§ 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.

Connecticut § 19a-533

• Jurisdiction: Connecticut
• Title 19a: Public Health and Well-Being
• Ch. 368v: Health Care Institutions

Text

(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; and (2) “indigent person” means any person who is eligible for or who is receiving medical assistance benefits from the state. (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, or (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. 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. See Sec. 17a-870 et seq. re Office of Long-Term Care Ombudsman and residents' advocates.

Legislative History

(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.) 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.