Public Health Committee
JOINT FAVORABLE REPORT
Bill No.: SB-922
AN ACT CONCERNING REVISIONS TO THE STATUTES PERTAINING TO
Title: DISCHARGES IN A RESIDENTIAL CARE HOME.
Vote Date: 3/12/2021
Vote Action: Joint Favorable
PH Date: 3/3/2021
File No.: 188
Disclaimer: The following JOINT FAVORABLE Report is prepared for the benefit of the
members of the General Assembly, solely for purposes of information, summarization and
explanation and does not represent the intent of the General Assembly or either chamber
thereof for any purpose.
SPONSORS OF BILL:
The Public Health Committee
REASONS FOR BILL:
To modify requirements for the involuntary discharge of residential care home (RCH)
residents to allow RCHs to qualify as Medicaid home and community-based settings.
Among other things:
SB 922 requires the written discharge notice that RCHs provide to residents and their
representatives to include contact information for the long-term care ombudsman, and for
residents with mental illness or intellectual disability, the contact information for Disability
Rights Connecticut.
The bill also requires RCHs to provide residents with a discharge plan for alternate residency
within seven days after issuing the discharge notice and submit it to the Department of Public
Health (DPH) in the case of an appeal. It requires the DPH to decide on RCHs request for
immediate emergency transfers within 20 days after a hearing and to send a copy of the
determination to the resident, the residents representative, and the long-term care
ombudsman.
It also allows RCHs or resident aggrieved by a DPH decision to appeal to the Superior Court
and requires the court to consider the appeal a privileged case in order to dispose of it with
the least possible delay.
RESPONSE FROM ADMINISTRATION/AGENCY:
The Connecticut Department of Public Health (DPH):
The Department of Public Health (DPH) supports SB 922 which would allow Residential Care
Home (RCH) to qualify as a home and community-based setting under federal regulations
and enhance the rights of their residents experiencing involuntary transfer or discharge. As
stated in the testimony, currently there are over 260 RCH residents receiving Medicaid
services under the Connecticut Home Care Program for Elders waiver. Guaranteeing
Connecticut's RCHs qualifies as home and community-based setting will help them to retain
their home and community-based services. Current Statutes affords residents living in RCHs
comparable protections as those afforded to tenants under the states landlord tenant law,
regarding an involuntary discharge. This legislation will also enhance the appeal rights of
RCH residents who are notified of a pending transfer or discharge.
Additionally, stated in the testimony, through the collective work of DPH, Department of
Social Services, Office of Policy and Management, State Long Term Care Ombudsman,
Connecticut Legal Services and representatives of the RCHs, this proposal will:
guarantee written discharge notice thirty days prior to the discharge date which will
allow the resident to receive information about their rights to appeal such discharge
along with a discharge plan for an alternative residency;
ensure the resident or the resident's representative will have ten days from the receipt
of the notice to request a hearing to appeal the discharge notice;
require the Department to hold a hearing within seven days of receiving the appeal
request and to issue a decision within twenty days after the conclusion of the hearing;
require a discharge plan to be prepared by the facility, in a form and manner
prescribed by the Commissioner, as modified from time to time. An RCH will be
required to provide the discharge plan to the resident, and if a hearing is held, to
submit the plan to DPH on or before the hearing;
require an RCH to provide notice of the involuntary discharge to the Office of the Long-
Term Care Ombudsman and, where appropriate, to the entity designated by the
Governor to serve as the Connecticut protection and advocacy system;
allow a facility or resident who is aggrieved by the final decision of the Commissioner
to appeal the decision to the Superior Court. The Superior Court shall consider such
an appeal as a privileged case in order to dispose of the case with the least possible
delay.
Mairead Painter, State Long-Term Care Ombudsman, Department of Aging and
Disability Services (LTCOP):
The LTCOP supports this legislation because it offers enhanced protections for residents of
Residential Care Homes (RCHs). Requiring notice to their program will allow an opportunity
for the offices Regional Ombudsman (RO) to intervene and support residents of RCHs to
avoid discharge.
As outlined in the testimony, the language in SB 922 provides the necessary protections to
the residents of RCHs against the potential loss of their home. Its passage will take LTCOP a
step forward as our state continue its works to help RCHs transition to qualified Home and
Community Based Settings (HCBS). Ms. Painter wrote. "I believe that moving in this direction
will reduce the need for involuntary discharges and improve the quality of life for the residents
of these homes."
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The Department of Social Services (DSS):
DSS supports this legislation and recognizes that Residential Care Homes (RCHs) have
been longstanding partners in the continuum of long-term services and supports in
Connecticut. Historically, RCHs have been reimbursed exclusively through state funding but
DSS and RCHs believe funding should be increase for this important level of care. Passage
of this bill will help qualify some of the services provided by RCHs for federal Medicaid
reimbursement. As stated in the testimony, in their effort to achieve this goal, DSS and the
Department of Public Health (DPH) collaborated on language to amend current law to
conform to federal regulation that requires all settings in which people receiving Medicaid-
funded home and community-based services must meet a range of requirements that
promote choice, privacy and community integration. One of these requirements obligates
Medicaid programs to ensure that residents of various types of congregate housing have
comparable protections to those provided to tenants under states landlord-tenant laws.
In addition, as stated in the testimony, the passage of S.B. 922 will:
allow RCHs to qualify as home and community-based settings under federal
regulations;
promote fairness and consistency in responding to emerging issues such as violation
of RCH rules, threatening or disruptive behavior, and/or nonpayment of rent;
reduce transfers and discharges, as well as the number of readmissions that result
from Appeals;
support DSS Plan to claim for services that are currently being provided by RCHs
(medication administration and personal care support, including laundry,
housekeeping, personal care assistance or cueing to complete activities of daily living)
for Federal Medicaid Reimbursement;
enable RCH residents to receive care management and services under Medicaid
Waivers (E.G., The Connecticut Home Care Program for Elders and the Department of
Mental Health and Addiction Services Mental Health Waiver);
increase census at RCHs as a result of new capacity to wrap Medicaid-Funded
services around the current level of Supports provided by RCH. Approximately 217
individuals in sixty-seven distinct settings currently reside in RCHs and receive
Medicaid Services under the Connecticut Home Care Program for Elders Waiver.
NATURE AND SOURCES OF SUPPORT:
Mag Morelli, President, LeadingAge Connecticut:
Mag Morelli, President of LeadingAge Connecticut, offers support of this bill. As outline in the
written testimony, SB 922 supports Connecticut's effort to qualify RCH setting as a Centers
for Medicare & Medicaid Services (CMS) approved home and community-based setting for
the purpose of allowing Medicaid waiver services to be delivered to residents of Residential
Care Home (RCH). It will also change the process for transfer and discharge of residents in
licensed RCHs.
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LeadingAge represents eleven non-profit RCHs and are in strong support of the States
efforts to qualify RCHs as CMS approved home and community base settings. This setting is
both supportive and affordable and can be a valuable community-based housing option for
those choosing to receive Medicaid funded home and community-based services.
Included in the testimony it states, "several stakeholders worked with the Administration to
draft language to revise the existing transfer and discharge process to comply with CMS
rules, which includes an appeal process like those of the landlord tenant law. There are still
some issues that we hope to resolve with the Administration and the Department of Public
Health. We are hopeful that the current efforts will result in a solution that is agreed on by all
parties."
NATURE AND SOURCES OF OPPOSITION:
Penny Lore, Administrator, Parsonage Cottage Senior Residence located in
Greenwich, CT:
Parson Cottage Senior Residence is a 40-room senior home providing supportive services to
the elderly for over 20 years. This bill would add a costly layer of appeals on a discharge
process that already has significant challenges. As stated in the testimony, "we have had less
than 5 incidents of involuntary discharge. This action is only taken to prevent harm to the
resident, other residents, and staff. The proposed discharge policy will influence our future
admission process." Overall, due to this, Parsonage Cottage Senior Residence is opposed to
the passage of this bill.
Mary Hagerty, RN, BSN, Owner/Administrator, Four Corners Rest Home Inc.:
Four Corners Rest Home is an 18-bed home that has been in existence for 47 years. They
offer written testimony in opposition to the passage of this bill. As stated in the testimony, "we
maintain a stable mental and physical well-being home setting. Ninety percent of our
residents have mild to severe mental health issues that require monitoring and guidance that
the individual and families cannot provide on their own. We are concern with this proposal
because it would add a costly layer of appeals and a lengthy discharge process."
Carmine Castiglione, Owner/Manager, Garden Brook Residential Care Home:
Garden Brook Residential Care Home operates a 16 room, 22 licensed facility located in
Watertown, Connecticut. Their community includes clients with a physical, mental or
substance abuse disability and older adults that are not able to live alone in a safe
environment. They are opposed to this legislation as it "would change the landscape of RCHs
and many would not be able to keep their resident safe. This would be a costly layer of
appeals. Residential care homes are small communal living arrangement that are sometimes
older homes with shared areas that does not allow for separation disruptive clients." It is also
acknowledged in this written testimony that families of residents would not be in favor of this
proposal. Garden Residential Care Home is opposed to the passage of this bill.
Kal Patel, Past President, Connecticut Association of Residential Care Homes
(CARCH): CARCH offers written testimony in opposition to the passage of this bill. As stated
in their testimony, CARCH has been in discussions with the Office of Policy and
Management, Department of Public Health (DPH) and Department of Social Services (DSS)
for several years on how our model of care could be considered a Home and Community-
Based Model under federal regulations. "Although we had proposed a two-tiered model,
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which unfortunately is not included in SB 922. Extending the landlord/ tenant laws to our
residents and requiring appeals to go through Superior Court could take up to a year after the
DPH renders its decision. We strongly recommend that DSS or another agency handles final
appeals in order to allow for a comparable appeal process while avoiding a costly delay."
Additionally, federal regulations do not require an exact procedure to the landlord/tenant law.
The following 2020 CMS email to DSS was quoted in the testimony: In terms of compliance
with the settings criteria, CMS requires that the state assure that the agreement provides
protections that address eviction processes and appeals that are comparable to those
provided under the jurisdictions landlord tenant law.
Reported by: Beverley Henry Date: 04/02/2021
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Statutes affected:
Raised Bill:
PH Joint Favorable:
File No. 188: