HB 5046 — AN ACT PROMOTING NURSING HOME RESIDENT QUALITY OF LIFE.

611(b) 5If sHB5046the FileDepartment of Public Health finds, through the results of a Public Act No.

61124-141 inclusive,7 aof "nursing25 facility"Substitute meansHouse aBill chronicNo. and convalescent home or a rest home with nursing supervision as defined in section 19a-521, which participates in the Medicaid program through a provider agreement with the Department of Social Services.

(b)5046 If the Department of Public Health finds, through the results of a survey, that a nursing facility is not in compliance with one or more of the requirements of Subsections (b), (c) and (d) of 42 USC 1396r, or the requirements of applicable state statutes or regulations, and that such noncompliance poses an immediate and serious threat to patient health or safety, the Department of Public Health shall issue a statement of charges to the facility and shall file a copy of the charges with the Department of Social Services with a request for a summary order from the Department of Social Services.

If the Department of Social Services finds, based on a statement of charges filed by the Department of Public Health, that a nursing facility is not in compliance with one or more of the requirements of Subsections (b), (c) sHB5046and /(d) Fileof No.42 USC 1396r, or the requirements of applicable state statutes or regulations, but does not issue a summary order, it may impose one or more of the following alternative remedies:

611Termination 6of sHB5046the FilePublic Act No.

61124-141 and8 (d) of 4225 USCSubstitute 1396r,House orBill theNo. requirements of applicable state statutes or regulations, but does not issue a summary order, it may impose one or more of the following alternative remedies:

Termination5046 of the facility's participation in Medicaid;

The civil monetary penalties imposed may be in the range of three thousand two hundred fifty dollars to ten thousand dollars per day for each day the facility is found to be out of compliance with one or more requirements of Subsections (b), (c) and (d) of 42 USC 1396r if the failure to comply with such requirements is found to constitute an immediate and serious threat to resident health or safety,or intherange oftwo hundreddollars to three thousand dollars per day for each day the facility is found to be out of compliance with a requirement of Subsections (b), (c) and (d) of 42 USC 1396r that is found not to constitute an immediate and serious threat to resident health or safety.

The deficient nursing facility shall be obligated to sHB5046reimburse /the FileDepartment of Social Services for any moneys expended Public Act No.

61124-141 79 sHB5046of File25 Substitute House Bill No.

6115046 reimburse the Department of Social Services for any moneys expended by the department at the facility from the fund established pursuant to this section.

5.6.

Upon a findingPublic ofAct noncompliance with such statutes or regulations, the sHB5046 / File No.

61124-141 810 sHB5046of File25 Substitute House Bill No.

6115046 finding of noncompliance with such statutes or regulations, the department shall issue a written notice of noncompliance to the institution.

6.7.

(a) A managed residential community shall enter into a written residency agreement with each resident that clearly sets forth the rights and responsibilities of the resident and the managed residential community, including the duties set forth in section 19a-562.

The residency agreement shall be signed by the managed residential community's authorized agent and byPublic theAct resident,No. or the resident's legal representative, prior to the resident taking possessionofaprivate residentialunit andshallinclude, at a minimum:

sHB504624-141 /11 Fileof 25 Substitute House Bill No.

6115046 9by sHB5046the Fileresident, No.or the resident's legal representative, prior to the resident taking possessionofaprivate residentialunit andshallinclude, at a minimum:

611 (1) An itemization of assisted living services, transportation services, recreationservices and any other services and goods, lodging and meals to be provided on behalf of the resident by the managed residential community;

(2) A full and fair disclosure of all charges, fees, expenses and costs to be borne by the resident including, for written residency agreements entered into on and after JulyOctober 1, 2024, nonrefundable charges, fees, expenses and costs;

(4) For written residency agreements entered into on and after JulyOctober 1, 2024, the manner in which the managed residential community may adjust monthly fees or other recurring fees, including, but not limited to, (A) how often fee increases may occur, (B) the schedule or specific dates of such increases, and (C) the history of fee increases over the past three calendar years;

[(7)] (8) The conditions under which the agreement can be terminated byPublic eitherAct party;No.

[(8)]24-141 (9)12 Full disclosure of the25 rightsSubstitute andHouse responsibilitiesBill of the resident and the managed residential community in situations involving serious deterioration in the health of the resident, hospitalization of the resident or death of the resident, including a provision that specifies that in the event that a resident of the sHB5046 / File No.

6115046 10by sHB5046either Fileparty; No.

611[(8)] (9) Full disclosure of the rights and responsibilities of the resident and the managed residential community in situations involving serious deterioration in the health of the resident, hospitalization of the resident or death of the resident, including a provision that specifies that in the event that a resident of the community dies, the estate or family of such resident shall only be responsible for further payment to the community for a period of time not to exceed fifteen days following the date of death of such resident as long as the private residential unit formerly occupied by the resident has been vacated;

(b) The provisions of subdivisions (2) and (4) of subsection (a) of this section shall not apply to a managed residential community that is (1) an elderly housing complex receiving assistance and funding through the United States Department of Housing and Urban Development's Assisted Living Conversion Program, or (2) a demonstration project for the provision of subsidized assisted living services pursuant to section 17b-347e.

7.8.

Section 19a-694 of the 2024 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective JulyOctober 1, 2024):

(2) Provide residents or residents' representatives advance notice of ninetyPublic daysAct ofNo. any increase to monthly or recurring fees and disclose in writing any nonrefundable charges;

(3)24-141 Provide13 residents prorated or full reimbursement of certain25 chargesSubstitute ifHouse theBill managedNo. residential community determines it can no longer meet the resident's needs during the first forty-five days after occupancy by the resident of the managed residential community unit, including, but not limited to, prorated first month's rent, prorated community fee, full last month's rent and full security deposit;

5046 ninety days of any increase to monthly or recurring fees and disclose in writing any nonrefundable charges;

(3) Provide residents prorated or full reimbursements of certain charges if the managed residential community determines it can no longer meet the resident's needs during the first forty-five days after occupancy by the resident of the managed residential community unit, including, but not limited to, prorated first month's rent, prorated community fee, full last month's rent and full security deposit;

[(3)] (5) Upon the request of a resident, arrange, in conjunction with the assisted living services agency, for the provision of ancillary medical services on behalf of a resident, including physician and dental services, sHB5046pharmacy /services, Filerestorative No.physical therapies, podiatry services, hospice care and home health agency services, provided the ancillary medical services are not administered by employees of the managed residential community, unless the resident chooses to receive such services;

611 11 sHB5046 File No.

611 pharmacy services, restorative physical therapies, podiatry services, hospice care and home health agency services, provided the ancillary medical services are not administered by employees of the managed residential community, unless the resident chooses to receive such services;

[(7)] (9) Assist a resident who has a long-term care insurance policy withPublic preparingAct andNo. submitting claims for benefits to the insurer, provided such resident has executed a written authorization requesting and directing the insurer to (A) disclose information to the managed residential community relevant to such resident's eligibility for an insurance benefit or payment, and (B) provide a copy of the acceptance or declination of a claim for benefits to the managed residential community at the same time such acceptance or declination is made to such resident;

24-141 14 of 25 Substitute House Bill No.

5046 with preparing and submitting claims for benefits to the insurer, provided such resident has executed a written authorization requesting and directing the insurer to (A) disclose information to the managed residential community relevant to such resident's eligibility for an insurance benefit or payment, and (B) provide a copy of the acceptance or declination of a claim for benefits to the managed residential community at the same time such acceptance or declination is made to such resident;

(b) NoThe provisions of subdivisions (2) and (3) of subsection (a) of this section shall not apply to a managed residential community shallthat controlis or(1) managean elderly housing complex receiving assistance and funding through the financialUnited affairsStates Department of Housing and Urban Development's Assisted Living Conversion Program, or personalproperty(2) ofanya resident,exceptdemonstration asprovidedproject for inthe subdivisionprovision [(7)]of (9)subsidized ofassisted subsectionliving (a)services ofpursuant thisto section.section 17b-347e.

[(b)] (c) No managed residential community shall control or manage the financial affairs or personal property of any resident, except as provided for in subdivision [(7)] (9) of subsection (a) of this section.

8.9.

Subsection (e) of section 19a-564 of the 2024 supplement to the sHB5046general /statutes Fileis No.repealed and the following is substituted in lieu thereof (Effective October 1, 2024):

611 12 sHB5046 File No.

611 general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2024):

[ensure that] (1) Ensure that allservicesbeing providedonanindividualbasisto clientsare fully understoodPublic andAct agreedNo. upon between either the client or the client's representative;

24-141 15 of 25 Substitute House Bill No.

5046 understood and agreed upon between either the client or the client's representative;

9.

Section 17b-99a of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) (1) For purposes of this section, (A) "extrapolation" means the determination of an unknown value by projecting the results of the review of a sample to the universe from which the sample was drawn, (B) "facility" means any facility described in this subsection and for which rates are established pursuant to section 17b-340 or 17b-340d, [and] (C) "universe" means a defined population of claims submitted by a facility during a specific time period, and (D) "forensic audit" means an examination of financial records for information or evidence that may be used in a legal proceeding.

(2) The Commissioner of Social Services shall conduct any audit, including a forensic audit, of a licensed chronic and convalescent nursing home, chronic disease hospital associated with a chronic and convalescent nursing home, a rest home with nursing supervision, a licensed residential care home, as defined in section 19a-490, and a sHB5046 / File No.

611 13 sHB5046 File No.

611 residential facility for persons with intellectual disability which is licensed pursuant to section 17a-227 and certified to participate in the Medicaid program as an intermediate care facility for individuals with intellectual disabilities in accordance with the provisions of this section.

(b) Not less than thirty days prior to the commencement of any such audit, the commissioner shall provide written notification of the audit to such facility, unless the commissioner makes a good-faith determination that (1) the health or safety of a recipient of services is at risk;

or (2) the facility is engaging in vendor fraud under sections 53a- 290 to 53a-296, inclusive.

(c) Any clerical error, including, but not limited to, recordkeeping, typographical, scrivener's or computer error, discovered in a record or document produced for any such audit, shall not of itself constitute a wilful violation of the rules of a medical assistance program administered by theDepartment ofSocialServicesunless proofofintent to commit fraud or otherwise violate program rules is established.

In determiningwhichfacilitiesshallbesubjectto audits,theCommissioner of Social Services may give consideration to the history of a facility's compliance in addition to other criteria used to select a facility for an audit.

(d) A finding of overpayment or underpayment to such facility shall not be based on extrapolation unless (1) there is a determination of sustained or high level of payment error involving the facility, (2) documented educational intervention has failed to correct the level of payment error, or (3) the value of the claims in aggregate exceeds two hundred thousand dollars on an annual basis.

(e) A facility, in complying with the requirements of any such audit, shall be allowed not less than thirty days to provide documentation in connection with any discrepancy discovered and brought to the attention of such facility in the course of any such audit.

(f) The commissioner shall produce a preliminary written report concerning any audit conducted pursuant to this section and such sHB5046 / File No.

611 14 sHB5046 File No.

611 preliminary report shall be provided to the facility that was the subject of the audit not later than sixty days after the conclusion of such audit.

(g) The commissioner shall, following the issuance of the preliminary report pursuant to subsection (f) of this section, hold an exit conference with any facility that was the subject of any audit pursuant to this subsection for the purpose of discussing the preliminary report.

Such facility may present evidence at such exit conference refuting findings in the preliminary report.

(h) The commissioner shall produce a final written report concerning any audit conducted pursuant to this subsection.

Such final written report shall be provided to the facility that was the subject of the audit not later than sixty days after the date of the exit conference conducted pursuant to subsection (g) of this section, unless the commissioner and the facility agree to a later date or there are other referrals or investigations pending concerning the facility.

(i) Any facility aggrieved by a final report issued pursuant to subsection (h) of this section may request a rehearing.

A rehearing shall be held by the commissioner or the commissioner's designee, provided a detailed written description of all items of aggrievement in the final report isfiledby thefacility not later thanninety daysfollowing thedate of written notice of the commissioner's decision.

The rehearing shall be held not later than thirty days following the date of filing of the detailed written description of each specific item of aggrievement.

The commissioner shall issue a final decision not later than sixty days following theclose ofevidence or thedate onwhich final briefs are filed, whichever occurs later.

Any items not resolved at such rehearing to the satisfaction of the facility or the commissioner shall be submitted to binding arbitration by an arbitration board consisting of one member appointed by the facility, one member appointed by the commissioner and one member appointed by the Chief Court Administrator from among the retired judges of the Superior Court, which retired judge shall be compensated for his services on such board in the same manner as a state referee is compensated for his services under section 52-434.

sHB5046 / File No.

611 15 sHB5046 File No.

611 The proceedings of the arbitration board and any decisions rendered by such board shall be conducted in accordance with the provisions of the Social Security Act, 42 USC 1396, as amended from time to time, and chapter 54.

(j) The submission of any false or misleading fiscal information or data to the commissioner shall be grounds for suspension of payments by the state under sections 17b-239 to 17b-246, inclusive, and sections 17b-340, and 17b-343, in accordance with regulations adopted by the commissioner.

In addition, any person, including any corporation, who knowingly makes or causes to be made any false or misleading statement or who knowingly submits false or misleading fiscal information or data on the forms approved by the commissioner shall be guilty of a class D felony.

(k) The commissioner, or any agent authorized by the commissioner to conduct any inquiry, investigation or hearing under the provisions of this section, shall have power to administer oaths and take testimony under oath relative to the matter of inquiry or investigation.

At any hearing ordered by the commissioner, the commissioner or such agent having authority by law to issue such process may subpoena witnesses and require the production of records, papers and documents pertinent to such inquiry.

If any person disobeys such process or, having appeared in obedience thereto, refuses to answer any pertinent question put to thepersonby the commissioner or thecommissioner'sauthorized agent or to produce any records and papers pursuant thereto, the commissioner or the commissioner's agent may apply to the superior court for the judicial district of Hartford or for the judicial district wherein the person resides or wherein the business has been conducted, or to any judge of such court if the same is not in session, setting forth such disobedience to process or refusal to answer, and such court or judge shall cite such person to appear before such court or judge to answer such question or to produce such records and papers.

(l) The commissioner shall provide free training to facilities on the preparation of cost reports to avoid clerical errors and shall post sHB5046 / File No.

611 16 sHB5046 File No.

611 information on the department's Internet web site concerning the auditing process and methods to avoid clerical errors.

Not later than April 1, 2015, the commissioner shall establish audit protocols to assist facilities subject to audit pursuant to this section in developing programs to improve compliance with Medicaid requirements under state and federal laws and regulations, provided audit protocols may not be relied upon to create a substantive or procedural right or benefit enforceable at law or in equity by any person, including a corporation.

The commissioner shall establish and publish on the department's Internet web site audit protocols for:

(1) Licensed chronic and convalescent nursing homes, (2) chronic disease hospitals associated with chronic and convalescent nursing homes, (3) rest homes with nursing supervision, (4) licensed residential care homes, as defined in section 19a-490, and (5) residential facilities for persons with intellectual disability that are licensed pursuant to section 17a-227 and certified to participate in the Medicaid program as intermediate care facilities for individuals with intellectual disabilities.

The commissioner shall ensure that the Department of Social Services, or any entity with which the commissioner contracts to conduct an audit pursuant to this section, has on staff or consults with, as needed, licensed health professionals with experience in treatment, billing and coding procedures used by the facilities being audited pursuant to this section.

(m) A facility shall be liable to the Department of Social Services for the costs of any forensic audit of a facility identified by the department as potentially experiencing a serious financial loss, including, but not limited to, any reports or subsequent testimony related thereto.

A facility shall cooperate and assist with a forensic audit as requested by the department and shall ensure that all facility personnel, financial consultants and accountants fully cooperate and assist with a forensic audit as may be necessary.

A facility shall be subject to a civil monetary penalty not to exceed three thousand two hundred fifty dollars per day for each day that the facility fails to comply with a written request by the department to cooperate and assist with a forensic audit.

A facility may request a fair hearing on the assessment of any such civil monetary penalty as an aggrieved person pursuant to section 17b-60.

The sHB5046 / File No.

611 17 sHB5046 File No.

611 department may recover the costs of any such forensic audit or civil monetary penalties assessed in accordance with this subsection through recoupment of such amounts against the funds that would otherwise be paid to such facility for services rendered to recipients of assistance under the Medicaid program.

Sec.

(1) Such facility or home is operating without a licenseissuedpursuanttothischapterorlicenseissuedpursuanttothischapterorsuchfacility'sorhome'slicense suchfacility'sorhome'slicense has been suspended or revoked pursuant to section 19a-494;

(a) The court may appoint any responsible individual whose name is proposed by the Commissioner of Public HealthAct andNo. the Commissioner of Social Services to act as a receiver.

[For24-141 a16 nursing home facility, such individual shall be a nursing home facility administrator licensed in the state of Connecticut25 withSubstitute substantialHouse experienceBill inNo. operating Connecticut nursing homes.

5046 (a) The court may appoint any responsible individual or entity whose name is proposed by the Commissioner of Public Health and the Commissioner ofSocialServicesto act asareceiver.

[For anursing home facility, such individual shall be a nursing home facility administrator licensed in the state of Connecticut with substantial experience in operating Connecticut nursing homes.

The Commissioner of Social Services shall adopt sHB5046regulations /governing Filequalifications No.for proposed receivers consistent with this subsection.] Such individual or entity shall (1) be a nursing home facility administrator licensed pursuant to the provisions of sections 19a-511 to 19a-520, inclusive, or (2) have substantial experience in the delivery of high-quality health care services and successful managementoroperationoflong-termcarefacilities,andhaveachieved an educational level or have such licensure as customarily is held by persons or entities managing or operating health care facilities similar to the facility or facilities subject to receivership.

611No 18state sHB5046employee Fileor No.owner, administrator or other person or entity with a financial interest in the nursing home facility or residential care home may serve as a receiver for that nursing home facility or residential care home.

611No regulationsperson governingor qualificationsentity forappointed proposedto receiversact consistentas witha thisreceiver subsection.] Such individual shall havebe substantialpermitted experienceto in the delivery of high-quality health care services and successful managementoroperationoflong-termcarefacilities,andhaveachieved an educational level or have sucha licensurecurrent asfinancial customarilyinterest isin heldthe bynursing personshome managingfacility or operatingresidential health care facilitieshome; similar to the facility or facilities subject to receivership.

Nonor stateshall employeesuch person or owner,entity administratorappointed oras othera personreceiver withbe permitted to have a financial interest in the nursing home facility or residential care home mayfor serve as a receiverperiod forof thatfive nursingyears homefrom facilitythe ordate residentialthe carereceivership home.ceases.

No person appointedwho tois actemployed asby a receiverprivate equity company or entity owned or controlled by a private equity company shall be permittedappointed to haveact as a currentreceiver financialof interesta in the nursing home facility or residential care home;home.

nor(b) shallThe suchcourt personmay appointedremove assuch a receiver be permitted to have a financial interest in theaccordance nursingwith homesection facilityPublic orAct residentialNo. care home for a period of five years from the date the receivership ceases.

(b)24-141 The17 courtof may25 removeSubstitute suchHouse receiverBill inNo. accordance with section 52-513.

5046 52-513.

The state shall have a claim for any court- ordered fees and expenses of the receiver that shall have priority over sHB5046all /other Fileclaims No.of secured and unsecured creditors and other persons whether or not such nursing home facility or residential care home is in bankruptcy, to the extent allowed under state or federal law.

611 19 sHB5046 File No.

611 all other claims of secured and unsecured creditors and other persons whether or not such nursing home facility or residential care home is in bankruptcy, to the extent allowed under state or federal law.

(b) No person or entity shall provide nursing facility management servicesinthis state without obtaining acertificate fromtheDepartment of Public Health.Act No.

24-141 18 of 25 Substitute House Bill No.

5046 (b) No person or entity shall provide nursing facility management servicesinthis state without obtaining acertificate fromtheDepartment of Public Health.

and (D) if the applicant currently provides nursing facility management servicesinanotherstate,acertificateofgoodstandingfromthelicensing sHB5046agency /with Filejurisdiction No.over public health for each state in which such services are provided;

611 20 sHB5046 File No.

611 agency with jurisdiction over public health for each state in which such services are provided;

(3) An affidavit signed by the applicant and any of the persons described in subparagraph (B) of subdivision (1) of this subsection disclosinganymatterinwhichtheapplicantorsuchperson(A)hasbeen convicted of an offense classified as a felony under section 53a-25 or pleaded nolo contendere to a felony charge, or (B) has been held liable or enjoined ina civil action by final judgment, if the felony or civil action involved fraud, embezzlement, fraudulent conversion or misappropriationPublic ofAct property,No. or (C) is subject to a currently effective injunction or restrictive or remedial order of a court of record at thetime of application, or (D) 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 business activity or health care, including, but not limited to, actions affecting the operation of a nursing facility, residential care home or any facility subject to sections 17b-520 to 17b-535, inclusive, or a similar statute in another state or country;

and24-141 (4)19 The location and description of any25 nursingSubstitute facilityHouse inBill thisNo. state or another state in which the applicant or a beneficial owner of the applicantcurrentlyprovidesmanagementservicesorhasprovidedsuch services or is currently or has been the owner, operator or administrator within the past five years and whether any such facility has been subject to:

5046 misappropriation of property, or (C) is subject to a currently effective injunction or restrictive or remedial order of a court of record at thetime of application, or (D) 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 business activity or health care, including, but not limited to, actions affecting the operation of a nursing facility, residential care home or any facility subject to sections 17b-520 to 17b-535, inclusive, or a similar statute in another state or country;

and (4) The location and description of any nursing facility in this state or another state in which the applicant or a beneficial owner of the applicantcurrentlyprovidesmanagementservicesor hasprovidedsuch services or is currently or has been the owner, operator or administrator within the past five years and whether any such facility has been subject to:

(B) Sanctions, other than civil penalties less than or equal to twenty sHB5046thousanddollars,imposedinany /state Filethroughfinaladjudicationunder No.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;

611 21 sHB5046 File No.

611 thousanddollars, imposedinany state throughfinaladjudicationunder 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;

(d)In additionto theinformationprovidedpursuant to subsection (c) of this section, the department may reasonably request to review the applicant'sPublic auditedAct andNo. certified financial statements, which shall remain the property of the applicant when used for either initial or renewal certification under this section.

24-141 20 of 25 Substitute House Bill No.

5046 applicant's audited and certified financial statements, which shall remain the property of the applicant when used for either initial or renewal certification under this section.

The department may deny certification to any applicant for the provision of nursing facility management services (1) [at any specific facility or facilities where there has been a substantial failure to comply with the Public Health Code, or (2)] if the applicant fails to provide the information required under [subdivision (1) of] subsection (c) of this section, or (2) if the department determines that the applicant or a beneficial owner of the applicant has an unacceptable sHB5046history /of Filepast and current compliance with state licensure requirements, applicable federal requirements and state regulatory requirements for each licensed health care facility owned, operated or managed by the applicant or a beneficial owner of the applicant in the United States or any territory of the United States during the five years precedingthedateonwhichsuchapplicationissubmitted,asevidenced Public Act No.

61124-141 2221 sHB5046of File25 Substitute House Bill No.

6115046 history of past and current compliance with state licensure requirements, applicable federal requirements and state regulatory requirements for each licensed health care facility owned, operated or managed by the applicant or a beneficial owner of the applicant in the United States or any territory of the United States during the five years precedingthedateonwhichsuchapplicationissubmitted,asevidenced by:

(h) In any case in which the Commissioner of Public Health finds that there has been a substantial failure by one or more managed facilities to comply with state licensure requirements, applicable federal requirements and state regulatory requirements or a substantial failure by a nursing facility management services certificate holder managing such facilities to comply with the requirements for such certificate holderestablishedunderthissection,thecommissionermayinitiate and impose disciplinary action against a nursing facility management sHB5046services /certificate Fileholder No.pursuant to section 19a-494.

611If 23three sHB5046or Filemore facilities managed by a nursing facility management services certificate holder are subject to civil penalties imposed through final order of the Public Act No.

61124-141 services22 certificateof holder25 pursuantSubstitute toHouse sectionBill 19a-494.No.

If5046 three or more facilities managed by a nursing facility management services certificate holder are subject to civil penalties imposed through final order of the commissioner in accordance with the provisions of sections 19a-524 to 19a-528, inclusive, during a twelve-month period, the commissioner may impose a civil penalty on the nursing facility management services certificate holder of not more than twenty thousand dollars.

sHB5046Sec. / File No.

61113. 24 sHB5046 File No.

611(Effective Thisfrom actpassage) shall(a) takeThere effectis asestablished followsa andworking shallPublic amendAct theNo. following sections:

Section24-141 123 fromof passage25 19a-521bSubstitute Sec.House Bill No.

25046 Julygroup 1,to 2024study 19a-533the Sec.impact of prohibiting licensed chronic and convalescent nursing homes and rest homes with nursing supervision from placing newly admitted residents in rooms containing more than two beds without consent pursuant to the provisions of subsection (b) of section 19a-521b of the general statutes, as amended by this act.

3The fromworking passagegroup Newshall sectionexamine Sec.methods to (1) assist such facilities affected by the provisions of said subsection, including identifying opportunities to support the financial sustainability of such facilities, and (2) ensure that such facilities are able to comply with the provisions of said subsection.

4(b) fromThe passageworking 17b-357group Sec.shall consist of the following members:

5(1) fromOne passageappointed 19a-496(b)by Sec.the speaker of the House of Representatives;

6(2) fromOne passageappointed 19a-700by Sec.the president pro tempore of the Senate;

7(3) JulyOne 1,appointed 2024by 19a-694the Sec.majority leader of the House of Representatives;

8(4) JulyOne 1,appointed 2024by 19a-564(e)the Sec.majority leader of the Senate;

9(5) fromOne passageappointed 17b-99aby Sec.the minority leader of the House of Representatives;

10(6) fromOne passageappointed 19a-543by Sec.the minority leader of the Senate;

11(7) fromThe passageSecretary 19a-547of Sec.the Office of Policy and Management, or the secretary's designee;

12(8) fromThe passageCommissioner 19a-561of StatementSocial ofServices, Legislativeor Commissioners:the commissioner's designee;

In(9) SectionThe 7(b),Commissioner "subdivisionof (7)"Public wasHealth, changedor tothe "subdivisioncommissioner's [(7)]designee; (9)" for accuracy.

APPPublic JointAct FavorableNo. Subst.

sHB504624-141 /24 Fileof 25 Substitute House Bill No.

6115046 25(10) sHB5046The Filechairpersons No.of the joint standing committee of the General Assembly having cognizance of matters relating to aging;

611 The following Fiscal Impact Statement and Bill(11) AnalysisThe areranking prepared for the benefit of the members of the Generaljoint Assembly,standing solelycommittee for purposes of information, summarization and explanation and do not represent the intent of the General Assembly orhaving eithercognizance chamberof thereofmatters forrelating anyto purpose.aging.

In(c) general,Any fiscalmember impactsof arethe basedworking upongroup aappointed varietyunder ofsubdivision informational(1),(2), sources,(3),(4),(5)or(6)ofsubsection(b)ofthissectionmaybeamember includingof the analyst’sGeneral professionalAssembly. knowledge.

Whenever(d) applicable,All agencyinitial dataappointments isto consultedthe asworking partgroup ofshall thebe analysis,made howevernot finallater productsthan dothirty notdays necessarilyafter reflectthe aneffective assessmentdate fromof anythis specificsection. department.

OFAAny Fiscalvacancy Noteshall Statebe Impact:filled by the appointing authority.

Agency(e) AffectedThe Fund-EffectHouse FYchairperson 25and $House FYranking 26member $of Socialthe Services,joint Dept.standing committee of the General Assembly having cognizance of mattersrelating to aging shall bethechairpersonsof theworking group.

GFSuchchairpersonsshallschedulethefirst -meeting Potentialoftheworkinggroup, Seewhich Belowshall Seebe Belowheld Resourcesnot oflater thethan Generalsixty Funddays GFafter -the Potentialeffective Seedate Belowof Seethis Belowsection. Revenue Gain Note:

GF=General(f) FundThe Municipaladministrative Impact:staff of the joint standing committee of the General Assembly having cognizance of matters relating to aging shall serve as administrative staff of the working group.

None(g) ExplanationNot Sectionlater 1than establishesJanuary 1, 2026, the working group shall submit a Classreport Bon violationits underfindings CGAand Sec.recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to aging, in accordance with the provisions of section 11-4a of the general statutes.

19a-527,The whichworking resultsinagroup potentialminimalGeneralshall Fundrevenueterminate gainstartingon 7/1/26totheextentthatviolationsoccur,nursinghomesareissuedcivilthe penaltiesdate bythat theit Departmentsubmits ofsuch Publicreport Healthor (DPH),January and1, associated2026, fineswhichever areis collected.later.

ForApproved eachJune violation,4, a2024 civilPublic penaltyAct ofNo. not more than $10,000 may beimposed.A newviolationoccurseachday that anursing home fails to comply.

Section24-141 925 may result in a fiscal impact to the Department of Social25 Services (DSS) associated with forensic audits and related potential civil monetary penalties on certain facilities.

The bill specifies that forensic audits may be conducted by DSS, the costs for which the audited facility would be liable.

The bill also subjects facilities to civil penalties of up to $3,250 per day until the facility cooperates.

DSS may (1) recover such costs and penalties through reduced Medicaid payments otherwise due to impacted facilities, or (2) receive reimbursement for audit costs and collect civil penalties and reflect an associated revenue gain.

The bill makesvarious other changesthat are not anticipatedto result sHB5046 / File No.

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611 in a fiscal impact to the state.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

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611 OLR Bill Analysis sHB 5046 AN ACT PROMOTING NURSING HOME RESIDENT QUALITY OF LIFE.

TABLE OF CONTENTS:

SUMMARY § 1 — NURSING HOME ROOM CAPACITY LIMITATIONS Prohibits each licensed chronic and convalescent nursing home and rest home with nursing supervision from placing residents in a room containing more than two beds § 2 — NURSING HOME WAITING LIST AND TRANSFERS Requires nursing homes, without regard for the waiting list, to admit transferring residents from a nursing home that is closing;

generally exempts from this requirement homes with no more than 30% self-pay patients if the transferring patient is indigent § 3 — DISCONTINUATION OF REST HOME WITH NURSING SUPERVISION LICENSES Prohibits the DPH commissioner from granting new rest home with nursing supervision licenses § 4 — NURSING FACILITIES AND STATE ENFORCEMENT AUTHORITY Extends certain existing procedures and penalties for nursing home violations of federal law to violations of state laws or regulations § 5 — PENALTIES FOR HEALTHCARE INSTITUTIONS FAILING TO COMPLY WITH CORRECTIVE ACTION PLANS Subjects DPH-licensed healthcare institutions to potential disciplinary action for failing to comply with an accepted plan of corrective action §§ 6 & 7 — MANAGED RESIDENTIAL COMMUNITY RESIDENCY AGREEMENTS AND FEES Requires MRCs to (1) include information in written residency agreements on how they may adjust monthly or other recurring fees;

(2) give residents, or their representatives, 90 days’ notice of any fee increases;

and (3) give residents prorated or full refunds of certain fees if the facility cannot meet the resident’s needs within the first 45 days of occupancy § 8 — ALSA FEES Requires ALSAs to (1) disclose fee increases to residents or their representatives at least 60 days before they take effect and (2) upon request, give them the history of fee increases over the past three years sHB5046 / File No.

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611 § 9 — FORENSIC AUDITS OF LONG-TERM CARE FACILITIES Requires long-term care facilities potentially experiencing serious financial losses to be liable for the costs of any forensic audit by DSS and subjects them to civil penalties for failure to cooperate §§ 10 & 11 — APPOINTMENT OF RECEIVERS OF NURSING HOMES OR RESIDENTIAL CARE HOMES Requires nursing home or residential care home receiver applications to be granted if the facility sustains any type of serious financial loss or failure and updates the criteria for who may be appointed as a receiver of these facilities § 12 — NURSING FACILITY MANAGEMENT SERVICES Requireseachentityseekinganursingfacilitymanagementcertificatetodiscloseadditional information in its application, revises the criteria upon which DPH can base its certificate issuance decisions, and expands the penalties and grounds upon which DPH can impose disciplinary action against these certificate holders BACKGROUND SUMMARY This bill makes changes related to the management and oversight of long-term care and similar licensed facilities.

For example, it:

1.

prohibits nursing homes from placing residents in a room containing more than two beds, for newly admitted residents starting July 1, 2025, and for all residents one year after that (§ 1);

2.

phases out the license category of rest homes with nursing supervision (§ 3);

3.

authorizes the Department of Public Health (DPH) to impose disciplinary action on licensed health care institutions that fail to comply with a plan of correction accepted by the department (§ 5);

and 4.

explicitly authorizes the Department of Social Services (DSS) to conduct forensic audits and makes facilities liable for the cost of these audits (§ 9).

The bill also makes various minor, technical, and conforming changes.

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611 EFFECTIVE DATE:

Upon passage, unless otherwise specified below.

§ 1 — NURSING HOME ROOM CAPACITY LIMITATIONS Prohibits each licensed chronic and convalescent nursing home and rest home with nursing supervision from placing residents in a room containing more than two beds The bill prohibits each licensed chronic and convalescent nursing home and rest home with nursing supervision (nursing home) from placing newly admitted residents in a room containing more than two beds beginning on July 1, 2025.

It also prohibits any resident room at a nursing home from containing more than two beds beginning on July 1, 2026.

A violation is a class B violation and may result in a civil penalty of up to $10,000.

A new violation occurs each day that a nursing home fails to comply with this section and an additional penalty may be assessed.

§ 2 — NURSING HOME WAITING LIST AND TRANSFERS Requires nursing homes, without regard for the waiting list, to admit transferring residents from a nursing home that is closing;

generally exempts from this requirement homes with no more than 30% self-pay patients if the transferring patient is indigent Under existing law and subject to certain exceptions, nursing homes receiving state funds for providing care for the indigent must admit applicants on a first-come, first-served basis and cannot discriminate against indigent applicants based on their source of payment.

Under oneexisting exception,anursing homewith30% or fewer self- pay residents is not required to admit an indigent person on a waiting list when a bed becomes available in the next six months, as long as a bed is not held open for more than 30 days.

A home taking advantage of this waiver must notify DSS and the regional long-term care ombudsman on a quarterly basis.

The bill specifically requires the home to notify these entities on the date the exemption began and quarterly thereafter.

Under current law, nursing homes are authorized to admit transferring residents from a nursing home that was closing without regard for the waiting list.

The bill makes this mandatory, with one exception (see below).

This specifically applies to applicants wishing to sHB5046 / File No.

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611 transfer froma nursing home (1) that is closing or (2) in which they were placed after the nursing home where they previously resided closed (or for homes in receivership, was anticipated to close).

Under the bill, nursing homes that qualify for the waiting list exemption described above (i.e., homes with no more than 30% self-pay patients) are not required to admit indigent people who are transferring under these provisions except when they are being transferred from a nursing home that is closing due to an emergency.

EFFECTIVE DATE:

July 1, 2024 § 3 — DISCONTINUATION OF REST HOME WITH NURSING SUPERVISION LICENSES Prohibits the DPH commissioner from granting new rest home with nursing supervision licenses The bill prohibits the DPH commissioner from granting new licenses to establish or operate a rest home with nursing supervision.

A rest home with nursing supervision is a residential facility that provides intermediate care services to residents.

(In practice, nursing homes generally have been phasing out these beds or converting them to chronic and convalescent nursing home beds.) The DPH commissioner is authorized to approve a one-time license renewal for a duration of one year or less if the applicant follows the existing criteria for renewal.

Applicants seeking a one-year license renewal are prohibited from appealing a decision to deny the renewal.

§ 4 — NURSING FACILITIES AND STATE ENFORCEMENT AUTHORITY Extends certain existing procedures and penalties for nursing home violations of federal law to violations of state laws or regulations Under the bill, if a Medicaid-participating nursing facility is found to be noncompliant with applicable state statutes or regulations during a DPH survey, it is treated the same as being noncompliant with specified federal law under existing procedures.

Under this law, among other things:

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611 1.

if DPH finds that this noncompliance poses an imminently serious threat to patient well-being, it must state the charges and request a summary order from DSS, which (if issued) must include termination of Medicaid participation or appointment of a temporary manager and may include other penalties (e.g., having patients transferred to other facilities or civil penalties);

2.

ifDPHfindsthatthisnoncompliancedoesnotposeanimmediate threat, it must state the charges and request that DSS impose any of a range of remedies similar to those for imminently serious charges (but none are mandatory);

and 3.

the facility may request a hearing with DSS within 10 days of the statement of charges or summary order.

Other existing laws, under specified procedures, authorize DPH to impose a range of sanctions on nursing homes that violate applicable state laws or regulations.

§ 5 — PENALTIES FOR HEALTHCARE INSTITUTIONS FAILING TO COMPLY WITH CORRECTIVE ACTION PLANS Subjects DPH-licensed healthcare institutions to potential disciplinary action for failing to comply with an accepted plan of corrective action By law, a DPH-licensed health care institution (such as a hospital or nursing home) must submit a correction plan to DPH if the department, after an inspection, issues a notice that the institution was out of compliance with applicable state laws or regulations.

DPH may impose disciplinary action on these institutions if they fail to submit a plan of correction meeting the law’s requirements.

The billadditionally authorizesDPHtoimpose disciplinary actionon theseinstitutionsiftheyfailtocomplywithaplanofcorrectionaccepted by the department.

These actions may only be imposed after a hearing and may include, among other things:

1.

revocation or suspension of a license;

2.

censure of a licensee;

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611 3.

placement of a licensee on probationary status, and the requirement to report regularly to the department on the matters that are the basis of the probation;

4.

restricting the acquisition of other facilities for a period set by the commissioner;

or 5.

issuing an order compelling compliance with applicable laws or regulations of the department.

§§ 6 & 7 — MANAGED RESIDENTIAL COMMUNITY RESIDENCY AGREEMENTS AND FEES Requires MRCs to (1) include information in written residency agreements on how they may adjust monthly or other recurring fees;

(2) give residents, or their representatives, 90 days’ notice of any fee increases;

and (3) give residents prorated or full refunds of certain fees if the facility cannot meet the resident’s needs within the first 45 days of occupancy Existing law requires managed residential communities (MRC) to give each resident a written residency agreement that clearly sets out the resident’s and the MRC’s rights and responsibilities.

The bill modifies the contents of the agreement and establishes notification and reimbursement requirements for certain resident fees.

EFFECTIVE DATE:

July 1, 2024, except the provisions on the residency agreements are effective upon passage.

Written Residency Agreement The bill adds to the required contents of the agreement the way that MRCs may adjust monthly or other recurring fees, including (1) how often fees may increase, (2) the schedule or specific dates of these increases, and(3)thehistoryoffeeincreasesoverthe past three calendar years.

Under current law, written residency agreements must include, among other things, a full and fair disclosure of all charges, fees, expenses, and costs to be borne by the resident.

The bill specifies that this includes nonrefundable charges, fees, expenses, and costs.

The bill’s provisions apply to written residency agreements entered into on and after July 1, 2024.

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611 Fee Notifications and Reimbursement The bill requires MRCs to give residents, or their representatives, 90 days’ advance notice of any increase in monthly or recurring fees and written disclosure of any nonrefundable charges.

It also requires MRCs to give residents prorated or full reimbursement of certain charges if the MRC determines it can no longer meettheresident’sneedsduring thefirst 45daysoftheresident’s occupancy (e.g., prorated first month’s rent, prorated community fee, full last month’s rent, and full security deposit).

Background — Related Bill sHB 5001, favorably reported by the Aging and Appropriations committees, modifies the contents of MRC residency agreements and related notification and reimbursement requirements in a similar way, effective on and after October 1, 2024, instead of July 1, 2024.

§ 8 — ALSA FEES Requires ALSAs to (1) disclose fee increases to residents or their representatives at least days before they take effect and (2) upon request, give them the history of fee increases over the past three years Existing law requires an assisted living services agency (ALSA) to ensure all services provided individually to clients are fully understood by the client or the client’s representative, and that the client or representative is made aware of their cost.

ThebillalsorequiresanALSAto(1)disclosefeeincreasestotheclient or representative at least 60 days before they take effect and (2) upon request, give the resident or representative the history of fee increases over the past three calendar years.

The bill specifies that this requirement does not limit an ALSA from immediately adjusting fees if (1) they are directly related to a change in the level of care or services necessary to meet the resident’s safety needs at the time of a scheduled resident care meeting or (2) the resident’s condition changes, resulting in a required change in services.

EFFECTIVE DATE:

July 1, 2024 sHB5046 / File No.

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611 Background — Related Bill sHB 5001, favorably reported by the Aging and Appropriations committees, requires ALSAs to disclose fee increases to residents or their representatives at least 90 days before they take effect and, upon request, to give them the history of fee increases over the past three years, effective October 1, 2024.

§ 9 — FORENSIC AUDITS OF LONG-TERM CARE FACILITIES Requires long-term care facilities potentially experiencing serious financial losses to be liable for the costs of any forensic audit by DSS and subjects them to civil penalties for failure to cooperate Existing law sets procedures and requirements related to DSS audits oflong-termcare facilitiesthat receive Medicaidor other state payments (including chronic and convalescent nursing homes, chronic disease hospitals associated with them, rest homes with nursing supervision, residential care homes, and certain residential facilities for persons with intellectual disabilities).

The bill explicitly extends these provisions to forensic audits.

A “forensic audit” is an examination of financial records for information or evidence which may be used in legal proceedings.

The bill also requires facilities identified by DSS as potentially experiencing a serious financial lossto be liable for thecostsofaforensic audit (such as reports or subsequent testimony) if DSS requires them to undergo one.

It requires the facilities to fully cooperate with forensic audits and to ensure that their personnel, financial consultants, and accountants also cooperate as necessary.

If a facility does not comply with DSS’s written request to cooperate, the facility is subject to a maximum civil penalty of $3,250 per day until it does.

Facilities are may appeal any civil penalties under this section by following DSS’s administrative appeals process.

The bill authorizes DSS to recover the costs of conducting a forensic audit, or these civil penalties, by deducting the amount from Medicaid payments due to be made to the facility.

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611 §§ 10 & 11 — APPOINTMENT OF RECEIVERS OF NURSING HOMES OR RESIDENTIAL CARE HOMES Requires nursing home or residential care home receiver applications to be granted if the facility sustains any type of serious financial loss or failure and updates the criteria for who may be appointed as a receiver of these facilities By law, DSS or DPH,orinsome casesafacility resident oraresident’s representative, may apply to Superior Court for the appointment of a receiver for a nursing home or residential care home under certain circumstances.

The bill requires the court to grant the application for a receiver if the facility experiences a serious financial loss or failure.

Under current law, this applies only if that financial loss or failure jeopardizes the health, safety, and well-being of patients.

Generally, a receiver is a neutral party the court appoints to operate the facility until conditions improve or, in some cases, the facility is ready to be closed.

The bill removes the requirement for a receiver to be a licensed nursing home facility administrator or have experience as a residential care home administrator or something similar, as applicable.

It requires candidates to have substantial experience in the delivery of high-quality healthcareservicesandmanagementoflong-termcarefacilities;current law does not specifically reference the quality of services.

The bill also requires candidates to have a level of education or licensure that is customarily commensurate with people who manage facilities like the one under receivership.

The bill also removes the requirement for DSS to adopt regulations on receiver qualifications.

§ 12 — NURSING FACILITY MANAGEMENT SERVICES Requires each entity seeking a nursing facility management certificate to disclose additional information in its application, revises the criteria upon which DPH can base its certificate issuance decisions, and expands the penalties and grounds upon which DPH can impose disciplinary action against these certificate holders The bill requires nursing facility management services certificate applicants who have beneficial owners to include the name of everyone with a 5% or greater ownership interest in the applying entity and a description of their relationship to the applicant.

Under current law, the threshold to disclose a beneficial owner is 10%.

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611 Under existing law, people listed on the application must sign an affidavit disclosing certain information about their criminal history, civil cases, or health care business-related disciplinary actions.

The bill requires applicants to also disclose:

1.

the location and description of any nursing facility (in any state) to which a beneficial owner provides, or has provided within the last five years, management services, and 2.

if a beneficial owner or applicant owns, operates, or administers a nursing facility, or has within the last five years.

Additionally, the bill requires applicants to disclose if any such nursing facility associated with the applicant or beneficial owner has been subject to any of the following:

1.

three or more civil penalties imposed through DPH final orders or by other states within the last two years;

2.

Medicare or Medicaid sanctions in any state, other than civil penalties of $20,000 or less;

and 3.

nonrenewal or termination of a Medicare or Medicaid provider agreement.

Providing Nursing Facility Management Services to Facilities Not Listed on the Original Certificate The bill requires nursing facility management certificate holders to request the approval of DPH to provide management services to a facility not listed on their certificate at least 30 days before doing so.

The department has the discretion to approve the request subject to conditions or deny the request based on the certificate holder’s compliancehistorywithstateandfederalregulatoryrequirementsatthe facilities it manages.

Adjudication of Applications The bill requires DPH to base its decision to renew or issue a sHB5046 / File No.

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611 certificate on information otherwise available to DPH, in addition to the information submitted to DPH by the applicant and the managed facilities’ compliance status as under current law.

The bill expands the conditions under which DPH may deny a nursing facility management certificate.

Current law allows DPH to do so based on the substantial failure to comply with the Public Health Code.

The bill instead allows DPH to deny issuing a certificate if the applicant or a beneficial owner has an evidentially demonstrable unacceptable history of compliance with (1) state licensure requirements;

(2) federal requirements;

and (3) state regulatory requirements for each licensed health care facility owned, operated, or managed by the applicant or beneficial owner in the United States in the five years before the application.

The bill states that an unacceptable history of compliance can be evidenced by:

1.

licensed health care facilities being subject to the adverse actions described above that must be listed on the application (e.g., three or more civil penalties);

2.

licensed health care facilities having continuing violations, or a pattern of violations, of state licensure standards or federal certification standards;

or 3.

the criminal conviction or guilty pleas by an applicant or beneficial owner to charges of fraud, patient or resident abuse or neglect, or a crime of violence or moral turpitude.

Under existing law, unchanged by the bill, DPH can also deny an application based on the facility’s failure to provide required information.

The bill requires renewal applicants to submit satisfactory evidence that any nursing facilities that the applicant provides management services to is in substantial compliance with federal regulatory requirements.

As under existing law, the applicant must also submit sHB5046 / File No.

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611 evidence that they are in substantial compliance with existing state law, the Public Health Code, and licensing regulations, in addition to any otherinformationDPHrequires.Thebillalsospecifiesthattheapplicant must show a history of past compliance.

Disciplinary Action for Failing to Comply With State and Federal Requirements Existing law authorizes DPH to impose disciplinary action (e.g., suspension or revocation of the certificate) on a nursing facility management services certificate holder for substantial failure to comply withstatutory requirements.The billspecifically authorizesDPHtoalso impose discipline on them if, at any of the facilities they manage, there is a substantial failure to comply with state licensure requirements, state regulatory requirements, or federal requirements.

The billalso authorizesDPH,after ahearing, to impose acivilpenalty on a nursing home facility management certificate holder of $20,000 or less if three or more facilities managed by the certificate holder are subject to civil penalties imposed by DPH during a 12-month period.

Under existing law, DPH may require a certificate holder and the nursing facility licensee to submit a plan of corrective action to DPH when the commissioner finds there has been a substantial failure to comply with requirements applicable to nursing home facility management certificate holders.

Under the bill, a plan of correction accepted by DPH is an order of the department, and violations of these orders can result in disciplinary action against the certificate holder.

Disciplinary actions can include, among other things, the suspension or revocation of the certificate.

BACKGROUND Legislative History The House referred the bill (File 146) to the Appropriations Committee, which reported out a substitute that eliminated provisions requiring the Department of Public Health to establish a nursing home center of excellence program and an online nursing home consumer sHB5046 / File No.

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611 report card.

COMMITTEE ACTION Aging Committee Joint Favorable Yea 15 Nay 0 (03/12/2024) Judiciary Committee Joint Favorable Yea 24 Nay 11 (04/05/2024) Appropriations Committee Joint Favorable Substitute Yea 52 Nay 0 (04/15/2024) sHB5046 / File No.

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