Sec. 19a-490r. Health care employer: Records and report re incidents of workplace violence.
Sec. 19a-490ii. Annual analysis of data re emergency department crowding. Report.
Sec. 19a-490qq. Emergency department diversion declaration. Notice to Department of Public Health.
Sec. 19a-491c. Criminal history and patient abuse background search program. Regulations.
Sec. 19a-494. (Formerly Sec. 19-579). Disciplinary action.
Sec. 19a-498d. Long-term care facilities. Discrimination against residents. Prohibited. Penalties.
Sec. 19a-563h. Nursing homes. Minimum staffing level requirements. Regulations.
Sec. 19a-490r. Health care employer: Records and report re incidents of workplace violence. A health care employer shall maintain records that detail incidents of workplace violence and include the specific area or department of such employer's premises where the incident occurred. A health care employer shall report not later than February first annually to the Department of Public Health the number of workplace violence incidents occurring on the employer's premises during the preceding calendar year and the specific area or department where such incidents occurred.
(P.A. 11-175, S. 2; P.A. 15-91, S. 2; P.A. 25-97, S. 19.)
History: P.A. 15-91 replaced provision re report by employer upon request of department with provision requiring employer to annually submit report on workplace violence incidences occurring during the preceding calendar year; P.A. 25-97 replaced “January 1, 2016, and annually thereafter,” with “February first annually” and made technical changes.
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Sec. 19a-490ii. Annual analysis of data re emergency department crowding. Report. (a) Not later than January 1, 2025, and annually thereafter until January 1, 2029, each hospital in the state with an emergency department shall, and each hospital operated exclusively by the state may, directly or in consultation with a hospital association in the state, analyze the following data from the previous calendar year concerning its emergency department: (1) The number of patients who received treatment in the emergency department; (2) the number of emergency department patients who were admitted to the hospital; (3) for patients admitted to the hospital after presenting to the emergency department, the average length of time from the patient's first presentation to the emergency department until the patient's admission to the hospital; and (4) the percentage of patients who were admitted to the hospital after presenting to the emergency department but were transferred to an available bed located in a physical location other than the emergency department more than four hours after an admitting order for the patient was completed. Each such hospital shall utilize such analysis with the goals of (A) developing policies or procedures to reduce wait times for admission to the hospital after a patient presents to the emergency department, (B) informing potential methods to improve admission efficiencies, and (C) examining root causes for delays in admission times.
(b) Not later than March 1, 2025, and annually thereafter until March 1, 2029, each hospital that conducts an analysis pursuant to subsection (a) of this section shall submit a report, in accordance with the provisions of section 11-4a, to the joint standing committee of the General Assembly having cognizance of matters relating to public health and, not later than March 1, 2026, and annually thereafter until March 1, 2029, shall also submit such report to the Commissioners of Public Health and Health Strategy and the Healthcare Advocate, regarding its findings and any recommendations for achieving the goals described in subparagraphs (A) to (C), inclusive, of subdivision (4) of subsection (a) of this section.
(P.A. 24-4, S. 1; P.A. 25-168, S. 189.)
History: P.A. 24-4 effective May 9, 2024; P.A. 25-168 amended Subsec. (b) by requiring submission of the annual report to Commissioners of Public Health and Health Strategy and the Healthcare Advocate, effective June 30, 2025.
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Sec. 19a-490pp. Provision of reproductive health care services by emergency departments. Prohibition on discrimination in provision of emergency care. Compliance with federal Emergency Medical Treatment and Labor Act. Policies and procedures. Investigations and disciplinary action. (a)(1) In cases in which there is a serious risk to a patient's life or health, each emergency department of a hospital licensed pursuant to this chapter shall include as part of the care required of such emergency departments the reproductive health care services related to complications of pregnancy that are legal in this state and necessary to treat the patient, including, but not limited to, services related to miscarriage management and treatment for ectopic pregnancies.
(2) When providing emergency care, no such emergency department or health care provider providing care at such emergency department shall discriminate against a patient based upon the following factors or categories: The person's ethnicity, citizenship, age, preexisting medical condition, insurance status, economic status, ability to pay for medical services, sex, race, color, religion, disability, genetic information, marital status, sexual orientation, gender identity or expression, primary language or immigration status. It shall not be discrimination for a health care provider providing care at an emergency department to consider any such factor or category if the health care provider believes that such factor or category is medically significant to the provision of appropriate medical care to the patient.
(b) Each emergency department of a hospital licensed pursuant to this chapter shall meet the requirements of (1) the federal Emergency Medical Treatment and Labor Act, 42 USC 1395dd, as amended from time to time, including, but not limited to, any federal regulations adopted pursuant to said act governing the transfer of patients by emergency departments, the capabilities of emergency departments and on-call professional staff of emergency departments, or (2) any regulations of Connecticut state agencies adopted pursuant to section 19a-131o.
(c) Nothing in this section shall be construed to impact accepted medical standards of care.
(d) Each hospital licensed pursuant to this chapter that provides emergency care shall (1) adopt policies and procedures to implement the provisions of this section, and (2) make such policies and procedures available to the Department of Public Health upon request.
(e) The Commissioner of Public Health may investigate each alleged violation of this section or section 19a-131o unless the commissioner concludes that the allegation does not include facts requiring further investigation or is otherwise unmeritorious.
(f) The Commissioner of Public Health may take any action authorized by sections 19a-494 and 19a-494a against a hospital, or authorized by section 19a-17 against a licensed health provider, for a violation of this section or section 19a-131o.
(P.A. 25-168, S. 171.)
History: P.A. 25-168 effective June 30, 2025.
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Sec. 19a-490qq. Emergency department diversion declaration. Notice to Department of Public Health. (a) For the purposes of this section, “emergency department diversion” means the status of a hospital licensed pursuant to this chapter that reroutes incoming ambulances to other hospitals due to the diverting hospital's lack of medical capability.
(b) Not later than two hours after declaring an emergency department diversion, a hospital licensed pursuant to this chapter shall provide notice to the Department of Public Health, in a form and manner prescribed by the Commissioner of Public Health, of such declaration.
(P.A. 25-96, S. 10.)
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Sec. 19a-490rr. Licensure requirements for chief medical officers and chief nursing officers employed by hospitals. On and after October 1, 2025, each chief medical officer and chief nursing officer employed by a hospital licensed pursuant to this chapter shall be licensed pursuant to chapters 370 and 378, respectively.
(P.A. 25-96, S. 15.)
History: P.A. 25-96 effective June 24, 2025.
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Sec. 19a-491c. Criminal history and patient abuse background search program. Regulations. (a) As used in this section:
(1) “Criminal history and patient abuse background search” or “background search” means (A) a review of the registry of nurse's aides maintained by the Department of Public Health pursuant to section 20-102bb, (B) checks of state and national criminal history records conducted in accordance with section 29-17a, and (C) a review of any other registry specified by the Department of Public Health which the department deems necessary for the administration of a background search program.
(2) “Direct access” means physical access to a patient or resident of a long-term care facility that affords an individual with the opportunity to commit abuse or neglect against or misappropriate the property of a patient or resident.
(3) “Disqualifying offense” means a conviction of (A) any crime described in 42 USC 1320a-7(a)(1), (2), (3) or (4), (B) a substantiated finding of neglect, abuse or misappropriation of property by a state or federal agency pursuant to an investigation conducted in accordance with 42 USC 1395i-3(g)(1)(C) or 42 USC 1396r(g)(1)(C), or (C) a conviction of any crime described in section 53a-59a, 53a-60b, 53a-60c, 53a-61a, 53a-321, 53a-322 or 53a-323.
(4) “Long-term care facility” means any facility, agency or provider that is a nursing home, as defined in section 19a-521, a residential care home, as defined in section 19a-521, a home health care agency, hospice agency or home health aide agency, as defined in section 19a-490, an assisted living services agency, as defined in section 19a-490, an intermediate care facility for individuals with intellectual disabilities, as defined in 42 USC 1396d(d), except any such facility operated by a Department of Developmental Services' program subject to background checks pursuant to section 17a-227a, a chronic disease hospital, as defined in section 19a-490, or an agency providing hospice care which is licensed to provide such care by the Department of Public Health or certified to provide such care pursuant to 42 USC 1395x.
(b) The Department of Public Health shall create and implement a criminal history and patient abuse background search program, within available appropriations, in order to facilitate the performance, processing and analysis of the criminal history and patient abuse background search of (1) any individual (A) to whom a long-term care facility will extend an offer of employment, or (B) with whom a long-term care facility will enter into a contract for the provision of long-term care services, and (2) any volunteer who a long-term care facility reasonably expects will regularly perform duties that are substantially similar to those of an employee with direct access.
(c) (1) Except as provided in subdivision (2) of this subsection, each long-term care facility, prior to extending an offer of employment to, or entering into a contract for, the provision of long-term care services with any individual, or prior to allowing any individual to begin volunteering at such long-term care facility when the long-term care facility reasonably expects such volunteer will regularly perform duties that are substantially similar to those of an employee with direct access, shall require that such individual submit to a background search. The Department of Public Health shall prescribe the manner by which (A) long-term care facilities perform the review of (i) the registry of nurse's aides maintained by the department pursuant to section 20-102bb, and (ii) any other registry specified by the department, including requiring long-term care facilities to report the results of such review to the department, and (B) individuals submit to state and national criminal history records checks, including requiring the Department of Emergency Services and Public Protection to report the results of such checks to the Department of Public Health.
(2) No long-term care facility shall be required to comply with the provisions of this subsection if (A) the individual provides evidence to the long-term care facility that such individual submitted to a background search conducted pursuant to subdivision (1) of this subsection not more than three years immediately preceding the date such individual applies for employment, seeks to enter into a contract or begins volunteering with the long-term care facility and that the prior background search confirmed that the individual did not have a disqualifying offense, or (B) the commissioner determines the need to temporarily suspend the requirements of this subsection in the event of an emergency or significant disruption. The commissioner shall inform the long-term care facility when the commissioner has suspended the requirements of this subsection pursuant to subparagraph (B) of this subdivision and when such suspension is rescinded.
(d) (1) The Department of Public Health shall review all reports provided to the department pursuant to subsection (c) of this section. If any such report contains evidence indicating that an individual has a disqualifying offense, the department shall provide notice to the individual and the long-term care facility indicating the disqualifying offense and providing the individual with the opportunity to file a request for a waiver pursuant to subdivisions (2) and (3) of this subsection.
(2) An individual may file a written request for a waiver with the department not later than thirty days after the date the department mails notice to the individual pursuant to subdivision (1) of this subsection. The department shall mail a written determination indicating whether the department shall grant a waiver pursuant to subdivision (3) of this subsection not later than fifteen business days after the department receives the written request from the individual, except that said time period shall not apply to any request for a waiver in which an individual challenges the accuracy of the information obtained from the background search.
(3) The department may grant a waiver from the provisions of subsection (e) of this section to an individual who identifies mitigating circumstances surrounding the disqualifying offense, including (A) inaccuracy in the information obtained from the background search, (B) lack of a relationship between the disqualifying offense and the position for which the individual has applied, (C) evidence that the individual has pursued or achieved rehabilitation with regard to the disqualifying offense, or (D) that substantial time has elapsed since committing the disqualifying offense. The department and its employees shall be immune from liability, civil or criminal, that might otherwise be incurred or imposed, for good faith conduct in granting waivers pursuant to this subdivision.
(4) After completing a review pursuant to subdivision (1) of this subsection, the department shall notify in writing the long-term care facility to which the individual has applied for employment or with which the individual seeks to enter into a contract or volunteer (A) of any disqualifying offense and any information the individual provided to the department regarding mitigating circumstances surrounding such offense, or of the lack of a disqualifying offense, and (B) whether the department granted a waiver pursuant to subdivision (3) of this subsection.
(e) Notwithstanding the provisions of section 46a-80, no long-term care facility shall employ an individual required to submit to a background search, contract with any such individual to provide long-term care services or allow such individual to volunteer if the long-term care facility receives notice from the department that the individual has a disqualifying offense in the individual's background search and the department has not granted a waiver pursuant to subdivision (3) of subsection (d) of this section. A long-term care facility may, but is not obligated to, employ, enter into a contract with or allow to volunteer an individual who was granted a waiver pursuant to said subdivision (3).
(f) (1) Except as provided in subdivision (2) of this subsection, a long-term care facility shall not employ, enter into a contract with or allow to volunteer any individual required to submit to a background search until the long-term care facility receives notice from the Department of Public Health pursuant to subdivision (4) of subsection (d) of this section.
(2) A long-term care facility may employ, enter into a contract with or allow to volunteer an individual required to submit to a background search on a conditional basis before the long-term care facility receives notice from the department that such individual does not have a disqualifying offense, provided: (A) The employment or contractual or volunteer period on a conditional basis shall last not more than sixty days, except the sixty-day time period may be extended by the department to allow for the filing and consideration of written request for a waiver of a disqualifying offense filed by an individual pursuant to subsection (d) of this section, (B) the long-term care facility has begun the review required under subsection (c) of this section and the individual has submitted to checks pursuant to subsection (c) of this section, (C) the individual is subject to direct, on-site supervision during the course of such conditional employment or contractual or volunteer period, and (D) the individual, in a signed statement (i) affirms that the individual has not committed a disqualifying offense, and (ii) acknowledges that a disqualifying offense reported in the background search required by subsection (c) of this section shall constitute good cause for termination and a long-term care facility may terminate the individual if a disqualifying offense is reported in said background search.
(g) Records and information with respect to any individual that are obtained by the department pursuant to this section shall not be subject to disclosure under section 1-210.
(h) The department shall adopt regulations, in accordance with the provisions of chapter 54, to implement the provisions of this section. The department may implement policies and procedures consistent with the provisions of this section while in the process of adopting such policies and procedures as regulation, provided notice of intention to adopt regulations is printed in the Connecticut Law Journal not later than twenty days after the date of implementation. Such policies and procedures shall be valid until the time final regulations are effective.
(P.A. 11-242, S. 90; P.A. 13-32, S. 14; 13-139, S. 16; 13-208, S. 3, 28; 13-220, S. 23; P.A. 17-146, S. 19; P.A. 18-168, S. 51; P.A. 19-116, S. 2; P.A. 21-121, S. 9, 47; P.A. 22-58, S. 2; P.A. 25-16, S. 1.)
History: P.A. 11-242 effective January 1, 2012 (Revisor's note: In Subsec. (c)(1)(B), “Department of Public Safety” was changed editorially by the Revisors to “Department of Emergency Services and Public Protection” to conform with changes made by P.A. 11-51); P.A. 13-32 amended Subsec. (b)(2) to replace “Department of Public Safety” with “Department of Emergency Services and Public Protection” and make a technical change, effective July 1, 2013; P.A. 13-139 amended Subsec. (a)(4) to redefine “long-term care facility” by substituting “individuals with intellectual disabilities” for “the mentally retarded”; P.A. 13-208 amended Subsec. (a)(4) to redefine “long-term care facility” by adding reference to residential care home, effective July 1, 2013, and amended Subsec. (c)(1) by adding provision re background search for certain volunteers and making technical changes, effective October 1, 2013; P.A. 13-220 amended Subsec. (b)(2) to replace “Department of Public Safety” with “Department of Emergency Services and Public Protection”, effective June 18, 2013; P.A. 17-146 amended Subsec. (f)(2) by adding provision re extension of sixty-day time period; P.A. 18-168 amended Subsec. (a)(4) by adding exception for facilities operated by Department of Developmental Services' program subject to background checks, amended Subsec. (b) by deleting Subdiv. (1) designator, deleting “On or before July 1, 2012,” and deleting Subdiv. (2) re plan to implement background search program, deleted former Subsec. (g) re phasing in implementation of background search program, added new Subsec. (g) re disclosure of records, and made conforming changes, effective July 1, 2018; P.A. 19-116 amended Subsec. (a)(3) by redefining “qualifying offense”; P.A. 21-121 amended Subsec. (a)(4) by redefining “long-term care facility” and amended Subsec. (c)(2) by designating existing provision re exception as Subpara. (A), adding Subpara. (B) re suspension of requirements during emergency or significant disruption and adding provision re commissioner to inform of suspension and rescission of suspension, effective July 1, 2021; P.A. 22-58 amended Subsec. (a)(4) by replacing “19a-550” with “19a-490”; P.A. 25-16 amended Subsec. (b) by deleting “individuals who have direct access”, adding Subdiv. (1) requiring long-term care facilities to perform criminal history and patient abuse background search for any individual to whom it offers employment or enters into contract with for the provision of services and adding Subdiv. (2) requiring long-term care facilities to perform criminal history and patient abuse background search for any volunteer who will perform duties similar to those of employee with direct access, and amended Subsec. (c) by deleting “who will have direct access”.
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Sec. 19a-491f. Collection and provision of certain client and location information to home health care agency and home health aide agency employees. Collection of crime-related data. Prohibition on the denial of the provision of services. Provision of certain client information at time of referral or transfer to home health care agency, home health aide agency or hospice agency. (a) Each home health care agency and home health aide agency, as such terms are defined in section 19a-490, except any such agency that is licensed as a hospice organization by the Department of Public Health pursuant to section 19a-122b or that operates solely as a hospice agency, a hospice program, as defined in subsection (b) of section 19-13-D72 of the regulations of Connecticut state agencies, a hospice-based home care program, as described in subsection (o) of section 19a-495-5b of the regulations of Connecticut state agencies, or a hospice inpatient facility, as defined in section 19a-495-6a of the regulations of Connecticut state agencies, shall, during intake of a prospective client who will be receiving services from the agency, collect and provide to any employee assigned to provide services to such client, to the extent feasible and consistent with state and federal laws, information regarding: (1) The client, including, if applicable, (A) the client's history of violence toward health care workers; (B) the client's history of substance use; (C) the client's history of domestic abuse; (D) a list of the client's diagnoses, including, but not limited to, psychiatric history; (E) whether the client's diagnoses or symptoms thereof have remained stable over time; and (F) any information concerning violent acts involving the client that is contained in judicial records or any sex offender registry information concerning the client; and (2) the location where the employee will provide services, including, if known to the agency, the (A) crime rate for the municipality in which the employee will provide services, as determined by the most recent annual report concerning crime in the state issued by the Department of Emergency Services and Public Protection pursuant to section 29-1c, (B) presence of any hazardous materials at the location, including, but not limited to, used syringes, (C) presence of firearms or other weapons at the location, (D) status of the location's fire alarm system, and (E) presence of any other safety hazards at the locations.
(b) To facilitate compliance with subparagraph (A) of subdivision (2) of subsection (a) of this section, each such agency shall annually review the annual report issued by the department pursuant to section 29-1c to collect crime-related data regarding the locations in the state where such agency's employees provide services.
(c) Notwithstanding any provision of subsection (a) or (b) of this section, no such agency shall deny the provision of services to a client solely based on (1) the inability or refusal of the client to provide the information described in subsection (a) of this section, or (2) the information collected from the client pursuant to subsection (a) of this section.
(d) Any health care provider, as defined in section 19a-17b, who refers or transfers a patient to a home health care agency, home health aide agency or hospice agency shall, at the time of such referral and to the extent feasible and consistent with state and federal laws, provide any documentation or information in such health care provider's possession relating to the topics described in subdivision (1) of subsection (a) of this section.
(P.A. 24-19, S. 1; P.A. 25-168, S. 184.)
History: P.A. 25-168 amended Subsec. (a) by adding exceptions for agencies that operate solely as a hospice agency, hospice program, hospice-based home care program or hospice inpatient facility and added Subsec. (d) re provision of certain client information at time of referral or transfer to home health care agency, home health aide agency or hospice agency.
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Sec. 19a-491g. Health and safety training curriculum and system for reporting incidences of violence or potential threats of violence in conjunction with monthly assessments with direct care staff by home health care agencies, home health aide agencies and hospice agencies. Evidence required for reimbursement. Rate enhancement for timely reporting of workplace violence incident. (a) Each home health care agency, home health aide agency and hospice agency, as such terms are defined in section 19a-490, shall (1) (A) adopt and implement a health and safety training curriculum for home care workers that is consistent with the health and safety training curriculum for such workers that is endorsed by the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health and the Occupational Safety and Health Administration, including, but not limited to, training to recognize hazards commonly encountered in home care workplaces and applying practical solutions to manage risks and improve safety, and (B) provide annual staff training consistent with such health and safety curriculum; and (2) establish a system by which staff may promptly report an incidence of violence or potential threat of violence in conjunction with monthly safety assessments conducted with direct care staff, which assessments may occur through in-person or virtual staff meetings or other communication methods, including, but not limited to, electronic mail, text messages, telephone calls, a hotline or a reporting portal.
(b) The Commissioner of Social Services shall require any home health care agency, home health aide agency and hospice agency that receives reimbursement for services rendered under the Connecticut medical assistance program, as defined in section 17b-245g, to provide evidence of adoption and implementation of such health and safety training curriculum pursuant to subdivision (1) of subsection (a) of this section, or, at the commissioner's discretion, an alternative workplace safety training program applicable to such agency to obtain reimbursement for services provided under the medical assistance program.
(c) The commissioner may, within available appropriations, provide a rate enhancement under the Connecticut medical assistance program for any home health care agency, home health aide agency or hospice agency for timely reporting of any workplace violence incident. For purposes of this section, “timely reporting” means reporting such incident not later than seven calendar days after its occurrence to the Department of Social Services and the Department of Public Health.
(P.A. 24-19, S. 2; P.A. 25-168, S. 185.)
History: P.A. 25-168 amended Subsec. (a) by adding reference to hospice agency and adding a requirement in Subdiv. (1) re establishing a system for reporting incidences of violence or potential threats of violence in conjunction with monthly safety assessments, amended Subsec. (b) by deleting exception re agencies licensed as a hospice organization and amended Subsec. (c) by requiring that any rate enhancement be provided within available appropriations and deleting exception re agencies licensed as a hospice agency.
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Sec. 19a-491h. Annual report by home health care agencies, home health aide agencies and hospice agencies re incidences of abuse of staff member and actions taken by the agency to ensure safety of staff member. Annual report by commissioner. (a) Not later than January 1, 2025, and annually thereafter, each home health care agency, home health aide agency and hospice agency, as such terms are defined in section 19a-490, shall report, in a form and manner prescribed by the Commissioner of Public Health, each instance of verbal abuse that is perceived as a threat or danger by a staff member of such agency, physical abuse, sexual abuse or any other abuse by an agency client or any other person against a staff member relating to such staff member's employment with such agency and the actions taken by the agency to ensure the safety of the staff member.
(b) Not later than March 1, 2025, and annually thereafter, the commissioner shall report, in accordance with the provisions of section 11-4a, to the joint standing committee of the General Assembly having cognizance of matters relating to public health regarding the number of reports received pursuant to subsection (a) of this section and the actions taken to ensure the safety of the staff member about whom the report was made.
(P.A. 24-19, S. 3; P.A. 25-168, S. 186.)
History: P.A. 25-168 amended Subsec. (a) to add reference to hospice agency, delete exception re hospice organizations, require reports of abuse by any other person in addition to a client and add requirement that abuse be related to staff member's employment with the agency.
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Sec. 19a-493. (Formerly Sec. 19-578). Initial license and renewal. Prior approval for change in ownership. Multicare institution. Regulations. (a) Upon receipt of an application for an initial license, the Department of Public Health, subject to the provisions of section 19a-491a, shall issue such license if, upon conducting a scheduled inspection and investigation, the department finds that the applicant and facilities meet the requirements established under section 19a-495, provided a license shall be issued to or renewed for an institution, as defined in section 19a-490, only if such institution is not otherwise required to be licensed by the state. If an institution, as defined in section 19a-490, except for a nursing home or nursing home facility, as defined in section 19a-490, applies for license renewal and, at the time of such application for license renewal, is certified as a provider of services by the United States Department of Health and Human Services under Medicare or Medicaid programs, the commissioner or the commissioner's designee may waive, on renewal of the institution's license, the inspection and investigation of such institution required by this section and, in such event, any such institution shall be deemed to have satisfied the requirements of section 19a-495 for the purposes of licensure. Such license shall be valid for two years or a fraction thereof and shall terminate on March thirty-first, June thirtieth, September thirtieth or December thirty-first of the appropriate year. A license issued pursuant to this chapter, unless sooner suspended or revoked, shall be renewable biennially (1) after an unscheduled inspection is conducted by the department, and (2) upon the filing by the licensee, and approval by the department, of a report upon such date and containing such information in such form as the department prescribes and satisfactory evidence of continuing compliance with requirements established under section 19a-495. In the case of an institution, as defined in subsection (d) of section 19a-490, that is also certified as a provider under the Medicare program, the license shall be issued for a period not to exceed three years, to run concurrently with the certification period. In the case of an institution, as defined in subsection (m) of section 19a-490, that is applying for renewal, the license shall be issued pursuant to section 19a-491. Except in the case of a multicare institution, each license shall be issued only for the premises and persons named in the application. Such license shall not be transferable or assignable. Licenses shall be posted in a conspicuous place in the licensed premises.
(b) A nursing home license may be renewed biennially after (1) an unscheduled inspection conducted by the department, (2) submission of the information required by section 19a-491a, and (3) submission of evidence satisfactory to the department that the nursing home is in compliance with the provisions of this chapter, the regulations of Connecticut state agencies and licensing regulations.
(c) (1) (A) For the purposes of this subsection, (i) “a person related by blood or marriage” means a parent, spouse, child, brother, sister, aunt, uncle, niece or nephew, (ii) “business entity” means a corporation, association, trust, estate, partnership, limited partnership, limited liability partnership, limited liability company, sole proprietorship, joint stock company, nonstock corporation or other legal entity, (iii) “institution” has the same meaning as provided in section 19a-490, and (iv) “organizational chart” means a graphical representation of an organization, including, but not limited to, the relationships between such organization's ownership interests.
(B) For the purposes of this subsection, (i) a change in the legal form of the licensee, including, but not limited to, changes from a corporation to a limited liability company, a partnership to a limited liability partnership, a sole proprietorship to a corporation and similar changes, shall not be considered a change in ownership if the beneficial ownership remains unchanged and the owner provides such information regarding the change to the department as may be required by the commissioner to properly identify the current status of ownership and beneficial ownership of the facility or institution, (ii) a public offering of the stock of any corporation that owns, conducts, operates or maintains any facility or institution shall not be considered a change in ownership or beneficial ownership of such facility or institution if the licensee and the officers and directors of such corporation remain unchanged, such public offering cannot result in an individual or entity owning ten per cent or more of the stock of such corporation, and the owner provides such information to the department as may be required by the department in order to properly identify the current status of ownership and beneficial ownership of the facility or institution, and (iii) a change of ownership of, or to, a business entity recognized as a nonprofit organization under Section 501(c)(3) of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time, that is licensed as a hospital pursuant to this chapter resulting in the transfer of ownership which is exempt from review required under subsection (a) of section 19a-486a shall not be considered a change in ownership provided the owner provides such information regarding the change to the department as may be required by the commissioner to properly identify the current status of ownership.
(C) For the purposes of this subsection, “serious risk to the life, safety or quality of care of patients or residents” includes, but is not limited to, any deficiency in state licensure or federal certification requirements, including the provisions of 42 CFR 488.400 et seq., resulting in:
(i) An action by a state or federal agency to ban, curtail or temporarily suspend admissions to a facility or to suspend or revoke a facility's license;
(ii) A decertification, termination or exclusion from Medicaid or Medicare participation, including denial of payment for new admissions resulting solely due to the provider's failure to correct deficiencies or noncompliance with regulatory requirements, imposed by the Department of Public Health or by the Centers for Medicare and Medicaid Services, as a result of noncompliance with Medicaid or Medicare conditions of participation;
(iii) A citation of any deficiency that constitutes a pattern or widespread scope of actual harm or immediate jeopardy, or any deficiency causing widespread actual harm, as described in 42 CFR 488;
(iv) A determination that the provider is a “poor performer” as defined by the Centers for Medicare and Medicaid Services on the basis of a finding of substandard quality of care or immediate jeopardy, as described in 42 CFR 488, on the current survey and on a survey during one of the two preceding years. For the purposes of this subparagraph, “substandard quality of care” means the failure to meet one or more requirements of 42 CFR 483.13, 42 CFR 483.15 or 42 CFR 483.25, that constitute either immediate jeopardy to resident health or safety, a pattern of or widespread actual harm that is not immediate jeopardy or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm; or
(v) A determination that the facility has failed to correct, on a second revisit, deficiencies that have been cited during a prior survey, and that has resulted in a denial by the Centers for Medicare and Medicaid Services of payment for new admissions or a requirement by the department to curtail admission.
(2) Any change in the ownership or beneficial ownership of a facility or institution owned by an individual or a business entity that owns, conducts, operates or maintains such facility or institution, including a change in ownership or beneficial ownership resulting in a transfer to a person related by blood or marriage to an owner or a beneficial owner, shall be subject to prior approval of the department, provided such approval shall be conditioned upon a showing by such facility or institution to the commissioner that it has complied with all requirements of this chapter, the regulations relating to licensure and all applicable requirements of the regulations of Connecticut state agencies and the change of ownership or beneficial ownership meets the requirements of subdivision (5) of subsection (c) of this section.
(3) Not later than one hundred twenty days before the proposed date of a change in ownership or beneficial ownership of a facility or institution, the proposed new owner, or in the case of a change in beneficial ownership, the current owner, of such facility or institution shall submit an application for approval to the department. Such application shall be in a form and manner prescribed by the commissioner and shall include, but need not be limited to, the following:
(A) A cover letter identifying the facility or institution subject to such change by name, address, county and number and type of beds licensed by the department;
(B) A description of the proposed transaction resulting in such change, including the name of each current owner of the facility or institution;
(C) The name of each proposed new owner or beneficial owner;
(D) The name of each owner of any nonpublicly traded parent corporation of each proposed new owner and beneficial owner;
(E) If applicable, (i) the proposed new owner's organizational chart, (ii) the proposed new owner's parent business entity's organizational chart, (iii) the organizational chart of each wholly-owned subsidiary of such proposed new owner, and (iv) the current owner's organizational chart showing the changes in beneficial ownership;
(F) A copy of the agreement of sale or other transfer of ownership interests and, if applicable, a copy of any lease or management agreements that will be in effect after the transaction;
(G) The name and address of any licensed health care facility owned, operated or managed by each proposed new owner and beneficial owner in the United States or any territory of the United States during the five years preceding the date on which such application is submitted, and information relating to any such facility, including:
(i) Disclosure of any direct or indirect interests, including such interests in intermediate entities and parent, management and property companies and other related entities arising from such ownership, operation or management;
(ii) Disclosure of whether each such facility or institution is the subject of a pending complaint, investigation or licensure action by a governmental authority;
(iii) Disclosure of whether each such facility or institution has been subject to:
(I) Three or more civil penalties imposed through final order of the commissioner in accordance with the provisions of sections 19a-524 to 19a-528, inclusive, or civil penalties imposed pursuant to the laws or regulations of another state during the two-year period preceding the date on which such application is submitted;
(II) Sanctions, other than civil penalties less than or equal to twenty thousand dollars, imposed in any state through final adjudication under the Medicare or Medicaid program pursuant to Title XVIII or XIX of the federal Social Security Act, 42 USC 301, as amended from time to time;
(III) Termination or nonrenewal of a Medicare or Medicaid provider agreement;
(IV) Any state licensing or federal certification deficiency during the five-year period prior to the submission of the application that presented a serious risk to the life, safety or quality of care of the facility's patients or residents; and
(V) Any violation of any state licensing or federal certification standard in connection with an inappropriate discharge or denial of admission; and
(H) Disclosure of whether each proposed new owner has ever been convicted or pleaded guilty to a charge of fraud, patient or resident abuse or neglect or a crime of violence or moral turpitude.
(4) After receiving an application for change in ownership, the commissioner may schedule an inspection of such facility or institution to determine if the facility or institution has complied with the requirements of this chapter and the regulations of Connecticut state agencies relating to licensure of such facility or institution.
(5) When evaluating an application for a change in ownership, the commissioner shall consider whether each proposed new owner and beneficial owner demonstrates character and competence, quality of care and whether an acceptable history of past and current compliance with state licensure requirements, applicable federal requirements and state regulatory requirements exists for each licensed health care facility owned, operated or managed by each proposed new owner and beneficial owner in the United States or any territory of the United States during the five years preceding the date on which such application is submitted. The commissioner may deny an application for change in ownership if such qualities are not demonstrated, as evidenced by:
(A) Any such licensed health care facility being subject to any adverse action described in subparagraph (G)(iii) of subdivision (3) of this subsection;
(B) Any such licensed health care facility exhibiting continuing violations or a pattern of violations of state licensure standards or federal certification standards; or
(C) An applicant's criminal conviction of, or guilty plea to, any of the crimes described in subparagraph (H) of subdivision (3) of this subsection.
(6) Notwithstanding the provisions of subdivision (5) of this subsection, the commissioner may stay the determination of an application if the commissioner determines that there is a pending investigation of actions of the applicant at any facility operated or managed by the applicant that, if substantiated, would constitute a threat to the life, safety or quality of care of the patients or residents until such time as there is a final determination of the allegations underlying the investigation.
(7) If the commissioner denies an application for change in ownership, a person related by blood or marriage to the applicant may not apply to acquire ownership interest in the facility or institution.
(8) In the event of a change in ownership or beneficial ownership resulting in a transfer to a person related by blood or marriage to an owner or beneficial owner, the commissioner may waive the submission of information required pursuant to the provisions of subparagraph (G) of subdivision (3) of this subsection. In the event of a change in ownership or beneficial ownership of five per cent or less of the ownership of a business entity that is a licensed institution, the commissioner may waive the submission of some or all of the information required pursuant to the provisions of subdivision (3) of this subsection or the determination required pursuant to subdivision (5) of this subsection. The commissioner shall develop an application process through which a person may request a waiver described in this subdivision and criteria to be used by the commissioner when evaluating such a request. The commissioner shall consult with representatives of the long-term care industry when developing such application process and criteria.
(9) The provisions of this subsection shall not apply in the event of a change of ownership or beneficial ownership of ten per cent or less of the ownership of a licensed outpatient surgical facility, as defined in section 19a-493b, resulting in a transfer to a physician licensed under chapter 370 if such facility provides information, in a form and manner prescribed by the commissioner, to update such facility's licensing information.
(d) (1) A multicare institution may, under the terms of its existing license, provide behavioral health services or substance use disorder treatment services on the premises of more than one facility, at a satellite unit or at another location outside of its facilities or satellite units that is acceptable to the patient receiving services and is consistent with the patient's assessment and treatment plan. Such behavioral health services or substance use disorder treatment services may include methadone delivery and related substance use treatment services to persons in a nursing home facility pursuant to the provisions of section 19a-495c or in a mobile narcotic treatment program, as defined in 21 CFR 1300.
(2) Any multicare institution that intends to offer services at a satellite unit or other location outside of its facilities or satellite units shall submit an application for approval to offer services at such location to the Department of Public Health. Such application shall be submitted on a form and in the manner prescribed by the Commissioner of Public Health. Not later than forty-five days after receipt of such application, the commissioner shall notify the multicare institution of the approval or denial of such application. If the satellite unit or other location is approved, that satellite unit or location shall be deemed to be licensed in accordance with this section and shall comply with the applicable requirements of this chapter and regulations adopted under this chapter.
(3) A multicare institution that is a hospital providing outpatient behavioral health services or other health care services shall provide the Department of Public Health with a list of satellite units or locations when completing the initial or renewal licensure application.
(4) The Commissioner of Public Health may adopt regulations, in accordance with the provisions of chapter 54, to carry out the provisions of this subsection. The Commissioner of Public Health may implement policies and procedures necessary to administer the provisions of this subsection while in the process of adopting such policies and procedures as regulation, provided the commissioner prints notice of intent to adopt regulations in the Connecticut Law Journal not later than twenty days after the date of implementation. Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are adopted.
(1953, 1955, S. 2053d; P.A. 77-304, S. 4; 77-601, S. 3, 11; 77-614, S. 323, 587, 610; P.A. 78-303, S. 85, 136; P.A. 79-46, S. 2, 3; P.A. 80-17; 80-199; P.A. 81-135; 81-201, S. 1; P.A. 84-546, S. 168, 173; P.A. 85-146, S. 2, 4; P.A. 89-350, S. 7; P.A. 90-13, S. 7; June Sp. Sess. P.A. 91-8, S. 28, 63; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; June Sp. Sess. P.A. 99-2, S. 15, 72; P.A. 00-10; P.A. 05-272, S. 6; P.A. 09-232, S. 14; P.A. 10-117, S. 1; P.A. 13-249, S. 3; P.A. 14-211, S. 2; P.A. 15-242, S. 40; P.A. 19-118, S. 5; P.A. 21-121, S. 35; P.A. 22-108, S. 4; P.A. 23-122, S. 1; P.A. 24-68, S. 59; P.A. 25-96, S. 5.)
History: Sec. 19-34 transferred to Sec. 19-578 in 1977; P.A. 77-304 added provisions re report of portions of federal income tax information as condition for license renewal and re notice and approval of proposed changes in ownership; P.A. 77-601 added provisions re approval and inspection of institutions required for issuance and renewal, respectively, of licenses; P.A. 77-614 and P.A. 78-303 replaced commissioner and department of health commissioner and department of health services, effective January 1, 1979; P.A. 79-46 rephrased proviso re license issuance or renewal and allowed issuance or renewal only if institution not otherwise required to be licensed by state; P.A. 80-17 allowed waiver of inspection and investigation if currently certified as provider of services by U.S. Department of Health and Human Resources or certified within last 12 months; P.A. 80-199 rephrased provision re prior approval of change in ownership; P.A. 81-135 specified that inspections conducted by the department of health services prior to the initial licensure of a facility or prior to the transfer of ownership of a nursing home shall be “scheduled” inspections and that inspections conducted for purposes of license renewal shall be “unscheduled”; P.A. 81-201 replaced requirement that a nursing home owner submit pertinent portions of his personal Federal Income Tax for purposes of annual license renewal with authorization for the department of health services to require the submission of “information related to the character and financial condition” of the owner; Sec. 19-578 transferred to Sec. 19a-493 in 1983; P.A. 84-546 made technical changes; P.A. 85-146 authorized the issuance of provisional licenses; P.A. 89-350 divided the existing section into Subsecs. (a) and (b), provided for biennial licensure, added the language in Subsec. (b) on requirements for the renewal of a nursing home license and on consent orders and made technical changes; P.A. 90-13 made technical change in Subsec. (a); June Sp. Sess. P.A. 91-8 amended Subsec. (b) to specify when changes re transfer or change of ownership to relatives are not subject to department approval and defined “a person related by blood or marriage”; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; June Sp. Sess. P.A. 99-2 amended Subsec. (b) by expanding definition of “a person related by blood or marriage” to include a “brother, sister, aunt, uncle, niece or nephew” and by adding provision re change in legal form of ownership entity, effective June 29, 1999; P.A. 00-10 made technical changes and added provisions re a public offering of stock that shall not be considered a change in ownership or beneficial ownership; P.A. 05-272 amended Subsec. (a) to remove “without charge” re biennial renewal of certain health care institution licenses; P.A. 09-232 amended Subsec. (a) by substituting United States Department of Health and Human Services for United States Department of Health and Human Resources and by adding exception re frequency of Department of Public Health inspections for Medicare-certified provider institutions, effective July 1, 2009; P.A. 10-117 amended Subsec. (a) by deleting provisions re provisional license, by deleting reference to Sec. 19a-490(c), by adding “on renewal” re inspection and investigation waiver, by changing “requirements” to “requirements established under section 19a-495”, by deleting reference to Sec. 19a-490(e) or (f), by replacing provision re inspection of institution certified as Medicare provider with provision re 3-year period of licensure for institution certified as Medicare provider and by making technical changes; P.A. 13-249 amended Subsec. (b)(1)(B) to delete “subsections (a) and (c) of section 19a-491a and any other information required by the commissioner pursuant to subsection (b) of said” and add “19a-491a”, effective January 1, 2014; P.A. 14-211 amended Subsec. (a) by deleting reference to Sec. 19a-490(d), (e) or (f), adding provision re multicare institution and making technical changes and added Subsec. (c) re multicare institutions; P.A. 15-242 amended Subsec. (c)(2) to make technical changes; P.A. 19-118 amended Subsec. (a) by adding provision re institution applying for approval, amended Subsec. (b)(2) by deleting reference to Subsec. (c) and replacing reference to 90 days with reference to 120 days re advance notice of change of ownership and amended Subsec. (c) by adding provision permitting behavioral health services or substance use disorder treatment services to include methadone delivery and related substance use treatment services in Subdiv. (1), adding Subdiv. (3) requiring certain multicare institutions to provide department with list of satellite units or locations and redesignating existing Subdiv. (3) as Subdiv. (4), effective July 1, 2019; P.A. 21-121 amended Subsec. (b) by replacing “Public Health Code” with “regulations of Connecticut state agencies” and adding “limited liability company,” in Subdiv. (2)(A), effective July 1, 2021; P.A. 22-108 amended Subsec. (c)(1) by adding reference to a mobile narcotic treatment program, effective July 1, 2022; P.A. 23-122 substantially revised section by adding new Subsec. (c)(1) re definitions of terms concerning changes of ownership, redesignating existing Subsec. (b)(2) as Subsec. (c)(2), and making substantial revisions therein re changes of ownership, adding new Subsec. (c)(3) and (4) re change of ownership procedures including disclosure requirements and facility inspections, adding Subsec. (c)(5) to (9) re application evaluations, stays of application determinations, reapplications by persons related by blood or marriage, waivers of submission of information to the commissioner, and applicability of section to changes of ownership of 10 per cent or less of licensed outpatient surgical facilities, redesignating existing Subsec. (c) as Subsec. (d), and making technical and conforming changes throughout; P.A. 24-68 amended Subsec. (c)(9) by making a technical change; P.A. 25-96 amended Subsec. (a) by deleting references to Sec. 19a-490(b) and (d) to (f), adding provision excepting nursing home or nursing facility, replacing “has been” with “at the time of such application for license renewal, is” and making technical and conforming changes.
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Sec. 19a-494. (Formerly Sec. 19-579). Disciplinary action. (a) The Commissioner of Public Health, after a hearing held in accordance with the provisions of chapter 54, may take any of the following actions, singly or in combination, in any case in which the commissioner finds that there has been a substantial failure to comply with the requirements established under this chapter or requirements relating to institutions licensed under this title, the Public Health Code or licensing regulations:
(1) Revoke a license or certificate;
(2) Suspend a license or certificate;
(3) Censure a licensee or certificate holder;
(4) Issue a letter of reprimand to a licensee or certificate holder;
(5) Place a licensee or certificate holder on probationary status and require such licensee or certificate holder to report regularly to the department on the matters which are the basis of the probation;
(6) Restrict the acquisition of other facilities for a period of time set by the commissioner;
(7) Issue an order compelling compliance with applicable statutes or regulations of the department;
(8) Impose a directed plan of correction; or
(9) Assess a civil penalty not to exceed twenty-five thousand dollars, provided no such penalty shall be assessed for violations arising from the investigation of a complaint filed with the Department of Public Health before July 1, 2024, except for violations of regulatory requirements relating to abuse or neglect of patients, as such terms are defined in 42 CFR 483.5.
(b) Notice of the hearing to the holder of a license or certificate shall be effected by registered or certified mail or by personal service, setting forth the particular reasons for the proposed action and fixing a date, not less than thirty days from the date of such mailing or service, at which the holder of such license or certificate shall be given an opportunity for a prompt and fair hearing, and witnesses may be subpoenaed by either party for such hearing. Such hearing may be conducted by the Commissioner of Public Health, a deputy commissioner, or by a member of the Department of Public Health, designated by said commissioner. On the basis of such hearing, or upon default of the holder of such license or certificate, the person conducting such hearing shall specify his findings and conclusions, and said department may, upon the basis of such findings and conclusions take any action authorized by this section that it deems necessary. A copy of such decision shall be sent by registered or certified mail or served personally upon the holder of such license or certificate.
(1953, 1955, S. 2054d; 1969, P.A. 399; P.A. 77-614, S. 323, 610; P.A. 78-303, S. 70, 136; P.A. 80-127, S. 2; P.A. 83-103, S. 1; P.A. 89-350, S. 8; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; P.A. 11-242, S. 85; P.A. 24-68, S. 32; P.A. 25-96, S. 8.)
History: 1969 act replaced department of health with public health council, included deputy commissioner or member of department or public health council as eligible for hearing panel and made slight language changes; Sec. 19-35 transferred to Sec. 19-579 in 1977; P.A. 77-614 replaced commissioner and department of health with commissioner and department of health services, effective January 1, 1979; P.A. 78-303 replaced public health council with commissioner of health services; P.A. 80-127 included references to certificates and holders of certificates; Sec. 19-579 transferred to Sec. 19a-494 in 1983; P.A. 83-103 deleted requirement making suspension or revocation of a license or certificate final 30 days after it is mailed or served; P.A. 89-350 divided the existing section into Subsecs. (a) and (b), substituted the reference to chapter 54 for language specifying hearing requirements and specified other actions besides suspension and revocation; P.A. 93-381 replaced department and commissioner of health services with department and commissioner of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; P.A. 11-242 amended Subsec. (a) by adding Subdiv. (8) re imposition of directed plan of correction and by making technical changes; P.A. 24-68 amended Subsec. (a) by adding Subdiv. (9) re assessment of civil penalties not to exceed $25,000 and making technical and conforming changes, effective July 1, 2024; P.A. 25-96 amended Subsec. (a) by adding “or requirements relating to institutions licensed under this title”, effective June 24, 2025.
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Sec. 19a-498d. Long-term care facilities. Discrimination against residents. Prohibited. Penalties. (a) As used in this section:
(1) “Long-term care facility” or “facility” means a nursing home facility, as defined in section 19a-490, or a managed residential community, as defined in section 19a-693, with assisted living services regulated by the Department of Public Health;
(2) “Long-term care facility staff” or “facility staff” means all persons employed by or contracted directly with a long-term care facility; and
(3) “Resident” means a resident or patient of a long-term care facility.
(b) (1) No long-term care facility or long-term care facility staff shall discriminate against any resident on the basis of such resident's race, color, religious creed, sex, actual or perceived gender identity or expression, sexual orientation, marital status, age, national origin, ancestry, intellectual disability, mental disability, learning disability, physical disability, status as a veteran, status as a victim of domestic violence or human immunodeficiency virus status.
(2) The provisions of this subsection shall not apply to the extent that they are incompatible with any professionally reasonable clinical judgment regarding the care of a resident.
(c) Each long-term care facility shall post in a prominent place in such facility the following notice printed in at least fourteen-point boldface capital letters: “(NAME OF FACILITY) DOES NOT DISCRIMINATE AND DOES NOT PERMIT DISCRIMINATION, INCLUDING, BUT NOT LIMITED TO, BULLYING, ABUSE, HARASSMENT OR DIFFERENTIAL TREATMENT ON THE BASIS OF RACE, COLOR, RELIGIOUS CREED, SEX, GENDER IDENTITY OR EXPRESSION, SEXUAL ORIENTATION, MARITAL STATUS, AGE, NATIONAL ORIGIN, ANCESTRY, INTELLECTUAL DISABILITY, MENTAL DISABILITY, LEARNING DISABILITY, PHYSICAL DISABILITY, STATUS AS A VETERAN, STATUS AS A VICTIM OF DOMESTIC VIOLENCE OR HUMAN IMMUNODEFICIENCY VIRUS STATUS. YOU MAY FILE A COMPLAINT WITH THE OFFICE OF THE LONG-TERM CARE OMBUDSMAN (PROVIDE CONTACT INFORMATION) IF YOU BELIEVE THAT YOU HAVE EXPERIENCED DISCRIMINATION.”
(d) The State Ombudsman shall establish policies and procedures for recording complaints filed by or on behalf of residents of long-term care facilities pursuant to the provisions of this section.
(e) Long-term care facility staff not directly involved in providing direct care to a resident shall not be present during physical examination or the provision of personal care to such resident if such resident is partially or fully unclothed without the express permission of such resident or such resident's legal guardian, legal representative or other legally responsible party. A facility shall use doors, curtains, screens or other effective visual barriers to provide bodily privacy for all residents whenever such residents are partially or fully unclothed. All residents shall be informed of and have the right to refuse to be examined, observed or treated by any facility staff when the primary purpose of such examination, observation or treatment is educational or informational rather than therapeutic, or for the evaluation or reevaluation of a resident's health. Such refusal shall not diminish the resident's access to care for the primary purpose of diagnosis or treatment.
(f) (1) At least once every two years, a long-term care facility shall ensure that every facility staff member who works directly with residents receives training, developed by the Commissioner of Public Health pursuant to subdivision (2) of this subsection, on cultural competency focusing on residents who identify as lesbian, gay, bisexual, transgender or gender-nonconforming or who are living with human immunodeficiency virus.
(2) Not later than January 1, 2026, the Commissioner of Public Health shall develop training materials for the purposes of subdivision (1) of this subsection. Such training materials (A) may be developed in consultation with entities with expertise in the legal and social challenges faced by aging persons who identify as lesbian, gay, bisexual or transgender or gender-nonconforming or who are living with human immunodeficiency virus, and (B) shall provide facility staff with the knowledge and skills necessary to provide effective care, in compliance with the provisions of this section, for such persons.
(3) Each long-term care facility shall ensure that a facility staff member required to receive training pursuant to the provisions of this subsection receives such training not more than six months after such facility staff member is hired unless such facility staff member provides proof of having received comparable training within the prior two years that the facility determines complies with the provisions of this subsection. If a facility determines that a facility staff member's prior training complies with the provisions of this subsection, a record of the content of such training sufficient to determine its compliance with the provisions of this subsection shall be kept on site at such facility.
(g) If the Commissioner of Public Health finds that a long-term care facility has failed to comply with the provisions of this section, the commissioner may take any disciplinary action against such long-term care facility permitted under section 19a-494.
(h) Nothing in this section shall be construed to limit any remedies available to a resident at law or in equity.
(P.A. 25-17, S. 1.)
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Sec. 19a-508c. Hospital and health system facility fees charged for outpatient services at hospital-based facilities. Notice re establishment of hospital-based facility at which facility fees billed. Penalties. Report. (a) As used in this section:
(1) “Affiliated provider” means a provider that is: (A) Employed by a hospital or health system, (B) under a professional services agreement with a hospital or health system that permits such hospital or health system to bill on behalf of such provider, or (C) a clinical faculty member of a medical school, as defined in section 33-182aa, that is affiliated with a hospital or health system in a manner that permits such hospital or health system to bill on behalf of such clinical faculty member;
(2) “Campus” means: (A) The physical area immediately adjacent to a hospital's main buildings and other areas and structures that are not strictly contiguous to the main buildings but are located within two hundred fifty yards of the main buildings, or (B) any other area that has been determined on an individual case basis by the Centers for Medicare and Medicaid Services to be part of a hospital's campus;
(3) “Facility fee” means any fee charged or billed by a hospital or health system for outpatient services provided in a hospital-based facility that is: (A) Intended to compensate the hospital or health system for the operational expenses of the hospital or health system, and (B) separate and distinct from a professional fee;
(4) “Health care provider” means an individual, entity, corporation, person or organization, whether for-profit or nonprofit, that furnishes, bills or is paid for health care service delivery in the normal course of business, including, but not limited to, a health system, a hospital, a hospital-based facility, a freestanding emergency department and an urgent care center;
(5) “Health system” means: (A) A parent corporation of one or more hospitals and any entity affiliated with such parent corporation through ownership, governance, membership or other means, or (B) a hospital and any entity affiliated with such hospital through ownership, governance, membership or other means;
(6) “Hospital” has the same meaning as provided in section 19a-490;
(7) “Hospital-based facility” means a facility that is owned or operated, in whole or in part, by a hospital or health system where hospital or professional medical services are provided;
(8) “Medicaid” means the program operated by the Department of Social Services pursuant to section 17b-260 and authorized by Title XIX of the Social Security Act, as amended from time to time;
(9) “Observation” means services furnished by a hospital on the hospital's campus, regardless of length of stay, including use of a bed and periodic monitoring by the hospital's nursing or other staff to evaluate an outpatient's condition or determine the need for admission to the hospital as an inpatient;
(10) “Payer mix” means the proportion of different sources of payment received by a hospital or health system, including, but not limited to, Medicare, Medicaid, other government-provided insurance, private insurance and self-pay patients;
(11) “Professional fee” means any fee charged or billed by a provider for professional medical services provided in a hospital-based facility;
(12) “Provider” means an individual, entity, corporation or health care provider, whether for profit or nonprofit, whose primary purpose is to provide professional medical services; and
(13) “Tagline” means a short statement written in a non-English language that indicates the availability of language assistance services free of charge.
(b) If a hospital or health system charges a facility fee utilizing a current procedural terminology evaluation and management (CPT E/M) code or assessment and management (CPT A/M) code for outpatient services provided at a hospital-based facility where a professional fee is also expected to be charged, the hospital or health system shall provide the patient with a written notice that includes the following information:
(1) That the hospital-based facility is part of a hospital or health system and that the hospital or health system charges a facility fee that is in addition to and separate from the professional fee charged by the provider;
(2) (A) The amount of the patient's potential financial liability, including any facility fee likely to be charged, and, where professional medical services are provided by an affiliated provider, any professional fee likely to be charged, or, if the exact type and extent of the professional medical services needed are not known or the terms of a patient's health insurance coverage are not known with reasonable certainty, an estimate of the patient's financial liability based on typical or average charges for visits to the hospital-based facility, including the facility fee, (B) a statement that the patient's actual financial liability will depend on the professional medical services actually provided to the patient, (C) an explanation that the patient may incur financial liability that is greater than the patient would incur if the professional medical services were not provided by a hospital-based facility, and (D) a telephone number the patient may call for additional information regarding such patient's potential financial liability, including an estimate of the facility fee likely to be charged based on the scheduled professional medical services; and
(3) That a patient covered by a health insurance policy should contact the health insurer for additional information regarding the hospital's or health system's charges and fees, including the patient's potential financial liability, if any, for such charges and fees.
(c) If a hospital or health system charges a facility fee without utilizing a current procedural terminology evaluation and management (CPT E/M) code for outpatient services provided at a hospital-based facility, located outside the hospital campus, the hospital or health system shall provide the patient with a written notice that includes the following information:
(1) That the hospital-based facility is part of a hospital or health system and that the hospital or health system charges a facility fee that may be in addition to and separate from the professional fee charged by a provider;
(2) (A) A statement that the patient's actual financial liability will depend on the professional medical services actually provided to the patient, (B) an explanation that the patient may incur financial liability that is greater than the patient would incur if the hospital-based facility was not hospital-based, and (C) a telephone number the patient may call for additional information regarding such patient's potential financial liability, including an estimate of the facility fee likely to be charged based on the scheduled professional medical services; and
(3) That a patient covered by a health insurance policy should contact the health insurer for additional information regarding the hospital's or health system's charges and fees, including the patient's potential financial liability, if any, for such charges and fees.
(d) Each initial billing statement that includes a facility fee shall: (1) Clearly identify the fee as a facility fee that is billed in addition to, or separately from, any professional fee billed by the provider; (2) provide the corresponding Medicare facility fee reimbursement rate for the same service as a comparison or, if there is no corresponding Medicare facility fee for such service, (A) the approximate amount Medicare would have paid the hospital for the facility fee on the billing statement, or (B) the percentage of the hospital's charges that Medicare would have paid the hospital for the facility fee; (3) include a statement that the facility fee is intended to cover the hospital's or health system's operational expenses; (4) inform the patient that the patient's financial liability may have been less if the services had been provided at a facility not owned or operated by the hospital or health system; and (5) include written notice of the patient's right to request a reduction in the facility fee or any other portion of the bill and a telephone number that the patient may use to request such a reduction without regard to whether such patient qualifies for, or is likely to be granted, any reduction. Not later than October 15, 2022, and annually thereafter, each hospital, health system and hospital-based facility shall submit to the Health Systems Planning Unit of the Office of Health Strategy a sample of a billing statement issued by such hospital, health system or hospital-based facility that complies with the provisions of this subsection and which represents the format of billing statements received by patients. Such billing statement shall not contain patient identifying information.
(e) The written notice described in subsections (b) to (d), inclusive, and (h) to (j), inclusive, of this section shall be in plain language and in a form that may be reasonably understood by a patient who does not possess special knowledge regarding hospital or health system facility fee charges. On and after October 1, 2022, such notices shall include tag lines in at least the top fifteen languages spoken in the state indicating that the notice is available in each of those top fifteen languages. The fifteen languages shall be either the languages in the list published by the Department of Health and Human Services in connection with section 1557 of the Patient Protection and Affordable Care Act, P.L. 111-148, or, as determined by the hospital or health system, the top fifteen languages in the geographic area of the hospital-based facility.
(f) (1) For nonemergency care, if a patient's appointment is scheduled to occur ten or more days after the appointment is made, such written notice shall be sent to the patient by first class mail, encrypted electronic mail or a secure patient Internet portal not less than three days after the appointment is made. If an appointment is scheduled to occur less than ten days after the appointment is made or if the patient arrives without an appointment, such notice shall be hand-delivered to the patient when the patient arrives at the hospital-based facility.
(2) For emergency care, such written notice shall be provided to the patient as soon as practicable after the patient is stabilized in accordance with the federal Emergency Medical Treatment and Active Labor Act, 42 USC 1395dd, as amended from time to time, or is determined not to have an emergency medical condition and before the patient leaves the hospital-based facility. If the patient is unconscious, under great duress or for any other reason unable to read the notice and understand and act on his or her rights, the notice shall be provided to the patient's representative as soon as practicable.
(g) Subsections (b) to (f), inclusive, and (l) of this section shall not apply if a patient is insured by Medicare or Medicaid or is receiving services under a workers' compensation plan established to provide medical services pursuant to chapter 568.
(h) A hospital-based facility shall prominently display written notice in locations that are readily accessible to and visible by patients, including patient waiting or appointment check-in areas, stating: (1) That the hospital-based facility is part of a hospital or health system, (2) the name of the hospital or health system, and (3) that if the hospital-based facility charges a facility fee, the patient may incur a financial liability greater than the patient would incur if the hospital-based facility was not hospital-based. On and after October 1, 2022, such notices shall include tag lines in at least the top fifteen languages spoken in the state indicating that the notice is available in each of those top fifteen languages. The fifteen languages shall be either the languages in the list published by the Department of Health and Human Services in connection with section 1557 of the Patient Protection and Affordable Care Act, P.L. 111-148, or, as determined by the hospital or health system, the top fifteen languages in the geographic area of the hospital-based facility. Not later than October 1, 2022, and annually thereafter, each hospital-based facility shall submit a copy of the written notice required by this subsection to the Health Systems Planning Unit of the Office of Health Strategy.
(i) A hospital-based facility shall clearly hold itself out to the public and payers as being hospital-based, including, at a minimum, by stating the name of the hospital or health system in its signage, marketing materials, Internet web sites and stationery.
(j) A hospital-based facility shall, when scheduling services for which a facility fee may be charged, inform the patient (1) that the hospital-based facility is part of a hospital or health system, (2) of the name of the hospital or health system, (3) that the hospital or health system may charge a facility fee in addition to and separate from the professional fee charged by the provider, and (4) of the telephone number the patient may call for additional information regarding such patient's potential financial liability.
(k) (1) If any transaction described in subsection (c) of section 19a-486i results in the establishment of a hospital-based facility at which facility fees may be billed, the hospital or health system, that is the purchaser in such transaction shall, not later than thirty days after such transaction, provide written notice, by first class mail, of the transaction to each patient served within the three years preceding the date of the transaction by the health care facility that has been purchased as part of such transaction.
(2) Such notice shall include the following information:
(A) A statement that the health care facility is now a hospital-based facility and is part of a hospital or health system, the health care facility's full legal and business name and the date of such facility's acquisition by a hospital or health system;
(B) The name, business address and phone number of the hospital or health system that is the purchaser of the health care facility;
(C) A statement that the hospital-based facility bills, or is likely to bill, patients a facility fee that may be in addition to, and separate from, any professional fee billed by a health care provider at the hospital-based facility;
(D) (i) A statement that the patient's actual financial liability will depend on the professional medical services actually provided to the patient, and (ii) an explanation that the patient may incur financial liability that is greater than the patient would incur if the hospital-based facility were not a hospital-based facility;
(E) The estimated amount or range of amounts the hospital-based facility may bill for a facility fee or an example of the average facility fee billed at such hospital-based facility for the most common services provided at such hospital-based facility; and
(F) A statement that, prior to seeking services at such hospital-based facility, a patient covered by a health insurance policy should contact the patient's health insurer for additional information regarding the hospital-based facility fees, including the patient's potential financial liability, if any, for such fees.
(3) A copy of the written notice provided to patients in accordance with this subsection shall be filed with the Health Systems Planning Unit of the Office of Health Strategy, established under section 19a-612. Said unit shall post a link to such notice on its Internet web site.
(4) A hospital, health system or hospital-based facility shall not collect a facility fee for services provided at a hospital-based facility that is subject to the provisions of this subsection from the date of the transaction until at least thirty days after the written notice required pursuant to this subsection is mailed to the patient or a copy of such notice is filed with the Health Systems Planning Unit of the Office of Health Strategy, whichever is later. A violation of this subsection shall be considered an unfair trade practice pursuant to section 42-110b.
(5) Not later than July 1, 2023, and annually thereafter, each hospital-based facility that was the subject of a transaction, as described in subsection (c) of section 19a-486i, during the preceding calendar year shall report to the Health Systems Planning Unit of the Office of Health Strategy the number of patients served by such hospital-based facility in the preceding three years.
(l) (1) Notwithstanding the provisions of this section, no hospital, health system or hospital-based facility shall collect a facility fee for (A) outpatient health care services that use a current procedural terminology evaluation and management (CPT E/M) code or assessment and management (CPT A/M) code and are provided at a hospital-based facility located off-site from a hospital campus, or (B) outpatient health care services provided at a hospital-based facility located off-site from a hospital campus received by a patient who is uninsured of more than the Medicare rate.
(2) Notwithstanding the provisions of this section, on and after July 1, 2024, no hospital or health system shall collect a facility fee for outpatient health care services that use a current procedural terminology evaluation and management (CPT E/M) code or assessment and management (CPT A/M) code and are provided on the hospital campus. The provisions of this subdivision shall not apply to (A) an emergency department located on a hospital campus, or (B) observation stays on a hospital campus and (CPT E/M) and (CPT A/M) codes when billed for the following services: (i) Wound care, (ii) orthopedics, (iii) anticoagulation, (iv) oncology, (v) obstetrics, and (vi) solid organ transplant.
(3) Notwithstanding the provisions of subdivisions (1) and (2) of this subsection, in circumstances when an insurance contract that is in effect on July 1, 2016, provides reimbursement for facility fees prohibited under the provisions of subdivision (1) of this subsection, and in circumstances when an insurance contract that is in effect on July 1, 2024, provides reimbursement for facility fees prohibited under the provisions of subdivision (2) of this subsection, a hospital or health system may continue to collect reimbursement from the health insurer for such facility fees until the applicable date of expiration, renewal or amendment of such contract, whichever such date is the earliest.
(4) The provisions of this subsection shall not apply to a freestanding emergency department. As used in this subdivision, “freestanding emergency department” means a freestanding facility that (A) is structurally separate and distinct from a hospital, (B) provides emergency care, (C) is a department of a hospital licensed under chapter 368v, and (D) has been issued a certificate of need to operate as a freestanding emergency department pursuant to chapter 368z.
(5) (A) On and after July 1, 2024, if the Commissioner of Health Strategy receives information and has a reasonable belief, after evaluating such information, that any hospital, health system or hospital-based facility charged facility fees, other than through isolated clerical or electronic billing errors, in violation of any provision of this section, or rule or regulation adopted thereunder, such hospital, health system or hospital-based facility shall be subject to a civil penalty of up to one thousand dollars. The commissioner may issue a notice of violation and civil penalty by first class mail or personal service. Such notice shall include: (i) A reference to the section of the general statutes, rule or section of the regulations of Connecticut state agencies believed or alleged to have been violated; (ii) a short and plain language statement of the matters asserted or charged; (iii) a description of the activity to cease; (iv) a statement of the amount of the civil penalty or penalties that may be imposed; (v) a statement concerning the right to a hearing; and (vi) a statement that such hospital, health system or hospital-based facility may, not later than ten business days after receipt of such notice, make a request for a hearing on the matters asserted.
(B) The hospital, health system or hospital-based facility to whom such notice is provided pursuant to subparagraph (A) of this subdivision may, not later than ten business days after receipt of such notice, make written application to the Office of Health Strategy to request a hearing to demonstrate that such violation did not occur. The failure to make a timely request for a hearing shall result in the issuance of a cease and desist order or civil penalty. All hearings held under this subsection shall be conducted in accordance with the provisions of chapter 54.
(C) Following any hearing before the Office of Health Strategy pursuant to this subdivision, if said office finds, by a preponderance of the evidence, that such hospital, health system or hospital-based facility violated or is violating any provision of this subsection, any rule or regulation adopted thereunder or any order issued by said office, said office shall issue a final cease and desist order in addition to any civil penalty said office imposes.
(6) A violation of this subsection shall be considered an unfair trade practice pursuant to section 42-110b.
(m) (1) Each hospital and health system shall report not later than October 1, 2023, and thereafter not later than July 1, 2024, and annually thereafter, to the Commissioner of Health Strategy, on a form prescribed by the commissioner, concerning facility fees charged or billed during the preceding calendar year. Such report shall include, but need not be limited to, (A) the name and address of each facility owned or operated by the hospital or health system that provides services for which a facility fee is charged or billed, and an indication as to whether each facility is located on or outside of the hospital or health system campus, (B) the number of patient visits at each such facility for which a facility fee was charged or billed, (C) the number, total amount and range of allowable facility fees paid at each such facility disaggregated by payer mix, (D) for each facility, the total amount of facility fees charged and the total amount of revenue received by the hospital or health system derived from facility fees, (E) the total amount of facility fees charged and the total amount of revenue received by the hospital or health system from all facilities derived from facility fees, (F) a description of the ten procedures or services that generated the greatest amount of facility fee gross revenue, disaggregated by current procedural terminology (CPT) category code for each such procedure or service and, for each such procedure or service, patient volume and the total amount of gross and net revenue received by the hospital or health system derived from facility fees, disaggregated by on-campus and off-campus, and (G) the top ten procedures or services for which facility fees are charged based on patient volume and the gross and net revenue received by the hospital or health system for each such procedure or service, disaggregated by on-campus and off-campus. For purposes of this subsection, “facility” means a hospital-based facility that is located on a hospital campus or outside a hospital campus.
(2) The commissioner shall publish the information reported pursuant to subdivision (1) of this subsection, or post a link to such information, on the Internet web site of the Office of Health Strategy.
(P.A. 14-145, S. 1, 2; P.A. 15-146, S. 13; P.A. 16-77, S. 2; P.A. 17-241, S. 5; P.A. 18-91, S. 57; 18-149, S. 1; P.A. 21-129, S. 4; P.A. 22-92, S. 8; P.A. 23-171, S. 9; P.A. 24-68, S. 48; 24-81, S. 196; P.A. 25-94, S. 10.)
History: P.A. 15-146 added new Subsec. (d) re billing statements that include facility fee, redesignated existing Subsecs. (d) to (h) as Subsecs. (e) to (i), added Subsec. (j) re transaction that results in establishment of hospital-based facility at which facility fees will likely be billed, added Subsec. (k) re when collection of facility fees is prohibited, added Subsec. (l) re annual report, and made conforming changes; P.A. 16-77 amended Subsec. (d) by replacing “billing statement” with “initial billing statement”, amended Subsec. (d)(2) by replacing “Medicare facility fee” with “corresponding Medicare facility fee” and adding provisions re no corresponding Medicare facility fee, amended Subsec. (d)(5) by adding provision re whether patient qualifies for or is likely to be granted any reduction and amended Subsec. (g) by adding reference to Subsec. (k), effective June 2, 2016; P.A. 17-241 amended Subsec. (a)(3) by replacing “outpatient hospital services” with “outpatient services”, amended Subsec. (b)(2) by adding Subpara. (D) re telephone number patient may call for additional information, amended Subsec. (c)(2) by adding Subpara. (C) re telephone number patient may call for additional information, amended Subsec. (h) by adding new Subdiv. (2) re name of hospital or health system and redesignating existing Subdiv. (2) as Subdiv. (3), added new Subsec. (j) re informing patient when scheduling services for which facility fee may be charged, redesignated existing Subsecs. (j) to (l) as Subsecs. (k) to (m), and made technical and conforming changes; P.A. 18-91 amended Subsec. (k)(3) and (4) by replacing references to Office of Health Care Access with references to Health Systems Planning Unit, amended Subsec. (m)(1) by replacing “Commissioner of Public Health” with “executive director of the Office of Health Strategy” and amended Subsec. (m)(2) by replacing “commissioner” with “executive director” and “Office of Health Care Access” with “Office of Health Strategy”, effective May 14, 2018; P.A. 18-149 amended Subsec. (l) by deleting “on and after January 1, 2017,”, replacing “management code” with “management (CPT E/M) code” in Subdiv. (1), deleting references to hospital emergency department in Subdivs. (1) and (2), and adding provision re freestanding emergency departments; P.A. 21-129 amended Subsec. (a) by adding new Subdiv. (7) defining “payer mix”, redesignating existing Subdivs. (7) and (8) as Subdivs. (8) and (9) and adding Subdiv. (10) defining “tagline”, amended Subsec. (b) by adding reference to assessment and management code, amended Subsec. (d) by deleting date reference and requiring hospitals, health systems and hospital-based facilities to submit sample of billing statement to Health Planning Unit of Office of Health Strategy, amended Subsec. (e) by requiring notices to include tag lines in at least the top 15 languages spoken in the state indicating the notice is available in such languages, amended Subsec. (h) by adding reference to appointment check-in areas, requiring notices to include tag lines in at least the top 15 languages spoken in the state indicating the notice is available in such languages, and requiring hospital-based facility to annually submit copy of such notices to Health Systems Planning Unit of Office of Health Strategy, amended Subsec. (k) by deleting date reference, replacing “previous three years” with “three years preceding the date of the transaction” and making technical changes in Subdiv. (1), adding requirement that the notice include health care facility's full legal and business name and date of facility's acquisition by a hospital or health system in Subdiv. (2)(A), and adding Subdiv. (5) requiring report to Health Systems Planning Unit of number of patients served by hospital-based facility in preceding 3 years, amended Subsec. (l) by adding reference to assessment and management code and to renewal or amendment of contract, and adding “, whichever such date is the earliest”, and amended Subsec. (m)(1) by replacing “July 1, 2016” with “July 1, 2023” and adding reference to form prescribed by executive director, replacing “location” with “address” in Subpara. (A), replacing “by Medicare, Medicaid or under private insurance policies” with “disaggregated by payer mix” in Subpara. (C), adding references to amount of facility fees charged in Subparas. (D) and (E), replacing “facility fee revenue” with “facility fee gross revenue”, requiring description of procedures or services to be disaggregated by current procedural terminology category code, adding reference to patient volume and inserting “gross and net” before “revenue” in Subpara. (F), and adding reference to services re top 10 facility fees charged and to gross and net revenue received by hospital or health system for each such procedure or service in Subpara. (G), effective October 1, 2022; P.A. 22-92 amended Subsec. (d)(5) by making a technical change and Subsec. (k)(4) and (5) by adding references to the Office of Health Strategy; P.A. 23-171 amended Subsec. (a) by adding new Subdiv. (4) defining “health care provider”, redesignating existing Subdivs. (4) to (6) as Subdivs. (5) to (7), adding new Subdiv. (8) defining “Medicaid”, adding new Subdiv. (9) defining “observation”, and redesignating existing Subdivs. (7) to (10) as Subdivs. (10) to (13), amended Subsec. (l) by inserting new Subdiv. (1) designator, redesignating existing Subdivs. (1) and (2) as Subparas. (A) and (B), adding new Subdiv. (2) re prohibition on collection of facility fee for services using certain codes and provided on the hospital campus, inserting Subdiv. (3) designator and amending same by adding reference to insurance contract in effect on July 1, 2024, that provides reimbursement for facility fees, deleting provision re a violation being considered an unfair trade practice and making technical changes, inserting Subdiv. (4) designator and amending same by making a technical change and adding Subdiv. (5) re penalties and amended Subsec. (m)(1) by replacing “July 1, 2023” with “October 1, 2023, and thereafter not later than July 1, 2024”, requiring report to include indication as to whether a facility is located on or outside of campus in Subpara. (A), requiring that the description be disaggregated by on-campus and off-campus in Subparas. (F) and (G) and making technical changes, effective July 1, 2023; P.A. 24-68 amended Subsec. (k)(1) by making a technical change, effective May 28, 2024; P.A. 24-81 amended Subsecs. (l) and (m) by replacing references to executive director of the Office of Health Strategy with references to Commissioner of Health Strategy, effective May 30, 2024; P.A. 25-94 amended Subsec. (l) by adding Subdiv. (6) re a violation considered an unfair trade practice and amended Subsec. (m)(1)(F) by making a technical change, effective January 1, 2026.
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Sec. 19a-533. (Formerly Sec. 19-614a). Discrimination against indigent applicants. Definitions. Prohibitions. Record-keeping. Investigation of complaints. Penalties. Waiting lists; not required to accept indigents. Removal from waiting lists. (a) As used in this section:
(1) “Nursing home” means any chronic and convalescent facility or any rest home with nursing supervision, as defined in section 19a-521, which has a provider agreement with the state to provide services to recipients of funds obtained through Title XIX of the Social Security Amendments of 1965;
(2) “Indigent person” means any person who is eligible for or who is receiving medical assistance benefits from the state;
(3) “Federally contracted veterans nursing home” means a nursing home that has a contract with the United States Department of Veterans Affairs to provide care for veterans; and
(4) “Service-connected veteran” means a veteran who meets the United States Department of Veterans Affairs service-connected eligibility criteria and all applicable United States Department of Veterans Affairs eligibility requirements.
(b) A nursing home which receives payment from the state for rendering care to indigent persons:
(1) Shall be prohibited from discriminating against indigent persons who apply for admission to such facility on the basis of source of payment. Except as otherwise provided by law, all applicants for admission to such facility shall be admitted in the order in which such applicants apply for admission as evidenced by the nursing home's acceptance of a substantially completed application for admission. Each nursing home shall (A) provide a receipt to each applicant who substantially completes an application for admission to its facility who requests placement on a waiting list stating the date and time of such substantial completion and acceptance of the application by the nursing home, and (B) maintain a dated list of such applications which shall be available at all times to any applicant, the applicant's bona fide representative, authorized personnel from the Departments of Public Health and Social Services and such other state agencies or other bodies established by state statute whose statutory duties necessitate access to such lists. A nursing home may maintain such waiting list in electronic form. On and after July 1, 2025, a nursing home shall maintain such waiting list in electronic form;
(2) Shall provide applications for admission to prospective residents by mail, electronic transmission or Internet web site posting;
(3) Shall develop and implement policies and procedures related to the waiting list that address (A) what information is required for such application to be considered substantially completed and accepted by the nursing home, (B) what steps the nursing home will take to protect the privacy of information submitted by a prospective resident, and (C) a description of how the integrity of information in the electronic waiting list will be maintained, including steps taken to ensure accuracy in recording of the (i) date and time a prospective resident is placed on the waiting list, and (ii) any dated notification made pursuant to subsection (c) of this section. A nursing home shall not be required to maintain a list of inquiries from prospective residents who have not yet submitted a substantially completed application for admission accepted by the nursing home, nor to provide any such person with a receipt of their inquiry;
(4) May, no sooner than ninety days after initial placement of the person's name on the waiting list, inquire by letter or electronic mail of such applicant and any one person if designated by such applicant whether the applicant desires continuation of the applicant's name on the waiting list. If the applicant does not respond and an additional thirty days pass, the nursing home may remove such applicant's name from its waiting list. A nursing home may annually send a waiting list placement continuation communication by letter or electronic mail to all persons on the waiting list for at least ninety days to inquire as to whether such person desires continuation of the person's name on the waiting list, provided such communication shall also be sent to any one person if designated by such applicant. If such person does not respond and at least thirty days pass, the facility may remove the person's name from its waiting list. Indigent persons shall be placed on any waiting list for admission to a facility and shall be admitted to the facility as vacancies become available, in the same manner as self-pay applicants, except as provided in subsections (f) and (g) of this section;
(5) Shall post in a conspicuous place a notice informing applicants for admission that the facility is prohibited by statute from discriminating against indigent applicants for admission on the basis of source of payment. Such notice shall advise applicants for admission of the remedies available under this section and shall list the name, address and telephone number of the ombudsman who serves the region in which the facility is located;
(6) Shall be prohibited from requiring that an indigent person pay any sum of money or furnish any other consideration, including but not limited to, the furnishing of an agreement by the relative, conservator or other responsible party of an indigent person which obligates such party to pay for care rendered to an indigent person as a condition for admission of such indigent person; and
(7) Shall maintain an electronic record of the number of patients who are Medicare, Medicaid and private pay patients and make such information available, upon request, to the state or regional ombudsman.
(c) Whenever a nursing home passes over the name of an applicant on its waiting list and admits another applicant, the nursing home shall make a dated notation on the waiting list indicating why the applicant who was passed over was not admitted. Upon the receipt of a complaint concerning a violation of this section, the Department of Social Services shall conduct an investigation into such complaint. A nursing home shall provide access to the department and the State Ombudsman to all records requested by the department or State Ombudsman for the purpose of investigating a complaint by or on behalf of an applicant related to the denial of an admission.
(d) The Department of Social Services is authorized to decrease the daily reimbursement rate to a nursing home for one year for a violation of this section which occurred during the twelve-month period covered by the cost report upon which the per diem rate is calculated. The per diem rate shall be reduced by one-quarter of one per cent for an initial violation of this section and one per cent for each additional violation.
(e) Prior to imposing any sanction, the Department of Social Services shall notify the nursing home of the alleged violation and the accompanying sanction, and shall permit such facility to request an administrative hearing, in accordance with sections 4-176e to 4-181a, inclusive. A facility shall request such hearing within fifteen days of receipt of the notice of violation from the Department of Social Services. The department shall stay the imposition of any sanction pending the outcome of the administrative hearing.
(f) A nursing home with a number of self-pay residents equal to or less than thirty per cent of its total number of residents shall not be required to admit an indigent person on a waiting list for admission when a vacancy becomes available during the subsequent six months, provided (1) no bed may be held open for more than thirty days, and (2) the nursing home notifies the Commissioner of Social Services and the regional nursing home ombudsman office on the date on which such six-month period of waiting list exemption began and thereafter on a quarterly basis if the conditions for exemption still apply.
(g) A nursing home shall not be required to admit an indigent person on a waiting list for admission when a vacancy becomes available if the vacancy is in a private room.
(h) Notwithstanding the provisions of this section, a nursing home shall, without regard to the order of its waiting list, admit an applicant who (1) seeks to transfer from a nursing home that is closing, (2) seeks to transfer from a nursing home in which the applicant was placed following the closure of the nursing home where such applicant previously resided or, in the case of a nursing home placed in receivership, the anticipated closure of the nursing home where such applicant previously resided, provided (A) the transfer occurs not later than sixty days following the date that such applicant was transferred from the nursing home where he or she previously resided, and (B) except when the nursing home that is closing transferred the resident due to an emergency, the applicant submitted an application to the nursing home to which he or she seeks admission at the time of the applicant's transfer from the nursing home where he or she previously resided, (3) is a service-connected veteran if such nursing home is a federally contracted veterans nursing home and such applicant is eligible for care therein, or (4) seeks to transfer from a nursing home that (A) has filed a certificate of need request pursuant to section 17b-352 on which the Commissioner of Social Services has not issued a final decision, and (B) has five residents or less. A nursing home that qualifies for a waiting list exemption pursuant to subsection (f) or (g) of this section shall not be required to admit an indigent person under this subsection except when the resident is being transferred from a nursing home that is closing due to an emergency. No nursing home shall be required to admit an applicant pursuant to the provisions of this subsection if the nursing home has determined that (i) the applicant does not have a payor source because the applicant has been denied Medicaid eligibility or the applicant has failed to pay a nursing home that is closing for the three months preceding the date of the application for admittance and has no pending application for Medicaid, (ii) the applicant is subject to a Medicaid penalty period, or (iii) the applicant does not require nursing home level of care as determined in accordance with applicable state and federal requirements.
(P.A. 80-364, S. 1-3; P.A. 84-245; P.A. 88-317, S. 83, 107; June Sp. Sess. P.A. 91-8, S. 29, 63; P.A. 92-231, S. 2, 10; P.A. 93-262, S. 59, 87; 93-327, S. 1, 4; 93-364; 93-381, S. 9, 39; 93-435, S. 59, 95; May 25 Sp. Sess. P.A. 94-1, S. 21, 130; P.A. 95-257, S. 12, 21, 58; June 18 Sp. Sess. P.A. 97-2, S. 129, 165; P.A. 99-176, S. 21, 24; June 30 Sp. Sess. P.A. 03-3, S. 74; P.A. 04-76, S. 28; P.A. 11-233, S. 1; 11-242, S. 52; P.A. 24-17, S. 1; 24-141, S. 2; P.A. 25-15, S. 10; 25-16, S. 9.)
History: Sec. 19-614a transferred to Sec. 19a-533 in 1983; P.A. 84-245 amended Subsec. (b)(1) to require each nursing home to provide a receipt to each applicant for admission and to maintain a dated list of applicants; P.A. 88-317 amended reference to Secs. 4-177 to 4-181 in Subsec. (e) to include new sections added to Ch. 54, effective July 1, 1989, and applicable to all agency proceedings commencing on or after that date; June Sp. Sess. P.A. 91-8 made technical corrections in Subsec. (b) and added Subsecs. (f), (g) and (h) governing admission of indigents to nursing homes and concerning a review of documentation requirements; P.A. 92-231 amended Subsec. (f) by substituting 30% for 20%, inserted new Subsec. (h) re priority admission for applicants insured under long-term care policies precertified under Sec. 38a-475 and relettered former Subsec. (h) accordingly; P.A. 93-262 and P.A. 93-435 replaced references to departments of income maintenance and aging with department of social services and deleted Subsec. (i) re review of documentation requirements by income maintenance department and suggestions to reduce administrative requirements made to general assembly, effective July 1, 1993; P.A. 93-327 amended Subsec. (b)(1) to describe process for removal of names from a waiting list and (b)(4) to replace requirements re daily log with requirements re patient roster and amended Subsec. (f) to require notice to commissioner of income maintenance and the ombudsman when waiver period begins; P.A. 93-364 deleted former Subsec. (h) allowing nursing homes to fill vacancies on a priority basis for applicants insured under long-term care insurance policies, and would have relettered former Subsec. (i) as (h), but the latter change failed to take effect, Subsec. (i) having been deleted by P.A. 93-262; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; May 25 Sp. Sess. P.A. 94-1 amended Subsec. (b)(1) by making technical changes, effective July 1, 1994; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (c) by requiring the Department of Social Services to conduct investigations, in addition to the regional ombudsman, effective July 1, 1997; P.A. 99-176 amended Subsec. (c) to delete reference to the regional ombudsman and delete required report of findings, effective July 1, 1999; June 30 Sp. Sess. P.A. 03-3 added new Subsec. (h) re priority given to nursing home applicant seeking to transfer from a nursing home that is closing, effective August 20, 2003; P.A. 04-76 amended Subsec. (a) by deleting reference to “general assistance benefits from a town” in definition of “indigent person”; P.A. 11-233 amended Subsec. (h) by designating existing provision re transfer from a nursing home that is closing as Subdiv. (1) and adding Subdiv. (2) re transfers from nursing homes under other circumstances, effective July 13, 2011; P.A. 11-242 made identical changes as P.A. 11-233; P.A. 24-17 amended Subsec. (a) by inserting Subdiv. designators, amended Subsec. (b) by adding provisions re substantially complete applications and electronic waiting lists in Subdiv. (1) and deleting provisions re removal from waiting list, added new Subdivs. (2) and (3) re means of application and waiting list procedures, designated existing provisions re waiting list communications as new Subdiv. (4) and added provisions re contact by electronic mail, redesignated existing Subdivs. (2) to (4) as Subdivs. (5) to (7) and replaced patient roster with electronic record in redesignated Subdiv. (7), amended Subsec. (c) by adding requirement for dated notations on waiting list when applicant is passed over and provisions re access to records, and made technical changes throughout, effective May 14, 2024; P.A. 24-141 amended Subsec. (b)(1) and (3) by making technical changes, amended Subsec. (f) by designating existing provisions as Subdivs. (1) and (2) and adding provisions re dates of nursing home notifications to Commissioner of Social Services and regional nursing home ombudsman office and making technical changes, amended Subsec. (h) by replacing “may” with “shall,”, adding “except when the nursing home that is closing transferred the resident due to an emergency,” in Subdiv. (2)(B) and adding provision exempting certain nursing homes from requirement to admit indigent persons, effective July 1, 2024; P.A. 25-15 amended Subsec. (a) by adding Subdiv. (3) re definition of “federally contracted veterans nursing home” and Subdiv. (4) re definition of “service-connected veteran”, amended Subsec. (h) by adding Subdiv. (3) re service-connected veteran applying for admission to federally contracted veterans nursing home and made technical changes, effective July 1, 2025; P.A. 25-16 amended Subsec. (h) by adding Subdiv. (3), codified by the Revisors as Subdiv. (4), re applicants who seek to transfer from a nursing home that has filed a certificate of need request and has 5 residents or fewer and making a conforming change.
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Sec. 19a-535. (Formerly Sec. 19-616). Transfer or discharge of residents. Notice. Plan required. Appeal. Hearing. Involuntary transfer, discharge reporting. (a) For the purposes of this section: (1) “Facility” means an entity certified as a nursing facility under the Medicaid program or an entity certified as a skilled nursing facility under the Medicare program or with respect to facilities that do not participate in the Medicaid or Medicare programs, a chronic and convalescent nursing home or a rest home with nursing supervision as defined in section 19a-521; (2) “continuing care facility which guarantees life care for its residents” has the same meaning as provided in section 17b-354; (3) “transfer” means the movement of a resident from one facility to another facility or institution, including, but not limited to, a hospital emergency department, if the resident is admitted to the facility or institution or is under the care of the facility or institution for more than twenty-four hours; (4) “discharge” means the movement of a resident from a facility to a noninstitutional setting; (5) “self-pay resident” means a resident who is not receiving state or municipal assistance to pay for the cost of care at a facility, but shall not include a resident who has filed an application with the Department of Social Services for Medicaid coverage for facility care but has not received an eligibility determination from the department on such application, provided the resident has timely responded to requests by the department for information that is necessary to make such determination; and (6) “emergency” means a situation in which a failure to effect an immediate transfer or discharge of the resident that would endanger the health, safety or welfare of the resident or other residents.
(b) A facility shall not transfer or discharge a resident from the facility except to meet the welfare of the resident which cannot be met in the facility, or unless the resident no longer needs the services of the facility due to improved health, the facility is required to transfer the resident pursuant to section 17b-359 or 17b-360, or the health or safety of individuals in the facility is endangered, or in the case of a self-pay resident, for the resident's nonpayment or arrearage of more than fifteen days of the per diem facility room rate, or the facility ceases to operate. In each case the basis for transfer or discharge shall be documented in the resident's medical record by a physician, a physician assistant or an advanced practice registered nurse. In each case where the welfare, health or safety of the resident is concerned the documentation shall be by the resident's physician, physician assistant or advanced practice registered nurse. A facility that is part of a continuing care facility which guarantees life care for its residents may transfer or discharge (1) a self-pay resident who is a member of the continuing care community and who has intentionally transferred assets in a sum that will render the resident unable to pay the costs of facility care in accordance with the contract between the resident and the facility, or (2) a self-pay resident who is not a member of the continuing care community and who has intentionally transferred assets in a sum that will render the resident unable to pay the costs of a total of forty-two months of facility care from the date of initial admission to the facility.
(c) (1) Before effecting any transfer or discharge of a resident from the facility, the facility shall notify, in writing, the resident and the resident's guardian or conservator, if any, or legally liable relative or other responsible party if known, of the proposed transfer or discharge, the reasons therefor, the effective date of the proposed transfer or discharge, the location to which the resident is to be transferred or discharged, the right to appeal the proposed transfer or discharge and the procedures for initiating such an appeal as determined by the Department of Social Services, the date by which an appeal must be initiated in order to preserve the resident's right to an appeal hearing and the date by which an appeal must be initiated in order to stay the proposed transfer or discharge and the possibility of an exception to the date by which an appeal must be initiated in order to stay the proposed transfer or discharge for good cause, that the resident may represent himself or herself or be represented by legal counsel, a relative, a friend or other spokesperson, an affirmation by the facility that notice of the proposed transfer or discharge has been provided to the State Long-Term Care Ombudsman, in accordance with the provisions of subdivision (3) of this subsection, and information as to bed hold and nursing home readmission policy when required in accordance with section 19a-537. The notice shall also include the name, mailing address and telephone number of the State Long-Term Care Ombudsman. If the resident is, or the facility alleges a resident is, mentally ill or developmentally disabled, the notice shall include the name, mailing address and telephone number of the nonprofit entity designated by the Governor in accordance with section 46a-10b to serve as the Connecticut protection and advocacy system. The notice shall be given at least thirty days and no more than sixty days prior to the resident's proposed transfer or discharge, except where the health or safety of individuals in the facility are endangered, or where the resident's health improves sufficiently to allow a more immediate transfer or discharge, or where immediate transfer or discharge is necessitated by urgent medical needs or where a resident has not resided in the facility for thirty days, in which cases notice shall be given as many days before the transfer or discharge as practicable.
(2) The resident may initiate an appeal pursuant to this section by submitting a written request to the Commissioner of Social Services not later than sixty calendar days after the facility issues the notice of the proposed transfer or discharge, except as provided in subsection (h) of this section. In order to stay a proposed transfer or discharge, the resident must initiate an appeal not later than twenty days after the date the resident receives the notice of the proposed transfer or discharge from the facility unless the resident demonstrates good cause for failing to initiate such appeal within the twenty-day period.
(3) On the date that the facility provides notice of a proposed involuntary transfer or discharge of a resident pursuant to the provisions of subdivision (1) of this subsection, the facility shall notify the State Ombudsman, appointed pursuant to section 17a-870, in a manner prescribed by the State Ombudsman, of such proposed involuntary transfer or discharge. Failure to provide notice to the State Ombudsman pursuant to the provisions of this subdivision shall invalidate any notice of the proposed involuntary transfer or discharge of a resident submitted pursuant to the provisions of subdivision (1) of this subsection.
(d) No resident shall be transferred or discharged from any facility as a result of a change in the resident's status from self-pay or Medicare to Medicaid provided the facility offers services to both categories of residents. Any such resident who wishes to be transferred to another facility that has agreed to accept the resident may do so upon giving at least fifteen days written notice to the administrator of the facility from which the resident is to be transferred and a copy thereof to the appropriate advocate of such resident. The resident's advocate may help the resident complete all administrative procedures relating to a transfer.
(e) Except in an emergency or in the case of transfer to a hospital, no resident shall be transferred or discharged from a facility unless a discharge plan has been developed by the personal physician, physician assistant or advanced practice registered nurse of the resident or the medical director in conjunction with the nursing director, social worker or other health care provider. To minimize the disruptive effects of the transfer or discharge on the resident, the person responsible for developing the plan shall consider the feasibility of placement near the resident's relatives, the acceptability of the placement to the resident and the resident's guardian or conservator, if any, or the resident's legally liable relative or other responsible party, if known, and any other relevant factors that affect the resident's adjustment to the move. The plan shall contain a written evaluation of the effects of the transfer or discharge on the resident and a statement of the action taken to minimize such effects. In addition, the plan shall outline the care and kinds of services that the resident shall receive upon transfer or discharge. Not less than thirty days prior to an involuntary transfer or discharge, a copy of the discharge plan shall be provided to the resident's personal physician, physician assistant or advanced practice registered nurse if the discharge plan was prepared by the medical director, to the resident and the resident's guardian or conservator, if any, or legally liable relative or other responsible party, if known.
(f) No resident shall be involuntarily transferred or discharged from a facility if such transfer or discharge is medically contraindicated.
(g) The facility shall be responsible for assisting the resident in finding appropriate placement and, in providing such assistance, shall consider the resident's proximity to family members and any other known support networks.
(h) (1) Except in the case of an emergency, as provided in subdivision (4) of this subsection, upon receipt of a request for a hearing to appeal any proposed transfer or discharge, the Commissioner of Social Services or the commissioner's designee shall hold a hearing to determine whether the transfer or discharge is being effected in accordance with this section. A hearing shall be convened not less than ten, but not more than thirty days from the date of receipt of such request and a written decision made by the commissioner or the commissioner's designee not later than thirty days after the date of termination of the hearing or not later than sixty days after the date of the hearing request, whichever occurs sooner. The hearing shall be conducted in accordance with chapter 54. In each case the facility shall prove by a preponderance of the evidence that it has complied with the provisions of this section. Except in the case of an emergency or in circumstances when the resident is not physically present in the facility, whenever the Commissioner of Social Services receives a request for a hearing in response to a notice of proposed transfer or discharge and such notice does not meet the requirements of subsection (c) of this section, the commissioner shall, not later than ten business days after the date of receipt of such notice from the resident or the facility, order the transfer or discharge stayed and return such notice to the facility. Upon receipt of such returned notice, the facility shall issue a revised notice that meets the requirements of subsection (c) of this section.
(2) The resident, the resident's guardian, conservator, legally liable relative or other responsible party shall have an opportunity to examine, during regular business hours at least three business days prior to a hearing conducted pursuant to this section, the contents of the resident's file maintained by the facility and all documents and records to be used by the commissioner or the commissioner's designee or the facility at the hearing. The facility shall have an opportunity to examine during regular business hours at least three business days prior to such a hearing, all documents and records to be used by the resident at the hearing.
(3) If a hearing conducted pursuant to this section involves medical issues, the commissioner or the commissioner's designee may order an independent medical assessment of the resident at the expense of the Department of Social Services that shall be made part of the hearing record.
(4) In an emergency the notice required pursuant to subsection (c) of this section shall be provided as soon as practicable. A resident who is transferred or discharged on an emergency basis or a resident who receives notice of such a transfer or discharge may contest the action by requesting a hearing in writing not later than twenty days after the date of receipt of notice or not later than twenty days after the date of transfer or discharge, whichever is later, unless the resident demonstrates good cause for failing to request a hearing within the twenty-day period. A hearing shall be held in accordance with the requirements of this subsection not later than fifteen business days after the date of receipt of the request. The commissioner, or the commissioner's designee, shall issue a decision not later than thirty days after the date on which the hearing record is closed.
(5) Except in the case of a transfer or discharge effected pursuant to subdivision (4) of this subsection, (A) an involuntary transfer or discharge shall be stayed pending a decision by the commissioner or the commissioner's designee, and (B) if the commissioner or the commissioner's designee determines the transfer or discharge is being effected in accordance with this section, the facility may not transfer or discharge the resident prior to fifteen days from the date of receipt of the decision by the resident and the resident's guardian or conservator, if any, or the resident's legally liable relative or other responsible party if known.
(6) If the commissioner, or the commissioner's designee, determines after a hearing held in accordance with this section that the facility has transferred or discharged a resident in violation of this section, the commissioner, or the commissioner's designee, may require the facility to readmit the resident to a bed in a semiprivate room or in a private room, if a private room is medically necessary, regardless of whether or not the resident has accepted placement in another facility pending the issuance of a hearing decision or is awaiting the availability of a bed in the facility from which the resident was transferred or discharged.
(7) A copy of a decision of the commissioner or the commissioner's designee shall be sent to the facility and to the resident, the resident's guardian, conservator, if any, legally liable relative or other responsible party, if known. The decision shall be deemed to have been received not later than five days after the date it was mailed, unless the facility, the resident or the resident's guardian, conservator, legally liable relative or other responsible party proves otherwise by a preponderance of the evidence. The Superior Court shall consider an appeal from a decision of the Department of Social Services pursuant to this section as a privileged case in order to dispose of the case with the least possible delay.
(i) A resident who receives notice from the Department of Social Services or its agent that the resident is no longer in need of the level of care provided by a facility and that, consequently, the resident's coverage for facility care will end, may request a hearing by the Commissioner of Social Services in accordance with the provisions of section 17b-60. If the resident requests a hearing prior to the date that Medicaid coverage for facility care is to end, Medicaid coverage shall continue pending the outcome of the hearing. If the resident receives a notice of denial of Medicaid coverage from the department or its agent and also receives a notice of discharge from the facility pursuant to subsection (c) of this section and the resident requests a hearing to contest each proposed action, the department may schedule one hearing at which the resident may contest both actions.
(j) Whenever a facility is discharging a resident to the resident's home in the community, the discharge shall be in accordance with sections 19a-535c and 19a-535d.
(k) Except as otherwise provided pursuant to subdivision (3) of subsection (c) of this section, a facility shall electronically report each involuntary transfer or discharge to the State Ombudsman, appointed pursuant to section 17a-870, (1) in a manner prescribed by the State Ombudsman, and (2) on an Internet web site portal maintained by the State Ombudsman in accordance with patient privacy provisions of the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time.
(P.A. 76-331, S. 9, 16; P.A. 79-265, S. 1; P.A. 89-348, S. 1, 10; P.A. 93-262, S. 1, 87; 93-327, S. 2; 93-381, S. 9, 39; P.A. 94-236, S. 5, 10; P.A. 95-160, S. 2, 69; P.A. 96-139, S. 12, 13; June 18 Sp. Sess. P.A. 97-2, S. 115, 165; P.A. 99-176, S. 22, 24; P.A. 03-278, S. 124; P.A. 11-236, S. 1; P.A. 16-39, S. 18; 16-59, S. 3; P.A. 17-96, S. 20; P.A. 21-196, S. 28, 29; P.A. 22-57, S. 9; P.A. 23-48, S. 1, 3; P.A. 25-16, S. 7.)
History: P.A. 79-265 defined “self-pay” patient in Subsec. (a) and added reference to self-pay status, added provisions re minimizing disruptive effects of transfers or discharges and re provision of copies of discharge plan and added Subsec. (c); Sec. 19-616 transferred to Sec. 19a-535 in 1983; P.A. 89-348 inserted new Subsecs. (a), (b), (c), (g) and (h) re the transfer or discharge of patients, a patient's right to appeal a transfer or discharge decision and a patient's right to a hearing, relettering previously existing Subsecs. as necessary; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; P.A. 93-327 amended Subsec. (c) to permit notice no more than 60 days prior to transfer or discharge and amended Subsec. (f) to replace standard of imminent danger of death with “medically contraindicated”; P.A. 93-381 replaced commissioner of health services with commissioner of public health and addiction services, effective July 1, 1993; P.A. 94-236 amended Subsec. (b) to add requirements re transfer or discharge of a patient in a nursing facility which is part of a continuing care facility, effective June 7, 1994; P.A. 95-160 amended Subsec. (a) by replacing former definition of “nursing facility” with new definitions applicable to section, amended Subsec. (c) by allowing a facility to notify, in writing, or other responsible party, if known, of a patient transfer or discharge and by requiring additional information in the notice of transfer or discharge, deleted in Subsec. (h)(1) a provision allowing a patient notified of a transfer or discharge to request a hearing within 10 days of receipt of such notice and added requirement that commissioner provide notice to a patient within 5 business days of receipt of a notice of proposed transfer or discharge and specified the provisions such notice shall include, amended Subsec. (h)(2) by replacing the Commissioner of Public Health and Addiction Services with the Commissioner of Social Services, by extending the time for a hearing to be held from within 7 “business days” to not less than 10 but not more than 30 days of the date of such request, by requiring the commissioner to issue a written decision of his determination, by extending the time the commissioner has to issue such decision from within 20 days “of the termination of the hearing” to within 60 days “of the determination of the hearing” or within 90 days of the date of the hearing request, whichever occurs sooner and by adding a provision that the facility shall prove by a preponderance of the evidence that it has complied with the provisions of this section, added Subsec. (h)(3)and (4) re requirements for the patient to have the opportunity to examine the contents of such patient's file and re commissioner's authority to order an independent medical assessment for a hearing, amended Subsec. (h)(5) by deleting a provision allowing a facility, in an emergency, to request the commissioner to make a determination as to the need for an immediate transfer or discharge of a patient, by adding a provision providing that in an emergency, “notice required pursuant to subsection (c) of this section and subdivision (1) of this subsection shall be provided as soon as practicable”, by adding a definition of emergency and by adding a provision allowing a patient who is transferred or discharged on an emergency basis to contest the action by requesting a hearing, amended Subsec. (h)(6) by providing that an emergency transfer or discharge be excepted from this Subdiv. and by adding Subdiv. (B) prohibiting the transfer or discharge of a patient prior to 15 days from the receipt of the decision and added Subsec. (h)(7) requiring a copy of the decision of the commissioner be sent to the facility and made technical changes, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (c) by eliminating the requirement that the commissioner be notified by a facility of a transfer or discharge and requiring notification to include the procedures for the right to appeal, amended Subsec. (e) by adding transfer to a hospital or transfer into or out of a Medicare distinct part within the same institution to the exceptions in which a patient may be transferred or discharged unless a discharge plan has been developed and eliminating a requirement that the department be notified of an involuntary discharge if the patient receives payments under Title XIX of the federal Social Security Act, as amended, deleted Subsec. (h)(1) which required that the department notify the patient or his representative of any transfer or discharge action a facility plans to make, renumbered the remaining Subdivs. of Subsec. (h) and made technical and conforming changes, effective July 1, 1997; P.A. 99-176 amended Subsec. (c) to substitute “State Long-Term Care Ombudsman” for “state nursing home ombudsman” and to make provisions gender neutral, effective July 1, 1999; P.A. 03-278 made technical changes in Subsec. (c), effective July 9, 2003; P.A. 11-236 replaced “patient” with “resident” throughout, amended Subsec. (a) by deleting definition of “Medicare distinct part” and adding definition of “continuing care facility which guarantees life care for its residents” in Subdiv. (2), by redefining “transfer” in Subdiv. (3), by replacing “discharge” with “movement” and deleting reference to “another institution” in Subdiv. (4) and by adding Subdiv. (5) re definition of “self-pay resident” and Subdiv. (6) re definition of “emergency”, amended Subsec. (b) by adding provision allowing facility to transfer or discharge resident if required by Sec. 17b-359 or 17b-360 and restating Subdivs. (1) and (2), amended Subsec. (c) by designating existing provisions as Subdiv. (1) and amending same by adding provision re notice to specify dates by which appeal must be initiated in order to preserve right to appeal hearing and stay proposed transfer or discharge, deleting provision re 10 days to initiate appeal to stay transfer, adding provision requiring notice of an exception to date to appeal transfer or discharge for good cause and adding provision re notice of readmission policy when required under Sec. 19a-537, and by adding Subdiv. (2) re request for appeal to stay proposed transfer or discharge, amended Subsec. (d) by deleting definition of “self pay”, deleted former Subsec. (e)(3) re transfer into or out of Medicare distinct part, providing amended Subsec. (h)(1) by providing that exceptions apply in the case of emergency, replacing requirement that written decision be made within 60 days of termination of hearing or 90 days after date of hearing request with requirement that such decision be made not later than 30 days after termination of hearing or 60 days after hearing request, and adding provision requiring commissioner to return to facility a request for a hearing that does not comply with requirements of Subsec. (c), amended Subsec. (h)(4) by deleting definition of “emergency”, replacing provision allowing resident to request a hearing within 10 days after receipt of notice or date of transfer or discharge with provision allowing request not later than 20 days after transfer or discharge, adding exception for resident who fails for good cause to request a hearing within 20-day period, replacing requirement that hearing be held within 7 days after receipt of request with requirement that hearing be held not later than 15 days after receipt, and adding provision requiring commissioner to issue decision within 30 days after hearing is closed, added new Subsec. (h)(6) re readmitting resident where transfer or discharge violated provisions of section, redesignated existing Subsec. (h)(6) as Subsec. (h)(7), and amended same by adding requirement that decision be sent to resident and resident's representatives, added Subsec. (i) re request for hearing by resident whose coverage for facility care will end, and made technical and conforming changes, effective July 13, 2011; P.A. 16-39 amended Subsecs. (b) and (e) by adding references to advanced practice registered nurse and made technical changes; P.A. 16-59 added Subsec. (j) re discharging resident to home in community; P.A. 17-96 amended Subsec. (c) (1) by replacing reference to Office of Protection and Advocacy for Persons with Disabilities with reference to nonprofit entity designated to serve as Connecticut protection and advocacy system, effective July 1, 2017; P.A. 21-196 amended Subsec. (b) by adding reference to physician assistant and making a technical change and amended Subsec. (e) by adding reference to physician assistant; P.A. 22-57 added Subsec. (k) re involuntary transfer and discharge reporting, effective July 1, 2022; P.A. 23-48 amended Subsec. (c)(1) by adding provision re affirmation by facility that notice of proposed transfer or discharge has been provided to the State Long-Term Care Ombudsman, and added Subsec. (b)(3) re notification of State Long-Term Care Ombudsman of proposed involuntary transfer or discharge, effective June 16, 2023 and amended Subsec. (k) by adding reference to Subsec. (c)(3) and replacing “17a-405” with “17a-870”, effective June 13, 2023; P.A. 25-16 amended Subsec. (g) by adding provision requiring facilities to consider resident's proximity to family members and other support networks when assisting residents in finding appropriate placements, effective June 3, 2025.
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Sec. 19a-535a. Residential care homes. Transfer or discharge of patients. Appeal. Hearing. Reporting on involuntary transfers, discharges. (a) As used in this section:
(1) “Facility” means a residential care home, as defined in section 19a-490;
(2) “Emergency” means a situation in which a resident of a facility presents an imminent danger to the resident's own health or safety, the health or safety of another resident or the health or safety of an employee or the owner of the facility;
(3) “Department” means the Department of Public Health; and
(4) “Commissioner” means the Commissioner of Public Health, or the commissioner's designee.
(b) A facility shall permit each resident to remain in the facility, and not transfer or discharge a resident unless (1) the transfer or discharge is necessary to meet the resident's welfare and the resident's welfare cannot be met in the facility, (2) the transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility, (3) the health or safety of individuals in the facility is endangered, (4) the resident has failed, after reasonable and appropriate notice, to pay for a stay or a requested service at the facility, or (5) the facility ceases to operate.
(c) In the case of an involuntary transfer or discharge, the facility shall, in a form and manner prescribed by the commissioner, provide written notice to the resident and, if known, the resident's legally liable relative, guardian or conservator not less than thirty days prior to the proposed transfer or discharge date, except when the facility has requested an immediate transfer or discharge in accordance with subsection (f) of this section. Such notice shall include (1) the reason for the transfer or discharge, (2) the effective date of the transfer or discharge, (3) the location to which the resident will be transferred or discharged, (4) the right of the resident to appeal a transfer or discharge by the facility pursuant to subsection (e) of this section, (5) the resident's right to represent himself or herself or be represented by legal counsel, (6) the name, mailing address and telephone number of the State Long-Term Care Ombudsman, and (7) an attestation by the facility that such notice has been submitted to the Internet web site portal maintained by the State Ombudsman in accordance with subsection (h) of this section. Such notice shall be submitted to the Internet web site portal maintained by the State Ombudsman on the same day such notice is provided to the resident. If the facility knows the resident has, or the facility alleges that the resident has, a mental illness or an intellectual disability, the notice shall also include the name, mailing address and telephone number of the entity designated by the Governor in accordance with section 46a-10b to serve as the Connecticut protection and advocacy system. If any information provided in a notice provided pursuant to the provisions of this subsection changes prior to effecting the transfer or discharge of a resident, the facility shall update each recipient of the notice in writing as soon as practicable once the updated information becomes available. No resident shall be involuntarily transferred or discharged from a facility if such transfer or discharge presents imminent danger of death to the resident.
(d) The facility shall be responsible for assisting the resident in finding an alternative residence and, in providing such assistance, shall consider the resident's proximity to family members and any other known support networks. A discharge plan, prepared by the facility, in a form and manner prescribed by the commissioner, as modified from time to time, shall include the resident's individual needs and shall be submitted to the resident not later than seven days after the notice of transfer or discharge is issued to the resident. The facility shall submit the discharge plan to the commissioner at or before the hearing held pursuant to subsection (e) of this section.
(e) (1) A resident or the resident's legally liable relative, guardian or conservator who has been notified by a facility, pursuant to subsection (c) of this section, that the resident will be transferred or discharged from the facility may appeal such transfer or discharge to the Commissioner of Public Health by filing a request for a hearing with the commissioner (A) not later than ten days after the receipt of such notice, or (B) if the facility updates the location to which the resident will be transferred or discharged pursuant to subsection (c) of this section, not later than ten days after the receipt of such update, provided any involuntary transfer or discharge shall be stayed during such ten-day period. Upon receipt of any such request, the commissioner shall hold a hearing to determine whether the transfer or discharge is being effected in accordance with this section. Such a hearing shall be held not later than seven business days after the receipt of such request. The commissioner shall issue a decision not later than twenty days after the closing of the hearing record. The hearing shall be conducted in accordance with chapter 54.
(2) Any involuntary transfer or discharge that is appealed under this subsection shall be stayed pending a final determination by the commissioner.
(3) The commissioner shall send a copy of the decision regarding a transfer or discharge to the facility, the resident and the resident's legal guardian, conservator or other authorized representative, if known, or the resident's legally liable relative or other responsible party, and the State Long-Term Care Ombudsman.
(f) (1) In the case of an emergency, the facility may request that the commissioner make a determination as to the need for an immediate transfer or discharge of a resident by submitting a sworn affidavit attesting to the basis for the emergency transfer or discharge. The facility shall provide a copy of the request for an immediate transfer or discharge and the notice described in subsection (c) of this section to the resident. After receipt of such request, the commissioner may issue an order for the immediate temporary transfer or discharge of the resident from the facility. The temporary order shall remain in place until a final decision is issued by the commissioner, unless earlier rescinded. The commissioner shall issue the determination as to the need for an immediate transfer or discharge of a resident not later than seven days after receipt of the request from the facility. A hearing shall be held not later than seven business days after the date on which a determination is issued pursuant to this section. The commissioner shall issue a decision not later than twenty days after the date on which the hearing record is closed. The hearing shall be conducted in accordance with the provisions of chapter 54.
(2) The commissioner shall send a copy of the decision regarding an emergency transfer or discharge to the facility, the resident and the resident's legal guardian, conservator or other authorized representative, if known, or the resident's legally liable relative or other responsible party and the State Long-Term Care Ombudsman.
(3) If the commissioner determines, based upon the request, that an emergency does not exist, the commissioner shall proceed with a hearing in accordance with the provisions of subsection (e) of this section.
(g) A facility or resident who is aggrieved by a final decision of the commissioner may appeal to the Superior Court in accordance with the provisions of chapter 54. Pursuant to subsection (f) of section 4-183, the filing of an appeal to the Superior Court shall not, of itself, stay enforcement of an agency decision. The Superior Court shall consider an appeal from a decision of the commissioner pursuant to this section as a privileged case in order to dispose of the case with the least possible delay.
(h) A facility shall electronically report each involuntary transfer or discharge (1) in a manner prescribed by the State Ombudsman, appointed pursuant to section 17a-405, and (2) on an Internet web site portal maintained by the State Ombudsman in accordance with patient privacy provisions of the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time.
(P.A. 89-348, S. 2, 10; P.A. 90-230, S. 96, 101; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58; P.A. 97-112, S. 3; P.A. 22-57, S. 10; 22-58, S. 46; P.A. 25-16, S. 3.)
History: P.A. 90-230 added “and, if known, his legally liable relative, guardian or conservator” to Subsec. (b)(5); P.A. 93-381 replaced commissioner of health services with commissioner of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; P.A. 97-112 amended Subsec. (a) to redefine “facility” as a residential care home and replace reference to Sec. 19a-521 with Sec. 19a-490; P.A. 22-57 added Subsec. (e), codified by the Revisors as Subsec. (g), re involuntary transfer and discharge reporting, effective May 23, 2022; P.A. 22-58 amended Subsec. (a) by designating definition of “facility” as Subdiv. (1), adding Subdivs. (2) to (4) defining “emergency”, “department” and “commissioner” and making conforming changes, substantially revised Subsecs. (b) to (d) re transfers and discharges of residents, including revising and adding provisions re notice requirements, residents' right to representation, discharge plans and appeals of involuntary transfers or discharges and making technical and conforming changes, added Subsec. (e) re emergency transfers or discharges and added Subsec. (f) re appeals to Superior Court; P.A. 25-16 amended Subsec. (b) by adding provision requiring facilities to permit residents to remain in the facility unless the conditions in Subdivs. (1) to (5) are satisfied and extensively revising provisions re written notice of involuntary transfers or discharges, including, but not limited to, designating existing notice requirements as Subdivs. (1), (2), (4) and (5), adding new notice requirements in Subdiv. (3) re location to which resident will be transferred or discharged and Subdiv. (6) re notice of the contact information of State Ombudsman and adding provision requiring updating of information provided in the written notice, designated such existing and added written notice provisions as Subsec. (c), redesignated existing Subsec. (c) as Subsec. (d) and therein added provision re consideration of resident proximity to family members and support networks, redesignated existing Subsec. (d) as Subsec. (e) and therein designated existing provision in Subdiv. (1) re timing of appeal as Subpara. (A) and added provision re such timing in event of written notice update as Subpara. (B), redesignated existing Subsecs. (e) to (g) as Subsecs. (f) to (h) and made technical and conforming changes throughout.
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Sec. 19a-561. Nursing facility management services. Certification. Initial applications and biennial renewals. Investigation. Disciplinary action. (a) As used in this section, (1) “nursing facility management services” means services provided in a nursing facility to manage the operations of such facility, including the provision of care and services, (2) “nursing facility management services certificate holder” means a person or entity certified by the Department of Public Health to provide nursing facility management services, and (3) “managed facility” means a nursing facility that receives nursing facility management services from a nursing facility management services certificate holder.
(b) No person or entity shall provide nursing facility management services in this state without obtaining a certificate from the Department of Public Health.
(c) Any person or entity seeking a certificate to provide nursing facility management services shall apply to the department, in writing, on a form and in the manner prescribed by the department. Such application shall include the following:
(1) (A) The name and business address of the applicant and whether the applicant is an individual, partnership, corporation or other legal entity; (B) if the applicant is a partnership, corporation or other legal entity, the names of the officers, directors, trustees, managing and general partners of the applicant, the names of the persons who have a five per cent or greater beneficial ownership interest in the partnership, corporation or other legal entity, and a description of each such person's relationship to the applicant; (C) if the applicant is a corporation incorporated in another state, a certificate of good standing from the state agency with jurisdiction over corporations in such state; and (D) if the applicant currently provides nursing facility management services in another state, a certificate of good standing from the licensing agency with jurisdiction over public health for each state in which such services are provided;
(2) A description of the applicant's nursing facility management experience;
(3) An affidavit signed by the applicant and any of the persons described in subparagraph (B) of subdivision (1) of this subsection disclosing any matter in which the applicant or such person (A) has been 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 in a civil action by final judgment, if the felony or civil action involved fraud, embezzlement, fraudulent conversion or misappropriation of property, or (C) is subject to a currently effective injunction or restrictive or remedial order of a court of record at the time 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 applicant currently provides management services or has provided such 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:
(A) Three or more civil penalties imposed through final order of the commissioner in accordance with the provisions of sections 19a-524 to 19a-528, inclusive, or civil penalties imposed pursuant to the laws or regulations of another state during the two-year period preceding the date on which such application is submitted;
(B) Sanctions, other than civil penalties less than or equal to twenty thousand dollars, imposed in any state through final adjudication under the Medicare or Medicaid program pursuant to Title XVIII or XIX of the federal Social Security Act, 42 USC 301, as amended from time to time; or
(C) Termination or nonrenewal of a Medicare or Medicaid provider agreement.
(d) In addition to the information provided pursuant to subsection (c) of this section, the department may reasonably request to review the 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.
(e) Each application for a certificate to provide nursing facility management services shall be accompanied by an application fee of three hundred dollars. The certificate shall list each location at which nursing facility management services may be provided by the holder of the certificate. The nursing facility management services certificate holder shall request the approval of the Department of Public Health to provide nursing facility management services not later than thirty days in advance of providing services to a nursing facility not listed on its certificate. The department may grant said approval subject to conditions or deny such approval based upon the compliance with state and federal regulatory requirements by the nursing facilities managed by the holder of the certificate.
(f) The department shall base its decision on whether to issue or renew a certificate on the information presented and otherwise available to the department and on the compliance status of the managed facilities. The department may deny certification to any applicant for the provision of nursing facility management services (1) if the applicant fails to provide the information required under subsection (c) of this section, or (2) if the department determines that the applicant or a beneficial owner of the applicant has an unacceptable 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 preceding the date on which such application is submitted, as evidenced by:
(A) Any such licensed health care facility being subject to any adverse action described in subdivision (4) of subsection (c) of this section;
(B) Any such licensed health care facility having continuing violations or a pattern of violations of state licensure standards or federal certification standards; or
(C) Criminal conviction of, or a guilty plea by, an applicant or beneficial owner of an applicant on or to a charge of fraud, patient or resident abuse or neglect or a crime of violence or moral turpitude.
(g) Renewal applications shall be made biennially after (1) submission of the information required by subsection (c) of this section and any other information required by the department, and (2) submission of evidence satisfactory to the department that any nursing facility at which the applicant provides nursing facility management services has been and currently is in substantial compliance with federal regulatory requirements, the provisions of this chapter, the Public Health Code and licensing regulations, and (3) payment of a three-hundred-dollar fee.
(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 holder established under this section, the commissioner may initiate and impose disciplinary action against a nursing facility management services certificate holder pursuant to section 19a-494. If 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. The procedure for imposition of said penalty shall be in accordance with subsection (b) of section 19a-494.
(i) The department may limit or restrict the provision of management services by any nursing facility management services certificate holder against whom disciplinary action has been initiated under subsection (h) of this section.
(j) The department, in implementing the provisions of this section, may conduct any inquiry or investigation, in accordance with the provisions of section 19a-498, regarding an applicant or certificate holder.
(k) In any case in which the commissioner finds that there has been a substantial failure to comply with the requirements established under this chapter, or regulations adopted thereunder, the commissioner may require the nursing facility licensee and the nursing facility management services certificate holder to jointly submit a plan of correction as described in section 19a-496. A plan of correction accepted by the department shall constitute an order of the department. Violation of such order may be the subject of disciplinary action against a nursing facility management services certificate holder pursuant to section 19a-494.
(l) Any person or entity providing nursing facility management services without the certificate required under this section shall be subject to a civil penalty of not more than one thousand dollars for each day that the services are provided without such certificate.
(P.A. 06-195, S. 23; P.A. 07-252, S. 14; P.A. 10-117, S. 9; P.A. 14-231, S. 7; P.A. 24-141, S. 12; P.A. 25-39, S. 16.)
History: P.A. 06-195 effective July 1, 2006; P.A. 07-252 amended Subsec. (c)(3) by making technical changes and organizing existing provisions as Subparas. (A) to (D); P.A. 10-117 amended Subsec. (a) by defining “nursing facility management services certificate holder”, amended Subsec. (b) by deleting “On and after January 1, 2007”, redesignated existing Subsec. (c)(1) as Subsec. (c)(1)(A), added Subsec. (c)(1)(B) to (D) re additional information required of applicants, amended Subsec. (c)(3) by making conforming changes, amended Subsec. (c)(4) by adding “in this state or another state”, redesignated provision of existing Subsec. (f) re failure to comply with Public Health Code as Subsec. (f)(1), added Subsec. (f)(2) re failure to provide information required under Subsec. (c)(1), added Subsec. (j) re department's authority to conduct inquiry or investigation and added Subsec. (k) re civil penalty; P.A. 14-231 added new Subsec. (k) re plan of correction and redesignated existing Subsec. (k) as Subsec. (l); P.A. 24-141 amended Subsec. (a) by designating existing definitions of “nursing home facility management services” and “nursing facility management services certificate holder” as Subdivs. (1) and (2) and adding Subdiv. (3) defining “managed facility”, amended Subsec. (c) by adding “and in the manner”, replacing “ten per cent” with “five per cent” in Subdiv. (1)(B), substantially revising Subdiv. (4) re disclosure requirements, including adding provisions applying requirements to beneficial owners, and adding Subparas. (A) to (C) re disclosure of certain penalties or sanctions, amended Subsec. (e) by adding provisions re department approval to provide nursing facility management services, amended Subsec. (f) by adding “and otherwise available”, replacing “entities” with “facilities”, deleting existing Subdiv. (1) re denial of certification for failure to comply with Public Health Code, redesignating existing Subdiv. (2) as Subdiv. (1) and adding new Subdiv. (2) re department determination of unacceptable history of past and current compliance with certain requirements, amended Subsec. (g) by adding “has been and currently” and “federal regulatory requirements,” and deleting reference to Subsec. (d), amended Subsec. (h) by adding provisions re substantial failure of managed facilities to comply with state licensure, state regulatory or federal requirements, substantial failure by nursing facility management services certificate holder to comply with requirements and commissioner authority to impose civil penalties, amended Subsec. (k) by adding provision re plans of correction constituting orders of the department and violation of such plans subject to disciplinary action and made technical and conforming changes, effective June 4, 2024; P.A. 25-39 made a technical change in Subsec. (k).
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Sec. 19a-563h. Nursing homes. Minimum staffing level requirements. Regulations. (a) As used in this section, “direct care” means hands-on care provided by a registered nurse, licensed pursuant to chapter 378, licensed practical nurse, licensed pursuant to chapter 378, or a nurse's aide, registered pursuant to chapter 378a, to residents of nursing homes, as defined in section 19a-563, including, but not limited to, assistance with feeding, bathing, toileting, dressing, lifting and moving, administering medication, promoting socialization and personal care services, but does not include food preparation, housekeeping, laundry services, maintenance of the physical environment of the nursing home or performance of administrative tasks.
(b) On or before January 1, 2022, the Department of Public Health shall (1) establish minimum staffing level requirements for nursing homes of three hours of direct care per resident per day, and (2) modify staffing level requirements for social work and recreational staff of nursing homes such that the requirements (A) for social work, a number of hours that is based on one full-time social worker per sixty residents and that shall vary proportionally based on the number of residents in the nursing home, and (B) for recreational staff are lower than the current requirements, as deemed appropriate by the Commissioner of Public Health.
(c) The Commissioner of Public Health shall adopt regulations in accordance with the provisions of chapter 54 that set forth nursing home staffing level requirements to implement the provisions of this section. The commissioner may implement policies and procedures necessary to administer the provisions of this section while in the process of adopting such policies and procedures as regulations, provided notice of intent to adopt regulations is published on the eRegulations System not later than twenty days after the date of implementation. Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are adopted.
(P.A. 21-185, S. 10; P.A. 22-58, S. 36; P.A. 24-19, S. 31; P.A. 25-97, S. 32.)
History: P.A. 22-58 amended Subsec. (a) by adding provision re proportional staffing of full-time social workers and making conforming changes and amended Subsec. (b) by adding provision re commissioner's authority to implement policies and procedures while in the process of adopting regulations, effective May 23, 2022; P.A. 24-19 added new Subsec. (a) defining “direct care” and redesignated existing Subsecs. (a) and (b), as Subsecs. (b) and (c), effective May 21, 2024; P.A. 25-97 amended Subsec. (c) by making technical changes.
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Sec. 19a-563i. Provision and maintenance of an automated external defibrillator by nursing homes and managed residential communities. (a) As used in this section:
(1) “Automated external defibrillator” means a device that: (A) Is used to administer an electric shock through the chest wall to the heart; (B) contains internal decision-making electronics, microcomputers or special software that allows it to interpret physiologic signals, make medical diagnoses and, if necessary, apply therapy; (C) guides the user through the process of using the device by audible or visual prompts; and (D) does not require the user to employ any discretion or judgment in its use;
(2) “Managed residential community” means a for-profit or not-for-profit facility consisting of private residential units that provides a managed group living environment consisting of housing and services for persons who are primarily fifty-five years of age or older. “Managed residential community” does not include (A) any state-funded congregate housing facility, (B) any elderly housing complex receiving assistance and funding through the United States Department of Housing and Urban Development's Assisted Living Conversion Program, or (C) any affordable housing unit subsidized under the assisted living demonstration project established pursuant to section 17b-347e; and
(3) “Nursing home” means (A) any chronic and convalescent nursing home or any rest home with nursing supervision that provides nursing supervision under a medical director twenty-four hours per day; or (B) any chronic and convalescent nursing home that provides skilled nursing care under medical supervision and direction to carry out nonsurgical treatment and dietary procedures for chronic diseases, convalescent stages, acute diseases or injuries.
(b) Not later than January 1, 2026, the administrator of each nursing home and each managed residential community shall (1) provide and maintain an automated external defibrillator in a central location on the premises of the nursing home or managed residential community, (2) make such central location known and accessible to staff members and residents of the home or community and family members of such residents who visit the home or community, and (3) maintain and test the automatic external defibrillator in accordance with the manufacturer's guidelines.
(P.A. 25-168, S. 179.)
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Sec. 19a-564. Assisted living services agencies. Licensure. Dementia special care approval. Regulations. (a) The Commissioner of Public Health shall license assisted living services agencies, as defined in section 19a-490. A managed residential community wishing to provide assisted living services shall become licensed as an assisted living services agency or shall arrange for assisted living services to be provided by another entity that is licensed as an assisted living services agency.
(b) A managed residential care community that intends to arrange for assisted living services shall only do so with a currently licensed assisted living services agency. Such managed residential community shall submit an application to arrange for the assisted living services to the Department of Public Health in a form and manner prescribed by the commissioner.
(c) An elderly housing complex receiving assistance and funding through the United States Department of Housing and Urban Development's Assisted Living Conversion Program that intends to arrange for assisted living services may do so with a currently licensed assisted living services agency. Such elderly housing complex shall inform the Department of Public Health of the arrangement upon request in a form and manner prescribed by the commissioner and shall not be required to register with the department as a managed residential community.
(d) An assisted living services agency providing services as a dementia special care unit or program, as defined in section 19a-562, shall obtain approval for such unit or program from the Department of Public Health. Such assisted living services agencies shall ensure that they have adequate staff to meet the needs of the residents. Each assisted living services agency that provides services as a dementia special care unit or program, as defined in section 19a-562, shall submit to the Department of Public Health a list of dementia special care units or locations and their staffing plans for any such units and locations when completing an initial or a renewal licensure application, or upon request from the department.
(e) An assisted living services agency shall: (1) Ensure that all services being provided on an individual basis to clients are fully understood and agreed upon between either the client or the client's representative; (2) ensure that the client or the client's representative is made aware of the cost of any such services; (3) disclose fee increases to a resident or a resident's representative not later than sixty days prior to such fees taking effect; and (4) provide, upon request, to a resident and a resident's representative the history of fee increases over the past three calendar years. Nothing in this subsection shall be construed to limit an assisted living services agency from immediately adjusting fees to the extent such adjustments are directly related to a change in the level of care or services necessary to meet individual resident safety needs at the time of a scheduled resident care meeting or if a resident's change of condition requires a change in services.
(f) The Department of Public Health may adopt regulations, in accordance with the provisions of chapter 54, to carry out the purposes of this section.
(g) An assisted living services agency may provide services that include, but need not be limited to, nursing services and assistance with activities of daily living to an individual who is no longer chronic and stable if (1) such individual is under the care of a licensed home health care agency or licensed hospice agency, or (2) such assisted living services agency is arranging, in conjunction with a managed residential community in accordance with subdivision (3) of subsection (a) of section 19a-694, for the provision of ancillary medical services on behalf of such individual, including physician and dental services, pharmacy services, restorative physical therapies, podiatry services, hospice care and home health agency services.
(P.A. 21-121, S. 56; P.A. 22-58, S. 54; P.A. 23-31, S. 2; P.A. 24-141, S. 9; P.A. 25-97, S. 33.)
History: P.A. 21-121 effective July 1, 2021; P.A. 22-58 added new Subsec. (c) re elderly housing complexes intending to arrange for assisted living services and redesignated existing Subsecs. (c) to (e) as Subsecs. (d) to (f), effective July 1, 2022; P.A. 23-31 added Subsec. (g) re provision of assisted living services to individuals who are no longer chronic and stable, effective June 7, 2023; P.A. 24-141 amended Subsec. (e) by adding Subdiv. (3) re fee increase disclosure, adding Subdiv. (4) re history of fee increases for prior 3 calendar years, adding provision re immediate fee adjustments related to changes in level of care and making technical and conforming changes; P.A. 25-97 amended Subsec. (e) by making a technical change.
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Sec. 19a-565. (Formerly Sec. 19a-30). Clinical laboratories, blood collection facilities and source plasma donation centers. Regulation and licensure. Proficiency standards for tests not performed in laboratories. Prohibitions. Penalties. Regulations. (a) As used in this section, “business entity” means a corporation, association, trust, estate, partnership, limited partnership, limited liability partnership, limited liability company, sole proprietorship, joint stock company, nonstock corporation, John Dempsey Hospital and The University of Connecticut Health Center.
(b) The Department of Public Health shall adopt regulations, in accordance with the provisions of chapter 54, governing clinical laboratories, blood collection facilities and source plasma donation centers. Such regulations shall establish reasonable standards for entities exempt from licensure as a clinical laboratory, operations and facilities, personnel qualifications and certification, levels of acceptable proficiency in testing programs approved by the department, the collection, acceptance and suitability of specimens for analysis and such other pertinent laboratory functions, including the establishment of advisory committees, as may be necessary to ensure public health and safety. Such regulations shall provide that a responsible physician, as defined in 21 CFR 630.3, as amended from time to time, may serve as the director of a blood collection facility or source plasma donation center. On or before October 1, 2023, the Commissioner of Public Health shall implement policies and procedures necessary to administer the provisions of this section while in the process of adopting such policies and procedures as regulations, provided the department posts such policies and procedures on the eRegulations System prior to adopting them. On or before October 1, 2024, the commissioner shall update the department's policies and procedures to include policies and procedures consistent with the provisions of this subsection. Policies and procedures implemented pursuant to this section shall be valid until final regulations are adopted in accordance with the provisions of chapter 54.
(c) No person or business entity shall establish, conduct, operate or maintain a clinical laboratory, blood collection facility or source plasma donation center unless such laboratory, facility or center is licensed or approved by said department in accordance with its regulations. Each blood collection facility or plasmapheresis center, as defined in section 19a-36-A47 of the regulations of Connecticut state agencies, that is registered with the department on or before October 1, 2023, shall apply to the department for an initial license pursuant to the provisions of this section not later than thirty days after the date that procedures for such licensure are implemented by the department pursuant to subsection (b) of this section. On and after the date on which procedures for licensure are implemented by the department pursuant to the provisions of said subsection, the department shall not renew any blood collection facility or plasmapheresis center registration. Each clinical laboratory, blood collection facility or source plasma donation center shall comply with all standards for such facilities established by the department and shall be subject to inspection by said department, including inspection of all records necessary to carry out the purposes of this section.
(d) Each initial or renewal application for licensure of a clinical laboratory, blood collection facility or source plasma donation center shall be made in a form and manner prescribed by the commissioner and shall be executed by the owner or owners or by a responsible officer of the firm or corporation owning such laboratory, facility or donation center and be accompanied by the fee required pursuant to the provisions of subsection (f) of this section. A mobile or temporary blood collection facility shall not be required to obtain a license if such person or business entity operating such facility is licensed as a blood collection facility. A licensed source plasma donation center shall not be required to obtain a clinical laboratory license to perform any pre-donation screening test required by Title 21, Chapter I of the Code of Federal Regulations. A hospital licensed under this chapter shall not be required to obtain a license as a blood collection facility for blood component collection activities that take place on the hospital campus, as defined in section 19a-508c.
(e) After the department receives an initial or renewal application for licensure pursuant to subsection (d) of this section, it shall conduct any inspections or investigations that are deemed necessary by the commissioner to determine the applicant's eligibility for licensure. As a condition of licensure, the commissioner may require the applicant to sign a consent order providing reasonable assurances of compliance with federal and state laws and regulations. The commissioner may deny licensure of an applicant if the commissioner determines that the applicant has previously failed to comply with federal and state laws and regulations or that licensure would pose a threat to the health, safety and well-being of the public. Licensure pursuant to the provisions of this section shall not be effective until the applicant receives notice of such licensure, including the effective date and term of such licensure, from the department.
(f) A nonrefundable fee of two hundred dollars shall accompany each application for a license or for renewal thereof, except in the case of a clinical laboratory owned and operated by a municipality, the state, the United States or any agency of said municipality, state or United States. Each license shall be issued for a period of not less than twenty-four months. Renewal applications shall be made biennially within the twentieth month of the current license. Any change in ownership of an entity licensed pursuant to the provisions of this section shall be made in compliance with section 19a-493. If any such entity changes its director, it shall notify the commissioner in a form and manner prescribed by the commissioner. If any such entity intends to expand or alter its facility, it shall notify the commissioner in a form and manner prescribed by the commissioner prior to such expansion or alteration. The licensed clinical laboratory shall report to the Department of Public Health, in a form and manner prescribed by the commissioner, the name and address of each specimen collection facility owned and operated by the clinical laboratory, prior to the issuance of a new license, prior to the issuance of a renewal license or whenever a specimen collection facility opens or closes.
(g) A license issued under this section may be revoked or suspended in accordance with chapter 54 or subject to any other disciplinary action specified in section 19a-494 if the licensed clinical laboratory, blood collection facility or source plasma donation center has engaged in fraudulent practices, fee-splitting inducements or bribes, including, but not limited to, in the case of a clinical laboratory, violations of subsection (h) of this section, or violated any other provision of this section or regulations adopted under this section after notice and a hearing is provided in accordance with the provisions of said chapter.
(h) No representative or agent of a clinical laboratory shall solicit referral of specimens to his or any other clinical laboratory in a manner which offers or implies an offer of fee-splitting inducements to persons submitting or referring specimens, including inducements through rebates, fee schedules, billing methods, personal solicitation or payment to the practitioner for consultation or assistance or for scientific, clerical or janitorial services.
(i) No clinical laboratory, blood collection facility or source plasma donation center shall terminate the employment of an employee because such employee reported a violation of this section to the Department of Public Health.
(j) Any person or business entity operating a clinical laboratory, blood collection facility or source plasma donation center in violation of this section shall be fined not less than one hundred dollars or more than three hundred dollars for each offense. For purposes of calculating civil penalties under this section, each day a licensee operates in violation of this section or a regulation adopted under this section shall constitute a separate violation.
(k) The Commissioner of Public Health shall adopt regulations in accordance with the provisions of chapter 54 to establish levels of acceptable proficiency to be demonstrated in testing programs approved by the department for those laboratory tests which are not performed in a licensed clinical laboratory. Such levels of acceptable proficiency shall be determined on the basis of the volume or the complexity of the examinations performed.
(1961, P.A. 514; P.A. 76-272; P.A. 77-275; 77-614, S. 323, 587, 610; P.A. 78-303, S. 85, 136; P.A. 79-421, S. 1, 2; P.A. 83-200; P.A. 93-381, S. 9, 39; P.A. 94-174, S. 3, 12; P.A. 95-257, S. 12, 21, 58; June Sp. Sess. P.A. 09-3, S. 164; P.A. 15-242, S. 14; P.A. 21-121, S. 39; P.A. 22-58, S. 23; P.A. 23-31, S. 9; P.A. 24-7, S. 1; P.A. 25-96, S. 9.)
History: P.A. 76-272 made previous provisions Subsecs. (a) to (c) and (e), substituted definition of “clinical laboratory” for “private clinical laboratory”, specified areas of operation governed by regulations, replaced registration with licensure, required that facilities be open to inspection by health department, removed provision re commissioner's right to “enjoin the operation” of facilities in violation of provisions, inserted new Subsec. (d) re license fees, renewals, etc., imposed minimum fine of $100, raised maximum fine from $100 to $300 and removed provisions that each day of continued violation constitutes separate offense; P.A. 77-275 excluded facilities of dentists and podiatrists from consideration as clinical laboratory and made their exemption contingent upon filing affidavit, specifically allowed inspection of records in Subsec. (b), required that license application contain itemized rate schedule and disclosure of contractual relationships with physicians, inserted new Subsecs. (e) to (h) re revocation or suspension of license, solicitation of referrals, protection of employees reporting violations and required affidavits and relettered former Subsec. (e) as Subsec. (i); P.A. 77-614 and P.A. 78-303 replaced department of health with department of health services, effective January 1, 1979; P.A. 79-421 replaced “licensed practitioner of a healing art or a licensed dentist or podiatrist” with reference to practitioners licensed under specific chapters and included exemption for facilities which meet exemption standards in Public Health Code re volume or complexity of examinations in Subsec. (a), included regulations governing “exemptions from licensing provisions” in Subsec. (b), included certificates of approval in provisions and broadened Subsec. (h) to allow for broadened exemptions in Subsec. (a); Sec. 19-9a transferred to Sec. 19a-30 in 1983; P.A. 83-200 added Subsec. (j) to establish proficiency levels for laboratory tests not performed in a licensed clinical laboratory; P.A. 93-381 replaced department and commissioner of health services with department and commissioner of public health and addiction services, effective July 1, 1993; P.A. 94-174 added testing for the presence of drugs, poisons and toxicological substances to the list of facility uses and removed the exception for laboratories in practitioners offices in definition of “clinical laboratory”, deleted references to certificates of approval and deleted Subsec. (h) which had required practitioners exempted from licensing requirements to file affidavits as to qualifications of persons performing tests and number and type of tests performed, relettering remaining Subsecs. accordingly, effective June 6, 1994; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995; June Sp. Sess. P.A. 09-3 amended Subsec. (d) to increase fee from $100 to $200 and made a technical change in Subsec. (h); P.A. 15-242 amended Subsec. (a) to delete references to Public Health Code, add reference to provisions of Ch. 54 and add provisions re inquiry, investigation or hearing, amended Subsec. (d) to add “clinical” re laboratory and add “established by the commissioner” re applications, amended Subsec. (e) to add reference to other disciplinary action specified in Sec. 19a-17 and regulations adopted under section and amended Subsec. (h) to add provisions re calculating civil penalties; P.A. 21-121 amended Subsec. (d) by adding provision re reporting of name and address of blood collection facilities, effective July 1, 2021; P.A. 22-58 amended Subsec. (a) by redefining “clinical laboratory”; Sec. 19a-30 transferred to Sec. 19a-565 in 2023; P.A. 23-31 added references to blood collection facilities and source plasma donation centers throughout, replaced references to firms or corporations with “business entity” throughout, amended Subsec. (a) by deleting definition of “clinical laboratory” and defining “business entity”, substantially revised Subsec. (b) re regulations, including by requiring regulation requiring onsite presence of registered nurse or advanced practice registered nurse, and adding provision re policies and procedures, designated existing provisions re licensure requirement for clinical laboratories in Subsec. (b) as new Subsec. (c), substantially revised new Subsec. (c), including by adding provisions re applications for initial licensure and deleting provisions re investigations, hearings and subpoenas, redesignated existing Subsec. (c) as new Subsec. (d)and substantially revised same by adding references to initial or renewal applications, deleting provision re laboratories located in institutions, replacing “on forms provided by said department” with “in a form and manner prescribed by the commissioner”, deleting existing provisions re contents of application and inspections and investigations after submission of application, and adding provisions re application fee and licensure exemptions, added new Subsec. (e) re inspections and investigations after submission of application, redesignated existing Subsec. (d) as new Subsec. (f) and amended same by deleting “nor more than twenty-seven” and “from the deadline for applications established by the commissioner”, replacing “twenty-fourth month” with “twentieth month”, deleting Subdivs. (2) and (3), adding provisions re changes of ownership and expansions and alterations to facilities, and replacing “blood collection facility” with “specimen collection facility”, redesignated existing Subsec. (e) as new Subsec. (g), redesignated existing Subsecs. (f) to (i) as new Subsecs. (h) and (i) and Subsecs. (j) and (k), and made technical and conforming changes throughout (Revisor's note: In new Subsec. (d), an incorrect reference to “chapter 386v” was deemed by the Revisors to be a reference to “chapter 368v” and changed editorially to “this chapter”); P.A. 24-7 amended Subsec. (b) by deleting provision re regulations to include requirement that registered nurse or advanced practice registered nurse be onsite during hours of operation of blood collection facility or source plasma donation center, adding provision requiring regulations to include provision allowing responsible physician to serve as director of blood collection facility or source plasma donation center and adding provision requiring commissioner to update department policies and procedures, effective May 9, 2024; P.A. 25-96 amended Subsec. (g) by replacing reference to Sec. 19a-17 with reference to Sec. 19a-494, effective June 24, 2025.
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Sec. 19a-567. Adverse credentialing or privileging action based on provision of reproductive health care services or gender-affirming health services prohibited. (a) As used in this section, (1) “credentialing” means the process of assessing and validating the qualifications of a health care provider applying to be approved to provide treatment, care or services in or for an institution, (2) “health care provider” means a person licensed pursuant to title 20 who provides reproductive health care services or gender-affirming health care services, (3) “institution” has the same meaning as provided in section 19a-490, (4) “privileging” means the process of authorizing a health care provider to provide specific treatment, care or services at an institution, and (5) “reproductive health care services” and “gender-affirming health care services” have the same meanings as provided in section 52-571m.
(b) An institution shall not revoke, suspend, reprimand, penalize, refuse to issue or renew credentials or privileges or take any other adverse action against a health care provider with respect to credentialing or privileging based solely on the alleged provision of, receipt of, assistance in provision or receipt of, material support for, or any theory of vicarious, joint, several or conspiracy liability derived therefrom, reproductive health care services or gender-affirming health care services that (1) are permitted under the laws of this state, (2) were provided in accordance with the standard of care applicable to such services, and (3) were provided by the health care provider (A) before the date on which the health care provider entered an employment relationship with the institution, or (B) outside the scope of the health care provider's employment with the institution, regardless of whether the patient receiving such services was a resident of this state.
(c) An institution shall not revoke, suspend, reprimand, penalize, refuse to issue or renew credentials or privileges or take any other adverse action against a health care provider based on pending disciplinary action, an unresolved complaint or the imposition of disciplinary action against the applicant by a duly authorized professional disciplinary agency of another state, the District of Columbia, or a commonwealth, territory or possession of the United States that is based solely on the alleged provision of, receipt of, assistance in provision or receipt of, material support for, or any theory of vicarious, joint, several or conspiracy liability derived therefrom, reproductive health care services or gender-affirming health care services that (1) are permitted under the laws of this state, (2) were provided in accordance with the standard of care applicable to such services, and (3) were provided by the health care provider (A) before the date on which the health care provider entered an employment relationship with the institution, or (B) outside the scope of the health care provider's employment with the institution, regardless of whether the patient receiving such services was a resident of this state.
(d) The provisions of this section shall not be construed to prevent an institution from taking any of the actions described in subsections (b) and (c) of this section against a health care provider for conduct that (1) does not conform to the standards of care for the provider's profession, (2) is illegal under the laws of this state, or (3) violates policies or rules of the institution that define the scope of services provided by the institution if (A) such conduct occurs within the scope of the health care provider's employment with, or delivery of care at, the institution, and (B) the institution's enforcement of such policies or rules is not otherwise prohibited by law or regulation.
(P.A. 23-128, S. 3; P.A. 25-168, S. 280.)
History: P.A. 23-128 effective June 27, 2023; P.A. 25-168 added references to gender-affirming health care services throughout and made technical changes, effective July 1, 2025.
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