Connecticut 2023 Regular Session

Connecticut Senate Bill SB01109 Compare Versions

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7	7		General Assembly Substitute Bill No. 1109
8	8		January Session, 2023
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13	13
14	14		AN ACT CONCERNING MEDICAID REIMBURSEMENT TO
15	15		COMMUNITY LIVING ARRANGEMENTS, INTERMEDIATE CARE
16	16		FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES,
17	17		RESIDENTIAL CARE HOMES AND NURSING FACILITIES.
18	18		Be it enacted by the Senate and House of Representatives in General
19	19		Assembly convened:
20	20
21	21		Section 1. Section 17b-244 of the general statutes is repealed and the 1
22	22		following is substituted in lieu thereof (Effective July 1, 2023): 2
23	23		(a) The room and board component of the rates to be paid by the 3
24	24		state to private facilities and facilities operated by regional education 4
25	25		service centers which are licensed to provide residential care pursuant 5
26	26		to section 17a-227, but not certified to participate in the Title XIX 6
27	27		Medicaid program as intermediate care facilities for individuals with 7
28	28		intellectual disabilities, shall be determined annually by the 8
29	29		Commissioner of Social Services. [, except that rates effective April 30, 9
30	30		1989, shall remain in effect through October 31, 1989. Any facility with 10
31	31		real property other than land placed in service prior to July 1, 1991, 11
32	32		shall, for the fiscal year ending June 30, 1995, receive a rate of return on 12
33	33		real property equal to the average of the rates of return applied to real 13
34	34		property other than land placed in service for the five years preceding 14
35	35		July 1, 1993.] For the fiscal year ending June 30, 1996, and any 15
36	36		succeeding fiscal year, the rate of return on real property for property 16
37	37		items shall be revised every five years. The commissioner shall, upon 17 Substitute Bill No. 1109
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44	44		submission of a request by such facility, allow actual debt service, 18
45	45		comprised of principal and interest, on the loan or loans in lieu of 19
46	46		property costs allowed pursuant to section 17-313b-5 of the regulations 20
47	47		of Connecticut state agencies, whether actual debt service is higher or 21
48	48		lower than such allowed property costs, provided such debt service 22
49	49		terms and amounts are reasonable in relation to the useful life and the 23
50	50		base value of the property. In the case of facilities financed through the 24
51	51		Connecticut Housing Finance Authority, the commissioner shall allow 25
52	52		actual debt service, comprised of principal, interest and a reasonable 26
53	53		repair and replacement reserve on the loan or loans in lieu of property 27
54	54		costs allowed pursuant to section 17-313b-5 of the regulations of 28
55	55		Connecticut state agencies, whether actual debt service is higher or 29
56	56		lower than such allowed property costs, provided such debt service 30
57	57		terms and amounts are determined by the commissioner at the time 31
58	58		the loan is entered into to be reasonable in relation to the useful life 32
59	59		and base value of the property. The commissioner may allow fees 33
60	60		associated with mortgage refinancing provided such refinancing will 34
61	61		result in state reimbursement savings, after comparing costs over the 35
62	62		terms of the existing proposed loans. For the fiscal year ending June 30, 36
63	63		1992, the inflation factor used to determine rates shall be one-half of 37
64	64		the gross national product percentage increase for the period between 38
65	65		the midpoint of the cost year through the midpoint of the rate year. For 39
66	66		fiscal year ending June 30, 1993, the inflation factor used to determine 40
67	67		rates shall be two-thirds of the gross national product percentage 41
68	68		increase from the midpoint of the cost year to the midpoint of the rate 42
69	69		year. For the fiscal years ending June 30, 1996, and June 30, 1997, no 43
70	70		inflation factor shall be applied in determining rates. The 44
71	71		Commissioner of Social Services shall prescribe uniform forms on 45
72	72		which such facilities shall report their costs. Such rates shall be 46
73	73		determined on the basis of a reasonable payment for necessary 47
74	74		services. Any increase in grants, gifts, fund-raising or endowment 48
75	75		income used for the payment of operating costs by a private facility in 49
76	76		the fiscal year ending June 30, 1992, shall be excluded by the 50
77	77		commissioner from the income of the facility in determining the rates 51
78	78		to be paid to the facility for the fiscal year ending June 30, 1993, 52 Substitute Bill No. 1109
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85	85		provided any operating costs funded by such increase shall not 53
86	86		obligate the state to increase expenditures in subsequent fiscal years. 54
87	87		Nothing contained in this section shall authorize a payment by the 55
88	88		state to any such facility in excess of the charges made by the facility 56
89	89		for comparable services to the general public. The service component 57
90	90		of the rates to be paid by the state to private facilities and facilities 58
91	91		operated by regional education service centers which are licensed to 59
92	92		provide residential care pursuant to section 17a-227, but not certified 60
93	93		to participate in the Title XIX Medicaid programs as intermediate care 61
94	94		facilities for individuals with intellectual disabilities, shall be 62
95	95		determined annually by the Commissioner of Developmental Services 63
96	96		in accordance with section 17b-244a. For the fiscal year ending June 30, 64
97	97		2008, no facility shall receive a rate that is more than two per cent 65
98	98		greater than the rate in effect for the facility on June 30, 2007, except 66
99	99		any facility that would have been issued a lower rate effective July 1, 67
100	100		2007, due to interim rate status or agreement with the department, 68
101	101		shall be issued such lower rate effective July 1, 2007. For the fiscal year 69
102	102		ending June 30, 2009, no facility shall receive a rate that is more than 70
103	103		two per cent greater than the rate in effect for the facility on June 30, 71
104	104		2008, except any facility that would have been issued a lower rate 72
105	105		effective July 1, 2008, due to interim rate status or agreement with the 73
106	106		department, shall be issued such lower rate effective July 1, 2008. For 74
107	107		the fiscal years ending June 30, 2010, and June 30, 2011, rates in effect 75
108	108		for the period ending June 30, 2009, shall remain in effect until June 30, 76
109	109		2011, except that (1) the rate paid to a facility may be higher than the 77
110	110		rate paid to the facility for the period ending June 30, 2009, if a capital 78
111	111		improvement required by the Commissioner of Developmental 79
112	112		Services for the health or safety of the residents was made to the 80
113	113		facility during the fiscal years ending June 30, 2010, or June 30, 2011, 81
114	114		and (2) any facility that would have been issued a lower rate for the 82
115	115		fiscal year ending June 30, 2010, or June 30, 2011, due to interim rate 83
116	116		status or agreement with the department, shall be issued such lower 84
117	117		rate. For the fiscal year ending June 30, 2012, rates in effect for the 85
118	118		period ending June 30, 2011, shall remain in effect until June 30, 2012, 86
119	119		except that (A) the rate paid to a facility may be higher than the rate 87 Substitute Bill No. 1109
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126	126		paid to the facility for the period ending June 30, 2011, if a capital 88
127	127		improvement required by the Commissioner of Developmental 89
128	128		Services for the health or safety of the residents was made to the 90
129	129		facility during the fiscal year ending June 30, 2012, and (B) any facility 91
130	130		that would have been issued a lower rate for the fiscal year ending 92
131	131		June 30, 2012, due to interim rate status or agreement with the 93
132	132		department, shall be issued such lower rate. Any facility that has a 94
133	133		significant decrease in land and building costs shall receive a reduced 95
134	134		rate to reflect such decrease in land and building costs. The rate paid to 96
135	135		a facility may be increased if a capital improvement approved by the 97
136	136		Department of Developmental Services, in consultation with the 98
137	137		Department of Social Services, for the health or safety of the residents 99
138	138		was made to the facility during the fiscal year ending June 30, 2014, or 100
139	139		June 30, 2015, only to the extent such increases are within available 101
140	140		appropriations. For the fiscal years ending June 30, 2016, and June 30, 102
141	141		2017, rates shall not exceed those in effect for the period ending June 103
142	142		30, 2015, except the rate paid to a facility may be higher than the rate 104
143	143		paid to the facility for the period ending June 30, 2015, if a capital 105
144	144		improvement approved by the Department of Developmental Services, 106
145	145		in consultation with the Department of Social Services, for the health 107
146	146		or safety of the residents was made to the facility during the fiscal year 108
147	147		ending June 30, 2016, or June 30, 2017, to the extent such rate increases 109
148	148		are within available appropriations. For the fiscal years ending June 30, 110
149	149		2016, and June 30, 2017, and each succeeding fiscal year, any facility 111
150	150		that would have been issued a lower rate, due to interim rate status, a 112
151	151		change in allowable fair rent or agreement with the department, shall 113
152	152		be issued such lower rate. For the fiscal years ending June 30, 2018, and 114
153	153		June 30, 2019, rates shall not exceed those in effect for the period 115
154	154		ending June 30, 2017, except the rate paid to a facility may be higher 116
155	155		than the rate paid to the facility for the period ending June 30, 2017, if a 117
156	156		capital improvement approved by the Department of Developmental 118
157	157		Services, in consultation with the Department of Social Services, for the 119
158	158		health or safety of the residents was made to the facility during the 120
159	159		fiscal year ending June 30, 2018, or June 30, 2019, to the extent such rate 121
160	160		increases are within available appropriations. For the fiscal years 122 Substitute Bill No. 1109
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167	167		ending June 30, 2020, and June 30, 2021, rates shall not exceed those in 123
168	168		effect for the fiscal year ending June 30, 2019, except the rate paid to a 124
169	169		facility may be higher than the rate paid to the facility for the fiscal 125
170	170		year ending June 30, 2019, if a capital improvement approved by the 126
171	171		Department of Developmental Services, in consultation with the 127
172	172		Department of Social Services, for the health or safety of the residents 128
173	173		was made to the facility during the fiscal year ending June 30, 2020, or 129
174	174		June 30, 2021, to the extent such rate increases are within available 130
175	175		appropriations. For the fiscal years ending June 30, 2022, and June 30, 131
176	176		2023, rates shall be based upon rates in effect for the fiscal year ending 132
177	177		June 30, 2021, inflated by the gross domestic product deflator 133
178	178		applicable to each rate year, except the commissioner may, in the 134
179	179		commissioner's discretion and within available appropriations, 135
180	180		provide pro rata fair rent increases to facilities which have 136
181	181		documented fair rent additions placed in service in the cost report 137
182	182		years ending September 30, 2020, and September 30, 2021, that are not 138
183	183		otherwise included in rates issued, or if a rate adjustment for a capital 139
184	184		improvement approved by the Department of Developmental Services, 140
185	185		in consultation with the Department of Social Services, for the health 141
186	186		or safety of the residents was made to the facility during the fiscal year 142
187		-	ending June 30, 2022, or June 30, 2023. 143
188		-	(b) Notwithstanding the provisions of subsection (a) of this section, 144
189		-	state rates of payment for the fiscal years ending June 30, 2018, June 30, 145
190		-	2019, June 30, 2020, and June 30, 2021, for residential care homes and 146
191		-	community living arrangements that receive the flat rate for residential 147
192		-	services under section 17-311-54 of the regulations of Connecticut state 148
193		-	agencies shall be set in accordance with section 298 of public act 19-149
194		-	117. For the fiscal years ending June 30, 2022, and June 30, 2023, rates 150
195		-	shall be based upon rates in effect for the fiscal year ending June 30, 151
196		-	2021, inflated by the gross domestic product deflator applicable to each 152
197		-	rate year. 153
198		-	(c) For the fiscal year ending June 30, 2024, and each subsequent 154
199		-	fiscal year, the commissioner may, in the commissioner's discretion 155 Substitute Bill No. 1109
	187	+	ending June 30, 2022, or June 30, 2023. For the fiscal years ending June 143
	188	+	30, 2024, and June 30, 2025, the rate paid to a facility may be higher 144
	189	+	than the rate paid to the facility for the fiscal year ending June 30, 2023, 145
	190	+	if a capital improvement approved by the Department of 146
	191	+	Developmental Services, in consultation with the Department of Social 147
	192	+	Services, for the health or safety of the residents was made to the 148
	193	+	facility during the fiscal year ending June 30, 2024, or June 30, 2025, to 149
	194	+	the extent such rate increases are within available appropriations. 150
	195	+	(b) Notwithstanding the provisions of subsection (a) of this section, 151
	196	+	state rates of payment for the fiscal years ending June 30, 2018, June 30, 152
	197	+	2019, June 30, 2020, and June 30, 2021, for residential care homes and 153
	198	+	community living arrangements that receive the flat rate for residential 154
	199	+	services under section 17-311-54 of the regulations of Connecticut state 155
	200	+	agencies shall be set in accordance with section 298 of public act 19-156 Substitute Bill No. 1109
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206		-	and within available appropriations, provide pro rata fair rent 156
207		-	increases to facilities which have documented fair rent additions 157
208		-	placed in service in the cost report years that are not otherwise 158
209		-	included in rates issued. 159
210		-	[(c)] (d) The Commissioner of Social Services and the Commissioner 160
211		-	of Developmental Services shall adopt regulations in accordance with 161
212		-	the provisions of chapter 54 to implement the provisions of this 162
213		-	section. 163
214		-	Sec. 2. Subsection (h) of section 17b-340 of the general statutes is 164
215		-	repealed and the following is substituted in lieu thereof (Effective July 165
216		-	1, 2023): 166
217		-	(h) (1) For the fiscal year ending June 30, 1993, any intermediate care 167
218		-	facility for individuals with intellectual disabilities with an operating 168
219		-	cost component of its rate in excess of one hundred forty per cent of 169
220		-	the median of operating cost components of rates in effect January 1, 170
221		-	1992, shall not receive an operating cost component increase. For the 171
222		-	fiscal year ending June 30, 1993, any intermediate care facility for 172
223		-	individuals with intellectual disabilities with an operating cost 173
224		-	component of its rate that is less than one hundred forty per cent of the 174
225		-	median of operating cost components of rates in effect January 1, 1992, 175
226		-	shall have an allowance for real wage growth equal to thirty per cent 176
227		-	of the increase determined in accordance with subsection (q) of section 177
228		-	17-311-52 of the regulations of Connecticut state agencies, provided 178
229		-	such operating cost component shall not exceed one hundred forty per 179
230		-	cent of the median of operating cost components in effect January 1, 180
231		-	1992. Any facility with real property other than land placed in service 181
232		-	prior to October 1, 1991, shall, for the fiscal year ending June 30, 1995, 182
233		-	receive a rate of return on real property equal to the average of the 183
234		-	rates of return applied to real property other than land placed in 184
235		-	service for the five years preceding October 1, 1993. For the fiscal year 185
236		-	ending June 30, 1996, and any succeeding fiscal year, the rate of return 186
237		-	on real property for property items shall be revised every five years. 187
238		-	The commissioner shall, upon submission of a request, allow actual 188 Substitute Bill No. 1109
	207	+	117. For the fiscal years ending June 30, 2022, and June 30, 2023, rates 157
	208	+	shall be based upon rates in effect for the fiscal year ending June 30, 158
	209	+	2021, inflated by the gross domestic product deflator applicable to each 159
	210	+	rate year. 160
	211	+	(c) For the fiscal year ending June 30, 2024, and each subsequent 161
	212	+	fiscal year, the commissioner may, in the commissioner's discretion 162
	213	+	and within available appropriations, provide pro rata fair rent 163
	214	+	increases to facilities which have documented fair rent additions 164
	215	+	placed in service in the cost report years that are not otherwise 165
	216	+	included in rates issued. 166
	217	+	[(c)] (d) The Commissioner of Social Services and the Commissioner 167
	218	+	of Developmental Services shall adopt regulations in accordance with 168
	219	+	the provisions of chapter 54 to implement the provisions of this 169
	220	+	section. 170
	221	+	Sec. 2. Subsection (h) of section 17b-340 of the general statutes is 171
	222	+	repealed and the following is substituted in lieu thereof (Effective July 172
	223	+	1, 2023): 173
	224	+	(h) (1) For the fiscal year ending June 30, 1993, any intermediate care 174
	225	+	facility for individuals with intellectual disabilities with an operating 175
	226	+	cost component of its rate in excess of one hundred forty per cent of 176
	227	+	the median of operating cost components of rates in effect January 1, 177
	228	+	1992, shall not receive an operating cost component increase. For the 178
	229	+	fiscal year ending June 30, 1993, any intermediate care facility for 179
	230	+	individuals with intellectual disabilities with an operating cost 180
	231	+	component of its rate that is less than one hundred forty per cent of the 181
	232	+	median of operating cost components of rates in effect January 1, 1992, 182
	233	+	shall have an allowance for real wage growth equal to thirty per cent 183
	234	+	of the increase determined in accordance with subsection (q) of section 184
	235	+	17-311-52 of the regulations of Connecticut state agencies, provided 185
	236	+	such operating cost component shall not exceed one hundred forty per 186
	237	+	cent of the median of operating cost components in effect January 1, 187
	238	+	1992. Any facility with real property other than land placed in service 188 Substitute Bill No. 1109
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245		-	~~debt service~~, ~~comprised of principal and interest~~, ~~in excess of property~~ 189
246		-	~~costs allowed pursuant~~ to ~~section 17-311-52~~ of the ~~regulations of~~ 190
247		-	~~Connecticut state agencies,~~ ~~provided such debt service terms and~~ 191
248		-	~~amounts are reasonable in relation to~~ the ~~useful life and~~ the ~~base value~~ 192
249		-	~~of the property. For the fiscal year~~ ending June 30, ~~1995~~, and any 193
250		-	~~succeeding fiscal year,~~ ~~the inflation adjustment made in accordance~~ 194
251		-	~~with subsection (p)~~ of ~~section 17-311-52 of the regulations of~~ 195
252		-	~~Connecticut state agencies shall not be applied to real~~ property ~~costs.~~ 196
253		-	~~For~~ the ~~fiscal year ending June 30, 1996, and any succeeding fiscal year,~~ 197
254		-	~~the allowance for real wage growth~~, ~~as determined in accordance with~~ 198
255		-	~~subsection (q) of section 17-311-52 of~~ the ~~regulations of Connecticut~~ 199
256		-	~~state agencies,~~ ~~shall not be applied~~. For the fiscal year ending June 30, 200
257		-	~~1996, and any~~ succeeding fiscal year, ~~no rate shall exceed three~~ 201
258		-	~~hundred seventy-five dollars per day unless~~ the ~~commissioner, in~~ 202
259		-	~~consultation with the Commissioner of Developmental Services,~~ 203
260		-	~~determines after a review of program~~ and ~~management costs~~, ~~that a~~ 204
261		-	~~rate~~ in ~~excess of this amount is necessary for care and treatment of~~ 205
262		-	~~facility residents.~~ ~~For~~ the ~~fiscal year ending June 30, 2002, rate period,~~ 206
263		-	~~the Commissioner of Social Services~~ shall ~~increase~~ the ~~inflation~~ 207
264		-	~~adjustment for rates made in accordance with subsection (p) of section~~ 208
265		-	~~17-311-52~~ of the ~~regulations of Connecticut state agencies to update~~ 209
266		-	~~allowable fiscal year 2000 costs to include a three and one-half per cent~~ 210
267		-	~~inflation factor.~~ ~~For the fiscal year ending June 30~~, ~~2003, rate period, the~~ 211
268		-	~~commissioner shall increase the inflation adjustment~~ for ~~rates made in~~ 212
269		-	~~accordance with subsection (p) of section 17-311-52 of~~ the ~~regulations~~ 213
270		-	of ~~Connecticut state agencies to update allowable fiscal year 2001 costs~~ 214
271		-	~~to include a one and one-half~~ ~~per cent inflation factor,~~ ~~except that such~~ 215
272		-	~~increase shall be effective November 1,~~ ~~2002, and such facility rate in~~ 216
273		-	~~effect for the~~ fiscal year ~~ending June 30,~~ ~~2002, shall be paid for services~~ 217
274		-	~~provided until October 31~~, ~~2002~~, ~~except any facility that would have~~ 218
275		-	~~been issued a lower rate effective July 1, 2002, than~~ for ~~the fiscal year~~ 219
276		-	~~ending June 30, 2002, due to interim rate status or agreement~~ with the 220
277		-	~~department shall be issued such lower rate effective July 1,~~ ~~2002, and~~ 221
278		-	~~have~~ such ~~rate updated effective November 1, 2002, in accordance with~~ 222
279		-	~~applicable statutes~~ and ~~regulations. For the fiscal year ending June 30,~~ 223 Substitute Bill No. 1109
	245	+	prior to October 1, 1991, shall, for the fiscal year ending June 30, 1995, 189
	246	+	receive a rate of return on real property equal to the average of the 190
	247	+	rates of return applied to real property other than land placed in 191
	248	+	service for the five years preceding October 1, 1993. For the fiscal year 192
	249	+	ending June 30, 1996, and any succeeding fiscal year, the rate of return 193
	250	+	on real property for property items shall be revised every five years. 194
	251	+	The commissioner shall, upon submission of a request, allow actual 195
	252	+	debt service, comprised of principal and interest, in excess of property 196
	253	+	costs allowed pursuant to section 17-311-52 of the regulations of 197
	254	+	Connecticut state agencies, provided such debt service terms and 198
	255	+	amounts are reasonable in relation to the useful life and the base value 199
	256	+	of the property. For the fiscal year ending June 30, 1995, and any 200
	257	+	succeeding fiscal year, the inflation adjustment made in accordance 201
	258	+	with subsection (p) of section 17-311-52 of the regulations of 202
	259	+	Connecticut state agencies shall not be applied to real property costs. 203
	260	+	For the fiscal year ending June 30, 1996, and any succeeding fiscal year, 204
	261	+	the allowance for real wage growth, as determined in accordance with 205
	262	+	subsection (q) of section 17-311-52 of the regulations of Connecticut 206
	263	+	state agencies, shall not be applied. For the fiscal year ending June 30, 207
	264	+	1996, and any succeeding fiscal year, no rate shall exceed three 208
	265	+	hundred seventy-five dollars per day unless the commissioner, in 209
	266	+	consultation with the Commissioner of Developmental Services, 210
	267	+	determines after a review of program and management costs, that a 211
	268	+	rate in excess of this amount is necessary for care and treatment of 212
	269	+	facility residents. For the fiscal year ending June 30, 2002, rate period, 213
	270	+	the Commissioner of Social Services shall increase the inflation 214
	271	+	adjustment for rates made in accordance with subsection (p) of section 215
	272	+	17-311-52 of the regulations of Connecticut state agencies to update 216
	273	+	allowable fiscal year 2000 costs to include a three and one-half per cent 217
	274	+	inflation factor. For the fiscal year ending June 30, 2003, rate period, the 218
	275	+	commissioner shall increase the inflation adjustment for rates made in 219
	276	+	accordance with subsection (p) of section 17-311-52 of the regulations 220
	277	+	of Connecticut state agencies to update allowable fiscal year 2001 costs 221
	278	+	to include a one and one-half per cent inflation factor, except that such 222
	279	+	increase shall be effective November 1, 2002, and such facility rate in 223 Substitute Bill No. 1109
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286		-	~~2004, rates in~~ effect for the ~~period~~ ending June 30, ~~2003~~, shall ~~remain in~~ 224
287		-	~~effect~~, except any facility that would have ~~been issued a lower rate~~ 225
288		-	effective July 1, ~~2003~~, than for the fiscal year ~~ending June 30, 2003, due~~ 226
289		-	to interim rate status or agreement with the ~~department shall be issued~~ 227
290		-	such lower rate effective July 1, ~~2003. For the fiscal year ending June~~ 228
291		-	30, ~~2005~~, ~~rates~~ in ~~effect for the period ending June 30, 2004, shall~~ 229
292		-	~~remain in effect until September~~ 30, ~~2004. Effective October 1, 2004,~~ 230
293		-	~~each facility~~ shall ~~receive a rate that is five per cent greater than the~~ 231
294		-	~~rate in~~ effect ~~September 30~~, ~~2004. Effective upon receipt of all the~~ 232
295		-	~~necessary federal approvals to secure federal financial participation~~ 233
296		-	~~matching funds associated~~ with the ~~rate increase provided in~~ 234
297		-	~~subdivision (4) of subsection (f) of this section~~, ~~but in no event earlier~~ 235
298		-	~~than October 1~~, 2005, ~~and provided~~ the ~~user fee imposed under section~~ 236
299		-	~~17b-320 is required to be collected~~, ~~each facility shall receive a rate that~~ 237
300		-	is ~~four~~ per cent ~~more~~ than the ~~rate the facility received in the prior~~ 238
301		-	~~fiscal year~~, ~~except any facility that would have been issued a lower rate~~ 239
302		-	~~effective October 1,~~ ~~2005, than for the fiscal year ending June 30, 2005,~~ 240
303		-	~~due to interim rate status or agreement~~ with the ~~department, shall be~~ 241
304		-	~~issued such lower rate effective October 1~~, ~~2005. Such rate increase~~ 242
305		-	~~shall remain in effect unless:~~ ~~[(1)] (A)~~ The ~~federal financial~~ 243
306		-	~~participation matching funds associated with the~~ rate ~~increase are no~~ 244
307		-	~~longer available;~~ ~~or [(2)] (B)~~ the ~~user fee created pursuant to section~~ 245
308		-	~~17b-320 is not in effect. For the~~ fiscal year ~~ending June 30~~, ~~2007, rates in~~ 246
309		-	~~effect~~ for the ~~period~~ ending June 30, ~~2006~~, ~~shall remain in effect until~~ 247
310		-	~~September 30~~, ~~2006, except any facility that would have been issued a~~ 248
311		-	lower rate effective ~~July~~ 1, ~~2006, than for the fiscal year ending June 30,~~ 249
312		-	~~2006, due to interim rate status or agreement with~~ the ~~department,~~ 250
313		-	~~shall be issued such lower~~ rate ~~effective July 1, 2006. Effective October~~ 251
314		-	~~1, 2006,~~ ~~no facility shall receive a rate that is more than three per cent~~ 252
315		-	~~greater than the rate~~ in effect for the ~~facility on September~~ 30, ~~2006~~, 253
316		-	~~except any facility that would have been issued a lower rate effective~~ 254
317		-	~~October 1~~, 2006, ~~due to interim rate status or agreement with the~~ 255
318		-	~~department, shall be issued such~~ lower rate effective ~~October~~ 1, 2006. 256
319		-	~~For~~ the ~~fiscal year ending June 30~~, ~~2008, each facility shall receive a rate~~ 257
320		-	~~that is two and nine-tenths per cent greater than the~~ rate ~~in effect for~~ 258 Substitute Bill No. 1109
	286	+	effect for the fiscal year ending June 30, 2002, shall be paid for services 224
	287	+	provided until October 31, 2002, except any facility that would have 225
	288	+	been issued a lower rate effective July 1, 2002, than for the fiscal year 226
	289	+	ending June 30, 2002, due to interim rate status or agreement with the 227
	290	+	department shall be issued such lower rate effective July 1, 2002, and 228
	291	+	have such rate updated effective November 1, 2002, in accordance with 229
	292	+	applicable statutes and regulations. For the fiscal year ending June 30, 230
	293	+	2004, rates in effect for the period ending June 30, 2003, shall remain in 231
	294	+	effect, except any facility that would have been issued a lower rate 232
	295	+	effective July 1, 2003, than for the fiscal year ending June 30, 2003, due 233
	296	+	to interim rate status or agreement with the department shall be issued 234
	297	+	such lower rate effective July 1, 2003. For the fiscal year ending June 235
	298	+	30, 2005, rates in effect for the period ending June 30, 2004, shall 236
	299	+	remain in effect until September 30, 2004. Effective October 1, 2004, 237
	300	+	each facility shall receive a rate that is five per cent greater than the 238
	301	+	rate in effect September 30, 2004. Effective upon receipt of all the 239
	302	+	necessary federal approvals to secure federal financial participation 240
	303	+	matching funds associated with the rate increase provided in 241
	304	+	subdivision (4) of subsection (f) of this section, but in no event earlier 242
	305	+	than October 1, 2005, and provided the user fee imposed under section 243
	306	+	17b-320 is required to be collected, each facility shall receive a rate that 244
	307	+	is four per cent more than the rate the facility received in the prior 245
	308	+	fiscal year, except any facility that would have been issued a lower rate 246
	309	+	effective October 1, 2005, than for the fiscal year ending June 30, 2005, 247
	310	+	due to interim rate status or agreement with the department, shall be 248
	311	+	issued such lower rate effective October 1, 2005. Such rate increase 249
	312	+	shall remain in effect unless: [(1)] (A) The federal financial 250
	313	+	participation matching funds associated with the rate increase are no 251
	314	+	longer available; or [(2)] (B) the user fee created pursuant to section 252
	315	+	17b-320 is not in effect. For the fiscal year ending June 30, 2007, rates in 253
	316	+	effect for the period ending June 30, 2006, shall remain in effect until 254
	317	+	September 30, 2006, except any facility that would have been issued a 255
	318	+	lower rate effective July 1, 2006, than for the fiscal year ending June 30, 256
	319	+	2006, due to interim rate status or agreement with the department, 257
	320	+	shall be issued such lower rate effective July 1, 2006. Effective October 258 Substitute Bill No. 1109
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327		-	~~the period ending June 30~~, ~~2007~~, ~~except any~~ facility that ~~would have~~ 259
328		-	~~been issued a lower~~ rate ~~effective July 1, 2007, than~~ for the ~~rate period~~ 260
329		-	~~ending June 30,~~ ~~2007, due to interim~~ rate ~~status, or agreement with the~~ 261
330		-	~~department, shall be issued such lower rate effective July~~ 1, ~~2007. For~~ 262
331		-	~~the fiscal year ending June 30~~, ~~2009~~, ~~rates in effect for the period~~ 263
332		-	ending June 30, 2008, shall ~~remain in effect until June 30, 2009, except~~ 264
333		-	~~any facility~~ that ~~would have been issued a lower~~ rate for ~~the fiscal year~~ 265
334		-	ending June 30, ~~2009~~, ~~due to interim rate status or agreement with the~~ 266
335		-	~~department, shall be~~ issued ~~such~~ lower rate. For the ~~fiscal years ending~~ 267
336		-	~~June 30, 2010, and~~ June 30, ~~2011~~, ~~rates in effect for~~ the ~~period ending~~ 268
337		-	~~June 30, 2009~~, shall ~~remain in effect until June 30~~, ~~2011, except any~~ 269
338		-	~~facility that would have been issued a lower rate for~~ the fiscal year 270
339		-	ending June 30, ~~2010~~, ~~or the fiscal year ending~~ June 30, ~~2011~~, ~~due to~~ 271
340		-	~~interim~~ rate ~~status or agreement with~~ the ~~department, shall be issued~~ 272
341		-	~~such lower rate. For the fiscal year~~ ending June 30, ~~2012~~, ~~rates in effect~~ 273
342		-	for the ~~period~~ ending ~~June 30, 2011, shall remain in effect until June 30,~~ 274
343		-	~~2012~~, ~~except any facility that would have been issued a lower rate~~ for 275
344		-	~~the fiscal year ending~~ June 30, ~~2012~~, ~~due to interim rate status or~~ 276
345		-	~~agreement with the department,~~ ~~shall be~~ issued ~~such~~ lower rate. For 277
346		-	the fiscal ~~years~~ ending June 30, ~~2014~~, ~~and June 30, 2015, rates shall not~~ 278
347		-	~~exceed those in effect for~~ the ~~period ending June 30~~, ~~2013, except the~~ 279
348		-	rate ~~paid to a facility may be higher than~~ the ~~rate paid to the facility for~~ 280
349		-	the period ending June 30, ~~2013~~, ~~if a capital improvement approved by~~ 281
350		-	~~the Department of Developmental Services~~, ~~in consultation with the~~ 282
351		-	~~Department of Social Services~~, ~~for the health~~ or ~~safety of the residents~~ 283
352		-	~~was made to~~ the ~~facility during the fiscal year ending June 30~~, ~~2014, or~~ 284
353		-	June 30, 2015, ~~to the extent such rate increases are within available~~ 285
354		-	~~appropriations. Any facility that would have been issued a lower rate~~ 286
355		-	~~for~~ the ~~fiscal year ending June 30, 2014, or~~ the ~~fiscal year ending June~~ 287
356		-	30, ~~2015~~, ~~due to interim rate status or agreement with the department,~~ 288
357		-	~~shall be issued such lower rate.~~ ~~For~~ the ~~fiscal years ending June 30,~~ 289
358		-	~~2016~~, ~~and June 30, 2017, rates shall not exceed those in effect~~ for the 290
359		-	~~period~~ ending June 30, ~~2015~~, ~~except the rate paid to a facility may be~~ 291
360		-	~~higher than the rate paid~~ to the ~~facility for the period ending June 30,~~ 292
361		-	~~2015, if~~ a ~~capital improvement approved by the Department of~~ 293 Substitute Bill No. 1109
	327	+	1, 2006, no facility shall receive a rate that is more than three per cent 259
	328	+	greater than the rate in effect for the facility on September 30, 2006, 260
	329	+	except any facility that would have been issued a lower rate effective 261
	330	+	October 1, 2006, due to interim rate status or agreement with the 262
	331	+	department, shall be issued such lower rate effective October 1, 2006. 263
	332	+	For the fiscal year ending June 30, 2008, each facility shall receive a rate 264
	333	+	that is two and nine-tenths per cent greater than the rate in effect for 265
	334	+	the period ending June 30, 2007, except any facility that would have 266
	335	+	been issued a lower rate effective July 1, 2007, than for the rate period 267
	336	+	ending June 30, 2007, due to interim rate status, or agreement with the 268
	337	+	department, shall be issued such lower rate effective July 1, 2007. For 269
	338	+	the fiscal year ending June 30, 2009, rates in effect for the period 270
	339	+	ending June 30, 2008, shall remain in effect until June 30, 2009, except 271
	340	+	any facility that would have been issued a lower rate for the fiscal year 272
	341	+	ending June 30, 2009, due to interim rate status or agreement with the 273
	342	+	department, shall be issued such lower rate. For the fiscal years ending 274
	343	+	June 30, 2010, and June 30, 2011, rates in effect for the period ending 275
	344	+	June 30, 2009, shall remain in effect until June 30, 2011, except any 276
	345	+	facility that would have been issued a lower rate for the fiscal year 277
	346	+	ending June 30, 2010, or the fiscal year ending June 30, 2011, due to 278
	347	+	interim rate status or agreement with the department, shall be issued 279
	348	+	such lower rate. For the fiscal year ending June 30, 2012, rates in effect 280
	349	+	for the period ending June 30, 2011, shall remain in effect until June 30, 281
	350	+	2012, except any facility that would have been issued a lower rate for 282
	351	+	the fiscal year ending June 30, 2012, due to interim rate status or 283
	352	+	agreement with the department, shall be issued such lower rate. For 284
	353	+	the fiscal years ending June 30, 2014, and June 30, 2015, rates shall not 285
	354	+	exceed those in effect for the period ending June 30, 2013, except the 286
	355	+	rate paid to a facility may be higher than the rate paid to the facility for 287
	356	+	the period ending June 30, 2013, if a capital improvement approved by 288
	357	+	the Department of Developmental Services, in consultation with the 289
	358	+	Department of Social Services, for the health or safety of the residents 290
	359	+	was made to the facility during the fiscal year ending June 30, 2014, or 291
	360	+	June 30, 2015, to the extent such rate increases are within available 292
	361	+	appropriations. Any facility that would have been issued a lower rate 293 Substitute Bill No. 1109
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367	367
368		-	~~Developmental Services, in consultation with~~ the ~~Department of Social~~ 294
369		-	~~Services~~, ~~for~~ the ~~health or safety of the residents was made to the~~ 295
370		-	~~facility during~~ the fiscal ~~year~~ ending June 30, ~~2016, or June 30, 2017, to~~ 296
371		-	~~the extent such rate increases are within available appropriations.~~ For 297
372		-	~~the fiscal years~~ ending June 30, ~~2016~~, ~~and June 30,~~ ~~2017, and each~~ 298
373		-	~~succeeding fiscal year,~~ ~~any~~ facility ~~that would have been issued a~~ 299
374		-	~~lower rate~~, ~~due to interim rate status,~~ a ~~change in allowable fair rent or~~ 300
375		-	~~agreement~~ with the department~~, shall be issued such lower rate. For~~ 301
376		-	the ~~fiscal years ending June 30,~~ ~~2018, and June 30,~~ ~~2019, rates shall not~~ 302
377		-	~~exceed those in effect for~~ the ~~period~~ ending June 30, 2017, ~~except the~~ 303
378		-	~~rate paid to a facility may be higher than the~~ rate ~~paid to the facility~~ for 304
379		-	the ~~period~~ ending June 30, 2017, ~~if a capital improvement approved by~~ 305
380		-	~~the Department of Developmental Services~~, ~~in consultation with the~~ 306
381		-	~~Department of Social Services~~, ~~for the health~~ or ~~safety of the residents~~ 307
382		-	~~was made to~~ the ~~facility during the fiscal year ending June 30~~, ~~2018, or~~ 308
383		-	June 30, 2019, ~~only to the extent such rate increases are within available~~ 309
384		-	~~appropriations.~~ For the ~~fiscal years~~ ending June 30, ~~2020~~, ~~and June 30,~~ 310
385		-	~~2021, rates shall not exceed those in effect~~ for ~~the fiscal year ending~~ 311
386		-	June 30, ~~2019~~, ~~except the rate paid to~~ a ~~facility may be higher than the~~ 312
387		-	~~rate paid to~~ the ~~facility for the fiscal year ending June 30, 2019, if a~~ 313
388		-	~~capital improvement approved by the~~ Department of ~~Developmental~~ 314
389		-	~~Services, in consultation with~~ the ~~Department of Social Services, for~~ the 315
390		-	~~health or safety of the residents was made~~ to the ~~facility during the~~ 316
391		-	fiscal ~~year~~ ending June 30, 2020, or June 30, ~~2021, only to the extent~~ 317
392		-	~~such rate increases are within available appropriations.~~ For the fiscal 318
393		-	~~year ending~~ June 30, ~~2022~~, ~~rates shall not exceed those in effect for~~ the 319
394		-	fiscal year ending June 30, ~~2021~~, ~~except the commissioner may, in the~~ 320
395		-	~~commissioner's discretion and within available appropriations,~~ 321
396		-	~~provide pro rata fair rent increases to facilities that have documented~~ 322
397		-	~~fair rent additions placed in service in~~ the ~~cost report year ending~~ 323
398		-	~~September~~ 30, 2020, ~~that are not otherwise included in rates issued. For~~ 324
399		-	the fiscal ~~year ending June 30, 2023, rates shall not exceed those in~~ 325
400		-	~~effect for the fiscal~~ year ending June 30, 2022, ~~except~~ the ~~commissioner~~ 326
401		-	may, in the ~~commissioner's discretion and within available~~ 327
402		-	appropriations, ~~provide pro rata fair rent increases to facilities which~~ 328 Substitute Bill No. 1109
	368	+	for the fiscal year ending June 30, 2014, or the fiscal year ending June 294
	369	+	30, 2015, due to interim rate status or agreement with the department, 295
	370	+	shall be issued such lower rate. For the fiscal years ending June 30, 296
	371	+	2016, and June 30, 2017, rates shall not exceed those in effect for the 297
	372	+	period ending June 30, 2015, except the rate paid to a facility may be 298
	373	+	higher than the rate paid to the facility for the period ending June 30, 299
	374	+	2015, if a capital improvement approved by the Department of 300
	375	+	Developmental Services, in consultation with the Department of Social 301
	376	+	Services, for the health or safety of the residents was made to the 302
	377	+	facility during the fiscal year ending June 30, 2016, or June 30, 2017, to 303
	378	+	the extent such rate increases are within available appropriations. For 304
	379	+	the fiscal years ending June 30, 2016, and June 30, 2017, and each 305
	380	+	succeeding fiscal year, any facility that would have been issued a 306
	381	+	lower rate, due to interim rate status, a change in allowable fair rent or 307
	382	+	agreement with the department, shall be issued such lower rate. For 308
	383	+	the fiscal years ending June 30, 2018, and June 30, 2019, rates shall not 309
	384	+	exceed those in effect for the period ending June 30, 2017, except the 310
	385	+	rate paid to a facility may be higher than the rate paid to the facility for 311
	386	+	the period ending June 30, 2017, if a capital improvement approved by 312
	387	+	the Department of Developmental Services, in consultation with the 313
	388	+	Department of Social Services, for the health or safety of the residents 314
	389	+	was made to the facility during the fiscal year ending June 30, 2018, or 315
	390	+	June 30, 2019, only to the extent such rate increases are within available 316
	391	+	appropriations. For the fiscal years ending June 30, 2020, and June 30, 317
	392	+	2021, rates shall not exceed those in effect for the fiscal year ending 318
	393	+	June 30, 2019, except the rate paid to a facility may be higher than the 319
	394	+	rate paid to the facility for the fiscal year ending June 30, 2019, if a 320
	395	+	capital improvement approved by the Department of Developmental 321
	396	+	Services, in consultation with the Department of Social Services, for the 322
	397	+	health or safety of the residents was made to the facility during the 323
	398	+	fiscal year ending June 30, 2020, or June 30, 2021, only to the extent 324
	399	+	such rate increases are within available appropriations. For the fiscal 325
	400	+	year ending June 30, 2022, rates shall not exceed those in effect for the 326
	401	+	fiscal year ending June 30, 2021, except the commissioner may, in the 327
	402	+	commissioner's discretion and within available appropriations, 328 Substitute Bill No. 1109
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409		-	~~have documented~~ fair rent ~~additions placed in service in the cost~~ 329
410		-	report year ending ~~September 30, 2021, that are not otherwise included~~ 330
411		-	in rates issued. For ~~the fiscal years ending June 30, 2022, and June 30,~~ 331
412		-	2023, ~~a facility may receive a rate increase for a capital improvement~~ 332
413		-	~~approved by~~ the ~~Department of Developmental Services~~, in 333
414		-	~~consultation with~~ the ~~Department of Social Services,~~ ~~for the health or~~ 334
415		-	~~safety of the residents during the fiscal year ending June 30~~, ~~2022, or~~ 335
416		-	~~June 30,~~ ~~2023, only to~~ the ~~extent such rate increases are within available~~ 336
417		-	~~appropriations. Any facility~~ that ~~has a significant decrease in land and~~ 337
418		-	~~building costs shall receive a reduced rate to reflect such decrease in~~ 338
419		-	~~land and building costs.~~ For ~~the fiscal years ending June 30, 2012, June~~ 339
420		-	30, ~~2013, June 30, 2014, June 30, 2015, June 30, 2016, June 30, 2017, June~~ 340
421		-	30, ~~2018, June 30,~~ ~~2019, June 30, 2020, June 30, 2021, June 30, 2022, and~~ 341
422		-	June 30, ~~2023~~, ~~the Commissioner of Social Services may provide fair~~ 342
423		-	~~rent~~ increases ~~to any facility that has undergone a material change in~~ 343
424		-	~~circumstances related to fair rent~~ and ~~has an approved certificate of~~ 344
425		-	~~need pursuant to section 17b-352~~, ~~17b-353, 17b-354~~ ~~or 17b-355.~~ 345
426		-	~~Notwithstanding~~ the ~~provisions~~ of ~~this section~~, ~~the Commissioner of~~ 346
427		-	Social Services ~~may~~, ~~within available appropriations, increase~~ or 347
428		-	~~decrease rates issued to intermediate care facilities for individuals with~~ 348
429		-	~~intellectual disabilities~~ to ~~reflect a reduction in~~ available 349
430		-	appropriations ~~as provided~~ in ~~subsection (a) of this section. For the~~ 350
431		-	~~fiscal years ending June 30,~~ ~~2014, and June 30,~~ ~~2015, the commissioner~~ 351
432		-	~~shall not consider rebasing in determining rates~~. ~~Notwithstanding~~ the 352
433		-	~~provisions of this subsection~~, ~~effective July 1~~, ~~2021~~, ~~and July 1~~, ~~2022~~, ~~the~~ 353
434		-	~~commissioner shall~~, ~~within available appropriations~~, ~~increase rates for~~ 354
435		-	~~the purpose of wage~~ and ~~benefit enhancements for employees~~ of 355
436		-	~~intermediate care facilities.~~ ~~Facilities~~ that ~~receive a rate adjustment for~~ 356
437		-	~~the purpose of wage~~ and ~~benefit enhancements but do not provide~~ 357
438		-	~~increases in employee salaries as described in this subsection on or~~ 358
439		-	~~before July 31~~, ~~2021~~, ~~and July 31, 2022, respectively, may be subject to a~~ 359
440		-	~~rate decrease in~~ the ~~same amount as the adjustment by the~~ 360
441		-	~~commissioner. There shall be no~~ increase to rates ~~based on inflation or~~ 361
442		-	~~any inflationary factor~~ for ~~the fiscal years ending June 30,~~ ~~2022, and~~ 362
443		-	~~June 30,~~ ~~2023. Notwithstanding any other provisions~~ of ~~the general~~ 363 Substitute Bill No. 1109
	409	+	provide pro rata fair rent increases to facilities that have documented 329
	410	+	fair rent additions placed in service in the cost report year ending 330
	411	+	September 30, 2020, that are not otherwise included in rates issued. For 331
	412	+	the fiscal year ending June 30, 2023, rates shall not exceed those in 332
	413	+	effect for the fiscal year ending June 30, 2022, except the commissioner 333
	414	+	may, in the commissioner's discretion and within available 334
	415	+	appropriations, provide pro rata fair rent increases to facilities which 335
	416	+	have documented fair rent additions placed in service in the cost 336
	417	+	report year ending September 30, 2021, that are not otherwise included 337
	418	+	in rates issued. For the fiscal years ending June 30, 2022, and June 30, 338
	419	+	2023, a facility may receive a rate increase for a capital improvement 339
	420	+	approved by the Depar tment of Developmental Services, in 340
	421	+	consultation with the Department of Social Services, for the health or 341
	422	+	safety of the residents during the fiscal year ending June 30, 2022, or 342
	423	+	June 30, 2023, only to the extent such rate increases are within available 343
	424	+	appropriations. For the fiscal years ending June 30, 2024, and June 30, 344
	425	+	2025, a facility may receive a rate increase for a capital improvement 345
	426	+	approved by the Department of Developmental Services, in 346
	427	+	consultation with the Department of Social Services, for the health or 347
	428	+	safety of the residents during the fiscal year ending June 30, 2024, or 348
	429	+	June 30, 2025, only to the extent such rate increases are within available 349
	430	+	appropriations. Any facility that has a significant decrease in land and 350
	431	+	building costs shall receive a reduced rate to reflect such decrease in 351
	432	+	land and building costs. For the fiscal years ending June 30, 2012, June 352
	433	+	30, 2013, June 30, 2014, June 30, 2015, June 30, 2016, June 30, 2017, June 353
	434	+	30, 2018, June 30, 2019, June 30, 2020, June 30, 2021, June 30, 2022, [and] 354
	435	+	June 30, 2023, June 30, 2024, and June 30, 2025, the Commissioner of 355
	436	+	Social Services may provide fair rent increases to any facility that has 356
	437	+	undergone a material change in circumstances related to fair rent and 357
	438	+	has an approved certificate of need pursuant to section 17b-352, 17b-358
	439	+	353, 17b-354 or 17b-355. Notwithstanding the provisions of this section, 359
	440	+	the Commissioner of Social Services may, within available 360
	441	+	appropriations, increase or decrease rates issued to intermediate care 361
	442	+	facilities for individuals with intellectual disabilities to reflect a 362
	443	+	reduction in available appropriations as provided in subsection (a) of 363 Substitute Bill No. 1109
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450		-	~~statutes or regulations adopted thereunder~~, ~~any subsequent increase to~~ 364
451		-	~~rates based on inflation as authorized for any succeeding fiscal year~~ 365
452		-	~~shall be adjusted as determined by~~ the ~~commissioner. The rate~~ of 366
453		-	~~inflation shall be computed based on~~ the ~~percentage increase~~, ~~if any, in~~ 367
454		-	~~the most recent calendar year average in~~ the ~~gross domestic product~~ 368
455		-	~~deflator over the average~~ for ~~the previous calendar year~~. ~~Any increase~~ 369
456		-	~~to rates based on inflation shall be applied prior to~~ the ~~application~~ of 370
457		-	~~any other budget adjustment factors that may impact such rates.~~ 371
458		-	~~(2) The Commissioner of Social Services shall determine whether~~ 372
459		-	~~and~~ to ~~what extent~~ a ~~change~~ in ~~ownership of a facility shall occasion~~ 373
460		-	~~the rebasing of~~ the ~~facility's costs~~. ~~There shall be no~~ inflation 374
461		-	~~adjustment during a year~~ in ~~which a facility's rates are rebased. For the~~ 375
462		-	~~fiscal~~ year ~~ending June 30, 2024, and each subsequent fiscal year,~~ the 376
463		-	~~commissioner may, in~~ the ~~commissioner's discretion and within~~ 377
464		-	~~available appropriations,~~ ~~provide pro rata fair rent increases~~ to 378
465		-	~~facilities which have documented fair rent additions placed in service~~ 379
466		-	in the ~~cost report years that are not otherwise included in rates issued.~~ 380
467		-	~~Sec. 3.~~ ~~Subsection (i)~~ of ~~section 17b-340~~ ~~of the general statutes is~~ 381
468		-	~~repealed and~~ the ~~following is substituted in lieu thereof (Effective~~ ~~July~~ 382
469		-	1, ~~2023):~~ 383
470		-	~~(i) For the fiscal year ending June 30~~, ~~1993, any residential care home~~ 384
471		-	~~with an operating cost component of its rate in excess of one hundred~~ 385
472		-	~~thirty per cent of~~ the ~~median of operating~~ cost ~~components of rates in~~ 386
473		-	~~effect January 1, 1992, shall~~ not ~~receive an operating cost component~~ 387
474		-	~~increase~~. ~~For~~ the ~~fiscal year ending June 30, 1993, any residential care~~ 388
475		-	~~home with an operating cost component of its rate that~~ is ~~less than one~~ 389
476		-	~~hundred thirty per cent of the median of operating cost components of~~ 390
477		-	~~rates in effect January 1, 1992, shall have an allowance~~ for ~~real wage~~ 391
478		-	~~growth equal to sixty-five~~ ~~per cent~~ of ~~the increase determined~~ in 392
479		-	~~accordance with subsection (q) of section 17-311-52~~ of the ~~regulations~~ 393
480		-	~~of Connecticut state agencies~~, ~~provided such~~ operating cost component 394
481		-	~~shall not exceed one hundred thirty per cent of~~ the ~~median of~~ 395
482		-	operating cost ~~components in effect January 1,~~ ~~1992. Beginning with~~ 396 Substitute Bill No. 1109
	450	+	this section. For the fiscal years ending June 30, 2014, and June 30, 364
	451	+	2015, the commissioner shall not consider rebasing in determining 365
	452	+	rates. Notwithstanding the provisions of this subsection, effective July 366
	453	+	1, 2021, and July 1, 2022, the commissioner shall, within available 367
	454	+	appropriations, increase rates for the purpose of wage and benefit 368
	455	+	enhancements for employees of intermediate care facilities. Facilities 369
	456	+	that receive a rate adjustment for the purpose of wage and benefit 370
	457	+	enhancements but do not provide increases in employee salaries as 371
	458	+	described in this subsection on or before July 31, 2021, and July 31, 372
	459	+	2022, respectively, may be subject to a rate decrease in the same 373
	460	+	amount as the adjustment by the commissioner. The rate of inflation 374
	461	+	shall be computed based on the percentage increase, if any, in the most 375
	462	+	recent calendar year average in the gross domestic product deflator 376
	463	+	over the average for the previous calendar year. Any increase to rates 377
	464	+	based on inflation shall be applied prior to the application of any other 378
	465	+	budget adjustment factors that may impact such rates. 379
	466	+	(2) The Commissioner of Social Services shall determine whether 380
	467	+	and to what extent a change in ownership of a facility shall occasion 381
	468	+	the rebasing of the facility's costs. For the fiscal year ending June 30, 382
	469	+	2024, and each subsequent fiscal year, the commissioner may, in the 383
	470	+	commissioner's discretion and within available appropriations, 384
	471	+	provide pro rata fair rent increases to facilities which have 385
	472	+	documented fair rent additions placed in service in the cost report 386
	473	+	years that are not otherwise included in rates issued. 387
	474	+	Sec. 3. Subsection (i) of section 17b-340 of the general statutes is 388
	475	+	repealed and the following is substituted in lieu thereof (Effective July 389
	476	+	1, 2023): 390
	477	+	(i) For the fiscal year ending June 30, 1993, any residential care home 391
	478	+	with an operating cost component of its rate in excess of one hundred 392
	479	+	thirty per cent of the median of operating cost components of rates in 393
	480	+	effect January 1, 1992, shall not receive an operating cost component 394
	481	+	increase. For the fiscal year ending June 30, 1993, any residential care 395
	482	+	home with an operating cost component of its rate that is less than one 396 Substitute Bill No. 1109
483	483
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489		-	~~the fiscal year ending June 30, 1993, for~~ the ~~purpose~~ of ~~determining~~ 397
490		-	~~allowable fair rent~~, ~~a residential care home with allowable fair rent less~~ 398
491		-	~~than the twenty-fifth percentile~~ of the ~~state-wide allowable fair rent~~ 399
492		-	~~shall be reimbursed as having allowable fair rent equal to~~ the ~~twenty-~~400
493		-	~~fifth percentile~~ of ~~the~~ state~~-wide allowable fair rent.~~ ~~Beginning with the~~ 401
494		-	~~fiscal year ending June 30,~~ ~~1997, a residential care home with allowable~~ 402
495		-	~~fair rent less than three dollars and ten cents per day shall be~~ 403
496		-	~~reimbursed as having allowable fair rent equal to three dollars and ten~~ 404
497		-	~~cents per day.~~ ~~Property additions placed in service during the cost year~~ 405
498		-	~~ending September 30,~~ ~~1996, or any succeeding cost year shall receive a~~ 406
499		-	fair rent ~~allowance for such additions as an addition~~ to ~~three dollars~~ 407
500		-	~~and ten cents per day if~~ the fair rent ~~for~~ the ~~facility for property placed~~ 408
501		-	~~in service prior to September~~ 30, ~~1995~~, ~~is less than or equal to three~~ 409
502		-	dollars and ten cents per day~~. Beginning with the fiscal year ending~~ 410
503		-	~~June 30, 2016, a residential care home shall be~~ reimbursed ~~the greater~~ 411
504		-	of the ~~allowable accumulated fair rent reimbursement associated with~~ 412
505		-	~~real property additions and land as calculated on~~ a ~~per day basis or~~ 413
506		-	three dollars ~~and ten cents per day if the allowable reimbursement~~ 414
507		-	~~associated with real~~ property ~~additions and land is less than three~~ 415
508		-	~~dollars and ten cents per day. For the fiscal year ending June~~ 30, ~~1996~~, 416
509		-	and ~~any succeeding~~ fiscal year~~, the allowance for real wage growth, as~~ 417
510		-	~~determined in accordance with subsection (q) of section 17-311-52 of~~ 418
511		-	the ~~regulations of Connecticut state agencies,~~ ~~shall not be applied. For~~ 419
512		-	~~the fiscal year ending June 30, 1996,~~ and ~~any succeeding fiscal year,~~ ~~the~~ 420
513		-	~~inflation adjustment made in accordance with subsection (p) of section~~ 421
514		-	~~17-311-52 of the regulations of Connecticut state agencies shall not be~~ 422
515		-	~~applied to real property costs~~. ~~Beginning with~~ the fiscal year ending 423
516		-	~~June 30~~, ~~1997, minimum allowable patient days~~ for ~~rate computation~~ 424
517		-	~~purposes for a residential care home~~ with ~~twenty-five beds or less shall~~ 425
518		-	~~be eighty-five per cent~~ of ~~licensed capacity~~. ~~Beginning with the fiscal~~ 426
519		-	year ending June 30, ~~2002~~, ~~for the purposes of determining~~ the 427
520		-	~~allowable salary~~ of ~~an administrator of a residential care home with~~ 428
521		-	~~sixty beds or less~~ the ~~department~~ shall ~~revise the allowable base salary~~ 429
522		-	~~to thirty-seven thousand dollars~~ to ~~be annually inflated thereafter in~~ 430
523		-	~~accordance with section 17-311-52 of the regulations of Connecticut~~ 431 Substitute Bill No. 1109
	489	+	hundred thirty per cent of the median of operating cost components of 397
	490	+	rates in effect January 1, 1992, shall have an allowance for real wage 398
	491	+	growth equal to sixty-five per cent of the increase determined in 399
	492	+	accordance with subsection (q) of section 17-311-52 of the regulations 400
	493	+	of Connecticut state agencies, provided such operating cost component 401
	494	+	shall not exceed one hundred thirty per cent of the median of 402
	495	+	operating cost components in effect January 1, 1992. Beginning with 403
	496	+	the fiscal year ending June 30, 1993, for the purpose of determining 404
	497	+	allowable fair rent, a residential care home with allowable fair rent less 405
	498	+	than the twenty-fifth percentile of the state-wide allowable fair rent 406
	499	+	shall be reimbursed as having allowable fair rent equal to the twenty-407
	500	+	fifth percentile of the state-wide allowable fair rent. Beginning with the 408
	501	+	fiscal year ending June 30, 1997, a residential care home with allowable 409
	502	+	fair rent less than three dollars and ten cents per day shall be 410
	503	+	reimbursed as having allowable fair rent equal to three dollars and ten 411
	504	+	cents per day. Property additions placed in service during the cost year 412
	505	+	ending September 30, 1996, or any succeeding cost year shall receive a 413
	506	+	fair rent allowance for such additions as an addition to three dollars 414
	507	+	and ten cents per day if the fair rent for the facility for property placed 415
	508	+	in service prior to September 30, 1995, is less than or equal to three 416
	509	+	dollars and ten cents per day. Beginning with the fiscal year ending 417
	510	+	June 30, 2016, a residential care home shall be reimbursed the greater 418
	511	+	of the allowable accumulated fair rent reimbursement associated with 419
	512	+	real property additions and land as calculated on a per day basis or 420
	513	+	three dollars and ten cents per day if the allowable reimbursement 421
	514	+	associated with real property additions and land is less than three 422
	515	+	dollars and ten cents per day. For the fiscal year ending June 30, 1996, 423
	516	+	and any succeeding fiscal year, the allowance for real wage growth, as 424
	517	+	determined in accordance with subsection (q) of section 17-311-52 of 425
	518	+	the regulations of Connecticut state agencies, shall not be applied. For 426
	519	+	the fiscal year ending June 30, 1996, and any succeeding fiscal year, the 427
	520	+	inflation adjustment made in accordance with subsection (p) of section 428
	521	+	17-311-52 of the regulations of Connecticut state agencies shall not be 429
	522	+	applied to real property costs. Beginning with the fiscal year ending 430
	523	+	June 30, 1997, minimum allowable patient days for rate computation 431 Substitute Bill No. 1109
524	524
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530		-	~~state agencies. The rates~~ for ~~the fiscal year ending June 30,~~ ~~2002,~~ shall 432
531		-	be ~~based upon~~ the ~~increased allowable salary of an administrator,~~ 433
532		-	~~regardless~~ of ~~whether such amount was expended in~~ the ~~2000 cost~~ 434
533		-	~~report period upon which the rates are based.~~ ~~Beginning~~ with ~~the fiscal~~ 435
534		-	~~year ending June 30, 2000, and until~~ the ~~fiscal year ending June 30,~~ 436
535		-	~~2009, inclusive,~~ ~~the inflation adjustment for rates made~~ in ~~accordance~~ 437
536		-	with ~~subsection (p) of~~ section 17-311-52 of the regulations of 438
537		-	~~Connecticut~~ state agencies shall ~~be increased by two per cent, and~~ 439
538		-	~~beginning with~~ the ~~fiscal year ending June 30~~, ~~2002, the inflation~~ 440
539		-	~~adjustment for rates made~~ in ~~accordance with subsection (c) of said~~ 441
540		-	~~section shall be increased by one per cent~~. Beginning with the fiscal 442
541		-	year ending June 30, ~~1999~~, ~~for~~ the ~~purpose of determining the~~ 443
542		-	~~allowable salary of a related party~~, the ~~department shall revise the~~ 444
543		-	~~maximum salary to twenty-seven thousand eight hundred fifty-six~~ 445
544		-	~~dollars to~~ be ~~annually inflated thereafter in accordance with section 17-~~446
545		-	~~311-52 of~~ the ~~regulations of Connecticut state agencies and beginning~~ 447
546		-	with ~~the fiscal year ending June 30, 2001, such allowable salary shall be~~ 448
547		-	~~computed on an hourly basis and~~ the ~~maximum number of hours~~ 449
548		-	~~allowed~~ for ~~a related party other than~~ the ~~proprietor shall be increased~~ 450
549		-	~~from forty hours to forty-eight~~ ~~hours per work week. For~~ the ~~fiscal~~ 451
550		-	~~year ending June 30,~~ ~~2005, each facility shall receive a rate that is two~~ 452
551		-	~~and one-quarter~~ ~~per cent more than the rate the facility received~~ in ~~the~~ 453
552		-	~~prior fiscal year,~~ ~~except any facility that would have been issued a~~ 454
553		-	~~lower rate effective July 1, 2004, than for~~ the fiscal year ending June 30, 455
554		-	~~2004, due to interim rate status or agreement with~~ the ~~department shall~~ 456
555		-	be ~~issued such lower rate effective July 1, 2004. Effective upon receipt~~ 457
556		-	~~of all~~ the ~~necessary federal approvals to secure federal financial~~ 458
557		-	~~participation matching funds associated with the~~ rate ~~increase~~ 459
558		-	~~provided~~ in ~~subdivision (4) of subsection (f) of this section, but in no~~ 460
559		-	~~event earlier than October 1~~, ~~2005, and provided the user fee imposed~~ 461
560		-	~~under section 17b-320~~ ~~is required to be collected~~, ~~each facility shall~~ 462
561		-	~~receive a~~ rate ~~that is determined in accordance~~ with ~~applicable law and~~ 463
562		-	~~subject to appropriations~~, ~~except any facility that would have been~~ 464
563		-	~~issued a lower rate effective October 1, 2005, than for~~ the ~~fiscal year~~ 465
564		-	~~ending June 30,~~ ~~2005, due to interim rate status or agreement~~ with the 466 Substitute Bill No. 1109
	530	+	purposes for a residential care home with twenty-five beds or less shall 432
	531	+	be eighty-five per cent of licensed capacity. Beginning with the fiscal 433
	532	+	year ending June 30, 2002, for the purposes of determining the 434
	533	+	allowable salary of an administrator of a residential care home with 435
	534	+	sixty beds or less the department shall revise the allowable base salary 436
	535	+	to thirty-seven thousand dollars to be annually inflated thereafter in 437
	536	+	accordance with section 17-311-52 of the regulations of Connecticut 438
	537	+	state agencies. The rates for the fiscal year ending June 30, 2002, shall 439
	538	+	be based upon the increased allowable salary of an administrator, 440
	539	+	regardless of whether such amount was expended in the 2000 cost 441
	540	+	report period upon which the rates are based. Beginning with the fiscal 442
	541	+	year ending June 30, 2000, and until the fiscal year ending June 30, 443
	542	+	2009, inclusive, the inflation adjustment for rates made in accordance 444
	543	+	with subsection (p) of section 17-311-52 of the regulations of 445
	544	+	Connecticut state agencies shall be increased by two per cent, and 446
	545	+	beginning with the fiscal year ending June 30, 2002, the inflation 447
	546	+	adjustment for rates made in accordance with subsection (c) of said 448
	547	+	section shall be increased by one per cent. Beginning with the fiscal 449
	548	+	year ending June 30, 1999, for the purpose of determining the 450
	549	+	allowable salary of a related party, the department shall revise the 451
	550	+	maximum salary to twenty-seven thousand eight hundred fifty-six 452
	551	+	dollars to be annually inflated thereafter in accordance with section 17-453
	552	+	311-52 of the regulations of Connecticut state agencies and beginning 454
	553	+	with the fiscal year ending June 30, 2001, such allowable salary shall be 455
	554	+	computed on an hourly basis and the maximum number of hours 456
	555	+	allowed for a related party other than the proprietor shall be increased 457
	556	+	from forty hours to forty-eight hours per work week. For the fiscal 458
	557	+	year ending June 30, 2005, each facility shall receive a rate that is two 459
	558	+	and one-quarter per cent more than the rate the facility received in the 460
	559	+	prior fiscal year, except any facility that would have been issued a 461
	560	+	lower rate effective July 1, 2004, than for the fiscal year ending June 30, 462
	561	+	2004, due to interim rate status or agreement with the department shall 463
	562	+	be issued such lower rate effective July 1, 2004. Effective upon receipt 464
	563	+	of all the necessary federal approvals to secure federal financial 465
	564	+	participation matching funds associated with the rate increase 466 Substitute Bill No. 1109
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571		-	~~department~~, ~~shall be issued such lower rate effective October 1, 2005.~~ 467
572		-	~~Such rate increase shall remain in effect unless: (1)~~ The ~~federal financial~~ 468
573		-	~~participation matching funds associated with the rate increase are no~~ 469
574		-	~~longer available;~~ ~~or (2) the user fee created pursuant to section 17b-320~~ 470
575		-	~~is not in effect. For the fiscal year ending June 30~~, ~~2007, rates in effect~~ 471
576		-	for the ~~period ending June 30, 2006, shall remain in effect until~~ 472
577		-	~~September~~ 30, ~~2006~~, ~~except any facility that would have been issued a~~ 473
578		-	lower rate effective ~~July~~ 1, ~~2006, than for the fiscal year ending June 30,~~ 474
579		-	~~2006, due to interim~~ rate ~~status or agreement with~~ the ~~department,~~ 475
580		-	~~shall be issued such lower~~ rate ~~effective July 1, 2006. Effective October~~ 476
581		-	~~1, 2006,~~ ~~no facility shall receive a rate that is more than four per cent~~ 477
582		-	~~greater than~~ the ~~rate~~ in effect ~~for the facility on September 30, 2006,~~ 478
583		-	~~except~~ for ~~any facility that would have been issued a lower rate~~ 479
584		-	~~effective October 1~~, 2006, ~~due to interim rate status or agreement with~~ 480
585		-	~~the department, shall be issued such~~ lower rate effective ~~October~~ 1, 481
586		-	2006~~. For~~ the ~~fiscal years ending June 30~~, ~~2010, and June 30, 2011, rates~~ 482
587		-	~~in effect for the period ending June 30~~, ~~2009, shall remain in effect until~~ 483
588		-	~~June 30~~, ~~2011~~, ~~except any~~ facility ~~that would have been issued~~ a ~~lower~~ 484
589		-	rate for the ~~fiscal year ending June~~ 30, ~~2010~~, ~~or the fiscal year ending~~ 485
590		-	~~June 30,~~ ~~2011, due to interim~~ rate ~~status or agreement with the~~ 486
591		-	~~department~~, ~~shall be issued such lower~~ rate~~, except (A) any facility that~~ 487
592		-	~~would have been~~ issued a lower rate ~~for the fiscal year ending June 30~~, 488
593		-	~~2010, or~~ the fiscal ~~year~~ ending June 30, 2011, ~~due to interim rate status~~ 489
594		-	~~or agreement with~~ the ~~Commissioner of Social Services~~ shall ~~be issued~~ 490
595		-	~~such~~ lower ~~rate; and (B) the commissioner may increase a facility's rate~~ 491
596		-	for ~~reasonable costs associated with such facility's compliance with~~ the 492
597		-	~~provisions of section 19a-495a~~ ~~concerning~~ the ~~administration of~~ 493
598		-	~~medication by unlicensed personnel.~~ ~~For the fiscal year ending June 30,~~ 494
599		-	~~2012, rates in effect~~ for the ~~period~~ ending June 30, ~~2011, shall remain in~~ 495
600		-	~~effect until~~ June 30, ~~2012~~, ~~except that (i) any facility that would have~~ 496
601		-	~~been~~ issued ~~a lower rate for the fiscal year ending June 30, 2012, due to~~ 497
602		-	~~interim~~ rate ~~status or agreement with~~ the Commissioner ~~of Social~~ 498
603		-	~~Services shall be issued~~ such ~~lower rate;~~ ~~and (ii)~~ the ~~commissioner may~~ 499
604		-	~~increase a facility's rate for reasonable costs associated with such~~ 500
605		-	~~facility's compliance with~~ the ~~provisions of section 19a-495a~~ 501 Substitute Bill No. 1109
	571	+	provided in subdivision (4) of subsection (f) of this section, but in no 467
	572	+	event earlier than October 1, 2005, and provided the user fee imposed 468
	573	+	under section 17b-320 is required to be collected, each facility shall 469
	574	+	receive a rate that is determined in accordance with applicable law and 470
	575	+	subject to appropriations, except any facility that would have been 471
	576	+	issued a lower rate effective October 1, 2005, than for the fiscal year 472
	577	+	ending June 30, 2005, due to interim rate status or agreement with the 473
	578	+	department, shall be issued such lower rate effective October 1, 2005. 474
	579	+	Such rate increase shall remain in effect unless: (1) The federal financial 475
	580	+	participation matching funds associated with the rate increase are no 476
	581	+	longer available; or (2) the user fee created pursuant to section 17b-320 477
	582	+	is not in effect. For the fiscal year ending June 30, 2007, rates in effect 478
	583	+	for the period ending June 30, 2006, shall remain in effect until 479
	584	+	September 30, 2006, except any facility that would have been issued a 480
	585	+	lower rate effective July 1, 2006, than for the fiscal year ending June 30, 481
	586	+	2006, due to interim rate status or agreement with the department, 482
	587	+	shall be issued such lower rate effective July 1, 2006. Effective October 483
	588	+	1, 2006, no facility shall receive a rate that is more than four per cent 484
	589	+	greater than the rate in effect for the facility on September 30, 2006, 485
	590	+	except for any facility that would have been issued a lower rate 486
	591	+	effective October 1, 2006, due to interim rate status or agreement with 487
	592	+	the department, shall be issued such lower rate effective October 1, 488
	593	+	2006. For the fiscal years ending June 30, 2010, and June 30, 2011, rates 489
	594	+	in effect for the period ending June 30, 2009, shall remain in effect until 490
	595	+	June 30, 2011, except any facility that would have been issued a lower 491
	596	+	rate for the fiscal year ending June 30, 2010, or the fiscal year ending 492
	597	+	June 30, 2011, due to interim rate status or agreement with the 493
	598	+	department, shall be issued such lower rate, except (A) any facility that 494
	599	+	would have been issued a lower rate for the fiscal year ending June 30, 495
	600	+	2010, or the fiscal year ending June 30, 2011, due to interim rate status 496
	601	+	or agreement with the Commissioner of Social Services shall be issued 497
	602	+	such lower rate; and (B) the commissioner may increase a facility's rate 498
	603	+	for reasonable costs associated with such facility's compliance with the 499
	604	+	provisions of section 19a-495a concerning the administration of 500
	605	+	medication by unlicensed personnel. For the fiscal year ending June 30, 501 Substitute Bill No. 1109
606	606
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612		-	~~concerning~~ the ~~administration of medication by unlicensed personnel.~~ 502
613		-	~~For the fiscal year ending~~ June 30, ~~2013~~, ~~the Commissioner of Social~~ 503
614		-	~~Services may, within available appropriations, provide~~ a rate ~~increase~~ 504
615		-	~~to a residential care home.~~ ~~Any facility that would have been issued a~~ 505
616		-	lower rate ~~for~~ the ~~fiscal year ending June 30, 2013, due to interim rate~~ 506
617		-	~~status or agreement~~ with ~~the Commissioner of Social Services shall be~~ 507
618		-	~~issued such lower rate. For~~ the ~~fiscal years ending June 30, 2012, and~~ 508
619		-	~~June 30, 2013,~~ the ~~Commissioner~~ of ~~Social Services may provide fair~~ 509
620		-	~~rent increases to any facility that has undergone a material change in~~ 510
621		-	~~circumstances related to fair rent and has an approved certificate of~~ 511
622		-	~~need pursuant~~ to ~~section 17b-352, 17b-353, 17b-354 or 17b-355~~. ~~For the~~ 512
623		-	fiscal ~~years~~ ending June 30, ~~2014~~, ~~and June 30,~~ ~~2015, for those facilities~~ 513
624		-	~~that have a calculated rate greater than~~ the ~~rate in effect for the fiscal~~ 514
625		-	~~year~~ ending June 30, ~~2013~~, ~~the commissioner may increase facility rates~~ 515
626		-	~~based upon available appropriations up to a stop gain as determined~~ 516
627		-	~~by the commissioner.~~ No facility ~~shall be issued~~ a ~~rate that is lower~~ 517
628		-	~~than the rate in effect on June 30,~~ ~~2013, except that any facility that~~ 518
629		-	~~would have been issued a lower rate~~ for the ~~fiscal year ending June 30,~~ 519
630		-	2014, ~~or the fiscal year ending~~ June 30, 2015, ~~due to interim rate status~~ 520
631		-	~~or agreement with~~ the ~~commissioner, shall be issued such lower rate.~~ 521
632		-	~~For the fiscal~~ year ending June 30, ~~2014~~, ~~and each fiscal year thereafter,~~ 522
633		-	~~a residential care home shall receive~~ a ~~rate increase for any capital~~ 523
634		-	~~improvement made during~~ the ~~fiscal year for the health and safety of~~ 524
635		-	~~residents and approved by~~ the ~~Department of Social Services~~, 525
636		-	~~provided such~~ rate ~~increase is within available appropriations.~~ For the 526
637		-	fiscal year ending June 30, 2015, ~~and each succeeding fiscal year~~ 527
638		-	~~thereafter~~, ~~costs of less than ten thousand dollars that are incurred by a~~ 528
639		-	~~facility~~ and ~~are associated with any land~~, ~~building or nonmovable~~ 529
640		-	~~equipment repair or improvement that are reported in the cost year~~ 530
641		-	~~used to establish~~ the ~~facility's rate shall not be capitalized~~ for ~~a period~~ 531
642		-	~~of more than five years for rate-setting purposes. For~~ the ~~fiscal year~~ 532
643		-	~~ending June 30,~~ ~~2015, subject to~~ available appropriations, the 533
644		-	~~commissioner may~~, ~~at the commissioner's discretion:~~ ~~Increase the~~ 534
645		-	~~inflation cost limitation under subsection (c)~~ of ~~section 17-311-52 of the~~ 535
646		-	~~regulations of Connecticut state agencies~~, ~~provided such inflation~~ 536 Substitute Bill No. 1109
	612	+	2012, rates in effect for the period ending June 30, 2011, shall remain in 502
	613	+	effect until June 30, 2012, except that (i) any facility that would have 503
	614	+	been issued a lower rate for the fiscal year ending June 30, 2012, due to 504
	615	+	interim rate status or agreement with the Commissioner of Social 505
	616	+	Services shall be issued such lower rate; and (ii) the commissioner may 506
	617	+	increase a facility's rate for reasonable costs associated with such 507
	618	+	facility's compliance with the provisions of section 19a-495a 508
	619	+	concerning the administration of medication by unlicensed personnel. 509
	620	+	For the fiscal year ending June 30, 2013, the Commissioner of Social 510
	621	+	Services may, within available appropriations, provide a rate increase 511
	622	+	to a residential care home. Any facility that would have been issued a 512
	623	+	lower rate for the fiscal year ending June 30, 2013, due to interim rate 513
	624	+	status or agreement with the Commissioner of Social Services shall be 514
	625	+	issued such lower rate. For the fiscal years ending June 30, 2012, and 515
	626	+	June 30, 2013, the Commissioner of Social Services may provide fair 516
	627	+	rent increases to any facility that has undergone a material change in 517
	628	+	circumstances related to fair rent and has an approved certificate of 518
	629	+	need pursuant to section 17b-352, 17b-353, 17b-354 or 17b-355. For the 519
	630	+	fiscal years ending June 30, 2014, and June 30, 2015, for those facilities 520
	631	+	that have a calculated rate greater than the rate in effect for the fiscal 521
	632	+	year ending June 30, 2013, the commissioner may increase facility rates 522
	633	+	based upon available appropriations up to a stop gain as determined 523
	634	+	by the commissioner. No facility shall be issued a rate that is lower 524
	635	+	than the rate in effect on June 30, 2013, except that any facility that 525
	636	+	would have been issued a lower rate for the fiscal year ending June 30, 526
	637	+	2014, or the fiscal year ending June 30, 2015, due to interim rate status 527
	638	+	or agreement with the commissioner, shall be issued such lower rate. 528
	639	+	For the fiscal year ending June 30, 2014, and each fiscal year thereafter, 529
	640	+	a residential care home shall receive a rate increase for any capital 530
	641	+	improvement made during the fiscal year for the health and safety of 531
	642	+	residents and approved by the Department of Social Services, 532
	643	+	provided such rate increase is within available appropriations. For the 533
	644	+	fiscal year ending June 30, 2015, and each succeeding fiscal year 534
	645	+	thereafter, costs of less than ten thousand dollars that are incurred by a 535
	646	+	facility and are associated with any land, building or nonmovable 536 Substitute Bill No. 1109
647	647
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652	652
653		-	~~allowance factor does not exceed a maximum of five per cent; establish~~ 537
654		-	~~a minimum~~ rate ~~of return applied to real property of five per cent~~ 538
655		-	~~inclusive~~ of ~~assets placed in service during cost~~ year ~~2013; waive the~~ 539
656		-	~~standard rate of return under subsection (f) of section 17-311-52 of~~ the 540
657		-	~~regulations of Connecticut state agencies for ownership changes or~~ 541
658		-	~~health and safety improvements that exceed one hundred thousand~~ 542
659		-	~~dollars and that are required under a consent order from the~~ 543
660		-	~~Department~~ of ~~Public Health~~; ~~and waive the rate of return adjustment~~ 544
661		-	~~under subsection (f)~~ of ~~section 17-311-52~~ of ~~the regulations of~~ 545
662		-	~~Connecticut state agencies to avoid financial hardship.~~ ~~For~~ the ~~fiscal~~ 546
663		-	~~years ending June 30,~~ ~~2016, and June 30,~~ ~~2017, rates shall not exceed~~ 547
664		-	~~those in effect~~ for ~~the period ending June 30, 2015, except the~~ 548
665		-	~~commissioner may, in the commissioner's discretion~~ and ~~within~~ 549
666		-	~~available appropriations,~~ ~~provide pro rata fair rent increases to~~ 550
667		-	~~facilities which have documented fair rent additions placed in service~~ 551
668		-	~~in cost report years ending September 30,~~ ~~2014, and September 30,~~ 552
669		-	~~2015, that are not otherwise included in rates issued~~. For the fiscal 553
670		-	years ending June 30, 2016, and June 30, 2017, ~~and each succeeding~~ 554
671		-	~~fiscal year~~, ~~any facility that would have been issued a lower rate~~, ~~due~~ 555
672		-	~~to interim rate status~~, ~~a change~~ in ~~allowable fair rent or agreement with~~ 556
673		-	~~the department~~, ~~shall be issued such lower rate.~~ ~~For the fiscal year~~ 557
674		-	~~ending June 30,~~ ~~2018, rates shall not exceed those~~ in ~~effect for the~~ 558
675		-	~~period~~ ending ~~June~~ 30, ~~2017~~, ~~except the commissioner may~~, ~~in the~~ 559
676		-	~~commissioner's discretion and within available appropriations,~~ 560
677		-	~~provide pro rata fair rent increases to facilities which have~~ 561
678		-	~~documented fair rent additions placed in service in the cost report~~ year 562
679		-	~~ending September 30~~, ~~2016, that are not otherwise included~~ in ~~rates~~ 563
680		-	issued. For the fiscal year ~~ending June 30, 2019, rates shall not exceed~~ 564
681		-	those in effect for the ~~period ending June 30, 2018, except the~~ 565
682		-	commissioner may, in the ~~commissioner's discretion and within~~ 566
683		-	available appropriations, ~~provide pro rata fair rent increases to~~ 567
684		-	facilities which have ~~documented fair rent additions placed in service~~ 568
685		-	in the cost report year ~~ending September 30, 2017, that are not~~ 569
686		-	otherwise included in rates ~~issued. For the fiscal year ending June 30,~~ 570
687		-	~~2020, rates shall not exceed those in effect~~ for the fiscal year ending 571 Substitute Bill No. 1109
	653	+	equipment repair or improvement that are reported in the cost year 537
	654	+	used to establish the facility's rate shall not be capitalized for a period 538
	655	+	of more than five years for rate-setting purposes. For the fiscal year 539
	656	+	ending June 30, 2015, subject to available appropriations, the 540
	657	+	commissioner may, at the commissioner's discretion: Increase the 541
	658	+	inflation cost limitation under subsection (c) of section 17-311-52 of the 542
	659	+	regulations of Connecticut state agencies, provided such inflation 543
	660	+	allowance factor does not exceed a maximum of five per cent; establish 544
	661	+	a minimum rate of return applied to real property of five per cent 545
	662	+	inclusive of assets placed in service during cost year 2013; waive the 546
	663	+	standard rate of return under subsection (f) of section 17-311-52 of the 547
	664	+	regulations of Connecticut state agencies for ownership changes or 548
	665	+	health and safety improvements that exceed one hundred thousand 549
	666	+	dollars and that are required under a consent order from the 550
	667	+	Department of Public Health; and waive the rate of return adjustment 551
	668	+	under subsection (f) of section 17-311-52 of the regulations of 552
	669	+	Connecticut state agencies to avoid financial hardship. For the fiscal 553
	670	+	years ending June 30, 2016, and June 30, 2017, rates shall not exceed 554
	671	+	those in effect for the period ending June 30, 2015, except the 555
	672	+	commissioner may, in the commissioner's discretion and within 556
	673	+	available appropriations, provide pro rata fair rent increases to 557
	674	+	facilities which have documented fair rent additions placed in service 558
	675	+	in cost report years ending September 30, 2014, and September 30, 559
	676	+	2015, that are not otherwise included in rates issued. For the fiscal 560
	677	+	years ending June 30, 2016, and June 30, 2017, and each succeeding 561
	678	+	fiscal year, any facility that would have been issued a lower rate, due 562
	679	+	to interim rate status, a change in allowable fair rent or agreement with 563
	680	+	the department, shall be issued such lower rate. For the fiscal year 564
	681	+	ending June 30, 2018, rates shall not exceed those in effect for the 565
	682	+	period ending June 30, 2017, except the commissioner may, in the 566
	683	+	commissioner's discretion and within available appropriations, 567
	684	+	provide pro rata fair rent increases to facilities which have 568
	685	+	documented fair rent additions placed in service in the cost report year 569
	686	+	ending September 30, 2016, that are not otherwise included in rates 570
	687	+	issued. For the fiscal year ending June 30, 2019, rates shall not exceed 571 Substitute Bill No. 1109
688	688
689	689
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693	693
694		-	June 30, ~~2019~~, except the ~~commissioner may, in the commissioner's~~ 572
695		-	discretion and within ~~available appropriations, provide pro rata fair~~ 573
696		-	rent increases to ~~facilities which have documented fair rent additions~~ 574
697		-	placed in service ~~in the cost report year ending September 30, 2018,~~ 575
698		-	that are not ~~otherwise included in rates issued. For the fiscal year~~ 576
699		-	ending June 30, ~~2021, rates shall not exceed those in effect for the fiscal~~ 577
700		-	year ending ~~June 30, 2020, except the commissioner may, in the~~ 578
701		-	commissioner's ~~discretion and within available appropriations,~~ 579
702		-	provide pro rata fair ~~rent increases to facilities which have~~ 580
703		-	documented fair rent additions ~~placed in service in the cost report year~~ 581
704		-	ending September 30, ~~2019~~, ~~that are not otherwise included in rates~~ 582
705		-	issued. For the fiscal year ~~ending June 30, 2022, the commissioner may,~~ 583
706		-	in the ~~commissioner's discretion and within available appropriations,~~ 584
707		-	~~provide pro rata fair rent increases to facilities that have documented~~ 585
708		-	~~fair rent additions placed in service in the cost report year ending~~ 586
709		-	~~September 30,~~ ~~2020, that are not otherwise included in rates issued. For~~ 587
710		-	~~the fiscal year ending June 30,~~ ~~2023, the commissioner may,~~ in the 588
711		-	~~commissioner's discretion and within available appropriations,~~ 589
712		-	~~provide pro rata fair rent increases to facilities which have~~ 590
713		-	~~documented fair rent additions placed in service~~ in the ~~cost report year~~ 591
714		-	~~ending September 30,~~ ~~2021,~~ that ~~are not otherwise included in rates~~ 592
715		-	~~issued. For~~ the ~~fiscal years~~ ending ~~June 30, 2022, and June 30, 2023, a~~ 593
716		-	~~facility may receive a rate increase~~ for ~~a capital improvement approved~~ 594
717		-	by the ~~Department of Social Services~~, ~~for the health or safety of~~ the 595
718		-	~~residents during the fiscal year ending June 30, 2022, or June 30, 2023~~, 596
719		-	~~only~~ to ~~the extent such rate increases are within available~~ 597
720		-	~~appropriations. For~~ the ~~fiscal~~ year ~~ending June 30, 2022, and June 30,~~ 598
721		-	~~2023~~, rates ~~shall be based upon rates in effect for the fiscal year ending~~ 599
722		-	June 30, ~~2021~~, ~~inflated by the gross domestic product deflator~~ 600
723		-	~~applicable to each~~ rate ~~year, except the commissioner may,~~ ~~in the~~ 601
724		-	~~commissioner's discretion and within available appropriations~~, 602
725		-	~~provide pro rata fair rent increases to facilities which have~~ 603
726		-	~~documented fair rent additions placed in service in~~ the ~~cost report~~ 604
727		-	~~years~~ ending ~~September~~ 30, ~~2020~~, and ~~September~~ 30, ~~2021, that are not~~ 605
728		-	~~otherwise included~~ in ~~rates issued.~~ ~~Notwithstanding any other~~ 606 Substitute Bill No. 1109
	694	+	those in effect for the period ending June 30, 2018, except the 572
	695	+	commissioner may, in the commissioner's discretion and within 573
	696	+	available appropriations, provide pro rata fair rent increases to 574
	697	+	facilities which have documented fair rent additions placed in service 575
	698	+	in the cost report year ending September 30, 2017, that are not 576
	699	+	otherwise included in rates issued. For the fiscal year ending June 30, 577
	700	+	2020, rates shall not exceed those in effect for the fiscal year ending 578
	701	+	June 30, 2019, except the commissioner may, in the commissioner's 579
	702	+	discretion and within available appropriations, provide pro rata fair 580
	703	+	rent increases to facilities which have documented fair rent additions 581
	704	+	placed in service in the cost report year ending September 30, 2018, 582
	705	+	that are not otherwise included in rates issued. For the fiscal year 583
	706	+	ending June 30, 2021, rates shall not exceed those in effect for the fiscal 584
	707	+	year ending June 30, 2020, except the commissioner may, in the 585
	708	+	commissioner's discretion and within available appropriations, 586
	709	+	provide pro rata fair rent increases to facilities which have 587
	710	+	documented fair rent additions placed in service in the cost report year 588
	711	+	ending September 30, 2019, that are not otherwise included in rates 589
	712	+	issued. For the fiscal year ending June 30, 2022, the commissioner may, 590
	713	+	in the commissioner's discretion and within available appropriations, 591
	714	+	provide pro rata fair rent increases to facilities that have documented 592
	715	+	fair rent additions placed in service in the cost report year ending 593
	716	+	September 30, 2020, that are not otherwise included in rates issued. For 594
	717	+	the fiscal year ending June 30, 2023, the commissioner may, in the 595
	718	+	commissioner's discretion and within available appropriations, 596
	719	+	provide pro rata fair rent increases to facilities which have 597
	720	+	documented fair rent additions placed in service in the cost report year 598
	721	+	ending September 30, 2021, that are not otherwise included in rates 599
	722	+	issued. For the fiscal years ending June 30, 2022, and June 30, 2023, a 600
	723	+	facility may receive a rate increase for a capital improvement approved 601
	724	+	by the Department of Social Services, for the health or safety of the 602
	725	+	residents during the fiscal year ending June 30, 2022, or June 30, 2023, 603
	726	+	only to the extent such rate increases are within available 604
	727	+	appropriations. For the fiscal year ending June 30, 2022, and June 30, 605
	728	+	2023, rates shall be based upon rates in effect for the fiscal year ending 606 Substitute Bill No. 1109
729	729
730	730
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734	734
735		-	~~provisions of~~ the ~~general statutes or regulations adopted thereunder,~~ 607
736		-	~~any subsequent increase~~ to ~~rates based on inflation as authorized for~~ 608
737		-	~~any succeeding fiscal year shall be adjusted as determined by the~~ 609
738		-	~~commissioner. The rate of inflation shall be computed based on the~~ 610
739		-	~~percentage increase,~~ ~~if any,~~ in the ~~most recent calendar year average in~~ 611
740		-	~~the gross domestic product deflator over the average for the previous~~ 612
741		-	~~calendar year.~~ ~~Any increase to~~ rates ~~based on~~ inflation shall be ~~applied~~ 613
742		-	~~prior to~~ the ~~application of~~ any ~~other budget adjustment factors that~~ 614
743		-	~~may impact such rates.~~ The ~~commissioner shall determine whether~~ 615
744		-	~~and~~ to ~~what extent a change in ownership of a facility shall occasion~~ 616
745		-	~~the rebasing of the facility's costs. There~~ shall be ~~no inflation~~ 617
746		-	adjustment ~~during a year in which a facility's~~ rates ~~are rebased.~~ 618
747		-	~~Sec. 4.~~ ~~Subsection (~~a) of ~~section 17b-340 of the general statutes is~~ 619
748		-	~~repealed and~~ the ~~following is substituted in lieu thereof (Effective~~ ~~from~~ 620
749		-	~~passage):~~ 621
750		-	~~(a)~~ For ~~purposes of this subsection, (1)~~ a ~~"related party"~~ ~~includes, but~~ 622
751		-	~~is not limited to~~, ~~any company related to a chronic and convalescent~~ 623
752		-	~~nursing home through family association~~, ~~common ownership~~, ~~control~~ 624
753		-	~~or business association with any of~~ the ~~owners, operators or officials of~~ 625
754		-	~~such nursing home;~~ ~~(2) "company" means any person~~, ~~partnership~~, 626
755		-	~~association~~, ~~holding company, limited liability company or~~ 627
756		-	~~corporation; (3) "family~~ ~~association" means a relationship by birth,~~ 628
757		-	~~marriage or domestic partnership;~~ ~~and (4) "profit~~ ~~and loss statement"~~ 629
758		-	~~means the most recent annual statement on profits and losses finalized~~ 630
759		-	~~by a related party before~~ the ~~annual report mandated under this~~ 631
760		-	~~subsection. The rates to be paid by or for persons aided or cared for by~~ 632
761		-	~~the state or any town in this state~~ to ~~licensed chronic and convalescent~~ 633
762		-	~~nursing homes,~~ ~~to chronic disease hospitals associated with chronic~~ 634
763		-	~~and convalescent nursing homes~~, ~~to rest homes with nursing~~ 635
764		-	~~supervision, to licensed residential care homes, as defined by~~ section 636
765		-	~~19a-490,~~ and ~~to residential facilities for persons with intellectual~~ 637
766		-	~~disability that are licensed pursuant to section 17a-227 and certified to~~ 638
767		-	~~participate in the Title XIX Medicaid program as intermediate care~~ 639 Substitute Bill No. 1109
	735	+	June 30, 2021, inflated by the gross domestic product deflator 607
	736	+	applicable to each rate year, except the commissioner may, in the 608
	737	+	commissioner's discretion and within available appropriations, 609
	738	+	provide pro rata fair rent increases to facilities which have 610
	739	+	documented fair rent additions placed in service in the cost report 611
	740	+	years ending September 30, 2020, and September 30, 2021, that are not 612
	741	+	otherwise included in rates issued. The rate of inflation shall be 613
	742	+	computed based on the percentage increase, if any, in the most recent 614
	743	+	calendar year average in the gross domestic product deflator over the 615
	744	+	average for the previous calendar year. Any increase to rates based on 616
	745	+	inflation shall be applied prior to the application of any other budget 617
	746	+	adjustment factors that may impact such rates. The commissioner shall 618
	747	+	determine whether and to what extent a change in ownership of a 619
	748	+	facility shall occasion the rebasing of the facility's costs. For the fiscal 620
	749	+	years ending June 30, 2024, and June 30, 2025, a facility may receive a 621
	750	+	rate increase for a capital improvement approved by the Department 622
	751	+	of Social Services, for the health or safety of the residents during the 623
	752	+	fiscal year ending June 30, 2024, or June 30, 2025, only to the extent 624
	753	+	such rate increases are within available appropriations. For the fiscal 625
	754	+	year ending June 30, 2024, the commissioner may, in the 626
	755	+	commissioner's discretion and within available appropriations, 627
	756	+	provide pro rata fair rent increases to facilities that have documented 628
	757	+	fair rent additions placed in service in the cost report year ending 629
	758	+	September 30, 2022, that are not otherwise included in rates issued. For 630
	759	+	the fiscal year ending June 30, 2025, the commissioner may, in the 631
	760	+	commissioner's discretion and within available appropriations, 632
	761	+	provide pro rata fair rent increases to facilities that have documented 633
	762	+	fair rent additions placed in service in the cost report year ending 634
	763	+	September 30, 2023, that are not otherwise included in rates issued. 635
	764	+	Sec. 4. Subsection (a) of section 17b-340 of the general statutes is 636
	765	+	repealed and the following is substituted in lieu thereof (Effective from 637
	766	+	passage): 638
	767	+	(a) For purposes of this subsection, (1) a "related party" includes, but 639 Substitute Bill No. 1109
768	768
769	769
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773	773
774		-	~~facilities for individuals with intellectual disabilities~~, ~~for room,~~ ~~board~~ 640
775		-	~~and services specified in licensing regulations issued by the licensing~~ 641
776		-	~~agency shall be determined annually~~, ~~except as otherwise provided in~~ 642
777		-	~~this subsection by the Commissioner of Social Services~~, ~~to be effective~~ 643
778		-	~~July first of each year except as otherwise provided in this subsection.~~ 644
779		-	~~Such rates shall be determined on~~ a ~~basis of a reasonable payment for~~ 645
780		-	~~such necessary services,~~ ~~which basis shall take into account as a factor~~ 646
781		-	the ~~costs of such services.~~ ~~Cost of such services shall include~~ 647
782		-	~~reasonable costs~~ mandated ~~by collective bargaining agreements with~~ 648
783		-	~~certified collective bargaining agents~~ or ~~other agreements between the~~ 649
784		-	~~employer~~ and ~~employees, provided "employees" shall not include~~ 650
785		-	~~persons employed as managers or chief administrators or required~~ to 651
786		-	~~be licensed as~~ nursing ~~home administrators~~, ~~and compensation for~~ 652
787		-	~~services rendered by proprietors at prevailing wage rates~~, as 653
788		-	~~determined by application of principles of accounting as prescribed by~~ 654
789		-	~~said commissioner.~~ ~~Cost of such services shall not include amounts~~ 655
790		-	~~paid by~~ the ~~facilities to employees~~ as ~~salary, or to attorneys or~~ 656
791		-	~~consultants as fees~~, ~~where the responsibility of the employees,~~ 657
792		-	~~attorneys, or consultants is to persuade or seek to persuade~~ the ~~other~~ 658
793		-	~~employees of the facility to support or oppose unionization.~~ ~~Nothing~~ 659
794		-	in this subsection ~~shall prohibit inclusion~~ of ~~amounts paid for legal~~ 660
795		-	~~counsel related to the negotiation~~ of ~~collective bargaining agreements,~~ 661
796		-	~~the settlement~~ of ~~grievances or normal administration of labor~~ 662
797		-	~~relations. The commissioner may~~, ~~in the commissioner's discretion,~~ 663
798		-	~~allow~~ the ~~inclusion of extraordinary and unanticipated~~ costs of 664
799		-	~~providing services that were incurred to avoid an immediate negative~~ 665
800		-	~~impact on~~ the ~~health and safety of patients. The commissioner may, in~~ 666
801		-	~~the commissioner's discretion~~, ~~based upon review of a facility's costs,~~ 667
802		-	~~direct care staff~~ to ~~patient ratio and any other related information,~~ 668
803		-	~~revise a facility's rate~~ for ~~any increases or decreases to total licensed~~ 669
804		-	~~capacity of more than ten beds or changes to its number of licensed~~ 670
805		-	~~rest home with nursing supervision beds and chronic and convalescent~~ 671
806		-	~~nursing home beds~~. ~~The commissioner may,~~ ~~in the commissioner's~~ 672
807		-	~~discretion, revise~~ the ~~rate of a facility that is closing.~~ ~~An interim rate~~ 673
808		-	~~issued for~~ the ~~period during which a facility is closing shall be based~~ 674 Substitute Bill No. 1109
	774	+	is not limited to, any company related to a chronic and convalescent 640
	775	+	nursing home through family association, common ownership, control 641
	776	+	or business association with any of the owners, operators or officials of 642
	777	+	such nursing home; (2) "company" means any person, partnership, 643
	778	+	association, holding company, limited liability company or 644
	779	+	corporation; (3) "family association" means a relationship by birth, 645
	780	+	marriage or domestic partnership; and (4) "profit and loss statement" 646
	781	+	means the most recent annual statement on profits and losses finalized 647
	782	+	by a related party before the annual report mandated under this 648
	783	+	subsection. The rates to be paid by or for persons aided or cared for by 649
	784	+	the state or any town in this state to licensed chronic and convalescent 650
	785	+	nursing homes, to chronic disease hospitals associated with chronic 651
	786	+	and convalescent nursing homes, to rest homes with nursing 652
	787	+	supervision, to licensed residential care homes, as defined by section 653
	788	+	19a-490, and to residential facilities for persons with intellectual 654
	789	+	disability that are licensed pursuant to section 17a-227 and certified to 655
	790	+	participate in the Title XIX Medicaid program as intermediate care 656
	791	+	facilities for individuals with intellectual disabilities, for room, board 657
	792	+	and services specified in licensing regulations issued by the licensing 658
	793	+	agency shall be determined annually, except as otherwise provided in 659
	794	+	this subsection by the Commissioner of Social Services, to be effective 660
	795	+	July first of each year except as otherwise provided in this subsection. 661
	796	+	Such rates shall be determined on a basis of a reasonable payment for 662
	797	+	such necessary services, which basis shall take into account as a factor 663
	798	+	the costs of such services. Cost of such services shall include 664
	799	+	reasonable costs mandated by collective bargaining agreements with 665
	800	+	certified collective bargaining agents or other agreements between the 666
	801	+	employer and employees, provided "employees" shall not include 667
	802	+	persons employed as managers or chief administrators or required to 668
	803	+	be licensed as nursing home administrators, and compensation for 669
	804	+	services rendered by proprietors at prevailing wage rates, as 670
	805	+	determined by application of principles of accounting as prescribed by 671
	806	+	said commissioner. Cost of such services shall not include amounts 672
	807	+	paid by the facilities to employees as salary, or to attorneys or 673
	808	+	consultants as fees, where the responsibility of the employees, 674 Substitute Bill No. 1109
809	809
810	810
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814	814
815		-	~~on a review of facility costs,~~ the ~~expected duration of the close-down~~ 675
816		-	~~period,~~ the ~~anticipated impact on Medicaid costs,~~ ~~available~~ 676
817		-	~~appropriations and the relationship~~ of ~~the rate requested by the facility~~ 677
818		-	to the ~~average Medicaid rate for a close-down period. The~~ 678
819		-	~~commissioner may so revise a facility's rate established for~~ the ~~fiscal~~ 679
820		-	~~year ending June 30~~, ~~1993, and thereafter for any bed increases~~, 680
821		-	~~decreases or changes in licensure effective after October 1, 1989.~~ 681
822		-	~~Effective July 1, 1991, in facilities~~ that ~~have both a chronic and~~ 682
823		-	~~convalescent nursing home~~ and ~~a rest home with nursing supervision~~, 683
824		-	the ~~rate for the rest home with nursing supervision shall not exceed~~ 684
825		-	~~such facility's rate for its chronic~~ and ~~convalescent nursing home.~~ ~~All~~ 685
826		-	~~such facilities~~ for ~~which rates are determined under this subsection~~ 686
827		-	~~shall report on a fiscal year basis ending on September thirtieth.~~ ~~Such~~ 687
828		-	~~report shall be submitted to the commissioner by February fifteenth.~~ 688
829		-	~~Each for-profit chronic and convalescent~~ nursing home ~~that receives~~ 689
830		-	~~state funding pursuant to this section shall include in such annual~~ 690
831		-	~~report~~ a ~~profit and loss statement from each related party that receives~~ 691
832		-	~~from such chronic and convalescent nursing home fifty thousand~~ 692
833		-	~~dollars or more per year for goods~~, ~~fees and services.~~ ~~No cause of~~ 693
834		-	~~action or liability shall arise against~~ the ~~state,~~ the ~~Department of Social~~ 694
835		-	~~Services, any state official or agent~~ for ~~failure to take action based on~~ 695
836		-	~~the information required to be reported under this subsection.~~ The 696
837		-	~~commissioner may reduce the rate in effect~~ for ~~a facility that fails to~~ 697
838		-	~~submit a complete and accurate report on~~ or ~~before February fifteenth~~ 698
839		-	~~by an amount not to exceed ten per cent of such rate. If~~ a ~~licensed~~ 699
840		-	~~residential care~~ home ~~fails to submit~~ a ~~complete and accurate report~~, 700
841		-	the ~~department~~ shall ~~notify such home of the failure and the home~~ 701
842		-	~~shall have thirty days from the date the notice was issued to submit a~~ 702
843		-	~~complete and accurate report.~~ ~~If a licensed residential care home fails~~ 703
844		-	~~to submit~~ a ~~complete and accurate report not later than thirty days~~ 704
845		-	~~after~~ the ~~date of notice,~~ ~~such home may not receive a retroactive rate~~ 705
846		-	~~increase, in the commissioner's discretion.~~ ~~The commissioner shall,~~ 706
847		-	~~annually, on or before April first,~~ ~~report the data contained~~ in ~~the~~ 707
848		-	~~reports of such facilities on the department's Internet web site.~~ ~~For the~~ 708
849		-	~~cost reporting year commencing October 1, 1985,~~ and ~~for subsequent~~ 709 Substitute Bill No. 1109
	815	+	attorneys, or consultants is to persuade or seek to persuade the other 675
	816	+	employees of the facility to support or oppose unionization. Nothing 676
	817	+	in this subsection shall prohibit inclusion of amounts paid for legal 677
	818	+	counsel related to the negotiation of collective bargaining agreements, 678
	819	+	the settlement of grievances or normal administration of labor 679
	820	+	relations. The commissioner may, in the commissioner's discretion, 680
	821	+	allow the inclusion of extraordinary and unanticipated costs of 681
	822	+	providing services that were incurred to avoid an immediate negative 682
	823	+	impact on the health and safety of patients. The commissioner may, in 683
	824	+	the commissioner's discretion, based upon review of a facility's costs, 684
	825	+	direct care staff to patient ratio and any other related information, 685
	826	+	revise a facility's rate for any increases or decreases to total licensed 686
	827	+	capacity of more than ten beds or changes to its number of licensed 687
	828	+	rest home with nursing supervision beds and chronic and convalescent 688
	829	+	nursing home beds. The commissioner may, in the commissioner's 689
	830	+	discretion, revise the rate of a facility that is closing. An interim rate 690
	831	+	issued for the period during which a facility is closing shall be based 691
	832	+	on a review of facility costs, the expected duration of the close-down 692
	833	+	period, the anticipated impact on Medicaid costs, available 693
	834	+	appropriations and the relationship of the rate requested by the facility 694
	835	+	to the average Medicaid rate for a close-down period. The 695
	836	+	commissioner may so revise a facility's rate established for the fiscal 696
	837	+	year ending June 30, 1993, and thereafter for any bed increases, 697
	838	+	decreases or changes in licensure effective after October 1, 1989. 698
	839	+	Effective July 1, 1991, in facilities that have both a chronic and 699
	840	+	convalescent nursing home and a rest home with nursing supervision, 700
	841	+	the rate for the rest home with nursing supervision shall not exceed 701
	842	+	such facility's rate for its chronic and convalescent nursing home. All 702
	843	+	such facilities for which rates are determined under this subsection 703
	844	+	shall report on a fiscal year basis ending on September thirtieth. Such 704
	845	+	report shall be submitted to the commissioner by February fifteenth. 705
	846	+	Each for-profit chronic and convalescent nursing home that receives 706
	847	+	state funding pursuant to this section shall include in such annual 707
	848	+	report a profit and loss statement from each related party that receives 708
	849	+	from such chronic and convalescent nursing home fifty thousand 709 Substitute Bill No. 1109
850	850
851	851
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853		-	~~R02~~-SB.docx }
854		-	22 of 29
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855	855
856		-	~~cost reporting years~~, ~~facilities shall report the cost~~ of ~~using the services~~ 710
857		-	of ~~any nursing personnel supplied by a temporary nursing services~~ 711
858		-	~~agency by separating said cost into two categories~~, ~~the portion of the~~ 712
859		-	~~cost equal~~ to ~~the salary of~~ the ~~employee for whom the nursing~~ 713
860		-	~~personnel supplied by~~ a ~~temporary nursing services agency is~~ 714
861		-	~~substituting shall be considered~~ a ~~nursing cost~~ and ~~any cost in excess~~ 715
862		-	~~of such salary shall be further divided so that seventy-five~~ per cent of 716
863		-	~~the excess cost shall be considered an administrative or general cost~~ 717
864		-	~~and twenty-five~~ ~~per cent~~ of the ~~excess cost shall be considered a~~ 718
865		-	~~nursing cost,~~ ~~provided if~~ the ~~total costs of~~ a ~~facility for nursing~~ 719
866		-	~~personnel supplied by~~ a ~~temporary nursing services agency in any cost~~ 720
867		-	~~year are equal~~ to ~~or exceed fifteen per cent of the total nursing~~ 721
868		-	~~expenditures~~ of ~~the facility for~~ such ~~cost year,~~ ~~no portion of such costs~~ 722
869		-	in ~~excess of fifteen per cent~~ shall ~~be classified as administrative or~~ 723
870		-	~~general costs.~~ The ~~commissioner,~~ in ~~determining such rates, shall also~~ 724
871		-	~~take into account~~ the ~~classification of patients or boarders according to~~ 725
872		-	~~special care requirements or classification of the facility according to~~ 726
873		-	~~such factors as~~ facilities ~~and~~ services ~~and such other factors as the~~ 727
874		-	~~commissioner deems reasonable,~~ ~~including anticipated fluctuations in~~ 728
875		-	~~the~~ cost ~~of providing such services.~~ The ~~commissioner may establish a~~ 729
876		-	~~separate rate~~ for ~~a facility or a portion of a facility for traumatic brain~~ 730
877		-	~~injury patients who require extensive care but not acute general~~ 731
878		-	~~hospital care. Such separate rate~~ shall ~~reflect the special care~~ 732
879		-	~~requirements~~ of such ~~patients. If changes in federal or state laws,~~ 733
880		-	~~regulations~~ or ~~standards adopted subsequent to June 30, 1985, result in~~ 734
881		-	~~increased costs or expenditures in an amount exceeding one-half~~ of 735
882		-	~~one per cent~~ of ~~allowable costs~~ for ~~the most recent cost reporting year,~~ 736
883		-	~~the commissioner shall adjust rates and provide payment for~~ any ~~such~~ 737
884		-	~~increased reasonable costs~~ or ~~expenditures within a reasonable period~~ 738
885		-	of ~~time retroactive to~~ the ~~date~~ of ~~enforcement. Nothing in this section~~ 739
886		-	shall be ~~construed to require the Department of Social Services to~~ 740
887		-	~~adjust rates and provide payment for any increases~~ in ~~costs resulting~~ 741
888		-	~~from an inspection~~ of ~~a facility by the Department of Public Health.~~ 742
889		-	~~Such assistance as~~ the ~~commissioner requires from other state agencies~~ 743
890		-	~~or departments in determining rates shall be made available to~~ the 744 Substitute Bill No. 1109
	856	+	dollars or more per year for goods, fees and services. No cause of 710
	857	+	action or liability shall arise against the state, the Department of Social 711
	858	+	Services, any state official or agent for failure to take action based on 712
	859	+	the information required to be reported under this subsection. The 713
	860	+	commissioner may reduce the rate in effect for a facility that fails to 714
	861	+	submit a complete and accurate report on or before February fifteenth 715
	862	+	by an amount not to exceed ten per cent of such rate. If a licensed 716
	863	+	residential care home fails to submit a complete and accurate report, 717
	864	+	the department shall notify such home of the failure and the home 718
	865	+	shall have thirty days from the date the notice was issued to submit a 719
	866	+	complete and accurate report. If a licensed residential care home fails 720
	867	+	to submit a complete and accurate report not later than thirty days 721
	868	+	after the date of notice, such home may not receive a retroactive rate 722
	869	+	increase, in the commissioner's discretion. The commissioner shall, 723
	870	+	annually, on or before April first, report the data contained in the 724
	871	+	reports of such facilities on the department's Internet web site. For the 725
	872	+	cost reporting year commencing October 1, 1985, and for subsequent 726
	873	+	cost reporting years, facilities shall report the cost of using the services 727
	874	+	of any nursing personnel supplied by a temporary nursing services 728
	875	+	agency by separating said cost into two categories, the portion of the 729
	876	+	cost equal to the salary of the employee for whom the nursing 730
	877	+	personnel supplied by a temporary nursing services agency is 731
	878	+	substituting shall be considered a nursing cost and any cost in excess 732
	879	+	of such salary shall be further divided so that seventy-five per cent of 733
	880	+	the excess cost shall be considered an administrative or general cost 734
	881	+	and twenty-five per cent of the excess cost shall be considered a 735
	882	+	nursing cost, provided if the total costs of a facility for nursing 736
	883	+	personnel supplied by a temporary nursing services agency in any cost 737
	884	+	year are equal to or exceed fifteen per cent of the total nursing 738
	885	+	expenditures of the facility for such cost year, no portion of such costs 739
	886	+	in excess of fifteen per cent shall be classified as administrative or 740
	887	+	general costs. The commissioner, in determining such rates, shall also 741
	888	+	take into account the classification of patients or boarders according to 742
	889	+	special care requirements or classification of the facility according to 743
	890	+	such factors as facilities and services and such other factors as the 744 Substitute Bill No. 1109
891	891
892	892
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895		-	23 of 29
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	895	+	23 of 30
896	896
897		-	commissioner ~~at the commissioner's request.~~ ~~Payment of the rates~~ 745
898		-	~~established pursuant to this section shall be conditioned on~~ the 746
899		-	~~establishment by such facilities~~ of ~~admissions procedures that conform~~ 747
900		-	~~with this section,~~ ~~section 19a-533~~ ~~and all other applicable provisions of~~ 748
901		-	~~the law and~~ the ~~provision of equality of treatment to all persons in~~ 749
902		-	such ~~facilities~~. ~~The established rates shall be the maximum amount~~ 750
903		-	~~chargeable by such facilities for care of such beneficiaries~~, ~~and the~~ 751
904		-	~~acceptance by~~ or ~~on behalf~~ of ~~any such facility of any additional~~ 752
905		-	~~compensation~~ for ~~care of any such beneficiary from any other person~~ 753
906		-	~~or source~~ shall ~~constitute the offense of aiding a beneficiary to obtain~~ 754
907		-	~~aid to which the beneficiary is not entitled and shall be punishable in~~ 755
908		-	the ~~same manner as is provided~~ in ~~subsection (b) of~~ section ~~17b-97.~~ 756
909		-	~~Notwithstanding any provision~~ of ~~this section,~~ ~~the Commissioner of~~ 757
910		-	~~Social Services may, within available appropriations,~~ provide an 758
911		-	~~interim rate increase for~~ a ~~licensed chronic and convalescent nursing~~ 759
912		-	~~home or a rest home with nursing supervision for rate periods no~~ 760
913		-	~~earlier than April 1,~~ ~~2004, only if the commissioner determines that~~ the 761
914		-	~~increase is necessary to avoid~~ the ~~filing~~ of ~~a petition for relief under~~ 762
915		-	~~Title 11 of~~ the ~~United States Code; imposition of receivership pursuant~~ 763
916		-	~~to sections 19a-542~~ ~~and 19a-543; or substantial deterioration~~ of ~~the~~ 764
917		-	~~facility's financial condition that may be expected to adversely affect~~ 765
918		-	~~resident care~~ and the ~~continued operation~~ of ~~the facility,~~ ~~and the~~ 766
919		-	~~commissioner determines that~~ the ~~continued operation of~~ the ~~facility is~~ 767
920		-	in the ~~best interest of the state. The commissioner shall consider any~~ 768
921		-	~~requests for interim rate increases~~ on ~~file with the department from~~ 769
922		-	~~March 30, 2004, and those submitted subsequently~~ for ~~rate periods no~~ 770
923		-	~~earlier than April 1,~~ ~~2004. When reviewing an interim rate increase~~ 771
924		-	~~request~~ the ~~commissioner~~ shall~~, at a minimum, consider: (A) Existing~~ 772
925		-	~~chronic and convalescent nursing home or rest home with nursing~~ 773
926		-	~~supervision utilization in~~ the ~~area and projected bed need; (B) physical~~ 774
927		-	~~plant long-term~~ ~~viability and the ability of the owner or purchaser to~~ 775
928		-	~~implement any necessary property improvements;~~ ~~(C) licensure~~ and 776
929		-	~~certification compliance history;~~ ~~(D) reasonableness of actual and~~ 777
930		-	~~projected expenses;~~ ~~and (E)~~ the ~~ability of~~ the ~~facility to meet wage and~~ 778
931		-	~~benefit costs.~~ ~~No interim rate shall be increased pursuant~~ to ~~this~~ 779 Substitute Bill No. 1109
	897	+	commissioner deems reasonable, including anticipated fluctuations in 745
	898	+	the cost of providing such services. The commissioner may establish a 746
	899	+	separate rate for a facility or a portion of a facility for traumatic brain 747
	900	+	injury patients who require extensive care but not acute general 748
	901	+	hospital care. Such separate rate shall reflect the special care 749
	902	+	requirements of such patients. If changes in federal or state laws, 750
	903	+	regulations or standards adopted subsequent to June 30, 1985, result in 751
	904	+	increased costs or expenditures in an amount exceeding one-half of 752
	905	+	one per cent of allowable costs for the most recent cost reporting year, 753
	906	+	the commissioner shall adjust rates and provide payment for any such 754
	907	+	increased reasonable costs or expenditures within a reasonable period 755
	908	+	of time retroactive to the date of enforcement. Nothing in this section 756
	909	+	shall be construed to require the Department of Social Services to 757
	910	+	adjust rates and provide payment for any increases in costs resulting 758
	911	+	from an inspection of a facility by the Department of Public Health. 759
	912	+	Such assistance as the commissioner requires from other state agencies 760
	913	+	or departments in determining rates shall be made available to the 761
	914	+	commissioner at the commissioner's request. Payment of the rates 762
	915	+	established pursuant to this section shall be conditioned on the 763
	916	+	establishment by such facilities of admissions procedures that conform 764
	917	+	with this section, section 19a-533 and all other applicable provisions of 765
	918	+	the law and the provision of equality of treatment to all persons in 766
	919	+	such facilities. The established rates shall be the maximum amount 767
	920	+	chargeable by such facilities for care of such beneficiaries, and the 768
	921	+	acceptance by or on behalf of any such facility of any additional 769
	922	+	compensation for care of any such beneficiary from any other person 770
	923	+	or source shall constitute the offense of aiding a beneficiary to obtain 771
	924	+	aid to which the beneficiary is not entitled and shall be punishable in 772
	925	+	the same manner as is provided in subsection (b) of section 17b-97. 773
	926	+	Notwithstanding any provision of this section, the Commissioner of 774
	927	+	Social Services may, within available appropriations, provide an 775
	928	+	interim rate increase for a licensed chronic and convalescent nursing 776
	929	+	home or a rest home with nursing supervision for rate periods no 777
	930	+	earlier than April 1, 2004, only if the commissioner determines that the 778
	931	+	increase is necessary to avoid the filing of a petition for relief under 779 Substitute Bill No. 1109
932	932
933	933
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937	937
938		-	~~subsection in excess of one hundred fifteen per cent~~ of the ~~median rate~~ 780
939		-	~~for~~ the ~~facility's peer grouping, established pursuant to [subdivision (2)~~ 781
940		-	~~of subsection (f) of this section]~~ ~~subdivision (3) of subsection (a) of~~ 782
941		-	~~section 17b-340d~~, ~~as amended by this act, unless recommended by~~ the 783
942		-	commissioner ~~and approved by~~ the ~~Secretary~~ of the ~~Office of Policy~~ 784
943		-	~~and Management after consultation with~~ the commissioner~~. Such~~ 785
944		-	~~median rates shall be published by~~ the Department ~~of Social Services~~ 786
945		-	~~not later than April first of each year.~~ ~~In the event that a facility~~ 787
946		-	~~granted~~ an interim rate increase ~~pursuant to this section is sold or~~ 788
947		-	~~otherwise conveyed for value to an unrelated entity less than five years~~ 789
948		-	~~after the effective date of such rate increase,~~ ~~the rate increase shall be~~ 790
949		-	~~deemed rescinded~~ and ~~the department shall recover an amount equal~~ 791
950		-	to the ~~difference between payments made for all affected rate periods~~ 792
951		-	and ~~payments that would have been made if the interim rate increase~~ 793
952		-	~~was not granted.~~ ~~The commissioner may seek recovery~~ of ~~such~~ 794
953		-	~~payments from any~~ facility ~~with common ownership.~~ ~~With the~~ 795
954		-	~~approval of the Secretary of the Office of Policy and Management, the~~ 796
955		-	~~commissioner may waive recovery and rescission~~ of the ~~interim~~ rate 797
956		-	for ~~good cause shown that is not inconsistent with this section,~~ 798
957		-	~~including, but not limited to,~~ ~~transfers to family members that were~~ 799
958		-	~~made for no value.~~ The ~~commissioner shall provide written quarterly~~ 800
959		-	~~reports to~~ the ~~joint standing committees~~ of the ~~General Assembly~~ 801
960		-	~~having cognizance of matters relating to aging,~~ ~~human services and~~ 802
961		-	~~appropriations and~~ the ~~budgets~~ of ~~state agencies, that identify each~~ 803
962		-	~~facility requesting an interim rate increase,~~ the ~~amount of the~~ 804
963		-	~~requested~~ rate increase ~~for each facility,~~ ~~the action taken by the~~ 805
964		-	~~commissioner and the secretary pursuant~~ to ~~this subsection,~~ ~~and~~ 806
965		-	~~estimates~~ of ~~the additional cost to~~ the ~~state for each approved interim~~ 807
966		-	~~rate increase.~~ ~~Nothing in this subsection~~ shall ~~prohibit the~~ 808
967		-	~~commissioner from increasing~~ the rate ~~of a licensed chronic and~~ 809
968		-	~~convalescent nursing home or a rest home with nursing supervision~~ 810
969		-	~~for allowable costs associated with facility capital improvements or~~ 811
970		-	~~increasing~~ the ~~rate in case of a sale of a licensed chronic and~~ 812
971		-	~~convalescent nursing home or a rest home with nursing supervision if~~ 813
972		-	~~receivership has been imposed on such home. For purposes~~ of ~~this~~ 814 Substitute Bill No. 1109
	938	+	Title 11 of the United States Code; imposition of receivership pursuant 780
	939	+	to sections 19a-542 and 19a-543; or substantial deterioration of the 781
	940	+	facility's financial condition that may be expected to adversely affect 782
	941	+	resident care and the continued operation of the facility, and the 783
	942	+	commissioner determines that the continued operation of the facility is 784
	943	+	in the best interest of the state. The commissioner shall consider any 785
	944	+	requests for interim rate increases on file with the department from 786
	945	+	March 30, 2004, and those submitted subsequently for rate periods no 787
	946	+	earlier than April 1, 2004. When reviewing an interim rate increase 788
	947	+	request the commissioner shall, at a minimum, consider: (A) Existing 789
	948	+	chronic and convalescent nursing home or rest home with nursing 790
	949	+	supervision utilization in the area and projected bed need; (B) physical 791
	950	+	plant long-term viability and the ability of the owner or purchaser to 792
	951	+	implement any necessary property improvements; (C) licensure and 793
	952	+	certification compliance history; (D) reasonableness of actual and 794
	953	+	projected expenses; and (E) the ability of the facility to meet wage and 795
	954	+	benefit costs. No interim rate shall be increased pursuant to this 796
	955	+	subsection in excess of one hundred fifteen per cent of the median rate 797
	956	+	for the facility's peer grouping, established pursuant to subdivision [(2) 798
	957	+	of subsection (f) of this section] (3) of subsection (a) of section 17b-799
	958	+	340d, as amended by this act, unless recommended by the 800
	959	+	commissioner and approved by the Secretary of the Office of Policy 801
	960	+	and Management after consultation with the commissioner. Such 802
	961	+	median rates shall be published by the Department of Social Services 803
	962	+	not later than April first of each year. In the event that a facility 804
	963	+	granted an interim rate increase pursuant to this section is sold or 805
	964	+	otherwise conveyed for value to an unrelated entity less than five years 806
	965	+	after the effective date of such rate increase, the rate increase shall be 807
	966	+	deemed rescinded and the department shall recover an amount equal 808
	967	+	to the difference between payments made for all affected rate periods 809
	968	+	and payments that would have been made if the interim rate increase 810
	969	+	was not granted. The commissioner may seek recovery of such 811
	970	+	payments from any facility with common ownership. With the 812
	971	+	approval of the Secretary of the Office of Policy and Management, the 813
	972	+	commissioner may waive recovery and rescission of the interim rate 814 Substitute Bill No. 1109
973	973
974	974
975	975		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2023SB-01109-
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978	978
979		-	section, "temporary nursing services agency" and "nursing personnel" 815
980		-	have the same meaning as provided in section 19a-118. 816
981		-	Sec. 5. Subsection (a) of section 17b-340d of the general statutes is 817
982		-	repealed and the following is substituted in lieu thereof (Effective from 818
983		-	passage): 819
984		-	(a) The Commissioner of Social Services shall implement an acuity-820
985		-	based methodology for Medicaid reimbursement of nursing home 821
986		-	services effective July 1, 2022. Notwithstanding section 17b-340, as 822
987		-	amended by this act, for the fiscal year ending June 30, 2023, and 823
988		-	annually thereafter, the Commissioner of Social Services shall establish 824
989		-	Medicaid rates paid to nursing home facilities based on cost years 825
990		-	ending on September thirtieth in accordance with the following: 826
991		-	(1) Case-mix adjustments to the direct care component, which will 827
992		-	be based on Minimum Data Set resident assessment data as well as 828
993		-	cost data reported for the cost year ending September 30, 2019, shall be 829
994		-	made effective beginning July 1, 2022, and updated every quarter 830
995		-	thereafter. After modeling such case-mix adjustments, the 831
996		-	Commissioner of Social Services shall evaluate impact on a facility by 832
997		-	facility basis and, not later than October 1, 2021, (A) make 833
998		-	recommendations to the Secretary of the Office of Policy and 834
999		-	Management, and (B) submit a report on the recommendations, in 835
1000		-	accordance with the provisions of section 11-4a, to the joint standing 836
1001		-	committees of the General Assembly having cognizance of matters 837
1002		-	relating to appropriations and the budgets of state agencies and 838
1003		-	human services on any adjustments needed to facilitate the transition 839
1004		-	to the new methodology on July 1, 2022. This evaluation may include a 840
1005		-	review of inflationary allowances, case mix and budget adjustment 841
1006		-	factors and stop loss and stop gain corridors and the ability to make 842
1007		-	such adjustments within available appropriations. 843
1008		-	(2) Beginning July 1, 2022, facilities will be required to comply with 844
1009		-	collection and reporting of quality metrics as specified by the 845
1010		-	Department of Social Services, after consultation with the nursing 846 Substitute Bill No. 1109
	979	+	for good cause shown that is not inconsistent with this section, 815
	980	+	including, but not limited to, transfers to family members that were 816
	981	+	made for no value. The commissioner shall provide written quarterly 817
	982	+	reports to the joint standing committees of the General Assembly 818
	983	+	having cognizance of matters relating to aging, human services and 819
	984	+	appropriations and the budgets of state agencies, that identify each 820
	985	+	facility requesting an interim rate increase, the amount of the 821
	986	+	requested rate increase for each facility, the action taken by the 822
	987	+	commissioner and the secretary pursuant to this subsection, and 823
	988	+	estimates of the additional cost to the state for each approved interim 824
	989	+	rate increase. Nothing in this subsection shall prohibit the 825
	990	+	commissioner from increasing the rate of a licensed chronic and 826
	991	+	convalescent nursing home or a rest home with nursing supervision 827
	992	+	for allowable costs associated with facility capital improvements or 828
	993	+	increasing the rate in case of a sale of a licensed chronic and 829
	994	+	convalescent nursing home or a rest home with nursing supervision if 830
	995	+	receivership has been imposed on such home. For purposes of this 831
	996	+	section, "temporary nursing services agency" and "nursing personnel" 832
	997	+	have the same meaning as provided in section 19a-118. 833
	998	+	Sec. 5. Subsection (a) of section 17b-340d of the general statutes is 834
	999	+	repealed and the following is substituted in lieu thereof (Effective from 835
	1000	+	passage): 836
	1001	+	(a) The Commissioner of Social Services shall implement an acuity-837
	1002	+	based methodology for Medicaid reimbursement of nursing home 838
	1003	+	services effective July 1, 2022. Notwithstanding section 17b-340, as 839
	1004	+	amended by this act, for the fiscal year ending June 30, 2023, and 840
	1005	+	annually thereafter, the Commissioner of Social Services shall establish 841
	1006	+	Medicaid rates paid to nursing home facilities based on cost years 842
	1007	+	ending on September thirtieth in accordance with the following: 843
	1008	+	(1) Case-mix adjustments to the direct care component, which will 844
	1009	+	be based on Minimum Data Set resident assessment data as well as 845
	1010	+	cost data reported for the cost year ending September 30, 2019, shall be 846
	1011	+	made effective beginning July 1, 2022, and updated every quarter 847 Substitute Bill No. 1109
1011	1012
1012	1013
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1016	1017
1017		-	~~home industry~~, ~~consumers, employees and~~ the ~~Department of Public 847~~
1018		-	~~Health. Rate adjustments based~~ on ~~performance on quality metrics will 848~~
1019		-	~~be phased in~~, ~~beginning July~~ 1, ~~2022~~, ~~with a period of reporting only. 849~~
1020		-	~~(3) Geographic peer groupings~~ of ~~facilities shall be established by 850~~
1021		-	the ~~Department of Social Services pursuant to regulations adopted~~ in ~~851~~
1022		-	accordance with ~~subsection (b)~~ of ~~this section.~~ ~~852~~
1023		-	~~(4) Allowable costs shall be divided into~~ the ~~following five cost 853~~
1024		-	~~components: (A) Direct costs,~~ ~~which shall include salaries for nursing 854~~
1025		-	~~personnel, related fringe benefits and costs for nursing personnel 855~~
1026		-	~~supplied by~~ a ~~temporary nursing services agency; (B) indirect costs, 856~~
1027		-	~~which shall include professional fees~~, ~~dietary expenses,~~ ~~housekeeping 857~~
1028		-	~~expenses, laundry expenses,~~ ~~supplies related~~ to ~~patient care,~~ ~~salaries 858~~
1029		-	~~for indirect care personnel and related fringe benefits; (C) fair rent, 859~~
1030		-	~~which shall~~ be ~~defined in regulations adopted in accordance~~ with ~~860~~
1031		-	~~subsection (b)~~ of ~~this section;~~ ~~(D) capital-related~~ ~~costs, which shall 861~~
1032		-	~~include property taxes~~, ~~insurance expenses,~~ ~~equipment leases and 862~~
1033		-	~~equipment depreciation;~~ and ~~(E) administrative and general costs,~~ ~~863~~
1034		-	~~which shall include maintenance and operation of plant expenses,~~ ~~864~~
1035		-	~~salaries for administrative and maintenance personnel and related 865~~
1036		-	~~fringe benefits. For~~ (i) ~~direct costs,~~ ~~the maximum cost~~ shall be ~~equal to 866~~
1037		-	~~one hundred thirty-five per cent~~ of ~~the median allowable cost of that 867~~
1038		-	~~peer grouping;~~ (ii) ~~indirect costs,~~ ~~the maximum cost shall be equal to 868~~
1039		-	~~one hundred fifteen per cent of~~ the ~~state-wide median allowable~~ cost~~; 869~~
1040		-	(~~iii~~) ~~fair rent~~, ~~the amount~~ shall ~~be calculated utilizing the amount 870~~
1041		-	~~approved pursuant to section 17b-353; (iv) capital-~~related costs~~, there 871~~
1042		-	~~shall be no maximum~~; ~~and~~ (v) ~~administrative and general~~ costs, ~~the 872~~
1043		-	~~maximum~~ shall ~~be equal to the state-wide~~ ~~median allowable cost. For 873~~
1044		-	~~purposes of this subdivision~~, ~~"temporary nursing services agency"~~ ~~and 874~~
1045		-	~~"nursing~~ personnel~~" have the same meaning as provided in section 875~~
1046		-	~~19a-118. 876~~
1047		-	(5) ~~Costs in excess~~ of ~~the maximum amounts established under~~ this ~~877~~
1048		-	~~subsection shall not be recognized as allowable costs~~, ~~except that the 878~~
1049		-	~~commissioner may establish rates whereby allowable~~ costs ~~may exceed 879~~ Substitute Bill No. 1109
	1018	+	thereafter. After modeling such case-mix adjustments, the 848
	1019	+	Commissioner of Social Services shall evaluate impact on a facility by 849
	1020	+	facility basis and, not later than October 1, 2021, (A) make 850
	1021	+	recommendations to the Secretary of the Office of Policy and 851
	1022	+	Management, and (B) submit a report on the recommendations, in 852
	1023	+	accordance with the provisions of section 11-4a, to the joint standing 853
	1024	+	committees of the General Assembly having cognizance of matters 854
	1025	+	relating to appropriations and the budgets of state agencies and 855
	1026	+	human services on any adjustments needed to facilitate the transition 856
	1027	+	to the new methodology on July 1, 2022. This evaluation may include a 857
	1028	+	review of inflationary allowances, case mix and budget adjustment 858
	1029	+	factors and stop loss and stop gain corridors and the ability to make 859
	1030	+	such adjustments within available appropriations. 860
	1031	+	(2) Beginning July 1, 2022, facilities will be required to comply with 861
	1032	+	collection and reporting of quality metrics as specified by the 862
	1033	+	Department of Social Services, after consultation with the nursing 863
	1034	+	home industry, consumers, employees and the Department of Public 864
	1035	+	Health. Rate adjustments based on performance on quality metrics will 865
	1036	+	be phased in, beginning July 1, 2022, with a period of reporting only. 866
	1037	+	(3) Geographic peer groupings of facilities shall be established by 867
	1038	+	the Department of Social Services pursuant to regulations adopted in 868
	1039	+	accordance with subsection (b) of this section. 869
	1040	+	(4) Allowable costs shall be divided into the following five cost 870
	1041	+	components: (A) Direct costs, which shall include salaries for nursing 871
	1042	+	personnel, related fringe benefits and costs for nursing personnel 872
	1043	+	supplied by a temporary nursing services agency; (B) indirect costs, 873
	1044	+	which shall include professional fees, dietary expenses, housekeeping 874
	1045	+	expenses, laundry expenses, supplies related to patient care, salaries 875
	1046	+	for indirect care personnel and related fringe benefits; (C) fair rent, 876
	1047	+	which shall be defined in regulations adopted in accordance with 877
	1048	+	subsection (b) of this section; (D) capital-related costs, which shall 878
	1049	+	include property taxes, insurance expenses, equipment leases and 879
	1050	+	equipment depreciation; and (E) administrative and general costs, 880 Substitute Bill No. 1109
1050	1051
1051	1052
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1055	1056
1056		-	~~such maximum amounts for beds~~ which ~~are restricted to use by 880~~
1057		-	~~patients with acquired immune deficiency syndrome,~~ ~~traumatic brain 881~~
1058		-	~~injury or other specialized services~~. ~~882~~
1059		-	~~[(5) For~~ the ~~fiscal year ending]~~ ~~(6) On or after June 30, 2022, the 883~~
1060		-	~~commissioner may~~, in the ~~commissioner's discretion and within 884~~
1061		-	~~available appropriations,~~ ~~provide pro rata fair rent increases to 885~~
1062		-	~~facilities which have documented~~ fair rent ~~additions placed in service 886~~
1063		-	~~in the most recently filed cost report [year ending September 30~~, ~~2020,] 887~~
1064		-	~~that are not otherwise included in~~ the ~~rates issued. 888~~
1065		-	~~(7)~~ For ~~the purpose of determining allowable fair rent, a facility with 889~~
1066		-	~~allowable fair rent less than the twenty-fifth percentile~~ of ~~the state-890~~
1067		-	~~wide allowable fair rent shall be reimbursed~~ as ~~having allowable fair 891~~
1068		-	~~rent equal to the twenty-fifth percentile of the state-wide allowable fair 892~~
1069		-	~~rent. Any facility with a rate~~ of ~~return on real property other than land 893~~
1070		-	~~in excess of eleven per cent~~ shall ~~have such allowance revised to eleven 894~~
1071		-	~~per cent.~~ ~~Any facility or its related realty affiliate which finances or 895~~
1072		-	~~refinances debt through bonds issued~~ by ~~the Connecticut Health and 896~~
1073		-	~~Education Facilities Authority shall report the terms and conditions of 897~~
1074		-	~~such financing~~ or ~~refinancing to the Commissioner of Social~~ Services ~~898~~
1075		-	~~not later than thirty days~~ after ~~completing such financing or 899~~
1076		-	~~refinancing.~~ The commissioner ~~may revise the facility~~'s ~~fair rent 900~~
1077		-	~~component of its rate~~ to ~~reflect any financial benefit the facility or its 901~~
1078		-	~~related realty affiliate received as a result of such financing or 902~~
1079		-	~~refinancing.~~ The ~~commissioner shall determine allowable fair rent for 903~~
1080		-	~~real property other than land based on~~ the ~~rate of return for~~ the ~~cost 904~~
1081		-	~~year in which such bonds were issued.~~ ~~The financial benefit resulting 905~~
1082		-	~~from a facility financing or refinancing debt through such bonds shall 906~~
1083		-	~~be shared between the state and the facility to an extent determined by 907~~
1084		-	~~the commissioner on a case-by-case basis and shall be reflected~~ in ~~an 908~~
1085		-	~~adjustment to the facility's allowable fair rent~~. ~~909~~
1086		-	(8) A facility ~~shall receive cost efficiency adjustments for indirect 910~~
1087		-	~~costs and for administrative and general costs if such costs are below 911~~
1088		-	~~the state-~~wide ~~median costs.~~ ~~The cost efficiency adjustments~~ shall ~~912~~ Substitute Bill No. 1109
	1057	+	which shall include maintenance and operation of plant expenses, 881
	1058	+	salaries for administrative and maintenance personnel and related 882
	1059	+	fringe benefits. For (i) direct costs, the maximum cost shall be equal to 883
	1060	+	one hundred thirty-five per cent of the median allowable cost of that 884
	1061	+	peer grouping; (ii) indirect costs, the maximum cost shall be equal to 885
	1062	+	one hundred fifteen per cent of the state-wide median allowable cost; 886
	1063	+	(iii) fair rent, the amount shall be calculated utilizing the amount 887
	1064	+	approved pursuant to section 17b-353; (iv) capital-related costs, there 888
	1065	+	shall be no maximum; and (v) administrative and general costs, the 889
	1066	+	maximum shall be equal to the state-wide median allowable cost. For 890
	1067	+	purposes of this subdivision, "temporary nursing services agency" and 891
	1068	+	"nursing personnel" have the same meaning as provided in section 892
	1069	+	19a-118. 893
	1070	+	(5) Costs in excess of the maximum amounts established under this 894
	1071	+	subsection shall not be recognized as allowable costs, except that the 895
	1072	+	commissioner may establish rates whereby allowable costs may exceed 896
	1073	+	such maximum amounts for beds which are restricted to use by 897
	1074	+	patients with acquired immune deficiency syndrome, traumatic brain 898
	1075	+	injury or other specialized services. 899
	1076	+	[(5) For the fiscal year ending] (6) On or after June 30, 2022, the 900
	1077	+	commissioner may, in the commissioner's discretion and within 901
	1078	+	available appropriations, provide pro rata fair rent increases to 902
	1079	+	facilities which have documented fair rent additions placed in service 903
	1080	+	in the most recently filed cost report [year ending September 30, 2020,] 904
	1081	+	that are not otherwise included in the rates issued. The commissioner 905
	1082	+	may provide, within available appropriations, pro rata fair rent 906
	1083	+	increases, which may, at the discretion of the commissioner, include 907
	1084	+	increases for facilities that have undergone a material change in 908
	1085	+	circumstances related to fair rent additions in the most recently filed 909
	1086	+	cost report. 910
	1087	+	(7) For the purpose of determining allowable fair rent, a facility with 911
	1088	+	allowable fair rent less than the twenty-fifth percentile of the state-912
	1089	+	wide allowable fair rent shall be reimbursed as having allowable fair 913 Substitute Bill No. 1109
1089	1090
1090	1091
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1094	1095
1095		-	equal twenty-five per cent of the difference between allowable 913
1096		-	reported costs and the applicable median allowable cost established 914
1097		-	pursuant to subdivision (4) of this subsection. 915
1098		-	(9) On and after July 1, 2025, costs shall be rebased no more 916
1099		-	frequently than every two years and no less frequently than every four 917
1100		-	years, as determined by the commissioner. There shall be no inflation 918
1101		-	adjustment during a year in which a facility's rates are rebased. The 919
1102		-	commissioner shall determine whether and to what extent a change in 920
1103		-	ownership of a facility shall occasion the rebasing of the facility's costs. 921
1104		-	(10) The method of establishing rates for new facilities shall be 922
1105		-	determined by the commissioner in accordance with the provisions of 923
1106		-	this subsection. 924
1107		-	[(6)] (11) There shall be no increase to rates based on inflation or any 925
1108		-	inflationary factor for the fiscal years ending June 30, 2022, and June 926
1109		-	30, 2023, unless otherwise authorized under subdivision (1) of this 927
1110		-	subsection. Notwithstanding any other provisions of the general 928
1111		-	statutes or regulations adopted thereunder, any subsequent increase to 929
1112		-	rates based on inflation as authorized for any succeeding fiscal year 930
1113		-	shall be adjusted as determined by the commissioner. The rate of 931
1114		-	inflation shall be computed based on the percentage increase, if any, in 932
1115		-	the most recent calendar year average in the gross domestic product 933
1116		-	deflator over the average for the previous calendar year. Any increase 934
1117		-	to rates based on inflation shall be applied prior to the application of 935
1118		-	any other budget adjustment factors that may impact such rates. 936
1119		-	[(7)] (12) For purposes of computing minimum allowable patient 937
1120		-	days, utilization of a facility's certified beds shall be determined at a 938
1121		-	minimum of ninety per cent of capacity, except for facilities that have 939
1122		-	undergone a change in ownership, new facilities, and facilities which 940
1123		-	are certified for additional beds which may be permitted a lower 941
1124		-	occupancy rate for the first three months of operation after the effective 942
1125		-	date of licensure. 943 Substitute Bill No. 1109
	1096	+	rent equal to the twenty-fifth percentile of the state-wide allowable fair 914
	1097	+	rent. Any facility with a rate of return on real property other than land 915
	1098	+	in excess of eleven per cent shall have such allowance revised to eleven 916
	1099	+	per cent. Any facility or its related realty affiliate which finances or 917
	1100	+	refinances debt through bonds issued by the Connecticut Health and 918
	1101	+	Education Facilities Authority shall report the terms and conditions of 919
	1102	+	such financing or refinancing to the Commissioner of Social Services 920
	1103	+	not later than thirty days after completing such financing or 921
	1104	+	refinancing. The commissioner may revise the facility's fair rent 922
	1105	+	component of its rate to reflect any financial benefit the facility or its 923
	1106	+	related realty affiliate received as a result of such financing or 924
	1107	+	refinancing. The commissioner shall determine allowable fair rent for 925
	1108	+	real property other than land based on the rate of return for the cost 926
	1109	+	year in which such bonds were issued. The financial benefit resulting 927
	1110	+	from a facility financing or refinancing debt through such bonds shall 928
	1111	+	be shared between the state and the facility to an extent determined by 929
	1112	+	the commissioner on a case-by-case basis and shall be reflected in an 930
	1113	+	adjustment to the facility's allowable fair rent. 931
	1114	+	(8) A facility shall receive cost efficiency adjustments for indirect 932
	1115	+	costs and for administrative and general costs if such costs are below 933
	1116	+	the state-wide median costs. The cost efficiency adjustments shall 934
	1117	+	equal twenty-five per cent of the difference between allowable 935
	1118	+	reported costs and the applicable median allowable cost established 936
	1119	+	pursuant to subdivision (4) of this subsection. 937
	1120	+	(9) On and after July 1, 2025, costs shall be rebased no more 938
	1121	+	frequently than every two years and no less frequently than every four 939
	1122	+	years, as determined by the commissioner, within available 940
	1123	+	appropriations. The commissioner shall determine whether and to 941
	1124	+	what extent a change in ownership of a facility shall occasion the 942
	1125	+	rebasing of the facility's costs. 943
	1126	+	(10) The method of establishing rates for new facilities shall be 944
	1127	+	determined by the commissioner in accordance with the provisions of 945
	1128	+	this subsection. 946 Substitute Bill No. 1109
1126	1129
1127	1130
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1131	1134
1132		-	[(8)] (13) Rates determined under this section shall comply with 944
1133		-	federal laws and regulations. 945
	1135	+	[(6)] (11) There shall be no increase to rates based on inflation or any 947
	1136	+	inflationary factor for the fiscal years ending June 30, 2022, and June 948
	1137	+	30, 2023, unless otherwise authorized under subdivision (1) of this 949
	1138	+	subsection. Notwithstanding any other provisions of the general 950
	1139	+	statutes or regulations adopted thereunder, allowable operating costs, 951
	1140	+	excluding fair rent, shall be inflated by the gross domestic product 952
	1141	+	deflator when funding is specifically appropriated for such purposes 953
	1142	+	in the enacted budget. The rate of inflation shall be computed by 954
	1143	+	comparing the most recent rate year to the average of the gross 955
	1144	+	domestic product deflator for the previous four fiscal quarters ending 956
	1145	+	April thirtieth. Any increase to rates based on inflation shall be applied 957
	1146	+	prior to the application of any other budget adjustment factors that 958
	1147	+	may impact such rates. 959
	1148	+	[(7)] (12) For purposes of computing minimum allowable patient 960
	1149	+	days, utilization of a facility's certified beds shall be determined at a 961
	1150	+	minimum of ninety per cent of capacity, except for facilities that have 962
	1151	+	undergone a change in ownership, new facilities, and facilities which 963
	1152	+	are certified for additional beds which may be permitted a lower 964
	1153	+	occupancy rate for the first three months of operation after the effective 965
	1154	+	date of licensure. 966
	1155	+	[(8)] (13) Rates determined under this section shall comply with 967
	1156	+	federal laws and regulations. 968
	1157	+	(14) The Commissioner of Social Services may authorize an interim 969
	1158	+	rate for a facility demonstrating individual, facility-specific 970
	1159	+	circumstances impacting facility finances or costs not reflected in the 971
	1160	+	underlying rates. There shall be no rate withholds pursuant to the 972
	1161	+	implementation of a value-based payment system for the fiscal years 973
	1162	+	ending June 30, 2024, and June 30, 2025. 974
1134	1163		This act shall take effect as follows and shall amend the following
1135	1164		sections:
1136	1165
1137		-	Section 1 July 1, 2023 17b-244
	1166	+	Section 1 July 1, 2023 17b-244 Substitute Bill No. 1109
	1167	+
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	1172	+
1138	1173		Sec. 2 July 1, 2023 17b-340(h)
1139	1174		Sec. 3 July 1, 2023 17b-340(i)
1140	1175		Sec. 4 from passage 17b-340(a)
1141	1176		Sec. 5 from passage 17b-340d(a)
1142	1177
1143	1178		HS Joint Favorable Subst. C/R APP
1144		-	APP Joint Favorable Subst.
1145	1179