Public Health Committee
JOINT FAVORABLE REPORT
AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS REGARDING THE PROTECTION OF RESIDENTS IN HEALTH CARE INSTITUTIONS.
Joint Favorable Substitute
SPONSORS OF BILL:
Public Health Committee
REASONS FOR BILL: Implements the recommendations of The Department of Public Health (DPH) regarding nursing home administrators, the issuance of citation and its process for nursing home facility, residential care home and the appointment of temporary management.
RESPONSE FROM ADMINISTRATION/AGENCY:
Commissioner Raul Pino, M.D., M.P.H., Department of Public Health: Urges the Committee to take favorable action on the bill. Sec. 1: clarifies that a nursing home is under the supervision of a licensed administrator who is also responsible for the quality and safety of services provided. CT Public Health Code does hold the administrator liable for overall management of the facility; it fails to address accountability of a nursing home's operation and fiduciary duty to vulnerable population.
Section 2 and 3 clarifies the responsibilities of both DPH and the administrator when that facility chooses to contest a citation for non-compliance. The bill will also extend the notification period from 3 to 5 days, should an administrator choose to contest the citation and request an informal conference.
Section 4: increases the rates of fines and puts it in better alignment with the Center for Medicare and Medicaid services enforcement process. Section 5: allows DPH to appoint temporary manager in the event there are findings of significant non-compliance. Sections 6-15 all replace the term nursing home with the term nursing home facility.
Nancy Shaffer, Connecticut State-Long Term Care Ombudsman Program, State Department on Aging: The bill allows the Commissioner of DPH to “appoint temporary management for a facility in accordance with the provisions of 42 CFR 488.415, as amended from time to time, for a period of time to be determined by the commissioner”. This action is more than appropriate in the event a nursing home is found to be in violation of statutory or regulatory requirements.
NATURE AND SOURCES OF SUPPORT: NONE
NATURE AND SOURCES OF OPPOSITION:
Mag Morelli, President of Leading Age Connecticut: Takes specific issue with Sections 1, and 4, of the bill. The language in sec. 1: is overly broad and incorrectly assumes responsibility lies with just the administrator, when in fact assuring quality and safety is a team effort. This could deter qualified peoples from becoming nursing home administrators. Additionally administrators are not clinicians. Leading age is unaware of other licensure provisions that vest such broad and vague responsibilities on the CEO or manager of health care institution. Presently the Department has authority to initiate an action against an administrator's license under CGS §19a-517 and §19a-17.
Sec. 4 proposes arbitrary and unnecessary increases in civil monetary penalties for nursing and residential care homes. The current penalties are effective enough.
Matthew V. Barrett, Connecticut Association of Health Care Facilities (CAHCF): Takes issue with sections 1, 4, and 5. Section 1: holds the administrator responsible for the overall quality of services and care. Firstly administrators are not clinicians; this alone is reason enough to remove this section. Secondly, the Department already has authority to initiate action/s against an administrator's license under CGS. §19a-517 and §19a-17. Lastly the language in this section will create a strict liability for administrators on issues often out of their control.
The fines mentioned in Sec. 4 will have a greater punitive and deterrent effect, which will only harm nursing and residential nursing homes currently experiencing financial hardship due to the state's budget woes.
Sec. 5 further duplicates and conflicts with existing federal law pertaining to the current appointment of a temporary manger. To address this conflict, CAHCF offers the proposed language: “Appoint temporary management for a facility in accordance with the provisions of 42 CFR 488.400 et seq related to the appointment of a temporary manager.”
Curtis Rodowicz, Council Health and Rehab Center of Plainfield: Takes issue with sections 1, 2, 3, 4, and 5. Section 1: holds the administrator responsible for the quality and safety of services provided in nursing homes. Currently the law already stipulates that the administrator is responsible for the overall management of the facility. Secondly this bill only adds responsibility for clinical issues, which is beyond the scope of any administrator's education training and licensing.
Section 2: will allow the Commissioner unguided discretionary authority. The Commissioner should instead be provided with guidance on how best to apply discretionary citations.
Section 3: makes modifications to timeframes should a citation be administered. Any violation that meets the minimum standard of the “probability of death or serious harm”, extending of the hearing process and associated resolution should be opposed by the committee.
Section 4: allow for the circumvention of Class A and B standards in CGS 19a-524 and Chapter 54. DPH can and already cites violations of statute and regulation. This section needs to be opposed unless DPH clarifies it will not circumvent the standards established in Class A and B.
Section 5: gives the Commissioner ability to a Temporary Manager over a healthcare facility in the event of substantial violation of “Public Health Code”. The only difference in the new bill is that DPH will refer the hearing to a DPH staff attorney to act as the hearing officer. This change is entirely unnecessary as there is nothing wrong with present law that places these matters before a superior court judge.
Reported by: Walter L. Morton IV