Human Services Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-5476

Title:

AN ACT EXPANDING CONSUMER CHOICE FOR SKILLED NURSING CARE AT HOME.

Vote Date:

3/22/2012

Vote Action:

Joint Favorable Substitute

PH Date:

3/13/2012

File No.:

SPONSORS OF BILL:

Human Services Committee

REASONS FOR BILL:

To expand consumer options for continuous, skilled nursing care at home.

The substitute language for HB 5476

Changes the language in the bill from a Medicaid waiver program to a state funded pilot program for up to ten people in Fairfield County.

RESPONSE FROM ADMINISTRATION/AGENCY:

RODERICK L. BREMBY, Commissioner, Department of Social Services, gave testimony in opposition of the bill. The Commissioner stated, “The bill would establish a pilot program under a Section 1115 Medicaid waiver to allow individuals receiving continuous skilled nursing services in their home to have the option of directly hiring registered and licensed practical nurses rather than the state paying for the services through a home health agency. The Department would be required to create a methodology and fee to certify nurses to provide such skilled care. Certification requirements would include, but not be limited to, nurses who (1) have a current affiliation with an accredited hospital or other nursing facility; (2) have a current Medicaid provider number; (3) have at least one year of experience providing such care; (4) certify, in writing, that they shall not terminate care without providing a two-week written notice to the consumer, except in cases of documented severe illness, injury or death; (5) agree to implement a physician-approved plan of care; (6) submit to a criminal background check and demonstrate no convictions and (7) certify in writing, that they shall assist the consumer in obtaining replacement care in the event the nurse is unable to work for any reason. The Department would also be required to survey Medicaid recipients living at home with continuous skilled nursing services to determine whether they have experienced interruptions of service and the reasons for such interruptions, and to determine the staffing levels of home health agencies and the salaries these agencies pay their nursing staff.”

“The Department funds nursing services provided to individuals in their homes by enrolling and paying home health care agencies as providers. Home health care agencies employ registered nurses, licensed practical nurses and home health aides, in addition to physical and occupational therapists. Home health care agencies are licensed by the Department of Public Health pursuant to state statute ( 19a-490 and 19a-491) and state regulations ( 19-13-D66 to -D79 and 17b-262-724 to -735, inclusive).”

“Under federal law, nursing services performed as a component of home health services must be provided “on a part-time or intermittent basis by a home health agency . . . or if there is no agency in the area, a registered nurse” who is licensed to practice in the state and who meets other specific requirements outlined in the law (42 C.F.R. 440.70(b)(1)).”

“While federal law permits states to cover private duty nursing without the use of licensed home health care agencies, the Department currently limits coverage to services provided by home health care agencies because such agencies are well regulated and afford the most protection for clients. For example, in the event that a nurse or other caregiver is unable to cover a shift one day, the home health care agency is responsible for arranging for coverage. Furthermore, if the home health care agency chooses to discontinue providing services to a client, they may do so only with proper notice and must continue service until another provider is identified.”

“The Department has opposed legislation similar to this bill in the past because it removes the protections clients have if their regular nurse cannot provide service, or if the agency wishes to discontinue services. In both cases, the agency is required to maintain services until another care provider is identified. Few clients, under the best of circumstances, have the resources to recruit and hire their own nurses. Similarly, the Department does not have the resources to recruit, certify and maintain a list of nurses interested in providing such services, nor does it have the resources to police the employment policies of home health agencies, a role more appropriate to the Department of Public Health. The language of Section 1(b) suggests that nurses employed by hospitals and nursing facilities could be enlisted to certify for the pilot, however, since these employers struggle themselves to maintain their cadres of nursing staff, it is doubtful that they would either welcome or cooperate with this pilot.”

“The pilot would also allow LPNs to practice without the supervision of an RN, which would require significant changes to Connecticut's Nurse Practice Act. A further review of this provision needs to be undertaken by the Department of Consumer Protection and the Department of Public Health.”

“Lastly, the bill requires a survey of Medicaid clients requiring continuous skilled nursing services in their homes to assess the frequency that their services are interrupted. The Department is not opposed to such a measure and will endeavor to conduct such a survey. This study can be conducted administratively, therefore legislation is not required.”

“It is our understanding that this legislation is being proposed to address the needs of one individual. However, this change to our services would require the department to seek a Medicaid waiver from the federal Centers for Medicare and Medicaid services, a long and arduous process which consumes limited resources. Moreover, if approved by CMS, this change would not apply to just this one individual but to all Medicaid recipients. Thus, we do not support the bill.”

LILE GIBBONS, House of Representatives, Ranking Member Human Services Committee: Representative Gibbons testified in support of this bill. In her testimony she states, “The bill would increase the pool of qualified nurses by raising the hourly rates many now receive under the state's agency-based system. This proposal could ultimately be a cost savings for the state as the initial hourly rate for a nurse would be less that the hourly rate through the agency, (but more than the nurse's current take-home pay).”

“I believe the current bill addresses these certification, termination and cost concerns. The state would take on the initial administrative burdens and costs of establishing a certification system, a registry of such nurses and a reimbursement plan to pay them as independent Medicaid providers (something already in place for other health care professionals). But the cost would be mitigated in the long run via hourly rates lower that they are now for some consumers.”

“Lastly the bill asks the DSS Commissioner to conduct a survey of Medicaid recipients receiving continuous, skilled nursing care at home to collect data on consumers requesting direct hires and on agencies providing home health care.”

NATURE AND SOURCES OF SUPPORT:

DONNA BARNICK, RRT-NPS, Licensed Respiratory Therapist: Ms. Barnick submitted testimony in support of this bill. In her statement she requested that the bill be amended to include licensed respiratory therapists as those who can provide services under this pilot project.

GERI BOUCHARD, RRT President of Conecticut Society for Respiratory Care (CSRC). Ms. Bouchard submitted testimony in support of this bill and requests the same amendments to the bill as Donna Barnick. In addition, in her testimony she provided additional sources of Clinical Practice Guidelines (CPGs), respiratory therapists who are specifically able to provide ventilator care.

Echoing Bouchard's testimony were:

DOROTHY ALVAREZ, RRT.

PAUL TRIGILIA, RRT, RCP, MHP, Manager Respiratory Services Lawrence & Memorial Hospital.

ANTONIO J. BUCKNER, RRT, Treasurer of Connecticut Society for Respiratory Care (CSRC).

CONNIE DILLS, MBA, RRT, RPFT Vice President of External Affairs, Connecticut Society for Respiratory Care (CSRC).

PETER W. KENNEDY, Phd., RRT Respiratory Care Program Director.

MAUREEN C. PARMELEE, RCP, RRT, Delegate Connecticut Society for Respiratory Care (CSRC).

FRANK R. SALVATORE Jr., RRT, MBA, FAARC.

KERRY McNIVEN, MS, RRT , Professor, Dir. Of Clinical Education Resp. Care Program, Manchester Community College.

NATURE AND SOURCES OF OPPOSITION:

RODERICK L. BREMBY, Commissioner, Department of Social Services, gave testimony in opposition of the bill.

MAG MORELLI, President of LeadingAge Connecticut: Ms. Morelli testified in opposition of this bill. In her testimony she expressed concerns about why the current licensed home care field can not meet the consumer demand, how his proposal changes the current scope and elements in the health care field for nursing homes and the creation of a central registry raises questions regarding whether the registry will be exclusive and whether consumers would be able to choose outside of the registry. She states, “At this point the bill raises too many concerns and we are not in a position to support this bill.”

Reported by: Dionne Abrams

Date: April 10, 2012