Connecticut 2024 Regular Session

Connecticut Senate Bill SB00156 Compare Versions

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7		-	General Assembly ~~Substitute~~ Bill No. 156
	5	+	General Assembly Raised Bill No. 156
8	6		February Session, 2024
	7	+	LCO No. 1504
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	9	+
	10	+	Referred to Committee on AGING
	11	+
	12	+
	13	+	Introduced by:
	14	+	(AGE)
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13		-
14		-	AN ACT ESTABLISHING A TASK FORCE TO STUDY REQUIRING
15		-	NURSING HOMES TO SPEND A PERCENTAGE OF MEDICAID
16		-	REIMBURSEMENT OR TOTAL REVENUE ON DIRECT CARE OF
17		-	NURSING HOME RESIDENTS.
	19	+	AN ACT REQUIRING NURSING HOME FACILITIES TO SPEND AT
	20	+	LEAST EIGHTY PER CENT OF MEDICAID FUNDING PROVIDED BY
	21	+	THE STATE ON DIRECT CARE.
18	22		Be it enacted by the Senate and House of Representatives in General
19	23		Assembly convened:
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21		-	Section 1. (Effective from passage) (a) There is established a task force 1
22		-	to study Medicaid reimbursement of nursing home services. The task 2
23		-	force shall (1) consider (A) whether to require nursing home facilities to 3
24		-	spend not less than a certain percentage of (i) Medicaid funding received 4
25		-	from the state, or (ii) total revenue, including payments from Medicaid, 5
26		-	Medicare, private insurers, and direct pay, on direct care of residents, 6
27		-	and (B) whether to expand transparency requirements relating to how 7
28		-	nursing home facilities expend revenue and prioritize resident care; and 8
29		-	(2) develop recommendations regarding the considerations described in 9
30		-	subdivision (1) of this subsection. 10
31		-	(b) The task force shall consist of the following members: 11
32		-	(1) Two appointed by the speaker of the House of Representatives; 12
33		-	(2) Two appointed by the president pro tempore of the Senate; 13
34		-	(3) One appointed by the majority leader of the House of 14
35		-	Representatives; 15 Substitute Bill No. 156
	25	+	Section 1. Subsection (a) of section 17b-340d of the 2024 supplement 1
	26	+	to the general statutes is repealed and the following is substituted in lieu 2
	27	+	thereof (Effective July 1, 2024): 3
	28	+	(a) The Commissioner of Social Services shall implement an acuity-4
	29	+	based methodology for Medicaid reimbursement of nursing home 5
	30	+	services effective July 1, 2022. Notwithstanding section 17b-340, for the 6
	31	+	fiscal year ending June 30, 2023, and annually thereafter, the 7
	32	+	Commissioner of Social Services shall establish Medicaid rates paid to 8
	33	+	nursing home facilities based on cost years ending on September 9
	34	+	thirtieth in accordance with the following: 10
	35	+	(1) Case-mix adjustments to the direct care component, which will be 11
	36	+	based on Minimum Data Set resident assessment data as well as cost 12
	37	+	data reported for the cost year ending September 30, 2019, shall be made 13
	38	+	effective beginning July 1, 2022, and updated every quarter thereafter. 14 Raised Bill No. 156
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42		-	(4) One appointed by the majority leader of the Senate; 16
43		-	(5) One appointed by the minority leader of the House of 17
44		-	Representatives; 18
45		-	(6) One appointed by the minority leader of the Senate; and 19
46		-	(7) The Commissioner of Social Services, or the commissioner's 20
47		-	designee. 21
48		-	(c) Any member of the task force appointed under subdivision (1), 22
49		-	(2), (3), (4), (5) or (6) of subsection (b) of this section may be a member 23
50		-	of the General Assembly. 24
51		-	(d) All initial appointments to the task force shall be made not later 25
52		-	than thirty days after the effective date of this section. Any vacancy shall 26
53		-	be filled by the appointing authority. 27
54		-	(e) The speaker of the House of Representatives and the president pro 28
55		-	tempore of the Senate shall select the chairpersons of the task force from 29
56		-	among the members of the task force. Such chairpersons shall schedule 30
57		-	the first meeting of the task force, which shall be held not later than sixty 31
58		-	days after the effective date of this section. 32
59		-	(f) The administrative staff of the joint standing committee of the 33
60		-	General Assembly having cognizance of matters relating to aging shall 34
61		-	serve as administrative staff of the task force. 35
62		-	(g) Not later than January 1, 2025, the task force shall submit a report 36
63		-	on its findings and recommendations to the joint standing committees 37
64		-	of the General Assembly having cognizance of matters relating to aging 38
65		-	and human services, in accordance with the provisions of section 11-4a 39
66		-	of the general statutes. The task force shall terminate on the date that it 40
67		-	submits such report or January 1, 2025, whichever is later. 41
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	44	+	After modeling such case-mix adjustments, the Commissioner of Social 15
	45	+	Services shall evaluate impact on a facility by facility basis and, not later 16
	46	+	than October 1, 2021, (A) make recommendations to the Secretary of the 17
	47	+	Office of Policy and Management, and (B) submit a report on the 18
	48	+	recommendations, in accordance with the provisions of section 11-4a, to 19
	49	+	the joint standing committees of the General Assembly having 20
	50	+	cognizance of matters relating to appropriations and the budgets of state 21
	51	+	agencies and human services on any adjustments needed to facilitate the 22
	52	+	transition to the new methodology on July 1, 2022. This evaluation may 23
	53	+	include a review of inflationary allowances, case mix and budget 24
	54	+	adjustment factors and stop loss and stop gain corridors and the ability 25
	55	+	to make such adjustments within available appropriations. 26
	56	+	(2) Beginning July 1, 2022, facilities [will be required to] shall comply 27
	57	+	with collection and reporting of quality metrics as specified by the 28
	58	+	Department of Social Services, after consultation with the nursing home 29
	59	+	industry, consumers, employees and the Department of Public Health. 30
	60	+	Rate adjustments based on performance on quality metrics [will] shall 31
	61	+	be phased in, beginning July 1, 2022, with a period of reporting only. 32
	62	+	Effective July 1, 2023, the Department of Social Services shall issue 33
	63	+	individualized reports annually to each nursing home facility showing 34
	64	+	the impact to the Medicaid rate for such home based on the quality 35
	65	+	metrics program. A nursing home facility receiving an individualized 36
	66	+	quality metrics report may use such report to evaluate the impact of the 37
	67	+	quality metrics program on said facility's Medicaid reimbursement. Not 38
	68	+	later than June 30, 2025, the department shall submit a report, in 39
	69	+	accordance with the provisions of section 11-4a, to the joint standing 40
	70	+	committees of the General Assembly having cognizance of matters 41
	71	+	relating to appropriations and the budgets of state agencies and human 42
	72	+	services on the quality metrics program. Such report shall include 43
	73	+	information regarding individualized reports and the anticipated 44
	74	+	impact on nursing homes if the state were to implement a rate withhold 45
	75	+	on nursing homes that fail to meet certain quality metrics. 46
	76	+	(3) Geographic peer groupings of facilities shall be established by the 47
	77	+	Department of Social Services pursuant to regulations adopted in 48 Raised Bill No. 156
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	83	+	accordance with subsection (b) of this section. 49
	84	+	(4) Allowable costs shall be divided into the following five cost 50
	85	+	components: (A) Direct costs, which shall include salaries for nursing 51
	86	+	personnel, related fringe benefits and costs for nursing personnel 52
	87	+	supplied by a temporary nursing services agency; (B) indirect costs, 53
	88	+	which shall include professional fees, dietary expenses, housekeeping 54
	89	+	expenses, laundry expenses, supplies related to patient care, salaries for 55
	90	+	indirect care personnel and related fringe benefits; (C) fair rent, which 56
	91	+	shall be defined in regulations adopted in accordance with subsection 57
	92	+	(b) of this section; (D) capital-related costs, which shall include property 58
	93	+	taxes, insurance expenses, equipment leases and eq uipment 59
	94	+	depreciation; and (E) administrative and general costs, which shall 60
	95	+	include maintenance and operation of plant expenses, salaries for 61
	96	+	administrative and maintenance personnel and related fringe benefits. 62
	97	+	For (i) direct costs, the maximum cost shall be equal to one hundred 63
	98	+	thirty-five per cent of the median allowable cost of that peer grouping; 64
	99	+	(ii) indirect costs, the maximum cost shall be equal to one hundred 65
	100	+	fifteen per cent of the state-wide median allowable cost; (iii) fair rent, 66
	101	+	the amount shall be calculated utilizing the amount approved pursuant 67
	102	+	to section 17b-353; (iv) capital-related costs, there shall be no maximum; 68
	103	+	and (v) administrative and general costs, the maximum shall be equal to 69
	104	+	the state-wide median allowable cost. For purposes of this subdivision, 70
	105	+	"temporary nursing services agency" and "nursing personnel" have the 71
	106	+	same meaning as provided in section 19a-118. 72
	107	+	(5) Costs in excess of the maximum amounts established under this 73
	108	+	subsection shall not be recognized as allowable costs, except that the 74
	109	+	commissioner may establish rates whereby allowable costs may exceed 75
	110	+	such maximum amounts for beds which are restricted to use by patients 76
	111	+	with acquired immune deficiency syndrome, traumatic brain injury or 77
	112	+	other specialized services. 78
	113	+	(6) On or after June 30, 2022, the commissioner may, in the 79
	114	+	commissioner's discretion and within available appropriations, provide 80
	115	+	pro rata fair rent increases to facilities which have documented fair rent 81 Raised Bill No. 156
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	119	+	LCO No. 1504 4 of 7
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	121	+	additions placed in service in the most recently filed cost report that are 82
	122	+	not otherwise included in the rates issued. The commissioner may 83
	123	+	provide, within available appropriations, pro rata fair rent increases, 84
	124	+	which may, at the discretion of the commissioner, include increases for 85
	125	+	facilities which have undergone a material change in circumstances 86
	126	+	related to fair rent additions in the most recently filed cost report. The 87
	127	+	commissioner may allow minimum fair rent as the basis upon which 88
	128	+	reimbursement associated with improvements to real property is 89
	129	+	added. 90
	130	+	(7) For the purpose of determining allowable fair rent, a facility with 91
	131	+	allowable fair rent less than the twenty-fifth percentile of the state-wide 92
	132	+	allowable fair rent shall be reimbursed as having allowable fair rent 93
	133	+	equal to the twenty-fifth percentile of the state-wide allowable fair rent. 94
	134	+	Any facility with a rate of return on real property other than land in 95
	135	+	excess of eleven per cent shall have such allowance revised to eleven per 96
	136	+	cent. Any facility or its related realty affiliate which finances or 97
	137	+	refinances debt through bonds issued by the Connecticut Health and 98
	138	+	Education Facilities Authority shall report the terms and conditions of 99
	139	+	such financing or refinancing to the Commissioner of Social Services not 100
	140	+	later than thirty days after completing such financing or refinancing. 101
	141	+	The commissioner may revise the facility's fair rent component of its rate 102
	142	+	to reflect any financial benefit the facility or its related realty affiliate 103
	143	+	received as a result of such financing or refinancing. The commissioner 104
	144	+	shall determine allowable fair rent for real property other than land 105
	145	+	based on the rate of return for the cost year in which such bonds were 106
	146	+	issued. The financial benefit resulting from a facility financing or 107
	147	+	refinancing debt through such bonds shall be shared between the state 108
	148	+	and the facility to an extent determined by the commissioner on a case-109
	149	+	by-case basis and shall be reflected in an adjustment to the facility's 110
	150	+	allowable fair rent. 111
	151	+	(8) A facility shall receive cost efficiency adjustments for indirect costs 112
	152	+	and for administrative and general costs if such costs are below the 113
	153	+	state-wide median costs. The cost efficiency adjustments shall equal 114
	154	+	twenty-five per cent of the difference between allowable reported costs 115 Raised Bill No. 156
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	160	+	and the applicable median allowable cost established pursuant to 116
	161	+	subdivision (4) of this subsection. 117
	162	+	(9) On and after July 1, 2025, costs shall be rebased no more frequently 118
	163	+	than every two years and no less frequently than every four years, as 119
	164	+	determined by the commissioner. There shall be no inflation adjustment 120
	165	+	during a year in which a facility's rates are rebased. The commissioner 121
	166	+	shall determine whether and to what extent a change in ownership of a 122
	167	+	facility shall occasion the rebasing of the facility's costs. 123
	168	+	(10) The method of establishing rates for new facilities shall be 124
	169	+	determined by the commissioner in accordance with the provisions of 125
	170	+	this subsection. 126
	171	+	(11) For the fiscal year beginning July 1, 2024, and each fiscal year 127
	172	+	thereafter, the commissioner shall require a nursing home facility to 128
	173	+	spend not less than eighty per cent of Medicaid funding received from 129
	174	+	the state on direct care of residents, provided the commissioner may 130
	175	+	adjust the percentage spent on direct care for a nursing home facility 131
	176	+	with a capital improvement project or a fair rent increase approved by 132
	177	+	the commissioner. For the fiscal year beginning July 1, 2026, and each 133
	178	+	fiscal year thereafter, the commissioner may decrease rates of 134
	179	+	reimbursement for any nursing home that does not comply with the 135
	180	+	provisions of this subdivision. For purposes of this subdivision, (A) 136
	181	+	"direct care" means hands-on care provided to a facility resident by 137
	182	+	nursing personnel, including, but not limited to, assistance with feeding, 138
	183	+	bathing, toileting, dressing, lifting or moving residents, medication 139
	184	+	administration and salary, fringe benefits and supplies related to direct 140
	185	+	care; and (B) "nursing personnel" means an advanced practice registered 141
	186	+	nurse, licensed pursuant to chapter 378, a registered nurse or practical 142
	187	+	nurse, licensed pursuant to chapter 378, or a nurse's aide, registered 143
	188	+	pursuant to chapter 378a. 144
	189	+	[(11)] (12) There shall be no increase to rates based on inflation or any 145
	190	+	inflationary factor for the fiscal years ending June 30, 2022, and June 30, 146
	191	+	2023, unless otherwise authorized under subdivision (1) of this 147 Raised Bill No. 156
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	197	+	subsection. Notwithstanding section 17-311-52 of the regulations of 148
	198	+	Connecticut state agencies, for the fiscal years ending June 30, 2024, and 149
	199	+	June 30, 2025, there shall be no inflationary increases to rates beyond 150
	200	+	those already factored into the model for the transition to an acuity-151
	201	+	based reimbursement system. Notwithstanding any other provisions of 152
	202	+	this chapter, any subsequent increase to allowable operating costs, 153
	203	+	excluding fair rent, shall be inflated by the gross domestic product 154
	204	+	deflator when funding is specifically appropriated for such purposes in 155
	205	+	the enacted budget. The rate of inflation shall be computed by 156
	206	+	comparing the most recent rate year to the average of the gross domestic 157
	207	+	product deflator for the previous four fiscal quarters ending April 158
	208	+	thirtieth. Any increase to rates based on inflation shall be applied prior 159
	209	+	to the application of any other budget adjustment factors that may 160
	210	+	impact such rates. 161
	211	+	[(12)] (13) For purposes of computing minimum allowable patient 162
	212	+	days, utilization of a facility's certified beds shall be determined at a 163
	213	+	minimum of ninety per cent of capacity, except for facilities that have 164
	214	+	undergone a change in ownership, new facilities, and facilities which 165
	215	+	are certified for additional beds which may be permitted a lower 166
	216	+	occupancy rate for the first three months of operation after the effective 167
	217	+	date of licensure. 168
	218	+	[(13)] (14) Rates determined under this section shall comply with 169
	219	+	federal laws and regulations. 170
	220	+	[(14)] (15) The Commissioner of Social Services may authorize an 171
	221	+	interim rate for a facility demonstrating circumstances particular to that 172
	222	+	individual facility impacting facility finances or costs not reflected in the 173
	223	+	underlying rates. 174
68	224		This act shall take effect as follows and shall amend the following
69	225		sections:
70		-	Substitute Bill No. 156
	226	+
	227	+	Section 1 July 1, 2024 17b-340d(a)
	228	+	Raised Bill No. 156
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77		-	~~Section 1 from passage New section~~
	232	+	LCO No. 1504 7 of 7
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79		-	Statement of Legislative Commissioners:
80		-	The title was changed for accuracy.
81		-
82		-	AGE Joint Favorable Subst.
	234	+	Statement of Purpose:
	235	+	To require nursing home facilities to spend at least eighty per cent of
	236	+	Medicaid funding provided by the state on direct care.
	237	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	238	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	239	+	underlined.]
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