SB 123

Substitute Senate Bill No. 123
  Public Act No. 26-74
AN ACT CONCERNING PUBLIC HEARINGS FOR CERTAIN RATE
INCREASES AT ASSISTED LIVING FACILITIES, MUNICIPAL
AGENTS FOR AGING, EMERGENCY POWER GENERATOR
REQUIREMENTS FOR CERTAIN MULTIFAMILY HOUSING
PROJECTS, PERSONAL PROTECTIVE EQUIPMENT FOR HOME
HEALTH AIDE EMPLOYEES, THE NURSING HOME BED
MORATORIUM AND NURSING HOME RESIDENT DATA.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
   Section 1. Subsection (e) of section 19a-564 of the 2026 supplement to
the general statutes is repealed and the following is substituted in lieu
thereof (Effective October 1, 2026):
   (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) if a fee increase exceeds ten per cent of the
previous fee, hold an informational hearing, not later than thirty days
prior to such fee increase taking effect, that provides an opportunity for
commentary, including, but not limited to, commentary by residents,
residents' representatives and residents' family members; and (5)
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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.
   Sec. 2. Section 7-127b of the general statutes is repealed and the
following is substituted in lieu thereof (Effective from passage):
   (a) The chief elected official or the chief executive officer if by
ordinance of each municipality shall appoint a municipal agent for
[elderly persons] aging. Such agent (1) shall be a (A) staff member of a
senior center, [a] (B) member of an agency that serves [elderly persons]
older adults in the municipality, or [a] (C) responsible resident of the
municipality who has demonstrated an interest in assisting [elderly
persons] older adults or has been involved in programs in the field of
aging, and (2) shall not have a conflict of interest or a potential conflict
of interest that may interfere with the municipal agent's ability to
provide unbiased information, assistance or referral services. Two or
more municipalities may jointly appoint one or more municipal agents
to carry out the duties and responsibilities of a municipal agent,
provided such municipalities enter into a memorandum of agreement
or understanding for such purpose, which may include, but need not be
limited to, terms concerning the sharing of any expenses relating to the
municipal agent or agents.
   (b) The duties of the municipal agent shall include, but need not be
limited to: (1) Disseminating information to [elderly persons] older
adults, assisting such persons in learning about the community
resources available to them and publicizing such resources and benefits;
(2) assisting [elderly persons] older adults in applying for federal and
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state benefits, and accessing community resources, available to such
persons; and (3) reporting to the chief elected official or chief executive
officer of the municipality and the Department of Aging and Disability
Services any needs and problems of [the elderly] older adults and any
recommendations for action to improve services to [the elderly] older
adults. For the purposes of this subsection, "community resources"
means resources that assist [elderly persons] older adults in gaining
access to housing opportunities, including, but not limited to,
information regarding access to waitlists for housing designated for
[elderly persons] older adults, applications and consumer reports.
   (c) Each municipal agent shall serve for a term of two or four years,
at the discretion of the appointing authority of each municipality, and
may be reappointed. If more than one agent is necessary to carry out the
purposes of this section, the appointing authority, in its discretion, may
appoint one or more assistant agents. The town clerk in each
municipality shall notify the Department of Aging and Disability
Services immediately of the appointment of a new municipal agent.
Each municipality may provide to its municipal agent resources
sufficient for such agent to perform the duties of the office.
   (d) The Department of Aging and Disability Services shall adopt and
disseminate to municipalities guidelines as to the role and duties of
municipal agents and such informational and technical materials as may
assist such agents in performance of their duties. The department, in
cooperation with the area agencies on aging, may provide training for
municipal agents within the available resources of the department and
of the area agencies on aging.
   (e) On or before January 1, 2025, the Commissioner of Aging and
Disability Services shall create a directory of municipal agents
appointed pursuant to the provisions of this section, which shall
include, but need not be limited to, the name, title, telephone number,
electronic mail address and mailing address of each municipal agent.
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The commissioner shall post a link to the directory on the Department
of Aging and Disability Services' Internet web site.
   (f) On and after July 1, 2026, each municipal agent, at the time of such
municipal agent's appointment or reappointment, shall certify, in
writing, that such municipal agent is unaware of any conflict of interest
or potential conflict of interest that may interfere with the municipal
agent's ability to provide unbiased information, assistance or referral
services and submit such certification to the Commissioner of Aging and
Disability Services in a form and manner prescribed by the
commissioner. If, during the term of a municipal agent, such a conflict
of interest or potential conflict of interest arises, any interested party
may, and a municipal agent shall, immediately report such conflict of
interest or potential conflict of interest to the appointing authority to
determine whether another municipal agent or municipal employee can
act in lieu of the affected municipal agent to nullify such conflict of
interest or potential conflict of interest. The appointing authority may
consult with the Department of Aging and Disability Services in making
such determination. For the purposes of this subsection, the term
"conflict of interest" includes, but is not limited to, the receipt of any
financial or personal benefit by a municipal agent, such agent's spouse,
parent, sibling, child or child's spouse or a business associated with such
agent.
   Sec. 3. Section 29-453a of the general statutes is repealed and the
following is substituted in lieu thereof (Effective October 1, 2026):
   (a) Any privately owned multifamily housing project, within a
municipality with a population of at least one hundred thirty thousand
but less than one hundred [thirty-five] forty thousand, as enumerated
in the 2020 federal decennial census, shall install and maintain one or
more emergency power generators capable of providing a minimum of
four to twelve hours of sufficient electrical power to (1) each unit for
heating, water, lighting and critical medical equipment, and (2) each
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passenger elevator.
  (b) For purposes of this section, "privately owned multifamily
housing project" means real property that (1) consists of, or
encompasses, a building not less than fifteen stories in height that
contains dwelling units whose occupancy is restricted by age, and (2) is
subject, in whole or in part, to a mortgage insured under the National
Housing Act, 12 USC 1701 et seq.
   Sec. 4. (NEW) (Effective October 1, 2026) (a) As used in this section: (1)
"Home health aide agency" has the same meaning as provided in section
19a-490 of the general statutes, (2) "home health aide employee" means
a person (A) who is employed as a home health aide by a home health
aide agency, or (B) with whom such agency has contracted to provide
home health aide services on behalf of such agency, (3) "home health
aide services" has the same meaning as provided in section 19a-490 of
the general statutes, and (4) "personal protective equipment" includes,
but is not limited to, disposable gloves, hand sanitizers, aprons, gowns,
foot covers, face shields, N95 masks or higher rated masks certified by
the National Institute for Occupational Safety and Health and surgical
masks.
   (b) Each home health aide agency shall provide each home health
aide employee, at no cost, personal protective equipment that is
necessary to safely provide home health aide services to each client of a
home health aide employee.
   Sec. 5. Subsection (a) of section 17b-354 of the 2026 supplement to the
general statutes is repealed and the following is substituted in lieu
thereof (Effective from passage):
   (a) The Department of Social Services shall not accept or approve any
requests for additional nursing home beds, except (1) beds restricted to
use by patients with acquired immune deficiency syndrome or by
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patients requiring neurological rehabilitation; (2) beds associated with a
continuing care facility, as described in section 17b-520, provided such
beds are not used in the Medicaid program; [. For the purpose of this
subsection, beds associated with a continuing care facility are not subject
to the certificate of need provisions pursuant to sections 17b-352 and
17b-353;] (3) Medicaid certified beds either to be relocated from one
licensed nursing facility to another licensed nursing facility to meet a
priority need identified in the strategic plan developed pursuant to
subsection (c) of section 17b-369 or new beds added to an existing
facility or a new facility with preference given to a nontraditional, small-
house-style nursing home facility that incorporates the goals for nursing
facilities referenced in the department's strategic plan for long-term
care, as described in section 17b-355, as amended by this act, to address
priority needs reflected by area census trends; (4) licensed Medicaid
nursing facility beds to be relocated from one or more existing nursing
facilities to a new nursing facility, including a replacement facility,
provided (A) no new Medicaid certified beds are added, (B) at least one
currently licensed facility is closed in the transaction as a result of the
relocation, (C) the relocation is done within available appropriations,
(D) the facility participates in the Money Follows the Person
demonstration project pursuant to section 17b-369, (E) the availability of
beds in the area of need will not be adversely affected, (F) the certificate
of need approval for such new facility or facility relocation and the
associated capital expenditures are obtained pursuant to sections 17b-
352 and 17b-353, and (G) the facilities included in the bed relocation and
closure shall be in accordance with the strategic plan developed
pursuant to subsection (c) of section 17b-369; and (5) proposals to build
a nontraditional, small-house style nursing home designed to enhance
the quality of life for nursing facility residents, provided that the
nursing facility agrees to reduce its total number of licensed beds by a
percentage determined by the Commissioner of Social Services in
accordance with the department's strategic plan for long-term care. For
the purposes of this subsection, beds associated with a continuing care
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facility are not subject to the certificate of need provisions pursuant to
sections 17b-352 and 17b-353.
   Sec. 6. Section 17b-355 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective from passage):
   (a) In determining whether a request submitted pursuant to sections
17b-352 to 17b-354, inclusive, as amended by this act, will be granted,
modified or denied, the Commissioner of Social Services shall consider
the following: (1) The financial feasibility of the request and its impact
on the applicant's rates and financial condition, (2) the contribution of
the request to the quality, accessibility and cost-effectiveness of the
delivery of long-term care in the region, including consideration of the
nursing home's star rating on the five-star quality rating system for
nursing homes published by the Centers for Medicare and Medicaid
Services, (3) whether there is clear public need for the request, (4) the
relationship of any proposed change to the applicant's current
utilization statistics and the effect of the proposal on the utilization
statistics of other facilities in the applicant's service area, (5) the business
interests of all owners, partners, associates, incorporators, directors,
sponsors, stockholders and operators and the personal background of
such persons, and (6) any other factor which the Department of Social
Services deems relevant. In considering whether there is clear public
need for any request for the relocation of beds to a replacement facility,
or for new beds added to an existing facility or a new facility, the
commissioner shall consider whether there is a demonstrated bed need
in the towns within a fifteen-mile radius of the town in which the beds
are proposed to be located and whether the availability of beds in the
applicant's service area will be adversely affected.
   (b) Any proposal to relocate nursing home beds from an existing
facility to a new facility shall not increase the number of Medicaid
certified beds and shall result in the closure of at least one currently
licensed facility. The commissioner may request that any applicant
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seeking to replace an existing facility reduce the number of beds in the
new facility by a percentage that is consistent with the department's
strategic state-wide long-term rebalancing plan for long-term care. If an
applicant seeking to replace an existing facility with a new facility owns
or operates more than one nursing facility, the commissioner may
request that the applicant close two or more facilities before approving
the proposal to build a new facility. The commissioner shall also
consider whether an application to establish a new or replacement
nursing facility proposes a nontraditional, small-house style nursing
facility and incorporates goals for nursing facilities referenced in the
department's strategic state-wide long-term rebalancing plan for long-
term care, including, but not limited to, (1) promoting person-centered
care, (2) providing enhanced quality of care, (3) creating community
space for all nursing facility residents, and (4) developing stronger
connections between the nursing facility residents and the surrounding
community. [Bed]
   (c) Demonstrated bed need shall be based on the recent occupancy
percentage of area nursing facilities [and the] with occupancy above
ninety-six per cent for a minimum of two consecutive quarters. The
department may consider projected bed need [for no more than five
years] into the future at [ninety-seven and one-half per cent] occupancy
above ninety-six per cent using the latest [official population projections
by town and age as published by the Office of Policy and Management
and the latest available state-wide nursing facility utilization statistics
by age cohort from the Department of Public Health] strategic state-
wide long-term rebalancing plan for long-term care as published by the
department. The commissioner may also consider area specific
utilization and reductions in utilization rates to account for the
increased use of less institutional alternatives.
    Sec. 7. Section 17b-99a of the 2026 supplement to the general statutes
is repealed and the following is substituted in lieu thereof (Effective July
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1, 2026):
   (a) (1) For purposes of this section, (A) "extrapolation" means the
determination of an unknown value by projecting the results of the
review of a sample to the universe from which the sample was drawn,
(B) "facility" means any facility described in this subsection and for
which rates are established pursuant to section 17b-340, (C) "minimum
data set" means the federal resident assessment tool required by the
Centers for Medicare and Medicaid Services, and [(C)] (D) "universe"
means a defined population of claims submitted by a facility during a
specific time period.
   (2) The Commissioner of Social Services shall conduct any audit of a
licensed chronic and convalescent nursing home, chronic disease
hospital associated with a chronic and convalescent nursing home, a rest
home with nursing supervision, a licensed residential care home, as
defined in section 19a-490, and a residential facility for persons with
intellectual disability which is licensed pursuant to section 17a-227 and
certified to participate in the Medicaid program as an intermediate care
facility for individuals with intellectual disabilities in accordance with
the provisions of this section.
   (b) Not less than thirty days prior to the commencement of any such
audit, the commissioner shall provide written notification of the audit
to such facility, unless the commissioner makes a good-faith
determination that (1) the health or safety of a recipient of services is at
risk; or (2) the facility is engaging in vendor fraud under sections 53a-
290 to 53a-296, inclusive.
   (c) Any clerical error, including, but not limited to, recordkeeping,
typographical, scrivener's or computer error, discovered in a record or
document produced for any such audit, shall not of itself constitute a
wilful violation of the rules of a medical assistance program
administered by the Department of Social Services unless proof of intent
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to commit fraud or otherwise violate program rules is established. In
determining which facilities shall be subject to audits, the Commissioner
of Social Services may give consideration to the history of a facility's
compliance in addition to other criteria used to select a facility for an
audit.
  (d) A finding of overpayment or underpayment to such facility shall
not be based on extrapolation unless (1) there is a determination of
sustained or high level of payment error involving the facility, (2)
documented educational intervention has failed to correct the level of
payment error, or (3) the value of the claims in aggregate exceeds two
hundred thousand dollars on an annual basis.
   (e) A facility, in complying with the requirements of any such audit,
shall be allowed not less than thirty days to provide documentation in
connection with any discrepancy discovered and brought to the
attention of such facility in the course of any such audit.
   (f) The commissioner shall produce a preliminary written report
concerning any audit conducted pursuant to this section and such
preliminary report shall be provided to the facility that was the subject
of the audit not later than sixty days after the conclusion of such audit.
   (g) The commissioner shall, following the issuance of the preliminary
report pursuant to subsection (f) of this section, hold an exit conference
with any facility that was the subject of any audit pursuant to this
subsection for the purpose of discussing the preliminary report. Such
facility may present evidence at such exit conference refuting findings
in the preliminary report.
   (h) The commissioner shall produce a final written report concerning
any audit conducted pursuant to this subsection. Such final written
report shall be provided to the facility that was the subject of the audit
not later than sixty days after the date of the exit conference conducted
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pursuant to subsection (g) of this section, unless the commissioner and
the facility agree to a later date or there are other referrals or
investigations pending concerning the facility.
   (i) Any facility aggrieved by a final report issued pursuant to
subsection (h) of this section may request a rehearing. A rehearing shall
be held by the commissioner or the commissioner's designee, provided
a detailed written description of all items of aggrievement in the final
report is filed by the facility not later than ninety days following the date
of written notice of the commissioner's decision. The rehearing shall be
held not later than thirty days following the date of filing of the detailed
written description of each specific item of aggrievement. The
commissioner shall issue a final decision not later than sixty days
following the close of evidence or the date on which final briefs are filed,
whichever occurs later. Any items not resolved at such rehearing to the
satisfaction of the facility or the commissioner shall be submitted to
binding arbitration by an arbitration board consisting of one member
appointed by the facility, one member appointed by the commissioner
and one member appointed by the Chief Court Administrator from
among the retired judges of the Superior Court, which retired judge
shall be compensated for his services on such board in the same manner
as a state referee is compensated for his services under section 52-434.
The proceedings of the arbitration board and any decisions rendered by
such board shall be conducted in accordance with the provisions of the
Social Security Act, 42 USC 1396, as amended from time to time, and
chapter 54.
   (j) The commissioner shall conduct audits of minimum data set
information used in the calculation of Medicaid acuity-based per diem
rates paid to licensed nursing homes. The commissioner shall conduct
an audit of minimum data set information in accordance with the
provisions of this section, except a nursing home shall provide all
documentation requested by the commissioner pursuant to the
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minimum data set audit not later than ten days after the date on which
the commissioner requests such documentation. The commissioner
shall not accept any documentation submitted by a nursing home after
the completion of the exit conference portion of the audit unless the
commissioner and the nursing home agree to such submission of
documentation.
   [(j)] (k) The submission of any false or misleading [fiscal] information
or data to the commissioner shall be grounds for suspension of
payments by the state under sections 17b-239 to 17b-246, inclusive, and
sections 17b-340, and 17b-343, in accordance with regulations adopted
by the commissioner. In addition, any person, including any
corporation, who knowingly makes or causes to be made any false or
misleading statement or who knowingly submits false or misleading
fiscal information or data on the forms approved by the commissioner
shall be guilty of a class D felony.
   [(k)] (l) The commissioner, or any agent authorized by the
commissioner to conduct any inquiry, investigation or hearing under
the provisions of this section, shall have power to administer oaths and
take testimony under oath relative to the matter of inquiry or
investigation. At any hearing ordered by the commissioner, the
commissioner or such agent having authority by law to issue such
process may subpoena witnesses and require the production of records,
papers and documents pertinent to such inquiry. If any person disobeys
such process or, having appeared in obedience thereto, refuses to
answer any pertinent question put to the person by the commissioner or
the commissioner's authorized agent or to produce any records and
papers pursuant thereto, the commissioner or the commissioner's agent
may apply to the superior court for the judicial district of Hartford or
for the judicial district wherein the person resides or wherein the
business has been conducted, or to any judge of such court if the same
is not in session, setting forth such disobedience to process or refusal to
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answer, and such court or judge shall cite such person to appear before
such court or judge to answer such question or to produce such records
and papers.
   [(l)] (m) The commissioner shall provide free training to facilities on
the preparation of cost reports to avoid clerical errors and shall post
information on the department's Internet web site concerning the
auditing process and methods to avoid clerical errors. Not later than
April 1, 2015, the commissioner shall establish audit protocols to assist
facilities subject to audit pursuant to this section in developing
programs to improve compliance with Medicaid requirements under
state and federal laws and regulations, provided audit protocols may
not be relied upon to create a substantive or procedural right or benefit
enforceable at law or in equity by any person, including a corporation.
The commissioner shall establish and publish on the department's
Internet web site audit protocols for: (1) Licensed chronic and
convalescent nursing homes, (2) chronic disease hospitals associated
with chronic and convalescent nursing homes, (3) rest homes with
nursing supervision, (4) licensed residential care homes, as defined in
section 19a-490, and (5) residential facilities for persons with intellectual
disability that are licensed pursuant to section 17a-227 and certified to
participate in the Medicaid program as intermediate care facilities for
individuals with intellectual disabilities. The commissioner shall ensure
that the Department of Social Services, or any entity with which the
commissioner contracts to conduct an audit pursuant to this section, has
on staff or consults with, as needed, licensed health professionals with
experience in treatment, billing and coding procedures used by the
facilities being audited pursuant to this section.
 Governor's Action:
 Approved May 27, 2026
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