OLR Bill Analysis

sSB 559 (File 599, as amended by Senate “A”)*

AN ACT CONCERNING A PILOT PROGRAM FOR SMALL HOUSE NURSING HOMES.

SUMMARY:

This bill directs the Department of Social Services (DSS) commissioner to establish a pilot program, within existing resources, to help develop up to 10 small house nursing homes in the state. (The bill does not specify how DSS must provide assistance. ) The goals of the pilot are to improve the quality of life for nursing home residents and provide nursing home care in home-like, rather than institutionalized, settings. The bill requires the commissioner to develop any program guidelines for design specifications and requirements by October 1, 2008.

An applicant must be a licensed nursing home. It must submit to DSS (1) a description of the proposed project, (2) information on the applicant's financial and technical capacity to undertake the project, (3) a project budget, and (4) any additional information the commissioner determines necessary.

The bill requires each participating home to seek Medicare and Medicaid certification. It authorizes the commissioner to establish additional criteria for homes and requires him to make all guidelines and criteria available to applicants.

When reviewing and selecting proposals, the commissioner must consult with the Long-Term Care Planning Committee and consider (1) the project's location in relation to other nursing homes in the service area, (2) the service area's need for the project, and (3) other factors the commissioner deems relevant. The commissioner must give priority to proposals that convert existing nursing homes into small house nursing homes or that use energy efficiency technology, including fuel cells.

The bill also exempts a small house nursing home participating in the pilot from certificate of need (CON) requirements and processes.

Finally, it exempts from the current moratorium on additional nursing home beds the relocation of up to 60 new or existing Medicaid-certified beds from a licensed nursing home in a city with a 2004 estimated population of 125,000 to another location within that city. (No city has an estimated population of 125,000; New Haven comes the closest to meeting this criterion with 125,012. ) The bill apparently applies only to existing beds since it is not clear how new beds can be relocated.

*Senate Amendment “A” (1) makes clarifying changes to the definition of “small house nursing home,” (2) limits eligibility to participate in the pilot program to nursing homes instead of any long term care provider, and (3) adds the exemption to the nursing home moratorium.

EFFECTIVE DATE: July 1, 2008

DEFINITIONS

Small House Nursing Home Defined

The bill defines a “small house nursing home” as a facility that:

1. consists of one or more units that are designed or modeled as a private home,

2. houses a maximum of 10 individuals in each unit,

3. includes private rooms and bathrooms,

4. provides an increased role for support staff in resident care,

5. incorporates a philosophy of individualized care, and

6. is licensed as a nursing home.

BACKGROUND

Certificate of Need for Nursing Homes

By law, any nursing home facility intending to do any of the following must apply for a CON from DSS:

1. transfer all or part of its ownership or control before initial licensure,

2. introduce any additional service or function into its program of care or expand an existing service or function,

3. terminate a service or decrease substantially its total bed capacity,

4. make a capital expenditure over $ 1 million that increases the facility's size by the greater of over 5,000 square feet or 5% of the existing footage,

5. make a capital expenditure of $ 2 million, or

6. acquire major medical equipment requiring a capital expenditure of over $ 400,000.

The law establishes a moratorium on CONs for additional nursing home beds until June 30, 2012. Exceptions are provided for:

1. beds restricted to use by patients with AIDS or traumatic brain injury;

2. beds associated with a continuing care facility that guarantees life care for its residents;

3. Medicaid-certified beds being relocated from one licensed nursing facility to another, provided (a) the availability of beds in an area of need will not be adversely affected, (b) the relocation will not result in increased state expenditures, and (c) the relocation reduces the number of nursing facility beds in the state;

4. a request for up to 20 beds from a nursing facility that does not participate in Medicaid or Medicare and demonstrates the financial ability to provide lifetime nursing home services to its residents without such participation; and

5. a request for up to 20 beds associated with a free standing facility authorized to provide hospice care for terminally ill people (CGS 17b-354).

“Small House” and “Green House” Nursing Home Models

Generally, “green houses” or “small houses” are “deinstitutionalized” nursing homes. They are self-contained dwellings for seven to 10 residents requiring nursing home levels of care. They incorporate physical design changes such as private rooms and bathrooms, a residential-style kitchen, a communal dining area, and accessible outdoor space. They avoid institutional elements. A cluster of green houses, in effect, forms a nursing facility.

COMMITTEE ACTION

Human Services Committee

Joint Favorable Substitute Change of Reference

Yea

19

Nay

0

(03/13/2008)

Appropriations Committee

Joint Favorable Substitute

Yea

51

Nay

0

(04/01/2008)