Table of Contents Sec. 17b-337. Long-term elderly care planning committee. Long-term care
plan for elderly persons. Membership. (a) There shall be established a Long-Term
Care Planning Committee for the purpose of exchanging information on long-term care
issues, coordinating policy development and establishing a long-term care plan for elderly persons. Such plan shall integrate the three components of a long-term care system
including home and community-based services, supportive housing arrangements and
nursing facilities. Such plan shall include: (1) A vision and mission statement for a
long-term care system; (2) the current number of elderly persons receiving services; (3)
demographic data concerning elderly persons by service type; (4) the current aggregate
cost of such system of services; (5) forecasts of future demand for services; (6) the type
of services available and the amount of funds necessary to meet the demand; (7) projected
costs for programs associated with such system; (8) strategies to promote the partnership
for long-term care program; (9) resources necessary to accomplish goals for the future;
(10) funding sources available; and (11) the number and types of providers needed to
deliver services. The plan shall address how changes in one component of such long-
term care system impact other components of such system. Sec. 17b-338. Long-Term Care Advisory Council. Membership. Duties. (a)
There is established a Long-Term Care Advisory Council which shall consist of the
following: (1) The executive director of the Commission on Aging, or the executive
director's designee; (2) the State Nursing Home Ombudsman, or the ombudsman's
designee; (3) the president of the Coalition of Presidents of Resident Councils, or the
president's designee; (4) the executive director of the Legal Assistance Resource Center
of Connecticut, or the executive director's designee; (5) one representative of the Connecticut Chapter of the American Association of Retired Persons, appointed by the
president of the chapter; (6) one representative of a bargaining unit for health care employees, appointed by the president of the bargaining unit; (7) the president of the Connecticut Association of Not-For-Profit Providers for the Aging, or the president's designee; (8) the president of the Connecticut Association of Health Care Facilities, or the
president's designee; (9) the president of the Connecticut Association of Licensed
Homes for the Aged, or the president's designee; (10) the president of the Connecticut
Hospital Association or the president's designee; (11) the executive director of the Connecticut Assisted Living Association or the executive director's designee; (12) the executive director of the Connecticut Homecare Association or the executive director's designee; (13) the president of Connecticut Community Care, Inc. or the president's
designee; (14) one member of the Connecticut Association of Area Agencies on Aging
appointed by the agency; (15) the executive director of the Connecticut Alzheimer's
Association or the executive director's designee; (16) one member of the Adult Day
Care Association appointed by the association; (17) the president of the Connecticut
Chapter of the American College of Health Care Administrators, or the president's
designee; (18) the president of the Connecticut Council for Persons with Disabilities,
or the president's designee; and (19) the president of the Connecticut Association of
Community Action Agencies, or the president's designee. Sec. 17b-339. Nursing Home Financial Advisory Committee. Duties. Membership. (a) There is established a Nursing Home Financial Advisory Committee to
examine the financial solvency of nursing homes on an ongoing basis and to support the
Departments of Social Services and Public Health in their mission to provide oversight to
the nursing home industry which promotes the financial solvency of and quality of
care provided by nursing homes. The committee shall consist of seven members: The
Commissioner of Social Services, or his designee; the Commissioner of Public Health,
or his designee; the Secretary of the Office of Policy and Management, or his designee;
the director of the Office of Fiscal Analysis, or his designee; the executive director of
the Connecticut Health and Education Facilities Authority, or his designee; and one
representative of nonprofit nursing homes and one representative of for-profit nursing
homes appointed by the Governor. Sec. 17b-340. (Formerly Sec. 17-314). Rates of payment to nursing homes,
chronic disease hospitals associated with chronic and convalescent homes, rest
homes with nursing supervision, residential care homes and residential facilities
for the mentally retarded. (a) The rates to be paid by or for persons aided or cared for
by the state or any town in this state to licensed chronic and convalescent nursing homes,
chronic disease hospitals associated with chronic and convalescent nursing homes, rest
homes with nursing supervision and to licensed residential care homes, as defined by
section 19a-490, and to residential facilities for the mentally retarded which are licensed
pursuant to section 17a-227 and certified to participate in the Title XIX Medicaid program as intermediate care facilities for the mentally retarded, for room, board and services specified in licensing regulations issued by the licensing agency shall be determined annually, except as otherwise provided in this subsection, after a public hearing,
by the Commissioner of Social Services, to be effective July first of each year except
as otherwise provided in this subsection. Such rates shall be determined on a basis of a
reasonable payment for such necessary services, which basis shall take into account as
a factor the costs of such services. Cost of such services shall include (1) reasonable
costs mandated by collective bargaining agreements with certified collective bargaining
agents or other agreements between the employer and employees, provided "employees"
shall not include persons employed as managers or chief administrators or required to
be licensed as nursing home administrators, and (2) compensation for services rendered
by proprietors at prevailing wage rates, as determined by application of principles of
accounting as prescribed by said commissioner. Cost of such services shall not include
amounts paid by the facilities to employees as salary, or to attorneys or consultants as
fees, where the responsibility of the employees, attorneys, or consultants is to persuade
or seek to persuade the other employees of the facility to support or oppose unionization.
Nothing in this subsection shall prohibit inclusion of amounts paid for legal counsel
related to the negotiation of collective bargaining agreements, the settlement of grievances or normal administration of labor relations. The commissioner may, in his discretion, allow the inclusion of extraordinary and unanticipated costs of providing services
which were incurred to avoid an immediate negative impact on the health and safety of
patients. The commissioner may, in his discretion, based upon review of a facility's
costs, direct care staff to patient ratio and any other related information, revise a facility's
rate for any increases or decreases to total licensed capacity of more than ten beds or
changes to its number of licensed rest home with nursing supervision beds and chronic
and convalescent nursing home beds. The commissioner may so revise a facility's rate
established for the fiscal year ending June 30, 1993, and thereafter for any bed increases,
decreases or changes in licensure effective after October 1, 1989. Effective July 1, 1991,
in facilities which have both a chronic and convalescent nursing home and a rest home
with nursing supervision, the rate for the rest home with nursing supervision shall not
exceed such facility's rate for its chronic and convalescent nursing home. All such
facilities for which rates are determined under this subsection shall report on a fiscal
year basis ending on the thirtieth day of September. Such report shall be submitted to
the commissioner by the thirty-first day of December. The commissioner may reduce
the rate in effect for a facility which fails to report on or before such date by an amount
not to exceed ten per cent of such rate. The commissioner shall annually, on or before
the fifteenth day of February, report the data contained in the reports of such facilities
to the joint standing committee of the General Assembly having cognizance of matters
relating to appropriations. For the cost reporting year commencing October 1, 1985, and
for subsequent cost reporting years, facilities shall report the cost of using the services of
any nursing pool employee by separating said cost into two categories, the portion of
the cost equal to the salary of the employee for whom the nursing pool employee is
substituting shall be considered a nursing cost and any cost in excess of such salary shall
be further divided so that seventy-five per cent of the excess cost shall be considered
an administrative or general cost and twenty-five per cent of the excess cost shall be
considered a nursing cost, provided if the total nursing pool costs of a facility for any
cost year are equal to or exceed fifteen per cent of the total nursing expenditures of the
facility for such cost year, no portion of nursing pool costs in excess of fifteen per cent
shall be classified as administrative or general costs. The commissioner, in determining
such rates, shall also take into account the classification of patients or boarders according
to special care requirements or classification of the facility according to such factors as
facilities and services and such other factors as he deems reasonable, including anticipated fluctuations in the cost of providing such services. The commissioner may establish a separate rate for a facility or a portion of a facility for traumatic brain injury patients
who require extensive care but not acute general hospital care. Such separate rate shall
reflect the special care requirements of such patients. If changes in federal or state laws,
regulations or standards adopted subsequent to June 30, 1985, result in increased costs
or expenditures in an amount exceeding one-half of one per cent of allowable costs for
the most recent cost reporting year, the commissioner shall adjust rates and provide
payment for any such increased reasonable costs or expenditures within a reasonable
period of time retroactive to the date of enforcement. Nothing in this section shall be
construed to require the Department of Social Services to adjust rates and provide payment for any increases in costs resulting from an inspection of a facility by the Department of Public Health. Such assistance as the commissioner requires from other state
agencies or departments in determining rates shall be made available to him at his request. Payment of the rates established hereunder shall be conditioned on the establishment by such facilities of admissions procedures which conform with this section, section 19a-533 and all other applicable provisions of the law and the provision of equality
of treatment to all persons in such facilities. The established rates shall be the maximum
amount chargeable by such facilities for care of such beneficiaries, and the acceptance
by or on behalf of any such facility of any additional compensation for care of any such
beneficiary from any other person or source shall constitute the offense of aiding a
beneficiary to obtain aid to which he is not entitled and shall be punishable in the same
manner as is provided in subsection (b) of section 17b-97. For the fiscal year ending
June 30, 1992, rates for licensed residential care homes and intermediate care facilities
for the mentally retarded may receive an increase not to exceed the most recent annual
increase in the Regional Data Resources Incorporated McGraw-Hill Health Care Costs:
Consumer Price Index (all urban)−All Items. Rates for newly certified intermediate care
facilities for the mentally retarded shall not exceed one hundred fifty per cent of the
median rate of rates in effect on January 31, 1991, for intermediate care facilities for
the mentally retarded certified prior to February 1, 1991. Sec. 17b-341. (Formerly Sec. 17-314a). Self-pay rates regulated. Provider
agreement. Rate adjustments. Appeals. Report. (a) The Commissioner of Social Services shall determine annually, after a public hearing, the rates to be charged to self-
pay patients in any of the following licensed facilities if the facility does not have a
provider agreement with the state to provide services to recipients of benefits obtained
through Title XIX of the Social Security Amendments of 1965, except a facility that
did not have a provider agreement in effect as of January 1, 1991, or had entered into
a limited provider agreement before January 1, 1991: Chronic and convalescent nursing
homes, chronic disease hospitals associated with chronic and convalescent nursing
homes and rest homes with nursing supervision. Each such facility that does have such
a provider agreement, each such facility that did not have a provider agreement in effect
as of January 1, 1991, or had entered into a limited provider agreement before January
1, 1991, and each residential care home shall determine its own self-pay rates. Rates
determined pursuant to this section shall be effective July 1, 1991, and on July first of
each year thereafter through June 30, 1993, and shall be determined for each facility
individually, on the basis of payment for the reasonable costs of providing all services.
All self-pay patients shall be given notice of a rate increase at least thirty days prior to
the effective date of such rate increase. In determining rates to be charged to self-pay
patients the commissioner shall: (1) Consider the quality of care provided by each facility, based on information which the Department of Public Health shall provide to the
commissioner, and any testimony or information received from other interested parties;
and (2) take into account the relevant cost considerations set forth in section 17b-340
and in the regulations adopted in accordance with subsection (a) of section 17b-238.
Such regulations shall include but not be limited to the establishment of a formula for
allowing profit or an operating surplus, and a fair rate of return on invested capital or
equity. Nothing in this section shall authorize the commissioner to set a rate lower than
the rate set under section 17b-340 for comparable services. As used in this section "self-
pay patient" means a patient who is not receiving state or municipal assistance to pay
for the cost of care. Each facility determining its own self-pay rates shall report such rates
to the commissioner upon determination and upon any modification. The commissioner
shall document each rate so reported and each rate determined for a facility by the
commissioner pursuant to this section and shall report all such rates to the joint standing
committee of the General Assembly having cognizance of matters relating to human
services on or before December 31, 1992. Each facility shall charge any self-pay patient
who is insured under a long-term care insurance policy which is precertified pursuant
to section 38a-475 a rate which is at least five per cent less than the rate charged other
self-pay patients. Sec. 17b-342. (Formerly Sec. 17-314b). Connecticut home-care program for
the elderly. (a) The Commissioner of Social Services shall administer the Connecticut
home-care program for the elderly state-wide in order to prevent the institutionalization
of elderly persons (1) who are recipients of medical assistance, (2) who are eligible for
such assistance, (3) who would be eligible for medical assistance if residing in a nursing
facility, or (4) who meet the criteria for the state-funded portion of the program under
subsection (i) of this section. For purposes of this section, a long-term care facility is a
facility which has been federally certified as a skilled nursing facility or intermediate
care facility. The commissioner shall make any revisions in the state Medicaid plan
required by Title XIX of the Social Security Act prior to implementing the program.
The annualized cost of the community-based services provided to such persons under
the program shall not exceed sixty per cent of the weighted average cost of care in skilled
nursing facilities and intermediate care facilities. The program shall be structured so
that the net cost to the state for long-term facility care in combination with the community-based services under the program shall not exceed the net cost the state would have
incurred without the program. The commissioner shall investigate the possibility of
receiving federal funds for the program and shall apply for any necessary federal waivers. A recipient of services under the program, and the estate and legally liable relatives
of the recipient, shall be responsible for reimbursement to the state for such services to
the same extent required of a recipient of assistance under the state supplement program,
medical assistance program, temporary family assistance program or food stamps program. Only a United States citizen or a noncitizen who meets the citizenship requirements for eligibility under the Medicaid program shall be eligible for home-care services
under this section, except a qualified alien, as defined in Section 431 of Public Law
104-193, admitted into the United States on or after August 22, 1996, or other lawfully
residing immigrant alien determined eligible for services under this section prior to July
1, 1997, shall remain eligible for such services until July 1, 2001. Qualified aliens or
other lawfully residing immigrant aliens not determined eligible prior to July 1, 1997,
shall be eligible for services under this section subsequent to six months from establishing residency until July 1, 2001. Notwithstanding the provisions of this subsection, any
qualified alien or other lawfully residing immigrant alien or alien who formerly held
the status of permanently residing under color of law who is a victim of domestic violence
or who has mental retardation shall be eligible for assistance pursuant to this section.
Qualified aliens, as defined in Section 431 of Public Law 104-193, or other lawfully
residing immigrant aliens or aliens who formerly held the status of permanently residing
under color of law shall be eligible for services under this section provided other conditions of eligibility are met. Sec. 17b-343. (Formerly Sec. 17-314c). Rates of payment for home care services, transportation and mental health counseling. The Commissioner of Social
Services shall establish annually the maximum allowable rate to be paid by said agencies
for homemaker services, chore person services, companion services, respite care, meals
on wheels, adult day care services, case management and assessment services, transportation, mental health counseling and elderly foster care, except that the maximum allowable rates in effect July 1, 1990, shall remain in effect during the fiscal years ending
June 30, 1992, and June 30, 1993. The Commissioner of Social Services shall prescribe
uniform forms on which agencies providing such services shall report their costs for
such services. Such rates shall be determined on the basis of a reasonable payment for
necessary services rendered. The maximum allowable rates established by the Commissioner of Social Services for the Connecticut home-care program for the elderly established under section 17b-342 shall constitute the rates required under this section until
revised in accordance with this section. The Commissioner of Social Services shall
establish a fee schedule, to be effective on and after July 1, 1994, for homemaker services, chore person services, companion services, respite care, meals on wheels, adult
day care services, case management and assessment services, transportation, mental
health counseling and elderly foster care. The commissioner may annually increase any
fee in the fee schedule based on an increase in the cost of services. The commissioner
shall increase the fee schedule effective July 1, 2000, by not less than five per cent, for
adult day care services. Nothing contained in this section shall authorize a payment by
the state to any agency for such services in excess of the amount charged by such agency
for such services to the general public. Sec. 17b-344. (Formerly Sec. 17-314d). Rates of payment to facilities for room,
board and services. (a) (1) The rates to be paid by or for persons aided or cared for by
the state or any town in this state to facilities for room, board and services specified in
licensing regulations issued by the licensing agency, based on the cost years ending on
September 30, 1988, and September 30, 1989, shall be determined by the Commissioner
of Social Services in accordance with section 17b-340 and the regulations of Connecticut
state agencies promulgated by the commissioner and in effect on April 1, 1989, except
as otherwise provided by this section. As used in this section, "commissioner" means
the Commissioner of Social Services, "self-pay census" means the number of self-pay
patient days properly reported on line 3D on page eight of the Annual Report of Long
Term Care for the cost years ending on September 30, 1988, and September 30, 1989,
and "facility" means licensed chronic and convalescent nursing homes, chronic disease
hospitals associated with chronic and convalescent nursing homes and rest homes with
nursing supervision and to residential facilities for the mentally retarded which are licensed pursuant to section 17a-227 and certified to participate in the Title XIX Medicaid
program as intermediate care facilities for the mentally retarded. Such percentiles shall be calculated by the commissioner after application of the adjustments set forth in subsections (b), (c), (d) and (e) of this section. Inflation adjustments
for allowable fair rental value reimbursement shall be calculated in accordance with the
regulations promulgated by the commissioner and in effect on April 1, 1989. (h) The commissioner shall calculate the rate adjustments made pursuant to subsections (b) to (g), inclusive, of this section in the following order: (1) Applying the inflation
cost limitations set forth in subsection (b) of this section, (2) calculating the cost efficiency adjustment set forth in subsection (c) of this section, (3) applying the reduction
for personal laundry set forth in subsection (d) of this section, (4) excluding the interest
expense and return on equity described in subsection (e) of this section, (5) applying
the inflation adjustments set forth in subsection (f) of this section and (6) calculating
and applying the percentage reduction set forth in subsection (g) of this section. Sec. 17b-345. (Formerly Sec. 17-314e). Self-pay rates in licensed chronic and
convalescent nursing homes and rest homes with nursing supervision based on
certain cost years. (a) Notwithstanding the provisions of section 17b-341 and the regulations of Connecticut state agencies, the commissioner shall determine the rates to be
charged to self-pay patients in licensed chronic and convalescent nursing homes and
rest homes with nursing supervision, based on the cost years ending September 30, 1988,
and September 30, 1989, by (1) determining the state rate as computed for purposes of
establishing self-pay rates for each facility in accordance with regulations promulgated
by the commissioner and in effect on April 1, 1989, as modified by subsection (b) of
section 17b-344 and (2) adding to that rate a percentage of the state-wide median Medicaid rate as determined by the commissioner in accordance with regulations promulgated
by him and in effect on April 1, 1989, as modified by subsection (b) of section 17b-
344, according to the following schedule: (b) The commissioner shall determine the rates to be charged to self-pay patients
pursuant to this section and shall notify facilities subject to the requirements of this
section of such rates as soon as practicable but not later than July 31, 1989, provided
the facility has filed the annual report for the year ending September 30, 1988, on or
before April 30, 1989. All self-pay patients shall be given notice of a rate increase, as
determined by the commissioner, at least thirty days prior to the effective date of such
rate increase. The commissioner shall not reconduct the annual public hearings which
were held in April, 1989. Sec. 17b-346. (Formerly Sec. 17-314f). Chronic and convalescent nursing facility: Title XIX Medicaid program participant. Provider agreement. (a) Effective
October 1, 1991, every chronic and convalescent nursing home, chronic disease hospital
associated with a chronic and convalescent nursing home, and rest home with nursing
supervision, that participates in the medical assistance program provided in Title XIX
of the Social Security Act shall, as a condition of participation in said program, if eligible,
maintain or execute a provider agreement with the Secretary of Health and Human
Services to participate in the Medicare program under Title XVIII of the Social Security
Act to the same extent that the facility participates in the Title XIX medical assistance
program. However, such facility may seek the approval of the Department of Social
Services to have a larger portion of its facility certified for the Title XIX medical assistance program than for the Title XVIII Medicare program if the facility is certified for
a distinct part pursuant to the Title XVIII Medicare program and the facility demonstrates
to the satisfaction of the department that the number of beds in the distinct part will be
adequate to ensure access to Title XVIII Medicare certified beds to all eligible Title
XVIII recipients who might reasonably be expected to seek admission to, or return to,
such facility. Sec. 17b-347. (Formerly Sec. 17-314g). Termination of Medicaid provider
agreements by nursing home facilities. Rates to be charged self-pay patients. (a)
Any nursing home facility, as defined in section 19a-521, which intends to decrease its
services to persons who receive medical assistance benefits from the state by terminating
its Medicaid provider agreement shall notify the Commissioner of Social Services in
writing and shall transfer all patients who receive such benefits to another facility which
participates in the Medicaid program within thirty days of the date of such termination.
The facility terminating such agreement shall be responsible for any loss of federal
financial participation arising from such termination. At least six months prior to a
nursing home facility notifying the commissioner of its intention to terminate its Medicaid provider agreement the facility shall provide written notification of such intention to
each patient, applicant for admission and, if known, each patient's and each applicant's
legally liable relative, guardian or conservator. Failure of a nursing home to provide
such notice to each patient, applicant and legally liable relative, guardian or conservator
shall invalidate any notice provided to the commissioner. If a facility terminates or fails to renew its provider agreement during a rate year, the
commissioner shall revise the rate to be charged self-pay patients determined in accordance with this subsection. The revised rate shall take effect (A) on the date of termination
or expiration of the provider agreement if the revision results in a decrease in the rate;
or (B) upon thirty days notice to the self-pay patients if the revision results in an increase
in the rate. Secs. 17b-347a to 17b-347d. Reserved for future use. Sec. 17b-347e. Demonstration project for provision of subsidized assisted living services for persons residing in affordable housing. Memorandum of understanding. (a) The Commissioner of Social Services, in collaboration with the Commissioner of Economic and Community Development and the Connecticut Housing Finance
Authority, shall establish a demonstration project to provide subsidized assisted living
services, as defined in section 19-13-D105 of the regulations of Connecticut state agencies, for persons residing in affordable housing, as defined in section 8-39a. The demonstration project shall be conducted in at least three municipalities to be determined by
the Commissioner of Social Services. The demonstration project may accept applications for up to three years from June 8, 1998, and shall be limited to a maximum of
three hundred subsidized dwelling units. Applicants for such subsidized assisted living
services shall be subject to the same eligibility requirements as the Connecticut home
care program for the elderly pursuant to section 17b-342. Sec. 17b-348. (Formerly Sec. 17-314h). Demonstration project: Skilled and
intermediate nursing home care for persons with AIDS. Rate. Regulations. (a) Notwithstanding any provision of the general statutes or the regulations of Connecticut state
agencies, the Department of Social Services shall establish rates based on reasonable
costs related to patient care for a demonstration project which shall provide skilled and
intermediate nursing home care for persons with acquired immune deficiency syndrome
or AIDS-related complex in a facility which is located within the Connecticut metropolitan area which has the highest incidence of AIDS and which is specifically established,
equipped and staffed for such purpose. Sec. 17b-349. (Formerly Sec. 17-314i). Adjustment of rates of payment to community health centers and free-standing medical clinics participating in Medicaid
program. (a) The rates paid by the state to community health centers and free-standing
medical clinics participating in the Medicaid program may be adjusted annually on the
basis of the cost reports submitted to the Commissioner of Social Services, except that
rates effective July 1, 1989, shall remain in effect through June 30, 1990. Secs. 17b-349a to 17b-349d. Reserved for future use. Sec. 17b-349e. Demonstration program for provision of respite care services
for caretakers of Alzheimer's patients. Definitions. Requirements. Regulations. (a)
As used in this section: Sec. 17b-350. (Formerly Sec. 17-314n). Demonstration program for respite
care in nursing homes for self-pay patients. The Commissioner of Social Services,
in consultation with the Commissioner of Public Health, shall establish a demonstration
program for respite care in nursing homes for self-pay patients. The program shall offer
a financial incentive for a nursing home to reserve beds for respite care. Sec. 17b-351. (Formerly Sec. 19a-155a). Nursing homes: Title XVIII and Title
XIX participants. Increased bed capacity. Capital construction project. (a) Notwithstanding the provisions of sections 17b-7, 17b-8 or 17b-9, any nursing home participating in the Title XVIII and Title XIX programs may, on a one-time basis, increase its
licensed bed capacity and implement a capital construction project to accomplish such an
increase without being required to request or obtain approval of the increase in services,
licensed bed capacity or the capital expenditures program from the Department of Social
Services provided that the project (1) shall not require licensure by the Department of
Public Health of more than ten additional nursing home beds and (2) the total capital cost
of said program shall not exceed thirty thousand dollars per bed, adjusted for inflation
annually by said department. Sec. 17b-352. Certificate of need for nursing home facilities; transfer of ownership or control; introduction of additional function or service; termination or
decrease of service. Regulations. (a) For the purposes of this section and section 17b-
353, "facility" means a residential facility for the mentally retarded licensed pursuant
to section 17a-277 and certified to participate in the Title XIX Medicaid program as
an intermediate care facility for the mentally retarded, a nursing home, rest home or
residential care home, as defined in section 19a-490. Sec. 17b-353. Certificate of need; capital expenditure or acquisition of major
medical equipment. Hearings. Regulations. (a) Any facility, as defined in subsection
(a) of section 17b-352, which proposes (1) a capital expenditure exceeding one million
dollars, which increases facility square footage by more than five thousand square feet or
five per cent of the existing square footage, whichever is greater, (2) a capital expenditure
exceeding two million dollars, or (3) the acquisition of major medical equipment requiring a capital expenditure in excess of four hundred thousand dollars, including the leasing
of equipment or space, shall submit a request for approval of such expenditure, with
such information as the department requires, to the Department of Social Services. Any
such facility which proposes to acquire imaging equipment requiring a capital expenditure in excess of four hundred thousand dollars, including the leasing of such equipment,
shall obtain the approval of the Office of Health Care Access in accordance with section
19a-639, subsequent to obtaining the approval of the Commissioner of Social Services.
Prior to the facility's obtaining the imaging equipment, the Commissioner of the Office
of Health Care Access, after consultation with the Commissioner of Social Services,
may elect to perform a joint or simultaneous review with the Department of Social
Services. Sec. 17b-354. Requests for additional nursing home beds. Continuing care facility. Construction. Financing. Regulations. (a) Except for applications deemed complete as of August 9, 1991, the Department of Social Services shall not accept or approve
any requests for additional nursing home beds or modify the capital cost of any prior
approval for the period from September 4, 1991, through June 30, 2002, except (1) beds
restricted to use by patients with acquired immune deficiency syndrome or traumatic
brain injury; (2) beds associated with a continuing care facility which guarantees life
care for its residents; and (3) Medicaid certified beds to be relocated from one licensed
nursing facility to another licensed nursing facility, provided (A) the availability of beds
in an area of need will not be adversely affected; (B) no such relocation shall result in
an increase in state expenditures; and (C) the relocation results in a reduction in the
number of nursing facility beds in the state. Notwithstanding the provisions of this
subsection, any provision of the general statutes or any decision of the Office of Health
Care Access, (i) the date by which construction shall begin for each nursing home certificate of need in effect August 1, 1991, shall be December 31, 1992, (ii) the date by which
a nursing home shall be licensed under each such certificate of need shall be October
1, 1995, and (iii) the imposition of such dates shall not require action by the Commissioner of Social Services. Except as provided in subsection (c) of this section, a nursing
home certificate of need in effect August 1, 1991, shall expire if construction has not
begun or licensure has not been obtained in compliance with the dates set forth in subparagraphs (i) and (ii) of this subsection. Sec. 17b-354a. Judicial enforcement. The Superior Court on application of the
Commissioner of Social Services or the Attorney General, may enforce, by appropriate
decree or process any provision of section 17b-352, 17b-353 or 17b-354, respectively,
or any act or any order of the commissioner rendered in pursuance of any such provision. Sec. 17b-354b. Relocation of Medicaid certified nursing home beds. The Commissioner of Social Services may approve the relocation of Medicaid certified nursing
home beds from a licensed nursing home to a continuing care facility registered with
the Department of Social Services in accordance with the provisions of section 17b-
520 to 17b-535, inclusive, and may approve Medicaid participation for any such nursing
home beds transferred to a continuing care facility as part of the approval of any such
relocation, provided the relocation of beds complies with the requirements of subdivision (3) of subsection (a) of section 17b-354 and provided further that: (1) Beds are
transferred and eliminated from existing four-bed rooms licensed prior to July 1, 1992;
(2) the Medicaid per diem rate does not exceed the rate in place at the facility that is
transferring beds, and increases in such rate are limited annually thereafter to any rate
increase limits under section 17b-340; and (3) any such nursing home bed transfer is to
a continuing care facility under the same ownership or a subsidiary of the nursing home
transferring such bed. Sec. 17b-355. Certificate of need for capital expenditures; transfer of ownership or control; criteria. In determining whether a request submitted pursuant to sections 17b-352 to 17b-354, inclusive, will be granted, modified or denied, the Commissioner of Social Services shall consider the following: The relationship of the request
to the state health plan, the financial feasibility of the request and its impact on the
applicant's rates and financial condition, the contribution of the request to the quality,
accessibility and cost-effectiveness of health care delivery in the region, whether there
is clear public need for the request, the relationship of any proposed change to the
applicant's current utilization statistics, the business interests of all owners, partners,
associates, incorporators, directors, sponsors, stockholders and operators and the personal background of such persons, and any other factor which the department deems
relevant. Whenever the granting, modification or denial of a request is inconsistent with
the state health plan, a written explanation of the reasons for the inconsistency shall be
included in the decision. The commissioner shall not grant a request for additional nursing facility beds unless there is a demonstrated bed need in the towns within twenty
miles of the town in which the beds are proposed to be located, including the town of
the proposed location, as listed in the March 1, 1974, Official Mileage Table of the
Public Utilities Commission. Bed need shall be projected no more than five years into
the future at ninety-seven and one-half per cent occupancy using the latest official population projections by town and age as published by the Office of Policy and Management
and the latest available nursing facility utilization statistics by age cohort from the Department of Public Health. Sec. 17b-356. Health care facility proposing to expand services by adding
nursing home beds. Procedures. Any health care facility or institution, as defined in
subsection (a) of section 19a-490, except a nursing home, rest home, residential care
home or residential facility for the mentally retarded licensed pursuant to section 17a-
227 and certified to participate in the Title XIX Medicaid program as an intermediate
care facility for the mentally retarded, proposing to expand its services by adding nursing
home beds shall obtain the approval of the Commissioner of Social Services in accordance with the procedures established pursuant to sections 17b-352, 17b-353 and 17b-
354 for a facility, as defined in section 17b-352, prior to obtaining the approval of the
Office of Health Care Access pursuant to section 19a-638 or 19a-639, or both. Sec. 17b-357. (Formerly Sec. 17-134v). Nursing facility: Compliance with federal law. Summary order. Temporary manager. Remedies. Regulations. Penalties.
Hearing. (a) For purposes of this section and sections 17b-358 to 17b-360, inclusive,
a "nursing facility" means a chronic and convalescent home or a rest home with nursing
supervision as defined in section 19a-521, which participates in the Medicaid program
through a provider agreement with the Department of Social Services. Sec. 17b-358. (Formerly Sec. 17-134w). Temporary manager: Powers and duties. Regulations. Certification. (a) Any temporary manager appointed pursuant to
section 17b-357, shall operate under the authority and supervision of the Department
of Social Services. A temporary manager shall have the same powers as a receiver
of a corporation under section 52-507, and shall exercise such powers to remedy the
conditions which constitute grounds for the imposition of the temporary manager, to
assure adequate health for the patients, and to preserve the assets and property of the
owner. If the temporary manager determines that the condition of the facility requires
that arrangements be made for the transfer of residents in order to assure their health
and safety, the temporary manager shall direct the facility's efforts in locating alternative
placements and in preparing discharge plans which meet the requirements of section 19a-
535 and shall supervise the transportation of residents and such residents' belongings and
medical records to the places where such residents are being transferred or discharged.
A temporary manager shall not be liable for injury to person or property that is attributable to the conditions of such facility and shall only be liable for his acts or omissions
that constitute gross, wilful or wanton negligence. The Department of Social Services,
upon application by the temporary manager or the administrator of such facility, may
terminate the temporary manager if it finds that the condition of the facility no longer
warrants the appointment of a temporary manager. If the department denies an application for the termination of a temporary manager brought pursuant to this section, the
facility or the temporary manager may obtain review of such determination by a hearing
conducted pursuant to chapter 54, provided that the hearing is requested within fifteen
days of the provision of notice denying the application. Any temporary manager appointed by the Department of Social Services pursuant to section 17b-357 shall be paid
a reasonable fee for his services to be determined and to be paid by the department. The
facility shall be liable to the department for the cost of services of the temporary manager
appointed at such facility and the department may recover the cost thereof by setting
off such amount against the funds that would otherwise be paid to such facility for
services rendered to recipients of assistance under the Medicaid program. The Department of Social Services shall adopt regulations in accordance with the provisions of
chapter 54, as to the qualifications required for a temporary manager and the procedure
by which a temporary manager is selected for appointment. Sec. 17b-359. (Formerly Sec. 17-134x). Nursing facility: Preadmission screening process in the case of mentally ill persons. Appeal. (a) For purposes of this section,
the terms "mentally ill" and "specialized services" shall be as defined in Subsections
(e)(7)(G)(i) and (iii) of Section 1919 of the Social Security Act and federal regulations. Sec. 17b-360. (Formerly Sec. 17-134y). Nursing facility: Preadmission screening process in the case of persons with mental retardation or condition related
thereto. Appeal. (a) For purposes of this section, the terms "mental retardation", "a
condition related to mental retardation" and "specialized services" shall be as defined
in Subsection (e)(7)(G)(ii) of Section 1919 of the Social Security Act and federal regulations. Sec. 17b-361. (Formerly Sec. 17-134hh). Payment for physicians' visits to
Medicaid patients in nursing homes. The Commissioner of Social Services shall pay
for a physician's visit to a patient who is a Medicaid recipient in a nursing home in
accordance with federal law and regulation. Sec. 17b-362. (Formerly Sec. 17-134ii). Ten-day limit on first time maintenance drug prescription for Medicaid or ConnPACE recipient. Five-day supply
of prescription drug may be requested for Medicaid patient. (a) A prescription for
a maintenance drug, as determined by the Commissioner of Social Services, dispensed
for the first time to any Medicaid or ConnPACE recipient, shall be dispensed in an
amount not greater than a ten-day supply. Sec. 17b-362a. Pharmacy review panel established. The Commissioner of Social Services shall establish a pharmacy review panel to serve as advisors in the operation
of pharmacy benefit programs administered by the Department of Social Services, including the implementation of any cost-saving initiatives undertaken pursuant to section
17b-362, subsection (e) of section 17b-491 and section 17b-363. The panel shall be
appointed by the commissioner to a three-year term and shall be composed of two representatives of independent pharmacies, two representatives of chain pharmacies, two
representatives of pharmacies that serve long-term care facilities, two representatives
of pharmaceutical manufacturers, one physician specializing in family practice and one
physician specializing in internal medicine or geriatrics. The panel shall meet at least
quarterly with the commissioner or said commissioner's designee. Sec. 17b-363. Demonstration program for exploring methods of returning
and dispensing prescription drugs which have been dispensed in long-term care
facilities. The Commissioner of Social Services may establish a two-year demonstration
program, to be administered in accordance with federal law, for the purpose of exploring
methods of returning and dispensing prescription drugs which have been dispensed to
patients in long-term care facilities and not used. Such program, may include an exception to subsection (h) of section 21a-70, to allow a long-term care facility, which employs
a pharmacist less than thirty-five hours per week, to purchase drugs from a wholesaler
or manufacturer or the implementation of a formulary. The Commissioner of Social
Services shall report the results of such program to the joint standing committees of
the General Assembly having cognizance of matters relating to human services and
appropriations on or before February 15, 2000. Sec. 17b-363a. Return of unused prescription drugs dispensed in long-term
care facilities to vendor pharmacies. Requirements. Regulations. (a) Each long-
term care facility shall return to the vendor pharmacy which shall accept, for repackaging
and reimbursement to the Department of Social Services, drug products that were dispensed to a patient and not used if such drug products are (1) prescription drug products
that are not controlled substances, (2) sealed in individually packaged units, (3) returned
to the vendor pharmacy within the recommended period of shelf life for the purpose of
redispensing such drug products, (4) determined to be of acceptable integrity by a licensed pharmacist, and (5) oral and parenteral medication in single-dose sealed containers approved by the federal Food and Drug Administration, topical or inhalant drug
products in units of use containers approved by the federal Food and Drug Administration or parenteral medications in multiple-dose sealed containers approved by the federal
Food and Drug Administration from which no doses have been withdrawn. Sec. 17b-364. Demonstration program for providing specialized long-term
care. Requests for proposals. (a) For purposes of this section, "specialized long-term
care" means goal-oriented, comprehensive, inpatient care designed for a patient with
an acute illness, injury or exacerbation of a disease process. Most patients receiving
such care shall not require high-technology monitoring or complex diagnostic procedures. Such care requires a specifically designed program of coordinated services of an
interdisciplinary team, including, but not limited to, physicians, nurses and professionals
in other relevant disciplines.
Sec. 17b-337. Long-term elderly care planning committee. Long-term care plan for elderly
persons. Membership.
Sec. 17b-338. Long-Term Care Advisory Council. Membership. Duties.
Sec. 17b-339. Nursing Home Financial Advisory Committee. Duties. Membership.
Sec. 17b-341. (Formerly Sec. 17-314a). Self-pay rates regulated. Provider agreement. Rate
adjustments. Appeals. Report.
Sec. 17b-342. (Formerly Sec. 17-314b). Connecticut home-care program for the elderly.
Sec. 17b-343. (Formerly Sec. 17-314c). Rates of payment for home care services, transportation and mental health counseling.
Sec. 17b-344. (Formerly Sec. 17-314d). Rates of payment to facilities for room, board and
services.
Sec. 17b-345. (Formerly Sec. 17-314e). Self-pay rates in licensed chronic and convalescent nursing homes and rest homes with nursing supervision based on certain cost years.
Sec. 17b-346. (Formerly Sec. 17-314f). Chronic and convalescent nursing facility: Title
XIX Medicaid program participant. Provider agreement.
Sec. 17b-347. (Formerly Sec. 17-314g). Termination of Medicaid provider agreements by
nursing home facilities. Rates to be charged self-pay patients.
Secs. 17b-347a to 17b-347d.
Sec. 17b-347e. Demonstration project for provision of subsidized assisted living services
for persons residing in affordable housing. Memorandum of understanding.
Sec. 17b-348. (Formerly Sec. 17-314h). Demonstration project: Skilled and intermediate
nursing home care for persons with AIDS. Rate. Regulations.
Sec. 17b-349. (Formerly Sec. 17-314i). Adjustment of rates of payment to community health
centers and free-standing medical clinics participating in Medicaid program.
Secs. 17b-349a to 17b-349d.
Sec. 17b-349e. Demonstration program for provision of respite care services for caretakers of Alzheimer's patients. Definitions. Requirements. Regulations.
Sec. 17b-350. (Formerly Sec. 17-314n). Demonstration program for respite care in nursing
homes for self-pay patients.
Sec. 17b-351. (Formerly Sec. 19a-155a). Nursing homes: Title XVIII and Title XIX participants. Increased bed capacity. Capital construction project.
Sec. 17b-352. Certificate of need for nursing home facilities; transfer of ownership or
control; introduction of additional function or service; termination or decrease of service. Regulations.
Sec. 17b-353. Certificate of need; capital expenditure or acquisition of major medical
equipment. Hearings. Regulations.
Sec. 17b-354. Requests for additional nursing home beds. Continuing care facility. Construction. Financing. Regulations.
Sec. 17b-354a. Judicial enforcement.
Sec. 17b-354b. Relocation of Medicaid certified nursing home beds.
Sec. 17b-355. Certificate of need for capital expenditures; transfer of ownership or control; criteria.
Sec. 17b-356. Health care facility proposing to expand services by adding nursing home
beds. Procedures.
Sec. 17b-357. (Formerly Sec. 17-134v). Nursing facility: Compliance with federal law.
Summary order. Temporary manager. Remedies. Regulations. Penalties. Hearing.
Sec. 17b-358. (Formerly Sec. 17-134w). Temporary manager: Powers and duties. Regulations.
Certification.
Sec. 17b-359. (Formerly Sec. 17-134x). Nursing facility: Preadmission screening process
in the case of mentally ill persons. Appeal.
Sec. 17b-360. (Formerly Sec. 17-134y). Nursing facility: Preadmission screening process
in the case of persons with mental retardation or condition related thereto. Appeal.
Sec. 17b-361. (Formerly Sec. 17-134hh). Payment for physicians' visits to Medicaid patients in nursing homes.
Sec. 17b-362. (Formerly Sec. 17-134ii). Ten-day limit on first time maintenance drug prescription for Medicaid or ConnPACE recipient. Five-day supply of prescription drug may be
requested for Medicaid patient.
Sec. 17b-362a. Pharmacy review panel established.
Sec. 17b-363. Demonstration program for exploring methods of returning and dispensing
prescription drugs which have been dispensed in long-term care facilities.
Sec. 17b-363a. Return of unused prescription drugs dispensed in long-term care facilities
to vendor pharmacies. Requirements. Regulations.
Sec. 17b-364. Demonstration program for providing specialized long-term care. Requests
for proposals.
Secs. 17b-365 to 17b-399.
(b) The Long-Term Care Planning Committee shall, within available appropriations, study issues relative to long-term care including, but not limited to, the case-mix
system of Medicaid reimbursement, community-based service options, access to long-
term care and geriatric psychiatric services.
(c) The Long-Term Care Planning Committee shall consist of: (1) The chairpersons
and ranking members of the joint standing and select committees of the General Assembly having cognizance of matters relating to human services, public health, elderly services and long-term care; (2) the Commissioner of Social Services, or the commissioner's designee; (3) one member of the Office of Policy and Management appointed by
the Secretary of the Office of Policy and Management; (4) one member from the Department of Social Services appointed by the Commissioner of Social Services; (5) one
member from the Department of Public Health appointed by the Commissioner of Public
Health; (6) one member from the Department of Economic and Community Development appointed by the Commissioner of Economic and Community Development; (7)
one member from the Office of Health Care Access appointed by the Commissioner
of Health Care Access; (8) one member from the Department of Mental Retardation
appointed by the Commissioner of Mental Retardation; (9) one member from the Department of Mental Health and Addiction Services appointed by the Commissioner of
Mental Health and Addiction Services; and (10) one member from the Department of
Transportation appointed by the Commissioner of Transportation. The committee shall
convene no later than ninety days after June 4, 1998. Any vacancy shall be filled by the
appointing authority. The chairperson shall be elected from among the members of
the committee. The committee shall seek the advice and participation of any person,
organization or state or federal agency it deems necessary to carry out the provisions
of this section.
(d) Not later than January 1, 1999, and biennially thereafter, the Long-Term Care
Planning Committee shall submit a long-term care plan pursuant to subsection (a) of
this section to the joint standing and select committees of the General Assembly having
cognizance of matters relating to human services, public health, elderly services and
long-term care, in accordance with the provisions of section 11-4a.
(P.A. 98-175, S. 1, 2; 98-239, S. 27, 35; P.A. 99-28, S. 1, 2.)
History: P.A. 98-175 effective June 4, 1998; P.A. 98-239 inserted new language in Subsec. (b), requiring committee
to study issues relative to long-term care and renumbered remaining Subsecs. accordingly, and amended Subsec. (c) to
authorize committee to seek the advice and participation of any person, organization or state or federal agency it deems
necessary to carry out the provisions of this section, effective July 1, 1998; P.A. 99-28 amended Subsec. (c) to add Subdivs.
(8), (9) and (10) re members appointed by the Commissioners of Mental Retardation, Mental Health and Addiction Services,
and Transportation, and substituted "the commissioner's" for "his", effective May 27, 1999.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) The council shall advise and make recommendations to the Long-Term Care
Planning Committee established under section 17b-337.
(P.A. 98-239, S. 29, 35; P.A. 00-135, S. 20, 21.)
History: P.A. 98-239 effective July 1, 1998; P.A. 00-135 amended Subsec. (a) by making technical changes and adding
new Subdivs. (10) to (19) re additional members of the council, effective May 26, 2000.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) The Commissioner of Social Services and the Commissioner of Public Health
shall be the chairpersons of the committee. Any vacancy shall be filled by the appointing
authority.
(c) The committee, upon receipt of a report relative to the financial solvency of and
quality of care provided by nursing homes in the state, shall recommend appropriate
action for improving the financial condition of any nursing home that is in financial
distress to the Commissioner of Social Services.
(d) Not later than January 1, 1999, and annually thereafter, the committee shall
submit a report on its activities to the joint standing committees of the General Assembly
having cognizance of matters relating to human services and public health and to the
select committee of the General Assembly having cognizance of matters relating to
aging, in accordance with the provisions of section 11-4a.
(P.A. 98-239, S. 26, 35.)
History: P.A. 98-239 effective July 1, 1998.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) The Commissioner of Social Services shall adopt regulations in accordance with
the provisions of chapter 54 to specify other allowable services. For purposes of this
section, other allowable services means those services required by any medical assistance beneficiary residing in such home or hospital which are not already covered in the
rate set by the commissioner in accordance with the provisions of subsection (a) of this
section.
(c) No facility subject to the requirements of this section shall accept payment in
excess of the rate set by the commissioner pursuant to subsection (a) of this section for
any medical assistance patient from this or any other state. No facility shall accept
payment in excess of the reasonable and necessary costs of other allowable services as
specified by the commissioner pursuant to the regulations promulgated under subsection
(b) of this section for any public assistance patient from this or any other state. Notwithstanding the provisions of this subsection, the commissioner may authorize a facility to
accept payment in excess of the rate paid for a medical assistance patient in this state
for a patient who receives medical assistance from another state.
(d) In any instance where the Commissioner of Social Services finds that a facility
subject to the requirements of this section is accepting payment for a medical assistance
beneficiary in violation of subsection (c) of this section, the commissioner shall proceed
to recover through the rate set for the facility any sum in excess of the stipulated per
diem and other allowable costs, as promulgated in regulations pursuant to subsections
(a) and (b) of this section. The commissioner shall make the recovery prospectively at
the time of the next annual rate redetermination.
(e) Except as provided in this subsection, the provisions of subsections (c) and (d)
of this section shall not apply to any facility subject to the requirements of this section,
which on October 1, 1981, (1) was accepting payments from the commissioner in accordance with the provisions of subsection (a), (2) was accepting medical assistance payments from another state for at least twenty per cent of its patients and (3) had not notified
the commissioner of any intent to terminate its provider agreement, in accordance with
section 17b-271, provided no patient residing in any such facility on May 22, 1984,
shall be removed from such facility for purposes of meeting the requirements of this
subsection. If the commissioner finds that the number of beds available to medical
assistance patients from this state in any such facility is less than fifteen per cent the
provisions of subsections (c) and (d) shall apply to that number of beds which is less
than said percentage.
(f) For the fiscal year ending June 30, 1992, the rates paid by or for persons aided
or cared for by the state or any town in this state to facilities for room, board and services
specified in licensing regulations issued by the licensing agency, except intermediate
care facilities for the mentally retarded and residential care homes, shall be based on
the cost year ending September 30, 1989. For the fiscal years ending June 30, 1993, and
June 30, 1994, such rates shall be based on the cost year ending September 30, 1990.
Notwithstanding the provisions of section 17b-344, such rates shall be determined by
the Commissioner of Social Services in accordance with this section and the regulations
of Connecticut state agencies promulgated by the commissioner and in effect on April
1, 1991, except that:
(1) Allowable costs shall be divided into the following five cost components: Direct
costs, which shall include salaries for nursing personnel, related fringe benefits and
nursing pool costs; indirect costs, which shall include professional fees, dietary expenses, housekeeping expenses, laundry expenses, supplies related to patient care, salaries for indirect care personnel and related fringe benefits; fair rent, which shall be
defined in accordance with subsection (f) of section 17-311-52 of the regulations of
Connecticut state agencies; capital-related costs, which shall include property taxes,
insurance expenses, equipment leases and equipment depreciation; and administrative
and general costs, which shall include maintenance and operation of plant expenses,
salaries for administrative and maintenance personnel and related fringe benefits. The
commissioner may provide a rate adjustment for nonemergency transportation services
required by nursing facility residents. Such adjustment shall be a fixed amount determined annually by the commissioner based upon a review of costs and other associated
information. Allowable costs shall not include costs for ancillary services payable under
Part B of the Medicare program.
(2) Two geographic peer groupings of facilities shall be established for each level
of care, as defined by the Department of Social Services for the determination of rates,
for the purpose of determining allowable direct costs. One peer grouping shall be comprised of those facilities located in Fairfield County. The other peer grouping shall be
comprised of facilities located in all other counties.
(3) For the fiscal year ending June 30, 1992, per diem maximum allowable costs
for each cost component shall be as follows: For direct costs, the maximum shall be
equal to one hundred forty per cent of the median allowable cost of that peer grouping;
for indirect costs, the maximum shall be equal to one hundred thirty per cent of the state-
wide median allowable cost; for fair rent, the amount shall be calculated utilizing the
amount approved by the Office of Health Care Access pursuant to section 19a-638; for
capital-related costs, there shall be no maximum; and for administrative and general
costs, the maximum shall be equal to one hundred twenty-five per cent of the state-wide
median allowable cost. For the fiscal year ending June 30, 1993, per diem maximum
allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred forty per cent of the median allowable cost of that
peer grouping; for indirect costs, the maximum shall be equal to one hundred twenty-
five per cent of the state-wide median allowable cost; for fair rent, the amount shall be
calculated utilizing the amount approved by the Office of Health Care Access pursuant
to section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to one hundred fifteen per cent of
the state-wide median allowable cost. For the fiscal year ending June 30, 1994, per diem
maximum allowable costs for each cost component shall be as follows: For direct costs,
the maximum shall be equal to one hundred thirty-five per cent of the median allowable
cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred
twenty per cent of the state-wide median allowable cost; for fair rent, the amount shall be
calculated utilizing the amount approved by the Office of Health Care Access pursuant to
section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to one hundred ten per cent of the
state-wide median allowable cost. For the fiscal year ending June 30, 1995, per diem
maximum allowable costs for each cost component shall be as follows: For direct costs,
the maximum shall be equal to one hundred thirty-five per cent of the median allowable
cost of that peer grouping; for indirect costs, the maximum shall be equal to one hundred
twenty per cent of the state-wide median allowable cost; for fair rent, the amount shall be
calculated utilizing the amount approved by the Office of Health Care Access pursuant to
section 19a-638; for capital-related costs, there shall be no maximum; and for administrative and general costs the maximum shall be equal to one hundred five per cent of
the state-wide median allowable cost. For the fiscal year ending June 30, 1996, and any
succeeding fiscal year, except for the fiscal years ending June 30, 2000, and June 30,
2001, for facilities with an interim rate in one or both periods, per diem maximum
allowable costs for each cost component shall be as follows: For direct costs, the maximum shall be equal to one hundred thirty-five per cent of the median allowable cost of
that peer grouping; for indirect costs, the maximum shall be equal to one hundred fifteen
per cent of the state-wide median allowable cost; for fair rent, the amount shall be
calculated utilizing the amount approved pursuant to section 19a-638; for capital-related
costs, there shall be no maximum; and for administrative and general costs the maximum
shall be equal to the state-wide median allowable cost. For the fiscal years ending June
30, 2000, and June 30, 2001, for facilities with an interim rate in one or both periods,
per diem maximum allowable costs for each cost component shall be as follows: For
direct costs, the maximum shall be equal to one hundred forty-five per cent of the median
allowable cost of that peer grouping; for indirect costs, the maximum shall be equal to
one hundred twenty-five per cent of the state-wide median allowable cost; for fair rent,
the amount shall be calculated utilizing the amount approved pursuant to section 19a-
638; for capital-related costs, there shall be no maximum; and for administrative and
general costs, the maximum shall be equal to the state-wide median allowable cost and
such medians shall be based upon the same cost year used to set rates for facilities
with prospective rates. Costs in excess of the maximum amounts established under this
subsection shall not be recognized as allowable costs, except that the Commissioner of
Social Services (A) may allow costs in excess of maximum amounts for any facility
with patient days covered by Medicare, including days requiring coinsurance, in excess
of twelve per cent of annual patient days which also has patient days covered by Medicaid
in excess of fifty per cent of annual patient days; (B) may establish a pilot program
whereby costs in excess of maximum amounts shall be allowed for beds in a nursing
home which has a managed care program and is affiliated with a hospital licensed under
chapter 368v; and (C) may establish rates whereby allowable costs may exceed such
maximum amounts for beds approved on or after July 1, 1991, which are restricted to
use by patients with acquired immune deficiency syndrome or traumatic brain injury.
(4) For the fiscal year ending June 30, 1992, (A) no facility shall receive a rate that
is less than the rate it received for the rate year ending June 30, 1991; (B) no facility
whose rate, if determined pursuant to this subsection, would exceed one hundred twenty
per cent of the state-wide median rate, as determined pursuant to this subsection, shall
receive a rate which is five and one-half per cent more than the rate it received for the
rate year ending June 30, 1991; and (C) no facility whose rate, if determined pursuant
to this subsection, would be less than one hundred twenty per cent of the state-wide
median rate, as determined pursuant to this subsection, shall receive a rate which is six
and one-half per cent more than the rate it received for the rate year ending June 30,
1991. For the fiscal year ending June 30, 1993, no facility shall receive a rate that is
less than the rate it received for the rate year ending June 30, 1992, or six per cent more
than the rate it received for the rate year ending June 30, 1992. For the fiscal year ending
June 30, 1994, no facility shall receive a rate that is less than the rate it received for the
rate year ending June 30, 1993, or six per cent more than the rate it received for the rate
year ending June 30, 1993. For the fiscal year ending June 30, 1995, no facility shall
receive a rate that is more than five per cent less than the rate it received for the rate
year ending June 30, 1994, or six per cent more than the rate it received for the rate year
ending June 30, 1994. For the fiscal years ending June 30, 1996, and June 30, 1997, no
facility shall receive a rate that is more than three per cent more than the rate it received
for the prior rate year. For the fiscal year ending June 30, 1998, a facility shall receive
a rate increase that is not more than two per cent more than the rate that the facility
received in the prior year. For the fiscal year ending June 30, 1999, a facility shall receive
a rate increase that is not more than three per cent more than the rate that the facility
received in the prior year and that is not less than one per cent more than the rate that
the facility received in the prior year, exclusive of rate increases associated with a wage,
benefit and staffing enhancement rate adjustment added for the period from April 1,
1999, to June 30, 1999, inclusive. For the fiscal year ending June 30, 2000, each facility,
except a facility with an interim rate or replaced interim rate for the fiscal year ending
June 30, 1999, and a facility having a certificate of need or other agreement specifying
rate adjustments for the fiscal year ending June 30, 2000, shall receive a rate increase
equal to one per cent applied to the rate the facility received for the fiscal year ending
June 30, 1999, exclusive of the facility's wage, benefit and staffing enhancement rate
adjustment. For the fiscal year ending June 30, 2000, no facility with an interim rate,
replaced interim rate or scheduled rate adjustment specified in a certificate of need or
other agreement for the fiscal year ending June 30, 2000, shall receive a rate increase
that is more than one per cent more than the rate the facility received in the fiscal year
ending June 30, 1999. For the fiscal year ending June 30, 2001, each facility, except a
facility with an interim rate or replaced interim rate for the fiscal year ending June
30, 2000, and a facility having a certificate of need or other agreement specifying rate
adjustments for the fiscal year ending June 30, 2001, shall receive a rate increase equal
to two per cent applied to the rate the facility received for the fiscal year ending June
30, 2000, subject to verification of wage enhancement adjustments pursuant to subdivision (15) of this subsection. For the fiscal year ending June 30, 2001, no facility with
an interim rate, replaced interim rate or scheduled rate adjustment specified in a certificate of need or other agreement for the fiscal year ending June 30, 2001, shall receive
a rate increase that is more than two per cent more than the rate the facility received for
the fiscal year ending June 30, 2000. For the fiscal year ending June 30, 2002, and any
succeeding fiscal year, no facility shall receive a rate that is more than the rate it received
in the prior year increased by the annual increase in the Consumer Price Index (all urban)
for the most recent calendar year. The Commissioner of Social Services may exclude
fair rent from any rate increase maximums established pursuant to this subdivision for
a facility which has undergone a material change in circumstances related to fair rent.
(5) For the purpose of determining allowable fair rent, a facility with allowable fair
rent less than the twenty-fifth percentile of the state-wide allowable fair rent shall be
reimbursed as having allowable fair rent equal to the twenty-fifth percentile of the state-
wide allowable fair rent, provided for the fiscal years ending June 30, 1996, and June
30, 1997, the reimbursement may not exceed the twenty-fifth percentile of the state-
wide allowable fair rent for the fiscal year ending June 30, 1995. On and after July 1,
1998, the Commissioner of Social Services may allow minimum fair rent as the basis
upon which reimbursement associated with improvements to real property is added.
Beginning with the fiscal year ending June 30, 1996, any facility with a rate of return
on real property other than land in excess of eleven per cent shall have such allowance
revised to eleven per cent. Any facility or its related realty affiliate which finances or
refinances debt through bonds issued by the State of Connecticut Health and Education
Facilities Authority shall report the terms and conditions of such financing or refinancing
to the Commissioner of Social Services within thirty days of completing such financing
or refinancing. The Commissioner of Social Services may revise the facility's fair rent
component of its rate to reflect any financial benefit the facility or its related realty
affiliate received as a result of such financing or refinancing, including but not limited
to, reductions in the amount of debt service payments or period of debt repayment. The
commissioner shall allow actual debt service costs for bonds issued by the State of
Connecticut Health and Educational Facilities Authority if such costs do not exceed
property costs allowed pursuant to subsection (f) of section 17-311-52 of the regulations
of Connecticut state agencies, provided the commissioner may allow higher debt service
costs for such bonds for good cause. For facilities which first open on or after October
1, 1992, the commissioner shall determine allowable fair rent for real property other
than land based on the rate of return for the cost year in which such bonds were issued.
The financial benefit resulting from a facility financing or refinancing debt through such
bonds shall be shared between the state and the facility to an extent determined by the
commissioner on a case-by-case basis and shall be reflected in an adjustment to the
facility's allowable fair rent.
(6) A facility shall receive cost efficiency adjustments for indirect costs and for
administrative and general costs if such costs are below the state-wide median costs. The
cost efficiency adjustments shall equal twenty-five per cent of the difference between
allowable reported costs and the applicable median allowable cost established pursuant
to this subdivision.
(7) For the fiscal year ending June 30, 1992, allowable operating costs, excluding
fair rent, shall be inflated using the Regional Data Resources Incorporated McGraw-
Hill Health Care Costs: Consumer Price Index (all urban)−All Items minus one and
one-half per cent. For the fiscal year ending June 30, 1993, allowable operating costs,
excluding fair rent, shall be inflated using the Regional Data Resources Incorporated
McGraw-Hill Health Care Costs: Consumer Price Index (all urban)−All Items minus
one and three-quarters per cent. For the fiscal years ending June 30, 1994, and June 30,
1995, allowable operating costs, excluding fair rent, shall be inflated using the Regional
Data Resources Incorporated McGraw-Hill Health Care Costs: Consumer Price Index
(all urban)−All Items minus two per cent. For the fiscal year ending June 30, 1996,
allowable operating costs, excluding fair rent, shall be inflated using the Regional Data
Resources Incorporated McGraw-Hill Health Care Costs: Consumer Price Index (all
urban)−All Items minus two and one-half per cent. For the fiscal year ending June 30,
1997, allowable operating costs, excluding fair rent, shall be inflated using the Regional
Data Resources Incorporated McGraw-Hill Health Care Costs: Consumer Price Index
(all urban)−All Items minus three and one-half per cent. For the fiscal year ending June
30, 1992, and any succeeding fiscal year, allowable fair rent shall be those reported in
the annual report of long-term care facilities for the cost year ending the immediately
preceding September thirtieth. The inflation index to be used pursuant to this subsection
shall be computed to reflect inflation between the midpoint of the cost year through the
midpoint of the rate year. The Department of Social Services shall study methods of
reimbursement for fair rent and shall report its findings and recommendations to the
joint standing committee of the General Assembly having cognizance of matters relating
to human services on or before January 15, 1993.
(8) On and after July 1, 1994, costs shall be rebased no more frequently than every
two years and no less frequently than every four years, as determined by the commissioner. The commissioner shall determine whether and to what extent a change in ownership of a facility shall occasion the rebasing of the facility's costs.
(9) The method of establishing rates for new facilities shall be determined by the
commissioner in accordance with the provisions of this subsection.
(10) Rates determined under this section shall comply with federal laws and regulations.
(11) For the fiscal year ending June 30, 1992, and any succeeding fiscal year, one-
half of the initial amount payable in June by the state to a facility pursuant to this subsection shall be paid to the facility in June and the balance of such amount shall be paid
in July.
(12) Notwithstanding the provisions of this subsection, interim rates issued for facilities on and after July 1, 1991, shall be subject to applicable fiscal year cost component
limitations established pursuant to subdivision (3) of this subsection.
(13) A chronic and convalescent nursing home having an ownership affiliation with
and operated at the same location as a chronic disease hospital may request that the
commissioner approve an exception to applicable rate-setting provisions for chronic
and convalescent nursing homes and establish a rate for the fiscal years ending June 30,
1992, and June 30, 1993, in accordance with regulations in effect June 30, 1991. Any
such rate shall not exceed one hundred sixty-five per cent of the median rate established
for chronic and convalescent nursing homes established under this section for the applicable fiscal year.
(14) For the fiscal year ending June 30, 1994, and any succeeding fiscal year, for
purposes of computing minimum allowable patient days, utilization of a facility's certified beds shall be determined at a minimum of ninety-five per cent of capacity, except
for new facilities and facilities which are certified for additional beds which may be
permitted a lower occupancy rate for the first three months of operation after the effective
date of licensure.
(15) The Commissioner of Social Services shall adjust facility rates from April 1,
1999, to June 30, 1999, inclusive, by a per diem amount representing each facility's
allocation of funds appropriated for the purpose of wage, benefit and staffing enhancement. A facility's per diem allocation of such funding shall be computed as follows:
(A) The facility's direct and indirect component salary, wage, nursing pool and allocated
fringe benefit costs as filed for the 1998 cost report period deemed allowable in accordance with this section and applicable regulations without application of cost component
maximums specified in subdivision (3) of this subsection shall be totaled; (B) such total
shall be multiplied by the facility's Medicaid utilization based on the 1998 cost report;
(C) the resulting amount for the facility shall be divided by the sum of the calculations
specified in subparagraphs (A) and (B) of this subdivision for all facilities to determine
the facility's percentage share of appropriated wage, benefit and staffing enhancement
funding; (D) the facility's percentage share shall be multiplied by the amount of appropriated wage, benefit and staffing enhancement funding to determine the facility's allocated amount; and (E) such allocated amount shall be divided by the number of days
of care paid for by Medicaid on an annual basis including days for reserved beds specified
in the 1998 cost report to determine the per diem wage and benefit rate adjustment
amount. The commissioner may adjust a facility's reported 1998 cost and utilization
data for the purposes of determining a facility's share of wage, benefit and staffing
enhancement funding when reported 1998 information is not substantially representative of estimated cost and utilization data for the fiscal year ending June 30, 2000,
due to special circumstances during the 1998 cost report period including change of
ownership with a part year cost filing or reductions in facility capacity due to facility
renovation projects. Upon completion of the calculation of the allocation of wage, benefit and staffing enhancement funding, the commissioner shall not adjust the allocations
due to revisions submitted to previously filed 1998 annual cost reports. In the event that
a facility's rate for the fiscal year ending June 30, 1999, is an interim rate or the rate
includes an increase adjustment due to a rate request to the commissioner or other reasons, the commissioner may reduce or withhold the per diem wage, benefit and staffing
enhancement allocation computed for the facility. Any enhancement allocations not
applied to facility rates shall not be reallocated to other facilities and such unallocated
amounts shall be available for the costs associated with interim rates and other Medicaid
expenditures. The wage, benefit and staffing enhancement per diem adjustment for the
period from April 1, 1999, to June 30, 1999, inclusive, shall also be applied to rates for
the fiscal years ending June 30, 2000, and June 30, 2001, except that the commissioner
may increase or decrease the adjustment to account for changes in facility capacity
or operations. Any facility accepting a rate adjustment for wage, benefit and staffing
enhancements shall apply payments made as a result of such rate adjustment for increased allowable employee wage rates and benefits and additional direct and indirect
component staffing. Adjustment funding shall not be applied to wage and salary increases provided to the administrator, assistant administrator, owners or related party
employees. Enhancement payments may be applied to increases in costs associated with
staffing purchased from staffing agencies provided such costs are deemed necessary
and reasonable by the commissioner. The commissioner shall compare expenditures for
wages, benefits and staffing for the 1998 cost report period to such expenditures in the
1999, 2000 and 2001 cost report periods to verify whether a facility has applied additional payments to specified enhancements. In the event that the commissioner determines that a facility did not apply additional payments to specified enhancements, the
commissioner shall recover such amounts from the facility through rate adjustments or
other means. The commissioner may require facilities to file cost reporting forms, in
addition to the annual cost report, as may be necessary, to verify the appropriate application of wage, benefit and staffing enhancement rate adjustment payments. For the purposes of this subdivision, "Medicaid utilization" means the number of days of care paid
for by Medicaid on an annual basis including days for reserved beds as a percentage of
total resident days.
(g) For the fiscal year ending June 30, 1993, any intermediate care facility for the
mentally retarded with an operating cost component of its rate in excess of one hundred
forty per cent of the median of operating cost components of rates in effect January 1,
1992, shall not receive an operating cost component increase. For the fiscal year ending
June 30, 1993, any intermediate care facility for the mentally retarded with an operating
cost component of its rate that is less than one hundred forty per cent of the median of
operating cost components of rates in effect January 1, 1992, shall have an allowance
for real wage growth equal to thirty per cent of the increase determined in accordance
with subsection (q) of section 17-311-52 of the regulations of Connecticut state agencies,
provided such operating cost component shall not exceed one hundred forty per cent of
the median of operating cost components in effect January 1, 1992. Any facility with
real property other than land placed in service prior to October 1, 1991, shall, for the
fiscal year ending June 30, 1995, receive a rate of return on real property equal to the
average of the rates of return applied to real property other than land placed in service
for the five years preceding October 1, 1993. For the fiscal year ending June 30, 1996,
and any succeeding fiscal year, the rate of return on real property for property items
shall be revised every five years. The commissioner shall, upon submission of a request,
allow actual debt service, comprised of principal and interest, in excess of property costs
allowed pursuant to section 17-311-52 of the regulations of Connecticut state agencies,
provided such debt service terms and amounts are reasonable in relation to the useful
life and the base value of the property. For the fiscal year ending June 30, 1995, and
any succeeding fiscal year, the inflation adjustment made in accordance with subsection
(p) of section 17-311-52 of the regulations of Connecticut state agencies, shall not be
applied to real property costs. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the allowance for real wage growth as determined in accordance
with subsection (q) of section 17-311-52 of the regulations of Connecticut state agencies,
shall not be applied. For the fiscal year ending June 30, 1996, and any succeeding fiscal
year, no rate shall exceed three hundred seventy-five dollars per day unless the commissioner, in consultation with the Commissioner of Mental Retardation, determines after
a review of program and management costs, that a rate in excess of this amount is
necessary for care and treatment of facility residents.
(h) For the fiscal year ending June 30, 1993, any residential care home with an
operating cost component of its rate in excess of one hundred thirty per cent of the
median of operating cost components of rates in effect January 1, 1992, shall not receive
an operating cost component increase. For the fiscal year ending June 30, 1993, any
residential care home with an operating cost component of its rate that is less than one
hundred thirty per cent of the median of operating cost components of rates in effect
January 1, 1992, shall have an allowance for real wage growth equal to sixty-five per
cent of the increase determined in accordance with subsection (q) of section 17-311-52
of the regulations of Connecticut state agencies, provided such operating cost component
shall not exceed one hundred thirty per cent of the median of operating cost components
in effect January 1, 1992. Beginning with the fiscal year ending June 30, 1993, for the
purpose of determining allowable fair rent, a residential care home with allowable fair
rent less than the twenty-fifth percentile of the state-wide allowable fair rent shall be
reimbursed as having allowable fair rent equal to the twenty-fifth percentile of the state-
wide allowable fair rent. Beginning with the fiscal year ending June 30, 1997, a residential care home with allowable fair rent less than three dollars and ten cents per day shall
be reimbursed as having allowable fair rent equal to three dollars and ten cents per day.
Property additions placed in service during the cost year ending September 30, 1996,
or any succeeding cost year shall receive a fair rent allowance for such additions as an
addition to three dollars and ten cents per day if the fair rent for the facility for property
placed in service prior to September 30, 1995, is less than or equal to three dollars and
ten cents per day. For the fiscal year ending June 30, 1996, and any succeeding fiscal
year, the allowance for real wage growth, as determined in accordance with subsection
(q) of section 17-311-52 of the regulations of Connecticut state agencies shall not be
applied. For the fiscal year ending June 30, 1996, and any succeeding fiscal year, the
inflation adjustment made in accordance with subsection (p) of section 17-311-52 of
the regulations of Connecticut state agencies shall not be applied to real property costs.
Beginning with the fiscal year ending June 30, 1997, minimum allowable patient days
for rate computation purposes for a residential care home with twenty-five beds or less
shall be eighty-five per cent of licensed capacity. Beginning with the fiscal year ending
June 30, 1998, for the purposes of determining the allowable salary of an administrator
of a residential care home with sixty beds or less the department shall revise the allowable
base salary to thirty thousand dollars to be annually inflated thereafter in accordance
with section 17-311-52 of the regulations of Connecticut state agencies and, beginning
with the fiscal year ending June 30, 2000, the inflation adjustment for rates made in
accordance with subsection (p) of section 17-311-52 of the regulations of state agencies
shall be increased by two per cent. Beginning with the fiscal year ending June 30, 1999,
for the purpose of determining the allowable salary of a related party, the department
shall revise the maximum salary to twenty-seven thousand eight hundred fifty-six dollars
to be annually inflated thereafter in accordance with section 17-311-52 of the regulations
of Connecticut state agencies and beginning with the fiscal year ending June 30, 2001,
such allowable salary shall be computed on an hourly basis and the maximum number
of hours allowed for a related party other than the proprietor shall be increased from
forty hours to forty-eight hours per work week.
(i) Notwithstanding the provisions of this section, the Commissioner of Social Services shall establish a fee schedule for payments to be made to chronic disease hospitals
associated with chronic and convalescent nursing homes to be effective on and after
July 1, 1995. The fee schedule may be adjusted annually beginning July 1, 1997, to
reflect necessary increases in the cost of services.
(1957, P.A. 336, S. 1; 1959, P.A. 98, S. 1; 1961, P.A. 474, S. 3; February, 1965, P.A. 237; P.A. 73-25, S. 3, 4; 73-117,
S. 27, 31; P.A. 77-574, S. 5, 6; 77-614, S. 323, 610; P.A. 79-560, S. 30, 39; P.A. 80-364, S. 4; P.A. 81-122; June Sp. Sess.
P.A. 83-39, S. 14; P.A. 84-135, S. 2, 3; 84-360, S. 1; P.A. 85-524; 85-528; P.A. 87-27, S. 2; P.A. 88-156, S. 20; June Sp.
Sess. P.A. 91-8, S. 17, 22, 61, 63; May Sp. Sess. P.A. 92-16, S. 29−31, 89; P.A. 93-262, S. 1, 87; 93-381, S. 9, 39; 93-406,
S. 3, 6; 93-418, S. 22, 33, 41; May Sp. Sess. P.A. 94-5, S. 12, 30; P.A. 95-160, S. 24, 69; 95-257, S. 12, 21, 39, 58; 95-
351, S. 4, 30; P.A. 96-137; 96-139, S. 12, 13; 96-268, S. 13, 20, 34; P.A. 97-112, S. 2; June 18 Sp. Sess. P.A. 97-2, S. 127,
165; June 18 Sp. Sess. P.A. 97-11, S. 50, 65; P.A. 98-156, S. 1, 2; 98-239, S. 25, 35; P.A. 99-279, S. 19−21, 45; June Sp.
Sess. P.A. 00-2, S. 21, 53.)
History: 1959 act included references to licensed homes for the aged and to boarders in such homes; 1961 act included
rest homes with nursing supervision, replaced committee of various state officers with hospital cost commission, required
public hearing before rates determined and required that rates consider costs of services, including compensation for
services rendered by proprietors at prevailing wage rates as factor; 1965 act deleted obsolete provision for rates for licensed
homes for aged when initially included in provisions, required that accounting principles be those prescribed by commission
rather than "generally accepted", required homes and hospitals to report on fiscal year ending September 30 and included
anticipated fluctuations in cost as factor in rate determination; P.A. 73-25 referred to Subsec. (b) of Sec. 17-83i rather than
to Sec. 17-132; P.A. 73-117 replaced hospital cost commission with committee established under Sec. 17-311; P.A. 77-
574 included costs mandated by collective bargaining agreements as factor in rate determination; P.A. 77-614 replaced
department of health with department of health services, effective January 1, 1979; P.A. 79-560 replaced committee with
commissioner of income maintenance; P.A. 80-364 conditioned payment on admissions procedures conforming with law
rather than on "priorities of accommodations for such beneficiaries as they become available"; P.A. 81-122 defined other
allowable services and authorized the commissioner to adopt regulations to specify these services in new Subsec. (b)
and added Subsecs. (c) and (d) prohibiting facilities from accepting payments in excess of the amount specified by the
commissioner and providing a procedure for the recovery of any excess amounts; June Sp. Sess. P.A. 83-39 amended
Subsec. (a) to include residential facilities for the mentally retarded licensed pursuant to Sec. 19a-467; P.A. 84-135 added
Subsec. (e) excepting certain facilities from the requirement that no facility accept payment in excess of the rate set by the
commissioner; P.A. 84-360 added the authority in Subsec. (a) for a separate rate for the treatment of traumatic brain injury
patients; P.A. 85-524 added the provisions on the treatment of the costs incurred in using the services of nursing pools in
Subsec. (a); P.A. 85-528 amended Subsec. (a) to provide for the adjustment of rates to reflect increased costs or expenditures
due to changes in federal or state laws, regulations or standards and added the provision on costs resulting from inspections
by the department of health services; P.A. 87-27 amended Subsec. (a) to exclude from "costs" amounts paid to employees,
attorneys or consultants due to unionization disputes; P.A. 88-156 substituted chronic and convalescent nursing homes for
chronic and convalescent hospitals and added chronic disease hospitals associated with chronic and convalescent nursing
homes to list of establishments for which the commissioner sets the rates in Subsec. (a); June Sp. Sess. P.A. 91-8 amended
Subsec. (a) to allow the commissioner the discretion to allow the inclusion of extraordinary and unanticipated costs of
providing services to avoid a negative impact on the health and safety of the patients, amended Subsec. (e) to specify
required minimum number of beds to be available for medical assistance patients, to place a cap on the number of beds
available to medical assistance patients at fifteen per cent and added Subsec. (f) re rates paid by or for persons aided or
cared for by the state or town for room, board and services of nursing homes, chronic disease hospitals associated with
chronic and convalescent nursing homes, chronic and convalescent hospitals, rest homes, homes for the aged and residential
facilities for the care of the mentally retarded, allowable costs, geographic peer groupings of facilities, cost components,
fair rent exclusions, cost efficiency adjustments and change of ownership and affiliations; May Sp. Sess. P.A. 92-16
amended Subsec. (a) by adding provisions re revision of a facility's rate, re date by which reports shall be submitted to
the commissioner, re reduction of rate for a facility which fails to report by such date, re report by commissioner to
appropriations committee and re modification of method for adjusting separate rates for traumatic brain injury patients,
amended Subsec. (f) by permitting the commissioner to allow costs in excess of maximum amounts for certain facilities
or certain beds in a facility, requiring the exclusion of the cost efficiency adjustment for indirect costs from rate increase
maximums for the fiscal year ending June 30, 1993, adding provisions re revision of a facility's fair rent component of its
rate and providing that for the fiscal year ending June 30, 1993, a facility may receive a cost efficiency adjustment for
indirect costs if such costs are below one hundred thirty per cent of the median, and added Subsec. (g) re rates for intermediate
care facilities for the mentally retarded and Subsec. (f) re rates for homes for the aged; P.A. 93-262 authorized substitution
of commissioner and department of social services for commissioner and department of income maintenance, effective
July 1, 1993; P.A. 93-381 replaced department of health services with department of public health and addiction services,
effective July 1, 1993; P.A. 93-406 amended Subdiv. (5) of Subsec. (f) to require the commissioner to allow actual debt
service costs for bonds, to determine allowable fair rent for real property other than land based on rate of return for cost
year in which bonds were issued, to include financing debt service in addition to refinancing and to provide that adjustments
to a facilities allowable fair rent be made on a case-by-case basis, effective June 29, 1993; P.A. 93-418 amended Subsec.
(c) to provide that for fiscal years ending June 30, 1994, and June 30, 1995, commissioner may authorize facility to accept
payment in excess of the rate paid for a medical assistance patient in this state for patient who receives medical assistance
from another state and amended Subsec. (f)(3) to make existing provisions re per diem maximum allowable costs effective
only for fiscal year ending June 30, 1994, adding new provision regarding such costs for fiscal year ending June 30, 1995,
and any succeeding fiscal year, added provision amending Subsec. (f)(4) to prohibit a facility from receiving a rate, for
the fiscal year ending June 30, 1995, which is more than five per cent less than the rate it received for the fiscal year ending
June 30, 1994, or six per cent more than it received for the fiscal year ending June 30, 1994, made Subsec. (f)(7) applicable
to any succeeding fiscal year and added new Subdiv. (14) concerning computing allowable patient days, effective July 1,
1993; May Sp. Sess. P.A. 94-5 amended Subsec. (g) to establish rates of return for real property for facilities with real
property other than land placed in service prior to July 1, 1991, effective July 1, 1994; Sec. 17-314 transferred to Sec. 17b-
340 in 1995; P.A. 95-160 amended Subdiv. (3) of Subsec. (f) by providing for per diem allowable costs for each cost
component for the fiscal year ending July 30, 1996, and any succeeding fiscal year and by deleting Subdivs. (A) and (B)
which allowed costs in excess of maximum amounts for any facility with patient days covered by Medicare and provided
for the establishment of a pilot program whereby costs in excess of maximum amounts shall be allowed for beds in a
nursing home which has a managed care program and is affiliated with a hospital, amended Subdiv. (4) of Subsec. (f) by
adding a provision that for the fiscal years ending June 30, 1996, and June 30, 1997, no facility shall receive a rate that is
more than three per cent more than the rate it received for the prior rate year, amended Subdiv. (5) of Subsec. (f) by adding
a provision that for fiscal years ending June 30, 1996, and June 30, 1997, the reimbursement may not exceed the twenty-
fifth percentile of the state-wide allowable fair rent for the fiscal year ending June 30, 1995, by lowering a provision
allowing for a rate of return of real property other than land in excess of sixteen per cent to have such allowance revised
to sixteen per cent to a provision allowing such rate of return to be in excess of eleven per cent and to have such allowance
revised to eleven per cent and by requiring that such provision begin with the fiscal year ending June 30, 1996, amended
Subdiv. (6) of Subsec. (f) by replacing a requirement that a facility receive cost efficiency adjustments for indirect costs
if such costs are below one hundred ten per cent of the state-wide median costs with a provision allowing for such adjustments
if indirect costs are below the state-wide median costs and by changing the provision requiring that the cost efficiency
adjustments shall equal twenty-five per cent of the difference between allowable reported costs and the applicable maximum
allowable cost to require that such adjustments be equal to twenty-five per cent of the difference between allowable reported
costs and the applicable median allowable cost, amended Subdiv. (7) of Subsec. (f) providing for the inflation of allowable
operating costs for the fiscal years ending June 30, 1996, and June 30, 1997, amended Subsecs. (g) and (h) by providing
for the allowance for real growth for the fiscal year ending June 30, 1996, and any succeeding year, and added Subsec. (i)
providing for a fee schedule for payments to be made to chronic disease hospitals associated with chronic and convalescent
homes and made technical changes, effective July 1, 1995; P.A. 95-257 replaced Commissioner and Department of Public
Health and Addiction Services with Commissioner and Department of Public Health and replaced Commission on Hospitals
and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 95-351 amended Subdiv. (3) of Subsec.
(f) by reenacting former Subdivs. (A) and (B) providing for costs in excess of maximum amounts for any facility with
patient days covered by Medicare and a pilot program for costs in excess of maximum amounts allowed for beds in a
nursing home, effective July 1, 1995; P.A. 96-137 amended Subsec. (c) to delete a reference to the fiscal year ending June
30, 1995, thereby allowing the commissioner to continue to authorize a facility to accept payment in excess of the rate
paid for a medical assistance patient in this state for a patient who receives medical assistance from another state; P.A. 96-
139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 96-268 amended Subsec. (f)(1) to allow
the commissioner to provide a rate adjustment for nonemergency transportation services and amended Subsec. (h) to add
provision re minimum allowable patient days for rate computation purposes beginning with the fiscal year ending June
30, 1997, and provision re allowable salary of an administrator beginning with the fiscal year ending June 30, 1998, effective
July 1, 1996; P.A. 97-112 replaced "home for the aged" with "residential care home"; June 18 Sp. Sess. P.A. 97-2 amended
Subsec. (h) by adding a provision increasing the inflation adjustment for rates made in accordance with Subsec. (p) of
section 17-311-52 of the regulations of Connecticut state agencies and by providing that, beginning in the fiscal year ending
June 30, 1999, for the purpose of determining the allowable salary of a related party, the department shall revise the
maximum salary to twenty-seven thousand eight hundred fifty-six dollars to be annually inflated in accordance with section
17-311-52 of the regulations of Connecticut state agencies, effective July 1, 1997; June 18 Sp. Sess. P.A. 97-11 amended
Subsec. (f)(4) to delete provisions re exclusion of fair rent from rate increase maximums for fiscal years ending June 30,
1992, and June 30, 1993, and exclusion of cost efficiency adjustment for indirect costs from rate increase maximums for
fiscal year ending June 30, 1993, and to add provisions re rate increases for facilities for fiscal years ending June 30, 1998,
and June 30, 1999, effective July 1, 1997; P.A. 98-156 amended Subsec. (f)(4)(C) to increase from two to three per cent
the maximum rate increase a facility shall receive for the fiscal year ending June 30, 1999, to make technical changes and
to prohibit a facility from receiving a rate, for the fiscal year ending June 30, 2000, and any succeeding fiscal year, which
is more than the rate it received in the prior year increased by the annual increase in the Consumer Price Index for the most
recent calendar year, effective July 1, 1998; P.A. 98-239 amended Subsec. (f)(5) to provide that on and after July 1, 1998,
the Commissioner of Social Services may allow minimum fair rent as the basis upon which reimbursement re improvements
to real property is added, effective July 1, 1998; P.A. 99-279 amended Subsec. (f)(3) by adding an exception for the fiscal
years ending June 30, 2000, and June 30, 2001, for facilities with an interim rate in one or both periods from the per diem
maximum allowable costs for each cost component and specifying the per diem maximum allowable costs for direct costs,
indirect costs, fair rent, capital-related costs and for administrative and general costs for the fiscal years ending June 30,
2000, and June 30, 2001, for facilities with an interim rate in one or both periods, and amended Subsec. (f)(4) by providing
for the fiscal year ending June 30, 1999, that a facility shall receive the specified rate increase "exclusive of rate increases
associated with a wage, benefit and staffing enhancement rate adjustment added for the period from April 1, 1999, to June
30, 1999, inclusive", by specifying rate increases for facilities for the fiscal years ending June 30, 2000, and June 30, 2001,
and maximum rate increases for facilities with an interim rate, replaced interim rate or scheduled rate adjustment specified
in a certificate of need or other agreement and by extending, from the fiscal year ending June 30, 2000, to June 30, 2002,
the prohibition against facilities receiving a rate that is more than the rate it received in the prior year increased by the
annual increase in the CPI for the most recent calendar year, added new Subdiv. (f)(15), requiring the Commissioner of
Social Services to adjust facility rates from April 1, 1999, to June 30, 1999, inclusive, by a per diem amount representing
each facility's allocation of funds appropriated for the purpose of wage, benefit and staffing enhancement, specifying the
manner in which a facility's per diem allocation of such funding shall be computed, specifying the usage of enhancement
payments, and requiring the commissioner to recover from a facility any amounts determined not to have been applied to
specified enhancements, and amended Subsec. (h) to increase the inflation adjustment for rates for residential care homes
from one to two per cent beginning with the fiscal year ending June 30, 2000, effective July 1, 1999; June Sp. Sess. P.A.
00-2 amended Subsec. (h) by adding provision re salary computation for a related party, beginning with the fiscal year
ending June 30, 2001, effective July 1, 2000.
Annotations to former section 17-314:
Cited. 176 C. 82−85, 88. Cited. 180 C. 474, 477. Cited. 208 C. 187, 188.
Cited. 42 CS 348, 351.
Annotations to present section:
Cited. 242 C. 345.
Subsec. (f):
Department's use of the lesser value methodology is not permitted; exclusive use of fair rent, in lieu of actual property
costs, required in determining allowable costs of all nursing facilities. 244 C. 378.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) Any hospital, home or any self-pay patient or his guardian or conservator aggrieved by said commissioner's decision regarding the rates to be charged to self-pay
patients may obtain, by written request to said commissioner, a hearing on all items of
aggrievement in accordance with sections 4-176e to 4-181a, inclusive, if the request is
made not later than ten days after written notice of the decision is provided by said
commissioner to such home or hospital. Upon receipt of such notice concerning the rate
decision, the home or hospital shall immediately give written notice of said commissioner's decision to any patient affected or his guardian or conservator.
(c) In the event of an unforeseen or material change in circumstances such hospital
or home may submit an application for a rate increase at any time in a form and manner
prescribed by the commissioner by regulations adopted in accordance with subsection
(a) of section 17b-238. All self-pay patients shall be given notice of an application for
a rate increase as soon as possible after receipt of such application by the commissioner,
but in no case shall such notice be provided less than ten days prior to the effective date
of such increase. The commissioner may approve, modify, or deny such rate increase
request with or without a public hearing thereon not less than ten nor more than thirty
days after receipt of such request. Notice of such decision shall be given immediately
to the hospital or home by certified mail and to the public by publication in a newspaper
having a circulation in the area affected. If such rate increase request is denied, modified
or approved without a public hearing the applicant or any member of the public may
request such a hearing not later than thirty days after the date of such decision, in which
case the commissioner shall hold a public hearing. Any public hearing provided by this
section shall be held not less than ten nor more than thirty days after receipt of the request
for a rate increase or the request for a hearing by the applicant or a member of the public.
Notice of the hearing shall be given to the hospital or home by certified mail and to the
public, by publication in a newspaper having a circulation in the area affected, at least
one week prior to such hearing. Such hearing shall be held, at the discretion of the
commissioner, in Hartford or in the area served by such hospital or home. The commissioner shall require from such hospital or home such information, data, records, studies
and evaluations as he considers necessary to determine the need for such increases in
accordance with the regulations adopted pursuant to section 17b-238. Such proposed
increases shall take effect thirty days after such hearing or thirty days after the receipt
of any data requested by the commissioner, whichever is later, unless within such period
the commissioner denies the requested increase or approves such percentage of the
increase as he feels is justified. If no hearing is held or requested the commissioner's
decision shall take effect thirty days after the date of such decision. The applicant shall
have the burden of proof that an increase is warranted.
(d) Any party aggrieved by said commissioner's decision after a hearing conducted
pursuant to subsection (b) or (c), may appeal therefrom in accordance with the provisions
of section 4-183, except venue shall be in the judicial district in which the home or
hospital is located. Such appeal shall have precedence in respect to order of trial over
all other cases except writs of habeas corpus, actions brought by or on behalf of the
state, including informations on the relation of private individuals, and appeals from
awards or decisions of workers' compensation commissioners.
(e) The Superior Court, on application of the Commissioner of Social Services or
the Attorney General, may enforce any determination made by the commissioner, pursuant to subsection (a), (b), or (c) of this section, by appropriate decree or process, including
but not limited to the following: (1) An order requiring a hospital or home to cease and
desist from charging a self-pay patient a rate in excess of the allowable rate set pursuant
to this section; and (2) an order that the hospital or home refund to a self-pay patient
any amount paid in excess of the allowable rate set pursuant to this section. The decree
or process shall issue upon proof of the allowable rate established pursuant to this section
and proof that a self-pay patient has paid any amount in excess of the allowable rate
established pursuant to this section, as required by the hospital or home.
(P.A. 79-182, S. 1, 4; P.A. 80-141; 80-203; 80-483, S. 77, 186; P.A. 88-156, S. 21; 88-317, S. 75, 107; June Sp. Sess.
P.A. 91-8, S. 23, 63; P.A. 92-231, S. 1, 10; P.A. 93-262, S. 1, 87; 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; P.A. 97-
112, S. 2.)
History: P.A. 80-141 required consideration of quality of care based on health services department information or on
other information or testimony in determination of rates; P.A. 80-203 required thirty-day notice of impending increase to
self-pay patients in Subsec. (a), required notification of application for increase to self-pay patients in Subsec. (c) and
placed burden of proof that increase is necessary on applicant and added Subsec. (e) re enforcement of orders by court;
P.A. 80-483 deleted reference to counties in Subsec. (d) and replaced "workmen's compensation" with "workers' compensation"; P.A. 88-156 substituted chronic and convalescent nursing homes for chronic and convalescent hospitals and added
chronic disease hospitals associated with chronic and convalescent nursing homes to list of establishments for which the
commissioner sets the rates to be charged to self-pay patients in Subsec. (a); P.A. 88-317 amended reference to Secs. 4-
177 to 4-181 in Subsec. (b) to include new sections added to Ch. 54, effective July 1, 1989, and applicable to all agency
proceedings commencing on or after that date; June Sp. Sess. P.A. 91-8 amended Subsec. (a) re rate determination and
the rate of payment for nursing homes, chronic disease hospitals associated with chronic and convalescent nursing homes,
chronic and convalescent hospitals, rest homes, homes for the aged and residential facilities for the care of the mentally
retarded added provisions requiring facilities with provider agreements and homes for aged to determine their own self
pay rates and to report rates to the commissioner and required commissioner to report rates to the human service committee
on December 31, 1992; P.A. 92-231 amended Subsec. (a) by requiring facilities to charge self-pay patients insured under
long-term care policies precertified pursuant to Sec. 38a-475 a rate at least five per cent less than the rate charged other
self-pay patients; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner
and department of income maintenance, effective July 1, 1993; P.A. 93-381 replaced department of health services with
department of public health and addiction services, effective July 1, 1993; Sec. 17-314a transferred to Sec. 17b-341 in
1995; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner
and Department of Public Health, effective July 1, 1995; P.A. 97-112 replaced "home for the aged" with "residential
care home".
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) The commissioner shall solicit bids through a competitive process and shall
contract with an access agency, approved by the Office of Policy and Management and
the Department of Social Services as meeting the requirements for such agency as defined by regulations adopted pursuant to subsection (e) of this section, that submits
proposals which meet or exceed the minimum bid requirements. In addition to such
contracts, the commissioner may use department staff to provide screening, coordination, assessment and monitoring functions for the program.
(c) The community-based services covered under the program shall include, but
not be limited to, the following services to the extent that they are not available under the
state Medicaid plan, occupational therapy, homemaker services, companion services,
meals on wheels, adult day care, transportation, mental health counseling, care management, elderly foster care, minor home modifications and assisted living services provided in state-funded congregate housing and in other assisted living pilot or demonstration projects established under state law. Recipients of state-funded services and persons
who are determined to be functionally eligible for community-based services who have
an application for medical assistance pending shall have the cost of home health and
community-based services covered by the program, provided they comply with all medical assistance application requirements. Access agencies shall not use department funds
to purchase community-based services or home health services from themselves or any
related parties.
(d) Physicians, hospitals, long-term care facilities and other licensed health care
facilities may disclose, and, as a condition of eligibility for the program, elderly persons,
their guardians, and relatives shall disclose, upon request from the Department of Social
Services, such financial, social and medical information as may be necessary to enable
the department or any agency administering the program on behalf of the department
to provide services under the program. Long-term care facilities shall supply the Department of Social Services with the names and addresses of all applicants for admission.
Any information provided pursuant to this subsection shall be confidential and shall not
be disclosed by the department or administering agency.
(e) The commissioner shall adopt regulations, in accordance with the provisions of
chapter 54, to define "access agency", to implement and administer the program, to
establish uniform state-wide standards for the program and a uniform assessment tool
for use in the screening process and to specify conditions of eligibility.
(f) The commissioner may require long-term care facilities to inform applicants for
admission of the program established under this section and to distribute such forms as
the commissioner prescribes for the program. Such forms shall be supplied by and be
returnable to the department.
(g) The commissioner shall report annually, by June first, to the joint standing committee of the General Assembly having cognizance of matters relating to human services
on the program in such detail, depth and scope as said committee requires to evaluate
the effect of the program on the state and program participants. Such report shall include
information on (1) the number of persons diverted from placement in a long-term care
facility as a result of the program, (2) the number of persons screened, (3) the average
cost per person in the program, (4) the administration costs, (5) the estimated savings,
and (6) a comparison between costs under the different contracts.
(h) An individual who is otherwise eligible for services pursuant to this section
shall, as a condition of participation in the program, apply for medical assistance benefits
pursuant to section 17b-260 when requested to do so by the department and shall accept
such benefits if determined eligible.
(i) (1) On and after July 1, 1992, the Commissioner of Social Services shall, within
available appropriations, administer a state-funded portion of the program for persons
(A) who are sixty-five years of age and older; (B) who are inappropriately institutionalized or at risk of inappropriate institutionalization; (C) whose income is less than or
equal to the amount allowed under subdivision (3) of subsection (a) of this section; and
(D) whose assets, if single, do not exceed the minimum community spouse protected
amount pursuant to Section 4022.05 of the department's uniform policy manual or, if
married, the couple's assets do not exceed one hundred fifty per cent of said community
spouse protected amount.
(2) Any person whose income exceeds two hundred per cent of the federal poverty
level shall contribute to the cost of care in accordance with the methodology established
for recipients of medical assistance pursuant to Sections 5035.20 and 5035.25 of the
department's uniform policy manual.
(3) On and after June 30, 1992, the program shall serve persons receiving state-
funded home and community-based services from the department, persons receiving
services under the promotion of independent living for the elderly program operated by
the Department of Social Services, regardless of age, and persons receiving services on
June 19, 1992, under the home care demonstration project operated by the Department
of Social Services. Such persons receiving state-funded services whose income and
assets exceed the limits established pursuant to subdivision (1) of this subsection may
continue to participate in the program, but shall be required to pay the total cost of care,
including case management costs.
(4) Services shall not be increased for persons who received services under the
promotion of independent living for the elderly program over the limits in effect under
said program in the fiscal year ending June 30, 1992, unless a person's needs increase
and the person is eligible for Medicaid.
(5) The annualized cost of services provided to an individual under the state-funded
portion of the program shall not exceed fifty per cent of the weighted average cost of
care in nursing homes in the state, except an individual who received services costing
in excess of such amount under the Department of Social Services in the fiscal year
ending June 30, 1992, may continue to receive such services, provided the annualized
cost of such services does not exceed eighty per cent of the weighted average cost of
such nursing home care. The commissioner may allow the cost of services provided to
an individual to exceed the maximum cost established pursuant to this subdivision in a
case of extreme hardship, as determined by the commissioner, provided in no case shall
such cost exceed that of the weighted cost of such nursing home care.
(j) The Commissioner of Social Services may implement revised criteria for the
operation of the program while in the process of adopting such criteria in regulation
form, provided the commissioner prints notice of intention to adopt the regulations in
the Connecticut Law Journal within twenty days of implementing the policy. Such criteria shall be valid until the time final regulations are effective.
(P.A. 85-556, S. 1, 2; P.A. 86-374, S. 4, 6; P.A. 87-363, S. 1, 2; P.A. 89-296, S. 7, 9; P.A. 90-182, S. 1, 3; P.A. 91-176;
May Sp. Sess. P.A. 92-16, S. 37, 89; P.A. 93-262, S. 1, 87; 93-418, S. 27, 41; P.A. 95-160, S. 7, 69; P.A. 96-139, S. 12,
13; June 18 Sp. Sess. P.A. 97-2, S. 76, 165; P.A. 99-279, S. 12, 45; P.A. 00-83, S. 4, 5; June Sp. Sess. P.A. 00-2, S. 10.)
History: P.A. 86-374 rephrased provision in Subsec. (b) re solicitation of bids and contracting processes, expanded
community-based services in Subsec. (c), and inserted new Subsec. (g) re commencement of preadmission screening and
community-based services program, relettering former Subsec. (g) as (h); P.A. 87-363 amended (1) Subsec. (b) to eliminate
the requirement that the commissioner contract with "at least three different" coordination, assessment and monitoring
agencies and (2) Subsec. (g) to remove language specifying that the program start on January 1, 1987, if the department
has approval and added the language providing for implementation when the department has approval and has arranged
for the provision of coordination, assessment and monitoring functions state-wide and added language on operation within
available appropriations; P.A. 89-296 added Subsec. (i) re application for medical assistance benefits under Sec. 17-134a
as condition of participation in program; P.A. 90-182 amended program eligibility criteria in Subsec. (a) to exclude persons
who would become eligible for medical assistance within 180 days if they were placed in a long-term care facility, and to
delete reference to sliding fee schedule for such persons, and to include persons receiving state-funded program services
on June 30, 1990, and persons who apply for such services by June 30, 1990, and are determined eligible; amended Subsec.
(c) to exclude persons who are ineligible for medical assistance from eligibility for home health services and to provide
that persons determined to be functionally eligible for community-based services who have applied for medical assistance
are eligible for home health and community-based services; amended Subsec. (f) to delete provision that long-term care
facilities shall not be required to determine if applicants for admission who are not medical assistance recipients would
become eligible for such assistance within 180 days following admission, and to delete provision that no long-term care
facility shall be subject to penalty or denied reimbursement due to failure of an applicant for admission who is not a medical
assistance recipient to apply for program established under section or to comply with program requirements; deleted
obsolete provisions of Subsec. (g) re implementation of program and renumbered remaining Subsecs; P.A. 91-176 amended
Subsec. (a) to require that the estate and legally liable relatives of a recipient of services under the program be responsible
for reimbursement to the state for such services; May Sp. Sess. P.A. 92-16 changed the name of the program to the
Connecticut home-care program for the elderly, added Subsec. (i) establishing a state-funded portion of the program and
made technical changes for consistency; P.A. 93-262 authorized substitution of commissioner and department of social
services for commissioner and department of income maintenance and commissioner and department on aging, effective
July 1, 1993; P.A. 93-418 amended Subsec. (i) to include persons whose gross income is less than or equal to the amount
allowed under the federally funded portion of the program and changed the provisions of the asset test to reflect whether
a person is single or married, effective July 1, 1993; Sec. 17-314b transferred to Sec. 17b-342 in 1995; P.A. 95-160 replaced
coordination, assessment and monitoring agency with access agency, amended Subsec. (e) to require the commissioner to
adopt regulations defining "access agency", amended Subsec. (g) to change the reporting date from January first to June
first, amended Subsec. (j) to allow the commissioner to implement revised criteria for the operation of the entire program,
instead of the state-funded portion of the program, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-
160 but without affecting this section; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (a) by allowing only citizens or
noncitizens who meet eligibility requirements under Medicaid to qualify for services under this section, by allowing certain
qualified aliens to be eligible for services under this section, by allowing any qualified alien or lawfully residing immigrant
alien who is a victim of domestic violence or who has mental retardation to be eligible for services under this section and
by making technical changes, effective July 1, 1997; P.A. 99-279 amended Subsec. (a) to extend from July 1, 1999, to
July 1, 2001, the eligibility of certain qualified aliens or other lawfully residing immigrant aliens for services under this
section, effective July 1, 1999; P.A. 00-83 amended Subsec. (a) to provide that alien who formerly held status of permanently
residing under color of law who is a domestic violence victim or who has mental retardation shall be eligible for assistance
under this section and to provide that qualified aliens or other lawfully residing immigrant aliens who formerly held such
status shall be eligible for services under this section if other eligibility conditions are met, effective July 1, 2000; June
Sp. Sess. P.A. 00-2 amended Subsec. (a) to add new Subdiv. (3) re eligibility for elderly persons who would be eligible
for medical assistance if residing in a nursing facility and to designate former Subdiv. (3) as Subdiv. (4), amended Subsec.
(c) to expand community-based services covered under the program to include "care", in lieu of "case", management,
minor home modifications and assisted living services provided in state-funded congregate housing and other assisted
living pilot or demonstration projects, amended Subsec. (f) to make a technical change, amended Subsec. (i)(1)(C) to
change income requirements from amount allowed under federally funded portion of program to amount allowed under
Subsec. (a)(3), deleted former Subsec. (i)(2) re sliding scale formula for required contributions for program participants,
and added new Subsec. (i)(2) requiring that persons whose income exceeds two hundred per cent of federal poverty level
contribute to cost of care in accordance with methodology established for medical assistance recipients.
(Return to TOC) (Return to Chapters) (Return to Titles)
(P.A. 86-319, S. 1; P.A. 87-516, S. 4; 87-589, S. 64, 87; June Sp. Sess. P.A. 91-8, S. 21, 63; May Sp. Sess. P.A. 92-16,
S. 32, 89; P.A. 93-262, S. 1, 38, 87; 93-418, S. 26, 41; 93-435, S. 59, 95; P.A. 95-160, S. 8, 69; P.A. 96-139, S. 12, 13;
June Sp. Sess. P.A. 00-2, S. 17, 53.)
History: P.A. 87-516 provided that the commissioner of income maintenance shall establish the maximum rates in
consultation with the commissioner of human resources and the commissioner on aging, added transportation and mental
health counseling to the list of services, and specified the maximum allowable rates for the preadmission screening and
community-based services program; P.A. 87-589 added "until revised in accordance with this section"; June Sp. Sess.
P.A. 91-8 amended the section re rate determination and the rate of payment for home care services, transportation and
mental health counseling; May Sp. Sess. P.A. 92-16 provided that the maximum allowable rates in effect on July 1, 1990,
shall remain in effect during the fiscal year ending June 30, 1993, and provided that for the fiscal year ending June 30,
1993, any rate established in a subcontact between coordination, assessment and monitoring agencies and direct care
providers shall not exceed the rate in effect on June 30, 1992, increased by the most recent annual increase in the consumer
price index for urban consumers; P.A. 93-262 replaced references to commissioners of income maintenance, human resources and aging with commissioner of social services and replaced the words "preadmission screening and community-
based services program" with the words "Connecticut home-care program for the elderly", effective July 1, 1993; P.A.
93-418 required the commissioner to establish a fee schedule for home care services on and after July 1, 1994, effective July
1, 1993; P.A. 93-435 authorized substitution of commissioner of social services for commissioner of income maintenance in
P.A. 93-418, effective June 28, 1993; Sec. 17-314c transferred to Sec. 17b-343 in 1995; P.A. 95-160 deleted the reference
to coordination, assessment and monitoring agencies, effective July 1, 1995; P.A. 96-139 changed effective date of P.A.
95-160 but without affecting this section; June Sp. Sess. P.A. 00-2 provided that the fee schedule for adult day care services
shall increase by not less than five per cent, effective July 1, 2000.
(Return to TOC) (Return to Chapters) (Return to Titles)
(2) Notwithstanding the provisions of subdivision (1) of this subsection, the rates
to be paid by or for persons aided or cared for by the state or any town in this state to
residential facilities for the mentally retarded which are licensed pursuant to section
17a-227 and certified to participate in the Title XIX Medicaid program as intermediate
care facilities for the mentally retarded for room, board and services specified in licensing regulations issued by the licensing agency, based only on the cost year ending on
September 30, 1988, shall be determined by the commissioner in accordance with section 17b-340 and the regulations of Connecticut state agencies in effect on April 1, 1989,
except as otherwise provided by this section.
(b) For the purpose of determining allowable costs to be included in the rates to be
paid to facilities subject to the requirements of this section, the commissioner shall
compute the amount to be disallowed with respect to the routine nursing cost centers
in accordance with subsection (c) of section 17-311-52 of the regulations of Connecticut
state agencies, except that for each one per cent self-pay census expressed as a whole
number, reported by the facility in accordance with the applicable regulations, the commissioner shall disallow only forty-two one hundredths of one per cent of the original
disallowance computed in accordance with such regulation. The remainder shall be an
allowable cost and shall be added to the facility's other allowable costs for the purposes
of determining its rates. All other inflation cost limitations in subsection (c) of section
17-311-52 of the regulations in Connecticut state agencies shall apply to the calculation
of such rates. The cost efficiency adjustment provided as part of such rates pursuant to
said regulations shall be calculated based on the amount of actual costs allowed after
application of all inflation cost limitations, as modified by this subsection.
(c) The cost efficiency adjustment percentage for the routine nursing cost center,
as described in subsection (e) of section 17-311-52 of the regulations of Connecticut
state agencies, after application of the inflation cost limitations as set forth in subsection
(b) of this section, shall be reduced from ten per cent to four and seven-tenths per cent
and from twenty per cent to nine and four-tenths per cent.
(d) The cost of laundering the personal apparel of patients shall not be included in
the rates paid to facilities pursuant to this section or in the self-pay rates established by
the commissioner pursuant to section 17b-341. Rates shall be reduced by twenty cents
per patient day to reflect this exclusion. Nursing homes may not charge any patient who
requires the laundering of personal apparel.
(e) The commissioner shall exclude as an allowable cost (1) any interest expense
on loans used for working capital and purchases of movable equipment and (2) any
return on equity.
(f) For the purpose of determining inflation adjustments to rates to be paid to facilities for the time lag between the cost years ending September 30, 1988, and September
30, 1989, and the rate years commencing July 1, 1989, and July 1, 1990, for facilities
whose allowable operating costs, exclusive of property costs, exceed the twenty-fifth
percentile of state-wide allowable costs, except those property costs covered by the
application of the fair rental value system, the commissioner shall calculate the gross
national product deflator and apply it to such costs as follows:
Percentile
The Gross National
Product Deflator Less the
Following Percentages90.01−100.00 5.1960 per cent 80.01− 90.00 4.6764 per cent 70.01− 80.00 4.1568 per cent 60.01− 70.00 3.6372 per cent 50.01− 60.00 3.1176 per cent 40.01− 50.00 2.5980 per cent 30.01− 40.00 2.0784 per cent 25.01− 30.00 1.5588 per cent
(g) After application of subsections (a) to (f), inclusive, of this section, the commissioner shall reduce the rates by multiplying the rates by the following percentages and
subtracting the resulting amount:
If Self-Pay Census is Reduction Amount 0 − 10 .342 of one per cent 10.01 − 20 .684 of one per cent 20.01 − 30 1.368 per cent 30.01 − 40 2.052 per cent 40.01 − 50 2.736 per cent 50.01 − 60 4.104 per cent 60.01 − 70 4.788 per cent 70.01 − 80 5.472 per cent 80.01 − 90 6.156 per cent 90.01 − 100 6.498 per cent
(i) The annual rate of return used by the commissioner in calculating the fair rental
value allowance for proprietary facilities shall be one and one-half times the Medicare
rate of return as set forth in the "Table Representing the Percentage Equal to One Times
the Interest Rates for Proprietary Providers' Return on Equity Capital for Other Than
Inpatient Hospitals" published by the Office of the Actuary within the Health Care
Financing Administration. Said rate of return shall be adjusted in accordance with the
regulations promulgated by the commissioner and in effect on April 1, 1989.
(j) With respect to any initial interim rate established by the commissioner which
is effective after January 1, 1990, and any adjustment to any such interim rate, wage
and salary costs per patient day shall be limited to one hundred twenty-five per cent of
the median wage and salary costs per patient day for the applicable rate year for facilities
within the Health Care Financing Administration wage index region of the facility for
which the interim rate is established, or such greater radius as may be necessary to
include a minimum of five facilities in the calculation of such median. The one hundred
twenty-five per cent limitation shall not affect the revised per diem rates or retroactive
adjustments to interim rates computed pursuant to regulations promulgated by the commissioner and in effect on April 1, 1989.
(k) The commissioner shall determine the rates for the rate year beginning July 1,
1989, and ending June 30, 1990, and shall notify facilities of such rates as soon as
practicable, but not later than July 31, 1989, for those facilities that filed annual reports
for the year ending September 30, 1988, before April 30, 1989. The commissioner shall
not reconduct the annual public hearing which was held on April 11, 1989.
(l) The provisions of subsections (a) to (k), inclusive, of this section shall not apply
to licensed residential care homes. The rates to be paid to licensed residential care homes
based on cost years ending September 30, 1988, and September 30, 1989, shall be computed pursuant to the applicable regulations in effect on April 1, 1989, except that the
effective date of such rates shall be September 1, 1989, for the cost year ending September 30, 1988, and September 1, 1990, for the cost year ending September 30, 1989.
(P.A. 89-325, S. 1, 26; P.A. 90-176, S. 1, 2; P.A. 93-262, S. 1, 87; P.A. 97-112, S. 2.)
History: P.A. 90-176 amended Subsec. (a) to add Subdiv. (2) limiting the applicability of this section to intermediate
care facilities for the mentally retarded to only the cost year ending September 30, 1988; P.A. 93-262 authorized substitution
of commissioner and department of social services for commissioner and department of income maintenance, effective
July 1, 1993; Sec. 17-314d transferred to Sec. 17b-344 in 1995; P.A. 97-112 replaced "homes for the aged" with "residential
care homes".
(Return to TOC) (Return to Chapters) (Return to Titles)
Type of Room Percentage of
State-Wide Median
Medicaid RatePrivate 55% Semiprivate 30% Three or more beds per room 20%
(c) Except as provided in this section, all provisions of the regulations of Connecticut state agencies concerning self-pay rates in effect on April 1, 1989, shall remain in
full force and effect.
(P.A. 89-325, S. 2, 26.)
History: Sec. 17-314e transferred to Sec. 17b-345 in 1995.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) The commissioner may issue a rate for any facility which fails to comply with
the provisions of this section provided such rate may not be lower than the lowest rate
paid to a facility for the same level of care.
(P.A. 89-325, S. 4, 26; June Sp. Sess. P.A. 91-8, S. 24; P.A. 93-262, S. 1, 87.)
History: June Sp. Sess. P.A. 91-8 amended Subsec. (a) by making technical corrections and deleted Subsec. (c) which
had exempted certain facilities from participating in program; P.A. 93-262 authorized substitution of commissioner and
department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-
314f transferred to Sec. 17b-346 in 1995.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) The commissioner may enter into a limited provider agreement to provide Medicaid reimbursement for care rendered to eligible patients for up to ninety days following
the date of termination of a facility's Medicaid provider agreement. Thereafter, the
commissioner shall enter into a limited provider agreement only for patients eligible
for Medicaid who are determined by the Department of Public Health to be in imminent
danger of death if involuntarily transferred or discharged in accordance with section
19a-535. The commissioner shall provide no reimbursement to any facility which has
terminated its Medicaid provider agreement other than the reimbursement provided
under a limited provider agreement entered into pursuant to this subsection.
(c) Notwithstanding the provisions of subsection (b) of this section, the commissioner shall enter into a limited provider agreement with any facility which provided
notice to the commissioner of its intention to terminate its Medicaid provider agreement
after July 1, 1989, and before March 1, 1990, to provide Medicaid reimbursement for
care rendered to (1) patients residing in such a facility who are eligible for Medicaid on
or before March 31, 1990, and (2) patients residing in such a facility on or before March
31, 1990, who become eligible for Medicaid. No such patient in such a facility shall be
involuntarily transferred or discharged on the basis of source of payment.
(d) Notwithstanding any provisions of the general statutes, the public or special acts
of 1989 or 1990 or the regulations of Connecticut state agencies, the Commissioner of
Social Services shall determine the maximum rate to be charged self-pay patients in any
nursing home facility which has notified the commissioner of its intention to terminate its
Medicaid provider agreement on or after March 1, 1990, by (1) determining the rate to
be paid for persons aided or cared for by the state or any town in this state pursuant to
regulations in effect March 1, 1990, adopted under section 17b-238; and (2) adding to
such rate a percentage of the state-wide median Medicaid rate as determined pursuant
to regulations in effect March 1, 1990, adopted under section 17b-238, according to the
following schedule:
Type of Room Percentage of
State-Wide Median
Medicaid RatePrivate 27% Semiprivate 14% Three or more beds per room 10%
(P.A. 89-325, S. 10, 26; P.A. 90-217, S. 2, 3; P.A. 92-163; P.A. 93-262, S. 1, 87; 93-381, S. 9, 39; P.A. 95-257, S. 12,
21, 58.)
History: P.A. 90-217 added provisions re notification required when a facility intends to terminate its provider
agreement, terms of limited provider agreements and rates to be charged self-pay patients in a facility which has terminated
its provider agreement and divided sections into Subsecs.; P.A. 92-163 amended Subsec. (b) by deleting provision requiring
patient to be eligible for Medicaid on the date of termination of a facility's provider agreement in order to be covered
under a limited provider agreement if in imminent danger of death if involuntarily transferred or discharged; P.A. 93-262
authorized substitution of commissioner and department of social services for commissioner and department of income
maintenance, effective July 1, 1993; P.A. 93-381 replaced department of health services with department of public health
and addiction services, effective July 1, 1993; Sec. 17-314g transferred to Sec. 17b-347 in 1995; P.A. 95-257 replaced
Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public
Health, effective July 1, 1995.
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(b) Not later than January 1, 1999, the Commissioner of Social Services shall enter
into a memorandum of understanding with the Commissioner of Economic and Community Development and the Connecticut Housing Finance Authority. Such memorandum
of understanding shall specify that (1) the Department of Social Services apply for a
Medicaid waiver to secure federal financial participation to fund assisted living services,
establish a process to select nonprofit and for-profit providers and determine the number
of dwelling units in the demonstration project, (2) the Department of Economic and
Community Development provide rental subsidy certificates pursuant to section 8-402
or rental assistance pursuant to section 8-119kk, and (3) the Connecticut Housing Finance Authority provide second mortgage loans for housing projects for which the authority has provided financial assistance in the form of a loan secured by a first mortgage
pursuant to section 8-403 for the demonstration project. Not later than July 1, 1999, the
Connecticut Housing Finance Authority shall issue a request for proposals for persons
or entities interested in participating in the demonstration project.
(c) Nothing in this section shall be construed to prohibit a combination of unsubsidized dwelling units and subsidized dwelling units under the demonstration project
within the same facility. Notwithstanding the provisions of section 8-402, the Department of Economic and Community Development may set the rental subsidy at any
percentage of the annual aggregate family income and define aggregate family income
and eligibility for subsidies in a manner consistent with such demonstration project.
(P.A. 98-239, S. 1, 35; P.A. 99-279, S. 22, 45.)
History: P.A. 98-239 effective June 8, 1998; P.A. 99-279 amended Subsec. (a) to allow the demonstration project to
be conducted in more than three municipalities and to specify that the maximum number of dwelling units be subsidized,
and added a new Subsec. (c) allowing a combination of subsidized and unsubsidized dwelling units under the demonstration
project within the same facility and permitting the Department of Economic and Community Development to set the rental
subsidy at any percentage of the annual aggregate family income and to define aggregate family income and eligibility for
subsidies, effective July 1, 1999.
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(b) The Commissioner of Social Services may implement the provisions of this
section prior to adopting or amending regulations.
(P.A. 89-325, S. 11, 26; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-314h transferred to Sec. 17b-348 in 1995.
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(b) For the fiscal year ending June 30, 1998, any grant awards made to a community
health center or its successor for the purpose of supporting the community health center
infrastructure services to the uninsured or expansion initiative projects shall be equivalent to base grant awards made in the fiscal year ending June 30, 1997, provided, if any
portion of the amount is not required by a given community health center, the differential
shall be distributed among all the other health centers according to their share of total
funding.
(c) For the fiscal year ending June 30, 1999, any grant awards made to a community
health center or its successor for the purpose of supporting the community health center
infrastructure services to the uninsured or expansion initiative projects shall be equivalent to base grant awards made in the fiscal year ending June 30, 1997, provided, if any
portion of the amount is not required by a given community health center, the differential
shall be distributed among all the other health centers according to their share of total
funding.
(d) For the fiscal year ending June 30, 2000, any grant awards made to a community
health center or its successor for the purpose of supporting the community health center
infrastructure services to the uninsured or expansion initiative projects shall be equivalent to base grant awards made in the fiscal year ending June 30, 1999, provided, if any
portion of the amount is not required by a given community health center, the differential
shall be distributed among all the other health centers according to their share of total
funding.
(e) For the fiscal year ending June 30, 2001, any grant awards made to a community
health center or its successor for the purpose of supporting the community health center
infrastructure services to the uninsured or expansion initiative projects shall be equivalent to base grant awards made in the fiscal year ending June 30, 1999, provided, if any
portion of the amount is not required by a given community health center, the differential
shall be distributed among all the other health centers according to their share of total
funding.
(P.A. 89-325, S. 16, 26; P.A. 93-262, S. 1, 87; June 18 Sp. Sess. P.A. 97-8, S. 21, 88; June Sp. Sess. P.A. 99-2, S. 24, 72.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-314i transferred to Sec. 17b-349 in 1995; June 18 Sp.
Sess. P.A. 97-8 added Subsecs. (b) and (c) re grants to community health centers for specified services and projects, for
1998 and 1999, respectively, effective July 1, 1997; June Sp. Sess. P.A. 99-2 added Subsecs. (d) and (e) re grants to
community health centers for specified services and projects, for the fiscal years ending June 30, 2000 and June 30, 2001,
respectively, effective July 1, 1999.
See Sec. 19a-490a for definition of "community health center".
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(1) "Respite care services" means support services which provide short-term relief
from the demands of ongoing care for an individual with Alzheimer's disease.
(2) "Caretaker" means a person who has the responsibility for the care of an individual with Alzheimer's disease or has assumed the responsibility for such individual voluntarily, by contract or by order of a court of competent jurisdiction.
(3) "Copayment" means a payment made by or on behalf of an individual with
Alzheimer's disease for respite care services.
(4) "Individual with Alzheimer's disease" means an individual with Alzheimer's
disease or related disorders.
(b) The Commissioner of Social Services shall establish a demonstration program,
within available appropriations, to provide respite care services for caretakers of individuals with Alzheimer's disease, provided such individuals with Alzheimer's disease meet
the requirements set forth in subsection (c) of this section. Such respite care services
may include, but need not be limited to (1) homemaker services; (2) adult day care; (3)
temporary care in a licensed medical facility; (4) home-health care; or (5) companion
services. Such respite care services may be administered directly by the department, or
through contracts for services with providers of such services, or by means of direct
subsidy to caretakers of individuals with Alzheimer's disease to purchase such services.
(c) (1) No individual with Alzheimer's disease may participate in the program if
such individual (A) has an annual income of more than thirty thousand dollars or liquid
assets of more than eighty thousand dollars, or (B) is covered by Medicaid.
(2) No individual with Alzheimer's disease who participates in the program may
receive more than three thousand five hundred dollars for services under the program
in any fiscal year or receive more than thirty days of out-of-home respite care services
other than adult day care services under the program in any fiscal year.
(3) The commissioner may require an individual with Alzheimer's disease who
participates in the program to pay a copayment for respite care services under the program, except the commissioner may waive such copayment upon demonstration of financial hardship by such individual.
(d) The commissioner shall adopt regulations in accordance with the provisions of
chapter 54 to implement the provisions of this section. Such regulations shall include,
but need not be limited to (1) standards for eligibility for respite care services; (2) the
basis for priority in receiving services; (3) qualifications and requirements of providers,
which shall include specialized training in Alzheimer's disease, dementia and related
disorders; (4) a requirement that providers accredited by the Joint Commission on the
Accreditation of Healthcare Organizations, when available, receive preference in contracting for services; (5) provider reimbursement levels; (6) limits on services and cost
of services; and (7) a fee schedule for copayments.
(e) The Commissioner of Social Services may allocate any funds appropriated in
excess of five hundred thousand dollars for the demonstration program among the five
area agencies on aging according to need, as determined by said commissioner.
(P.A. 98-239, S. 14, 35; P.A. 99-162, S. 1, 2; 99-279, S. 23, 45.)
History: P.A. 98-239 effective July 1, 1998; P.A. 99-162 amended Subsec. (c) to increase, from twenty-one to thirty,
the maximum number of days of out-of-home respite care services available under the program in any fiscal year, to provide
that adult day care services are not subject to such maximum and to make technical changes, and Subsec. (d) to delete
requirement in Subdiv. (1) that regulations include in standards accreditation by the Joint Commission on the Accreditation
of Healthcare Organizations and to add in Subdiv. (4) a requirement that providers accredited by said commission, when
available, receive preference in contracting for services and renumbered remaining Subdivs. accordingly, effective July
1, 1999; P.A. 99-279 added a new Subsec. (e) allowing allocation of funds appropriated in excess of five hundred thousand
dollars for the demonstration program among the five area agencies on aging based on need, as determined by the commissioner, effective July 1, 1999.
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(P.A. 92-231, S. 7, 10; P.A. 93-262, S. 1, 87; 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; P.A. 93-381 authorized substitution of commissioner and
department of public health and addiction services for commissioner and department of health services, effective July 1,
1993; Sec. 17-314n transferred to Sec. 17b-350 in 1995; P.A. 95-257 replaced Commissioner and Department of Public
Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995.
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(b) The General Assembly finds evidence of insufficient need for all the nursing
home beds permitted pursuant to subsection (a) of this section, but not licensed by the
Department of Public Health and finds allowing unnecessary beds to be licensed will
result in severely damaging economic consequences to the state and to consumers. An
addition of beds initiated pursuant to this section shall be licensed no later than June 9,
1993. A facility which has initiated the addition of beds but has not obtained licensure
of such beds, may, no later than July 15, 1993, apply to the Office of Health Care Access
for authorization to proceed with completion of the additional beds and application
for licensure, provided (A) plans for the additional beds have been approved by the
Department of Public Health pursuant to section 19-13-D-8t(v)(4) of the Public Health
Code no later than June 1, 1993, and (B) twenty-five per cent of estimated project costs
have been expended no later than June 9, 1993, provided project costs may not exceed
thirty-one thousand two hundred eleven dollars per bed. The office shall issue a decision
on such application within forty-five days of receipt of documentation necessary to
determine expended project costs. Evidence of project costs expended shall be submitted
in the form of a report prepared by a certified public accountant having no affiliation
with the owner of the facility or the developer of the project. The owner of a facility for
which completion of additional beds is not so authorized may apply to the Commissioner
of Social Services for compensation on or after June 29, 1993, but no later than September 1, 1993, provided plans for the additional beds have been approved by the Department of Public Health no later than June 1, 1993. Such compensation shall be limited
to actual verifiable losses which directly result from the failure to gain authorization
pursuant to this subsection and which cannot be otherwise recouped through the mitigating efforts of the owner, excluding consequential and incidental losses such as lost
profits. In no event may such compensation exceed project costs. An owner aggrieved
by the amount of compensation determined by the commissioner may request a hearing
in accordance with the provisions of sections 17b-60 and 17b-61. This subsection shall
not apply to any addition of beds pursuant to this section which is part of a construction
project that also includes an addition of beds authorized pursuant to subdivision (4) of
subsection (f) of section 19a-638.
(P.A. 89-325, S. 3, 26; P.A. 93-262, S. 1, 19, 87; 93-381, S. 9, 39; 93-406, S. 2, 6; 93-435, S. 59, 95; P.A. 95-257, S.
12, 21, 39, 58; P.A. 98-150, S. 12, 17.)
History: P.A. 93-262 and P.A. 93-435 replaced commission on hospitals and health care and commissioner of income
maintenance with commissioner of social services and made technical changes, effective July 1, 1993; P.A. 93-381 and
P.A. 93-435 replaced department of health services with department of public health and addiction services, effective July
1, 1993; P.A. 93-406 added Subsec. (b) re deadline for licensure of additional beds, effective June 29, 1993; Sec. 19a-
155a transferred to Sec. 17b-351 in 1995; P.A. 95-257 replaced Commissioner and Department of Public Health and
Addiction Services with Commissioner and Department of Public Health and replaced Commission on Hospitals and
Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 98-150 made a technical correction to Subsec.
(b) re reference to Sec. 19a-638, effective June 5, 1998.
Cited. 235 C. 128, 131−135, 137, 139−144.
Subsec. (b):
Cited. 235 C. 128, 143.
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(b) Any facility which intends to (1) transfer all or part of its ownership or control
prior to being initially licensed; (2) introduce any additional function or service into its
program of care or expand an existing function or service; or (3) terminate a service or
decrease substantially its total bed capacity, shall submit a complete request for permission to implement such transfer, addition, expansion, increase, termination or decrease
with such information as the department requires to the Department of Social Services.
(c) An applicant, prior to submitting a certificate of need application, shall request,
in writing, application forms and instructions from the department. The request shall
include: (1) The name of the applicant or applicants; (2) a statement indicating whether
the application is for (A) a new, additional, expanded or replacement facility, service
or function, (B) a termination or reduction in a presently authorized service or bed
capacity or (C) any new, additional or terminated beds and their type; (3) the estimated
capital cost; (4) the town where the project is or will be located; and (5) a brief description
of the proposed project. Such request shall be deemed a letter of intent. No certificate
of need application shall be considered submitted to the department unless a current
letter of intent, specific to the proposal and in accordance with the provisions of this
subsection, has been on file with the department for not less than ten business days. For
purposes of this subsection, "a current letter of intent" means a letter of intent on file
with the department for not more than one hundred eighty days. A certificate of need
application shall be deemed withdrawn by the department, if a department completeness
letter is not responded to within one hundred eighty days.
(d) The department shall review a request made pursuant to subsection (b) of this
section to the extent it deems necessary, including, but not limited to, in the case of a
proposed transfer of ownership or control prior to initial licensure, the financial responsibility and business interests of the transferee and the ability of the facility to continue
to provide needed services, or in the case of the addition or expansion of a function or
service, ascertaining the availability of the function or service at other facilities within
the area to be served, the need for the service or function within the area and any other
factors the department deems relevant to a determination of whether the facility is justified in adding or expanding the function or service. The commissioner shall grant, modify or deny the request within ninety days of receipt thereof, except as otherwise provided
in this section. Upon the request of the applicant, the review period may be extended
for an additional fifteen days if the department has requested additional information
subsequent to the commencement of the commissioner's review period. The director
of the office of certificate of need and rate setting may extend the review period for a
maximum of thirty days if the applicant has not filed in a timely manner information
deemed necessary by the department. The applicant may request and shall receive a
hearing in accordance with section 4-177 if aggrieved by a decision of the commissioner.
(e) The Commissioner of Social Services shall not approve any requests for beds
in residential facilities for the mentally retarded which are licensed pursuant to section
17a-227 and are certified to participate in the Title XIX Medicaid Program as intermediate care facilities for the mentally retarded, except those beds necessary to implement
the residential placement goals of the Department of Mental Retardation which are
within available appropriations.
(f) The Commissioner of Social Services shall adopt regulations, in accordance
with chapter 54, to implement the provisions of this section. The commissioner shall
implement the standards and procedures of the Office of Health Care Access concerning
certificates of need established pursuant to section 19a-643, as appropriate for the purposes of this section, until the time final regulations are adopted in accordance with said
chapter 54.
(P.A. 93-262, S. 21, 87; P.A. 94-236, S. 1, 10; P.A. 95-257, S. 39, 58; P.A. 97-112, S. 2; June 18 Sp. Sess. P.A. 97-2,
S. 147, 165.)
History: P.A. 93-262 effective July 1, 1993; P.A. 94-236 amended Subsec. (c) to permit the director of the office of
certificate of need and rate setting to extend the review period instead of the commissioner, to provide for a hearing and
made technical changes in the section, effective June 7, 1994; P.A. 95-257 replaced Commission on Hospitals and Health
Care with Office of Health Care Access, effective July 1, 1995; P.A. 97-112 replaced "home for the aged" with "residential
care home" in Subsec. (a); June 18 Sp. Sess. P.A. 97-2 added a new Subsec. (c) concerning requirements for the application
procedure prior to submitting a certificate of need application, and redesignated existing Subsecs. accordingly, effective
July 1, 1997.
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(b) An applicant, prior to submitting a certificate of need application, shall request,
in writing, application forms and instructions from the department. The request shall
include: (1) The name of the applicant or applicants; (2) a statement indicating whether
the application is for (A) a new, additional, expanded or replacement facility, service
or function, (B) a termination or reduction in a presently authorized service or bed
capacity or (C) any new, additional or terminated beds and their type; (3) the estimated
capital cost; (4) the town where the project is or will be located; and (5) a brief description
of the proposed project. Such request shall be deemed a letter of intent. No certificate
of need application shall be considered submitted to the department unless a current
letter of intent, specific to the proposal and in accordance with the provisions of this
subsection, has been on file with the department for not less than ten business days. For
purposes of this subsection, "a current letter of intent" means a letter of intent on file
with the department for not more than one hundred eighty days. A certificate of need
application shall be deemed withdrawn by the department if a department completeness
letter is not responded to within one hundred eighty days.
(c) The commissioner or his designee shall hold a hearing, pursuant to section 4-
177, with respect to the request. At least two weeks' notice of the hearing shall be given
to the facility by certified mail and to the public by publication in a newspaper having
a substantial circulation in the area served by the facility. Such hearing shall be held at
the discretion of the commissioner in Hartford or in the area so served. The commissioner
or his designee shall consider such request in relation to the community or regional need
for such capital program or purchase of land, the possible effect on the operating costs
of the facility and such other relevant factors as the commissioner or his designee deems
necessary. In approving or modifying such request, the commissioner or his designee
may not prescribe any condition, such as, but not limited to, any condition or limitation
on the indebtedness of the facility in connection with a bond issued, the principal amount
of any bond issued or any other details or particulars related to the financing of such
capital expenditure, not directly related to the scope of such capital program and within
the control of the facility. Upon a showing by such facility that the need for such capital
program is of an emergency nature, the commissioner may waive the requirement that
a hearing be held thereon, provided such request shall be submitted at least ten business
days before the proposed initiation date of the project. If the hearing is conducted by a
designee of the commissioner, the designee shall submit his findings and recommendations to the commissioner. The commissioner shall grant, modify or deny such request
within ninety days or within ten business days, as the case may be, of receipt thereof,
except as provided for in this section. Upon the request of the applicant, the review
period may be extended for an additional fifteen days if the commissioner or his designee
has requested additional information subsequent to the commencement of the review
period. The commissioner or his designee may extend the review period for a maximum
of thirty days if the applicant has not filed in a timely manner information deemed
necessary by the commissioner or his designee.
(d) The Commissioner of Social Services shall adopt regulations, in accordance
with chapter 54, to implement the provisions of this section. The commissioner shall
implement the standards and procedures of the Office of Health Care Access concerning
certificates of need established pursuant to section 19a-643, as appropriate for the purposes of this section, until the time final regulations are adopted in accordance with said
chapter 54.
(P.A. 93-262, S. 22, 87; P.A. 94-236, S. 2, 10; P.A. 95-257, S. 39, 58; June 18 Sp. Sess. P.A. 97-2, S. 148, 165; P.A.
98-150, S. 13, 17.)
History: P.A. 93-262 effective July 1, 1993; P.A. 94-236 made technical changes and amended Subsec. (b) to provide
that a hearing shall be in accordance with Sec. 4-177 and to add "or his designee" after commissioner, effective June 7,
1994; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July
1, 1995; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (a) by replacing a capital expenditure exceeding one million dollars
with a capital expenditure exceeding one million dollars which increases facility square footage by more than five thousand
square feet or five per cent of the existing square footage, whichever is greater, and by adding a capital expenditure
exceeding two million dollars to those facilities required to submit a request for approval of such expenditure, added
Subsec. (b) outlining an applicant's required procedure prior to submitting a certificate of need application and redesignated
existing Subsecs. accordingly, effective July 1, 1997; (Revisor's note: A reference in Subsec. (a) to "subsection (b) of"
Sec. 19a-639, deleted by vetoed P.A. 97-204 and so reflected in June 18 Sp. Sess. P.A. 97-2, was codified since purported
deletion was void); P.A. 98-150 amended Subsec. (a) to allow joint or simultaneous review and made a technical change,
effective June 5, 1998 (Revisor's note: In Subsec. (a) a reference to "Commissioner of the Department of Social Services"
was changed editorially by the Revisors to "Commissioner of Social Services" for consistency with customary statutory
language).
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(b) For the purposes of subsection (a) of this section, "a continuing care facility
which guarantees life care for its residents" means: (1) A facility which does not participate in the Medicaid program; (2) a facility which establishes its financial stability by
submitting to the commissioner documentation which (A) demonstrates in financial
statements compiled by certified public accountants that the facility and its direct or
indirect owners have (i) on the date of the certificate of need application and for five
years preceding such date, net assets or reserves equal to or greater than the projected
operating revenues for the facility in its first two years of operation or (ii) assets or other
indications of financial stability determined by the commissioner to be sufficient to
provide for the financial stability of the facility based on its proposed financial structure
and operations, (B) demonstrates in financial statements compiled by certified public
accountants that the facility, on the date of the certificate of need application, has a
projected debt coverage ratio at ninety-five per cent occupancy of at least one and twenty-
five one-hundredths, (C) details the financial operation and projected cash flow of the
facility on the date of the certificate of need application, to be updated every five years
thereafter, and demonstrates that fees payable by residents and the assets, income and
insurance coverage of residents, in combination with other sources of facility funding,
are sufficient to provide for the expenses of life care services for the life of the residents
to be made available within a continuum of care which shall include the provision of
health services in the independent living units, and (D) provides that any transfer of
ownership of the facility to take place within a five-year period from the date of approval
of its certificate of need shall be subject to the approval of the Commissioner of Social
Services in accordance with the provisions of section 17b-355; (3) a facility which
establishes to the satisfaction of the commissioner that it can provide for the expenses
of the continuum of care to be made available to residents by complying with the provisions of chapter 319f and demonstrating sufficient assets, income, financial reserves or
long-term care insurance to provide for such expenses and maintain financially viable
operation of the facility for a thirty-year period based on generally accepted accounting
practices and actuarial principles, which demonstration (A) may include making available to prospective residents long-term care insurance policies which are substantially
equivalent in value and coverage to policies precertified pursuant to section 38a-475,
(B) shall include establishing eligibility criteria and screening each resident prior to
admission and annually thereafter to ensure that his assets, income and insurance coverage are sufficient in combination with other sources of facility funding to cover such
expenses, (C) shall include entering into contracts with residents concerning monthly
or other periodic fees payable by residents for services provided, and (D) allowing
residents whose expenses are not covered by insurance to pledge or transfer income,
assets or proceeds from the sale of assets in amounts sufficient to cover such expenses;
(4) a facility which demonstrates it will establish a contingency fund, prior to becoming
operational, in an initial amount of five hundred thousand dollars which shall be increased in equal annual increments to at least one million dollars by the start of the
facility's sixth year of operation and which shall be replenished within twelve months
of any expenditure, provided the amount to be replenished shall not exceed two hundred
fifty thousand dollars annually until one million dollars is reached, to provide for the
expenses of the continuum of care to be made available to residents which may not
be covered by residents' assets, income or insurance, provided the commissioner may
approve the establishment of a contingency fund in a lesser amount upon the application
of a facility for which a lesser amount is appropriate based on the size of the facility;
and (5) a facility which is operated by management with demonstrated experience and
ability in the operation of similar facilities. Notwithstanding the provisions of this subsection, a facility may be deemed a continuing care facility which guarantees life care
for its residents if (A) the facility meets the criteria set forth in subdivisions (2) to (5),
inclusive, of this subsection, was Medicaid certified prior to October 1, 1993, and has
been deemed qualified to enter into a continuing care contract under chapter 319hh for
at least two consecutive years prior to filing its certificate of need application under
this section, provided (i) no additional bed approved pursuant to this section shall be
Medicaid certified; (ii) no patient in such a bed shall be involuntarily transferred to
another bed due to his eligibility for Medicaid and (iii) the facility shall pay the cost of
care for a patient in such a bed who is Medicaid eligible and does not wish to be transferred to another bed or (B) the facility is operated exclusively by and for a religious
order which is committed to the care and well-being of its members for the duration of
their lives and whose members are bound thereto by the profession of permanent vows.
On and after July 1, 1997, the Department of Social Services shall give priority to a
request for modification of a certificate of need from a continuing care facility which
guarantees life care for its residents pursuant to the provisions of this subsection.
(c) For the purposes of this section and sections 17b-352 and 17b-353, construction
shall be deemed to have begun if the following have occurred and the department has
been so notified in writing within the thirty days prior to the date by which construction
is to begin: (1) All necessary town, state and federal approvals required to begin construction have been obtained, including all zoning and wetlands approvals; (2) all necessary
town and state permits required to begin construction or site work have been obtained;
(3) financing approval, as defined in subsection (d) of this section, has been obtained;
and (4) construction of a structure approved in the certificate of need has begun. For
the purposes of this subsection, commencement of construction of a structure shall
include, at a minimum, completion of a foundation. Notwithstanding the provisions of
this subsection, upon receipt of an application filed at least thirty days prior to the date
by which construction is to begin, the commissioner may deem construction to have
begun if: (A) An owner of a certificate of need has fully complied with the provisions
of subdivisions (1), (2) and (3) of this subsection; (B) such owner submits clear and
convincing evidence that he has complied with the provisions of this subsection sufficiently to demonstrate a high probability that construction shall be completed in time
to obtain licensure by the Department of Public Health on or before the date required
pursuant to subsection (a) of this section; (C) construction of a structure cannot begin
due to unforseeable circumstances beyond the control of the owner; and (D) at least ten
per cent of the approved total capital expenditure or two hundred fifty thousand dollars,
whichever is greater, has been expended.
(d) For the purposes of subsection (c) of this section, subject to the provisions of
subsection (e) of this section, financing shall be deemed to have been obtained if the
owner of the certificate of need receives a commitment letter from a lender indicating
an affirmative interest in financing the project subject to reasonable and customary
conditions, including a final commitment from the lender's loan committee or other
entity responsible for approving loans. If a lender which has issued a commitment letter
subsequently refuses to finance the project, the owner shall notify the department in
writing within five business days of the receipt of the refusal. The owner shall, if so
requested by the department, provide the commissioner with copies of all communications between the owner and the lender concerning the request for financing. The owner
shall have one further opportunity to obtain financing which shall be demonstrated by
submitting another commitment letter from a lender to the department within thirty days
of the owner's receipt of the refusal from the first lender.
(e) On and after March 1, 1993, financing shall be deemed to have been obtained
for the purposes of this section and sections 17b-352 and 17b-353 if the owner of the
certificate of need has (1) received a final commitment for financing in writing from a
lender or (2) provided evidence to the department that the owner has sufficient funds
available to construct the project without financing.
(f) Any decision of the Office of Health Care Access issued prior to July 1, 1993,
as to whether construction has begun or financing has been obtained for nursing home
beds approved by the office prior to said date shall be deemed to be a decision of the
Commissioner of Social Services for the purposes of this section and sections 17b-352
and 17b-353.
(g) (1) A continuing care facility which guarantees life care for its residents, as
defined in subsection (b) of this section, (A) shall arrange for a medical assessment to
be conducted by an independent physician or an access agency approved by the Office
of Policy and Management and the Department of Social Services as meeting the requirements for such agency as defined by regulations adopted pursuant to subsection (e) of
section 17b-342, prior to the admission of any resident to the nursing facility and shall
document such assessment in the resident's medical file and (B) may transfer or discharge a resident who has intentionally transferred assets in a sum which will render
the resident unable to pay the cost of nursing facility care in accordance with the contract
between the resident and the facility.
(2) A continuing care facility which guarantees life care for its residents, as defined
in subsection (b) of this section, may, for the seven-year period immediately subsequent
to becoming operational, accept nonresidents directly as nursing facility patients on a
contractual basis provided any such contract shall include, but not be limited to, requiring
the facility (A) to document that placement of the patient in such facility is medically
appropriate; (B) to apply to a potential nonresident patient the financial eligibility criteria
applied to a potential resident of the facility pursuant to said subsection (b); and (C) to
at least annually screen each nonresident patient to ensure the maintenance of assets,
income and insurance sufficient to cover the cost of at least forty-two months of nursing
facility care. A facility may transfer or discharge a nonresident patient upon the patient
exhausting assets sufficient to pay the costs of his care or upon the facility determining
the patient has intentionally transferred assets in a sum which will render the patient
unable to pay the costs of a total of forty-two months of nursing facility care from the
date of initial admission to the nursing facility. Any such transfer or discharge shall be
conducted in accordance with section 19a-535. The commissioner may grant up to a
three-year extension of the period during which a facility may accept nonresident patients, provided the facility is in compliance with the provisions of this section.
(h) Notwithstanding the provisions of subsection (a) of this section, if an owner of
an approved certificate of need for additional nursing home beds has notified the Office
of Health Care Access or the Department of Social Services on or before September 30,
1993, of his intention to utilize such beds for a continuing care facility which guarantees
life care for its residents in accordance with subsection (b) of this section and has filed
documentation with the Department of Social Services on or before September 30, 1994,
demonstrating the requirements of said subsection (b) have been met, the certificate of
need shall not expire.
(i) The Commissioner of Social Services may waive or modify any requirement of
this section, except subdivision (1) of subsection (b) which prohibits participation in
the Medicaid program, to enable an established continuing care facility registered pursuant to chapter 319hh prior to September 1, 1991, to add nursing home beds provided the
continuing care facility agrees to no longer admit nonresidents into any of the facility's
nursing home beds except for spouses of residents of such facility and provided the
addition of nursing home beds will not have an adverse impact on the facility's financial
stability, as defined in subsection (b) of this section, and are located within a structure
constructed and licensed prior to July 1, 1992.
(j) The Commissioner of Social Services shall adopt regulations, in accordance
with chapter 54, to implement the provisions of this section. The commissioner shall
implement the standards and procedures of the Office of Health Care Access concerning
certificates of need established pursuant to section 19a-643, as appropriate for the purposes of this section, until the time final regulations are adopted in accordance with said
chapter 54.
(P.A. 93-262, S. 23, 87; 93-381, S. 9, 39; 93-435, S. 59, 95; P.A. 94-236, S. 3, 10; P.A. 95-160, S. 9, 15, 16, 69; 95-
257, S. 12, 21, 39, 58; 95-351, S. 18, 30; P.A. 96-139, S. 12, 13; P.A. 98-250, S. 27, 39.)
History: P.A. 93-262 effective July 1, 1993; P.A. 93-381 and P.A. 93-435 authorized substitution of commissioner and
department of public health and addiction services for commissioner and department of health services, effective July 1,
1993; P.A. 94-236 amended Subsec. (a) to extend moratorium from June 30, 1994, to June 30, 1997, Subsec. (b) to prohibit
continuing care facilities from participating in Medicaid, require facilities to arrange for medical screening of prospective
patients, revise the way the facility demonstrates its ability to cover its expenses, increase the amounts that must be deposited
in contingency funds from initially one to five hundred thousand and increments from two hundred fifty thousand to one
million dollars and allow exceptions from these amounts, clarify the definition of services and benefits that facilities provide,
added new Subsec. (g) to allow transfers and discharges of continuing care facility residents in certain circumstances and
allow facilities to accept nonresidents into their nursing facilities, added new Subsec. (h) to specify the conditions under
which a certificate of need for continuing care facilities beds will not expire, added new Subsec. (i) to permit commissioner
to waive or modify the continuing care facility requirements except the Medicaid prohibition to enable development of
up to three facilities, and relettered Subsec. (g) as Subsec. (j), effective June 7, 1994; P.A. 95-160 extended the moratorium
on requests for additional nursing home beds or requests for modifying the capital cost of any prior approval in Subsec.
(a) from June 30, 1997, to June 30, 2002, added Subdiv. (3) providing for Medicaid certified beds to be relocated and made
technical changes, amended Subdiv. (5) of Subsec. (b) by adding Subdiv. (A) outlining criteria by which a facility may
be deemed a continuing care facility which guarantees life care for its residents and replaced coordination, assessment and
monitoring agency with access agency under Subsec. (g), effective July 1, 1995; P.A. 95-257 replaced Commissioner and
Department of Public Health and Addiction Services with Commissioner and Department of Public Health and replaced
Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A. 95-351 amended
Subdiv. (3) of Subsec. (a) deleting "a proposed nursing facility" and therefore allowing Medicaid certified beds to be
relocated only to another licensed nursing facility, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-
160 but without affecting this section; P.A. 98-250 amended Subsec. (i) to replace waiver to enable "the development of
up to three continuing care facilities which provide life care for their residents" with waiver to enable an established facility
registered prior to September 1, 1991, and to add beds under specified conditions, effective July 1, 1998.
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(P.A. 94-236, S. 6, 10.)
History: P.A. 94-236 effective June 7, 1994.
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(P.A. 98-250, S. 28, 39.)
History: P.A. 98-250 effective July 1, 1998.
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(P.A. 93-262, S. 24, 87; P.A. 94-236, S. 4, 10; P.A. 95-160, S. 17, 69; 95-257, S. 12, 21, 58; P.A. 96-139, S. 12, 13.)
History: P.A. 93-262 effective July 1, 1993; P.A. 94-262 made technical change to replace commissioner with department, effective June 7, 1994; P.A. 95-160 added a provision prohibiting the commissioner from granting a request for
additional nursing facility beds unless there is a demonstrated bed need in the towns within twenty miles of the town in
which the beds are proposed, including the town of the proposed location, effective July 1, 1995; P.A. 95-257 replaced
Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public
Health, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section.
(Return to TOC) (Return to Chapters) (Return to Titles)
(P.A. 93-262, S. 15, 87; P.A. 95-257, S. 39, 58; P.A. 97-112, S. 2.)
History: P.A. 93-262 effective July 1, 1993; P.A. 95-257 replaced Commission on Hospitals and Health Care with
Office of Health Care Access, effective July 1, 1995; P.A. 97-112 replaced "home for the aged" with "residential care home".
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) If the Department of Public Health finds, through the results of a survey, that a
nursing facility is not in compliance with one or more of the requirements of Subsections
(b), (c) and (d) of 42 USC 1396r and that such noncompliance poses an immediate and
serious threat to patient health or safety, the Department of Public Health shall issue a
statement of charges to the facility and shall file a copy of the charges with the Department of Social Services with a request for a summary order from the Department of
Social Services. The summary order which the Department of Social Services may issue
shall include termination of the facility's participation in Medicaid or appointment of
a temporary manager to oversee the operation of the facility and may include transfer
of patients to other participating facilities; denial of payment under Medicaid for new
admissions; imposition of a directed plan of correction of the facility's deficiencies;
imposition of civil monetary penalties; or imposition of other remedies authorized by
regulations adopted by the Department of Social Services in accordance with chapter 54.
(c) If the Department of Public Health finds, through the results of a survey, that a
nursing facility is not in compliance with one or more of the requirements of Subsections
(b), (c) and (d) of 42 USC 1396r but that such noncompliance does not pose an immediate
and obvious threat to patient health or safety, the Department of Public Health shall
issue a statement of charges to the facility and shall file a copy of the charges with the
Department of Social Services with a request for an order imposing one or more alternative remedies under this subsection. If the Department of Social Services finds, based
on a statement of charges filed by the Department of Public Health, that a nursing facility
is not in compliance with one or more of the requirements of Subsections (b), (c) and
(d) of 42 USC 1396r, but does not issue a summary order, it may impose one or more
of the following alternative remedies: Termination of the facility's participation in Medicaid; appointment of a temporary manager to oversee the operation of the facility;
transfer of patients to other participating facilities; denial of payment under Medicaid for
new admissions; imposition of a directed plan of correction of the facility's deficiencies;
imposition of civil monetary penalties; or imposition of other remedies authorized by
regulations adopted by the Department of Social Services in accordance with chapter
54. The civil monetary penalties imposed may be in the range of three thousand two
hundred fifty dollars to ten thousand dollars per day for each day the facility is found
to be out of compliance with one or more requirements of Subsections (b), (c) and (d)
of 42 USC 1396r if the failure to comply with such requirements is found to constitute
an immediate and serious threat to resident health or safety, or in the range of two
hundred dollars to three thousand dollars per day for each day the facility is found to
be out of compliance with a requirement of Subsections (b), (c) and (d) of 42 USC 1396r
that is found not to constitute an immediate and serious threat to resident health or safety.
The exact civil monetary penalty will be set depending on such factors as the existence
of repeat deficiencies or uncorrected deficiencies and the overall compliance history of
the provider. The remedies available to the Department of Social Services for violations
of the requirements of Subsections (b), (c) and (d) of 42 USC 1396r are cumulative and
are in addition to the remedies available to the Department of Public Health under chapter
368v for violations of state licensure requirements. Any penalties collected by the Department of Social Services pursuant to this section shall be deposited in a special fund
under the control of the Department of Social Services, which fund shall be utilized, in
the discretion of the department, for the protection of the health or property of residents
of nursing facilities found to be deficient, including payment for the costs of relocating
residents, payment for the maintenance of operation of a facility pending correction of
deficiencies or closure, and reimbursement of residents for personal funds lost. The
deficient nursing facility shall be obligated to reimburse the Department of Social Services for any moneys expended by the department at the facility from the fund established
pursuant to this section.
(d) The facility may request a hearing in accordance with the provisions of chapter
54 from the Department of Social Services within ten days of the issuance of the statement of charges or the summary order, as the case may be. If the facility does not request
a hearing within ten days and no summary order has been issued, the Department of
Social Services shall automatically adopt the Department of Public Health's findings
and shall issue an order incorporating one or more of the remedies authorized by subsection (c) of this section. If the facility timely requests a hearing or the Department of
Social Services issues a summary order, the Department of Social Services shall issue
a notice of hearing. At such hearing the facility shall be given the opportunity to present
evidence and cross-examine witnesses. The Department of Social Services shall issue
a decision based on the administrative record and may, if it finds the facility not in
compliance with one or more of the requirements of Subsections (b), (c) and (d) of 42
USC 1396r, order any of the remedies specified in this section. The Department of Social
Services may impose any of the alternative remedies, except for a civil monetary penalty,
during the pendency of any proceedings conducted pursuant to this subsection. In such
cases, the Department of Social Services must provide the facility the opportunity to
discuss the Department of Public Health's findings at an informal conference prior to
the imposition of any remedy. The requirement of an informal conference does not apply
to summary order proceedings.
(P.A. 89-348, S. 6, 10; P.A. 93-262, S. 1, 87; 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner
and department of income maintenance, effective July 1, 1993; P.A. 93-381 replaced department of health services with
department of public health and addiction services, effective July 1, 1993; Sec. 17-134v transferred to Sec. 17b-357 in
1995; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner
and Department of Public Health, effective July 1, 1995.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) In order to participate in the Medicaid program and to receive payment on behalf
of patients assisted under said program, a nursing facility is required to be certified by
the Department of Public Health as being qualified to participate in said program by
meeting the requirements of Subsections (b), (c) and (d) of 42 USC 1396r and shall
execute a provider agreement with the Department of Social Services. In the event of
decertification of a nursing facility and the consequent termination or nonrenewal of a
Medicaid provider agreement with a facility, the Department of Social Services may
continue Medicaid payments on behalf of recipients of medical assistance for a phase-
down period of thirty days, provided eligibility for continued Medicaid payments during
such thirty-day phase-down period shall be conditioned upon a determination by the
Department of Social Services that the facility has engaged in reasonable efforts to
transfer assisted patients to alternative facilities during such period. As a further condition of eligibility for continued Medicaid payments during such period, the facility shall
cooperate with any temporary manager appointed for such facility by the Department
of Social Services. Certification determinations as to whether a facility is qualified to
participate in the program shall be made by the Department of Public Health, subject
to the right of the Secretary of the United States Department of Health and Human
Services under federal law to make independent, binding determinations as to whether
the facility is certifiable under federal law.
(P.A. 89-348, S. 7, 10; P.A. 93-262, S. 1, 87; 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner
and department of income maintenance, effective July 1, 1993; P.A. 93-381 replaced department of health services with
department of public health and addiction services, effective July 1, 1993; Sec. 17-134w transferred to Sec. 17b-358 in
1995; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner
and Department of Public Health, effective July 1, 1995.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) No nursing facility shall admit any person, irrespective of source of payment,
who has not undergone a preadmission screening process by which the Department of
Mental Health and Addiction Services determines, based upon an independent physical
and mental evaluation performed by or under the auspices of the Department of Social
Services, whether the person is mentally ill and, if so, whether such person requires the
level of services provided by a nursing facility and, if such person is mentally ill and
does require such level of services, whether the person requires specialized services. A
person who is determined to be mentally ill and not to require nursing facility level
services shall not be admitted to a nursing facility. In order to implement the preadmission review requirements of this section and to identify applicants for admission who
may be mentally ill and subject to the requirements of this section, nursing facilities
may not admit any person, irrespective of source of payment, unless an identification
screen developed, or in the case of out-of-state residents approved, by the Department
of Social Services has been completed and filed in accordance with federal law.
(c) No payment from any source shall be due to any nursing facility that admits a
resident in violation of the preadmission screening requirements of this section.
(d) A nursing facility shall notify the Department of Mental Health and Addiction
Services when a resident who is mentally ill undergoes a significant change in condition
or when a resident who has not previously been diagnosed as mentally ill undergoes a
change in condition which may require specialized services. Upon such notifications,
the Department of Mental Health and Addiction Services, under the auspices of the
Department of Social Services, shall perform an evaluation to determine whether the
resident requires the level of services provided by a nursing facility or requires specialized services for mental illness.
(e) In the case of a mentally ill resident who is determined under subsection (d) not
to require the level of services provided by a nursing facility but to require specialized
services for mental illness and who has continuously resided in a nursing facility for at
least thirty months before the date of the determination, the resident may elect to remain
in the facility or to receive services covered by Medicaid in an alternative appropriate
institutional or noninstitutional setting in accordance with the alternative disposition
plan submitted by the Department of Social Services to the Secretary of the United
States Department of Health and Human Services, and consistent with the Department
of Mental Health and Addiction Services requirements for the provision of specialized
services.
(f) In the case of a mentally ill resident who is determined under subsection (d) not
to require the level of services provided by a nursing facility but to require specialized
services for mental illness and who has not continuously resided in a nursing facility
for at least thirty months before the date of the determination, the nursing facility in
consultation with the Department of Mental Health and Addiction Services shall arrange
for the safe and orderly discharge of the resident from the facility. If the department
determines that the provision of specialized services requires an alternate residential
placement, the discharge and transfer of the resident shall be made in accordance with
the alternative disposition plan submitted by the Department of Social Services and
approved by the Secretary of the United States Department of Health and Human Services, except if an alternate residential placement is not available, the resident shall not
be transferred.
(g) In the case of a resident who is determined under subsection (d) not to require
the level of services provided by a nursing facility and not to require specialized services,
the nursing facility shall arrange for the safe and orderly discharge of the resident from
the facility.
(h) Any person seeking admittance to a nursing facility or any resident of a nursing
facility who is adversely affected by a determination of the Department of Mental Health
and Addiction Services under this section may appeal such determination to the Department of Social Services within fifteen days of the receipt of the notice of a determination
by the Department of Mental Health and Addiction Services. If an appeal is taken to
the Department of Social Services the determination of the Department of Mental Health
and Addiction Services shall be stayed pending determination by the Department of
Social Services.
(P.A. 89-348, S. 8, 10; P.A. 93-262, S. 1, 87; P.A. 95-257, S. 11, 58; June 18 Sp. Sess. P.A. 97-2, S. 135, 165.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134x transferred to Sec. 17b-359 in 1995; P.A. 95-257
replaced Commissioner and Department of Mental Health with Commissioner and Department of Mental Health and
Addiction Services, effective July 1, 1995; June 18 Sp. Sess. P.A. 97-2 replaced "active treatment" with "specialized
services" and amended Subsec. (d) by eliminating an annual requirement that each resident of a nursing facility who is
mentally ill be reviewed by the Department of Mental Health and Addiction Services and replacing it with a requirement
that a nursing facility shall notify the Department of Mental Health and Addiction Services when a resident who is mentally
ill undergoes a significant change in condition or when a resident not previously diagnosed as mentally ill undergoes a
change in condition which may require specialized services, effective July 1, 1997.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) No nursing facility may admit any new resident irrespective of source of payment, who has mental retardation or has a condition related to mental retardation unless
the Department of Mental Retardation has determined prior to admission based upon
an independent physical and mental evaluation performed by or under the auspices of
the Department of Social Services that because of the physical and mental condition of
the individual, the individual requires the level of services provided by a nursing facility.
If the individual requires such level of services, the Department of Mental Retardation
shall also determine whether the individual requires specialized services for such condition. An individual who is determined by the Department of Mental Retardation to have
mental retardation or to have a related condition and is determined not to require nursing
facility level of services shall not be admitted to a nursing facility. In order to implement
the preadmission review requirements of this section, and to identify applicants for
admission who may have mental retardation or have conditions related to mental retardation and subject to the requirements of this section, nursing facilities may not admit any
individual irrespective of source of payment, unless an identification screen developed,
or in the case of out-of-state residents approved, by the Department of Social Services
has been completed for the applicant and filed in accordance with federal law.
(c) No payment from any source shall be due to a nursing facility that admits a
resident in violation of the preadmission screening requirements of this section.
(d) A nursing facility shall notify the Department of Mental Retardation when a
resident who has mental retardation undergoes a change in condition or when a resident
who has not previously been diagnosed as having mental retardation undergoes a significant change in condition which may require specialized services. Upon such notification,
the Department of Mental Retardation, under the auspices of the Department of Social
Services, shall perform an evaluation to determine whether the resident requires the
level of services provided by a nursing facility or requires specialized services for mental
retardation.
(e) In the case of a resident who is determined under subsection (d) not to require
the level of services provided by a nursing facility but to require specialized services for
mental retardation or a condition related to mental retardation and who has continually
resided in a nursing facility for at least thirty months before the date of the determination,
the resident may elect to remain in the facility or to receive services covered by Medicaid
in an alternative appropriate institutional or noninstitutional setting in accordance with
the terms of the alternative disposition plan submitted by the Department of Social
Services and approved by the Secretary of the United States Department of Health and
Human Services.
(f) In the case of a resident with mental retardation or a related condition who is
determined under subsection (d) not to require the level of services provided by a nursing
facility but to require specialized services for mental retardation or the related condition
and who has not continuously resided in a nursing facility for at least thirty months before
the date of the determination, the nursing facility in consultation with the Department of
Mental Retardation shall arrange for the safe and orderly discharge of the resident from
the facility. If the department determines that the provision of specialized services requires an alternative residential placement, the discharge and transfer of the patient shall
be in accordance with the alternative disposition plan submitted by the Department of
Social Services and approved by the Secretary of the United States Department of Health
and Human Services, except if an alternative residential facility is not available, the
resident shall not be transferred.
(g) In the case of a resident who is determined under subsection (d) not to require
the level of services provided by a nursing facility and not to require specialized services,
the nursing facility shall arrange for the safe and orderly discharge of the resident from
the facility.
(h) The Department of Mental Retardation shall be the agency responsible for making the determinations required by this section on behalf of individuals who have mental
retardation and on behalf of individuals with conditions related to mental retardation
and may provide services to such individuals to the extent required by federal law.
(i) Any person seeking admittance to a nursing facility or any resident of a nursing
facility who is adversely affected by a determination of the Department of Mental Retardation under this section may appeal such determination to the Department of Social
Services within fifteen days of the receipt of the notice of a determination by the Department of Mental Retardation. If an appeal is taken to the Department of Social Services,
the determination of the Department of Mental Retardation shall be stayed pending
determination by the Department of Social Services.
(P.A. 89-348, S. 9, 10; P.A. 93-262, S. 1, 87; June 18 Sp. Sess. P.A. 97-2, S. 136, 165.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134y transferred to Sec. 17b-360 in 1995; June 18 Sp.
Sess. P.A. 97-2 replaced "active treatment" with "specialized services" and amended Subsec. (d) by eliminating an annual
requirement that the level of services each resident of a nursing home receives be evaluated and replacing it with a requirement that a nursing facility shall notify the Department of Mental Health and Addiction Services when a resident who has
mental retardation undergoes a change in condition or a resident who has not previously been diagnosed as having mental
retardation undergoes a significant change in condition which may require specialized services, effective July 1, 1997.
(Return to TOC) (Return to Chapters) (Return to Titles)
(P.A. 92-231, S. 6, 10; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department of income maintenance, effective July 1, 1993; Sec. 17-134hh transferred to Sec. 17b-361 in 1995.
(Return to TOC) (Return to Chapters) (Return to Titles)
(b) Each nursing home which participates in the Medicaid program may request of
the dispensing pharmacist that a prescription be dispensed in an amount equal to a five-
day supply whenever (1) a drug product is prescribed for the first time for a patient who
is a Medicaid recipient or (2) a refill of a prescription is necessary for such a patient and
the patient's discharge from the home is imminent.
(P.A. 92-231, S. 5, 10; P.A. 95-160, S. 27, 69; P.A. 96-139, S. 12, 13; June 18 Sp. Sess. P.A. 97-2, S. 131, 165.)
History: Sec. 17-134ii transferred to Sec. 17b-362 in 1995; P.A. 95-160 deleted requirement that a nursing home
participating in the Medicaid program request in writing that a prescription be dispensed, effective July 1, 1995; P.A. 96-
139 changed effective date of P.A. 95-160 but without affecting this section; June 18 Sp. Sess. P.A. 97-2 added Subsec.
(a) requiring a maintenance drug dispensed for the first time to a Medicaid or ConnPACE recipient to be dispensed in an
amount no greater than a ten-day supply and designated existing provisions as Subsec. (b), effective July 1, 1997.
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(June 18 Sp. Sess. P.A. 97-2, S. 134, 165; June Sp. Sess. P.A. 00-2, S. 39, 53.)
History: June 18 Sp. Sess. P.A. 97-2 effective July 1, 1997; June Sp. Sess. P.A. 00-2 revised membership to include
two representatives of pharmacies serving long-term care facilities, effective July 1, 2000.
(Return to TOC) (Return to Chapters) (Return to Titles)
(P.A. 95-160, S. 28, 69; P.A. 96-139, S. 12, 13; June 18 Sp. Sess. P.A. 97-2, S. 133, 165.)
History: P.A. 95-160, S. 28 effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without
affecting this section; June Sp. Sess. P.A. 97-2 extended the duration of the demonstration program, amended the focus
of the program from exploring methods of reducing destruction of prescription drugs in long-term care facilities to exploring
methods of returning and dispensing prescription drugs which have been dispensed to patients in long-term care facilities
and not used, deleted obsolete provisions referring to the submittal of proposals to the Commissioner of Social Services,
replaced the public health committee with the appropriations committee for purposes of reporting and extended the reporting
deadline from February 15, 1997, to February 15, 2000, effective July 1, 1997.
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(b) Notwithstanding the provisions of subsection (a) of this section:
(1) If such drug products are packaged in manufacturer's unit-dose packages, such
drug products shall be returned to the vendor pharmacy for redispensing and reimbursement to the Department of Social Services if such drugs may be redispensed for use
before the expiration date, if any, indicated on the package.
(2) If such drug products are repackaged in manufacturer's unit-dose or multiple-
dose blister packs, such drug products shall be returned to the vendor pharmacy for
redispensing and reimbursement to the Department of Social Services if (A) the date
on which such drug product was repackaged, such drug product's lot number and expiration date are indicated clearly on the package of such repackaged drug; (B) ninety days
or fewer have elapsed from the date of repackaging of such drug product; and (C) a
repackaging log is maintained by the pharmacy in the case of drug products repackaged
in advance of immediate needs.
(3) No drug products dispensed in a bulk dispensing container may be returned to
the vendor pharmacy.
(c) Each long-term care facility shall establish procedures for the return of unused
drug products to the vendor pharmacy from which such drug products were purchased.
(d) The Department of Social Services (1) shall reimburse to the vendor pharmacy
the reasonable cost of services incurred in the operation of this section, as determined
by the commissioner, and (2) may establish procedures, if feasible, for reimbursement
to non Medicaid payors for drug products returned pursuant to this section.
(e) The Department of Consumer Protection, in consultation with the Department
of Social Services, shall adopt regulations, in accordance with the provisions of chapter
54, which shall govern the repackaging and labeling of drug products returned pursuant
to subsections (a) and (b) of this section. The Department of Consumer Protection shall
implement the policies and procedures necessary to carry out the provisions of this
section until January 1, 2002, while in the process of adopting such policies and procedures in regulation form, provided notice of intent to adopt the regulations is published
in the Connecticut Law Journal within twenty days after implementation.
(June Sp. Sess. P.A. 00-2, S. 37, 53.)
History: June Sp. Sess. P.A. 00-2 effective July 1, 2000.
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(b) Notwithstanding any provision of the general statutes or the regulations of Connecticut state agencies, the Department of Social Services shall establish a demonstration
project which shall provide specialized long-term care for chronically disabled and dependent patients with traumatic head, brain or spinal cord injuries, who are ventilator
dependent, or suffer severe neurological dysfunction and disorders, including multiple
sclerosis, cerebral palsy and such other similar chronic medical conditions as the Commissioner of Social Services deems appropriate.
(c) Said demonstration project shall be conducted in no more than three facilities,
involving up to seventy-five existing licensed beds, that are specifically equipped and
staffed for such purpose. Said demonstration project shall supplement a facility's scope
of services and, if necessary, modify its physical environment to improve access for
patients with specific chronic medical conditions, provide care that meets such patient's
specialized health, social and environmental needs, particularly those of children and
young adults, and evaluate the optimum design for such programs.
(d) Said demonstration project shall establish rates based on costs related to patient
care. Said demonstration project shall be designed for this specific patient population
and shall not necessarily require separate facilities or special units.
(e) Said demonstration project shall address the different needs of (1) a child or
young adult with specific chronic medical conditions, and (2) an elderly patient in either
a hospital or a skilled nursing home.
(f) Said demonstration project shall restrict direct patient ventilator care to appropriately licensed health care providers.
(g) The commissioner shall issue a request for proposals for acute care hospitals,
chronic disease hospitals and skilled nursing homes interested in participating in said
demonstration project. Proposals shall identify: (1) The population to be served; (2) the
specific services to be provided and budgeted for; (3) the number of existing licensed
beds to be designated for said demonstration project; and (4) the evaluation process of
said demonstration project. In approving said demonstration project, the commissioner
shall consider, to the extent possible, geographic distribution.
(h) The commissioner may increase the number of facilities participating in the
demonstration project from three to four on or after January 1, 2000. The commissioner
may issue a request for proposals or select from respondents to a request for proposals
issued to select the initial three demonstration project facilities.
(P.A. 97-142; June 18 Sp. Sess. P.A. 97-2, S. 150, 165; P.A. 99-279, S. 24, 45.)
History: June 18 Sp. Sess. P.A. 97-2 amended Subsec. (c) by expanding the demonstration project from two to three
facilities, effective July 1, 1997; P.A. 99-279 amended Subsec. (c) to increase the number of licensed beds from sixty to
seventy-five and added a new Subsec. (h) allowing the commissioner to increase the number of facilities participating in
the demonstration project from three to four on or after January 1, 2000, and to issue a request for proposals or select from
respondents to a request for proposals to select the initial three facilities, effective July 1, 1999.
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