Connecticut 2025 Regular Session

Connecticut Senate Bill SB00805 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
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3		-	LCO 3806 1 of 6
	3	+
	4	+	LCO No. 3806 1 of 7
4	5
5	6		General Assembly Committee Bill No. 805
6	7		January Session, 2025
7	8		LCO No. 3806
8	9
9	10
10	11		Referred to Committee on HUMAN SERVICES
11	12
12	13
13	14		Introduced by:
14	15		(HS)
15	16
16	17
17	18
18	19		AN ACT REQUIRING NURSING HOMES TO SPEND NOT LESS THAN
19	20		EIGHTY PER CENT OF REVENUES ON DIRECT PATIENT CARE.
20	21		Be it enacted by the Senate and House of Representatives in General
21	22		Assembly convened:
22	23
23	24		Section 1. Subsection (a) of section 17b-340d of the general statutes is 1
24	25		repealed and the following is substituted in lieu thereof (Effective July 1, 2
25	26		2025): 3
26	27		(a) The Commissioner of Social Services shall implement an acuity-4
27	28		based methodology for Medicaid reimbursement of nursing home 5
28	29		services effective July 1, 2022. Notwithstanding section 17b-340, for the 6
29	30		fiscal year ending June 30, 2023, and annually thereafter, the 7
30	31		Commissioner of Social Services shall establish Medicaid rates paid to 8
31	32		nursing home facilities based on cost years ending on September 9
32	33		thirtieth in accordance with the following: 10
33	34		(1) Case-mix adjustments to the direct care component, which will be 11
34	35		based on Minimum Data Set resident assessment data as well as cost 12
35	36		data reported for the cost year ending September 30, 2019, shall be made 13
36	37		effective beginning July 1, 2022, and updated every quarter thereafter. 14
37		-	After modeling such case-mix adjustments, the Commissioner of Social 15 Committee Bill No. 805
	38	+	After modeling such case-mix adjustments, the Commissioner of Social 15
	39	+	Committee Bill No. 805
38	40
39	41
40		-	LCO 3806 2 of 6
	42	+	LCO No. 3806 2 of 7
41	43
42	44		Services shall evaluate impact on a facility by facility basis and, not later 16
43	45		than October 1, 2021, (A) make recommendations to the Secretary of the 17
44	46		Office of Policy and Management, and (B) submit a report on the 18
45	47		recommendations, in accordance with the provisions of section 11-4a, to 19
46	48		the joint standing committees of the General Assembly having 20
47	49		cognizance of matters relating to appropriations and the budgets of state 21
48	50		agencies and human services on any adjustments needed to facilitate the 22
49	51		transition to the new methodology on July 1, 2022. This evaluation may 23
50	52		include a review of inflationary allowances, case mix and budget 24
51	53		adjustment factors and stop loss and stop gain corridors and the ability 25
52	54		to make such adjustments within available appropriations. 26
53	55		(2) Beginning July 1, 2022, facilities [will be required to] shall comply 27
54	56		with collection and reporting of quality metrics as specified by the 28
55	57		Department of Social Services, after consultation with the nursing home 29
56	58		industry, consumers, employees and the Department of Public Health. 30
57	59		Rate adjustments based on performance on quality metrics [will] shall 31
58	60		be phased in, beginning July 1, 2022, with a period of reporting only. 32
59	61		Effective July 1, 2023, the Department of Social Services shall issue 33
60	62		individualized reports annually to each nursing home facility showing 34
61	63		the impact to the Medicaid rate for such home based on the quality 35
62	64		metrics program. A nursing home facility receiving an individualized 36
63	65		quality metrics report may use such report to evaluate the impact of the 37
64	66		quality metrics program on said facility's Medicaid reimbursement. Not 38
65	67		later than June 30, 2025, the department shall submit a report, in 39
66	68		accordance with the provisions of section 11-4a, to the joint standing 40
67	69		committees of the General Assembly having cognizance of matters 41
68	70		relating to appropriations and the budgets of state agencies and human 42
69	71		services on the quality metrics program. Such report shall include 43
70	72		information regarding individualized reports and the anticipated 44
71	73		impact on nursing homes if the state were to implement a rate withhold 45
72	74		on nursing homes that fail to meet certain quality metrics. 46
73	75		(3) Geographic peer groupings of facilities shall be established by the 47
74	76		Department of Social Services pursuant to regulations adopted in 48
75		-	~~accordance with subsection (b) of this section. 49~~ Committee Bill No. 805
	77	+	Committee Bill No. 805
76	78
77	79
78		-	LCO 3806 3 of 6
	80	+	LCO No. 3806 3 of 7
79	81
	82	+	accordance with subsection (b) of this section. 49
80	83		(4) Allowable costs shall be divided into the following five cost 50
81	84		components: (A) Direct costs, which shall include salaries for nursing 51
82	85		personnel, related fringe benefits and costs for nursing personnel 52
83	86		supplied by a temporary nursing services agency; (B) indirect costs, 53
84	87		which shall include professional fees, dietary expenses, housekeeping 54
85	88		expenses, laundry expenses, supplies related to patient care, salaries for 55
86	89		indirect care personnel and related fringe benefits; (C) fair rent, which 56
87	90		shall be defined in regulations adopted in accordance with subsection 57
88	91		(b) of this section; (D) capital-related costs, which shall include property 58
89	92		taxes, insurance expenses, equipment leases and equipment 59
90	93		depreciation; and (E) administrative and general costs, which shall 60
91	94		include maintenance and operation of plant expenses, salaries for 61
92	95		administrative and maintenance personnel and related fringe benefits. 62
93	96		For (i) direct costs, the maximum cost shall be equal to one hundred 63
94	97		thirty-five per cent of the median allowable cost of that peer grouping; 64
95	98		(ii) indirect costs, the maximum cost shall be equal to one hundred 65
96	99		fifteen per cent of the state-wide median allowable cost; (iii) fair rent, 66
97	100		the amount shall be calculated utilizing the amount approved pursuant 67
98	101		to section 17b-353; (iv) capital-related costs, there shall be no maximum; 68
99	102		and (v) administrative and general costs, the maximum shall be equal to 69
100	103		the state-wide median allowable cost. For purposes of this subdivision, 70
101	104		"temporary nursing services agency" and "nursing personnel" have the 71
102	105		same meaning as provided in section 19a-118. 72
103	106		(5) Costs in excess of the maximum amounts established under this 73
104	107		subsection shall not be recognized as allowable costs, except that the 74
105	108		commissioner may establish rates whereby allowable costs may exceed 75
106	109		such maximum amounts for beds which are restricted to use by patients 76
107	110		with acquired immune deficiency syndrome, traumatic brain injury or 77
108	111		other specialized services. 78
109	112		(6) On or after June 30, 2022, the commissioner may, in the 79
110	113		commissioner's discretion and within available appropriations, provide 80
	114	+	Committee Bill No. 805
	115	+
	116	+
	117	+	LCO No. 3806 4 of 7
	118	+
111	119		pro rata fair rent increases to facilities which have documented fair rent 81
112	120		additions placed in service in the most recently filed cost report that are 82
113		-	not otherwise included in the rates issued. The commissioner may 83 Committee Bill No. 805
114		-
115		-
116		-	LCO 3806 4 of 6
117		-
	121	+	not otherwise included in the rates issued. The commissioner may 83
118	122		provide, within available appropriations, pro rata fair rent increases, 84
119	123		which may, at the discretion of the commissioner, include increases for 85
120	124		facilities which have undergone a material change in circumstances 86
121	125		related to fair rent additions in the most recently filed cost report. The 87
122	126		commissioner may allow minimum fair rent as the basis upon which 88
123	127		reimbursement associated with improvements to real property is 89
124	128		added. 90
125	129		(7) For the purpose of determining allowable fair rent, a facility with 91
126	130		allowable fair rent less than the twenty-fifth percentile of the state-wide 92
127	131		allowable fair rent shall be reimbursed as having allowable fair rent 93
128	132		equal to the twenty-fifth percentile of the state-wide allowable fair rent. 94
129	133		Any facility with a rate of return on real property other than land in 95
130	134		excess of eleven per cent shall have such allowance revised to eleven per 96
131	135		cent. Any facility or its related realty affiliate which finances or 97
132	136		refinances debt through bonds issued by the Connecticut Health and 98
133	137		Education Facilities Authority shall report the terms and conditions of 99
134	138		such financing or refinancing to the Commissioner of Social Services not 100
135	139		later than thirty days after completing such financing or refinancing. 101
136	140		The commissioner may revise the facility's fair rent component of its rate 102
137	141		to reflect any financial benefit the facility or its related realty affiliate 103
138	142		received as a result of such financing or refinancing. The commissioner 104
139	143		shall determine allowable fair rent for real property other than land 105
140	144		based on the rate of return for the cost year in which such bonds were 106
141	145		issued. The financial benefit resulting from a facility financing or 107
142	146		refinancing debt through such bonds shall be shared between the state 108
143	147		and the facility to an extent determined by the commissioner on a case-109
144	148		by-case basis and shall be reflected in an adjustment to the facility's 110
145	149		allowable fair rent. 111
146	150		(8) A facility shall receive cost efficiency adjustments for indirect costs 112
147	151		and for administrative and general costs if such costs are below the 113
	152	+	Committee Bill No. 805
	153	+
	154	+
	155	+	LCO No. 3806 5 of 7
	156	+
148	157		state-wide median costs. The cost efficiency adjustments shall equal 114
149	158		twenty-five per cent of the difference between allowable reported costs 115
150	159		and the applicable median allowable cost established pursuant to 116
151		-	subdivision (4) of this subsection. 117 Committee Bill No. 805
152		-
153		-
154		-	LCO 3806 5 of 6
155		-
	160	+	subdivision (4) of this subsection. 117
156	161		(9) On and after July 1, 2025, costs shall be rebased no more frequently 118
157	162		than every two years and no less frequently than every four years, as 119
158	163		determined by the commissioner. There shall be no inflation adjustment 120
159	164		during a year in which a facility's rates are rebased. The commissioner 121
160	165		shall determine whether and to what extent a change in ownership of a 122
161	166		facility shall occasion the rebasing of the facility's costs. 123
162	167		(10) The method of establishing rates for new facilities shall be 124
163	168		determined by the commissioner in accordance with the provisions of 125
164	169		this subsection. 126
165	170		(11) There shall be no increase to rates based on inflation or any 127
166	171		inflationary factor for the fiscal years ending June 30, 2022, and June 30, 128
167	172		2023, unless otherwise authorized under subdivision (1) of this 129
168	173		subsection. Notwithstanding section 17-311-52 of the regulations of 130
169	174		Connecticut state agencies, for the fiscal years ending June 30, 2024, and 131
170	175		June 30, 2025, there shall be no inflationary increases to rates beyond 132
171	176		those already factored into the model for the transition to an acuity-133
172	177		based reimbursement system. Notwithstanding any other provisions of 134
173	178		this chapter, any subsequent increase to allowable operating costs, 135
174	179		excluding fair rent, shall be inflated by the gross domestic product 136
175	180		deflator when funding is specifically appropriated for such purposes in 137
176	181		the enacted budget. The rate of inflation shall be computed by 138
177	182		comparing the most recent rate year to the average of the gross domestic 139
178	183		product deflator for the previous four fiscal quarters ending March 140
179	184		thirty-first. Any increase to rates based on inflation shall be applied 141
180	185		prior to the application of any other budget adjustment factors that may 142
181	186		impact such rates. 143
182	187		(12) For the fiscal year beginning July 1, 2025, and each fiscal year 144
183	188		thereafter, the commissioner shall require a nursing home facility to 145
	189	+	Committee Bill No. 805
	190	+
	191	+
	192	+	LCO No. 3806 6 of 7
	193	+
184	194		spend not less than eighty per cent of funding received from Medicaid, 146
185	195		Medicare and all other payment sources on direct care of residents, 147
186	196		provided the commissioner may adjust the percentage spent on direct 148
187	197		care for a nursing home facility with a capital improvement project or a 149
188		-	fair rent increase approved by the commissioner. For the fiscal year 150 Committee Bill No. 805
189		-
190		-
191		-	LCO 3806 6 of 6
192		-
	198	+	fair rent increase approved by the commissioner. For the fiscal year 150
193	199		beginning July 1, 2027, and each fiscal year thereafter, the commissioner 151
194	200		may decrease rates of Medicaid reimbursement for any nursing home 152
195	201		that does not comply with the provisions of this subdivision. For 153
196	202		purposes of this subdivision, (A) "direct care" means hands-on care 154
197	203		provided to a facility resident by nursing personnel, including, but not 155
198	204		limited to, assistance with feeding, bathing, toileting, dressing, lifting or 156
199	205		moving residents, medication administration and salary, fringe benefits 157
200	206		and supplies related to direct care; and (B) "nursing personnel" means 158
201	207		an advanced practice registered nurse, licensed pursuant to chapter 378, 159
202	208		a registered nurse or practical nurse, licensed pursuant to chapter 378, 160
203	209		or a nurse's aide, registered pursuant to chapter 378a. 161
204	210		[(12)] (13) For purposes of computing minimum allowable patient 162
205	211		days, utilization of a facility's certified beds shall be determined at a 163
206	212		minimum of ninety per cent of capacity, except for facilities that have 164
207	213		undergone a change in ownership, new facilities, and facilities which 165
208	214		are certified for additional beds which may be permitted a lower 166
209	215		occupancy rate for the first three months of operation after the effective 167
210	216		date of licensure. 168
211	217		[(13)] (14) Rates determined under this section shall comply with 169
212	218		federal laws and regulations. 170
213	219		[(14)] (15) The Commissioner of Social Services may authorize an 171
214	220		interim rate for a facility demonstrating circumstances particular to that 172
215	221		individual facility impacting facility finances or costs not reflected in the 173
216	222		underlying rates. 174
217	223		This act shall take effect as follows and shall amend the following
218	224		sections:
219	225
	226	+	Committee Bill No. 805
	227	+
	228	+
	229	+	LCO No. 3806 7 of 7
	230	+
220	231		Section 1 July 1, 2025 17b-340d(a)
221	232
222		-	HS Joint Favorable
	233	+	Statement of Purpose:
	234	+	To improve the quality of care in nursing homes.
	235	+
	236	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	237	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	238	+	underlined.]
	239	+
	240	+	Co-Sponsors: SEN. LOONEY, 11th Dist.
	241	+
	242	+	S.B. 805
	243	+
223	244