You asked about state laws pertaining to nursing home waiting lists.

SUMMARY

State law requires nursing homes receiving state funds to admit applicants on a first-come, first-served basis, regardless of their source of payment, with several exceptions. Homes are required to keep waiting lists and must admit applicants in the order in which they are received, unless the law allows otherwise. Homes must send a receipt to each applicant who requests to be placed on the waiting list that indicates the time and date of the request (CGS § 19a-533).

The Department of Social Services (DSS) can reduce the home's Medicaid reimbursement for one year for each violation of the waiting list law. Initial violations result in a 0.25% reduction and subsequent violations a 1% reduction (CGS § 19a-533(d)).

EXCEPTIONS

There are certain exceptions to the nursing home waiting list law. If more than 70% of a home's residents are Medicaid recipients, it does not have to admit a Medicaid patient when a bed opens up during the next six months. But, a bed cannot be held open for more than 30 days. A home taking advantage of this waiver must notify DSS and the regional long-term care ombudsman on a quarterly basis (CGS § 19a-533(f)). A home may also bypass the waiting list when a private room becomes available (CGS §19a-533(g)).

In addition, a home may bypass the waiting list for one of the following reasons, provided it does so uniformly, consistently, and regardless of the applicant's payment source:

1. an application is incomplete;

2. an applicant fails to meet the Public Health Code's level of care requirements;

3. a resident is returning from a hospital stay;

4. a resident is being transferred for medical reasons from one level of care to another in the same home;

5. an applicant needs protective services;

6. the Department of Public Health refers a resident to the home due to decertification or license revocation at another home;

7. the home is granted permission to withdraw from the Medicaid program;

8. an applicant has a contract with a continuing care retirement community or resides in a residential facility that offers health and other services and is owned or operated by the nursing home's owner or operator;

9. a designated number of beds are set aside for specialized care (e.g. Alzheimer's disease), short-term rehabilitation, hospice, or respite care;

10. the applicant's spouse is a resident;

11. the applicant was discharged from the home within 15 days of his or her request for re-admission;

12. a municipality owns and operates the facility and has a residency requirement;

13. the facility offers specialized medical treatments (a facility must designate a maximum number of beds);

14. the facility is owned by, operated by, or affiliated with a tax-exempt religious or fraternal organization that exists to serve its members;

15. the facility is owned or operated by a tax-exempt, nonstock, nonprofit corporation which benefits the municipality in which it is located and receives grants or donations from that municipality; or

16. the facility has a contract with a hospital allowing the hospital to discharge patients directly to the home (up to 15% of the facility's beds) (Conn. Agency Regulations, § 17-311-209).

A home that passes over someone's name on a waiting list must note the date on the list, indicate why that person was not admitted, and maintain and make available supportive documentation.

REMOVING A NAME FROM A WAITING LIST

Generally, a nursing home may not remove a person's name from its waiting list until that person is admitted, dies, or requests to have his or her name removed. However, a home may remove someone who has not responded to phone calls and letters if it (1) waits at least 90 days from the date the name was originally placed on the list; (2) writes to the individual and his or her designee, if the applicant requests it, asking whether he or she wishes to remain on the list; and receive a (3) response within 30 days. Likewise, the law allows homes to send an annual waiting list placement continuation letter to anyone who has been on a list for at least 90 days, and his or her designee. If the person does not respond in 30 days, the home may remove the name from its waiting list (CGS § 19a-533(b)(1)).

ND:ts