Connecticut Seal

General Assembly


Raised Bill No. 5476

February Session, 2012


LCO No. 2052



Referred to Committee on Human Services


Introduced by:





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

Section 1. (NEW) (Effective July 1, 2012) (a) The Commissioner of Social Services shall apply for a federal Medicaid waiver pursuant to Section 1115 of the Social Security Act to establish a pilot program to give Medicaid recipients, who are receiving continuous, skilled nursing care at home, the option of directly hiring private duty nurses. For purposes of this section, skilled nursing care means complex medical care provided by a licensed practical nurse or registered nurse, including, but not limited to, treating patients on respiratory assistance via a ventilator. "Continuous" means a minimum of four consecutive hours of skilled nursing care per day.

(b) The commissioner shall establish a process whereby nurses are certified by the Department of Social Services to provide such skilled care. The commissioner may establish a reasonable fee payable to the Department of Social Services by any nurse who applies for certification. Certification requirements shall include, but not be limited to, that nurses (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.

(c) The commissioner shall establish a central registry of such certified nurses and shall (1) post such registry on the department's Internet web site, and (2) provide such list to consumers who make inquiries by telephone.

(d) The commissioner shall establish (1) a system to compensate individual certified nurses who have obtained a Medicaid provider number, and (2) a rate structure commensurate with the specialized experience such nurses possess. Under the rate structure, for the fiscal year ending June 30, 2013, (A) registered nurses certified under the program shall be paid a minimum of thirty-eight dollars per hour, and (B) licensed practical nurses certified under the program shall be paid a minimum of twenty-eight dollars per hour.

(e) The pilot program shall end five years after inception, and the commissioner shall apply for federal approval to renew the program at that time. The program shall be structured so that net federal costs under the program do not exceed net costs the federal government would have incurred without the pilot program.

(f) At least annually, the Department of Social Services or a health-care provider licensed by the department shall screen each interested consumer for competency to manage his or her care. The consumer, a legal guardian or other designated able adult, shall certify, in writing, that he or she is responsible for scheduling care, including back-up support should an assigned nurse be unable to work in the event of severe illness, injury or death.

(g) The nurses certified for said pilot program shall work within the hourly limits of (1) the physician-directed care plan approved by the Department of Social Services for the consumer, (2) the physician-directed care plan developed by any licensed agency which has contracted with the department for the consumer's care, or (3) a care plan developed by the consumer's physician and approved by the Department of Social Services.

(h) The consumer may hire private duty nurses to complement care provided by a licensed agency or to provide sole coverage for all hours approved for Medicaid coverage under the physician-approved care plan.

Sec. 2. (NEW) (Effective July 1, 2012) (a) Not later than October 1, 2012, the commissioner shall conduct a survey of Medicaid recipients receiving continuous, skilled nursing care at home and of the licensed home care agencies that serve them to determine (1) the number of recipients receiving such care at home; (2) the number of times each consumer has had his or her care terminated by any such agency over the past two years and the reasons given by the agency for such termination; (3) the number of nurses, experience and degree level hired by any such agency, and the percentage such nurses comprise of the total staff; and (4) the hourly rate of pay and pay differential, if any, provided to such nurses as compared to other nursing staff hired by each agency.

(b) Not later than January 1, 2013, the commissioner shall submit a report on the survey results, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to human services.

Sec. 3. Section 20-87a of the 2012 supplement to the general statutes is amended by adding subsection (e) as follows (Effective July 1, 2012):

(NEW) (e) In the case of a registered or licensed practical nurse certified as an independent Medicaid provider of skilled nursing care in the state of Connecticut, the practice of nursing includes, but is not limited to, executing the medical regimen for a Medicaid recipient who is receiving continuous, skilled nursing care at home under a care plan directed by a physician. A licensed practical nurse who is a state-certified Medicaid provider of skilled nursing services may execute such regimen regardless of whether the licensed practical nurse is directly supervised by a registered nurse.

This act shall take effect as follows and shall amend the following sections:

Section 1

July 1, 2012

New section

Sec. 2

July 1, 2012

New section

Sec. 3

July 1, 2012


Statement of Purpose:

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

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]