Connecticut Seal

General Assembly

File No. 579

    January Session, 2017

Substitute House Bill No. 6155

House of Representatives, April 13, 2017

The Committee on Government Administration and Elections reported through REP. FOX of the 148th Dist., Chairperson of the Committee on the part of the House, that the substitute bill ought to pass.

AN ACT AUTHORIZING DEEMED STATUS LICENSE RENEWALS FOR CERTAIN NONPROFIT COMMUNITY SERVICE PROVIDERS.

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

Section 1. Section 17a-20 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section):

(a) For the purposes of this section, "psychiatric clinic" means an organization licensed by the Department of Children and Families and staffed by psychiatrists, psychologists, social workers and such other professional, paraprofessional and clerical personnel as local circumstances may require, working in collaboration with other social service agencies, to provide mental health services that are designed to (1) effectively decrease the prevalence and incidence of mental illness, emotional disturbance and social [disfunctioning] dysfunction, and (2) promote mental health in individuals, groups and institutions, and includes a general hospital with such clinic services. The Department of Children and Families shall develop and maintain a program of outpatient psychiatric clinics for children and youths and their families.

(b) For the purposes of this section, "child guidance clinic" means a subset of psychiatric clinics for children designated by the Department of Children and Families pursuant to this section to receive grant funds for the purpose of assisting the department to provide community-based psychiatric services for children, youths and families. In order to meet such mandate, the department shall designate a subset of outpatient psychiatric clinics for children to be known as child guidance clinics. The department shall provide grants to such child guidance clinics in accordance with the provisions of this section. Any town having a population of not less than forty thousand, as most recently determined by the Secretary of the Office of Policy and Management, or any combination of towns with a combined population of not less than forty thousand as similarly determined, or any nonprofit corporation organized or existing for the purpose of establishing or maintaining a psychiatric clinic for children and youths or for children and youths and their families, or any clinic designated by the Department of Children and Families as of January 1, 1995, may apply to the Department of Children and Families for funds to be used to assist in establishing, maintaining or expanding a psychiatric clinic. The applications, and any grant of funds pursuant thereto, shall not be subject to the provisions of section 17a-476, except to the extent required by federal law. The department shall base any grant of funds on the services provided to children and youths under eighteen years of age and on the effectiveness of the services. No grant shall exceed two-thirds of the ordinary recurring operating expenses of the clinic, nor shall any grant be made to pay for any portion of capital expenditures for the clinic. No clinic in existence as of October 1, 1995, shall be eligible for grants of any funds under this section unless it has obtained a license within six months of the adoption of regulations under subsection (c) of this section. No clinic receiving funds under this section shall refuse services to any resident of this state solely because of his or her place of residence.

(c) The Department of Children and Families shall adopt regulations, in accordance with the provisions of chapter 54, defining the minimum requirements for outpatient psychiatric clinics for children to be eligible for licensure under this section in regard to (1) qualification and number of staff members, (2) clinic operation, including, but not limited, to physical plant, governing body and recordkeeping, (3) effectiveness of services, [and] (4) populations targeted for priority access, (5) national accrediting organizations that the department finds have standards that are more or at least as stringent for obtaining accreditation as the state requirements for obtaining a license under this section, and (6) any other provisions necessary to implement the provisions of subsection (d) of this section. The regulations shall also govern the granting of the funds to assist in establishing, maintaining and expanding psychiatric clinics. The regulations may also set an administrative fee sufficient to pay for the costs to the department of processing an application for a deemed status license under subsection (d) of this section. The department shall, upon payment of a fee of three hundred dollars, issue to any qualifying clinic a license that shall be in force for twenty-four months from the date of issue and, except as provided in subsection (d) of this section, shall be renewable for additional twenty-four-month periods, upon payment of a fee of three hundred dollars for each such period, provided the clinic continues to meet conditions satisfactory to the department.

(d) In lieu of applying for renewal of a license under subsection (c) of this section, a clinic may, at the time when any renewal is due, submit evidence, satisfactory to the department, that such clinic has been accredited as a provider of outpatient psychiatric services within the immediately preceding twelve-month period by a national accrediting organization that the department has listed in regulations adopted pursuant to subsection (c) of this section. The department may waive the inspection and investigation of such clinic required by this section and, in such event, any such clinic shall be deemed to have satisfied the requirements of this section for the purposes of licensure. Such deemed status license shall be valid for two years and shall not be transferable or assignable. The provisions of this subsection shall not be construed to limit the department's authority to inspect any clinic or suspend or revoke any license or deemed status license issued pursuant to this section or to take any other legal action authorized by any provision of the general statutes.

(e) The department shall make available to child guidance clinics forms to be used in making application for available funds. Upon receipt of proper application, the department shall grant the funds, provided the plans for financing, the standards of operation and the effectiveness of services of the clinics are approved by the department in accordance with the provisions of this section. The grants shall be made on an annual basis.

Sec. 2. Section 17a-145 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section):

(a) No person or entity shall care for or board a child without a license obtained from the Commissioner of Children and Families, except: (1) When a child has been placed by a person or entity holding a license from the commissioner; (2) any residential educational institution exempted by the State Board of Education under the provisions of section 17a-152; (3) residential facilities licensed by the Department of Developmental Services pursuant to section 17a-227, as amended by this act; (4) facilities providing child care services, as defined in section 19a-77; or (5) any home that houses students participating in a program described in subparagraph (B) of subdivision (8) of section 10a-29.

(b) The person or entity seeking a child care facility license shall file with the commissioner an application for a license, in such form as the commissioner furnishes, stating the location where it is proposed to care for such child, the number of children to be cared for, in the case of a corporation, the purpose of the corporation and the names of its chief officers and of the actual person responsible for the child. The Commissioner of Children and Families is authorized to fix the maximum number of children to be boarded and cared for in any such home or institution or by any person or entity licensed by the commissioner. If the population served at any facility, institution or home operated by any person or entity licensed under this section changes after such license is issued, such person or entity shall file a new license application with the commissioner, and the commissioner shall notify the chief executive officer of the municipality in which the facility is located of such new license application, except that no confidential client information may be disclosed.

(c) In lieu of applying for the renewal of a license under this section, a person or entity may, at the time when any renewal is due, submit evidence, satisfactory to the commissioner, that such person or entity has been accredited as a provider of services within the immediately preceding twelve-month period by a national accrediting organization that the department has listed in regulations adopted pursuant to subsection (f) of this section. The commissioner may waive any inspection and investigation of such person or entity and, in such event, any such person or entity shall be deemed to have satisfied the requirements of this section for the purposes of licensure. Such deemed status license shall be valid for two years and shall not be transferable or assignable. The provisions of this subsection shall not be construed to limit the commissioner's authority to inspect any person or entity, to suspend or revoke any license or deemed status license issued pursuant to this section or to take any other legal action authorized by any provision of the general statutes.

[(b)] (d) Each person or entity licensed by the commissioner pursuant to subsection (a) of this section shall designate an on-site staff member who shall apply a reasonable and prudent parent standard, as defined in subsection (a) of section 17a-114d, on behalf of the child.

[(c)] (e) The Commissioner of Children and Families shall not be responsible for the licensing of any facility that does not board or care for children or youths under eighteen years of age.

(f) The Commissioner of Children and Families shall adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of subsection (c) of this section. Such regulations shall (1) list any national accrediting organizations that the commissioner finds have standards that are more or at least as stringent for obtaining accreditation as the state requirements for obtaining a license under this section, and (2) contain any other provisions necessary to implement the provisions of subsection (c) of this section. The regulations may also set an administrative fee sufficient to pay for the costs to the department of processing an application for a deemed status license under subsection (c) of this section.

Sec. 3. Section 17a-147 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section):

(a) For the purposes of this section and section 17a-22, "extended day treatment" means a supplementary care community-based program providing a comprehensive multidisciplinary approach to treatment and rehabilitation of emotionally disturbed, mentally ill, behaviorally disordered or multiply handicapped children and youths during the hours immediately before and after school while they reside with their parents or surrogate family. Extended day treatment programs, except any such program provided by a regional educational service center established in accordance with section 10-66a, shall be licensed by the Department of Children and Families.

(b) The goal of extended day treatment is to improve the functioning of the child or youth as an individual and the family as a unit with the least possible interruption of beneficial relationships with the family and the community. An extended day treatment program (1) shall offer the broadest range of therapeutic services consistent with the needs of the children and youths it serves, including, but not limited to, (A) a therapeutic setting, (B) the integration of the family into the treatment and the treatment planning process, (C) support and emergency services to families designed to allow continued residence of the children and youths in their homes, (D) professional clinical services, (E) access to educational services, and (F) the coordination of community services in support of the treatment effort, or (2) if provided for children requiring special education by a regional educational service center, shall offer such services as are specified in the prescribed educational program for each such child in accordance with section 10-76d.

(c) The Commissioner of Children and Families shall adopt such regulations, in accordance with chapter 54, as are necessary to establish procedures and requirements for the licensure of extended day treatment programs, except any such program provided by a regional educational service center. Such regulations shall (1) set forth an optional process for the provider of an extended day treatment program to apply for renewal of such license by submitting evidence, satisfactory to the commissioner, that such person or entity has been accredited as a provider of extended day treatment services within the immediately preceding twelve-month period by a national accrediting organization, (2) list the national accrediting organizations that the department finds have standards that are more or at least as stringent for obtaining accreditation as the state requirements for obtaining a license under this section, and (3) contain any other provisions necessary to implement this section. The regulations may also set an administrative fee sufficient to pay for the costs to the department of processing an application for a deemed status license.

(d) After the adoption of regulations in accordance with this section, the commissioner may waive any inspection and investigation of a provider of extended day treatment programs applying for a renewal of such license that is accredited in accordance with, and that satisfies any other requirements of, the regulations adopted under this section, and, in such event, any such provider shall be deemed to have satisfied the requirements of this section for the purposes of licensure. Such license shall not be transferable or assignable. The provisions of this subsection shall not be construed to limit the commissioner's authority to inspect any provider, to suspend or revoke any license or deemed status license issued pursuant to this section or to take any other legal action authorized by any provision of the general statutes.

Sec. 4. Section 17a-149 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with section 17a-150):

(a) No person or entity except a parent, an adult relative as specified by section 17b-75 or guardian of any child shall place a child without a license obtained from the Commissioner of Children and Families. Application for a child-placing license shall be in a form furnished by the commissioner, and shall state the location of the principal place of business of the applicant, its organization or corporate name, its purposes and the name, title and degree of professional training of each of its staff members engaged in carrying out its stated purposes. Any such applicant shall consent to such inspection, review and supervision of all acts in relation to child placing as are reasonably necessary to enable the commissioner to perform his or her duties under section 17a-151, as amended by this act. The provisions of this section with regard to the commissioner's authority to inspect, review and supervise all acts in relation to child placing under section 17a-151, as amended by this act, shall be limited to inspection, review and supervision of the applicant under this section and shall not include inspection, review or supervision of the homes in which a child is placed.

(b) In lieu of applying for renewal of a license under this section, an applicant may, at the time when any renewal is due, submit evidence, satisfactory to the commissioner, that such applicant has been accredited as a provider of child-placing services within the immediately preceding twelve-month period by a national accrediting organization that the department has listed in regulations adopted pursuant to section 17a-150, as amended by this act. The commissioner may waive any inspection and investigation of such applicant required under this section and, in such event, any such applicant shall be deemed to have satisfied the requirements of this section for the purposes of licensure. Such deemed status license shall be valid for two years and shall not be transferable or assignable. The provisions of this subsection shall not be construed to limit the commissioner's authority to inspect any applicant, to suspend or revoke any license or deemed status license issued pursuant to this section or to take any other legal action authorized by any provision of the general statutes.

Sec. 5. Section 17a-150 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017):

(a) The Commissioner of Children and Families shall adopt regulations in accordance with chapter 54 setting forth standards for licensing of persons or entities which place children. The regulations shall require a person or entity licensed on or after March 9, 1984, to have a minimum of two staff persons who are qualified by a combination of education and work experience, and be a nonprofit organization qualified as a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as from time to time amended. Such regulations shall (1) set forth an optional process for persons or entities which place children to apply for renewal of their license by submitting evidence, satisfactory to the commissioner, that such person or entity has been accredited as a provider of child placement services within the immediately preceding twelve-month period by a national accrediting organization, (2) list the national accrediting organizations that the department finds have standards that are more or at least as stringent for obtaining accreditation as the state requirements for obtaining a license under section 17a-149, as amended by this act, and (3) contain any other provisions necessary to implement the provisions of section 17a-149, as amended by this act. The regulations may also set an administrative fee sufficient to pay for the costs to the department of processing an application for a deemed status license under section 17a-149, as amended by this act.

(b) Said commissioner shall adopt regulations prescribing the minimum standards for homes in which children may be placed.

Sec. 6. Section 17a-151 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017):

(a) [The] Except as provided in subsection (b) of this section, the Commissioner of Children and Families shall investigate the conditions stated in each application made under the provisions of sections 17a-145 and 17a-149, as amended by this act, and shall require any person identified on the application under said sections to submit to state and national criminal history records checks. [The] Except as provided in subsection (b) of this section, the commissioner shall investigate the conditions in each application under the provisions of sections 17a-145 and 17a-149, as amended by this act, and, if the commissioner finds such conditions suitable for the proper care of children, or for the placing out of children, under such standards for the promotion of the health, safety, morality and well-being of such children as the commissioner prescribes, shall issue such license as is required as promptly as possible, without expense to the licensee. If, after such investigation, the commissioner finds that the applicant, notwithstanding good faith efforts, is not able to fully comply with all the requirements the commissioner prescribes, but compliance can be achieved with minimal efforts, the commissioner may issue a provisional license for a period not to exceed sixty days. The provisional license may be renewed for additional sixty-day periods, but in no event shall the total of such periods be for longer than one year. Before issuing any license, the commissioner shall give to the selectmen of the town wherein such licensee proposes to carry on the licensed activity ten days' notice in writing that the issuance of such license is proposed, but such notice shall not be required in case of intention to issue such license to any corporation incorporated for the purpose of caring for or placing such children. Each license so issued shall specify whether it is granted for child-caring or child-placing purposes, shall state the number of children who may be cared for, shall be in force twenty-four months from date of issue, and shall be renewed for the ensuing twenty-four months, if conditions continue to be satisfactory to the commissioner. The commissioner shall also provide such periodical inspections and review as shall safeguard the well-being, health and morality of all children cared for or placed under a license issued by the commissioner under this section and shall visit and consult with each such child and with the licensee as often as the commissioner deems necessary but for licenses other than deemed status licenses, at intervals of not more than ninety days. Each licensee under the provisions of this section shall file annually with the commissioner a report containing such information concerning its functions, services and operation, including financial data, as the commissioner requires. Any license issued under this section, including a deemed status license, may be revoked, suspended or limited by the commissioner for cause, after notice given to the person or entity concerned and after opportunity for a hearing thereon. Any party whose application is denied or whose license is revoked, suspended or limited by the commissioner may appeal from such adverse decision in accordance with the provisions of section 4-183. Appeals under this section shall be privileged in respect to the order of trial assignment.

(b) The criminal history records checks required pursuant to subsection (a) of this section shall be conducted in accordance with section 29-17a.

(c) The commissioner may waive any inspection and investigation of a person who is applying or who has obtained a deemed status license in accordance with the provisions of sections 17a-145 and 17a-149, as amended by this act.

Sec. 7. Section 17a-227 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section):

(a) No person, firm or corporation shall operate within this state a community living arrangement or community companion home which it owns, leases or rents for the lodging, care or treatment of persons with intellectual disability, Prader-Willi syndrome or autism spectrum disorder unless such person, firm or corporation, upon written application, verified by oath, has obtained a license issued by the Department of Developmental Services.

(b) The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to insure the comfort, safety, adequate medical care and treatment of such persons at the residential facilities described in subsection (a) of this section. Such regulations shall include requirements that: (1) All residential facility staff be certified in cardiopulmonary resuscitation in a manner and time frame prescribed by the commissioner; (2) records of staffing schedules and actual staff hours worked, by residential facility, be available for inspection by the department upon advance notice; (3) each residential facility develop and implement emergency plans and staff training to address emergencies that may pose a threat to the health and safety of the residents of the facility; (4) department staff verify during quality service reviews and licensing inspections, that (A) staff is adequately trained to respond in an emergency, and (B) a summary of information on each resident is available to emergency medical personnel for use in an emergency; (5) all residential facilities serving persons with Down syndrome fifty years of age or older have at least one staff member trained in Alzheimer's disease and dementia symptoms and care; and (6) not less than one-half of the quality service reviews, licensing inspections or facility visits conducted by the department after initial licensure, if applicable, are unannounced. Such regulations shall also set forth an optional process for a person, firm or corporation which operates a community living arrangement or community companion home within this state to apply for renewal of a license under this section by submitting evidence, satisfactory to the commissioner, that such person, firm or corporation has been accredited as a provider of services within the immediately preceding twelve-month period by a national accrediting organization, list the national accrediting organizations that the department finds have standards that are more or at least as stringent for obtaining accreditation as the state requirements for obtaining a license under this section, and contain any other provisions necessary to implement the provisions of this subsection. The regulations may also set an administrative fee sufficient to pay for the costs to the department of processing an application for a deemed status license under this section.

(c) After receiving an application and making such investigation as is deemed necessary and after finding the specified requirements to have been fulfilled, the department shall grant a license to such applicant to operate a facility of the character described in such application, which license shall specify the name of the person to have charge and the location of each facility operated under the license. In the case of a renewal of such license, an applicant may, at the time when any such renewal is due, submit evidence, satisfactory to the department, that such applicant has been accredited as a provider of services within the immediately preceding twelve-month period by a national accrediting organization that the department has listed in regulations adopted pursuant to subsection (b) of this section. The department may waive any inspection and investigation of such applicant required under this section and, in such event, any such applicant shall be deemed to have satisfied the requirements of this section for the purposes of licensure. Such deemed status license shall be valid for two years and shall not be transferable or assignable. The provisions of this subsection shall not be construed to limit the department's authority to inspect any applicant, to suspend or revoke any license or deemed status license issued pursuant to this section or to take any other legal action authorized by any provision of the general statutes. Any person, firm or corporation aggrieved by any requirement of the regulations or by the refusal to grant any license may request an administrative hearing in accordance with the provisions of chapter 54. If the licensee of any such facility desires to place in charge thereof a person other than the one specified in the license, application shall be made to the Department of Developmental Services, in the same manner as provided for the original application, for permission to make such change. Such application shall be acted upon not later than ten calendar days from the date of the filing of the application. Each such license shall be renewed annually upon such terms as may be established by regulations and may be revoked by the department upon proof that the facility for which such license was issued is being improperly operated, or for the violation of any of the provisions of this section or of the regulations adopted pursuant to this section, provided the licensee shall first be given a reasonable opportunity to be heard in reference to such proposed revocation. Any person, firm or corporation aggrieved by such revocation may request an administrative hearing in accordance with the provisions of chapter 54. Each person, firm or corporation, upon filing an application under the provisions of this section for a license for a community living arrangement, shall pay to the State Treasurer the sum of fifty dollars.

(d) The Department of Developmental Services may contract, within available appropriations, with any qualified provider for the operation of a community-based residential facility, provided the qualified provider is licensed by the department to operate such facilities, including a deemed status license. The department shall include in all contracts with such licensed qualified providers, provisions requiring the department to (1) conduct periodic reviews of contract performance, and (2) take progressive enforcement actions if the department finds poor performance or noncompliance with the contract, as follows: (A) The licensed qualified provider may be placed on a strict schedule of monitoring and oversight by the department; (B) the licensed qualified provider may be placed on a partial-year contract; and (C) payments due under the contract may be reduced by specific amounts on a monthly basis until the licensed qualified provider complies with the contract. If compliance cannot be achieved, the department shall terminate the contract.

(e) The department may contract with any person, firm or corporation to provide residential support services for persons with intellectual disability, Prader-Willi syndrome or autism spectrum disorder who reside in settings which are not licensed by the department. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to ensure the safety, adequate supervision and support of persons receiving such residential support services.

(f) Any person, firm or corporation who operates any facility contrary to the provisions of this section shall be fined not more than one thousand dollars or imprisoned not more than six months or both. Any person, firm or corporation who operates any facility contrary to the regulations adopted pursuant to subsection (b) of this section shall be fined not more than one thousand dollars.

Sec. 8. Section 19a-491 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section):

(a) No person acting individually or jointly with any other person shall establish, conduct, operate or maintain an institution in this state without a license as required by this chapter, except for persons issued a license by the Commissioner of Children and Families pursuant to section 17a-145, as amended by this act, for the operation of (1) a substance abuse treatment facility, or (2) a facility for the purpose of caring for women during pregnancies and for women and their infants following such pregnancies. Application for such license shall be made to the Department of Public Health upon forms provided by it and shall contain such information as the department requires, which may include affirmative evidence of ability to comply with reasonable standards and regulations prescribed under the provisions of this chapter or of a national accrediting organization listed in regulations adopted by the commissioner under subsection (b) of section 19a-493, as amended by this act. The commissioner may require as a condition of licensure that an applicant sign a consent order providing reasonable assurances of compliance with the Public Health Code. The commissioner may issue more than one chronic disease hospital license to a single institution until such time as the state offers a rehabilitation hospital license.

(b) If any person acting individually or jointly with any other person owns real property or any improvements thereon, upon or within which an institution, as defined in subsection (c) of section 19a-490, is established, conducted, operated or maintained and is not the licensee of the institution, such person shall submit a copy of the lease agreement to the department at the time of any change of ownership and with each license renewal application. The lease agreement shall, at a minimum, identify the person or entity responsible for the maintenance and repair of all buildings and structures within which such an institution is established, conducted or operated. If a violation is found as a result of an inspection or investigation, the commissioner may require the owner to sign a consent order providing assurances that repairs or improvements necessary for compliance with the provisions of the Public Health Code shall be completed within a specified period of time or may assess a civil penalty of not more than one thousand dollars for each day that such owner is in violation of the Public Health Code or a consent order. A consent order may include a provision for the establishment of a temporary manager of such real property who has the authority to complete any repairs or improvements required by such order. Upon request of the Commissioner of Public Health, the Attorney General may petition the Superior Court for such equitable and injunctive relief as such court deems appropriate to ensure compliance with the provisions of a consent order. The provisions of this subsection shall not apply to any property or improvements owned by a person licensed in accordance with the provisions of subsection (a) of this section to establish, conduct, operate or maintain an institution on or within such property or improvements.

(c) Notwithstanding any regulation other than the regulations adopted under subsection (b) of section 19a-493, as amended by this act, the Commissioner of Public Health shall charge the following fees for the biennial licensing and inspection of the following institutions: (1) Chronic and convalescent nursing homes, per site, four hundred forty dollars; (2) chronic and convalescent nursing homes, per bed, five dollars; (3) rest homes with nursing supervision, per site, four hundred forty dollars; (4) rest homes with nursing supervision, per bed, five dollars; (5) outpatient dialysis units and outpatient surgical facilities, six hundred twenty-five dollars; (6) mental health residential facilities, per site, three hundred seventy-five dollars; (7) mental health residential facilities, per bed, five dollars; (8) hospitals, per site, nine hundred forty dollars; (9) hospitals, per bed, seven dollars and fifty cents; (10) nonstate agency educational institutions, per infirmary, one hundred fifty dollars; (11) nonstate agency educational institutions, per infirmary bed, twenty-five dollars; (12) home health care agencies, except certified home health care agencies described in subsection (d) of this section, per agency, three hundred dollars; (13) home health care agencies, except certified home health care agencies described in subsection (d) of this section, per satellite patient service office, one hundred dollars; (14) assisted living services agencies, except such agencies participating in the congregate housing facility pilot program described in section 8-119n, per site, five hundred dollars; (15) short-term hospitals special hospice, per site, nine hundred forty dollars; (16) short-term hospitals special hospice, per bed, seven dollars and fifty cents; (17) hospice inpatient facility, per site, four hundred forty dollars; and (18) hospice inpatient facility, per bed, five dollars.

(d) Notwithstanding any regulation other than the regulations adopted under subsection (b) of section 19a-493, as amended by this act, the commissioner shall charge the following fees for the triennial licensing and inspection of the following institutions: (1) Residential care homes, per site, five hundred sixty-five dollars; (2) residential care homes, per bed, four dollars and fifty cents; (3) home health care agencies that are certified as a provider of services by the United States Department of Health and Human Services under the Medicare or Medicaid program, three hundred dollars; and (4) certified home health care agencies, as described in section 19a-493, as amended by this act, per satellite patient service office, one hundred dollars.

(e) The commissioner shall charge one thousand dollars for the licensing and inspection every four years of outpatient clinics that provide either medical or mental health service, and well-child clinics, except those which have deemed status licenses under section 19a-493, as amended by this act, or those operated by municipal health departments, health districts or licensed nonprofit nursing or community health agencies.

(f) The commissioner shall charge a fee of five hundred sixty-five dollars for the technical assistance provided for the design, review and development of an institution's construction, renovation, building alteration, sale or change in ownership when the cost of the project is one million dollars or less and shall charge a fee of one-quarter of one per cent of the total construction cost when the cost of the project is more than one million dollars. Such fee shall include all department reviews and on-site inspections. For purposes of this subsection, "institution" does not include a facility owned by the state.

(g) The commissioner may require as a condition of the licensure of home health care agencies and homemaker-home health aide agencies that each agency meet minimum service quality standards. In the event the commissioner requires such agencies to meet minimum service quality standards as a condition of their licensure, the commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to define such minimum service quality standards, which shall (1) allow for training of homemaker-home health aides by adult continuing education, (2) require a registered nurse to visit and assess each patient receiving homemaker-home health aide services as often as necessary based on the patient's condition, but not less than once every sixty days, and (3) require the assessment prescribed by subdivision (2) of this subsection to be completed while the homemaker-home health aide is providing services in the patient's home.

(h) No person acting individually or jointly with any other person shall establish, conduct, operate or maintain a home health care agency or homemaker-home health aide agency without maintaining professional liability insurance or other indemnity against liability for professional malpractice. The amount of insurance which such person shall maintain as insurance or indemnity against claims for injury or death for professional malpractice shall be not less than one million dollars for one person, per occurrence, with an aggregate of not less than three million dollars.

(i) On and after June 15, 2012, until June 30, 2017, the commissioner shall not issue or renew a license under this chapter for any hospital certified to participate in the Medicare program as a long-term care hospital under Section 1886(d)(1)(B)(iv) of the Social Security Act (42 USC 1395ww) unless such hospital was so certified under said federal act on January 1, 2012.

(j) (1) A chronic disease hospital shall (A) maintain its medical records on-site in an accessible manner or be able to retrieve such records from an off-site location not later than the end of the next business day after receiving a request for such records, (B) keep a patient's medical records on-site for a minimum of ten years after the date of such patient's discharge, except the hospital may destroy the patient's original medical records prior to the expiration of the ten-year period if a copy of such medical records is preserved by a process that is consistent with current hospital standards, or (C) complete a patient's medical records not more than thirty days after the date of such patient's discharge, except in unusual circumstances that shall be specified in the hospital's rules and regulations for its medical staff. Each chronic disease hospital shall provide the Department of Public Health with a list of the process it uses for preserving a copy of medical records in accordance with subparagraph (B) of this subdivision.

(2) A children's hospital shall (A) maintain its medical records on-site in an accessible manner or be able to retrieve such records from an off-site location not later than the end of the next business day after receiving a request for such records, and (B) keep a patient's medical records on-site for a minimum of ten years after the date of such patient's discharge, except the hospital may destroy the patient's original medical records prior to the expiration of the ten-year period if a copy of such medical records is preserved by a process that is consistent with current hospital standards. Each children's hospital shall provide the Department of Public Health a list of the process it uses for preserving a copy of medical records in accordance with subparagraph (B) of this subdivision.

(3) The Department of Public Health may adopt regulations in accordance with the provisions of chapter 54 to implement the provisions of this subsection.

Sec. 9. Section 19a-493 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section):

(a) Upon receipt of an application for an initial license, the Department of Public Health, subject to the provisions of section 19a-491a, shall issue such license if, upon conducting a scheduled inspection and investigation, the department finds that the applicant and facilities meet the requirements established under section 19a-495, provided a license shall be issued to or renewed for an institution, as defined in section 19a-490, only if such institution is not otherwise required to be licensed by the state. If an institution, (1) as defined in subsections (b), (d), (e) and (f) of section 19a-490, applies for license renewal and has been certified as a provider of services by the United States Department of Health and Human Services under Medicare or Medicaid programs within the immediately preceding twelve-month period, [or if an institution,] (2) as defined in subsection (b) of section 19a-490, is currently certified, or (3) as defined in subsections (g), (h) and (m) of section 19a-490, applies for license renewal and has been accredited as a provider of services within the immediately preceding twelve-month period by a national accrediting organization that the department has listed in regulations adopted pursuant to subsection (b) of this section, the commissioner or the commissioner's designee may waive on renewal the inspection and investigation of such facility required by this section and, in such event, any such facility shall be deemed to have satisfied the requirements of section 19a-495 for the purposes of licensure. Such license shall be valid for two years or a fraction thereof and shall terminate on March thirty-first, June thirtieth, September thirtieth or December thirty-first of the appropriate year. A license issued pursuant to this chapter, unless sooner suspended or revoked, shall be renewable biennially [(1)] (A) after an unscheduled inspection is conducted by the department, and [(2)] (B) upon the filing by the licensee, and approval by the department, of a report upon such date and containing such information in such form as the department prescribes and satisfactory evidence of continuing compliance with requirements established under section 19a-495. In the case of an institution, as defined in subsection (d) of section 19a-490, that is also certified as a provider under the Medicare program, the license shall be issued for a period not to exceed three years, to run concurrently with the certification period. Except in the case of a multicare institution, each license shall be issued only for the premises and persons named in the application. Such license shall not be transferable or assignable. Licenses shall be posted in a conspicuous place in the licensed premises.

(b) The Commissioner of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of subsection (a) of this section concerning licensure renewal for an institution, as defined in subsections (g), (h) and (m) of section 19a-490. Such regulations shall (1) list any national accrediting organizations that the department finds have standards that are more or at least as stringent for obtaining accreditation as the state requirements for obtaining a license under this section, and (2) contain any other provisions necessary to implement the provisions of subsection (a) of this section. The regulations may also set an administrative fee sufficient to pay for the costs to the department of processing an application for a deemed status license under subsection (a) of this section.

[(b)] (c) (1) A nursing home license may be renewed biennially after (A) an unscheduled inspection conducted by the department, (B) submission of the information required by section 19a-491a, and (C) submission of evidence satisfactory to the department that the nursing home is in compliance with the provisions of this chapter, the Public Health Code and licensing regulations.

(2) Any change in the ownership of a facility or institution, as defined in subsection (c) of section 19a-490, owned by an individual, partnership or association or the change in ownership or beneficial ownership of ten per cent or more of the stock of a corporation which owns, conducts, operates or maintains such facility or institution, shall be subject to prior approval of the department after a scheduled inspection of such facility or institution is conducted by the department, provided such approval shall be conditioned upon a showing by such facility or institution to the commissioner that it has complied with all requirements of this chapter, the regulations relating to licensure and all applicable requirements of the Public Health Code. Any such change in ownership or beneficial ownership resulting in a transfer to a person related by blood or marriage to such an owner or beneficial owner shall not be subject to prior approval of the department unless: (A) Ownership or beneficial ownership of ten per cent or more of the stock of a corporation, partnership or association which owns, conducts, operates or maintains more than one facility or institution is transferred; (B) ownership or beneficial ownership is transferred in more than one facility or institution; or (C) the facility or institution is the subject of a pending complaint, investigation or licensure action. If the facility or institution is not in compliance, the commissioner may require the new owner to sign a consent order providing reasonable assurances that the violations shall be corrected within a specified period of time. Notice of any such proposed change of ownership shall be given to the department at least ninety days prior to the effective date of such proposed change. For the purposes of this subdivision, "a person related by blood or marriage" means a parent, spouse, child, brother, sister, aunt, uncle, niece or nephew. For the purposes of this subdivision, a change in the legal form of the ownership entity, including, but not limited to, changes from a corporation to a limited liability company, a partnership to a limited liability partnership, a sole proprietorship to a corporation and similar changes, shall not be considered a change of ownership if the beneficial ownership remains unchanged and the owner provides such information regarding the change to the department as may be required by the department in order to properly identify the current status of ownership and beneficial ownership of the facility or institution. For the purposes of this subdivision, a public offering of the stock of any corporation that owns, conducts, operates or maintains any such facility or institution shall not be considered a change in ownership or beneficial ownership of such facility or institution if the licensee and the officers and directors of such corporation remain unchanged, such public offering cannot result in an individual or entity owning ten per cent or more of the stock of such corporation, and the owner provides such information to the department as may be required by the department in order to properly identify the current status of ownership and beneficial ownership of the facility or institution.

[(c)] (d) (1) A multicare institution may, under the terms of its existing license, provide behavioral health services or substance use disorder treatment services on the premises of more than one facility, at a satellite unit or at another location outside of its facilities or satellite units that is acceptable to the patient receiving services and is consistent with the patient's assessment and treatment plan.

(2) Any multicare institution that intends to offer services at a satellite unit or other location outside of its facilities or satellite units shall submit an application for approval to offer services at such location to the Department of Public Health. Such application shall be submitted on a form and in the manner prescribed by the Commissioner of Public Health. Not later than forty-five days after receipt of such application, the commissioner shall notify the multicare institution of the approval or denial of such application. If the satellite unit or other location is approved, that satellite unit or location shall be deemed to be licensed in accordance with this section and shall comply with the applicable requirements of this chapter and regulations adopted under this chapter.

(3) The Commissioner of Public Health may adopt regulations, in accordance with the provisions of chapter 54, to carry out the provisions of this subsection. The Commissioner of Public Health may implement policies and procedures necessary to administer the provisions of this subsection while in the process of adopting such policies and procedures as regulation, provided the commissioner prints notice of intent to adopt regulations in the Connecticut Law Journal not later than twenty days after the date of implementation. Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are adopted.

Sec. 10. Section 19a-493c of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section):

(a) The Commissioner of Public Health shall license outpatient clinics, as defined in section 19a-490. In lieu of applying for the renewal of such license, an applicant may, at the time when any such renewal is due, submit evidence, satisfactory to the commissioner, that such applicant has been accredited as a provider of outpatient clinic services within the immediately preceding twelve-month period by a national accrediting organization that the commissioner has listed in regulations adopted pursuant to this section. Any such applicant shall be deemed to have satisfied the requirements of this section for the purposes of licensure. Such deemed status license shall be valid for two years and shall not be transferable or assignable. The provisions of this subsection shall not be construed to limit the commissioner's authority to inspect any applicant, to suspend or revoke any license or deemed status license issued pursuant to this section or to take any other legal action authorized by any provision of the general statutes.

(b) The commissioner [may] shall adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of this section. Such regulations shall (1) list any national accrediting organizations that the commissioner finds have standards that are more or at least as stringent for obtaining accreditation as the state requirements for obtaining a license under this section, and (2) contain any other provisions necessary to implement the provisions of subsection (a) of this section. The regulations may also set an administrative fee sufficient to pay for the costs to the department of processing an application for a deemed status license under subsection (a) of this section. The commissioner may waive any provision of the regulations for outpatient clinics. The commissioner may implement policies and procedures necessary to administer the provisions of this section while in the process of adopting such policies and procedures as regulations, except for the regulations concerning deemed status licenses, provided notice of intent to adopt regulations is published in the Connecticut Law Journal not later than twenty days after the date of implementation. Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are adopted.

Sec. 11. Section 19a-507b of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section):

(a) No community residence shall be established on or after July 1, 1984, within one thousand feet of any other community residence. If more than one community residence is proposed to be established in any municipality, the total capacity of all community residences in the municipality in which such residence is proposed to be established shall not exceed one-tenth of one per cent of the population of such municipality.

(b) Any resident of a municipality in which a community residence is or will be located may, through the chief executive officer of the municipality, or the legislative body of such municipality may, petition the Commissioner of Public Health to deny an application for a license to operate a community residence on the grounds that the operation of such a community residence would be in violation of the limits established under subsection (a) of this section.

(c) An applicant for a license to operate a community residence shall mail a copy of the application made to the Department of Public Health to the regional mental health board and the governing body of the municipality in which the community residence is to be located, by certified mail, return receipt requested. All applications shall specify the number of community residences in the municipality, the address of each such residence and the number of residents in each and the address of the proposed community residence, and shall include population and occupancy statistics reflecting compliance with the limits established pursuant to subsection (a) of this section.

(d) The Commissioner of Public Health shall not issue a license for a community residence until the applicant has submitted proof that the mailing required by subsection (c) of this section has been made and until at least thirty days have elapsed since the receipt of such mailing by all required recipients.

(e) In the case of a renewal of such license, an applicant may, at the time when any renewal is due, submit evidence, satisfactory to the commissioner, that such applicant has been accredited as a provider of community residence services within the immediately preceding twelve-month period by a national accrediting organization that the commissioner has listed in regulations adopted pursuant this section. The commissioner may waive any inspection and investigation of such applicant required under this section and, in such event, any such applicant shall be deemed to have satisfied the requirements of this section for the purposes of licensure. Such license shall be valid for two years and shall not be transferable or assignable. The provisions of this subsection shall not be construed to limit the commissioner's authority to inspect any applicant, to suspend or revoke any license or deemed status license issued pursuant to this section or to take any other legal action authorized by any provision of the general statutes.

(f) The Commissioner of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of subsection (e) of this section concerning deemed status licensure for a community residence. Such regulations shall (1) list any national accrediting organizations that the commissioner finds have standards that are more or at least as stringent for obtaining accreditation as the state requirements for obtaining a license under this section, and (2) contain any other provisions necessary to implement the provisions of subsection (e) of this section. The regulations may also set an administrative fee sufficient to pay for the costs to the department of processing an application for a deemed status license under subsection (e) of this section.

Sec. 12. Section 19a-507c of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017):

A community residence shall be evaluated twice a year by the Department of Mental Health and Addiction Services, except that a community residence that has obtained deemed status licensure under section 19a-507b, as amended by this act, may be evaluated less frequently and may be evaluated by the department or the accrediting organization. Evaluations by said department shall include a review of individual client records and shall be sent to the Department of Public Health upon its request.

Sec. 13. Section 19a-507g of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section):

(a) The Department of Social Services shall adopt regulations, in accordance with chapter 54, for the certification of adult day health care facilities. In establishing such regulations, the Department of Social Services shall consult with the Connecticut Association of Adult Day Centers and such other persons or entities it deems appropriate. In the case of a renewal of such certification, an applicant may, at the time when any renewal is due, submit evidence, satisfactory to the commissioner, that such applicant has been accredited as a provider of adult day health care services within the immediately preceding twelve-month period by a national accrediting organization that the department has listed in regulations adopted pursuant to this section. The department may waive any inspection and investigation of such applicant required under this section and, in such event, any such applicant shall be deemed to have satisfied the requirements of this section for the purposes of certification. Such certificate shall be valid for two years and shall not be transferable or assignable. The provisions of this subsection shall not be construed to limit the department's authority to inspect any applicant, to suspend or revoke any certificate or deemed status certificate issued pursuant to this section or to take any other legal action authorized by any provision of the general statutes.

(b) The Department of Social Services shall adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of subsection (a) of this section concerning certification renewal for adult day health care facilities. Such regulations shall (1) list any national accrediting organizations that the department finds have standards that are more or at least as stringent for obtaining accreditation as the state requirements for obtaining certification under this section, and (2) contain any other provisions necessary to implement the provisions of subsection (a) of this section. The regulations may also set an administrative fee sufficient to pay for the costs to the department of processing an application for a deemed status certificate under subsection (a) of this section.

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

Section 1

October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section

17a-20

Sec. 2

October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section

17a-145

Sec. 3

October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section

17a-147

Sec. 4

October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with section 17a-150

17a-149

Sec. 5

October 1, 2017

17a-150

Sec. 6

October 1, 2017

17a-151

Sec. 7

October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section

17a-227

Sec. 8

October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section

19a-491

Sec. 9

October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section

19a-493

Sec. 10

October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section

19a-493c

Sec. 11

October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section

19a-507b

Sec. 12

October 1, 2017

19a-507c

Sec. 13

October 1, 2017, and applicable to applications for renewal submitted after the adoption of regulations in accordance with this section

19a-507g

Statement of Legislative Commissioners:

In Section 5(a)(2), "this section" was changed to "section 17a-149" for accuracy, and in Section 11(f) "license" was added for consistency and throughout the bill "national" was added before "accrediting" for consistency.

GAE

Joint Favorable Subst. -LCO

 

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.


OFA Fiscal Note

State Impact: See Below

Municipal Impact: None

Explanation

This bill requires the Departments of Children and Families (DCF), Developmental Services (DDS), Public Health (DPH), and Social Services (DSS) to grant “deemed status” license or certification renewals to certain contracted private providers that have earned and maintained accreditation from a recognized national accrediting organization. It allows the departments to charge an administrative fee to cover associated processing costs. It is unknown how many providers will seek deemed status and what fee, if any, departments will charge. Revenue that may be lost from existing licensing fees may, or may not, be recouped or surpassed through deemed status fees established by the departments.

Section 13 results in a potential savings to DSS. The agency contracts with the Connecticut Association of Adult Day Centers Inc. to complete the certification of adult day centers under the Connecticut Home Care Program for Elders waiver. Assuming an amendment to the waiver is approved by the federal Centers for Medicare and Medicaid Services, DSS could experience savings associated with reduced contract costs. Savings are anticipated to the extent that DSS chooses to waive inspections and/or investigations due to applicants meeting accreditation requirements.

Existing Licensure Fees

DCF does not charge fees for its health care institution licenses.

DDS collects a $50 annual licensing fee from private providers for each group home they operate with five or more individuals. There are approximately 85 providers qualified to operate group homes and there are approximately 390 group homes for which providers must pay the fee, generating $19,500 annually for the General Fund.

DPH generates approximately $11,470 for the General Fund every two years and approximately $25,000 for the General Fund every four years through health care institution licensure.

DSS contracts with the Connecticut Association of Adult Day Centers Inc., which does charge a fee for its adult day health care facilities certification.

The Out Years

The fiscal impact identified above would continue into the future subject to the number of entities seeking deemed status and fees established by the departments.

OLR Bill Analysis

sHB 6155

AN ACT AUTHORIZING DEEMED STATUS LICENSE RENEWALS FOR CERTAIN NONPROFIT COMMUNITY SERVICE PROVIDERS.

SUMMARY

This bill requires the departments of children and families (DCF), developmental services (DDS), public health (DPH), and social services (DSS) to adopt regulations in order to grant “deemed status” license or certification renewals to certain contracted private providers that have earned and maintained accreditation from a recognized national accrediting organization. The accreditation requirements must be no less stringent than the state licensing or certification requirements. The deemed status license or certification is valid for two years and cannot be transferred or assigned.

The bill gives the affected providers the option to satisfy their license or certification renewal requirements by submitting proof of accreditation for the same services within the preceding 12-month period by an accrediting organization that the department has accepted and listed in its regulations for this purpose. The bill authorizes these agencies' regulations to set an administrative fee to cover associated processing costs.

Under the bill, a department may waive, for deemed status license or certification renewals, the inspection and investigation that would otherwise be required for standard renewals. This does not limit any department's authority to inspect providers, suspend or revoke a license or certification, or take any other legal action to address complaints or non-compliance under the law.

The bill also makes technical and conforming changes.

EFFECTIVE DATE: October 1, 2017, and applicable to renewal applications submitted after the adoption of associated regulations.

PROVIDERS ELIGIBLE FOR DEEMED STATUS

The provisions apply to certain types of providers (depicted in Table 1) which may have purchase of service contracts with the state (see BACKGROUND).

Table 1: Providers Eligible for Deemed Status License or Certification Renewals under the Bill

Bill Section

Citation

Type of Private Provider

Licensing Agency

1

CGS 17a-20

Outpatient psychiatric clinics

DCF

2

CGS 17a-145

Childcare facilities

3

CGS 17a-147

Extended day treatment programs

4-5

CGS 17a-149, CGS 17a-150

Child-placing services

7

CGS 17a-227

Community-based residential facilities

DDS

8-9

CGS 19a-491, CGS 19a-493

Behavioral health facilities, alcohol or drug treatment facilities, and outpatient clinics

DPH

10

CGS 19a-493c

Outpatient clinics

11-12

CGS 19a-507b,

CGS 19a-507c

Community residences

13

CGS 19a-507g

Adult day health care facilities

DSS

BACKGROUND

Purchase of Service Contracts

A purchase of service is a contract between a state agency and a private provider organization or municipality for the purpose of obtaining direct health and human services for agency clients (CGS 4-70b).

COMMITTEE ACTION

Government Administration and Elections Committee

Joint Favorable

Yea

17

Nay

0

(03/27/2017)

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