Capitol Line
May 8, 2014 – End of Session Report
2014 State Legislative Session Ends
The Legislature adjourned at midnight on May 7 after passing a final budget implementer bill and bidding fond farewell to several retiring legislators. Our lobbyists were working aggressively on our behalf until the bitter end and in the final analysis we had a very successful session.
We have prepared the following summary of the final outcome of relevant legislation for your information and review. Wiggin and Dana will also be preparing a detailed session report which will be published and distributed at a later date. When reviewing this summary, please remember that a bill does not become an enacted law until the Governor signs it.
State Budget and a 1% Home Care Program for Elders Rate Increase and Cost Study
Despite disappointing revenue collections, the State Legislature did pass a package of mid-term budget adjustments (HB 5596) that includes a 1% increase in theCT Home Care Program for Eldersprovider rates effective January 1, 2015. In addition, we were able to have included into the budget implementer bill (HB 5597) language that will require the Department of Social Services (DSS) to conduct an analysis of the costs of providing services under the Connecticut Home Care Program for Elders and the pilot program to provide home care services to persons with disabilities under the age of 65 (which was also increased from 50 to 100 slots). The study must begin by November 1, 2014 and must include a determination of the rates necessary to reimburse providers for such costs. On or before January 1, 2015, DSS must submit a report of the study to the Human Services and Appropriations Committees of the General Assembly. This language is very important because it will offer us the opportunity in the 2015 session to advocate for the additional funding that will be needed to establish updated provider rates as determined by the study.Analysis of HB 5597
The increase in the rates and the mandated cost study are great victoriesand mark the first time in many years that such comprehensive attention has been placed on the Home Care Program for Elders provider rates. This was a legislative priority for LeadingAge Connecticut this session and we worked together with a strong coalition of other provider organizations and access agencies to achieve this successful outcome. We thank all of our members for their grassroots advocacy efforts and look forward to continuing to work on this rate issue moving forward.
State Budget and Payment Rates at Residential Care Homes
The budget implementer bill (HB 5597) mentioned above also allows the DSS commissioner, at his discretion, to waive specified regulations and make other changes to residential care home (RCH) cost reporting for rate-setting for FY 15, subject to available appropriations. These changes could affect rates paid by DSS to RCHs, but do not mandate any changes. Under the bill, DSS may increase, to a maximum of 5%, the inflation cost limitation on certain costs reported by RCHs. By regulation, this limitation applies to (1) dietary expenses; (2) laundry; (3) housekeeping; and (4) routine nursing care, excluding care provided at nonmedical facilities (e.g., homes for the aged).
DSS regulations require the agency to calculate an allowance for RCH real property costs (e.g., costs for land, buildings, and non-moveable equipment) in part by applying a rate of return (ROR) on the value of a portion of the property and adjusting that ROR after 10 years. The bill allows the commissioner to change the ROR for real property by establishing a 5% minimum ROR on real property, including property acquired in FY 13; waiving the standard ROR for property costs for (a) ownership changes or (b) health and safety improvements exceeding $100,000 required under a DPH consent order; and waiving the ROR adjustment to avoid financial hardship of the RCH.
Nursing Home Transparency Bill
HB 5051, An Act Concerning Increasing Transparency in Nursing Home Operations as amended by House Amendment B, was passed by both the House and the Senate and now awaits the Governor’s signature. The bill will require for-profit nursing homes to submit copies of their related parties’ profit and loss statements if they pay the related party $50,000 or more a year. The bill exempts non-profit nursing homes from this new financial disclosure requirement. One of this session’s most controversial and highly contested bills, HB 5051 was strongly supported by the Governor’s office and SEIU 1199 and was aggressively opposed by CAHCF. We also opposed the legislation.
The bill also will reconvene the Nursing Home Financial Advisory Committee to examine the financial solvency of nursing homes on an ongoing basis and to support the Departments of Social Services and Public Health in their mission to provide oversight to the nursing home industry on issues concerning the financial solvency of and quality of care providedby nursing homes. The Committee will be required to begin meeting by August 1, 2014, and there must be a representative of non-profit nursing homes appointed to the Committee. The Committee will be charged with evaluating any information and data available, including, but not limited to, (A) quality of care, (B) acuity, (C) census, and (D) staffing levels of nursing homes operating in the state to assess the overall infrastructure and projected needs of such homes, and recommending appropriate action consistent with the goals, strategies and long-term care needs set forth in the strategic plan developed pursuant to subsection (c) of section 17b-369 to the Commissioner of Social Services and the Commissioner of Public Health.
Medicaid Audit Bill
HB 5500, An Act Concerning Provider Audits under the Medicaid Program was passed by the Senate late last night in concurrence with the House after a flurry of lobbying activity by the health care provider associations who worked together all session in support of this bill. The amended bill was the result of extensive negotiations between the Human Services Committee chairs who supported this bill and the Department of Social Services who opposed it. While the amended bill does not include all that was requested by the providers, it is an excellent first step in placing a mechanism to improve the current audit environment and is inclusive of most Medicaid providers. It now awaits the Governor’s signature.
The amended bill changes certain criteria concerning the DSS selection of providers to audit and also increases the threshold for the use of extrapolation from claims with an aggregate value of $150,000 to claims with an aggregate value of $200,000. It also requires the DSS commissioner to adopt facility audit regulations to ensure fairness in the audit process, including associated sampling methodologies. The law already requires the commissioner to adopt such regulations for provider audits, but the health care provider associations have been able to hold off the adoption of those regulations while this new bill has been under consideration.
The bill requires the commissioner to establish and publish on the department website audit protocols to help providers and facilities comply with state and federal Medicaid laws and regulations. The bill also (1) requires DSS to provide free training to providers and facilities to help them avoid clerical errors and (2) imposes reporting requirements on DSS pertaining to the revised audit protocols and procedures. (Effective date of July 1, 2014)
Dementia Care Training
SB 179, An Act Concerning the Alzheimer’s Disease and Dementia Task Force’s Recommendations on Training was passed by both the House and Senate with one amendment and now awaits the Governor’s signature. This bill establishes mandatory Alzheimer's and dementia-specific training for a wide range of personnel, including emergency medical technicians (EMTs), probate judges, paid conservators, and protective services employees. It requires staff in Alzheimer's special care units hired on or after October 1, 2014 to complete the currently required initial Alzheimer's and dementia-specific training within the first 120 days of employment. Under current law, the training must be completed within six months of employment. The amendmentdeleted requirements in the original bill that Alzheimer's disease and dementia symptoms be included in (1) continuing medical examination for physicians and (2) police initial and review training. (Effective date of October1, 2014 except for required nursing home administrator training which has an effective date of November 1, 2014)
Provider Tax Postponed Payment Bill Fails
SB 104,An Act Providing Financial Relief to Nursing Homes for Uncompensated Care was the subject of much activity in the last few days. The bill had been passed by the Senate with one amendment, but then was re-amended late last night in the House and was required to be sent back to the Senate. Unfortunately the bill did not survive and died in the Senate.The bill proposed to reduce resident day user fees paid by nursing homes that have not yet received Medicaid payments for providing care for individuals who have filed pending Medicaid applications. Thank you to everyone who sent grassroots messages to their House members on this bill.
Hospital Conversions
While not an issue that we were directly involved in, we know that many members are very interested in the outcome of this legislation. The final agreement is found in Senate Bill 35 as amended by Senate Amendment B, a strike all amendment that contains the final language of the bill. The bill appears to make changes in three areas. First, it makes it easier for for-profit hospitals to operate in Connecticut. Second, it expands state oversight on the sale of nonprofit hospitals. Third, the bill gives the state more oversight over transactions involving physician practices. (Various effective dates)
Other Bills of Interest that Passed and Now Await the Governor’s Signature
HB 5537, An Act Concerning the Department of Public Health's Recommendations Regarding Various Revisions to the Public Health Statutes
This is the traditionally lengthy bill that makes corrections and updates to public health statutes. This year we worked with DPH to modify two sections of the bill that will affect nursing homes. Section 7 will allow DPH to hold a nursing home management services entity accountable for deficiencies found through inspection and allow DPH to require that a plan of correction be developed jointly by the management entity and the licensee. DPH does not currently have this authority over the management entity. We were able to successfully negotiate out a reference in this section to the CMS 5-Star Rating System. Section 27 adds an initial and then annual training requirement on the topic of oral health and oral hygiene techniques. We were able to negotiate a more reasonable training requirement than what was originally proposed. In addition, Section 10 of the bill will allow nursing homes to utilize electronic signatures. (Effective date of October 1, 2014 for Sections 7, 10 and 27)
SB 29, An Act Authorizing and Adjusting Bonds of the State for Capital Improvements, Transportation and Other Purposes
This bill is the mid-term bond package that was passed by both the House and the Senate in concurrence with Senate Amendment A, a “strike all” amendment that becomes the bill and then Senate Amendment B amending Senate A. The bill, as amended by Senate Amendments A and B is now headed to the Governor for his signature.Included in this bonding package is money for home modifications and assistive technology for aging in place. Senate Amendment A, Senate Amendment B, and Fiscal Note As Amended by Senate A and Senate B
SB 413, An Act Concerning the Department of Public Health's Recommendations Regarding Medical Orders For Life-Sustaining Treatment (MOLST)
The MOLST pilot bill was passed by the House in concurrence with the Senate and now heads to the Governor for his signature. The bill will implement the Department of Public Health's recommendations regarding the establishment of a pilot program to implement the use of Medical Orders for Life-Sustaining Treatment (MOLST). (Effective upon passage)
HB 5535An Act Concerning Notice Of A Patient's Observation Status
This bill requires hospitals to provide oral and written notice informing patients when the hospital has placed them in observation status, no later than 24 hours after the placement. The requirement does not apply if the patient was discharged or left the hospital prior to the end of that 24-hour period. (Effective date of October 1, 2014)
HB 5229, An Act Concerning the Expansion of a Small House Nursing Home Pilot Program
This bill expands the small house nursing home pilot program and opens up the opportunity for additional small house projects. (Effective date of July 1, 2014)
SB-323, An Act Concerning Capital Expenditures at Residential Care Homes
This bill will allow residential care homes to recover costs incurred for minor repair, maintenance and improvements over a period that more closely reflects common asset-based bank loans of five years. (Effective date of July 1, 2014)
HB 5441, An Act Concerning Direct Payment of Residential Care Facilities
This bill allows the Department of Social Services to pay Temporary Family Assistance (TFA) and State Supplement Program (SSP) benefits directly to a licensed residential care home or a boarding or other “rated housing facility” through a per diem or monthly rate. The bill also allows DSS, at its discretion, to withhold any retroactive rate increase from a licensed residential care home that fails, within 30 days of DSS' notification, to submit the annual cost report DSS uses to establish rates. The bill specifies that reports must be complete and accurate. Finally, the bill directs DSS to give rate increases, within available appropriations, for any capital improvement a residential care home makes for the health and safety of its residents. (Effective upon passaged except Section 5 has an effective date of July 1, 2014)
HB 5453, An Act Concerning Employers and Home Care Workers
This bill allows a “sleep-time” exclusion from overtime pay requirements for certain employees employed by third-party providers (e.g., home care agencies) to provide “companionship services” as defined by federal regulations. In general, these regulations define “companionship services” to mean fellowship, protection, and limited care for an elderly person or person with an illness, injury, or disability. The bill's sleep-time exclusion aligns state law with changes in federal regulations. (Effective date of January 1, 2015)
HB 5527 , An Act Concerning a Domestic Workers Bill of Rights
There is established a domestic workers task force. The task force is to study issues involving domestic workers in the state and make recommendations for legislative initiatives to provide outreach and education services to domestic workers and employers of domestic workers in the state. (Effective date of October 1, 2015)
SB 36, An Act Concerning the Governor’s Recommendations to Improve Access to Health Care
This bill allows advanced practice registered nurses (APRNs) who have been licensed and practicing in collaboration with a physician in Connecticut for at least three years to practice independently without needing to collaborate with physicians. Current law requires APRNs to work in collaboration with a physician, including having a written agreement regarding the APRN's prescriptive authority. This bill was further modified in the DPH technical billHB 5537. (Various effective dates)
SB 410, An Act Concerning Administrative Hearings Conducted by the Department of Social Services
This bill makes several changes to the procedures the Department of Social Services must follow when conducting an administrative hearing for an appeal of a department decision. (Effective date of October 1, 2014)
SB 321, An Act Concerning Medicaid Cost Savings
This bill expands the membership of the Council on Medical Assistance Program Oversight (MAPOC), including the addition of a representative of non-profit nursing homes, and then creates a subcommittee to study and make annual recommendations to the council on evidence-based best practices concerning Medicaid cost savings. (Effective upon passage)
HB 5131, An Act Transferring Certain Powers and Functions of the Department of Economic And Community Development To The Department Of Housing. This bill transfers various housing-related powers from the Department of Economic and Community Development (DECD) commissioner to the Department of Housing (DOH) commissioner. (Various effective dates)
SB 260, An Act Concerning the Duties of a Conservator and Other Persons Authorized to Make Decisions Relating to the Care and Disposition of a Deceased Person's Body
This bill makes various changes concerning the disposition of a body after a person's death. It allows an agent with power of attorney to execute a written document before the principal's death (1) directing the body's disposition upon death or (2) designating someone to have custody and control of the body's disposition upon death. It gives the same authority to a conservator in regard to the conserved person's body after death, but only if the probate court expressly authorizes it. The bill generally prohibits someone with custody and control of the disposition of a deceased person's body from knowingly providing for disposition in a manner inconsistent with such documents or a person's own advance directive or other document setting forth health care instructions (including those relating to anatomical gifts). But, a contrary disposition is allowed if approved by the probate court. (Effective date of October 1, 2014)
HB 5227, An Act Concerning Livable Communities And Elderly Nutrition
The bill requires the Commission on Aging to recognize communities that have implemented livable communities’ initiatives. The bill also requires the Departments of Aging and Social Services to hold quarterly meetings concerning elderly nutrition. (Effective date of July 1, 2014)
HB 5222, An Act Concerning A Study Of Funding And Support For Home And Community-Based Care For Elderly Persons And Persons With Alzheimer's Disease