You asked (1) if the nursing home user fee is still in effect and (2) whether a home that is part of a continuing care retirement community (CCRC) that is exempt from the fee would be subject to it if new owners began accepting Medicare revenue.

The nursing home resident user fee, established in 2005, is still in effect. The 2007 legislature amended it to reflect changes at the federal level (lowered the maximum fee from 6% to 5. 5%), but otherwise left it unchanged. The law continues to exempt from the fee nursing homes that are owned and operated by CCRCs (CGS § 176 – 323).

Homes within CCRCs that are registered with the Department of Social Services (DSS) as of May 1, 2005 are exempt from the fee, regardless of whether they accept Medicaid. Homes part of CCRCs that registered after that date are also exempt, but the law says nothing about their Medicaid participation. As a practical matter, CCRCs registering after that date would probably not participate in Medicaid. This is because a statutory moratorium generally prohibits new nursing home beds in the state, except for those associated with CCRCs, provided the CCRCs do not participate in the Medicaid program. Those few CCRCs that participated in Medicaid before the CON moratorium passed in the early 1990s continue to participate and their nursing home beds are exempt from the fee.

The provision exempting CCRCs from the user fee mentions nothing about Medicare. It states simply that if DSS receives a federal waiver (which it did), it can exempt from the fee any nursing home that is owned and operated by the legal entity that is registered with the department as a CCRC. So if a home that is part of a CCRC began accepting Medicare revenue, it would have no bearing on the exemption. But if the home's ownership changed to a legal entity different from the one registered with DSS, the exemption could potentially be jeopardized. Currently, 13 of the state's 15 nursing home associated with CCRCs are exempt from the user fee—the other two have owners-operators who are different from the legally registered entities.

RC: dw