SB 156 — AN ACT ESTABLISHING A TASK FORCE TO STUDY REQUIRING NURSING HOMES TO SPEND A PERCENTAGE OF MEDICAID REIMBURSEMENT OR TOTAL REVENUE ON DIRECT CARE OF NURSING HOME RESIDENTS.

Senate General Assembly RaisedFile Bill No.

156112 February Session, 2024 LCOSubstitute Senate Bill No.

1504156 ReferredSenate, toMarch 26, 2024 The Committee on AGINGAging Introducedreported by:through SEN.

(AGE)HOCHADEL ANof ACTthe REQUIRING13th NURSINGDist., HOMEChairperson FACILITIESof TOthe SPENDCommittee ATon LEASTthe EIGHTYpart PERof CENTthe OFSenate, MEDICAIDthat FUNDINGthe PROVIDEDsubstitute BYbill THEought STATEto ONpass. DIRECT CARE.

AN ACT ESTABLISHING A TASK FORCE TO STUDY REQUIRING NURSING HOMES TO SPEND A PERCENTAGE OF MEDICAID REIMBURSEMENT OR TOTAL REVENUE ON DIRECT CARE OF NURSING HOME RESIDENTS.

Subsection(Effective (a)from ofpassage) section(a) 17b-340dThere ofis theestablished 2024a supplementtask force to thegeneralstatutesisrepealedandthefollowingstudy isMedicaid substitutedreimbursement inlieuof thereofnursing (Effectivehome Julyservices. 1, 2024):

(a) The Commissionertask offorce Socialshall Services(1) shallconsider implement(A) anwhether acuity-to basedrequire methodologynursing forhome Medicaidfacilities reimbursementto spendnotlessthanacertainpercentageof(i)Medicaidfundingreceived from the state, or (ii) total revenue, including payments from Medicaid, Medicare, private insurers, and direct pay, on direct care of residents, and (B) whether to expand transparency requirements relating to how nursing home servicesfacilities effectiveexpend Julyrevenue 1,and 2022.prioritize resident care;

Notwithstandingand section(2) 17b-340,developrecommendations forregarding the fiscalconsiderations yeardescribed endingin Junesubdivision 30,(1) 2023, and annually thereafter, the Commissioner of Socialthis Servicessubsection. shall establish Medicaid rates paid to nursing home facilities based on cost years ending on September thirtieth in accordance with the following:

(1)(b) Case-mixThe adjustmentstask toforce theshall directconsist careof component, which will be based on Minimum Data Set resident assessment data as well as cost data reported for the costfollowing yearmembers: ending September 30, 2019, shall be made effective beginning July 1, 2022, and updated every quarter thereafter.

LCO(1) No.Two appointed by the speaker of the House of Representatives;

1504sSB156 1/ ofFile 7No. Raised Bill No.156 After modeling such case-mix adjustments, the Commissioner of Social Services shall evaluate impact on a facility by facility basis and, not later than October 1, 2021, (A) make recommendations to the Secretary of the Office of Policy and Management, and (B) submit a report on the recommendations, in accordance with the provisions of section 11-4a, to the joint standing committees of the General Assembly having cognizanceofmattersrelatingto appropriationsandthebudgetsofstate agenciesandhumanservices onanyadjustmentsneededtofacilitatethe transition to the new methodology on July 1, 2022.

This112 evaluation1 maysSB156 includeFile aNo. review of inflationary allowances, case mix and budget adjustment factors and stop loss and stop gain corridors and the ability to make such adjustments within available appropriations.

112 (2) BeginningTwo Julyappointed 1, 2022, facilities [will be required to] shall comply with collection and reporting of quality metrics as specified by the Departmentpresident ofpro Socialtempore Services,of after consultation with the nursingSenate; home industry, consumers, employees and the Department of Public Health.

Rate(3) adjustmentsOne basedappointed onby performancethe onmajority qualityleader metricsof [will]the shallHouse be phased in, beginning July 1, 2022, with a period of reportingRepresentatives; only.

Effective(4) JulyOne 1,appointed 2023,by the Departmentmajority leader of Social Services shall issue individualized reports annually to each nursing home facility showing the impactSenate; to the Medicaid rate for such home based on the quality metrics program.

A(5) nursingOne homeappointed facilityby receivingthe anminority individualizedleader qualityof metrics report may use such report to evaluate the impactHouse of theRepresentatives; quality metrics program on said facility's Medicaid reimbursement.

Not(6) laterOne thanappointed Juneby 30, 2025, the departmentminority shallleader submit a report, in accordance with the provisions of section 11-4a, to the jointSenate; standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies and human services on the quality metrics program.

Such report shall include information regarding individualized reports and the(7) anticipatedThe impactCommissioner onof nursingSocial homesServices, ifor the statecommissioner's weredesignee. to implement a rate withhold on nursing homes that fail to meet certain quality metrics.

(3)(c) GeographicAny peermember groupings of facilitiesthe shalltask beforce establishedappointed byunder thesubdivision Department(1), (2), (3), (4), (5) or (6) of Socialsubsection Services(b) pursuantof tothis regulationssection adoptedmay inbe LCOa No.member of the General Assembly.

1504(d) 2All ofinitial 7appointments Raisedto Billthe No.task force shall be made not later thanthirty daysafter theeffective date ofthis section.Any vacancy shall be filled by the appointing authority.

156(e)The accordancespeaker withoftheHouse subsectionofRepresentativesandthepresident (b)pro tempore of thisthe section.Senate shall select the chairpersons of the task force from among the members of the task force.

(4)Such Allowablechairpersons costsshall schedule thefirst meeting ofthe task force, which shall bebeheld dividednot intolater thansixty days after the followingeffective fivedate costof components:this section.

(A)(f) DirectThe costs,administrative whichstaff shallof includethe salariesjoint forstanding nursingcommittee personnel,of relatedthe fringeGeneral benefitsAssembly andhaving costscognizance forof nursingmatters personnelrelating suppliedto byaging ashall temporaryserve nursingas servicesadministrative agency;staff of the task force.

(B)(g) indirectNot costs,later whichthan shallJanuary include1, professional2025, fees,the dietarytask expenses,force housekeepingshall expenses,submit laundrya expenses,report supplieson relatedits findings and recommendations to patientthe care,joint salariesstanding forcommittees indirectof carethe personnelGeneral Assembly having cognizance of matters relating to aging and relatedhuman fringeservices, benefits;in accordance with the provisions of section 11-4a of the general statutes.

(C)The fairtask rent,force which shall beterminate definedon inthe regulationsdate adoptedthat init accordancesubmits withsuch subsectionreport (b)or ofJanuary this1, section;2025, whichever is later.

(D)sSB156 capital-related/ costs,File whichNo. shall include property taxes, insurance expenses, equipment leases and equipment depreciation;

and112 (E)2 administrativesSB156 andFile generalNo. costs, which shall include maintenance and operation of plant expenses, salaries for administrative and maintenance personnel and related fringe benefits.

For112 (i)This directact costs, the maximum cost shall betake equaleffect toas onefollows hundredand thirty-fiveshall peramend cent of the medianfollowing allowablesections: cost of that peer grouping;

(ii)Section indirect1 costs,from thepassage maximumNew costsection shallStatement be equal to one hundred fifteen per cent of theLegislative state-wideCommissioners: median allowable cost;

(iii)The fairtitle rent,was thechanged amountfor shallaccuracy. be calculated utilizing the amount approved pursuant to section 17b-353;

(iv)AGE capital-relatedJoint costs,Favorable thereSubst. shall be no maximum;

andsSB156 (v)/ administrativeFile andNo. general costs, the maximum shall be equal to the state-wide median allowable cost.

For112 purposes3 ofsSB156 thisFile subdivision,No. "temporary nursing services agency" and "nursing personnel" have the same meaning as provided in section 19a-118.

(5)112 CostsThe infollowing excessFiscal ofImpact theStatement maximumand amountsBill establishedAnalysis underare thisprepared subsectionfor shallthe notbenefit beof recognizedthe asmembers allowableof costs, except that the commissionerGeneral mayAssembly, establishsolely ratesfor wherebypurposes allowableof costsinformation, maysummarization exceedand suchexplanation maximumand amountsdo fornot bedsrepresent whichthe areintent restrictedof tothe useGeneral byAssembly patientsor witheither acquiredchamber immunethereof deficiencyfor syndrome,any traumaticpurpose. brain injury or other specialized services.

(6)In Ongeneral, orfiscal afterimpacts Juneare 30,based 2022,upon thea commissionervariety may,of ininformational thesources, commissioner'sincluding discretionthe andanalyst’s withinprofessional availableknowledge. appropriations, provide pro rata fair rent increases to facilities which have documented fair rent LCO No.

1504Whenever 3applicable, ofagency 7data Raisedis Billconsulted No.156as additionspart placedof in service in the mostanalysis, recentlyhowever filedfinal costproducts reportdo thatnot arenecessarily notreflect otherwisean includedassessment infrom theany ratesspecific issued.department.

TheOFA commissionerFiscal mayNote provide,State withinImpact: available appropriations, pro rata fair rent increases, which may, at the discretion of the commissioner, include increases for facilities which have undergone a material change in circumstances related to fair rent additions in the most recently filed cost report.

TheNone commissionerMunicipal mayImpact: allow minimum fair rent as the basis upon which reimbursement associated with improvements to real property is added.

(7)None ForExplanation theThere purposeis ofno determininganticipated allowablefiscal fairimpact rent,to athe facilitystate withor allowablemunicipalities fairto rentestablish lessa thantask theforce twenty-fifthto percentilestudy ofrequiring thenursing state-widehomes allowableto fairspend renta shallpercentage beof reimbursedMedicaid asreimbursement havingor allowabletotal fairrevenue renton equaldirect tocare of residents as the twenty-fifthtask percentileforce ofmembers thehave state-wideexpertise allowablein fairthe rent.subject area.

AnyThe facilityadministrative withstaff a rate of returnthe onAging realCommittee propertywill otherserve thanas landadministrative instaff excess of eleventhe pertask centforce. shall have such allowance revised to eleven per cent.