Sec. 19a-490. (Formerly Sec. 19-576). Licensing of institutions. Definitions.
Sec. 19a-490l. Mandatory limits on overtime for nurses working in hospitals. Exceptions.
Sec. 19a-535c. Nursing home facility discharge. Caregiver instruction and training requirements.
Sec. 19a-566. Birth centers. Licensure. Regulations.
Sec. 19a-490. (Formerly Sec. 19-576). Licensing of institutions. Definitions. As used in this chapter, unless the context otherwise requires:
(a) “Institution” means a hospital, short-term hospital special hospice, hospice inpatient facility, residential care home, nursing home facility, home health care agency, home health aide agency, behavioral health facility, assisted living services agency, substance abuse treatment facility, outpatient surgical facility, outpatient clinic, clinical laboratory, blood collection facility, source plasma donation center, birth center, an infirmary operated by an educational institution for the care of students enrolled in, and faculty and employees of, such institution; a facility engaged in providing services for the prevention, diagnosis, treatment or care of human health conditions, including facilities operated and maintained by any state agency; and a residential facility for persons with intellectual disability licensed pursuant to section 17a-227 and certified to participate in the Title XIX Medicaid program as an intermediate care facility for individuals with intellectual disability. “Institution” does not include any facility for the care and treatment of persons with mental illness or substance use disorder operated or maintained by any state agency, except Whiting Forensic Hospital and the hospital and psychiatric residential treatment facility units of the Albert J. Solnit Children's Center;
(b) “Hospital” means an establishment for the lodging, care and treatment of persons suffering from disease or other abnormal physical or mental conditions and includes inpatient psychiatric services in general hospitals;
(c) “Residential care home” or “rest home” means a community residence that furnishes, in single or multiple facilities, food and shelter to two or more persons unrelated to the proprietor and, in addition, provides services that meet a need beyond the basic provisions of food, shelter and laundry and may qualify as a setting that allows residents to receive home and community-based services funded by state and federal programs;
(d) “Home health care agency” means a public or private organization, or a subdivision thereof, engaged in providing professional nursing services and the following services, available twenty-four hours per day, in the patient's home or a substantially equivalent environment: Home health aide services as defined in this section, physical therapy, speech therapy, occupational therapy or medical social services. The agency shall provide professional nursing services and at least one additional service directly and all others directly or through contract. An agency shall be available to enroll new patients seven days a week, twenty-four hours per day;
(e) “Home health aide agency” means a public or private organization, except a home health care agency, which provides in the patient's home or a substantially equivalent environment supportive services which may include, but are not limited to, assistance with personal hygiene, dressing, feeding and incidental household tasks essential to achieving adequate household and family management. Such supportive services shall be provided under the supervision of a registered nurse and, if such nurse determines appropriate, shall be provided by a social worker, physical therapist, speech therapist or occupational therapist. Such supervision may be provided directly or through contract;
(f) “Home health aide services” as defined in this section shall not include services provided to assist individuals with activities of daily living when such individuals have a disease or condition that is chronic and stable as determined by a physician licensed in the state;
(g) “Behavioral health facility” means any facility that provides mental health services to persons eighteen years of age or older or substance use disorder services to persons of any age in an outpatient treatment or residential setting to ameliorate mental, emotional, behavioral or substance use disorder issues;
(h) “Clinical laboratory” means any facility or other area used for microbiological, serological, chemical, hematological, immunohematological, biophysical, cytological, pathological or other examinations of human body fluids, secretions, excretions or excised or exfoliated tissues for the purpose of providing information for the (1) diagnosis, prevention or treatment of any human disease or impairment, (2) assessment of human health, or (3) assessment of the presence of drugs, poisons or other toxicological substances;
(i) “Person” means any individual, firm, partnership, corporation, limited liability company or association;
(j) “Commissioner” means the Commissioner of Public Health or the commissioner's designee;
(k) “Home health agency” means an agency licensed as a home health care agency or a home health aide agency;
(l) “Assisted living services agency” means an agency that provides chronic and stable individuals with services that include, but need not limited to, nursing services and assistance with activities of daily living and may have a dementia special care unit or program as defined in section 19a-562;
(m) “Outpatient clinic” means an organization operated by a municipality or a corporation, other than a hospital, that provides (1) ambulatory medical care, including preventive and health promotion services, (2) dental care, or (3) mental health services in conjunction with medical or dental care for the purpose of diagnosing or treating a health condition that does not require the patient's overnight care;
(n) “Multicare institution” means a hospital that provides outpatient behavioral health services or other health care services, psychiatric outpatient clinic for adults, free-standing facility for the care or treatment of substance abusive or dependent persons, hospital for psychiatric disabilities, as defined in section 17a-495, or a general acute care hospital that provides outpatient behavioral health services that (1) is licensed in accordance with this chapter, (2) has more than one facility or one or more satellite units owned and operated by a single licensee, and (3) offers complex patient health care services at each facility or satellite unit. For purposes of this subsection, “satellite unit” means a location where a segregated unit of services is provided by the multicare institution;
(o) “Nursing home” or “nursing home facility” means (1) any chronic and convalescent nursing home or any rest home with nursing supervision that provides nursing supervision under a medical director twenty-four hours per day, or (2) any chronic and convalescent nursing home that provides skilled nursing care under medical supervision and direction to carry out nonsurgical treatment and dietary procedures for chronic diseases, convalescent stages, acute diseases or injuries;
(p) “Outpatient dialysis unit” means (1) an out-of-hospital out-patient dialysis unit that is licensed by the department to provide (A) services on an out-patient basis to persons requiring dialysis on a short-term basis or for a chronic condition, or (B) training for home dialysis, or (2) an in-hospital dialysis unit that is a special unit of a licensed hospital designed, equipped and staffed to (A) offer dialysis therapy on an out-patient basis, (B) provide training for home dialysis, and (C) perform renal transplantations;
(q) “Hospice agency” means a public or private organization that provides home care and hospice services to terminally ill patients;
(r) “Psychiatric residential treatment facility” means a nonhospital facility with a provider agreement with the Department of Social Services to provide inpatient services to Medicaid-eligible individuals under the age of twenty-one;
(s) “Chronic disease hospital” means a long-term hospital having facilities, medical staff and all necessary personnel for the diagnosis, care and treatment of chronic diseases;
(t) “Blood collection facility” means a facility that performs blood component collection activities where blood is removed from a human being for the purpose of administering such blood or any of its components to any human being. “Blood collection facility” does not include a facility that performs blood component collection activities to collect source plasma or perform testing that would require licensure as a clinical laboratory. For the purposes of this subsection, “source plasma” means the liquid portion of human blood collected by plasmapheresis and intended as source material for further manufacturing use and does not include single donor plasma products intended for intravenous use, and “plasmapheresis” means a procedure in which blood is removed from a blood donor, the plasma is separated from the formed elements and at least the red blood cells are returned to the blood donor at the time of the donation;
(u) “Source plasma donation center” means a facility where source plasma is collected by plasmapheresis. For the purposes of this subsection, “source plasma” means the liquid portion of human blood collected by plasmapheresis and intended as source material for further manufacturing use and does not include single donor plasma products intended for intravenous use, and “plasmapheresis” means a procedure in which blood is removed from a blood donor, the plasma is separated from the formed elements and at least the red blood cells are returned to the blood donor at the time of the donation; and
(v) “Birth center” means a freestanding facility that is licensed by the department (1) to provide perinatal, labor, delivery and postpartum care during and immediately after delivery to persons presenting with a low-risk pregnancy and healthy newborns for a period typically less than twenty-four hours, and (2) that is not a hospital licensed pursuant to the provisions of this chapter, or attached to or located in such a hospital. For the purposes of this subsection, “low-risk pregnancy” means an uncomplicated, singleton pregnancy that has vertex presentation and is at low risk for developing complications during labor and birth, as determined by an evaluation and examination conducted by a licensed health care provider acting within the scope of such provider's practice.
(1953, 1955, S. 2051d; 1957, P.A. 217, S. 2; 455, S. 1; 586, S. 6; 1959, P.A. 188; February, 1965, P.A. 161; 1969, P.A. 713; P.A. 74-137, S. 12, 21; P.A. 77-569, S. 4; 77-601, S. 2, 11; P.A. 78-60, S. 1, 2; P.A. 79-46, S. 1, 3; 79-610, S. 22; P.A. 80-186, S. 1, 2; 80-483, S. 87, 186; P.A. 87-107; P.A. 88-357, S. 5; P.A. 89-350, S. 5; P.A. 90-230, S. 30, 101; June Sp. Sess. P.A. 91-8, S. 18, 63; P.A. 92-80, S. 1, 3; May Sp. Sess. P.A. 92-16, S. 38, 89; P.A. 93-381, S. 9, 39; 93-415, S. 1, 2; P.A. 95-79, S. 63, 189; 95-160, S. 10, 69; 95-257, S. 12, 21, 58; 95-271, S. 34, 40; P.A. 96-139, S. 12, 13; 96-268, S. 6, 34; P.A. 97-112, S. 2; P.A. 01-57, S. 1; P.A. 03-274, S. 2; P.A. 05-280, S. 60; P.A. 06-195, S. 42; P.A. 07-252, S. 12, 13, 68; P.A. 10-117, S. 32; P.A. 13-139, S. 15; 13-208, S. 4, 25, 77; P.A. 14-211, S. 1; P.A. 15-242, S. 39; P.A. 16-66, S. 5; P.A. 17-146, S. 2; 17-202, S. 71; P.A. 18-86, S. 5; P.A. 19-97, S. 2–4; 19-118, S. 6; P.A. 21-121, S. 45; June Sp. Sess. P.A. 21-2, S. 29, 30; P.A. 22-58, S. 1; P.A. 23-31, S. 1; 23-147, S. 1.)
History: 1959 act made technical changes, included as institutions in Subdiv. (c)(2) hospitals for mentally ill or retarded persons and substituted “any state agency” for “the commission on tuberculosis and other chronic illness” in the same subdivision; 1965 act added reference to “nursing home” and “rest home”; 1969 act redefined “institution” to include infirmaries operated by educational institutions, health facilities operated by commercial or industrial establishments for their employees and facilities operated by corporations or municipalities providing medical services on outpatient basis; P.A. 74-137 deleted health facilities operated by commercial or industrial establishments for their employees from “institution” definition; Sec. 19-32 transferred to Sec. 19-576 in 1977; P.A. 77-569 included health care facilities for the handicapped in “institution” definition; P.A. 77-601 included home health care, homemaker-home health aide and coordination, assessment and monitoring agencies in “institution” definition and included exceptions to definition which had been listed elsewhere in section and defined “home health care agency”, “homemaker-home health aide agency” and “coordination, assessment and monitoring agency”; P.A. 78-60 rephrased definition of “homemaker-home health care agency” and included social workers; P.A. 79-46 deleted exception for institutions otherwise required by law to be licensed by the state in “institution” definition, included subdivisions of organizations in “home health care agency” definition and deleted “primarily” as modifier of “engaged” and rephrased “homemaker-home health aide agency”; P.A. 79-610 included mental health facilities in “institution” definition and defined “mental health facility” and “alcohol or drug treatment facility”; P.A. 80-186 and P.A. 80-483 included alcohol or drug treatment facilities in “institution” definition; Sec. 19-576 transferred to Sec. 19a-490 in 1983; P.A. 87-107 inserted definition of “homemaker-home health aide services” as Subdiv. (f), relettering prior Subdivs. as necessary; P.A. 88-357 redefined “institution”; P.A. 89-350 added Subdiv. (k), defining “commissioner”; P.A. 90-230 made technical change in Subdiv. (a); June Sp. Sess. P.A. 91-8 redefined “institution” to include residential facilities for the mentally retarded which are certified to participate in Title XIX Medicaid program; P.A. 92-80 redefined “mental health facility” to exclude family care homes after October 1, 1993; May Sp. Sess. P.A. 92-16 added Subdiv. (l) defining “home health agency”; P.A. 93-381 replaced commissioner of health services with commissioner of public health and addiction services, effective July 1, 1993; P.A. 93-415 amended the definition of “home health care agency” in Subdiv. (d) to specify provision of twenty-four-hour care and round-the-clock, seven-day-a-week enrollment and redefined “coordination, assessment and monitoring agency” in Subdiv. (g) to require targeting of patients with chronic conditions; P.A. 95-79 redefined “person” to include a limited liability company, effective May 31, 1995; P.A. 95-160 replaced “coordination, assessment and monitoring agency” with “access agency” in definitions of “institution” and “home health agency” and deleted former Subdiv. (g), which had defined said term, relettering remaining Subdivs. as necessary, effective July 1, 1995; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; P.A. 95-271 added new Subdiv. (l) defining “assisted living services agencies”; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 96-268 deleted reference to access agencies in definition of “institution”, effective July 1, 1996 (Revisor's note: The word “in” was inserted editorially by the Revisors in Subdiv. (a) in the phrase “… operated by an educational institution for the care of students in, and faculty and employees of, …”); P.A. 97-112 replaced “home for the aged” with “residential care home”; P.A. 01-57 amended Subdiv. (g) by making a technical change and adding provision re mental health outpatient treatment facility that provides treatment to persons 16 years of age or older who are receiving services from the Department of Mental Health and Addiction Services; P.A. 03-274 amended Subdiv. (a) by adding outpatient surgical facility to definition of “institution”, effective July 1, 2003; P.A. 05-280 extended applicability of definitions to Secs. 17b-261e, 19a-487 to 19a-487b, inclusive, 38a-498b and 38a-525b and added Subdiv. (m) defining “critical access hospital”, effective July 1, 2005; P.A. 06-195 redefined “mental health facility” in Subdiv. (g) to include any facility for the care or treatment of mentally ill or emotionally disturbed persons, rather than adults, effective June 7, 2006; P.A. 07-252 amended Subdiv. (a) to redefine “institution” to include assisted living services agencies, amended Subdiv. (l) to redefine “assisted living services agency” to include an “agency”, rather than an “institution”, that provides nursing services and assistance with daily living activities and, effective July 12, 2007, amended Subdiv. (m) to substitute “mobile field hospital” for “critical access hospital” and expand definition to include modular, transportable facilities used for providing medical services at a mass gathering or providing surge capacity for a hospital during a mass casualty event or infrastructure failure; P.A. 10-117 deleted former Subdiv. (m) re definition of “mobile field hospital” and made technical changes; P.A. 13-139 amended Subdiv. (a) to redefine “institution” by substituting “persons with intellectual disability” or “individuals with intellectual disabilities” for “the mentally retarded”; P.A. 13-208 amended Subdiv. (c) by making technical changes, effective July 1, 2013, amended Subdiv. (a) to redefine “institution” by including short-term hospital special hospice and hospice inpatient facility, effective October 1, 2013, and further amended Subdiv. (a) to redefine “institution” by including outpatient clinic and added Subdiv. (m) defining “outpatient clinic”, effective January 1, 2014; P.A. 14-211 added Subdiv. (n) defining “multicare institution”; P.A. 15-242 amended Subdiv. (n) by redesignating Subparas. (A) to (C) as Subparas. (1) to (3); P.A. 16-66 amended Subdiv. (a) to redefine “institution” by replacing “nursing home” with “nursing home facility”, deleting “rest home,” and replacing “mental health facility” with “behavioral health facility”, amended Subdiv. (c) to delete “nursing home” and redefine “residential care home” or “rest home” by replacing “an establishment” with “a community residence” and adding provision re qualifying as setting that allows residents to receive home and community-based services funded by state and federal programs, amended Subdiv. (g) to replace “Mental health facility” with “Behavioral health facility” and define same, amended Subdiv. (j) to add reference to commissioner's designee and added Subdiv. (o) defining “nursing home” or “nursing home facility”; P.A. 17-146 added Subsec. (p) defining “outpatient dialysis unit” and made technical changes; P.A. 17-202 amended Subsec. (a) to redefine “institution” by deleting “health care facility for the handicapped”; P.A. 18-86 amended Subsec. (a) by deleting provision re exception for facilities for care or treatment of mentally ill persons or persons with substance abuse problems, adding provision re “institution” not to include facility for care and treatment of persons with mental illness or substance use disorder operated or maintained by state agency, except Whiting Forensic Hospital, and making technical changes, effective June 4, 2018; P.A. 19-97 amended Subsec. (a) by replacing “homemaker-home health aide agency” with “home health aide agency”, amended Subsec. (d) by replacing “Homemaker-home health aide services” with “Home health aide services”, amended Subsec. (e) by replacing “Homemaker-home health aide agency” with “Home health aide agency”, amended Subsec. (f) by replacing “Homemaker-home health aide services” with “Home health aide services” and making a technical change and amended Subsec. (k) by replacing “homemaker-home health aide agency” with “home health aide agency”, effective July 1, 2019; P.A. 19-118 amended Subsec. (n) by redefining “multicare institution” and adding provision defining “satellite unit”, effective July 1, 2019; P.A. 21-121 amended Subsec. (a) by redefining “institution,”, amended Subsec. (l) by redefining “assisted living services agency”, added Subsec. (q) re definition of “hospice agency” and made conforming changes, effective July 1, 2021; June Sp. Sess. P.A. 21-2 amended Subsec (a) by adding reference to the hospital and psychiatric residential treatment facility units of the Albert J. Solnit Children's Center and added Subsec. (q), codified by the Revisors as Subsec. (r), defining “psychiatric residential treatment facility”; P.A. 22-58 added provision re applicability of definitions to Ch. 368v, amended Subsec. (a) by redefining “institution”, amending Subsec. (h) by deleting definition of “alcohol and drug treatment facility” and defining “clinical laboratory”, added Subsec. (s) defining “chronic disease hospital”, and made technical and conforming changes; (Revisor's note: In 2023, the changes made by P.A. 21-121, S. 45, were incorporated editorially by the Revisors in the version of Subsec. (a), as amended by June Sp. Sess. P.A. 21-2, S. 29, that became effective on October 1, 2022); P.A. 23-31 amended Subsec. (a) by adding references to blood collection facility and source plasma donation center, amended Subsec. (l) by redefining “assisted living services agency”, added Subsec. (t) defining “blood collection facility”, added Subsec. (u) defining “source plasma donation center”, and made conforming changes; P.A. 23-147 amended Subsec. (a) by adding “birth center”, added Subsec. (t), codified by the Revisors as Subsec. (v), defining “birth center” and made conforming changes, effective January 1, 2024.
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Sec. 19a-490l. Mandatory limits on overtime for nurses working in hospitals. Exceptions. (a) As used in this section:
(1) “Nurse” means a registered nurse or a practical nurse licensed pursuant to chapter 378, or a nurse's aide registered pursuant to chapter 378a;
(2) “Hospital” has the same meaning as set forth in section 19a-490; and
(3) “Overtime” means working (A) in excess of a predetermined scheduled work shift, regardless of the length of such scheduled work shift, provided such scheduled work shift is determined and communicated not less than forty-eight hours prior to the commencement of such scheduled work shift, (B) more than twelve hours in a twenty-four-hour period, or (C) more than forty-eight hours in any hospital-defined work week.
(b) Except as provided in this section, no hospital shall require a nurse to work overtime. No hospital shall discriminate against, discharge, discipline, threaten to discharge or discipline or otherwise retaliate against a nurse for refusing to work overtime.
(c) Any nurse may volunteer or agree to work overtime.
(d) When the safety of a patient requires and when there is no reasonable alternative, the provisions of subsection (b) of this section shall not apply: (1) To any nurse participating in an ongoing surgical procedure until such procedure is completed; (2) to any nurse working in a critical care unit until such nurse is relieved by another nurse who is commencing a scheduled work shift; (3) in the case of a public health emergency; (4) in the case of an institutional emergency, including, but not limited to, adverse weather conditions, catastrophe or widespread illness, that in the opinion of the hospital administrator will significantly reduce the number of nurses available for a scheduled work shift, provided the hospital administrator has made a good faith effort to mitigate the impact of such institutional emergency on the availability of nurses; or (5) to any nurse employed at a behavioral health facility operated by a state agency who is covered by a collective bargaining agreement that contains provisions addressing the issue of mandatory overtime.
(e) Before requiring a nurse to work overtime in accordance with the provisions of subsection (d) of this section, a hospital shall make a good faith effort to have such overtime hours covered on a voluntary basis. Mandatory overtime shall not be required as a regular practice for providing appropriate staffing for the necessary level of patient care or in any situation that is the result of routine staffing needs caused by typical staffing patterns, expected levels of absenteeism or time off typically approved by the hospital for vacation, holidays, sick leave and personal leave.
(f) (1) The provisions of this section shall not be construed to alter or impair the terms of any bona fide collective bargaining agreement that places additional restrictions or limitations on the use of mandatory overtime.
(2) The provisions of this section shall not prohibit mandatory overtime with respect to any nurse who is covered by a bona fide collective bargaining agreement that is in effect prior to October 1, 2023, or by a bona fide collective bargaining agreement entered into pursuant to section 5-278 that is in effect prior to June 1, 2027, and contains provisions addressing the issue of mandatory overtime, until the expiration date of the collective bargaining agreement.
(P.A. 04-242, S. 1; P.A. 14-122, S. 119; P.A. 23-204, S. 55.)
History: P.A. 04-242 effective October 1, 2005; P.A. 14-122 made a technical change in Subsec. (a)(2); P.A. 23-204 amended Subsec. (a) by adding Subdiv. (3) defining “overtime”, amended Subsec. (b) by making technical changes and adding prohibition on discriminating against, discharging, disciplining or threatening to discharge or discipline or otherwise retaliate against a nurse for refusing to work overtime, designated existing provision re allowing a nurse to volunteer or agree to work overtime as new Subsec. (c) and made technical changes thereto, redesignated existing Subsec. (c) as Subsec. (d) and amended same by adding provision re when safety of a patient requires and there is no reasonable alternative, replacing “an” with “ongoing” in Subdiv. (1) and inserting “employed at a behavioral health facility operated by a state agency” in Subdiv. (5), added Subsec. (e) re a good faith effort by hospital to have overtime hours covered and prohibiting mandatory overtime as a regular practice for providing appropriate staffing for the necessary level of patient care, and added Subsec. (f) re collective bargaining agreement terms and prohibition on mandatory overtime with respect to any nurse covered by collective bargaining agreement in effect prior to October 1, 2023, or June 1, 2027.
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Sec. 19a-490u. Training in symptoms of dementia, implicit bias and perinatal mood and anxiety disorders for hospital direct care staff. (a) Each hospital, as defined in section 19a-490, shall include training in the symptoms of dementia as part of such hospital's regularly provided training to staff members who provide direct care to patients.
(b) On and after October 1, 2021, each hospital shall include training in implicit bias as part of such hospital's regularly provided training to staff members who provide direct care to women who are pregnant or in the postpartum period. As used in this subsection, “implicit bias” means an attitude or internalized stereotype that affects a person's perceptions, actions and decisions in an unconscious manner and often contributes to unequal treatment of a person based on such person's race, ethnicity, gender identity, sexual orientation, age, disability or other characteristic.
(c) On and after October 1, 2023, each hospital shall include training in perinatal mood and anxiety disorders as part of such hospital's regularly provided training to staff members who provide direct care to women who are pregnant or in the postpartum period.
(P.A. 15-129, S. 1; P.A. 21-35, S. 13; P.A. 23-97, S. 26.)
History: P.A. 15-129 effective July 1, 2015; P.A. 21-35 designated existing provision re training in symptoms of dementia as Subsec. (a) and amended same by replacing “On or after October 1, 2015, each” with “Each” and making technical changes, and added Subsec. (b) re implicit bias training, effective June 14, 2021; P.A. 23-97 added Subsec. (c) requiring training in perinatal mood and anxiety disorders.
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Sec. 19a-490ff. Prohibition on hospitals requiring physicians to provide credentials of board certification in a certain specialty for a certain time or board recertification as part of the credentialing process. (a) As used in this section, (1) “board eligible” means eligible to take a qualifying examination administered by a medical specialty board after having graduated from a medical school, completed a residency program and trained under supervision in a specialty fellowship program, (2) “board certified” means having passed the qualifying examination administered by a medical specialty board to become board certified in a particular specialty, and (3) “board recertification” means recertification in a particular specialty after a predetermined time period prescribed by a medical specialty board after having passed the qualifying examination administered by the medical specialty board to become board certified in a particular specialty.
(b) No hospital, or medical review committee of a hospital, shall require, as part of its credentialing requirements (1) for a board eligible physician to acquire privileges to practice in the hospital, that the physician provide credentials of board certification in a particular specialty until five years after the date on which the physician became board eligible in such specialty, or (2) for a board certified physician to acquire or retain privileges to practice in the hospital, that the physician provide credentials of board recertification.
(P.A. 23-97, S. 12.)
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Sec. 19a-490gg. Written notification by hospitals to the mother of a stillborn child re burial and cremation arrangement options. Decision regarding disposition. (a) For each stillborn child for which a fetal death certificate will be issued pursuant to section 7-60, a hospital shall provide the mother of the stillborn child written notification of the burial and cremation arrangement options for such child (1) when practicable, upon admission to the hospital if the mother expects to deliver a stillborn child, or (2) if notification is not practicable upon admission or the mother did not expect to deliver a stillborn child, not less than twenty-four hours after the delivery of the stillborn child, provided a health care provider responsible for the mother's care agrees it is appropriate to provide such notification to the mother.
(b) Consistent with the provisions of subdivision (3) of subsection (d) of section 45a-318, a mother who has received notification pursuant to subsection (a) of this section and the other parent of the stillborn child, if known, shall inform the hospital, in writing, of their decision regarding the disposition of the stillborn child at any time during hospitalization and prior to discharge, provided the mother and other parent, if known, shall have a minimum of twenty-four hours after receipt of the written notification from the hospital to inform the hospital in writing of such decision.
(c) Nothing in this section shall be construed to prohibit a health care provider or a hospital from providing the notification described in subsection (a) of this section to a family member or friend of the mother consistent with the privacy provisions of the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time, or from referring the mother and other parent, if known, to a licensed funeral director for additional information regarding disposition options.
(P.A. 23-195, S. 15.)
History: P.A. 23-195 effective July 1, 2023.
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Sec. 19a-490hh. Appointment of medical staff or an individual medical staff member of a hospital. Regulations. (a) Appointment of the medical staff or an individual medical staff member of a hospital, as defined in the regulations of Connecticut state agencies and licensed pursuant to subsection (a) of section 19a-491, may be biennial or triennial and consistent with the federal Medicare conditions of participation and standards and with the requirements of approved national accreditation organizations in accordance with 42 CFR 488.8.
(b) The Commissioner of Public Health may amend existing regulations adopted pursuant to section 19a-14 as necessary to implement the provisions of this section.
(P.A. 23-195, S. 14.)
History: P.A. 23-195 effective June 29, 2023.
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Sec. 19a-491. (Formerly Sec. 19-577). License and certificate required. Application. Assessment of civil penalties or a consent order. Fees. Minimum service quality standards. Regulations. Professional liability insurance. Prohibition. Maintenance of medical records. (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 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, provided such exception shall not apply to the hospital and psychiatric residential treatment facility units of the Albert J. Solnit Children's Center. Application for such license shall (A) be made to the Department of Public Health upon forms provided by it, (B) be accompanied by the fee required under subsection (c), (d) or (e) of this section, (C) 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, and (D) not be required to be notarized. 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 subsections (c) and (o) 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 regulations of Connecticut state agencies 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 regulations of Connecticut state agencies 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) 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, hospice agencies or home health aide agencies, except certified home health care agencies, hospice agencies or home health aide 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; (18) hospice inpatient facility, per bed, five dollars; and (19) birth centers, per site, nine hundred forty dollars and, per bed, seven dollars and fifty cents.
(d) Notwithstanding any regulation, 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 or hospice agencies, as described in section 19a-493, per satellite patient service office, one hundred dollars.
(e) The commissioner shall charge one thousand dollars for the licensing and inspection of outpatient clinics that provide either medical or mental health service, urgent care services and well-child clinical services, except those operated by a municipal health department, health district or licensed nonprofit nursing or community health agency. Such licensing and inspection shall be performed every three years, except those outpatient clinics that have obtained accreditation from a national accrediting organization within the immediately preceding twelve-month period may be inspected by the commissioner once every four years, provided the outpatient clinic has not committed any violation that the commissioner determines would pose an immediate threat to the health, safety or welfare of the patients of the outpatient clinic. The provisions of this subsection shall not be construed to limit the commissioner's authority to inspect any applicant for licensure or renewal of licensure as an outpatient clinic, suspend or revoke any license granted to an outpatient clinic pursuant to this section or take any other legal action against an outpatient clinic that is authorized by any provision of the general statutes.
(f) Any institution that is planning a project for construction or building alteration shall provide the plan for such project to the Department of Public Health for review. Any such project shall comply with nationally established facility guidelines for health care construction, as approved by the commissioner, that are in place at the time the institution provides the plan to the department. The commissioner shall post a reference to such guidelines, including the effective date of such guidelines, on the Department of Public Health's Internet web site. No institution shall be required to include matters outside the scope and applicability of such guidelines in the institution's plan.
(g) 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.
(h) The commissioner may require as a condition of the licensure of a home health care agency, hospice agency and home health aide agency 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 home health aides by adult continuing education, (2) require a registered nurse to visit and assess each patient receiving 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 home health aide is providing services in the patient's home.
(i) No person acting individually or jointly with any other person shall establish, conduct, operate or maintain a home health care agency, hospice agency or 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.
(j) 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.
(k) (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.
(1953, 1955, S. 2052d; P.A. 77-601, S. 9, 11; 77-614, S. 323, 610; P.A. 79-610, S. 23; P.A. 80-127, S. 1; P.A. 84-546, S. 167, 173; P.A. 85-588, S. 1; P.A. 89-350, S. 6; May Sp. Sess. P.A. 92-6, S. 14, 117; P.A. 93-74, S. 44, 67; 93-201, S. 9, 24; 93-381, S. 9, 39; 93-415, S. 9; P.A. 94-196, S. 1, 2; P.A. 95-160, S. 12, 69; 95-257, S. 12, 21, 58; P.A. 96-139, S. 12, 13; P.A. 97-112, S. 2; 97-297; June 30 Sp. Sess. P.A. 03-3, S. 28; P.A. 05-64, S. 1; P.A. 09-197, S. 1; June Sp. Sess. P.A. 09-3, S. 177; P.A. 10-117, S. 10; P.A. 11-242, S. 28; P.A. 12-118, S. 2; P.A. 13-208, S. 5; 13-234, S. 140; 13-249, S. 2; P.A. 15-242, S. 1, 2; P.A. 16-66, S. 23; P.A. 17-95, S. 1; 17-146, S. 1; June Sp. Sess. P.A. 17-2, S. 39, 675; P.A. 18-168, S. 40; P.A. 19-97, S. 6; 19-118, S. 42, 73; P.A. 21-121, S. 46; P.A. 22-58, S. 9; 22-92, S. 17; P.A. 23-147, S. 3.)
History: Sec. 19-33 transferred to Sec. 19-577 in 1977; P.A. 77-601 added exception re continued operation of certain facilities in operation as of January 1, 1979; P.A. 77-614 replaced department of health with department of health services, effective January 1, 1979; P.A. 79-610 added Subsec. (b) re validity of certain licenses issued before October 1, 1979; P.A. 80-127 added Subsec. (c) re certificate of compliance with public health code; Sec. 19-577 transferred to Sec. 19a-491 in 1983; P.A. 84-546 made technical change to Subsec. (a), deleting obsolete provision re home health care agency, homemaker-home health aide agency or coordination, assessment and monitoring agency in operation on January 1, 1979; P.A. 85-588 added Subsec. (d) to include in the definition of “institution” any person or agency who advertises, arranges or provides homemaker-home health aides or services in a patient's home; P.A. 89-350 added the language on consent orders, deleted former Subsec. (b) re period of validity for licenses and renewal and relettered the remaining Subsecs. and changed “annually” to “biennially” in Subsec. (b); May Sp. Sess. P.A. 92-6 added new Subsec. (d) to establish fees for biennial licensing and inspection of chronic and convalescent nursing homes, rest homes with nursing supervision, homes for the aged, ambulatory facilities, mental health residential facilities, hospitals, nonstate agency educational facilities and for technical assistance for design, review and development; P.A. 93-74 amended Subsec. (d) by exempting municipal health departments, health districts or licensed nursing or community health and well-child clinics from the biennial licensing and inspection fees, by reducing educational institution infirmary fee from $500 to $75 and by instituting a per-bed charge of $25, effective July 1, 1993; P.A. 93-201 amended Subsec. (d)(13) to add “infirmary”, effective July 1, 1993; P.A. 93-381 replaced department and commissioner of health services with department and commissioner of public health and addiction services, effective July 1, 1993; P.A. 93-415 added Subsec. (e) authorizing commissioner to develop minimum service quality standards; P.A. 94-196 amended Subsec. (a) to authorize issuance of more than one chronic disease hospital license to a single institution until the state offers a rehabilitation hospital license, effective June 9, 1994 (Revisor's note: In 1995 the words “said chapter and sections” were replaced editorially by the Revisors with “this chapter”); P.A. 95-160 amended Subsec. (e) by deleting a reference to coordination, assessment and monitoring agencies and made a technical change, effective July 1, 1995; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 97-112 replaced “homes for the aged” with “residential care homes”; P.A. 97-297 amended Subsec. (e) to add provision re training of homemaker-home health care aides by continuing education; June 30 Sp. Sess. P.A. 03-3 amended Subsec. (b) by requiring submittal of a lease agreement and deleting provisions re biennial issuance of certificate of compliance with Public Health Code, deleted former Subsec. (c) defining “institution”, redesignating existing Subsec. (d) as new Subsec. (c) and adding licensing and inspection requirement for outpatient dialysis units and outpatient surgical facilities, deleting references to residential care homes and ambulatory facilities and deleting provision re technical assistance fee, added new Subsec. (d) to change license renewal for residential care homes from biennially to triennially and to increase fees from $300 per site and $3 per bed to $450 per site and $4.50 per bed, added new Subsec. (e) to require license renewal and inspection with fees every four years for outpatient clinics and maternity homes, added new Subsec. (f) re technical assistance fee, redesignated existing Subsec. (e) as new Subsec. (g) and made technical changes, effective January 1, 2004; P.A. 05-64 amended Subsec. (g) by designating existing language re regulations allowing for training as Subdiv. (1), making technical changes and adding new Subdivs. (1) and (2) re additional requirements for regulations establishing minimum service quality standards, effective June 2, 2005; P.A. 09-197 amended Subsec. (a) by adding exception for certain facilities licensed by the Commissioner of Children and Families, effective July 1, 2009; June Sp. Sess. P.A. 09-3 amended Subsecs. (c), (d) and (f) to increase fees; P.A. 10-117 amended Subsec. (b) to make a technical change and add provisions permitting commissioner to assess civil penalty of not more than $1,000 per day against an owner who is in violation of Public Health Code or consent order and providing that consent order may include establishment of temporary manager and that Attorney General may petition Superior Court to ensure compliance with consent order; P.A. 11-242 amended Subsec. (e) by deleting former Subdivs. (2) and (3) re license fees for maternity homes on a per site and per bed basis and by making technical changes; P.A. 12-118 added Subsec. (h) prohibiting commissioner from issuing or renewing the license of certain long-term care hospitals from June 15, 2012, until June 30, 2017, unless the hospital was certified under federal act on January 1, 2012, effective June 15, 2012; P.A. 13-208 amended Subsec. (c) by adding provisions, codified by the Revisors as Subdivs. (15) to (18), re hospice facility biennial fees and by making a technical change; P.A. 13-234 amended Subsec. (c) by adding Subdivs. (12) and (13) re home health care agency biennial fees and adding Subdiv. (14) re assisted living services agency biennial fees, amended Subsec. (d) by adding Subdiv. (3) re home health care agency triennial fees and adding Subdiv. (4) re certified home health care agency triennial fees, and amended Subsec. (f) by adding provisions re renovation and building alteration, re fees relative to cost of project, re fees to include reviews and inspections and re definition of “institution”, effective July 1, 2013; P.A. 13-249 added new Subsec. (h) re professional liability insurance or other indemnity against liability for professional malpractice and redesignated existing Subsec. (h) as Subsec. (i), effective January 1, 2014; P.A. 15-242 amended Subsec. (f) by changing “project cost” to “construction cost” and making technical changes and added Subsec. (j) re maintenance of medical records; P.A. 16-66 amended Subsec. (j)(1)(A) and (2)(A) to add provision re retrieval of records from off-site location not later than end of next business day after receiving records request and further amended Subsec. (j)(2)(A) to delete “, except nurse's notes,”; P.A. 17-95 added new Subsec. (f) re review of plan for construction or building alteration project and compliance with nationally established facility guidelines and redesignated existing Subsecs. (f) to (j) as Subsecs. (g) to (k); P.A. 17-146 amended Subsec. (a)(2) by designating provision re forms as Subpara. (A), adding Subpara. (B) re fee, designating provision re information as department requires as Subpara. (C), and making technical changes; June Sp. Sess. P.A. 17-2 amended Subsec. (e) by replacing “four” with “three”, adding reference to “urgent care services” and replacing “clinics” with “clinical services”, effective October 31, 2017, and made identical changes, effective December 1, 2017; P.A. 18-168 amended Subsec. (a) by adding Subpara. (D) re notarization of application not required; P.A. 19-97 amended Subsecs. (h) and (i) by replacing references to homemaker-home health aides with references to home health aides, effective July 1, 2019; P.A. 19-118 amended Subsec. (b) by adding reference to Sec. 19a-490(o), effective July 9, 2019, and amended Subsec. (e) by adding provisions re exception to requirement of licensing and inspection every 3 years and making technical changes, effective July 1, 2019; P.A. 21-121 amended Subsec. (b) by replacing references to “Public Health Code” with references to “regulations of Connecticut state agencies”, amended Subsec. (c)(13) by adding references to hospice agencies and home health aide agencies, amended Subsec. (d)(4) by adding “or hospice agencies”, amended Subsec. (h) by adding reference to hospice agency and making conforming changes and amended Subsec. (i) by adding “, hospice agency”, effective July 1, 2021; P.A. 22-58 amended Subsec. (a)(2) by adding provision re applicability to hospital and psychiatric residential treatment facility units of Albert J. Solnit Children's Center, effective May 23, 2022; P.A. 22-92 amended Subsec. (c)(13) by making a technical change, effective May 24, 2022; P.A. 23-147 amended Subsec. (a) by deleting “Notwithstanding any regulation,”, adding Subdiv. (19) re birth centers, and making conforming changes, effective January 1, 2024.
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Sec. 19a-491a. Information required for nursing home license. Professional liability insurance requirements. Procedure upon failure to provide information. (a) A person seeking a license to establish, conduct, operate or maintain a nursing home shall provide the Department of Public Health with the following information:
(1) (A) The name and business address of the owner and a statement of whether the owner is an individual, partnership, corporation or other legal entity; (B) the names of the officers, directors, trustees, or managing and general partners of the owner, the names of persons having a five per cent or greater ownership interest in the owner, and a description of each such person's occupation with the owner; (C) if the owner is a corporation which is incorporated in another state, a certificate of good standing from the secretary of state of the state of incorporation; and (D) if a private equity company or real estate investment trust owns any portion of the business, any information regarding such company or trust required to be disclosed (i) on federal Form CMS-855a, and (ii) in accordance with 42 CFR 424.516 or 42 CFR 455.104, as amended from time to time;
(2) A description of the relevant business experience of the owner and of the administrator of the nursing home and evidence that the administrator has a license issued pursuant to section 19a-514;
(3) Affidavits signed by the owner, any of the persons described in subdivision (1) of this subsection, the administrator, assistant administrator, the medical director, the director of nursing and assistant director of nursing disclosing any matter in which such person has been convicted of a felony, as defined in section 53a-25, or has pleaded nolo contendere to a felony charge, or has been held liable or enjoined in a civil action by final judgment, if the felony or civil action involved fraud, embezzlement, fraudulent conversion or misappropriation of property; or is subject to an injunction or restrictive or remedial order of a court of record at the time of application, within the past five years has had any state or federal license or permit suspended or revoked as a result of an action brought by a governmental agency or department, arising out of or relating to health care business activity, including, but not limited to, actions affecting the operation of a nursing home, retirement home, residential care home or any facility subject to sections 17b-520 to 17b-535, inclusive, or a similar statute in another state or country;
(4) (A) A statement as to whether or not the owner is, or is affiliated with, a religious, charitable or other nonprofit organization; (B) the extent of the affiliation, if any; (C) the extent to which the affiliate organization will be responsible for the financial obligations of the owner; and (D) the provision of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as from time to time amended, if any, under which the owner or affiliate is exempt from the payment of income tax;
(5) The location and a description of other health care facilities of the owner, existing or proposed, and, if proposed, the estimated completion date or dates and whether or not construction has begun;
(6) Audited and certified financial statements of the owner, including (A) a balance sheet as of the end of the most recent fiscal year, and (B) income statements for the most recent fiscal year of the owner or such shorter period of time as the owner shall have been in existence; and
(7) If the operation of the nursing home has not yet commenced, a statement of the anticipated source and application of the funds used or to be used in the purchase or construction of the home, including:
(A) An estimate of such costs as financing expense, legal expense, land costs, marketing costs and other similar costs which the owner expects to incur or become obligated for prior to the commencement of operations; and
(B) A description of any mortgage loan or any other financing intended to be used for the financing of the nursing home, including the anticipated terms and costs of such financing.
(b) In addition to the information provided pursuant to subsection (a) of this section, the commissioner may reasonably require an applicant for a nursing home license or renewal of a nursing home license to submit additional information. Such information may include audited and certified financial statements of the owner, including, (1) a balance sheet as of the end of the most recent fiscal year, and (2) income statements for the most recent fiscal year of the owner or such shorter period of time as the owner shall have been in existence.
(c) No person acting individually or jointly with any other person shall establish, conduct, operate or maintain a nursing home 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. The requirements of this subsection shall not apply to any person who establishes, conducts, operates or maintains a residential care home.
(d) A person seeking to renew a nursing home license shall furnish the department with any information required under this section that was not previously submitted and with satisfactory written proof that the owner of the nursing home consents to such renewal, if the owner is different from the person seeking renewal, and shall provide data on any change in the information submitted. The commissioner shall refuse to issue or renew a nursing home license if the person seeking renewal fails to provide the information required under this section. Upon such refusal, the commissioner shall grant such license to the holder of the certificate of need, provided such holder meets all requirements for such licensure. If such holder does not meet such requirements, the commissioner shall proceed in accordance with sections 19a-541 to 19a-549, inclusive. If the commissioner is considering a license renewal application pursuant to an order of the commissioner, the procedures in this subsection shall apply to such consideration.
(P.A. 89-350, S. 1; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; P.A. 97-112, S. 2; June Sp. Sess. P.A. 99-2, S. 39, 72; P.A. 01-195, S. 148, 181; P.A. 04-221, S. 33; P.A. 06-196, S. 149; P.A. 13-249, S. 1; P.A. 23-48, S. 8; 23-122, S. 2.)
History: P.A. 93-381 replaced department of health services with the department of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; P.A. 97-112 replaced “home for the aged” with “residential care home”; June Sp. Sess. P.A. 99-2 amended Subsec. (c) by adding requirement of written proof of consent of owner when owner is different from the person seeking renewal, effective June 29, 1999; P.A. 01-195 made technical changes in Subsecs. (a) to (c), effective July 11, 2001; P.A. 04-221 amended Subsec. (c) by changing from allowing to requiring the commissioner to refuse to issue or renew license if required information not provided, by providing that license shall be granted to holder of certificate of need in certain circumstances and by providing for procedure in renewals pursuant to order of the commissioner, effective June 8, 2004; P.A. 06-196 made a technical change in Subsec. (c), effective June 7, 2006; P.A. 13-249 added new Subsec. (c) re professional liability insurance or other indemnity against liability for professional malpractice, redesignated existing Subsec. (c) as Subsec. (d) and made a technical change, effective January 1, 2014; P.A. 23-48 amended Subsec. (a) by adding Subdiv. (1)(D) re private equity company or real estate investment trust ownership of a nursing home business, adding new Subdiv. (6) re audited and certified financial statements of owner, redesignating existing Subdiv. (6) as Subdiv. (7) and made conforming changes, effective July 1, 2023; P.A. 23-122 amended Subsec. (a)(1)(B) replacing “ten per cent” with “five per cent”.
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Sec. 19a-493. (Formerly Sec. 19-578). Initial license and renewal. Prior approval for change in ownership. Multicare institution. Regulations. (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, 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, as defined in subsection (b) of section 19a-490, is currently certified, 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) after an unscheduled inspection is conducted by the department, and (2) 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. In the case of an institution, as defined in subsection (m) of section 19a-490, that is applying for renewal, the license shall be issued pursuant to section 19a-491. 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) A nursing home license may be renewed biennially after (1) an unscheduled inspection conducted by the department, (2) submission of the information required by section 19a-491a, and (3) submission of evidence satisfactory to the department that the nursing home is in compliance with the provisions of this chapter, the regulations of Connecticut state agencies and licensing regulations.
(c) (1) (A) For the purposes of this subsection, (i) “a person related by blood or marriage” means a parent, spouse, child, brother, sister, aunt, uncle, niece or nephew, (ii) “business entity” means a corporation, association, trust, estate, partnership, limited partnership, limited liability partnership, limited liability company, sole proprietorship, joint stock company, nonstock corporation or other legal entity, (iii) “institution” has the same meaning as provided in section 19a-490, and (iv) “organizational chart” means a graphical representation of an organization, including, but not limited to, the relationships between such organization's ownership interests.
(B) For the purposes of this subsection, (i) a change in the legal form of the licensee, 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 in 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 commissioner to properly identify the current status of ownership and beneficial ownership of the facility or institution, (ii) a public offering of the stock of any corporation that owns, conducts, operates or maintains any 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, and (iii) a change of ownership of, or to, a business entity recognized as a nonprofit 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 amended from time to time, that is licensed as a hospital pursuant to this chapter resulting in the transfer of ownership which is exempt from review required under subsection (a) of section 19a-486a shall not be considered a change in ownership provided the owner provides such information regarding the change to the department as may be required by the commissioner to properly identify the current status of ownership.
(C) For the purposes of this subsection, “serious risk to the life, safety or quality of care of patients or residents” includes, but is not limited to, any deficiency in state licensure or federal certification requirements, including the provisions of 42 CFR 488.400 et seq., resulting in:
(i) An action by a state or federal agency to ban, curtail or temporarily suspend admissions to a facility or to suspend or revoke a facility's license;
(ii) A decertification, termination or exclusion from Medicaid or Medicare participation, including denial of payment for new admissions resulting solely due to the provider's failure to correct deficiencies or noncompliance with regulatory requirements, imposed by the Department of Public Health or by the Centers for Medicare and Medicaid Services, as a result of noncompliance with Medicaid or Medicare conditions of participation;
(iii) A citation of any deficiency that constitutes a pattern or widespread scope of actual harm or immediate jeopardy, or any deficiency causing widespread actual harm, as described in 42 CFR 488;
(iv) A determination that the provider is a “poor performer” as defined by the Centers for Medicare and Medicaid Services on the basis of a finding of substandard quality of care or immediate jeopardy, as described in 42 CFR 488, on the current survey and on a survey during one of the two preceding years. For the purposes of this subparagraph, “substandard quality of care” means the failure to meet one or more requirements of 42 CFR 483.13, 42 CFR 483.15 or 42 CFR 483.25, that constitute either immediate jeopardy to resident health or safety, a pattern of or widespread actual harm that is not immediate jeopardy or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm; or
(v) A determination that the facility has failed to correct, on a second revisit, deficiencies that have been cited during a prior survey, and that has resulted in a denial by the Centers for Medicare and Medicaid Services of payment for new admissions or a requirement by the department to curtail admission.
(2) Any change in the ownership or beneficial ownership of a facility or institution owned by an individual or a business entity that owns, conducts, operates or maintains such facility or institution, including a change in ownership or beneficial ownership resulting in a transfer to a person related by blood or marriage to an owner or a beneficial owner, shall be subject to prior approval of 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 regulations of Connecticut state agencies and the change of ownership or beneficial ownership meets the requirements of subdivision (5) of subsection (c) of this section.
(3) Not later than one hundred twenty days before the proposed date of a change in ownership or beneficial ownership of a facility or institution, the proposed new owner, or in the case of a change in beneficial ownership, the current owner, of such facility or institution shall submit an application for approval to the department. Such application shall be in a form and manner prescribed by the commissioner and shall include, but need not be limited to, the following:
(A) A cover letter identifying the facility or institution subject to such change by name, address, county and number and type of beds licensed by the department;
(B) A description of the proposed transaction resulting in such change, including the name of each current owner of the facility or institution;
(C) The name of each proposed new owner or beneficial owner;
(D) The name of each owner of any nonpublicly traded parent corporation of each proposed new owner and beneficial owner;
(E) If applicable, (i) the proposed new owner's organizational chart, (ii) the proposed new owner's parent business entity's organizational chart, (iii) the organizational chart of each wholly-owned subsidiary of such proposed new owner, and (iv) the current owner's organizational chart showing the changes in beneficial ownership;
(F) A copy of the agreement of sale or other transfer of ownership interests and, if applicable, a copy of any lease or management agreements that will be in effect after the transaction;
(G) The name and address of any licensed health care facility owned, operated or managed by each proposed new owner and beneficial owner in the United States or any territory of the United States during the five years preceding the date on which such application is submitted, and information relating to any such facility, including:
(i) Disclosure of any direct or indirect interests, including such interests in intermediate entities and parent, management and property companies and other related entities arising from such ownership, operation or management;
(ii) Disclosure of whether each such facility or institution is the subject of a pending complaint, investigation or licensure action by a governmental authority;
(iii) Disclosure of whether each such facility or institution has been subject to:
(I) Three or more civil penalties imposed through final order of the commissioner in accordance with the provisions of sections 19a-524 to 19a-528, inclusive, or civil penalties imposed pursuant to the laws or regulations of another state during the two-year period preceding the date on which such application is submitted;
(II) Sanctions, other than civil penalties less than or equal to twenty thousand dollars, imposed in any state through final adjudication under the Medicare or Medicaid program pursuant to Title XVIII or XIX of the federal Social Security Act, 42 USC 301, as amended from time to time;
(III) Termination or nonrenewal of a Medicare or Medicaid provider agreement;
(IV) Any state licensing or federal certification deficiency during the five-year period prior to the submission of the application that presented a serious risk to the life, safety or quality of care of the facility's patients or residents; and
(V) Any violation of any state licensing or federal certification standard in connection with an inappropriate discharge or denial of admission; and
(H) Disclosure of whether each proposed new owner has ever been convicted or pleaded guilty to a charge of fraud, patient or resident abuse or neglect or a crime of violence or moral turpitude.
(4) After receiving an application for change in ownership, the commissioner may schedule an inspection of such facility or institution to determine if the facility or institution has complied with the requirements of this chapter and the regulations of Connecticut state agencies relating to licensure of such facility or institution.
(5) When evaluating an application for a change in ownership, the commissioner shall consider whether each proposed new owner and beneficial owner demonstrates character and competence, quality of care and whether an acceptable history of past and current compliance with state licensure requirements, applicable federal requirements and state regulatory requirements exists for each licensed health care facility owned, operated or managed by each proposed new owner and beneficial owner in the United States or any territory of the United States during the five years preceding the date on which such application is submitted. The commissioner may deny an application for change in ownership if such qualities are not demonstrated, as evidenced by:
(A) Any such licensed health care facility being subject to any adverse action described in subparagraph (G)(iii) of subdivision (3) of this subsection;
(B) Any such licensed health care facility exhibiting continuing violations or a pattern of violations of state licensure standards or federal certification standards; or
(C) An applicant's criminal conviction of, or guilty plea to, any of the crimes described in subparagraph (H) of subdivision (3) of this subsection.
(6) Notwithstanding the provisions of subdivision (5) of this subsection, the commissioner may stay the determination of an application if the commissioner determines that there is a pending investigation of actions of the applicant at any facility operated or managed by the applicant that, if substantiated, would constitute a threat to the life, safety or quality of care of the patients or residents until such time as there is a final determination of the allegations underlying the investigation.
(7) If the commissioner denies an application for change in ownership, a person related by blood or marriage to the applicant may not apply to acquire ownership interest in the facility or institution.
(8) In the event of a change in ownership or beneficial ownership resulting in a transfer to a person related by blood or marriage to an owner or beneficial owner, the commissioner may waive the submission of information required pursuant to the provisions of subparagraph (G) of subdivision (3) of this subsection. In the event of a change in ownership or beneficial ownership of five per cent or less of the ownership of a business entity that is a licensed institution, the commissioner may waive the submission of some or all of the information required pursuant to the provisions of subdivision (3) of this subsection or the determination required pursuant to subdivision (5) of this subsection. The commissioner shall develop an application process through which a person may request a waiver described in this subdivision and criteria to be used by the commissioner when evaluating such a request. The commissioner shall consult with representatives of the long-term care industry when developing such application process and criteria.
(9) The provisions of this subsection shall not apply the event of a change of ownership or beneficial ownership of ten per cent or less of the ownership of a licensed outpatient surgical facility, as defined in section 19a-493b, resulting in a transfer to a physician licensed under chapter 370 if such facility provides information, in a form and manner prescribed by the commissioner, to update such facility's licensing information.
(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. Such behavioral health services or substance use disorder treatment services may include methadone delivery and related substance use treatment services to persons in a nursing home facility pursuant to the provisions of section 19a-495c or in a mobile narcotic treatment program, as defined in 21 CFR 1300.
(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) A multicare institution that is a hospital providing outpatient behavioral health services or other health care services shall provide the Department of Public Health with a list of satellite units or locations when completing the initial or renewal licensure application.
(4) 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.
(1953, 1955, S. 2053d; P.A. 77-304, S. 4; 77-601, S. 3, 11; 77-614, S. 323, 587, 610; P.A. 78-303, S. 85, 136; P.A. 79-46, S. 2, 3; P.A. 80-17; 80-199; P.A. 81-135; 81-201, S. 1; P.A. 84-546, S. 168, 173; P.A. 85-146, S. 2, 4; P.A. 89-350, S. 7; P.A. 90-13, S. 7; June Sp. Sess. P.A. 91-8, S. 28, 63; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; June Sp. Sess. P.A. 99-2, S. 15, 72; P.A. 00-10; P.A. 05-272, S. 6; P.A. 09-232, S. 14; P.A. 10-117, S. 1; P.A. 13-249, S. 3; P.A. 14-211, S. 2; P.A. 15-242, S. 40; P.A. 19-118, S. 5; P.A. 21-121, S. 35; P.A. 22-108, S. 4; P.A. 23-122, S. 1.)
History: Sec. 19-34 transferred to Sec. 19-578 in 1977; P.A. 77-304 added provisions re report of portions of federal income tax information as condition for license renewal and re notice and approval of proposed changes in ownership; P.A. 77-601 added provisions re approval and inspection of institutions required for issuance and renewal, respectively, of licenses; P.A. 77-614 and P.A. 78-303 replaced commissioner and department of health commissioner and department of health services, effective January 1, 1979; P.A. 79-46 rephrased proviso re license issuance or renewal and allowed issuance or renewal only if institution not otherwise required to be licensed by state; P.A. 80-17 allowed waiver of inspection and investigation if currently certified as provider of services by U.S. Department of Health and Human Resources or certified within last 12 months; P.A. 80-199 rephrased provision re prior approval of change in ownership; P.A. 81-135 specified that inspections conducted by the department of health services prior to the initial licensure of a facility or prior to the transfer of ownership of a nursing home shall be “scheduled” inspections and that inspections conducted for purposes of license renewal shall be “unscheduled”; P.A. 81-201 replaced requirement that a nursing home owner submit pertinent portions of his personal Federal Income Tax for purposes of annual license renewal with authorization for the department of health services to require the submission of “information related to the character and financial condition” of the owner; Sec. 19-578 transferred to Sec. 19a-493 in 1983; P.A. 84-546 made technical changes; P.A. 85-146 authorized the issuance of provisional licenses; P.A. 89-350 divided the existing section into Subsecs. (a) and (b), provided for biennial licensure, added the language in Subsec. (b) on requirements for the renewal of a nursing home license and on consent orders and made technical changes; P.A. 90-13 made technical change in Subsec. (a); June Sp. Sess. P.A. 91-8 amended Subsec. (b) to specify when changes re transfer or change of ownership to relatives are not subject to department approval and defined “a person related by blood or marriage”; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; June Sp. Sess. P.A. 99-2 amended Subsec. (b) by expanding definition of “a person related by blood or marriage” to include a “brother, sister, aunt, uncle, niece or nephew” and by adding provision re change in legal form of ownership entity, effective June 29, 1999; P.A. 00-10 made technical changes and added provisions re a public offering of stock that shall not be considered a change in ownership or beneficial ownership; P.A. 05-272 amended Subsec. (a) to remove “without charge” re biennial renewal of certain health care institution licenses; P.A. 09-232 amended Subsec. (a) by substituting United States Department of Health and Human Services for United States Department of Health and Human Resources and by adding exception re frequency of Department of Public Health inspections for Medicare-certified provider institutions, effective July 1, 2009; P.A. 10-117 amended Subsec. (a) by deleting provisions re provisional license, by deleting reference to Sec. 19a-490(c), by adding “on renewal” re inspection and investigation waiver, by changing “requirements” to “requirements established under section 19a-495”, by deleting reference to Sec. 19a-490(e) or (f), by replacing provision re inspection of institution certified as Medicare provider with provision re 3-year period of licensure for institution certified as Medicare provider and by making technical changes; P.A. 13-249 amended Subsec. (b)(1)(B) to delete “subsections (a) and (c) of section 19a-491a and any other information required by the commissioner pursuant to subsection (b) of said” and add “19a-491a”, effective January 1, 2014; P.A. 14-211 amended Subsec. (a) by deleting reference to Sec. 19a-490(d), (e) or (f), adding provision re multicare institution and making technical changes and added Subsec. (c) re multicare institutions; P.A. 15-242 amended Subsec. (c)(2) to make technical changes; P.A. 19-118 amended Subsec. (a) by adding provision re institution applying for approval, amended Subsec. (b)(2) by deleting reference to Subsec. (c) and replacing reference to 90 days with reference to 120 days re advance notice of change of ownership and amended Subsec. (c) by adding provision permitting behavioral health services or substance use disorder treatment services to include methadone delivery and related substance use treatment services in Subdiv. (1), adding Subdiv. (3) requiring certain multicare institutions to provide department with list of satellite units or locations and redesignating existing Subdiv. (3) as Subdiv. (4), effective July 1, 2019; P.A. 21-121 amended Subsec. (b) by replacing “Public Health Code” with “regulations of Connecticut state agencies” and adding “limited liability company,” in Subdiv. (2)(A), effective July 1, 2021; P.A. 22-108 amended Subsec. (c)(1) by adding reference to a mobile narcotic treatment program, effective July 1, 2022; P.A. 23-122 substantially revised section by adding new Subsec. (c)(1) re definitions of terms concerning changes of ownership, redesignating existing Subsec. (b)(2) as Subsec. (c)(2), and making substantial revisions therein re changes of ownership, adding new Subsec. (c)(3) and (c)(4) re change of ownership procedures including disclosure requirements and facility inspections, adding Subsec. (c)(5) to (c)(9) re application evaluations, stays of application determinations, reapplications by persons related by blood or marriage, waivers of submission of information to the commissioner, and applicability of section to changes of ownership of 10 per cent or less of licensed outpatient surgical facilities, redesignating existing Subsec. (c) as Subsec. (d), and making technical and conforming changes throughout.
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Sec. 19a-504c. Regulations re standards for hospital discharge planning. Caregiver designation and training. (a) For purposes of this section and section 19a-504e:
(1) “Caregiver” means any individual who a patient designates as a caregiver to provide post-discharge assistance to the patient in the patient's home in the community. The term “caregiver” includes, but is not limited to, a relative, spouse, partner, friend or neighbor who has a significant relationship with the patient. For the purposes of this section and section 19a-504e, the term caregiver shall not include any individual who receives compensation for providing post-discharge assistance to the patient.
(2) “Home” means the dwelling that the patient considers to be the patient's home in the community. The term “home” shall not include, and the provisions of this section and section 19a-504e shall not apply to, a discharge to any rehabilitation facility, hospital, nursing home, assisted living facility, group home or any other setting that was not the patient's home in the community immediately preceding the patient's inpatient admission.
(3) “Hospital” has the same meaning as provided in section 19a-490.
(4) “Post-discharge assistance” means nonprofessional care provided by a designated caregiver to a patient following the patient's discharge from an inpatient admission to a hospital in accordance with the written discharge plan of care signed by the patient or the patient's representative, including, but not limited to, assisting with basic activities of daily living, instrumental activities of daily living and carrying out support tasks, such as assisting with wound care, administration of medications and use of medical equipment.
(b) The Department of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, to set minimum standards for hospital discharge planning services. Such standards shall include, but need not be limited to, requirements for (1) a written discharge plan prepared in consultation with the patient, or the patient's family or representative, and the patient's physician, including, but not limited to, the date and location of each follow-up medical appointment scheduled prior to the patient's discharge and, to the extent known to the hospital, a list of all medications the patient is currently taking and will continue to take after the patient's discharge, and (2) a procedure for advance notice to the patient of the patient's discharge and provision of a copy of the discharge plan to the patient prior to discharge.
(c) Whenever a hospital refers a patient's name to a nursing home as part of the hospital's discharge planning process, or when a hospital patient requests such a referral, the hospital shall make a copy of the patient's hospital record available to the nursing home and shall allow the nursing home access to the patient for purposes of care planning and consultation.
(d) Whenever a hospital's discharge planning indicates that an inpatient will be discharged to the patient's home, the hospital shall (1) allow the patient to designate a caregiver at, or prior to, the time that a written copy of the discharge plan is provided to the patient, and (2) transmit in an electronic manner to the patient's pharmacy each prescription ordered by a hospital employee for the patient prior to discharge that the patient will need after discharge. A patient is not required to designate any individual as a caregiver and any individual designated as a caregiver under this section is not obligated to perform any post-discharge assistance for the patient.
(e) If an inpatient designates a caregiver pursuant to subsection (d) of this section prior to receiving written discharge instructions, the hospital shall:
(1) Record the patient's designation of caregiver, the relationship of the designated caregiver to the patient, and the name, telephone number and address of the patient's designated caregiver in the discharge plan.
(2) Make reasonable attempts to notify the patient's designated caregiver of the patient's discharge to the patient's home as soon as practicable. In the event the hospital is unable to contact the designated caregiver, the lack of contact shall not interfere with, delay, or otherwise affect the medical care provided to the patient or an appropriate discharge of the patient.
(3) Prior to discharge, provide caregivers with instructions in all post-discharge assistance tasks described in the discharge plan. Training and instructions for caregivers may be conducted in person or through video technology, as determined by the hospital to effectively provide the necessary instruction. Any training or instructions provided to a caregiver shall be provided in nontechnical language, to the extent possible. At a minimum, this instruction shall include: (A) A live or recorded demonstration of the tasks performed by an individual designated by the hospital who is authorized to perform the post-discharge assistance task and is able to perform the demonstration in a culturally competent manner and in accordance with the hospital's requirements to provide language access services under state and federal law; (B) an opportunity for the caregiver to ask questions about the post-discharge assistance tasks; and (C) answers to the caregiver's questions provided in a culturally competent manner and in accordance with the hospital's requirements to provide language access services under state and federal law.
(4) Document in the patient's medical record any training for initial implementation of the discharge plan provided to the patient, the patient's representative or the designated caregiver. Any instruction required under subdivision (3) of this subsection shall be documented in the patient's medical record, including, at a minimum, the date, time and contents of the instruction.
(f) If the patient agrees, the written discharge materials referenced in this section may include electronic-only versions, and acknowledgment of any such written discharge materials may be documented through electronic means.
(P.A. 88-335, S. 2, 5; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; P.A. 11-236, S. 4; P.A. 15-32, S. 1; P.A. 21-26, S. 10; P.A. 23-39, S. 1.)
History: P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; P.A. 11-236 added provision requiring hospital referring a patient to a nursing home to make the patient's hospital record available and to allow the nursing home access to the patient, and made technical changes, effective July 13, 2011; P.A. 15-32 added Subsec. (a) re definitions, designated existing provisions re regulations as Subsec. (b) and existing provision re hospital referral of patient's name as Subsec. (c), and added Subsecs. (d) and (e) re patient-designated caregivers; P.A. 21-26 added Subsec. (f) re electronic-only versions of written discharge materials, effective July 1, 2021; P.A. 23-39 amended Subsec. (b) by requiring written discharge plan to include date and location of follow-up medical appointments and list of all medications patient is currently taking and will continue to take and Subsec. (d) by designating existing provisions as Subdiv. (1) and adding Subdiv. (2) requiring hospital to electronically transmit to the patient's pharmacy each prescription ordered by a hospital employee prior to discharge that patient will need after discharge.
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Sec. 19a-505. (Formerly Sec. 19-588). (Note: This section is repealed, effective July 1, 2025.) Maternity hospitals; license; inspection. (a) No person shall keep a maternity hospital or lying-in place unless such person has previously obtained a license therefor, issued by the Department of Public Health. Each such license shall be valid for a term of two years and may be revoked by the Department of Public Health upon proof that the institution for which such license was issued is being improperly conducted or for the violation of any of the provisions of this section or of the Public Health Code, or on the basis of lack of demonstrable need, provided the licensee shall be given a reasonable opportunity to be heard in reference to such proposed revocation.
(b) Within six hours after the departure, removal or withdrawal of any child born at such maternity hospital or lying-in place, the keeper thereof shall make a record of such departure, removal or withdrawal of such child, the names and residences of the persons who took such child or its body and the place to which it was taken and where it was left, which record shall be produced by the keeper or licensee of such hospital or lying-in place, for inspection by and upon the demand of any person authorized to make such inspection by the Department of Public Health or the council. Each keeper of any such hospital or lying-in place, and his servants and agents, shall permit any person so authorized to enter such hospital or lying-in place and inspect such hospital or lying-in place and all of its appurtenances, for the purpose of detecting any improper treatment of any child or any improper management or conduct in such hospital or lying-in place or its appurtenances. Each person so authorized may remove any article which he may think presents evidence of any crime being committed therein and deliver the same to the appropriate law enforcement official to be disposed of according to law. Any person who violates any provision of this section shall be fined not more than two hundred dollars or imprisoned not more than six months or both.
(c) On and after January 1, 2024, the Commissioner of Public Health shall not grant or renew a maternity hospital license pursuant to this section.
(1949 Rev., S. 4687; 1949, S. 2336d; 1969, P.A. 693, S. 4; 699, S. 23; P.A. 77-614, S. 323, 610; P.A. 89-339, S. 2, 6; P.A. 93-381 , S. 9, 39; P.A. 95-257, S. 12, 21, 58; P.A. 23-147, S. 7, 17.)
History: 1969 acts divided section into Subsecs., allowed revocation of license on basis of lack of demonstrable need, added reference to inspectors authorized by council on hospitals and deleted reference to presentation of evidence to coroner, referring instead to “appropriate law enforcement official”; Sec. 19-43 transferred to Sec. 19-588 in 1977; P.A. 77-614 replaced department of health with department of health services, effective January 1, 1979; Sec. 19-588 transferred to Sec. 19a-505 in 1983; P.A. 89-339 amended Subsec. (a) to replace provision that license terminates December thirty-first, annually, with provision that license is valid for two years; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; P.A. 23-147 added Subsec. (c) re cessation of grants and renewals of maternity hospital licenses, effective October 1, 2023, and repealed section, effective July 1, 2025.
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Sec. 19a-507a. (Formerly Sec. 19a-80a). Community residences for adults impacted by mental health disorder. Definitions. As used in section 8-3g and sections 19a-507a to 19a-507d, inclusive: (1) “Adult impacted by mental health disorder” means any adult who experiences symptoms of, or is in remission from, a mental or emotional condition that has a clinically significant impact on one or more areas of such adult's functioning and who requires care and treatment but shall not mean any adult who is dangerous to such adult or others, as defined in section 17a-495, or who is an alcohol-dependent person or a drug-dependent person, as defined in section 17a-680, or who has been placed in any community-based residential home by order of the Superior Court or has been released to any community-based residential home by the Department of Correction or any person found not competent to stand trial for any crime pursuant to section 54-56d or committed pursuant to sections 17a-580 to 17a-602, inclusive; and (2) “community residence” means a facility which houses the staff of such facility and eight or fewer adults impacted by mental health disorders that is licensed by the Commissioner of Public Health and which provides supervised, structured group living activities and psychosocial rehabilitation and other support services to adults impacted by mental health disorders who are discharged from a state-operated or licensed facility or referred by a licensed physician specializing in psychiatry or a licensed psychologist.
(P.A. 84-341, S. 1, 8; P.A. 85-506, S. 29, 32; P.A. 90-209, S. 24; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 11, 12, 21, 58; June 18 Sp. Sess. P.A. 97-8, S. 35, 88; P.A. 22-69, S. 11; P.A. 23-137, S. 67.)
History: P.A. 85-506 replaced reference to repealed Sec. 53a-77 with reference to Secs. 17-257a to 17-257w, inclusive; Sec. 19a-80a transferred to Sec. 19a-507a in 1987; P.A. 90-209 in Subdiv. (1) redefined “mentally ill adult” by substituting “alcohol-dependent person” for “alcoholic” and “drug-dependent person, as defined in section 17-155l” for an adult “whose psychiatric disorder is drug dependence, as defined in subdivision (18) of section 21a-240”; P.A. 93-381 replaced commissioner of health services with commissioner of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Mental Health with Commissioner and Department of Mental Health and Addiction Services and replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; June 18 Sp. Sess. P.A. 97-8 deleted former Subdiv. (3) defining “regional mental health director” and renumbered remaining Subdiv. accordingly, effective July 1, 1997; P.A. 22-69 deleted Subdiv. (2) re definition of “regional mental health board”, redesignated existing Subdiv. (3) as new Subdiv. (2) and made a technical change, effective May 24, 2022; P.A. 23-137 substituted the term “adult impacted by mental health disorder” for “mentally ill adult” and revised associated definition.
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Sec. 19a-507b. (Formerly Sec. 19a-80b). Establishment of community residence. Limitations. Petitions. (a) No community residence, as defined in section 19a-507a, except a community residence that houses eight or fewer persons receiving mental health or addiction services and necessary staff persons paid for or provided by the Department of Mental Health and Addiction Services that has been issued a license by the Department of Public Health under the provisions of section 19a-491 shall be established 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 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.
(P.A. 84-341, S. 3, 8; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; June 18 Sp. Sess. P.A. 97-8, S. 36, 88; P.A. 22-69, S. 12; P.A. 23-137, S. 68; 23-204, S. 172.)
History: Sec. 19a-80b transferred to Sec. 19a-507b in 1987; P.A. 93-381 replaced department and commissioner of health services with department and commissioner of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; June 18 Sp. Sess. P.A. 97-8 deleted reference in Subsec. (c) to regional mental health directors, effective July 1, 1997; P.A. 22-69 amended Subsec. (c) by deleting provision requiring applicant to mail copy of application to regional mental health board, effective May 24, 2022; P.A. 23-137 amended Subsec. (a) to exempt any community residence housing 8 or fewer persons with intellectual disability, children with mental or physical disabilities and persons receiving mental health or addiction services from the prohibition of establishing such residence within 1,000 feet of another such residence; P.A. 23-204 amended Subsec. (a) by deleting Subdiv. (1) designator, inserting reference to section 19a-507a definition, deleting Subdiv. (1)(A) re residences for persons with intellectual disability and deleting Subdiv. (2) re child-care residential facilities, effective June 12, 2023.
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Sec. 19a-508c. Hospital and health system facility fees charged for outpatient services at hospital-based facilities. Notice re establishment of hospital-based facility at which facility fees billed. Penalties. Report. (a) As used in this section:
(1) “Affiliated provider” means a provider that is: (A) Employed by a hospital or health system, (B) under a professional services agreement with a hospital or health system that permits such hospital or health system to bill on behalf of such provider, or (C) a clinical faculty member of a medical school, as defined in section 33-182aa, that is affiliated with a hospital or health system in a manner that permits such hospital or health system to bill on behalf of such clinical faculty member;
(2) “Campus” means: (A) The physical area immediately adjacent to a hospital's main buildings and other areas and structures that are not strictly contiguous to the main buildings but are located within two hundred fifty yards of the main buildings, or (B) any other area that has been determined on an individual case basis by the Centers for Medicare and Medicaid Services to be part of a hospital's campus;
(3) “Facility fee” means any fee charged or billed by a hospital or health system for outpatient services provided in a hospital-based facility that is: (A) Intended to compensate the hospital or health system for the operational expenses of the hospital or health system, and (B) separate and distinct from a professional fee;
(4) “Health care provider” means an individual, entity, corporation, person or organization, whether for-profit or nonprofit, that furnishes, bills or is paid for health care service delivery in the normal course of business, including, but not limited to, a health system, a hospital, a hospital-based facility, a freestanding emergency department and an urgent care center;
(5) “Health system” means: (A) A parent corporation of one or more hospitals and any entity affiliated with such parent corporation through ownership, governance, membership or other means, or (B) a hospital and any entity affiliated with such hospital through ownership, governance, membership or other means;
(6) “Hospital” has the same meaning as provided in section 19a-490;
(7) “Hospital-based facility” means a facility that is owned or operated, in whole or in part, by a hospital or health system where hospital or professional medical services are provided;
(8) “Medicaid” means the program operated by the Department of Social Services pursuant to section 17b-260 and authorized by Title XIX of the Social Security Act, as amended from time to time;
(9) “Observation” means services furnished by a hospital on the hospital's campus, regardless of length of stay, including use of a bed and periodic monitoring by the hospital's nursing or other staff to evaluate an outpatient's condition or determine the need for admission to the hospital as an inpatient;
(10) “Payer mix” means the proportion of different sources of payment received by a hospital or health system, including, but not limited to, Medicare, Medicaid, other government-provided insurance, private insurance and self-pay patients;
(11) “Professional fee” means any fee charged or billed by a provider for professional medical services provided in a hospital-based facility;
(12) “Provider” means an individual, entity, corporation or health care provider, whether for profit or nonprofit, whose primary purpose is to provide professional medical services; and
(13) “Tagline” means a short statement written in a non-English language that indicates the availability of language assistance services free of charge.
(b) If a hospital or health system charges a facility fee utilizing a current procedural terminology evaluation and management (CPT E/M) code or assessment and management (CPT A/M) code for outpatient services provided at a hospital-based facility where a professional fee is also expected to be charged, the hospital or health system shall provide the patient with a written notice that includes the following information:
(1) That the hospital-based facility is part of a hospital or health system and that the hospital or health system charges a facility fee that is in addition to and separate from the professional fee charged by the provider;
(2) (A) The amount of the patient's potential financial liability, including any facility fee likely to be charged, and, where professional medical services are provided by an affiliated provider, any professional fee likely to be charged, or, if the exact type and extent of the professional medical services needed are not known or the terms of a patient's health insurance coverage are not known with reasonable certainty, an estimate of the patient's financial liability based on typical or average charges for visits to the hospital-based facility, including the facility fee, (B) a statement that the patient's actual financial liability will depend on the professional medical services actually provided to the patient, (C) an explanation that the patient may incur financial liability that is greater than the patient would incur if the professional medical services were not provided by a hospital-based facility, and (D) a telephone number the patient may call for additional information regarding such patient's potential financial liability, including an estimate of the facility fee likely to be charged based on the scheduled professional medical services; and
(3) That a patient covered by a health insurance policy should contact the health insurer for additional information regarding the hospital's or health system's charges and fees, including the patient's potential financial liability, if any, for such charges and fees.
(c) If a hospital or health system charges a facility fee without utilizing a current procedural terminology evaluation and management (CPT E/M) code for outpatient services provided at a hospital-based facility, located outside the hospital campus, the hospital or health system shall provide the patient with a written notice that includes the following information:
(1) That the hospital-based facility is part of a hospital or health system and that the hospital or health system charges a facility fee that may be in addition to and separate from the professional fee charged by a provider;
(2) (A) A statement that the patient's actual financial liability will depend on the professional medical services actually provided to the patient, (B) an explanation that the patient may incur financial liability that is greater than the patient would incur if the hospital-based facility was not hospital-based, and (C) a telephone number the patient may call for additional information regarding such patient's potential financial liability, including an estimate of the facility fee likely to be charged based on the scheduled professional medical services; and
(3) That a patient covered by a health insurance policy should contact the health insurer for additional information regarding the hospital's or health system's charges and fees, including the patient's potential financial liability, if any, for such charges and fees.
(d) Each initial billing statement that includes a facility fee shall: (1) Clearly identify the fee as a facility fee that is billed in addition to, or separately from, any professional fee billed by the provider; (2) provide the corresponding Medicare facility fee reimbursement rate for the same service as a comparison or, if there is no corresponding Medicare facility fee for such service, (A) the approximate amount Medicare would have paid the hospital for the facility fee on the billing statement, or (B) the percentage of the hospital's charges that Medicare would have paid the hospital for the facility fee; (3) include a statement that the facility fee is intended to cover the hospital's or health system's operational expenses; (4) inform the patient that the patient's financial liability may have been less if the services had been provided at a facility not owned or operated by the hospital or health system; and (5) include written notice of the patient's right to request a reduction in the facility fee or any other portion of the bill and a telephone number that the patient may use to request such a reduction without regard to whether such patient qualifies for, or is likely to be granted, any reduction. Not later than October 15, 2022, and annually thereafter, each hospital, health system and hospital-based facility shall submit to the Health Systems Planning Unit of the Office of Health Strategy a sample of a billing statement issued by such hospital, health system or hospital-based facility that complies with the provisions of this subsection and which represents the format of billing statements received by patients. Such billing statement shall not contain patient identifying information.
(e) The written notice described in subsections (b) to (d), inclusive, and (h) to (j), inclusive, of this section shall be in plain language and in a form that may be reasonably understood by a patient who does not possess special knowledge regarding hospital or health system facility fee charges. On and after October 1, 2022, such notices shall include tag lines in at least the top fifteen languages spoken in the state indicating that the notice is available in each of those top fifteen languages. The fifteen languages shall be either the languages in the list published by the Department of Health and Human Services in connection with section 1557 of the Patient Protection and Affordable Care Act, P.L. 111-148, or, as determined by the hospital or health system, the top fifteen languages in the geographic area of the hospital-based facility.
(f) (1) For nonemergency care, if a patient's appointment is scheduled to occur ten or more days after the appointment is made, such written notice shall be sent to the patient by first class mail, encrypted electronic mail or a secure patient Internet portal not less than three days after the appointment is made. If an appointment is scheduled to occur less than ten days after the appointment is made or if the patient arrives without an appointment, such notice shall be hand-delivered to the patient when the patient arrives at the hospital-based facility.
(2) For emergency care, such written notice shall be provided to the patient as soon as practicable after the patient is stabilized in accordance with the federal Emergency Medical Treatment and Active Labor Act, 42 USC 1395dd, as amended from time to time, or is determined not to have an emergency medical condition and before the patient leaves the hospital-based facility. If the patient is unconscious, under great duress or for any other reason unable to read the notice and understand and act on his or her rights, the notice shall be provided to the patient's representative as soon as practicable.
(g) Subsections (b) to (f), inclusive, and (l) of this section shall not apply if a patient is insured by Medicare or Medicaid or is receiving services under a workers' compensation plan established to provide medical services pursuant to chapter 568.
(h) A hospital-based facility shall prominently display written notice in locations that are readily accessible to and visible by patients, including patient waiting or appointment check-in areas, stating: (1) That the hospital-based facility is part of a hospital or health system, (2) the name of the hospital or health system, and (3) that if the hospital-based facility charges a facility fee, the patient may incur a financial liability greater than the patient would incur if the hospital-based facility was not hospital-based. On and after October 1, 2022, such notices shall include tag lines in at least the top fifteen languages spoken in the state indicating that the notice is available in each of those top fifteen languages. The fifteen languages shall be either the languages in the list published by the Department of Health and Human Services in connection with section 1557 of the Patient Protection and Affordable Care Act, P.L. 111-148, or, as determined by the hospital or health system, the top fifteen languages in the geographic area of the hospital-based facility. Not later than October 1, 2022, and annually thereafter, each hospital-based facility shall submit a copy of the written notice required by this subsection to the Health Systems Planning Unit of the Office of Health Strategy.
(i) A hospital-based facility shall clearly hold itself out to the public and payers as being hospital-based, including, at a minimum, by stating the name of the hospital or health system in its signage, marketing materials, Internet web sites and stationery.
(j) A hospital-based facility shall, when scheduling services for which a facility fee may be charged, inform the patient (1) that the hospital-based facility is part of a hospital or health system, (2) of the name of the hospital or health system, (3) that the hospital or health system may charge a facility fee in addition to and separate from the professional fee charged by the provider, and (4) of the telephone number the patient may call for additional information regarding such patient's potential financial liability.
(k) (1) If any transaction described in subsection (c) of section 19a-486i, results in the establishment of a hospital-based facility at which facility fees may be billed, the hospital or health system, that is the purchaser in such transaction shall, not later than thirty days after such transaction, provide written notice, by first class mail, of the transaction to each patient served within the three years preceding the date of the transaction by the health care facility that has been purchased as part of such transaction.
(2) Such notice shall include the following information:
(A) A statement that the health care facility is now a hospital-based facility and is part of a hospital or health system, the health care facility's full legal and business name and the date of such facility's acquisition by a hospital or health system;
(B) The name, business address and phone number of the hospital or health system that is the purchaser of the health care facility;
(C) A statement that the hospital-based facility bills, or is likely to bill, patients a facility fee that may be in addition to, and separate from, any professional fee billed by a health care provider at the hospital-based facility;
(D) (i) A statement that the patient's actual financial liability will depend on the professional medical services actually provided to the patient, and (ii) an explanation that the patient may incur financial liability that is greater than the patient would incur if the hospital-based facility were not a hospital-based facility;
(E) The estimated amount or range of amounts the hospital-based facility may bill for a facility fee or an example of the average facility fee billed at such hospital-based facility for the most common services provided at such hospital-based facility; and
(F) A statement that, prior to seeking services at such hospital-based facility, a patient covered by a health insurance policy should contact the patient's health insurer for additional information regarding the hospital-based facility fees, including the patient's potential financial liability, if any, for such fees.
(3) A copy of the written notice provided to patients in accordance with this subsection shall be filed with the Health Systems Planning Unit of the Office of Health Strategy, established under section 19a-612. Said unit shall post a link to such notice on its Internet web site.
(4) A hospital, health system or hospital-based facility shall not collect a facility fee for services provided at a hospital-based facility that is subject to the provisions of this subsection from the date of the transaction until at least thirty days after the written notice required pursuant to this subsection is mailed to the patient or a copy of such notice is filed with the Health Systems Planning Unit of the Office of Health Strategy, whichever is later. A violation of this subsection shall be considered an unfair trade practice pursuant to section 42-110b.
(5) Not later than July 1, 2023, and annually thereafter, each hospital-based facility that was the subject of a transaction, as described in subsection (c) of section 19a-486i, during the preceding calendar year shall report to the Health Systems Planning Unit of the Office of Health Strategy the number of patients served by such hospital-based facility in the preceding three years.
(l) (1) Notwithstanding the provisions of this section, no hospital, health system or hospital-based facility shall collect a facility fee for (A) outpatient health care services that use a current procedural terminology evaluation and management (CPT E/M) code or assessment and management (CPT A/M) code and are provided at a hospital-based facility located off-site from a hospital campus, or (B) outpatient health care services provided at a hospital-based facility located off-site from a hospital campus received by a patient who is uninsured of more than the Medicare rate.
(2) Notwithstanding the provisions of this section, on and after July 1, 2024, no hospital or health system shall collect a facility fee for outpatient health care services that use a current procedural terminology evaluation and management (CPT E/M) code or assessment and management (CPT A/M) code and are provided on the hospital campus. The provisions of this subdivision shall not apply to (A) an emergency department located on a hospital campus, or (B) observation stays on a hospital campus and (CPT E/M) and (CPT A/M) codes when billed for the following services: (i) Wound care, (ii) orthopedics, (iii) anticoagulation, (iv) oncology, (v) obstetrics, and (vi) solid organ transplant.
(3) Notwithstanding the provisions of subdivisions (1) and (2) of this subsection, in circumstances when an insurance contract that is in effect on July 1, 2016, provides reimbursement for facility fees prohibited under the provisions of subdivision (1) of this subsection, and in circumstances when an insurance contract that is in effect on July 1, 2024, provides reimbursement for facility fees prohibited under the provisions of subdivision (2) of this subsection, a hospital or health system may continue to collect reimbursement from the health insurer for such facility fees until the applicable date of expiration, renewal or amendment of such contract, whichever such date is the earliest.
(4) The provisions of this subsection shall not apply to a freestanding emergency department. As used in this subdivision, “freestanding emergency department” means a freestanding facility that (A) is structurally separate and distinct from a hospital, (B) provides emergency care, (C) is a department of a hospital licensed under chapter 368v, and (D) has been issued a certificate of need to operate as a freestanding emergency department pursuant to chapter 368z.
(5) (A) On and after July 1, 2024, if the executive director of the Office of Health Strategy receives information and has a reasonable belief, after evaluating such information, that any hospital, health system or hospital-based facility charged facility fees, other than through isolated clerical or electronic billing errors, in violation of any provision of this section, or rule or regulation adopted thereunder, such hospital, health system or hospital-based facility shall be subject to a civil penalty of up to one thousand dollars. The executive director may issue a notice of violation and civil penalty by first class mail or personal service. Such notice shall include: (i) A reference to the section of the general statutes, rule or section of the regulations of Connecticut state agencies believed or alleged to have been violated; (ii) a short and plain language statement of the matters asserted or charged; (iii) a description of the activity to cease; (iv) a statement of the amount of the civil penalty or penalties that may be imposed; (v) a statement concerning the right to a hearing; and (vi) a statement that such hospital, health system or hospital-based facility may, not later than ten business days after receipt of such notice, make a request for a hearing on the matters asserted.
(B) The hospital, health system or hospital-based facility to whom such notice is provided pursuant to subparagraph (A) of this subdivision may, not later than ten business days after receipt of such notice, make written application to the Office of Health Strategy to request a hearing to demonstrate that such violation did not occur. The failure to make a timely request for a hearing shall result in the issuance of a cease and desist order or civil penalty. All hearings held under this subsection shall be conducted in accordance with the provisions of chapter 54.
(C) Following any hearing before the Office of Health Strategy pursuant to this subdivision, if said office finds, by a preponderance of the evidence, that such hospital, health system or hospital-based facility violated or is violating any provision of this subsection, any rule or regulation adopted thereunder or any order issued by said office, said office shall issue a final cease and desist order in addition to any civil penalty said office imposes.
(m) (1) Each hospital and health system shall report not later than October 1, 2023, and thereafter not later than July 1, 2024, and annually thereafter, to the executive director of the Office of Health Strategy, on a form prescribed by the executive director, concerning facility fees charged or billed during the preceding calendar year. Such report shall include, but need not be limited to, (A) the name and address of each facility owned or operated by the hospital or health system that provides services for which a facility fee is charged or billed, and an indication as to whether each facility is located on or outside of the hospital or health system campus, (B) the number of patient visits at each such facility for which a facility fee was charged or billed, (C) the number, total amount and range of allowable facility fees paid at each such facility disaggregated by payer mix, (D) for each facility, the total amount of facility fees charged and the total amount of revenue received by the hospital or health system derived from facility fees, (E) the total amount of facility fees charged and the total amount of revenue received by the hospital or health system from all facilities derived from facility fees, (F) a description of the ten procedures or services that generated the greatest amount of facility fee gross revenue, disaggregated by current procedural terminology category (CPT) code for each such procedure or service and, for each such procedure or service, patient volume and the total amount of gross and net revenue received by the hospital or health system derived from facility fees, disaggregated by on-campus and off-campus, and (G) the top ten procedures or services for which facility fees are charged based on patient volume and the gross and net revenue received by the hospital or health system for each such procedure or service, disaggregated by on-campus and off-campus. For purposes of this subsection, “facility” means a hospital-based facility that is located on a hospital campus or outside a hospital campus.
(2) The executive director shall publish the information reported pursuant to subdivision (1) of this subsection, or post a link to such information, on the Internet web site of the Office of Health Strategy.
(P.A. 14-145, S. 1, 2; P.A. 15-146, S. 13; P.A. 16-77, S. 2; P.A. 17-241, S. 5; P.A. 18-91, S. 57; 18-149, S. 1; P.A. 21-129, S. 4; P.A. 22-92, S. 8; P.A. 23-171, S. 9.)
History: P.A. 15-146 added new Subsec. (d) re billing statements that include facility fee, redesignated existing Subsecs. (d) to (h) as Subsecs. (e) to (i), added Subsec. (j) re transaction that results in establishment of hospital-based facility at which facility fees will likely be billed, added Subsec. (k) re when collection of facility fees is prohibited, added Subsec. (l) re annual report, and made conforming changes; P.A. 16-77 amended Subsec. (d) by replacing “billing statement” with “initial billing statement”, amended Subsec. (d)(2) by replacing “Medicare facility fee” with “corresponding Medicare facility fee” and adding provisions re no corresponding Medicare facility fee, amended Subsec. (d)(5) by adding provision re whether patient qualifies for or is likely to be granted any reduction and amended Subsec. (g) by adding reference to Subsec. (k), effective June 2, 2016; P.A. 17-241 amended Subsec. (a)(3) by replacing “outpatient hospital services” with “outpatient services”, amended Subsec. (b)(2) by adding Subpara. (D) re telephone number patient may call for additional information, amended Subsec. (c)(2) by adding Subpara. (C) re telephone number patient may call for additional information, amended Subsec. (h) by adding new Subdiv. (2) re name of hospital or health system and redesignating existing Subdiv. (2) as Subdiv. (3), added new Subsec. (j) re informing patient when scheduling services for which facility fee may be charged, redesignated existing Subsecs. (j) to (l) as Subsecs. (k) to (m), and made technical and conforming changes; P.A. 18-91 amended Subsecs. (k)(3) and (k)(4) by replacing references to Office of Health Care Access with references to Health Systems Planning Unit, amended Subsec. (m)(1) by replacing “Commissioner of Public Health” with “executive director of the Office of Health Strategy” and amended Subsec. (m)(2) by replacing “commissioner” with “executive director” and “Office of Health Care Access” with “Office of Health Strategy”, effective May 14, 2018; P.A. 18-149 amended Subsec. (l) by deleting “on and after January 1, 2017,”, replacing “management code” with “management (CPT E/M) code” in Subdiv. (1), deleting references to hospital emergency department in Subdivs. (1) and (2), and adding provision re freestanding emergency departments; P.A. 21-129 amended Subsec. (a) by adding new Subdiv. (7) defining “payer mix”, redesignating existing Subdivs. (7) and (8) as Subdivs. (8) and (9) and adding Subdiv. (10) defining “tagline”, amended Subsec. (b) by adding reference to assessment and management code, amended Subsec. (d) by deleting date reference and requiring hospitals, health systems and hospital-based facilities to submit sample of billing statement to Health Planning Unit of Office of Health Strategy, amended Subsec. (e) by requiring notices to include tag lines in at least the top 15 languages spoken in the state indicating the notice is available in such languages, amended Subsec. (h) by adding reference to appointment check-in areas, requiring notices to include tag lines in at least the top 15 languages spoken in the state indicating the notice is available in such languages, and requiring hospital-based facility to annually submit copy of such notices to Health Systems Planning Unit of Office of Health Strategy, amended Subsec. (k) by deleting date reference, replacing “previous three years” with “three years preceding the date of the transaction” and making technical changes in Subdiv. (1), adding requirement that the notice include health care facility's full legal and business name and date of facility's acquisition by a hospital or health system in Subdiv. (2)(A), and adding Subdiv. (5) requiring report to Health Systems Planning Unit of number of patients served by hospital-based facility in preceding 3 years, amended Subsec. (l) by adding reference to assessment and management code and to renewal or amendment of contract, and adding “, whichever such date is the earliest”, and amended Subsec. (m)(1) by replacing “July 1, 2016” with “July 1, 2023” and adding reference to form prescribed by executive director, replacing “location” with “address” in Subpara. (A), replacing “by Medicare, Medicaid or under private insurance policies” with “disaggregated by payer mix” in Subpara. (C), adding references to amount of facility fees charged in Subparas. (D) and (E), replacing “facility fee revenue” with “facility fee gross revenue”, requiring description of procedures or services to be disaggregated by current procedural terminology category code, adding reference to patient volume and inserting “gross and net” before “revenue” in Subpara. (F), and adding reference to services re top 10 facility fees charged and to gross and net revenue received by hospital or health system for each such procedure or service in Subpara. (G), effective October 1, 2022; P.A. 22-92 amended Subsec. (d)(5) by making a technical change and Subsecs. (k)(4) and (5) by adding references to the Office of Health Strategy; P.A. 23-171 amended Subsec. (a) by adding new Subdiv. (4) defining “health care provider”, redesignating existing Subdivs. (4) to (6) as Subdivs. (5) to (7), adding new Subdiv. (8) defining “Medicaid”, adding new Subdiv. (9) defining “observation”, and redesignating existing Subdivs. (7) to (10) as Subdivs. (10) to (13), amended Subsec. (l) by inserting new Subdiv. (1) designator, redesignating existing Subdivs. (1) and (2) as Subparas. (A) and (B), adding new Subdiv. (2) re prohibition on collection of facility fee for services using certain codes and provided on the hospital campus, inserting Subdiv. (3) designator and amending same by adding reference to insurance contract in effect on July 1, 2024, that provides reimbursement for facility fees, deleting provision re a violation being considered an unfair trade practice and making technical changes, inserting Subdiv. (4) designator and amending same by making a technical change and adding Subdiv. (5) re penalties and amended Subsec. (m)(1) by replacing “July 1, 2023,” with “October 1, 2023, and thereafter not later than July 1, 2024”, requiring report to include indication as to whether a facility is located on or outside of campus in Subpara. (A), requiring that the description be disaggregated by on-campus and off-campus in Subparas. (F) and (G) and making technical changes, effective July 1, 2023.
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Sec. 19a-528a. Application of licensure for acquisition of a nursing home. Notice of liability for abuse or neglect. Required disclosures. (a) For any application of licensure for the acquisition of a nursing home, any potential nursing home licensee or owner shall submit in writing, a change in ownership application with respect to the facility for which the change in ownership is sought. The application shall be submitted in the form and manner prescribed by the Commissioner of Public Health. The commissioner shall include on the first page of the application the following statement: “NOTICE: The State of Connecticut values the quality of care provided to all nursing home residents. Please know that any nursing home licensee, owner or officer, including, but not limited to, a director, trustee, limited partner, managing partner, general partner or any person having at least a five per cent ownership interest in the nursing home or the entity that owns the nursing home, and any administrator, assistant administrator, medical director, director of nursing or assistant director of nursing may be subject to civil and criminal liability, as well as administrative sanctions under applicable federal and state law, for the abuse or neglect of a resident of the nursing home perpetrated by an employee of the nursing home.”.
(b) Such statement shall not be construed as expanding or otherwise affecting the liability of any person or entity referenced in the statement. The application shall also include questions as to whether such potential nursing home licensee or owner has had (1) three or more civil penalties imposed through final order of the commissioner in accordance with the provisions of sections 19a-524 to 19a-528, inclusive, or civil penalties imposed pursuant to the statutes or regulations of another state, during the two-year period preceding the application, (2) in any state, sanctions, other than civil penalties of less than twenty thousand dollars, imposed through final adjudication under the Medicare or Medicaid program pursuant to Title XVIII or XIX of the federal Social Security Act, 42 USC 301, as from time to time amended, or (3) in any state, such potential licensee's or owner's Medicare or Medicaid provider agreement terminated or not renewed. If a potential nursing home licensee or owner's application contains information concerning civil penalties, sanctions, terminations or nonrenewals, as described in this section, the commissioner shall not approve the application to acquire another nursing home in this state for a period of five years from the date of final order on such civil penalties, final adjudication of such sanctions, or termination or nonrenewal, except for good cause shown.
(P.A. 89-350, S. 4; P.A. 01-195, S. 158, 181; P.A. 04-258, S. 39; P.A. 10-117, S. 8; P.A. 16-6, S. 1; P.A. 23-122, S. 3.)
History: P.A. 01-195 made technical changes, effective July 11, 2001; P.A. 04-258 required that for any application of licensure for the acquisition of a nursing home filed after July 1, 2004, the potential licensee or owner must submit a written change in ownership application for the facility for which the ownership change is sought, amended Subdiv. (1) to require disclosure of civil penalties imposed by statutes or regulations of any state, amended Subdivs. (2) and (3) to require disclosure of out-of-state sanctions and termination of Medicaid provider agreements and added provision permitting Commissioner of Public Health to make exceptions for good cause shown re acquisition prior to expiration of five-year period, effective July 1, 2004; P.A. 10-117 required that application include such information as commissioner deems necessary, amended Subdiv. (1) by changing civil penalties provision to “three or more” during 2-year period preceding application, amended Subdiv. (2) by changing “state intermediate sanctions” to “state sanctions, other than civil penalties of less than twenty thousand dollars”, amended Subdiv. (3) to provide that if application contains information re civil penalties, sanctions, terminations or nonrenewals, such application shall not be approved except for good cause shown, and deleted provision re commissioner's authority to grant exceptions prior to expiration of 5-year period; P.A. 16-6 designated existing provisions re licensure for acquisition of nursing home as Subsec. (a) and amended same to delete reference to July 1, 2004, and add provisions re submission of application and statement on first page of application, designated existing provisions re information to be included on application as Subsec. (b) and amended same to add provision re statement not to be construed as expanding or affecting liability, and made technical changes; P.A. 23-122 amended Subsec. (a) by replacing “ten per cent” with “five per cent”.
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Sec. 19a-535. (Formerly Sec. 19-616). Transfer or discharge of residents. Notice. Plan required. Appeal. Hearing. Involuntary transfer, discharge reporting. (a) For the purposes of this section: (1) “Facility” means an entity certified as a nursing facility under the Medicaid program or an entity certified as a skilled nursing facility under the Medicare program or with respect to facilities that do not participate in the Medicaid or Medicare programs, a chronic and convalescent nursing home or a rest home with nursing supervision as defined in section 19a-521; (2) “continuing care facility which guarantees life care for its residents” has the same meaning as provided in section 17b-354; (3) “transfer” means the movement of a resident from one facility to another facility or institution, including, but not limited to, a hospital emergency department, if the resident is admitted to the facility or institution or is under the care of the facility or institution for more than twenty-four hours; (4) “discharge” means the movement of a resident from a facility to a noninstitutional setting; (5) “self-pay resident” means a resident who is not receiving state or municipal assistance to pay for the cost of care at a facility, but shall not include a resident who has filed an application with the Department of Social Services for Medicaid coverage for facility care but has not received an eligibility determination from the department on such application, provided the resident has timely responded to requests by the department for information that is necessary to make such determination; and (6) “emergency” means a situation in which a failure to effect an immediate transfer or discharge of the resident that would endanger the health, safety or welfare of the resident or other residents.
(b) A facility shall not transfer or discharge a resident from the facility except to meet the welfare of the resident which cannot be met in the facility, or unless the resident no longer needs the services of the facility due to improved health, the facility is required to transfer the resident pursuant to section 17b-359 or 17b-360, or the health or safety of individuals in the facility is endangered, or in the case of a self-pay resident, for the resident's nonpayment or arrearage of more than fifteen days of the per diem facility room rate, or the facility ceases to operate. In each case the basis for transfer or discharge shall be documented in the resident's medical record by a physician, a physician assistant or an advanced practice registered nurse. In each case where the welfare, health or safety of the resident is concerned the documentation shall be by the resident's physician, physician assistant or advanced practice registered nurse. A facility that is part of a continuing care facility which guarantees life care for its residents may transfer or discharge (1) a self-pay resident who is a member of the continuing care community and who has intentionally transferred assets in a sum that will render the resident unable to pay the costs of facility care in accordance with the contract between the resident and the facility, or (2) a self-pay resident who is not a member of the continuing care community and who has intentionally transferred assets in a sum that will render the resident unable to pay the costs of a total of forty-two months of facility care from the date of initial admission to the facility.
(c) (1) Before effecting any transfer or discharge of a resident from the facility, the facility shall notify, in writing, the resident and the resident's guardian or conservator, if any, or legally liable relative or other responsible party if known, of the proposed transfer or discharge, the reasons therefor, the effective date of the proposed transfer or discharge, the location to which the resident is to be transferred or discharged, the right to appeal the proposed transfer or discharge and the procedures for initiating such an appeal as determined by the Department of Social Services, the date by which an appeal must be initiated in order to preserve the resident's right to an appeal hearing and the date by which an appeal must be initiated in order to stay the proposed transfer or discharge and the possibility of an exception to the date by which an appeal must be initiated in order to stay the proposed transfer or discharge for good cause, that the resident may represent himself or herself or be represented by legal counsel, a relative, a friend or other spokesperson, an affirmation by the facility that notice of the proposed transfer or discharge has been provided to the State Long-Term Care Ombudsman, in accordance with the provisions of subdivision (3) of this subsection, and information as to bed hold and nursing home readmission policy when required in accordance with section 19a-537. The notice shall also include the name, mailing address and telephone number of the State Long-Term Care Ombudsman. If the resident is, or the facility alleges a resident is, mentally ill or developmentally disabled, the notice shall include the name, mailing address and telephone number of the nonprofit entity designated by the Governor in accordance with section 46a-10b to serve as the Connecticut protection and advocacy system. The notice shall be given at least thirty days and no more than sixty days prior to the resident's proposed transfer or discharge, except where the health or safety of individuals in the facility are endangered, or where the resident's health improves sufficiently to allow a more immediate transfer or discharge, or where immediate transfer or discharge is necessitated by urgent medical needs or where a resident has not resided in the facility for thirty days, in which cases notice shall be given as many days before the transfer or discharge as practicable.
(2) The resident may initiate an appeal pursuant to this section by submitting a written request to the Commissioner of Social Services not later than sixty calendar days after the facility issues the notice of the proposed transfer or discharge, except as provided in subsection (h) of this section. In order to stay a proposed transfer or discharge, the resident must initiate an appeal not later than twenty days after the date the resident receives the notice of the proposed transfer or discharge from the facility unless the resident demonstrates good cause for failing to initiate such appeal within the twenty-day period.
(3) On the date that the facility provides notice of a proposed involuntary transfer or discharge of a resident pursuant to the provisions of subdivision (1) of this subsection, the facility shall notify the State Ombudsman, appointed pursuant to section 17a-870, in a manner prescribed by the State Ombudsman, of such proposed involuntary transfer or discharge. Failure to provide notice to the State Ombudsman pursuant to the provisions of this subdivision shall invalidate any notice of the proposed involuntary transfer or discharge of a resident submitted pursuant to the provisions of subdivision (1) of this subsection.
(d) No resident shall be transferred or discharged from any facility as a result of a change in the resident's status from self-pay or Medicare to Medicaid provided the facility offers services to both categories of residents. Any such resident who wishes to be transferred to another facility that has agreed to accept the resident may do so upon giving at least fifteen days written notice to the administrator of the facility from which the resident is to be transferred and a copy thereof to the appropriate advocate of such resident. The resident's advocate may help the resident complete all administrative procedures relating to a transfer.
(e) Except in an emergency or in the case of transfer to a hospital, no resident shall be transferred or discharged from a facility unless a discharge plan has been developed by the personal physician, physician assistant or advanced practice registered nurse of the resident or the medical director in conjunction with the nursing director, social worker or other health care provider. To minimize the disruptive effects of the transfer or discharge on the resident, the person responsible for developing the plan shall consider the feasibility of placement near the resident's relatives, the acceptability of the placement to the resident and the resident's guardian or conservator, if any, or the resident's legally liable relative or other responsible party, if known, and any other relevant factors that affect the resident's adjustment to the move. The plan shall contain a written evaluation of the effects of the transfer or discharge on the resident and a statement of the action taken to minimize such effects. In addition, the plan shall outline the care and kinds of services that the resident shall receive upon transfer or discharge. Not less than thirty days prior to an involuntary transfer or discharge, a copy of the discharge plan shall be provided to the resident's personal physician, physician assistant or advanced practice registered nurse if the discharge plan was prepared by the medical director, to the resident and the resident's guardian or conservator, if any, or legally liable relative or other responsible party, if known.
(f) No resident shall be involuntarily transferred or discharged from a facility if such transfer or discharge is medically contraindicated.
(g) The facility shall be responsible for assisting the resident in finding appropriate placement.
(h) (1) Except in the case of an emergency, as provided in subdivision (4) of this subsection, upon receipt of a request for a hearing to appeal any proposed transfer or discharge, the Commissioner of Social Services or the commissioner's designee shall hold a hearing to determine whether the transfer or discharge is being effected in accordance with this section. A hearing shall be convened not less than ten, but not more than thirty days from the date of receipt of such request and a written decision made by the commissioner or the commissioner's designee not later than thirty days after the date of termination of the hearing or not later than sixty days after the date of the hearing request, whichever occurs sooner. The hearing shall be conducted in accordance with chapter 54. In each case the facility shall prove by a preponderance of the evidence that it has complied with the provisions of this section. Except in the case of an emergency or in circumstances when the resident is not physically present in the facility, whenever the Commissioner of Social Services receives a request for a hearing in response to a notice of proposed transfer or discharge and such notice does not meet the requirements of subsection (c) of this section, the commissioner shall, not later than ten business days after the date of receipt of such notice from the resident or the facility, order the transfer or discharge stayed and return such notice to the facility. Upon receipt of such returned notice, the facility shall issue a revised notice that meets the requirements of subsection (c) of this section.
(2) The resident, the resident's guardian, conservator, legally liable relative or other responsible party shall have an opportunity to examine, during regular business hours at least three business days prior to a hearing conducted pursuant to this section, the contents of the resident's file maintained by the facility and all documents and records to be used by the commissioner or the commissioner's designee or the facility at the hearing. The facility shall have an opportunity to examine during regular business hours at least three business days prior to such a hearing, all documents and records to be used by the resident at the hearing.
(3) If a hearing conducted pursuant to this section involves medical issues, the commissioner or the commissioner's designee may order an independent medical assessment of the resident at the expense of the Department of Social Services that shall be made part of the hearing record.
(4) In an emergency the notice required pursuant to subsection (c) of this section shall be provided as soon as practicable. A resident who is transferred or discharged on an emergency basis or a resident who receives notice of such a transfer or discharge may contest the action by requesting a hearing in writing not later than twenty days after the date of receipt of notice or not later than twenty days after the date of transfer or discharge, whichever is later, unless the resident demonstrates good cause for failing to request a hearing within the twenty-day period. A hearing shall be held in accordance with the requirements of this subsection not later than fifteen business days after the date of receipt of the request. The commissioner, or the commissioner's designee, shall issue a decision not later than thirty days after the date on which the hearing record is closed.
(5) Except in the case of a transfer or discharge effected pursuant to subdivision (4) of this subsection, (A) an involuntary transfer or discharge shall be stayed pending a decision by the commissioner or the commissioner's designee, and (B) if the commissioner or the commissioner's designee determines the transfer or discharge is being effected in accordance with this section, the facility may not transfer or discharge the resident prior to fifteen days from the date of receipt of the decision by the resident and the resident's guardian or conservator, if any, or the resident's legally liable relative or other responsible party if known.
(6) If the commissioner, or the commissioner's designee, determines after a hearing held in accordance with this section that the facility has transferred or discharged a resident in violation of this section, the commissioner, or the commissioner's designee, may require the facility to readmit the resident to a bed in a semiprivate room or in a private room, if a private room is medically necessary, regardless of whether or not the resident has accepted placement in another facility pending the issuance of a hearing decision or is awaiting the availability of a bed in the facility from which the resident was transferred or discharged.
(7) A copy of a decision of the commissioner or the commissioner's designee shall be sent to the facility and to the resident, the resident's guardian, conservator, if any, legally liable relative or other responsible party, if known. The decision shall be deemed to have been received not later than five days after the date it was mailed, unless the facility, the resident or the resident's guardian, conservator, legally liable relative or other responsible party proves otherwise by a preponderance of the evidence. The Superior Court shall consider an appeal from a decision of the Department of Social Services pursuant to this section as a privileged case in order to dispose of the case with the least possible delay.
(i) A resident who receives notice from the Department of Social Services or its agent that the resident is no longer in need of the level of care provided by a facility and that, consequently, the resident's coverage for facility care will end, may request a hearing by the Commissioner of Social Services in accordance with the provisions of section 17b-60. If the resident requests a hearing prior to the date that Medicaid coverage for facility care is to end, Medicaid coverage shall continue pending the outcome of the hearing. If the resident receives a notice of denial of Medicaid coverage from the department or its agent and also receives a notice of discharge from the facility pursuant to subsection (c) of this section and the resident requests a hearing to contest each proposed action, the department may schedule one hearing at which the resident may contest both actions.
(j) Whenever a facility is discharging a resident to the resident's home in the community, the discharge shall be in accordance with sections 19a-535c and 19a-535d.
(k) Except as otherwise provided pursuant to subdivision (3) of subsection (c) of this section, a facility shall electronically report each involuntary transfer or discharge to the State Ombudsman, appointed pursuant to section 17a-870, (1) in a manner prescribed by the State Ombudsman, and (2) on an Internet web site portal maintained by the State Ombudsman in accordance with patient privacy provisions of the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time.
(P.A. 76-331, S. 9, 16; P.A. 79-265, S. 1; P.A. 89-348, S. 1, 10; P.A. 93-262, S. 1, 87; 93-327, S. 2; 93-381, S. 9, 39; P.A. 94-236, S. 5, 10; P.A. 95-160, S. 2, 69; P.A. 96-139, S. 12, 13; June 18 Sp. Sess. P.A. 97-2, S. 115, 165; P.A. 99-176, S. 22, 24; P.A. 03-278, S. 124; P.A. 11-236, S. 1; P.A. 16-39, S. 18; 16-59, S. 3; P.A. 17-96, S. 20; P.A. 21-196, S. 28, 29; P.A. 22-57, S. 9; P.A. 23-48, S. 1, 3.)
History: P.A. 79-265 defined “self-pay” patient in Subsec. (a) and added reference to self-pay status, added provisions re minimizing disruptive effects of transfers or discharges and re provision of copies of discharge plan and added Subsec. (c); Sec. 19-616 transferred to Sec. 19a-535 in 1983; P.A. 89-348 inserted new Subsecs. (a), (b), (c), (g) and (h) re the transfer or discharge of patients, a patient's right to appeal a transfer or discharge decision and a patient's right to a hearing, relettering previously existing Subsecs. as necessary; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; P.A. 93-327 amended Subsec. (c) to permit notice no more than 60 days prior to transfer or discharge and amended Subsec. (f) to replace standard of imminent danger of death with “medically contraindicated”; P.A. 93-381 replaced commissioner of health services with commissioner of public health and addiction services, effective July 1, 1993; P.A. 94-236 amended Subsec. (b) to add requirements re transfer or discharge of a patient in a nursing facility which is part of a continuing care facility, effective June 7, 1994; P.A. 95-160 amended Subsec. (a) by replacing former definition of “nursing facility” with new definitions applicable to section, amended Subsec. (c) by allowing a facility to notify, in writing, or other responsible party, if known, of a patient transfer or discharge and by requiring additional information in the notice of transfer or discharge, deleted in Subsec. (h)(1) a provision allowing a patient notified of a transfer or discharge to request a hearing within 10 days of receipt of such notice and added requirement that commissioner provide notice to a patient within 5 business days of receipt of a notice of proposed transfer or discharge and specified the provisions such notice shall include, amended Subsec. (h)(2) by replacing the Commissioner of Public Health and Addiction Services with the Commissioner of Social Services, by extending the time for a hearing to be held from within 7 “business days” to not less than 10 but not more than 30 days of the date of such request, by requiring the commissioner to issue a written decision of his determination, by extending the time the commissioner has to issue such decision from within 20 days “of the termination of the hearing” to within 60 days “of the determination of the hearing” or within 90 days of the date of the hearing request, whichever occurs sooner and by adding a provision that the facility shall prove by a preponderance of the evidence that it has complied with the provisions of this section, added Subsec. (h)(3)and (4) re requirements for the patient to have the opportunity to examine the contents of such patient's file and re commissioner's authority to order an independent medical assessment for a hearing, amended Subsec. (h)(5) by deleting a provision allowing a facility, in an emergency, to request the commissioner to make a determination as to the need for an immediate transfer or discharge of a patient, by adding a provision providing that in an emergency, “notice required pursuant to subsection (c) of this section and subdivision (1) of this subsection shall be provided as soon as practicable”, by adding a definition of emergency and by adding a provision allowing a patient who is transferred or discharged on an emergency basis to contest the action by requesting a hearing, amended Subsec. (h)(6) by providing that an emergency transfer or discharge be excepted from this Subdiv. and by adding Subdiv. (B) prohibiting the transfer or discharge of a patient prior to 15 days from the receipt of the decision and added Subsec. (h)(7) requiring a copy of the decision of the commissioner be sent to the facility and made technical changes, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (c) by eliminating the requirement that the commissioner be notified by a facility of a transfer or discharge and requiring notification to include the procedures for the right to appeal, amended Subsec. (e) by adding transfer to a hospital or transfer into or out of a Medicare distinct part within the same institution to the exceptions in which a patient may be transferred or discharged unless a discharge plan has been developed and eliminating a requirement that the department be notified of an involuntary discharge if the patient receives payments under Title XIX of the federal Social Security Act, as amended, deleted Subsec. (h)(1) which required that the department notify the patient or his representative of any transfer or discharge action a facility plans to make, renumbered the remaining Subdivs. of Subsec. (h) and made technical and conforming changes, effective July 1, 1997; P.A. 99-176 amended Subsec. (c) to substitute “State Long-Term Care Ombudsman” for “state nursing home ombudsman” and to make provisions gender neutral, effective July 1, 1999; P.A. 03-278 made technical changes in Subsec. (c), effective July 9, 2003; P.A. 11-236 replaced “patient” with “resident” throughout, amended Subsec. (a) by deleting definition of “Medicare distinct part” and adding definition of “continuing care facility which guarantees life care for its residents” in Subdiv. (2), by redefining “transfer” in Subdiv. (3), by replacing “discharge” with “movement” and deleting reference to “another institution” in Subdiv. (4) and by adding Subdiv. (5) re definition of “self-pay resident” and Subdiv. (6) re definition of “emergency”, amended Subsec. (b) by adding provision allowing facility to transfer or discharge resident if required by Sec. 17b-359 or 17b-360 and restating Subdivs. (1) and (2), amended Subsec. (c) by designating existing provisions as Subdiv. (1) and amending same by adding provision re notice to specify dates by which appeal must be initiated in order to preserve right to appeal hearing and stay proposed transfer or discharge, deleting provision re 10 days to initiate appeal to stay transfer, adding provision requiring notice of an exception to date to appeal transfer or discharge for good cause and adding provision re notice of readmission policy when required under Sec. 19a-537, and by adding Subdiv. (2) re request for appeal to stay proposed transfer or discharge, amended Subsec. (d) by deleting definition of “self pay”, deleted former Subsec. (e)(3) re transfer into or out of Medicare distinct part, providing amended Subsec. (h)(1) by providing that exceptions apply in the case of emergency, replacing requirement that written decision be made within 60 days of termination of hearing or 90 days after date of hearing request with requirement that such decision be made not later than 30 days after termination of hearing or 60 days after hearing request, and adding provision requiring commissioner to return to facility a request for a hearing that does not comply with requirements of Subsec. (c), amended Subsec. (h)(4) by deleting definition of “emergency”, replacing provision allowing resident to request a hearing within 10 days after receipt of notice or date of transfer or discharge with provision allowing request not later than 20 days after transfer or discharge, adding exception for resident who fails for good cause to request a hearing within 20-day period, replacing requirement that hearing be held within 7 days after receipt of request with requirement that hearing be held not later than 15 days after receipt, and adding provision requiring commissioner to issue decision within 30 days after hearing is closed, added new Subsec. (h)(6) re readmitting resident where transfer or discharge violated provisions of section, redesignated existing Subsec. (h)(6) as Subsec. (h)(7), and amended same by adding requirement that decision be sent to resident and resident's representatives, added Subsec. (i) re request for hearing by resident whose coverage for facility care will end, and made technical and conforming changes, effective July 13, 2011; P.A. 16-39 amended Subsecs. (b) and (e) by adding references to advanced practice registered nurse and made technical changes; P.A. 16-59 added Subsec. (j) re discharging resident to home in community; P.A. 17-96 amended Subsec. (c) (1) by replacing reference to Office of Protection and Advocacy for Persons with Disabilities with reference to nonprofit entity designated to serve as Connecticut protection and advocacy system, effective July 1, 2017; P.A. 21-196 amended Subsec. (b) by adding reference to physician assistant and making a technical change and amended Subsec. (e) by adding reference to physician assistant; P.A. 22-57 added Subsec. (k) re involuntary transfer and discharge reporting, effective July 1, 2022; P.A. 23-48 amended Subsec. (c)(1) by adding provision re affirmation by facility that notice of proposed transfer or discharge has been provided to the State Long-Term Care Ombudsman, and added Subsec. (b)(3) re notification of State Long-Term Care Ombudsman of proposed involuntary transfer or discharge, effective June 16, 2023 and amended Subsec. (k) by adding reference to Subsec. (c)(3) and replacing “17a-405” with “17a-870”, effective June 13, 2023.
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Sec. 19a-535c. Nursing home facility discharge. Caregiver instruction and training requirements. (a) For purposes of this section and section 19a-535d:
(1) “Caregiver” means any individual who a resident designates to provide post-discharge assistance to the resident in the resident's home in the community. The term “caregiver” includes, but is not limited to, a relative, spouse, partner, friend or neighbor who has a significant relationship with the resident. For the purposes of this section and section 19a-535d, the term “caregiver” shall not include any individual who receives compensation for providing post-discharge assistance to the resident.
(2) “Home” means the dwelling that the resident considers to be the resident's home in the community. The term “home” shall not include, and the provisions of this section and section 19a-535d, shall not apply to, a discharge to any rehabilitation facility, hospital, assisted living facility, group home or any other setting that was not the resident's home in the community immediately preceding the resident's admission.
(3) “Resident” means a resident of a nursing home facility or the resident's representative.
(4) “Nursing home facility” has the same meaning as provided in section 19a-521.
(5) “Post-discharge assistance” means nonprofessional tasks provided by a designated caregiver to a resident following the resident's discharge from a nursing home facility in accordance with the written discharge plan of care signed by the resident or the resident's representative, which involves assisting with basic activities of daily living, instrumental activities of daily living and carrying out support tasks, such as assisting with wound care, administration of medications and use of medical equipment.
(b) The Department of Public Health may adopt regulations, in accordance with the provisions of chapter 54, to set minimum standards for nursing home facility discharge planning services. Any such standards shall include, but need not be limited to, requirements for (1) a written discharge plan prepared in consultation with the resident, or the resident's family or representative, and the resident's physician, including, but not limited to, the date and location of each follow-up medical appointment scheduled prior to the resident's discharge and a list of all medications the resident is currently taking and, to the extent known to the nursing home facility, will continue to take after the resident's discharge, and (2) a procedure for advance notice to the resident of the resident's discharge and provision of a copy of the discharge plan to the resident prior to discharge.
(c) Whenever a discharge plan from a nursing home facility indicates that a resident shall be discharged to the resident's home, the nursing home facility shall (1) allow the resident to designate a caregiver at, or prior to, the time that a written copy of the discharge plan is provided to the resident, and (2) transmit in an electronic manner to the resident's pharmacy each prescription ordered by a nursing home facility employee for the resident prior to discharge that the resident will need after discharge. A resident is not required to designate any individual as a caregiver and any individual designated as a caregiver under this section is not obligated to perform any post-discharge assistance for the resident or agree to receive any instruction required under this section.
(d) If a resident designates a caregiver pursuant to subsection (c) of this section prior to receiving written discharge instructions, the nursing home facility shall:
(1) Record the resident's designation of caregiver, the relationship of the designated caregiver to the resident and, if known, the name, telephone number and address of the resident's designated caregiver in the discharge plan.
(2) Make more than one reasonable attempt to notify the resident's designated caregiver of the resident's discharge to the resident's home as soon as practicable. In the event the nursing home facility is unable to contact the designated caregiver, the lack of contact shall not interfere with, delay, or otherwise affect the medical care provided to the resident or an appropriate discharge of the resident.
(3) Prior to discharge, provide caregivers with instructions in all post-discharge assistance tasks described in the discharge plan. Training and instructions for caregivers may be provided in writing or conducted in person or through video technology, as determined by the nursing home facility to effectively provide the necessary instruction. Any training or instructions provided to a caregiver shall be provided in nontechnical language, to the extent possible. At a minimum, this instruction shall include: (A) A written, live or recorded demonstration of the tasks performed by an individual designated by the nursing home facility who is authorized to perform the post-discharge assistance task and is able to perform the demonstration in a culturally competent manner and in accordance with the requirements of the nursing home facility to provide language access services under state and federal law; (B) an opportunity for the caregiver to ask questions about the post-discharge assistance tasks; and (C) answers to the caregiver's questions provided in a culturally competent manner and in accordance with the requirements of the nursing home facility to provide language access services under state and federal law.
(4) Document in the resident's medical record any training for initial implementation of the discharge plan provided to the resident, the resident's representative or the designated caregiver. Any instruction required under subdivision (3) of this subsection shall be documented in the resident's medical record, including, at a minimum, the date, time and subject of the instruction.
(P.A. 16-59, S. 1; P.A. 23-39, S. 2.)
History: P.A. 23-39 amended Subsec. (b) by requiring a written discharge plan to include the date and location of each follow-up medical appointment and all medications the resident is currently taking and will continue to take after discharge and Subsec. (c) by designating existing provisions as Subdiv. (1) and adding Subdiv. (2) requiring the nursing home facility to electronically transmit to the resident's pharmacy each prescription ordered by a nursing home facility employee for the resident prior to discharge that the resident will continue to take after discharge.
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Sec. 19a-564. Assisted living services agencies. Licensure. Dementia special care approval. Regulations. (a) The Commissioner of Public Health shall license assisted living services agencies, as defined in section 19a-490. A managed residential community wishing to provide assisted living services shall become licensed as an assisted living services agency or shall arrange for assisted living services to be provided by another entity that is licensed as an assisted living services agency.
(b) A managed residential care community that intends to arrange for assisted living services shall only do so with a currently licensed assisted living services agency. Such managed residential community shall submit an application to arrange for the assisted living services to the Department of Public Health in a form and manner prescribed by the commissioner.
(c) An elderly housing complex receiving assistance and funding through the United States Department of Housing and Urban Development's Assisted Living Conversion Program that intends to arrange for assisted living services may do so with a currently licensed assisted living services agency. Such elderly housing complex shall inform the Department of Public Health of the arrangement upon request in a form and manner prescribed by the commissioner and shall not be required to register with the department as a managed residential community.
(d) An assisted living services agency providing services as a dementia special care unit or program, as defined in section 19a-562, shall obtain approval for such unit or program from the Department of Public Health. Such assisted living services agencies shall ensure that they have adequate staff to meet the needs of the residents. Each assisted living services agency that provides services as a dementia special care unit or program, as defined in section 19a-562, shall submit to the Department of Public Health a list of dementia special care units or locations and their staffing plans for any such units and locations when completing an initial or a renewal licensure application, or upon request from the department.
(e) An assisted living services agency shall ensure that (1) all services being provided on an individual basis to clients are fully understood and agreed upon between either the client or the client's representative, and (2) the client or the client's representative are made aware of the cost of any such services.
(f) The Department of Public Health may adopt regulations, in accordance with the provisions of chapter 54, to carry out the purposes of this section.
(g) An assisted living services agency may provide services that include, but need not be limited to, nursing services and assistance with activities of daily living to an individual who is no longer chronic and stable if (1) such individual is under the care of a licensed home health care agency or licensed hospice agency, or (2) such assisted living services agency is arranging, in conjunction with a managed residential community in accordance with subdivision (3) of subsection (a) of section 19a-694, for the provision of ancillary medical services on behalf of such individual, including physician and dental services, pharmacy services, restorative physical therapies, podiatry services, hospice care and home health agency services.
(P.A. 21-121, S. 56; P.A. 22-58, S. 54; P.A. 23-31, S. 2.)
History: P.A. 21-121 effective July 1, 2021; P.A. 22-58 added new Subsec. (c) re elderly housing complexes intending to arrange for assisted living services and redesignated existing Subsecs. (c) to (e) as Subsecs. (d) to (f), effective July 1, 2022; P.A. 23-31 added Subsec. (g) re provision of assisted living services to individuals who are no longer chronic and stable, effective June 7, 2023.
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Sec. 19a-565. (Formerly Sec. 19a-30). Clinical laboratories, blood collection facilities and source plasma donation centers. Regulation and licensure. Proficiency standards for tests not performed in laboratories. Prohibitions. Penalties. Regulations. (a) As used in this section, “business entity” means a corporation, association, trust, estate, partnership, limited partnership, limited liability partnership, limited liability company, sole proprietorship, joint stock company, nonstock corporation, John Dempsey Hospital and The University of Connecticut Health Center.
(b) The Department of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, governing clinical laboratories, blood collection facilities and source plasma donation centers. Such regulations shall establish reasonable standards for entities exempt from licensure as a clinical laboratory, operations and facilities, personnel qualifications and certification, levels of acceptable proficiency in testing programs approved by the department, the collection, acceptance and suitability of specimens for analysis and such other pertinent laboratory functions, including the establishment of advisory committees, as may be necessary to ensure public health and safety. Such regulations shall include a requirement that a registered nurse or advanced practice registered nurse licensed under chapter 378 be onsite during the hours of operation of a blood collection facility or source plasma donation center. On or before October 1, 2023, the Commissioner of Public Health shall implement policies and procedures necessary to administer the provisions of this section while in the process of adopting such policies and procedures as regulations, provided the department posts such policies and procedures on the eRegulations System prior to adopting them. Policies and procedures implemented pursuant to this section shall be valid until final regulations are adopted in accordance with the provisions of chapter 54.
(c) No person or business entity shall establish, conduct, operate or maintain a clinical laboratory, blood collection facility or source plasma donation center unless such laboratory, facility or center is licensed or approved by said department in accordance with its regulations. Each blood collection facility or plasmapheresis center, as defined in section 19a-36-A47 of the regulations of Connecticut state agencies, that is registered with the department on or before October 1, 2023, shall apply to the department for an initial license pursuant to the provisions of this section not later than thirty days after the date that procedures for such licensure are implemented by the department pursuant to subsection (b) of this section. On and after the date on which procedures for licensure are implemented by the department pursuant to the provisions of said subsection, the department shall not renew any blood collection facility or plasmapheresis center registration. Each clinical laboratory, blood collection facility or source plasma donation center shall comply with all standards for such facilities established by the department and shall be subject to inspection by said department, including inspection of all records necessary to carry out the purposes of this section.
(d) Each initial or renewal application for licensure of a clinical laboratory, blood collection facility or source plasma donation center shall be made in a form and manner prescribed by the commissioner and shall be executed by the owner or owners or by a responsible officer of the firm or corporation owning such laboratory, facility or donation center and be accompanied by the fee required pursuant to the provisions of subsection (f) of this section. A mobile or temporary blood collection facility shall not be required to obtain a license if such person or business entity operating such facility is licensed as a blood collection facility. A licensed source plasma donation center shall not be required to obtain a clinical laboratory license to perform any pre-donation screening test required by Title 21, Chapter I of the Code of Federal Regulations. A hospital licensed under this chapter shall not be required to obtain a license as a blood collection facility for blood component collection activities that take place on the hospital campus, as defined in section 19a-508c.
(e) After the department receives an initial or renewal application for licensure pursuant to subsection (d) of this section, it shall conduct any inspections or investigations that are deemed necessary by the commissioner to determine the applicant's eligibility for licensure. As a condition of licensure, the commissioner may require the applicant to sign a consent order providing reasonable assurances of compliance with federal and state laws and regulations. The commissioner may deny licensure of an applicant if the commissioner determines that the applicant has previously failed to comply with federal and state laws and regulations or that licensure would pose a threat to the health, safety and well-being of the public. Licensure pursuant to the provisions of this section shall not be effective until the applicant receives notice of such licensure, including the effective date and term of such licensure, from the department.
(f) A nonrefundable fee of two hundred dollars shall accompany each application for a license or for renewal thereof, except in the case of a clinical laboratory owned and operated by a municipality, the state, the United States or any agency of said municipality, state or United States. Each license shall be issued for a period of not less than twenty-four months. Renewal applications shall be made biennially within the twentieth month of the current license. Any change in ownership of an entity licensed pursuant to the provisions of this section shall be made in compliance with section 19a-493. If any such entity changes its director, it shall notify the commissioner in a form and manner prescribed by the commissioner. If any such entity intends to expand or alter its facility, it shall notify the commissioner in a form and manner prescribed by the commissioner prior to such expansion or alteration. The licensed clinical laboratory shall report to the Department of Public Health, in a form and manner prescribed by the commissioner, the name and address of each specimen collection facility owned and operated by the clinical laboratory, prior to the issuance of a new license, prior to the issuance of a renewal license or whenever a specimen collection facility opens or closes.
(g) A license issued under this section may be revoked or suspended in accordance with chapter 54 or subject to any other disciplinary action specified in section 19a-17 if the licensed clinical laboratory, blood collection facility or source plasma donation center has engaged in fraudulent practices, fee-splitting inducements or bribes, including, but not limited to, in the case of a clinical laboratory, violations of subsection (h) of this section, or violated any other provision of this section or regulations adopted under this section after notice and a hearing is provided in accordance with the provisions of said chapter.
(h) No representative or agent of a clinical laboratory shall solicit referral of specimens to his or any other clinical laboratory in a manner which offers or implies an offer of fee-splitting inducements to persons submitting or referring specimens, including inducements through rebates, fee schedules, billing methods, personal solicitation or payment to the practitioner for consultation or assistance or for scientific, clerical or janitorial services.
(i) No clinical laboratory, blood collection facility or source plasma donation center shall terminate the employment of an employee because such employee reported a violation of this section to the Department of Public Health.
(j) Any person or business entity operating a clinical laboratory, blood collection facility or source plasma donation center in violation of this section shall be fined not less than one hundred dollars or more than three hundred dollars for each offense. For purposes of calculating civil penalties under this section, each day a licensee operates in violation of this section or a regulation adopted under this section shall constitute a separate violation.
(k) The Commissioner of Public Health shall adopt regulations in accordance with the provisions of chapter 54 to establish levels of acceptable proficiency to be demonstrated in testing programs approved by the department for those laboratory tests which are not performed in a licensed clinical laboratory. Such levels of acceptable proficiency shall be determined on the basis of the volume or the complexity of the examinations performed.
(1961, P.A. 514; P.A. 76-272; P.A. 77-275; 77-614, S. 323, 587, 610; P.A. 78-303, S. 85, 136; P.A. 79-421, S. 1, 2; P.A. 83-200; P.A. 93-381, S. 9, 39; P.A. 94-174, S. 3, 12; P.A. 95-257, S. 12, 21, 58; June Sp. Sess. P.A. 09-3, S. 164; P.A. 15-242, S. 14; P.A. 21-121, S. 39; P.A. 22-58, S. 23; P.A. 23-31, S. 9.)
History: P.A. 76-272 made previous provisions Subsecs. (a) to (c) and (e), substituted definition of “clinical laboratory” for “private clinical laboratory”, specified areas of operation governed by regulations, replaced registration with licensure, required that facilities be open to inspection by health department, removed provision re commissioner's right to “enjoin the operation” of facilities in violation of provisions, inserted new Subsec. (d) re license fees, renewals, etc., imposed minimum fine of $100, raised maximum fine from $100 to $300 and removed provisions that each day of continued violation constitutes separate offense; P.A. 77-275 excluded facilities of dentists and podiatrists from consideration as clinical laboratory and made their exemption contingent upon filing affidavit, specifically allowed inspection of records in Subsec. (b), required that license application contain itemized rate schedule and disclosure of contractual relationships with physicians, inserted new Subsecs. (e) to (h) re revocation or suspension of license, solicitation of referrals, protection of employees reporting violations and required affidavits and relettered former Subsec. (e) as Subsec. (i); P.A. 77-614 and P.A. 78-303 replaced department of health with department of health services, effective January 1, 1979; P.A. 79-421 replaced “licensed practitioner of a healing art or a licensed dentist or podiatrist” with reference to practitioners licensed under specific chapters and included exemption for facilities which meet exemption standards in Public Health Code re volume or complexity of examinations in Subsec. (a), included regulations governing “exemptions from licensing provisions” in Subsec. (b), included certificates of approval in provisions and broadened Subsec. (h) to allow for broadened exemptions in Subsec. (a); Sec. 19-9a transferred to Sec. 19a-30 in 1983; P.A. 83-200 added Subsec. (j) to establish proficiency levels for laboratory tests not performed in a licensed clinical laboratory; P.A. 93-381 replaced department and commissioner of health services with department and commissioner of public health and addiction services, effective July 1, 1993; P.A. 94-174 added testing for the presence of drugs, poisons and toxicological substances to the list of facility uses and removed the exception for laboratories in practitioners offices in definition of “clinical laboratory”, deleted references to certificates of approval and deleted Subsec. (h) which had required practitioners exempted from licensing requirements to file affidavits as to qualifications of persons performing tests and number and type of tests performed, relettering remaining Subsecs. accordingly, effective June 6, 1994; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; June Sp. Sess. P.A. 09-3 amended Subsec. (d) to increase fee from $100 to $200 and made a technical change in Subsec. (h); P.A. 15-242 amended Subsec. (a) to delete references to Public Health Code, add reference to provisions of Ch. 54 and add provisions re inquiry, investigation or hearing, amended Subsec. (d) to add “clinical” re laboratory and add “established by the commissioner” re applications, amended Subsec. (e) to add reference to other disciplinary action specified in Sec. 19a-17 and regulations adopted under section and amended Subsec. (h) to add provisions re calculating civil penalties; P.A. 21-121 amended Subsec. (d) by adding provision re reporting of name and address of blood collection facilities, effective July 1, 2021; P.A. 22-58 amended Subsec. (a) by redefining “clinical laboratory”; Sec. 19a-30 transferred to Sec. 19a-565 in 2023; P.A. 23-31 added references to blood collection facilities and source plasma donation centers throughout, replaced references to firms or corporations with “business entity” throughout, amended Subsec. (a) by deleting definition of “clinical laboratory” and defining “business entity”, substantially revised Subsec. (b) re regulations, including by requiring regulation requiring onsite presence of registered nurse or advanced practice registered nurse, and adding provision re policies and procedures, designated existing provisions re licensure requirement for clinical laboratories in Subsec. (b) as new Subsec. (c), substantially revised new Subsec. (c), including by adding provisions re applications for initial licensure and deleting provisions re investigations, hearings and subpoenas, redesignated existing Subsec. (c) as new Subsec. (d)and substantially revised same by adding references to initial or renewal applications, deleting provision re laboratories located in institutions, replacing “on forms provided by said department” with “in a form and manner prescribed by the commissioner”, deleting existing provisions re contents of application and inspections and investigations after submission of application, and adding provisions re application fee and licensure exemptions, added new Subsec. (e) re inspections and investigations after submission of application, redesignated existing Subsec. (d) as new Subsec. (f) and amended same by deleting “nor more than twenty-seven” and “from the deadline for applications established by the commissioner”, replacing “twenty-fourth month” with “twentieth month”, deleting Subdivs. (2) and (3), adding provisions re changes of ownership and expansions and alterations to facilities, and replacing “blood collection facility” with “specimen collection facility”, redesignated existing Subsec. (e) as new Subsec. (g), redesignated existing Subsecs. (f) to (i) as new Subsecs. (h) and (i) and Subsecs. (j) and (k), and made technical and conforming changes throughout (Revisor's note: In new Subsec. (d), an incorrect reference to “chapter 386v” was deemed by the Revisors to be a reference to “chapter 368v” and changed editorially to “this chapter”).
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Sec. 19a-566. Birth centers. Licensure. Regulations. (a) On and after January 1, 2024, no person, entity, firm, partnership, corporation, limited liability company or association shall establish, conduct, operate or maintain a birth center, as defined in section 19a-490, in this state without obtaining a license pursuant to the provisions of this section. Except in the case of an emergency, an outpatient clinic shall not offer any birth center services as part of its ambulatory medical services without being licensed as a birth center. For the purposes of this subsection, “birth center services” means perinatal, labor, delivery and postpartum care during and immediately after delivery to persons presenting with a low-risk pregnancy and healthy newborns for a period typically less than twenty-four hours and “low-risk pregnancy” has the same meaning as provided in subsection (t) of section 19a-490.
(b) Each birth center shall be accredited by the Commission for the Accreditation of Birth Centers on or before the effective date of its licensure and maintain such accreditation during the time it is licensed. If a birth center loses its accreditation, the birth center shall immediately notify the Commissioner of Public Health and cease providing birth center services to patients until authorized by the commissioner to reinstate such services.
(c) (1) Each birth center shall have a written plan to obtain services for its patients from a hospital, licensed pursuant to this chapter, to provide services in the event of an emergency or other conditions that pose a risk to the health of a patient that require transfer of the patient to a hospital. Before issuing a license pursuant to this section, the commissioner shall review and approve the information submitted by the birth center to the Commission for the Accreditation of Birth Centers, including, but not limited to, (A) information relating to the birth center's plan for ongoing risk assessment and adherence to patient eligibility criteria, as determined by the Commission for the Accreditation of Birth Centers, during the delivery of birth center services to a patient, and (B) information relating to the birth center's policies and procedures for the prenatal, intrapartum or postpartum transfer of a patient in the event that such patient no longer meets such patient eligibility criteria.
(2) If a patient receiving birth center services no longer presents with a low-risk pregnancy, as defined in section 19a-490, or otherwise fails to meet the patient eligibility criteria described subparagraph (A) of subdivision (1) of this subsection, the birth center providing such services shall ensure the patient's care is transferred to a licensed health care provider capable of providing the appropriate level of obstetrical care for the patient.
(d) Each hospital licensed pursuant to this chapter that maintains an emergency department, other than a children's hospital, shall work cooperatively with birth centers to coordinate the care of patients who may require services in the event of an emergency or other conditions that pose a risk to the health of a patient that require transfer of the patient to a hospital. Each children's hospital that maintains an emergency department shall work cooperatively with birth centers to coordinate the care of neonatal patients who may require services in the event of an emergency or other conditions that pose a risk to the health of a patient that require transfer of the patient to a children's hospital.
(e) The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of this section and section 19a-495. 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, provided notice of intent to adopt regulations is published on the eRegulations System 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. The regulations and policies and procedures shall include, but need not be limited to, provisions regarding the administration of the facility, staffing requirements, infection control protocols, physical plant requirements, accommodation of the participation of support persons of the patient's choice, limitations on the provision of anesthesia and surgical procedures, operating procedures for determining risk status of patients at admission and during labor, reportable events, medical records, pharmaceutical services, laundry services, requirements for professional and medical liability insurance for the facility and health care providers and emergency planning.
(P.A. 23-147, S. 2.)
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Sec. 19a-567. Adverse credentialing or privileging action based on provision of reproductive health care services prohibited. (a) As used in this section, (1) “credentialing” means the process of assessing and validating the qualifications of a health care provider applying to be approved to provide treatment, care or services in or for an institution, (2) “health care provider” means a person licensed pursuant to title 20 who provides reproductive health care services, (3) “institution” has the same meaning as provided in section 19a-490, (4) “privileging” means the process of authorizing a health care provider to provide specific treatment, care or services at an institution, and (5) “reproductive health care services” has the same meaning as provided in section 52-571m.
(b) An institution shall not revoke, suspend, reprimand, penalize, refuse to issue or renew credentials or privileges or take any other adverse action against a health care provider with respect to credentialing or privileging based solely on the alleged provision of, receipt of, assistance in provision or receipt of, material support for, or any theory of vicarious, joint, several or conspiracy liability derived therefrom, reproductive health care services that (1) are permitted under the laws of this state, (2) were provided in accordance with the standard of care applicable to such services, and (3) were provided by the health care provider (A) before the date on which the health care provider entered an employment relationship with the institution, or (B) outside the scope of the health care provider's employment with the institution, regardless of whether the patient receiving such services was a resident of this state.
(c) An institution shall not revoke, suspend, reprimand, penalize, refuse to issue or renew credentials or privileges or take any other adverse action against a health care provider based on pending disciplinary action, an unresolved complaint or the imposition of disciplinary action against the applicant by a duly authorized professional disciplinary agency of another state, the District of Columbia, or a commonwealth, territory or possession of the United States that is based solely on the alleged provision of, receipt of, assistance in provision or receipt of, material support for, or any theory of vicarious, joint, several or conspiracy liability derived therefrom, reproductive health care services that (1) are permitted under the laws of this state, (2) were provided in accordance with the standard of care applicable to such services, and (3) were provided by the health care provider (A) before the date on which the health care provider entered an employment relationship with the institution, or (B) outside the scope of the health care provider's employment with the institution, regardless of whether the patient receiving such services was a resident of this state.
(d) The provisions of this section shall not be construed to prevent an institution from taking any of the actions described in subsections (b) and (c) of this section against a health care provider for conduct that (1) does not conform to the standards of care for the provider's profession, (2) is illegal under the laws of this state, or (3) violates policies or rules of the institution that define the scope of services provided by the institution if (A) such conduct occurs within the scope of the health care provider's employment with, or delivery of care at, the institution, and (B) the institution's enforcement of such policies or rules is not otherwise prohibited by law or regulation.
(P.A. 23-128, S. 3.)
History: P.A. 23-31 effective June 7, 2023.
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