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,
to chronic disease hospitals associated with chronic and convalescent nursing homes,
to rest homes with nursing supervision, 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 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 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. Notwithstanding any provision of this section, the Commissioner of Social
Services may, within available appropriations, provide an interim rate increase for a
licensed chronic and convalescent nursing home or a rest home with nursing supervision
for rate periods no earlier than April 1, 2004, only if the commissioner determines that
the increase is necessary to avoid the filing of a petition for relief under Title 11 of the
United States Code; imposition of receivership pursuant to sections 19a-541 to 19a-549, inclusive; or substantial deterioration of the facility's financial condition that may
be expected to adversely affect resident care and the continued operation of the facility,
and the commissioner determines that the continued operation of the facility is in the
best interest of the state. The commissioner shall consider any requests for interim rate
increases on file with the department from March 30, 2004, and those submitted subsequently for rate periods no earlier than April 1, 2004. When reviewing a rate increase
request the commissioner shall, at a minimum, consider: (1) Existing chronic and convalescent nursing home or rest home with nursing supervision utilization in the area and
projected bed need; (2) physical plant long-term viability and the ability of the owner
or purchaser to implement any necessary property improvements; (3) licensure and
certification compliance history; and (4) reasonableness of actual and projected expenses, but shall not consider the immediate profitability of the operation of the facility.
No rate shall be increased pursuant to this subsection in excess of one hundred fifteen
per cent of the median rate for the facility's peer grouping, established pursuant to
subdivision (2) of subsection (f) of this section, unless recommended by the commissioner and approved by the Secretary of the Office of Policy and Management after
consultation with the commissioner. Such median rates shall be published by the Department of Social Services not later than April first of each year. In the event that a facility
granted an interim rate increase pursuant to this section is sold or otherwise conveyed
for value to an unrelated entity less than five years after the effective date of such rate
increase, the rate increase shall be deemed rescinded and the department shall recover
an amount equal to the difference between payments made for all affected rate periods
and payments that would have been made if the interim rate increase was not granted.
The commissioner may seek recovery from payments made to any facility with common
ownership. With the approval of the Secretary of the Office of Policy and Management,
the commissioner may waive recovery and rescission of the interim rate for good cause
shown that is not inconsistent with this section, including, but not limited to, transfers
to family members that were made for no value. The commissioner shall provide written
quarterly reports to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state
agencies and to the select committee of the General Assembly having cognizance of
matters relating to aging, that identify each facility requesting an interim rate increase,
the amount of the requested rate increase for each facility, the action taken by the commissioner and the secretary pursuant to this subsection, and estimates of the additional
cost to the state for each approved interim rate increase. Notwithstanding any provision
of the general statutes, on and after July 1, 2005, the commissioner shall not provide an
interim rate increase for a licensed chronic and convalescent nursing home or a rest
home with nursing supervision. Nothing in this subsection shall prohibit the commissioner from increasing the rate of a licensed chronic and convalescent nursing home or
a rest home with nursing supervision for allowable costs associated with facility capital
improvements or increasing the rate in case of a sale of a licensed chronic and convalescent nursing home or a rest home with nursing supervision, pursuant to subdivision (16)
of subsection (f) of this section, if receivership has been imposed on such home.
(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 adopted 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 provided for in regulations adopted 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) of this section, (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) of this section 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.
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, each
facility shall receive a rate that is two and one-half per cent more than the rate the facility
received in the prior fiscal year. For the fiscal year ending June 30, 2003, each facility
shall receive a rate that is two per cent more than the rate the facility received in the
prior fiscal year, except that such increase shall be effective January 1, 2003, and such
facility rate in effect for the fiscal year ending June 30, 2002, shall be paid for services
provided until December 31, 2002, except any facility that would have been issued a
lower rate effective July 1, 2002, than for the fiscal year ending June 30, 2002, due to
interim rate status or agreement with the department shall be issued such lower rate
effective July 1, 2002, and have such rate increased two per cent effective June 1, 2003.
For the fiscal year ending June 30, 2004, rates in effect for the period ending June 30,
2003, shall remain in effect, except any facility that would have been issued a lower
rate effective July 1, 2003, than for the fiscal year ending June 30, 2003, due to interim
rate status or agreement with the department shall be issued such lower rate effective
July 1, 2003. For the fiscal year ending June 30, 2005, rates in effect for the period
ending June 30, 2004, shall remain in effect until December 31, 2004, except any facility
that would have been issued a lower rate effective July 1, 2004, than for the fiscal year
ending June 30, 2004, due to interim rate status or agreement with the department shall
be issued such lower rate effective July 1, 2004. Effective January 1, 2005, each facility
shall receive a rate that is one per cent greater than the rate in effect December 31, 2004.
The Commissioner of Social Services shall add fair rent increases to any other rate
increases 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 totalled; (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.
(16) The interim rate established to become effective upon sale of any licensed
chronic and convalescent home or rest home with nursing supervision for which a receivership has been imposed pursuant to sections 19a-541 to 19a-549, inclusive, shall not
exceed the rate in effect for the facility at the time of the imposition of the receivership,
subject to any annual increases permitted by this section; provided if such rate is less
than the median rate for the facility's peer grouping, as defined in subdivision (2) of this
subsection, the Commissioner of Social Services may, in the commissioner's discretion,
establish an increased rate for the facility not to exceed such median rate unless the
Secretary of the Office of Policy and Management, after review of area nursing facility
bed availability and other pertinent factors, authorizes the Commissioner of Social Services to establish a rate higher than the median rate.
(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. For the fiscal year ending June
30, 2002, rate period, the Commissioner of Social Services shall increase the inflation
adjustment for rates made in accordance with subsection (p) of section 17-311-52 of
the regulations of Connecticut state agencies to update allowable fiscal year 2000 costs
to include a three and one-half per cent inflation factor. For the fiscal year ending June
30, 2003, rate period, the commissioner shall increase the inflation adjustment for rates
made in accordance with subsection (p) of section 17-311-52 of the regulations of Connecticut state agencies to update allowable fiscal year 2001 costs to include a one and
one-half per cent inflation factor, except that such increase shall be effective November
1, 2002, and such facility rate in effect for the fiscal year ending June 30, 2002, shall
be paid for services provided until October 31, 2002, except any facility that would have
been issued a lower rate effective July 1, 2002, than for the fiscal year ending June 30,
2002, due to interim rate status or agreement with the department shall be issued such
lower rate effective July 1, 2002, and have such rate updated effective November 1,
2002, in accordance with applicable statutes and regulations. For the fiscal year ending
June 30, 2004, rates in effect for the period ending June 30, 2003, shall remain in effect,
except any facility that would have been issued a lower rate effective July 1, 2003, than
for the fiscal year ending June 30, 2003, due to interim rate status or agreement with
the department shall be issued such lower rate effective July 1, 2003. For the fiscal year
ending June 30, 2005, rates in effect for the period ending June 30, 2004, shall remain
in effect until September 30, 2004. Effective October 1, 2004, each facility shall receive
a rate that is five per cent greater than the rate in effect September 30, 2004.
(h) (1) 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, 2002, 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-seven thousand dollars to be annually inflated thereafter in accordance with section 17-311-52 of the regulations of Connecticut state agencies. The rates
for the fiscal year ending June 30, 2002, shall be based upon the increased allowable
salary of an administrator, regardless of whether such amount was expended in the 2000
cost report period upon which the rates are based. 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 Connecticut state agencies shall be increased by two per cent, and beginning with the fiscal year ending June 30, 2002, the
inflation adjustment for rates made in accordance with subsection (c) of said section
shall be increased by one 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. For the fiscal year ending June 30, 2005,
each facility shall receive a rate that is two and one-quarter per cent more than the rate
the facility received in the prior fiscal year, except any facility that would have been
issued a lower rate effective July 1, 2004, than for the fiscal year ending June 30, 2004,
due to interim rate status or agreement with the department shall be issued such lower
rate effective July 1, 2004.
(2) The commissioner shall, upon determining that a loan to be issued to a residential
care home by the Connecticut Housing Finance Authority is reasonable in relation to
the useful life and property cost allowance pursuant to section 17-311-52 of the regulations of Connecticut state agencies, allow actual debt service, comprised of principal,
interest and a repair and replacement reserve on the loan, in lieu of allowed property
costs whether actual debt service is higher or lower than such allowed property costs.
(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; June Sp. Sess. P.A. 01-2, S. 38, 52, 62, 69; June Sp. Sess. P.A. 01-9, S. 95, 129, 131; P.A. 02-89, S. 32; May 9 Sp. Sess. P.A. 02-7, S. 17, 18; P.A. 03-2, S. 17; 03-19, S. 45; June 30 Sp. Sess. P.A. 03-3, S. 50; P.A. 04-5, S. 1; 04-16, S. 11; 04-258, S. 2; May Sp. Sess. P.A. 04-2, S. 86.)
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; June Sp. Sess. P.A. 01-2 amended Subsec. (f)(4) by requiring, for the fiscal
year ending June 30, 2002, that each facility receive a rate increase that is two and one-half per cent more than the rate the
facility received in the prior fiscal year, requiring, for the fiscal year ending June 30, 2003, that each facility receive a rate
increase that is two per cent more than the rate the facility received in the prior fiscal year, deleting provision prohibiting
a facility from receiving a rate, for the fiscal year ending June 30, 2002, and any succeeding fiscal year, 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, and
requiring that commissioner add fair rent increases to any other rate increases established for a facility which has undergone
a material change in circumstances re fair rent, deleting authority of commissioner to exclude fair rent from any rate
increase maximums, amended Subsec. (g) to require commissioner, for fiscal year ending June 30, 2002, rate period, to
increase the inflation adjustment for rates made in accordance with regulations to update allowable fiscal year 2000 costs
to include a three and one-half per cent inflation factor, and for fiscal year ending June 30, 2003, rate period, to increase
the inflation adjustment for rates made in accordance with regulations to update allowable fiscal year 2001 costs to include
a one and one-half per cent inflation factor, and amended Subsec. (h) to increase the allowable base salary of an administrator
of a residential care home from thirty to thirty-seven thousand dollars, beginning with the fiscal year ending June 30, 2002,
require rates for the fiscal year ending June 30, 2002, to be based upon the increased allowable salary of an administrator,
regardless of whether such amount was expended in the 2000 cost report period upon which rates are based, and require
inflation adjustment for rates made in accordance with Subsec. (c) to be increased by one per cent, beginning with the
fiscal year ending June 30, 2002, effective July 1, 2001; June Sp. Sess. P.A. 01-9 amended Subsec. (f)(4) to delete reference
to a rate "increase" and make a technical change, effective July 1, 2001, and revised effective date of June Sp. Sess. P.A.
01-2 but without affecting this section; P.A. 02-89 amended Subsec. (f) to delete "Notwithstanding the provisions of section
17b-344" from the prefatory provision re determination of rates, reflecting the repeal of said section by the same public
act; May 9 Sp. Sess. P.A. 02-7 amended Subsec. (f)(4)(C) by delaying from July 1, 2002, to January 1, 2003, a two per
cent rate increase to Medicaid nursing homes and specifying that facilities whose rate would have been lowered on July
1, 2002, will be issued such lower rate until January 1, 2003, when a two per cent rate increase will take effect and amended
Subsec. (g) by delaying from July 1, 2002, to November 1, 2002, a one and one-half per cent rate increase to intermediate
care facilities for the mentally retarded and specifying that facilities whose rate would have been lowered on July 1, 2002,
will be issued such lower rate until November 1, 2002, at which time the rate will be updated, effective August 15, 2002;
P.A. 03-2 amended Subsec. (f)(4) by delaying from January 1, 2003, to June 1, 2003, a two per cent rate increase for any
facility that would have been paid a lower rate effective July 1, 2002, than for the fiscal year ending June 30, 2002, due
to interim rate status or agreement with the department, effective February 28, 2003; P.A. 03-19 made technical changes
in Subsecs. (g) and (h), effective May 12, 2003; June 30 Sp. Sess. P.A. 03-3 amended Subsec. (a) to limit authority of
commissioner to adjust rates for licensed chronic and convalescent nursing homes or rest homes with nursing supervision
for the fiscal years ending June 30, 2004, and June 30, 2005, made technical changes in Subsec. (e), amended Subsec.
(f)(4)(C) to provide that, with the exception of those facilities which would have received a lower rate, rates for the fiscal
year ending June 30, 2003, remain in effect for the fiscal year ending June 30, 2004, rates for the fiscal year ending June
30, 2004, remain in effect until December 31, 2004, and effective January 1, 2005, facilities shall receive a rate that is one
per cent greater than the rate in effect on December 31, 2004, added new Subsec. (f)(16) re interim rates for licensed
chronic and convalescent homes or rest homes with nursing supervision for which receivership has been imposed and
authority of commissioner to adjust such rates, amended Subsec. (g) to provide that, with the exception of those intermediate
care facilities for the mentally retarded which would have received a lower rate, rates for the fiscal year ending June 30,
2003, remain in effect for the fiscal year ending June 30, 2004, and effective July 1, 2004, such facilities shall receive a
rate that is three-quarters of one per cent greater than the rate in effect on June 30, 2004, amended Subsec. (h) by designating
existing provisions as Subdiv. (1), making technical changes therein, and adding new Subdiv. (2) re authority of commissioner to allow actual debt service on certain loans issued to residential care homes by the Connecticut Housing Finance
Authority, effective August 20, 2003; P.A. 04-5 amended Subsec. (a) to delete limit on commissioner's authority to adjust
rates for licensed chronic and convalescent nursing homes or rest homes with nursing supervision for the fiscal years
ending June 30, 2004, and June 30, 2005, authorize commissioner to provide, within available appropriations, an interim
rate increase for rate periods no earlier than April 1, 2004, subject to enumerated conditions, provide for rescission and
recovery of certain interim rates and payments, and require quarterly reports to certain committees of the General Assembly,
effective March 30, 2004; P.A. 04-16 made technical changes in Subsecs. (a), (c) and (d); P.A. 04-258 amended Subsec.
(g) by eliminating provision re three-quarters of one per cent rate increase to intermediate care facilities for the mentally
retarded effective July 1, 2004, and adding provisions re rates in effect on June 30, 2004, remaining in effect until September
30, 2004, and on October 1, 2004, each facility shall receive a rate that is five per cent greater than the rate in effect on
September 30, 2004, effective July 1, 2004; May Sp. Sess. P.A. 04-2 amended Subsec. (h)(1) by providing that for fiscal
year ending June 30, 2005, each residential care home shall receive a rate that is two and one-quarter per cent more than
the rate the facility received in the prior fiscal year, except that facilities that would have been issued a lower rate effective
on July 1, 2004, shall be issued such lower rate, effective July 1, 2004.
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.
Sec. 17b-341. (Formerly Sec. 17-314a). Self-pay rates regulated. Provider
agreement. Rate adjustments. Appeals. (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. 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.
(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; P.A. 03-268, S. 9.)
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"; P.A. 03-268 amended Subsec. (a) by deleting provision which required commissioner to report facility self-pay
rates to human services committee by December 31, 1992.
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. 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.
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.
(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;
June Sp. Sess. P.A. 01-9, S. 110, 131; May 9 Sp. Sess. P.A. 02-7, S. 23; P.A. 04-258, S. 17.)
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 comm