hundred thousand 542
dollars and that are required under a consent order from the 543
Department of Public Health; and waive the rate of return adjustment 544
under subsection (f) of section 17-311-52 of the regulations of 545
Connecticut state agencies to avoid financial hardship. For the fiscal 546
years ending June 30, 2016, and June 30, 2017, rates shall not exceed 547
those in effect for the period ending June 30, 2015, except the 548
commissioner may, in the commissioner's discretion and within 549
available appropriations, provide pro rata fair rent increases to 550
facilities which have documented fair rent additions placed in service 551
in cost report years ending September 30, 2014, and September 30, 552
2015, that are not otherwise included in rates issued. For the fiscal 553
years ending June 30, 2016, and June 30, 2017, and each succeeding 554
fiscal year, any facility that would have been issued a lower rate, due 555
to interim rate status, a change in allowable fair rent or agreement with 556
the department, shall be issued such lower rate. For the fiscal year 557
ending June 30, 2018, rates shall not exceed those in effect for the 558
period ending June 30, 2017, except the commissioner may, in the 559
commissioner's discretion and within available appropriations, 560
provide pro rata fair rent increases to facilities which have 561
documented fair rent additions placed in service in the cost report year 562
ending September 30, 2016, that are not otherwise included in rates 563
issued. For the fiscal year ending June 30, 2019, rates shall not exceed 564
those in effect for the period ending June 30, 2018, except the 565
commissioner may, in the commissioner's discretion and within 566
available appropriations, provide pro rata fair rent increases to 567
facilities which have documented fair rent additions placed in service 568
in the cost report year ending September 30, 2017, that are not 569
otherwise included in rates issued. For the fiscal year ending June 30, 570
2020, rates shall not exceed those in effect for the fiscal year ending 571 Substitute Bill No. 1109
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June 30, 2019, except the commissioner may, in the commissioner's 572
discretion and within available appropriations, provide pro rata fair 573
rent increases to facilities which have documented fair rent additions 574
placed in service in the cost report year ending September 30, 2018, 575
that are not otherwise included in rates issued. For the fiscal year 576
ending June 30, 2021, rates shall not exceed those in effect for the fiscal 577
year ending June 30, 2020, except the commissioner may, in the 578
commissioner's discretion and within available appropriations, 579
provide pro rata fair rent increases to facilities which have 580
documented fair rent additions placed in service in the cost report year 581
ending September 30, 2019, that are not otherwise included in rates 582
issued. For the fiscal year ending June 30, 2022, the commissioner may, 583
in the commissioner's discretion and within available appropriations, 584
provide pro rata fair rent increases to facilities that have documented 585
fair rent additions placed in service in the cost report year ending 586
September 30, 2020, that are not otherwise included in rates issued. For 587
the fiscal year ending June 30, 2023, the commissioner may, in the 588
commissioner's discretion and within available appropriations, 589
provide pro rata fair rent increases to facilities which have 590
documented fair rent additions placed in service in the cost report year 591
ending September 30, 2021, that are not otherwise included in rates 592
issued. For the fiscal years ending June 30, 2022, and June 30, 2023, a 593
facility may receive a rate increase for a capital improvement approved 594
by the Department of Social Services, for the health or safety of the 595
residents during the fiscal year ending June 30, 2022, or June 30, 2023, 596
only to the extent such rate increases are within available 597
appropriations. For the fiscal year ending June 30, 2022, and June 30, 598
2023, rates shall be based upon rates in effect for the fiscal year ending 599
June 30, 2021, inflated by the gross domestic product deflator 600
applicable to each rate year, except the commissioner may, in the 601
commissioner's discretion and within available appropriations, 602
provide pro rata fair rent increases to facilities which have 603
documented fair rent additions placed in service in the cost report 604
years ending September 30, 2020, and September 30, 2021, that are not 605
otherwise included in rates issued. Notwithstanding any other 606 Substitute Bill No. 1109
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provisions of the general statutes or regulations adopted thereunder, 607
any subsequent increase to rates based on inflation as authorized for 608
any succeeding fiscal year shall be adjusted as determined by the 609
commissioner. The rate of inflation shall be computed based on the 610
percentage increase, if any, in the most recent calendar year average in 611
the gross domestic product deflator over the average for the previous 612
calendar year. Any increase to rates based on inflation shall be applied 613
prior to the application of any other budget adjustment factors that 614
may impact such rates. The commissioner shall determine whether 615
and to what extent a change in ownership of a facility shall occasion 616
the rebasing of the facility's costs. There shall be no inflation 617
adjustment during a year in which a facility's rates are rebased. 618
Sec. 4. Subsection (a) of section 17b-340 of the general statutes is 619
repealed and the following is substituted in lieu thereof (Effective from 620
passage): 621
(a) For purposes of this subsection, (1) a "related party" includes, but 622
is not limited to, any company related to a chronic and convalescent 623
nursing home through family association, common ownership, control 624
or business association with any of the owners, operators or officials of 625
such nursing home; (2) "company" means any person, partnership, 626
association, holding company, limited liability company or 627
corporation; (3) "family association" means a relationship by birth, 628
marriage or domestic partnership; and (4) "profit and loss statement" 629
means the most recent annual statement on profits and losses finalized 630
by a related party before the annual report mandated under this 631
subsection. The rates to be paid by or for persons aided or cared for by 632
the state or any town in this state to licensed chronic and convalescent 633
nursing homes, to chronic disease hospitals associated with chronic 634
and convalescent nursing homes, to rest homes with nursing 635
supervision, to licensed residential care homes, as defined by section 636
19a-490, and to residential facilities for persons with intellectual 637
disability that are licensed pursuant to section 17a-227 and certified to 638
participate in the Title XIX Medicaid program as intermediate care 639 Substitute Bill No. 1109
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facilities for individuals with intellectual disabilities, for room, board 640
and services specified in licensing regulations issued by the licensing 641
agency shall be determined annually, except as otherwise provided in 642
this subsection by the Commissioner of Social Services, to be effective 643
July first of each year except as otherwise provided in this subsection. 644
Such rates shall be determined on a basis of a reasonable payment for 645
such necessary services, which basis shall take into account as a factor 646
the costs of such services. Cost of such services shall include 647
reasonable costs mandated by collective bargaining agreements with 648
certified collective bargaining agents or other agreements between the 649
employer and employees, provided "employees" shall not include 650
persons employed as managers or chief administrators or required to 651
be licensed as nursing home administrators, and compensation for 652
services rendered by proprietors at prevailing wage rates, as 653
determined by application of principles of accounting as prescribed by 654
said commissioner. Cost of such services shall not include amounts 655
paid by the facilities to employees as salary, or to attorneys or 656
consultants as fees, where the responsibility of the employees, 657
attorneys, or consultants is to persuade or seek to persuade the other 658
employees of the facility to support or oppose unionization. Nothing 659
in this subsection shall prohibit inclusion of amounts paid for legal 660
counsel related to the negotiation of collective bargaining agreements, 661
the settlement of grievances or normal administration of labor 662
relations. The commissioner may, in the commissioner's discretion, 663
allow the inclusion of extraordinary and unanticipated costs of 664
providing services that were incurred to avoid an immediate negative 665
impact on the health and safety of patients. The commissioner may, in 666
the commissioner's discretion, based upon review of a facility's costs, 667
direct care staff to patient ratio and any other related information, 668
revise a facility's rate for any increases or decreases to total licensed 669
capacity of more than ten beds or changes to its number of licensed 670
rest home with nursing supervision beds and chronic and convalescent 671
nursing home beds. The commissioner may, in the commissioner's 672
discretion, revise the rate of a facility that is closing. An interim rate 673
issued for the period during which a facility is closing shall be based 674 Substitute Bill No. 1109
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on a review of facility costs, the expected duration of the close-down 675
period, the anticipated impact on Medicaid costs, available 676
appropriations and the relationship of the rate requested by the facility 677
to the average Medicaid rate for a close-down period. The 678
commissioner may so revise a facility's rate established for the fiscal 679
year ending June 30, 1993, and thereafter for any bed increases, 680
decreases or changes in licensure effective after October 1, 1989. 681
Effective July 1, 1991, in facilities that have both a chronic and 682
convalescent nursing home and a rest home with nursing supervision, 683
the rate for the rest home with nursing supervision shall not exceed 684
such facility's rate for its chronic and convalescent nursing home. All 685
such facilities for which rates are determined under this subsection 686
shall report on a fiscal year basis ending on September thirtieth. Such 687
report shall be submitted to the commissioner by February fifteenth. 688
Each for-profit chronic and convalescent nursing home that receives 689
state funding pursuant to this section shall include in such annual 690
report a profit and loss statement from each related party that receives 691
from such chronic and convalescent nursing home fifty thousand 692
dollars or more per year for goods, fees and services. No cause of 693
action or liability shall arise against the state, the Department of Social 694
Services, any state official or agent for failure to take action based on 695
the information required to be reported under this subsection. The 696
commissioner may reduce the rate in effect for a facility that fails to 697
submit a complete and accurate report on or before February fifteenth 698
by an amount not to exceed ten per cent of such rate. If a licensed 699
residential care home fails to submit a complete and accurate report, 700
the department shall notify such home of the failure and the home 701
shall have thirty days from the date the notice was issued to submit a 702
complete and accurate report. If a licensed residential care home fails 703
to submit a complete and accurate report not later than thirty days 704
after the date of notice, such home may not receive a retroactive rate 705
increase, in the commissioner's discretion. The commissioner shall, 706
annually, on or before April first, report the data contained in the 707
reports of such facilities on the department's Internet web site. For the 708
cost reporting year commencing October 1, 1985, and for subsequent 709 Substitute Bill No. 1109
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cost reporting years, facilities shall report the cost of using the services 710
of any nursing personnel supplied by a temporary nursing services 711
agency by separating said cost into two categories, the portion of the 712
cost equal to the salary of the employee for whom the nursing 713
personnel supplied by a temporary nursing services agency is 714
substituting shall be considered a nursing cost and any cost in excess 715
of such salary shall be further divided so that seventy-five per cent of 716
the excess cost shall be considered an administrative or general cost 717
and twenty-five per cent of the excess cost shall be considered a 718
nursing cost, provided if the total costs of a facility for nursing 719
personnel supplied by a temporary nursing services agency in any cost 720
year are equal to or exceed fifteen per cent of the total nursing 721
expenditures of the facility for such cost year, no portion of such costs 722
in excess of fifteen per cent shall be classified as administrative or 723
general costs. The commissioner, in determining such rates, shall also 724
take into account the classification of patients or boarders according to 725
special care requirements or classification of the facility according to 726
such factors as facilities and services and such other factors as the 727
commissioner deems reasonable, including anticipated fluctuations in 728
the cost of providing such services. The commissioner may establish a 729
separate rate for a facility or a portion of a facility for traumatic brain 730
injury patients who require extensive care but not acute general 731
hospital care. Such separate rate shall reflect the special care 732
requirements of such patients. If changes in federal or state laws, 733
regulations or standards adopted subsequent to June 30, 1985, result in 734
increased costs or expenditures in an amount exceeding one-half of 735
one per cent of allowable costs for the most recent cost reporting year, 736
the commissioner shall adjust rates and provide payment for any such 737
increased reasonable costs or expenditures within a reasonable period 738
of time retroactive to the date of enforcement. Nothing in this section 739
shall be construed to require the Department of Social Services to 740
adjust rates and provide payment for any increases in costs resulting 741
from an inspection of a facility by the Department of Public Health. 742
Such assistance as the commissioner requires from other state agencies 743
or departments in determining rates shall be made available to the 744 Substitute Bill No. 1109
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commissioner at the commissioner's request. Payment of the rates 745
established pursuant to this section shall be conditioned on the 746
establishment by such facilities of admissions procedures that conform 747
with this section, section 19a-533 and all other applicable provisions of 748
the law and the provision of equality of treatment to all persons in 749
such facilities. The established rates shall be the maximum amount 750
chargeable by such facilities for care of such beneficiaries, and the 751
acceptance by or on behalf of any such facility of any additional 752
compensation for care of any such beneficiary from any other person 753
or source shall constitute the offense of aiding a beneficiary to obtain 754
aid to which the beneficiary is not entitled and shall be punishable in 755
the same manner as is provided in subsection (b) of section 17b-97. 756
Notwithstanding any provision of this section, the Commissioner of 757
Social Services may, within available appropriations, provide an 758
interim rate increase for a licensed chronic and convalescent nursing 759
home or a rest home with nursing supervision for rate periods no 760
earlier than April 1, 2004, only if the commissioner determines that the 761
increase is necessary to avoid the filing of a petition for relief under 762
Title 11 of the United States Code; imposition of receivership pursuant 763
to sections 19a-542 and 19a-543; or substantial deterioration of the 764
facility's financial condition that may be expected to adversely affect 765
resident care and the continued operation of the facility, and the 766
commissioner determines that the continued operation of the facility is 767
in the best interest of the state. The commissioner shall consider any 768
requests for interim rate increases on file with the department from 769
March 30, 2004, and those submitted subsequently for rate periods no 770
earlier than April 1, 2004. When reviewing an interim rate increase 771
request the commissioner shall, at a minimum, consider: (A) Existing 772
chronic and convalescent nursing home or rest home with nursing 773
supervision utilization in the area and projected bed need; (B) physical 774
plant long-term viability and the ability of the owner or purchaser to 775
implement any necessary property improvements; (C) licensure and 776
certification compliance history; (D) reasonableness of actual and 777
projected expenses; and (E) the ability of the facility to meet wage and 778
benefit costs. No interim rate shall be increased pursuant to this 779 Substitute Bill No. 1109
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subsection in excess of one hundred fifteen per cent of the median rate 780
for the facility's peer grouping, established pursuant to [subdivision (2) 781
of subsection (f) of this section] subdivision (3) of subsection (a) of 782
section 17b-340d, as amended by this act, unless recommended by the 783
commissioner and approved by the Secretary of the Office of Policy 784
and Management after consultation with the commissioner. Such 785
median rates shall be published by the Department of Social Services 786
not later than April first of each year. In the event that a facility 787
granted an interim rate increase pursuant to this section is sold or 788
otherwise conveyed for value to an unrelated entity less than five years 789
after the effective date of such rate increase, the rate increase shall be 790
deemed rescinded and the department shall recover an amount equal 791
to the difference between payments made for all affected rate periods 792
and payments that would have been made if the interim rate increase 793
was not granted. The commissioner may seek recovery of such 794
payments from any facility with common ownership. With the 795
approval of the Secretary of the Office of Policy and Management, the 796
commissioner may waive recovery and rescission of the interim rate 797
for good cause shown that is not inconsistent with this section, 798
including, but not limited to, transfers to family members that were 799
made for no value. The commissioner shall provide written quarterly 800
reports to the joint standing committees of the General Assembly 801
having cognizance of matters relating to aging, human services and 802
appropriations and the budgets of state agencies, that identify each 803
facility requesting an interim rate increase, the amount of the 804
requested rate increase for each facility, the action taken by the 805
commissioner and the secretary pursuant to this subsection, and 806
estimates of the additional cost to the state for each approved interim 807
rate increase. Nothing in this subsection shall prohibit the 808
commissioner from increasing the rate of a licensed chronic and 809
convalescent nursing home or a rest home with nursing supervision 810
for allowable costs associated with facility capital improvements or 811
increasing the rate in case of a sale of a licensed chronic and 812
convalescent nursing home or a rest home with nursing supervision if 813
receivership has been imposed on such home. For purposes of this 814 Substitute Bill No. 1109
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section, "temporary nursing services agency" and "nursing personnel" 815
have the same meaning as provided in section 19a-118. 816
Sec. 5. Subsection (a) of section 17b-340d of the general statutes is 817
repealed and the following is substituted in lieu thereof (Effective from 818
passage): 819
(a) The Commissioner of Social Services shall implement an acuity-820
based methodology for Medicaid reimbursement of nursing home 821
services effective July 1, 2022. Notwithstanding section 17b-340, as 822
amended by this act, for the fiscal year ending June 30, 2023, and 823
annually thereafter, the Commissioner of Social Services shall establish 824
Medicaid rates paid to nursing home facilities based on cost years 825
ending on September thirtieth in accordance with the following: 826
(1) Case-mix adjustments to the direct care component, which will 827
be based on Minimum Data Set resident assessment data as well as 828
cost data reported for the cost year ending September 30, 2019, shall be 829
made effective beginning July 1, 2022, and updated every quarter 830
thereafter. After modeling such case-mix adjustments, the 831
Commissioner of Social Services shall evaluate impact on a facility by 832
facility basis and, not later than October 1, 2021, (A) make 833
recommendations to the Secretary of the Office of Policy and 834
Management, and (B) submit a report on the recommendations, in 835
accordance with the provisions of section 11-4a, to the joint standing 836
committees of the General Assembly having cognizance of matters 837
relating to appropriations and the budgets of state agencies and 838
human services on any adjustments needed to facilitate the transition 839
to the new methodology on July 1, 2022. This evaluation may include a 840
review of inflationary allowances, case mix and budget adjustment 841
factors and stop loss and stop gain corridors and the ability to make 842
such adjustments within available appropriations. 843
(2) Beginning July 1, 2022, facilities will be required to comply with 844
collection and reporting of quality metrics as specified by the 845
Department of Social Services, after consultation with the nursing 846 Substitute Bill No. 1109
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home industry, consumers, employees and the Department of Public 847
Health. Rate adjustments based on performance on quality metrics will 848
be phased in, beginning July 1, 2022, with a period of reporting only. 849
(3) Geographic peer groupings of facilities shall be established by 850
the Department of Social Services pursuant to regulations adopted in 851
accordance with subsection (b) of this section. 852
(4) Allowable costs shall be divided into the following five cost 853
components: (A) Direct costs, which shall include salaries for nursing 854
personnel, related fringe benefits and costs for nursing personnel 855
supplied by a temporary nursing services agency; (B) indirect costs, 856
which shall include professional fees, dietary expenses, housekeeping 857
expenses, laundry expenses, supplies related to patient care, salaries 858
for indirect care personnel and related fringe benefits; (C) fair rent, 859
which shall be defined in regulations adopted in accordance with 860
subsection (b) of this section; (D) capital-related costs, which shall 861
include property taxes, insurance expenses, equipment leases and 862
equipment depreciation; and (E) administrative and general costs, 863
which shall include maintenance and operation of plant expenses, 864
salaries for administrative and maintenance personnel and related 865
fringe benefits. For (i) direct costs, the maximum cost shall be equal to 866
one hundred thirty-five per cent of the median allowable cost of that 867
peer grouping; (ii) indirect costs, the maximum cost shall be equal to 868
one hundred fifteen per cent of the state-wide median allowable cost; 869
(iii) fair rent, the amount shall be calculated utilizing the amount 870
approved pursuant to section 17b-353; (iv) capital-related costs, there 871
shall be no maximum; and (v) administrative and general costs, the 872
maximum shall be equal to the state-wide median allowable cost. For 873
purposes of this subdivision, "temporary nursing services agency" and 874
"nursing personnel" have the same meaning as provided in section 875
19a-118. 876
(5) Costs in excess of the maximum amounts established under this 877
subsection shall not be recognized as allowable costs, except that the 878
commissioner may establish rates whereby allowable costs may exceed 879 Substitute Bill No. 1109
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such maximum amounts for beds which are restricted to use by 880
patients with acquired immune deficiency syndrome, traumatic brain 881
injury or other specialized services. 882
[(5) For the fiscal year ending] (6) On or after June 30, 2022, the 883
commissioner may, in the commissioner's discretion and within 884
available appropriations, provide pro rata fair rent increases to 885
facilities which have documented fair rent additions placed in service 886
in the most recently filed cost report [year ending September 30, 2020,] 887
that are not otherwise included in the rates issued. 888
(7) For the purpose of determining allowable fair rent, a facility with 889
allowable fair rent less than the twenty-fifth percentile of the state-890
wide allowable fair rent shall be reimbursed as having allowable fair 891
rent equal to the twenty-fifth percentile of the state-wide allowable fair 892
rent. Any facility with a rate of return on real property other than land 893
in excess of eleven per cent shall have such allowance revised to eleven 894
per cent. Any facility or its related realty affiliate which finances or 895
refinances debt through bonds issued by the Connecticut Health and 896
Education Facilities Authority shall report the terms and conditions of 897
such financing or refinancing to the Commissioner of Social Services 898
not later than thirty days after completing such financing or 899
refinancing. The commissioner may revise the facility's fair rent 900
component of its rate to reflect any financial benefit the facility or its 901
related realty affiliate received as a result of such financing or 902
refinancing. The commissioner shall determine allowable fair rent for 903
real property other than land based on the rate of return for the cost 904
year in which such bonds were issued. The financial benefit resulting 905
from a facility financing or refinancing debt through such bonds shall 906
be shared between the state and the facility to an extent determined by 907
the commissioner on a case-by-case basis and shall be reflected in an 908
adjustment to the facility's allowable fair rent. 909
(8) A facility shall receive cost efficiency adjustments for indirect 910
costs and for administrative and general costs if such costs are below 911
the state-wide median costs. The cost efficiency adjustments shall 912 Substitute Bill No. 1109
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equal twenty-five per cent of the difference between allowable 913
reported costs and the applicable median allowable cost established 914
pursuant to subdivision (4) of this subsection. 915
(9) On and after July 1, 2025, costs shall be rebased no more 916
frequently than every two years and no less frequently than every four 917
years, as determined by the commissioner. There shall be no inflation 918
adjustment during a year in which a facility's rates are rebased. The 919
commissioner shall determine whether and to what extent a change in 920
ownership of a facility shall occasion the rebasing of the facility's costs. 921
(10) The method of establishing rates for new facilities shall be 922
determined by the commissioner in accordance with the provisions of 923
this subsection. 924
[(6)] (11) There shall be no increase to rates based on inflation or any 925
inflationary factor for the fiscal years ending June 30, 2022, and June 926
30, 2023, unless otherwise authorized under subdivision (1) of this 927
subsection. Notwithstanding any other provisions of the general 928
statutes or regulations adopted thereunder, any subsequent increase to 929
rates based on inflation as authorized for any succeeding fiscal year 930
shall be adjusted as determined by the commissioner. The rate of 931
inflation shall be computed based on the percentage increase, if any, in 932
the most recent calendar year average in the gross domestic product 933
deflator over the average for the previous calendar year. Any increase 934
to rates based on inflation shall be applied prior to the application of 935
any other budget adjustment factors that may impact such rates. 936
[(7)] (12) For purposes of computing minimum allowable patient 937
days, utilization of a facility's certified beds shall be determined at a 938
minimum of ninety per cent of capacity, except for facilities that have 939
undergone a change in ownership, new facilities, and facilities which 940
are certified for additional beds which may be permitted a lower 941
occupancy rate for the first three months of operation after the effective 942
date of licensure. 943 Substitute Bill No. 1109
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[(8)] (13) Rates determined under this section shall comply with 944
federal laws and regulations. 945
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)
HS Joint Favorable Subst. C/R APP
APP Joint Favorable Subst.