Connecticut Seal

General Assembly

 

Raised Bill No. 209

February Session, 2016

 

LCO No. 1488

 

*01488_______PH_*

Referred to Committee on PUBLIC HEALTH

 

Introduced by:

 

(PH)

 

AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS REGARDING THE PROTECTION OF RESIDENTS IN HEALTH CARE INSTITUTIONS.

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

Section 1. Section 19a-511 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

As used in this section and sections [19a-511] 19a-512 to 19a-520, inclusive, as amended by this act, ["nursing home"] "nursing home facility" means an institution licensed under this chapter and "nursing home facility administrator" means the person in general administrative charge of a nursing home facility. All nursing [homes] home facilities licensed under this chapter shall be under the supervision of a licensed nursing home facility administrator. The nursing home facility administrator shall be responsible for the quality and safety of all services provided in the nursing home facility.

Sec. 2. Section 19a-524 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

If, upon review, investigation or inspection pursuant to section 19a-498, the Commissioner of Public Health determines that a nursing home facility or residential care home has violated any provision of section 17a-411, 19a-491a to 19a-491c, inclusive, 19a-493a, 19a-521 to 19a-529, inclusive, 19a-531 to 19a-551, inclusive, or 19a-553 to 19a-555, inclusive, or any regulation in the Public Health Code or regulation relating to licensure or the Fire Safety Code relating to the operation or maintenance of a nursing home facility or residential care home, which violation has been classified in accordance with section 19a-527, as amended by this act, [he or she shall immediately] the commissioner may issue or cause to be issued a citation to the licensee of such nursing home facility or residential care home. Governmental immunity shall not be a defense to any citation issued or civil penalty imposed pursuant to sections 19a-524 to 19a-528, inclusive. Each such citation shall be in writing, shall provide notice of the nature and scope of the alleged violation or violations and shall be sent by certified mail to the licensee at the address of the nursing home facility or residential care home in issue. A copy of such citation shall also be sent to the licensed administrator at the address of the nursing home facility or residential care home.

Sec. 3. Section 19a-525 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

(a) The administrator of the nursing home facility or residential care home, or [his or her] the administrator's designee, shall, [within three days, excluding Saturdays, Sundays and holidays, of] not later than five business days after receipt of the citation by the licensee, notify the commissioner if the licensee contests the citation. If the administrator fails to so notify the commissioner [within such three-day] after such five-day period, the citation shall be deemed a final order of the commissioner, effective upon the expiration of said period.

(b) If any administrator of a nursing home facility or residential care home, or his or her designee, notifies the commissioner that the licensee contests the citation, the commissioner shall provide [within five days of such notice, excluding Saturdays, Sundays and holidays,] an informal conference between the licensee and the commissioner or the commissioner's designee. Not later than five business days after the conclusion of the informal conference, the commissioner shall notify the licensee of the commissioner's conclusions resulting from the informal conference. If the licensee [and commissioner fail to reach an agreement at such conference, the] disagrees with the commissioner's conclusions, the licensee shall notify the commissioner in writing and the commissioner shall set the matter down for a hearing as a contested case in accordance with chapter 54. [, not more than five nor less than three days after such conference, with notice of the date of such hearing to the administrator not less than two days before such hearing, provided the minimum time requirements may be waived by agreement. The commissioner shall, not later than three days, excluding Saturdays, Sundays and holidays,] The commissioner shall, after the conclusion of the informal conference if an agreement is reached at, or as a result of, such conference, or after the hearing, issue a final order, based on findings of fact, affirming, modifying or vacating the citation.

Sec. 4. Section 19a-527 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

Citations issued pursuant to section 19a-524, as amended by this act, for violations of statutory or regulatory requirements shall be classified according to the nature of the violation and shall state such classification and the amount of the civil penalty to be imposed on the face thereof. The Commissioner of Public Health shall, by regulation in accordance with chapter 54, classify violations as follows:

[(a)] (1) Class A violations are conditions that the Commissioner of Public Health determines present an immediate danger of death or serious harm to any patient in the nursing home facility or residential care home. For each class A violation, a civil penalty of not more than [five] ten thousand dollars may be imposed;

[(b)] (2) Class B violations are conditions that the Commissioner of Public Health determines present a probability of death or serious harm in the reasonably foreseeable future to any patient in the nursing home facility or residential care home, but that he or she does not find constitute a class A violation. For each [such] Class B violation, a civil penalty of not more than [three] five thousand dollars may be imposed.

Sec. 5. Subsection (a) of section 19a-494 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

(a) The Commissioner of Public Health, after a hearing held in accordance with the provisions of chapter 54, may take any of the following actions, singly or in combination, in any case in which the commissioner finds that there has been a substantial failure to comply with the requirements established under this chapter, the Public Health Code or licensing regulations:

(1) Revoke a license or certificate;

(2) Suspend a license or certificate;

(3) Censure a licensee or certificate holder;

(4) Issue a letter of reprimand to a licensee or certificate holder;

(5) Place a licensee or certificate holder on probationary status and require him to report regularly to the department on the matters which are the basis of the probation;

(6) Restrict the acquisition of other facilities for a period of time set by the commissioner;

(7) Issue an order compelling compliance with applicable statutes or regulations of the department; [or]

(8) Impose a directed plan of correction; or

(9) 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.

Sec. 6. Section 19a-512 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

(a) In order to be eligible for licensure by examination pursuant to sections 19a-511 to 19a-520, inclusive, as amended by this act, a person shall submit an application, together with a fee of two hundred dollars, and proof satisfactory to the Department of Public Health that he (1) is physically and emotionally capable of administering a nursing home facility; (2) has satisfactorily completed a program of instruction and training, including residency training which meets the requirements of subsection (b) of this section and which is approved by the Commissioner of Public Health; and (3) has passed an examination prescribed and administered by the Department of Public Health designed to test the applicant's knowledge and competence in the subject matter referred to in subsection (b) of this section. Passing scores shall be established by the department.

(b) Minimum education and training requirements for applicants for licensure are as follows:

(1) Each person other than an applicant for renewal, applying prior to February 1, 1985, shall have completed: (A) A program so designed as to content and so administered as to present sufficient knowledge of the needs to be properly served by nursing [homes] home facilities, laws and regulations governing the operation of nursing [homes] home facilities and the protection of the interest of patients therein and the elements of good nursing home facility administration, or presented evidence satisfactory to the Department of Public Health of sufficient education and training in the foregoing fields; and (B) a one-year residency period under the joint supervision of a duly licensed nursing home facility administrator in an authorized nursing home facility and an accredited institution of higher education, approved by said department, which period may correspond to one academic year in such accredited institution. The supervising nursing home facility administrator shall submit such reports as may be required by the department on the performance and progress of such administrator-in-training, on forms provided by the department. This subdivision shall not apply to any person who has successfully completed a program of study for a master's degree in nursing home facility administration or in a related health care field and who has been awarded such degree from an accredited institution of higher learning.

(2) Each such person applying on or after February 1, 1985, in addition to the requirements of subdivision (1) of this subsection, shall either (A) have a baccalaureate degree in any area and have completed a course in long-term care administration approved by the department, or (B) have a master's degree in long-term care administration or in a related health care field approved by the commissioner.

(3) Each such person applying on or after November 1, 2014, in addition to the requirements of subdivisions (1) and (2) of this subsection, shall have completed training in Alzheimer's disease and dementia symptoms and care.

(c) Notwithstanding the provisions of subsection (b) of this section, the Department of Public Health shall renew the license of any person licensed as a nursing home facility administrator on July 1, 1983.

Sec. 7. Section 19a-513 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

In order to be eligible for licensure by endorsement pursuant to sections 19a-511 to 19a-520, inclusive, as amended by this act, a person shall submit an application for endorsement licensure on a form provided by the department, together with a fee of two hundred dollars, and meet the following requirements: (1) Hold a current license in good standing as a nursing home facility administrator in another state that was issued on the basis of holding, at a minimum, a baccalaureate degree and having passed the examination required for licensure in such state; (2) have practiced as a licensed nursing home facility administrator for not less than twelve months within the twenty-four-month period preceding the date of the application; and (3) have received training or education in long-term care, including, but not limited to, Alzheimer's disease and dementia symptoms and care or have certified, in writing, agreement to receive such training or education not later than one hundred twenty days after license issuance. No license shall be issued under this section to any applicant against whom disciplinary action is pending or who is the subject of an unresolved complaint.

Sec. 8. Section 19a-514 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

The Commissioner of Public Health shall issue a license as a nursing home facility administrator to any applicant meeting the requirements for licensure as specified in sections 19a-511 to 19a-520, inclusive, as amended by this act. A nursing home facility administrator's license shall be nontransferable.

Sec. 9. Section 19a-515 of the 2016 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

(a) Each nursing home facility administrator's license issued pursuant to the provisions of sections 19a-511 to 19a-520, inclusive, as amended by this act, shall be renewed once every two years, in accordance with section 19a-88, except for cause, by the Department of Public Health, upon forms to be furnished by said department and upon the payment to said department, by each applicant for license renewal, of the sum of two hundred five dollars. Each such fee shall be remitted to the Department of Public Health on or before the date prescribed under section 19a-88. Such renewals shall be granted unless said department finds the applicant has acted or failed to act in such a manner or under such circumstances as would constitute grounds for suspension or revocation of such license.

(b) Each licensee shall complete a minimum of forty hours of continuing education every two years, including, but not limited to, training in Alzheimer's disease and dementia symptoms and care. Such two-year period shall commence on the first date of renewal of the licensee's license after January 1, 2004. The continuing education shall be in areas related to the licensee's practice. Qualifying continuing education activities are courses offered or approved by the Connecticut Association of Healthcare Facilities, LeadingAge Connecticut, Inc., the Connecticut Assisted Living Association, the Connecticut Alliance for Subacute Care, Inc., the Connecticut Chapter of the American College of Health Care Administrators, the Association For Long Term Care Financial Managers, the Alzheimer's Association or any accredited college or university, or programs presented or approved by the National Continuing Education Review Service of the National Association of Boards of Examiners of Long Term Care Administrators, or by federal or state departments or agencies.

(c) Each licensee shall obtain a certificate of completion from the provider of the continuing education for all continuing education hours that are successfully completed and shall retain such certificate for a minimum of three years. Upon request by the department, the licensee shall submit the certificate to the department. A licensee who fails to comply with the continuing education requirements shall be subject to disciplinary action pursuant to section 19a-517, as amended by this act.

(d) The continuing education requirements shall be waived for licensees applying for licensure renewal for the first time. The department may, for a licensee who has a medical disability or illness, grant a waiver of the continuing education requirements for a specific period of time or may grant the licensee an extension of time in which to fulfill the requirements.

Sec. 10. Section 19a-517 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

(a) The Department of Public Health shall have jurisdiction to hear all charges of unacceptable conduct brought against any person licensed to practice as a nursing home facility administrator and, after holding a hearing, written notice of which shall be given to such person, said department, if it finds that any grounds for action by the department enumerated in subsection (b) of this section exist, may take any of the actions set forth in section 19a-17. Such notice shall be given, and such hearing conducted, as provided in the regulations adopted by the Commissioner of Public Health. Any person aggrieved by the finding of the department may appeal therefrom in accordance with the provisions of section 4-183, and such appeal shall have precedence over nonprivileged cases in respect to order of trial.

(b) The department may take action under section 19a-17 for any of the following reasons: (1) The license holder has employed or knowingly cooperated in fraud or material deception in order to obtain his license or has engaged in fraud or material deception in the course of professional services or activities; (2) the license holder is suffering from physical or mental illness, emotional disorder or loss of motor skill, including but not limited to, deterioration through the aging process, or is suffering from the abuse or excessive use of drugs, including alcohol, narcotics or chemicals; (3) illegal, incompetent or negligent conduct in his practice; (4) violation of any provision of state or federal law governing the license holder's practices within a nursing home facility; or (5) violation of any provision of this chapter or any regulation adopted hereunder. The Commissioner of Public Health may order a license holder to submit to a reasonable physical or mental examination if his physical or mental capacity to practice safely is being investigated. Said commissioner may petition the superior court for the judicial district of Hartford to enforce such order or any action taken pursuant to section 19a-17.

Sec. 11. Section 19a-518 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

No person shall act as a nursing home facility administrator unless such person has been licensed as a nursing home facility administrator under the provisions of sections 19a-511 to 19a-520, inclusive, as amended by this act. Any person who violates this section or who wilfully makes false representation to the Department of Public Health shall be fined not more than five hundred dollars or imprisoned not more than six months or both. The department shall cause to be presented, to the prosecuting officer having jurisdiction, evidence of any violation of any provision of said sections.

Sec. 12. Section 19a-519 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

(a) The Commissioner of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, with respect to standards for: (1) Approval of institutions of higher education, (2) course or degree requirements, or both, for licensing and renewal of licenses, which requirements shall include, but not be limited to, nursing home facility administration, management behavior, financial management, business administration, psychosocial behavior, gerontology, Alzheimer's disease and dementia, (3) the residency training program, and (4) reinstatement of individuals who fail to renew their licenses upon expiration, as provided in section 19a-515, to carry out the provisions of sections 19a-511 to 19a-520, inclusive, as amended by this act.

(b) The Commissioner of Public Health may make provision for one or more programs of instruction and training sufficient to meet the requirements of sections 19a-511 to 19a-520, inclusive, as amended by this act, considering the accessibility of such programs to residents of this state, if he finds there are not a sufficient number of approved courses conducted in this state.

Sec. 13. Section 19a-520 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

The Commissioner of Public Health may make such changes in the rules and regulations adopted under this chapter, as will enable them to conform with federal statutes and regulations relating to licensure of nursing home facility administrators, subject to the provisions of chapter 54.

Sec. 14. Section 19a-536 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

Each nursing home facility administrator, as defined in section 19a-511, as amended by this act, shall permit patients in the nursing home, relatives and legal representatives of, and any other person designated by, such patients and persons interested in placing someone in a nursing home facility to inspect all inspection reports pertaining to nursing home facilities made by the Department of Public Health, the State Fire Marshal, local fire and health departments or other state and local agencies having jurisdiction over the institution, and all summary copies of current inspection reports of the United States Department of Health and Human Services as provided in the Social Security Act, and shall provide a room adequate for such inspection during normal business hours, provided no such reports or copies thereof shall disclose the name of any patient in any nursing home facility. Such nursing home facility administrator shall post or cause to be posted in a conspicuous place in the nursing home facility a notice stating that such reports are available for inspection and the location where they may be inspected.

Sec. 15. Section 29-1f of the 2016 supplement to the general statutes, as amended by section 56 of public act 15-240, is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

(a) The clearinghouse established under section 29-1e shall collect, process, maintain and disseminate information to assist in the location of any missing person who (1) is eighteen years of age or older and has a mental impairment, or (2) is sixty-five years of age or older, provided a missing person report prepared by the Department of Emergency Services and Public Protection has been filed by such missing person's relative, guardian, conservator or agent appointed by the missing person in accordance with sections 1-350 to 1-353b, inclusive, any health care representative appointed by the missing person in accordance with section 19a-576 or a nursing home facility administrator, as defined in section 19a-511, as amended by this act, or, pursuant to section 17a-465b, by an employee of the Department of Mental Health and Addiction Services who is certified under the provisions of sections 7-294a to 7-294e, inclusive. Such relative, guardian, conservator, agent, health care representative, nursing home facility administrator or employee shall attest under penalty of perjury that the missing person (A) is eighteen years of age or older and has a mental impairment, or (B) is sixty-five years of age or older. No other proof shall be required in order to verify that the missing person meets the criteria to be eligible for assistance under this subsection. Such relative, guardian, conservator, agent, health care representative, nursing home facility administrator or employee who files a missing person report shall immediately notify the clearinghouse or law enforcement agency if the missing person's location has been determined.

(b) Subject to available resources, the clearinghouse established by section 29-1e may collect, process, maintain and disseminate information to assist in the location of missing persons other than children and those persons who are eligible for assistance under subsection (a) of this section.

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

Section 1

October 1, 2016

19a-511

Sec. 2

October 1, 2016

19a-524

Sec. 3

October 1, 2016

19a-525

Sec. 4

October 1, 2016

19a-527

Sec. 5

October 1, 2016

19a-494(a)

Sec. 6

October 1, 2016

19a-512

Sec. 7

October 1, 2016

19a-513

Sec. 8

October 1, 2016

19a-514

Sec. 9

October 1, 2016

19a-515

Sec. 10

October 1, 2016

19a-517

Sec. 11

October 1, 2016

19a-518

Sec. 12

October 1, 2016

19a-519

Sec. 13

October 1, 2016

19a-520

Sec. 14

October 1, 2016

19a-536

Sec. 15

October 1, 2016

29-1f

Statement of Purpose:

To implement the Department of Public Health's recommendations regarding the responsibilities of nursing home facility administrators, the process after receipt of a citation by a nursing home facility or residential care home, penalties for violations and appointment of temporary management.

[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.]