File No. 322

House of Representatives, April 10, 2012

The Committee on Public Health reported through REP. RITTER, E. of the 38th Dist., Chairperson of the Committee on the part of the House, that the substitute bill ought to pass.

AN ACT CONCERNING REGULATIONS RELATING TO HOSPICE CARE.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 19a-122b of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) Notwithstanding the provisions of chapters 368v and 368z, an organization licensed as a hospice [pursuant to the Public Health Code] by the Department of Public Health or certified as a hospice pursuant to 42 USC 1395x, shall be authorized to operate a hospice facility, including a hospice residence, for the purpose of providing hospice services for terminally ill persons [, for the purpose of providing hospice home care arrangements including, but not limited to, hospice home care services and supplemental] who are in need of hospice home care or hospice inpatient services. Such arrangements shall be provided to those patients who would otherwise receive such care from family members. The facility or residence shall provide a homelike atmosphere for such patients for a time period deemed appropriate for home health care services under like circumstances. Any hospice that operates a facility or residence pursuant to the provisions of this section shall cooperate with the Commissioner of Public Health to develop standards for the licensure and operation of such [homes] facility or residence.

(b) On and after January 1, 2008, any organization seeking initial licensure as a hospice by the Department of Public Health shall (1) agree to provide hospice care services for terminally ill persons on a twenty-four-hour basis in all settings including, but not limited to, a private home, nursing home, residential care home or specialized residence that provides supportive services, and (2) present to the department satisfactory evidence that such organization has the necessary qualified personnel to provide services in such settings.

(c) No organization may use the title "hospice" or "hospice care program" or make use of any title, words, letters or abbreviations indicating or implying that such organization is licensed to provide hospice services unless such organization is licensed to provide such services by the Department of Public Health and certified as a hospice pursuant to 42 USC 1395x.

Sec. 2. Subsection (a) of section 19a-490 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) "Institution" means a hospital, residential care home, health care facility for the handicapped, nursing home, rest home, home health care agency, homemaker-home health aide agency, mental health facility, assisted living services agency, substance abuse treatment facility, outpatient surgical facility, short-term hospital special hospice, hospice facility, an infirmary operated by an educational institution for the care of students enrolled in, and faculty and employees of, such institution; a facility engaged in providing services for the prevention, diagnosis, treatment or care of human health conditions, including facilities operated and maintained by any state agency, except facilities for the care or treatment of mentally ill persons or persons with substance abuse problems; and a residential facility for the mentally retarded licensed pursuant to section 17a-227 and certified to participate in the Title XIX Medicaid program as an intermediate care facility for the mentally retarded;

Sec. 3. Subsection (a) of section 19a-495 of the 2012 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The Department of Public Health shall, after consultation with the appropriate public and voluntary hospital planning agencies, establish classifications of institutions. The department shall [, in the Public Health Code,] adopt, amend, promulgate and enforce such regulations based upon reasonable standards of health, safety and comfort of patients and demonstrable need for such institutions, with respect to each classification of institutions to be licensed under sections 19a-490 to 19a-503, inclusive, as amended by this act, including their special facilities, as will further the accomplishment of the purposes of said sections in promoting safe, humane and adequate care and treatment of individuals in institutions. The department shall adopt such regulations, in accordance with chapter 54, concerning home health care agencies and homemaker-home health aide agencies.

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note

State Impact:

Note: GF=General Fund

Municipal Impact: None

Explanation

The bill results in an anticipated General Fund revenue gain of approximately $2,000 in FY 13 and $1,000 in FY 14 from the licensing of two short-term hospital special hospices or hospice facilities in FY 13 and one in FY 14. These two categories of a health care institution are added under the bill, extending to these entities statutory requirements for health care institutions. As such, these institutions would be required to be licensed by the Department of Public Health (DPH), resulting in a General Fund revenue gain from associated fees. As the number of such facilities seeking licensure is small, approximately three facilities every two years, no cost to DPH is anticipated to issue these licenses.

The fee for hospices licensure is $940 and $7.50 per bed biannually.¹ It is estimated that there are three short-term hospital special hospices or hospice facilities that would seek licensure in the two fiscal years following passage of this bill. Assuming an average of 9 beds per facility and two such facilities seeking licensure in FY 13 and one seeking licensure in FY 14, approximately $2,000 in General Fund revenue gain is anticipated in FY 13 and approximately $1,000 is anticipated in FY 14.

The Out Years

The fiscal impact identified above would continue into the future subject to the number of short-term hospital special hospices and hospice facilities licensed by DPH.

OLR Bill Analysis

sHB 5499

AN ACT CONCERNING REGULATIONS RELATING TO HOSPICE CARE.

SUMMARY:

Current law authorizes a Department of Public Health- (DPH) licensed or Medicare-certified hospice to operate a specialized residence for the terminally ill that provides hospice home care and supportive services. The bill allows a hospice to also operate a “hospice facility” that provides hospice home care or hospice inpatient services. (The bill does not distinguish between a facility and a residence.)

The bill extends to a hospice facility, the current requirement that a residence (1) provide a home-like atmosphere for patients for an appropriate time period and (2) cooperate with the DPH commissioner to develop licensure and operational standards.

The bill also adds to the statutory definition of health care “institution” a “short-term hospital special hospice” and “hospice facility,” but not a “hospice.” These terms are not defined in statute but they appear in the department's proposed hospice regulations (see BACKGROUND). Thus, the bill extends to these entities statutory requirements for health care institutions, regarding, among other things, workplace safety committees, access to patient records, disclosure of HIV-related information, and smoking prohibitions.

The law requires DPH to consult with appropriate public and voluntary hospital planning agencies to establish classifications of licensed health care institutions. The bill maintains the current requirement that the department adopt, amend, promulgate, and enforce associated regulations, but removes the requirement that it do so only in the Public Health Code.

EFFECTIVE DATE: Upon passage

BACKGROUND

DPH Proposed Hospice Regulations

Currently, DPH regulates hospices that are considered free-standing or established as a distinct unit within a health care facility (e.g., inpatient hospice facilities). DPH regulations define “hospice” under the broader category of “short-term hospital special hospice.” Inpatient hospice facilities must meet a variety of requirements concerning physical plant, administration, staffing, records, and infection control. A home care program offered by an institutionally based hospice is also subject to DPH regulations. The program must address the physical, psychological, and spiritual needs of the patient and family and provide services 24 hours a day, seven days a week.

In March 2011, DPH published notice of its intent to amend these regulations to create a second licensure category for inpatient hospice facilities called “hospice facility.” The proposal keeps the existing “short-term hospital special hospice” licensure category so that facilities that want to continue to provide hospice services at a hospital level of care may do so. The new “hospital facility” licensure category would allow entities to create new facilities under regulations based on Medicare's minimum regulatory requirements for inpatient hospital facilities (42 CFR § 418.110). (These requirements are less stringent than the department's current short-term hospital special hospice regulations.)

DPH held a public hearing on the proposed regulations in April 2011. The proposal was submitted to the attorney general's office for final review in March 2012 after which it will be submitted to the Regulation Review Committee for legislative approval.

COMMITTEE ACTION

Public Health Committee

Joint Favorable Substitute

¹ Currently, there is one hospice licensed in Connecticut.