SB 288 — AN ACT CONCERNING THE DEPARTMENT OF SOCIAL SERVICES' RECOMMENDATIONS REGARDING EXCEPTIONS TO THE NURSING HOME BED MORATORIUM, NURSING HOME RESIDENT DATA AND NURSING HOME REIMBURSEMENT RATE CAPS FOR RELATED PARTY EMPLOYEES.

288 chronic and convalescent nursing home that receives state funding pursuant to this section shall include in such annual report a profit and loss statement from each related party that receives from such chronic and convalescent nursing home thirty thousand dollars or more per year for goods, fees and services.

For the cost reporting year commencing October 1, 1985, and for subsequent cost reporting years, facilities shall report the cost of using the services of any nursing personnel supplied by a temporary nursing services agency by separating said cost into two categories, the portion of the cost equal to the salary of the employee for whom the nursing personnel supplied by a temporary nursing services agency is substituting shall be considered a nursing cost and any cost in excess of such salary shall be further divided so that seventy-five per cent of the excess cost shall be considered an administrative or general cost and twenty-five per cent of the excess cost shall be considered a nursingcost,providedifthetotalcostsofafacilityfor nursingpersonnel supplied by a temporary nursing services agency in any cost year are equal to or exceed fifteen per cent of the total nursing expenditures of the facility for such cost year, no portion of such costs in excess of fifteen persSB288 cent/ shallFile beNo. classified as administrative or general costs.

The124 commissioner, indetermining suchrates,shallalso take into accountthe LCO 11 ofsSB288 14File Substitute Bill No.

288124 classificationper ofcent patientsshall orbe boardersclassified accordingas toadministrative special care requirements or classificationgeneral ofcosts. the facility according to such factors as facilities and services and such other factors as the commissioner deems reasonable, including anticipated fluctuations in the cost of providing such services.

The commissioner, indetermining suchrates,shallalso take into accountthe classification of patients or boarders according to special care requirements or classification of the facility according to such factors as facilities and services and such other factors as the commissioner deems reasonable, including anticipated fluctuations in the cost of providing such services.

Notwithstanding any provision of this section, the Commissioner of Social Services may, within available appropriations, providesSB288 an/ interimFile rate increase for a licensed chronic and convalescent nursing home or a rest home with nursing supervision for rate periods LCO 12 of 14 Substitute Bill No.

288124 no12 earliersSB288 thanFile AprilNo. 1, 2004, only if the commissioner determines that the increase is necessary to avoid the filing of a petition for relief under Title 11 of the United States Code;

124 provide an interim rate increase for a licensed chronic and convalescent nursing home or a rest home with nursing supervision for rate periods no earlier than April 1, 2004, only if the commissioner determines that the increase is necessary to avoid the filing of a petition for relief under Title 11 of the United States Code;

The commissioner may seek recovery of such payments fromsSB288 any/ facilityFile withNo. common ownership.

With124 the approval of the Secretary of the Office of Policy and Management, the commissioner LCO 13 ofsSB288 14File Substitute Bill No.

288124 mayfrom waiveany recoveryfacility and rescission of the interim rate for good cause shown that is not inconsistent with thiscommon section,ownership. including, but not limited to, transferstofamily membersthat were madefor novalue.The commissioner shall provide written quarterly reports to the joint standing committees of the General Assembly having cognizance of matters relating to aging, human services and appropriations and the budgets of state agencies, that identify each facility requesting an interim rate increase, the amount of the requested rate increase for each facility,theactiontakenbythecommissioner andthesecretarypursuant to this subsection, and estimates of the additional cost to the state for each approved interim rate increase.

With the approval of the Secretary of the Office of Policy and Management, the commissioner may waive recovery and rescission of the interim rate for good cause shown that is not inconsistent with this section, including, but not limited to, transferstofamily membersthat were madefor novalue.The commissioner shall provide written quarterly reports to the joint standing committees of the General Assembly having cognizance of matters relating to aging, human services and appropriations and the budgets of state agencies, that identify each facility requesting an interim rate increase, the amount of the requested rate increase for each facility,theactiontakenbythecommissioner andthesecretarypursuant to this subsection, and estimates of the additional cost to the state for each approved interim rate increase.

-LCO LCOsSB288 14/ ofFile 14No.

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124 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

Agency Affected Fund-Effect FY 27 $ FY 28 $ Social Services, Dept.

GF - Potential See Below See Below Cost/ Savings Note:

GF=General Fund Municipal Impact:

None Explanation Sections 1 and 2 of the bill could result in increased Medicaid costs to theDepartment ofSocialServices(DSS)associatedwithallowing DSS to approve requests to add new Medicaid-certified beds to existing or new nursing homes.

To the extent this results in a higher cost per bed than Medicaid would otherwise support, or new costs related to a new facility, the state will incur associated allowable Medicaid expenditures.

The actual fiscal impact is dependent on the scope and approval of such requests.

Section 2 also adds to the list of items DSS must consider when determining whether to approve or deny requests for additional nursing home beds.

To the extent considering the Center for Medicare and Medicaid Services' (CMS) five-star quality rating system alters the decision DSS would have otherwise made, the agency could experience an impact, which cannot be determined at this time.

Section 3 modifies minimum data set requirements for audit purposes.

This could impact nursing home rates to the extent limiting the timeframe in which minimum data set information must be sSB288 / File No.

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124 submitted adjusts the calculation of Medicaid acuity-based per diem rates paid to nursing homes.

Section 4 limits Medicaid reimbursement for union employees who are related to an owner of a nursing home, which will reduce rates to the extent such related parties costs would otherwise be factored into Medicaid rates.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to related adjustments to Medicaid rates for nursing homes.

sSB288 / File No.

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124 OLR Bill Analysis SB 288 AN ACT CONCERNING THE DEPARTMENT OF SOCIAL SERVICES' RECOMMENDATIONS REGARDING EXCEPTIONS TO THE NURSING HOME BED MORATORIUM, NURSING HOME RESIDENT DATA AND NURSING HOME REIMBURSEMENT RATE CAPS FOR RELATED PARTY EMPLOYEES.

SUMMARY This bill makes several unrelated changes to laws on nursing homes.

Primarily, it:

1.

creates an exception to the state’s nursing home bed moratorium, allowing the Department of Social Services (DSS) to approve additional Medicaid-certified beds in existing or new nursing homes under certain circumstances;

2.

modifies the factors the DSS commissioner must consider when reviewing certificate of need (CON) applications;

3.

establishes a separate process for DSS audits of licensed nursing homes’ minimumdataset informationfor acuity-basedMedicaid payments;

and 4.

caps the Medicaid reimbursement rate of pay for union employees who are related to the owner of a nursing home.

The bill also makes minor, technical and conforming changes.

EFFECTIVE DATE:

Upon passage, except the provisions on DSS audits and Medicaid reimbursement for related-party pay are effective July 1, 2026.

§ 1— NURSING HOME BED MORATORIUM EXCEPTION Existing law establishes a nursing home bed moratorium that generally prohibits DSS from accepting or approving CON requests for sSB288 / File No.

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124 more nursing home beds, with certain exceptions (see BACKGROUND).

The bill adds a new exception that allows DSS to approve a request to add new Medicaid-certified beds to existing or new nursing homes.

When doing so, the department must give preference to nontraditional, small-house style nursing homes whose goals are in keeping with the department’s long-term care strategic plan to address facility needs in priority census tracts.

§ 2 — CON CRITERIA By law, nursing homes, rest homes, and intermediate care facilities for people with intellectual disabilities must generally receive CON approval from DSS when (1) introducing new services, (2) changing ownership, (3) relocating licensed beds or decreasing bed capacity, (4) terminating a service, or (5) incurring certain capital expenditures.

Under existing law and the bill, the DSS commissioner must consider several factors when reviewing CON requests, such as whether there is clear public need for the proposal.

When determining public need for requests to add new Medicaid-certified beds under the bill, the commissioner must consider whether there is a demonstrated bed need in the towns within a 15-mile radius of the town where the new beds will be added.

(Existing law also requires the commissioner to do this when considering requests to relocate beds to a replacement nursing home.) For all CON requests, existing law requires the commissioner to consider how a request contributes to regional long-term care delivery quality, accessibility, and cost-effectiveness.

Under the bill, in making this consideration, she must include the requesting nursing home’s star rating on the Centers for Medicare and Medicaid Service’s (CMS) five- star quality rating system for nursing homes.

The bill also modifies how bed need is determined for CON requests.

Underthebill,aserviceareawithademonstratedbedneedisonewhose nursing home occupancy is above 96% for at least two consecutive sSB288 / File No.

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124 quarters.

The DSS commissioner may also consider the service area’s projected future bed need above 96%occupancy using its latest strategic statewide long-term care rebalancing plan.

Currently, demonstrated bed need is based on a service area’s nursing home occupancy (the law does not specify a percentage) and projected bed need for up to five years at 97.5% occupancy using the (1) Office of Policy and Management’s latest population projections by town and age and (2) Department of Public Health’s latest available nursing home utilization statistics by age cohort.

§ 3 — NURSING HOME MINIMUM DATA SET AUDITS Existing law sets procedures and requirements related to DSS audits oflong-termcare facilitiesthat receive Medicaidor other state payments (for example, nursing homes, residential care homes, and intermediate care facilities for people with intellectual disabilities).

The bill establishes a different process for DSS audits of nursing homes’ minimum data set (MDS) information.

Federal law requires nursing homes to assess each resident’s functional capacity using the MDS assessment tool and DSS then uses the information to calculate nursing homes’ acuity-based Medicaid reimbursement rates.

(Generally, acuity-based rates refer to rates that vary based on, among other things, the facility’s patient casemix.) Deadline to Provide Information Under the bill, if DSS requests documentation related to an MDS audit, the nursing home must provide it within 10 days.

For other types of audits, existing law grants facilities at least 30 days to provide documentation on any discrepancies found during the audit.

Limitation on Post-Exit Interview Submissions Under existing law, unchanged by the bill, the commissioner must prepare a preliminary report on an audit’s findings.

She must then hold an exit conference with the audited facility to discuss the preliminary report, and the facility may present evidence refuting the report’s findings.

For MDS audits, the bill prohibits nursing homes from giving sSB288 / File No.

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124 the commissioner any more documentation after the exit conference, unless the commissioner and nursing home agree to it.

§ 4 — MEDICAID REIMBURSEMENT FOR RELATIVES’ WAGES Under existing law, the DSS commissioner sets Medicaid reimbursement rates for nursing homes, (as well as certain chronic disease hospitals,residentialcare homes,andintermediate care facilities for people with intellectual disabilities).

These rates take into account the costs of providing necessary services and include expenses required under any collective bargaining agreement, such as union employee compensation, or other agreements.

For union employees who are related to a nursing home’s owners, operators, or officials, the bill limits how much of the employee’s compensation is eligible for Medicaid reimbursement.

The bill appears to limit Medicaid reimbursement for these employees to the allowable salary amount set in law for related parties.

Under existing law, unchanged by the bill, reimbursement for a non- union related party’s salary is limited to amounts annually published in a salary limitations schedule.

By law, “related parties” include any company related to a nursing home’s owners, operators, or officials through common ownership, control, business association, or family association (a relationship by birth, marriage, or domestic partnership).

BACKGROUND DSS CON Program By law, nursing homes, rest homes, and intermediate care facilities for people with intellectual disabilities must generally receive CON approval from DSS when (1) introducing new services, (2) changing ownership, (3) relocating licensed beds or decreasing bed capacity, (4) terminating a service, or (5) incurring certain capital expenditures.

Exceptions to Nursing Home Bed Moratorium For over 30 years, the state has placed a moratorium on new nursing sSB288 / File No.

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124 home beds, except for those:

1.

restricted to use by patients with AIDS or who require neurological rehabilitation;

2.

associated with a continuing care facility, if they are not used for Medicaid patients;

3.

that are Medicaid-certified and relocated from one licensed nursing home to another or to a new facility, under certain conditions;

and 4.

in certain nontraditional, small-house style nursing homes.

COMMITTEE ACTION Aging Committee Joint Favorable Yea 14 Nay 0 (03/05/2026) sSB288 / File No.

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