reglab/statecodes huggingface dataset:
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Section 17-311-53 - Desk review and field audits

Current through July 10, 2024
(a) The per diem
				  rate of payment established pursuant to section
				  17-311-50
				  et seq. shall be determined by desk review of the submitted annual report which
				  shall subsequently be verified and authenticated by field audit procedures
				  which are approved by the United States Department of Health and Human
				  Services. Facilities shall generally be audited on a biennial basis. This audit
				  cycle may be changed based upon audit experience. A recomputation of rate,
				  based upon field audit adjustments or otherwise, shall be made retroactive to
				  the applicable period. Such retroactive recomputation replaces the originally
				  determined annual Medicaid per diem rate and shall not be construed to
				  constitute a new annual Medicaid per diem rate so as to require the public
				  hearing mandated by Connecticut General Statutes, section 17-314.
(b) Whenever the Commissioner of Income
				  Maintenance renders a rate decision, whether based upon a field audit or
				  otherwise, which decision results in the facility being indebted to the
				  Department of Income Maintenance for past Medicaid overpayments, the department
				  shall recoup said Medicaid overpayments as soon as possible from the
				  department's monthly Medicaid payments to the facility. If the facility submits
				  a rehearing request in compliance with Connecticut General Statutes, section
				  17-311(b), the department shall afford the facility a rehearing as soon as
				  practicable after commencement of recoupment of past Medicaid overpayments.
				  Said rehearing request shall not automatically stay the recoupment, which may
				  be stayed in the discretion of the commissioner.
(c) In a recoupment situation, the Department
				  of Income Maintenance shall determine a recoupment schedule of amounts to be
				  recouped from the facility's monthly Medicaid payments after consideration of
				  the following factors:
(1) The amount of the
				  indebtedness;
(2) The objective of
				  completion of total recoupment of past Medicaid overpayments as soon as
				  possible;
(3) The cash flow of the
				  facility; and
(4) Any other factors
				  brought to the attention of the department by the facility relative to the
				  provider's ability to function after recoupment.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Section 17-311-54 - Optional rate determination

Current through July 10, 2024
Homes for the aged and community residences for the
					 mentally retarded shall have the option of complying with section
					 17-311-50
					 of the regulations which requires the annual reports and cost data be provided
					 for individual rate determination for each facility or acceptance of the per
					 diem rate determined as explained below. The election to have an individual
					 rate computed shall necessitate the filing of the annual report.
The rate for the year beginning July 1, 1982 for homes for
					 the aged and community residences for the mentally retarded which do not elect
					 to have an individual per diem rate computed shall be predicated on the rate
					 authorized for providers with 10 or less beds for the prior rate year adjusted
					 prospectively by multiplying it by the quotient derived by dividing the GNP
					 deflator for the upcoming rate year by the GNP deflator for the prior rate
					 year. Thereafter the rate for such facilities shall be computed by multiplying
					 the rate for the prior year by the quotient derived by dividing the GNP
					 deflator for the upcoming rate year by the GNP deflator for the prior rate
					 year.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Section 17-311-55 - Interim rates

Current through July 10, 2024
Newly constructed facilities shall receive an interim per
					 diem rate of payment for each level of care computed on the basis of budgetary
					 data (from CHHCFD-4 new 6/75) submitted to the commissioner.
Newly acquired facilities shall receive an interim per diem
					 rate of payment for each level of care based on the existing rate adjusted to
					 reflect any changes in property values pursuant to section
					 17-311-57(1).
					 In the event that substantive changes in operation have been affected by the
					 new owners materially changing operating costs, additional adjustments to the
					 existing rates may be made to the extent such changes in operations and related
					 costs are specifically identified and documented by the facility.
An interim per diem rate may be authorized for a facility
					 which has undergone changes in level of care or significant changes in licensed
					 bed capacity mandated or approved by the department of health services and the
					 commission on hospitals and health care.
An interim per diem rate may be revised by the commissioner
					 at any time based on additional information which may become available to him.
					 The interim rate shall remain in effect until the first of the following
					 occurs:
(a) a per diem rate is
				  computed on the basis of an annual report for a full cost year in which the
				  facility achieved ninety percent (90%) occupancy of its certified beds;
				  or
(b) a per diem rate is computed
				  on the basis of the facility's second annual report for a full cost year.
Interim rates shall be replaced by revised per diem rates
					 computed on the basis of actual costs which are allowable as defined in these
					 regulations, and minimum allowable patient days (ninety percent utilization
					 except as provided in section
					 17-311-52(15)
					 for the period in which the interim rates were in effect. Proper retroactive
					 adjustments, in favor of the provider or the state, shall be made to all
					 amounts paid on the basis of interim rates.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Section 17-311-56 - Record maintenance and retention

Current through July 10, 2024
Through June 30, 2004, each facility shall maintain all
					 supporting records for the ten (10) most recent cost years without regard to
					 change in ownership. Beginning July 1, 2004, each facility shall maintain all
					 supporting records for the seven (7) most recent cost years without regard to
					 change in ownership. At the discretion of the commissioner, any facility which
					 fails to comply with such requirements may be paid at the lowest rate paid to
					 another facility for the same level of care, or the commissioner may disallow
					 those costs for which appropriate documentation has not been maintained. All
					 facilities shall be required to maintain their books of account on the accrual
					 method of accounting and accurate time records shall be maintained for all
					 persons paid salaries or wages. This section does not affect the independent
					 requirement that any medical records must be maintained for the length of time
					 specified in section
					 19-13-D8t(o)
					 of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Section 17-311-58a - Calculated rates

Current through July 10, 2024
The rates that were calculated and paid for the rate year
					 commencing July 1, 1983, and calculated and to be paid for the rate year
					 commencing July 1, 1984, which were calculated, based on the skilled nursing
					 facility and intermediate care facility levels of care designations, shall be
					 deemed to have been set based on the State licensure levels of chronic and
					 convalescent home and rest home with nursing supervision, respectively.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Section 17-311-59a - Facility beds licensed as

Current through July 10, 2024
All facility beds licensed as chronic and convalescent
					 nursing home beds by the Connecticut Department of Health Services ("DHS")
					 pursuant to Sections
					 19a-493
					 of the Connecticut General Statutes and 19-13-D8t of the Regulations of
					 Connecticut State Agencies and certified by DHS and HCFA pursuant to the
					 Medicaid program (Title XIX) solely as skilled nursing facility beds prior to
					 the effective date of this regulation, which subsequent to the effective date
					 of this regulation receive an additional or dual certification as intermediate
					 care beds, shall continue to be reimbursed by the DIM pursuant to the
					 provisions of the regulations formerly applicable to skilled nursing facility
					 beds.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Cost Related Reimbursement System for Long-Term Care Facilities › Section 17-311-60a - Definitions

Current through July 10, 2024
The following terms are defined pursuant to Section
						17-314(b), of the Connecticut General Statutes.
(a) "Other allowable services" are defined as
					 those services provided by the types of providers listed below to the extent
					 that the cost of said services are not included in the calculation of the per
					 diem rate of the facility.
(1)
					 Physicians
(2) Dentists
(3) Other practitioners (e.g., podiatrists,
					 and optometrists)
(4)
					 Laboratories
(5)
					 Pharmacies
(6) Physical therapists,
					 speech therapists and occupational therapists
(7) Providers of transportation to other
					 medical services
(8) Other medical
					 services except for nursing facility and inpatient hospital care
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Cost Related Reimbursement System for Long-Term Care Facilities › Section 17-311-62a - Rate adjustments for facilities subject to the provisions of section 17-314 (e) of the Connecticut general statutes

Current through July 10, 2024
(a) "Available
					 beds" are defined as the average number of beds occupied by medical assistance
					 patients from this State and the average number of beds that are empty.
					 Available beds are determined as follows:
Multiply certified beds reported in Annual Report of Long
						Term Care Facility by 365. Subtract from this product the total patient days
						reported in the Annual Report. To this number add the patient days for
						Connecticut Medicaid patients. Dividing this sum by 365 will result in the
						available beds.
(b)
					 "Required number" is defined as the average number of beds occupied by medical
					 assistance patients from this State during the period October 1, 1980 through
					 September 30, 1981 and is determined by dividing the number of Medicaid patient
					 days reported in the Annual Report of Long Term Care Facility for the cost year
					 1981 by three hundred sixty-five.
(c) Any facility subject to the provisions of
					 Section 17-314(e) of the Connecticut General Statutes, which as of the
					 effective date of these regulations has less beds available to medical
					 assistance patients from this State than the required number shall petition the
					 Department stating the number of beds available in the facility as of the
					 effective date of the regulations.
(d) If at any time after the effective date
					 of these regulations said facility has fewer available beds than the required
					 number, such facility shall actively solicit Connecticut Medicaid patients for
					 admission by advising out-placement directors at referring hospitals of
					 available vacancies and by accepting referrals of Connecticut Medicaid patients
					 from the Department.
(e) If the
					 average number of available beds in any such facility for the cost year falls
					 below the required number, the provisions of subsections (c) and (d) of Section
					 17-314 and the regulations promulgated pursuant thereto shall apply. The excess
					 amount shall be determined by multiplying the number of available beds less
					 than the required number by the amount received for other allowable services in
					 excess of the rate approved by the Commissioner and multiplying this product by
					 365. This amount shall be deducted from the allowable costs establishing rates
					 for the rate period covered by the Annual Report in which the available beds
					 were less than the required number.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Cost Related Reimbursement System for Long-Term Care Facilities › Section 17-311-63 to 17-311-90 - Repealed

Current through July 10, 2024
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Cost Related Reimbursement System for Long-Term Care Facilities › Section 17-311-91 to 17-311-100 - Reserved

Current through July 10, 2024
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Part IV - Relating to Rules of Practice for the Arbitration of Items of › Section 17-311-101 - Objective of proceedings

Current through July 10, 2024
The objective of the rehearing and arbitration
						proceedings of Sec. 17-311 is to provide a means for the expeditious
						disposition of disputes relating to rates established by the commissioner for
						any provider pursuant to his authority under Sec. 17-312 to 17-314 inclusive
						and the regulations promulgated thereunder.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Part IV - Relating to Rules of Practice for the Arbitration of Items of › Section 17-311-102 - Designation of tribunal

Current through July 10, 2024
The arbitration tribunal established according to the
						procedures set forth in Section 17-311 and the regulations promulgated
						thereunder, to adjudicate the above disputes, shall be termed the "arbitration
						tribunal."
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › RULES OF PRACTICE › Article 4 - COST RELATED REIMBURSEMENT SYSTEM › Part IV - Relating to Rules of Practice for the Arbitration of Items of › Section 17-311-103 - Administration

Current through July 10, 2024
The administration of the arbitration proceedings shall
						be conducted jointly by the office of the chief court administrator and the
						clerk of the superior court of the judicial district wherein the state referee
						who is to serve as an arbitrator has his office and chambers. Requests for
						arbitration, all correspondence and any other papers or process necessary or
						proper for the initiation of continuation of an arbitration under these
						regulations and for any court action therewith or for the entry of judgment on
						an award made thereunder shall be served, in addition to the commissioner and
						the provider, on the chief court administrator, the state referee participating
						as the third arbitrator, and the office of the clerk of the superior court for
						the judicial district where the state referee has his chambers. All papers,
						process or notices to the commissioner shall be mailed to by certified mail or
						served upon the commissioner at 110 Bartholomew Avenue, Hartford, Connecticut.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › I - Rehearings › Section 17-311-104 - Rehearing procedure

Current through July 10, 2024
Any provider to which payments are made by the commissioner
				  pursuant to Sec. 17-312 to 17-314 inclusive, which is aggrieved by any decision
				  of the commissioner, may, within ten days after written notice thereof from the
				  Committee, obtain, by written request to the commissioner, a rehearing on all
				  items of aggrievement. The request for a rehearing shall be accompanied by a
				  detailed statement outlining the items of aggrievement. The commissioner shall,
				  upon the receipt of all papers and documents necessary to determine and
				  evaluate said request, conduct such a rehearing as soon as practicable after
				  the receipt of the same.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › I - Rehearings › Section 17-311-105 - Conduct of rehearing

Current through July 10, 2024
The rehearing shall be deemed a contested case, which means a
				  proceeding in the commissioner's disposition of matters delegated to his
				  jurisdiction by law, in which the legal rights, duties or privileges of the
				  party are determined by the commissioner after an opportunity for a hearing.
				  The definition stated in Section
				  4-166(2)
				  of the General Statutes shall further define this term, and all other
				  regulations of the commissioner as appear in the commissioner's description of
				  organization and rules of practice, i.e. Sec.
				  17-311-27
				  et seq. shall govern the rehearing procedure. Pursuant to the authority vested
				  in him by Section 17-2, the commissioner may delegate to any deputy, assistant,
				  investigator or supervisor the power to serve as hearing officer or presiding
				  officer and to issue directly the final decision of the department containing
				  findings of fact, conclusions of law and an order. In the alternative, the
				  commissioner may himself preside at the rehearing and issue directly final
				  decision. In the alternative, the commissioner may designate any person to
				  serve as hearing officer or presiding officer and then to submit a proposal for
				  decision to the commissioner pursuant to section
				  4-179.
				  At such rehearing official notice may be taken of any records maintained in the
				  files of the department, and the hearing officer or presiding officer is
				  authorized to have the assistance of members or representatives of the agency
				  including but not limited to legal and accounting advisors.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › I - Rehearings › Section 17-311-106 - The decision on rehearing

Current through July 10, 2024
The commissioner shall render his decision in writing, in
				  accordance with the contested case provisions of Chapter 54 of the General
				  Statutes and regulations referred to above within ninety days of close of the
				  proceedings, or after thirty days after the receipt of any data the close of
				  the rehearing, the subsequent submission of a late file, the subsequent
				  submission of a memorandum of law, or the receipt of the hearing transcript,
				  whichever is later.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-107 - Commencement of arbitration

Current through July 10, 2024
In the event that items of aggrievement are not resolved at
				  the rehearing to the satisfaction of both the commissioner and the provider,
				  then said items shall be submitted to binding arbitration to an arbitration
				  board consisting of one member appointed by the provider, one member appointed
				  by the commissioner, and one member appointed by the chief court administrator
				  from among the retired judges of said 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 Sec.
				  52-434.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-108 - Institution of arbitration

Current through July 10, 2024
Proceedings for arbitration shall be instituted by filing a
				  request for arbitration in the form of a pleading as prescribed by applicable
				  provisions of the Connecticut Practice Book and the Connecticut General
				  Statutes within thirty days after the mailing of the notice of the final
				  decision of the commissioner with respect to the rehearing. Copies of the
				  request for arbitration shall be sent to the chief court administrator, and to
				  the commissioner at the address provided for in these regulations and in the
				  rules of practice of the commissioner.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-109 - Position paper of party requesting arbitration; filing of record; memorandum in response

Current through July 10, 2024
The provider requesting arbitration shall file together with
				  its request for arbitration a memorandum setting forth its position and
				  contentions concerning each of the items of aggrievement which have not been
				  resolved in a satisfactory manner by the decision on the rehearing. Within
				  thirty (30) days of the receipt of such position paper and memorandum, the
				  commissioner shall file the original or a certified copy of the entire record
				  of the rehearing appealed from, which shall include the department's findings
				  of fact and conclusions of law, separately stated. By stipulation of all
				  parties to such appeal proceedings, the record may be shortened. The
				  arbitration board may require or permit subsequent corrections or additions to
				  the record. Within thirty days of the filing of the record, the department
				  shall file its memorandum in response.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-110 - Appointment of arbitrators by the parties

Current through July 10, 2024
Each of the parties shall file the name of the person which
				  the provider and the commissioner has designated as the arbitrator. Each of the
				  parties will file together with the name of the arbitrator a request to the
				  chief court administrator for the designation of a state referee as the third
				  arbitrator. The chief court administrator shall appoint from a panel of
				  referees designated by the chief court administrator one arbitrator to serve as
				  the third member of the panel, provided that the appointment shall be made no
				  later than thirty days from the receipt of a copy of the request for
				  arbitration as described above.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-111 - Appointment of arbitrator; qualifications

Current through July 10, 2024
The chief court administrator may appoint one or more state
				  referees as permanent arbitrators to serve in the arbitration of disputes
				  referred to arbitration panels in accordance with the procedure set forth
				  herein. The provider and the commissioner shall be required to name persons as
				  their choice for their representative arbitrator who have had knowledge of the
				  matters which are the subject of the arbitration issues. The commissioner may
				  not serve as arbitrator.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-112 - Scope of review

Current through July 10, 2024
The arbitration board shall confine itself to a review of the
				  record. The arbitration board shall not substitute its judgment for that of the
				  department as to the weight of the evidence on questions of fact. The
				  arbitration board may affirm the decision of the department or remand the case
				  to the department to reopen the rehearing. The arbitation board may reverse the
				  department's rehearing decision and remand it to the department for a new
				  rehearing if substantial rights of the provider have been prejudiced because
				  the administrative findings, inferences, conclusions, or decisions are:
1. In violation of constitutional or
				statutory provisions;
2. In excess
				of the statutory authority of the agency;
3. Made upon unlawful procedure;
4. Affected by other error of law;
5. Clearly erroneous in view of the reliable,
				probative, and substantial evidence on the whole record;
6. Arbitrary or capricious or characterized
				by abuse of discretion or clearly unwarranted exercise of discretion.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-113 - Oral argument; time and place; adjournment

Current through July 10, 2024
The arbitrators shall appoint a time and place for oral
				  argument based on the record and notify the parties thereof and, on application
				  of either party and for good cause shown, shall postpone the time of the oral
				  argument. They may also adjourn the oral argument, from time to time, as may be
				  necessary, but no postponement or adjournment shall extend the time, if any,
				  fixed in the arbitration agreement or by these rules for rendering the review
				  of the record decision.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-114 - Stay of department rehearing decision pending arbitration board's review of the record

Current through July 10, 2024
The institution of the arbitration proceeding pursuant to
				  these regulations shall not of itself stay enforcement of the department's
				  rehearing decision. The department, or the arbitration board, may order a stay
				  upon appropriate terms in its discretion.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-116 - Stenographic record

Current through July 10, 2024
Whenever a stenographic record is requested by one or more
				  parties, the arbitration panel will arrange for a stenographer. The total cost
				  of the transcript shall be paid by the requesting party.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-117 - Attendance at hearings

Current through July 10, 2024
Persons having a direct interest in the arbitration,
				  including representatives of certified collective bargaining agents at the
				  institution are entitled to attend and observe arbitration
				  proceedings.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-119 - Subsequent court proceedings

Current through July 10, 2024
The provisions of section
				  52-417
				  through section
				  52-424,
				  inclusive, are herewith incorporated by reference as if fully set forth for the
				  purpose of governing any judicial proceedings subsequent to the entry of the
				  final decision based upon review of the rehearing record by the arbitration
				  board.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-120 - Aggrieved provider's choice of remedy to contest Sec. 17-311 (b) final administrative rate rehearing decision

Current through July 10, 2024
As an alternative remedy to the arbitration process set forth
				  in Sec.
				  17-311-107
				  to Sec.
				  17-311-119
				  supra, a provider aggrieved by a final decision of the commissioner pursuant to
				  a rate rehearing conducted pursuant to the provisions of Sec. 17-311(b) as a
				  contested case in accordance with the provisions of Sec.
				  4-177
				  et seq. of the Connecticut General Statutes may pursue its administrative
				  appeal in the Connecticut Superior Court pursuant to the provisions of Sec.
				  4-183
				  Conn. Gen. Stat. The provider will not be required to pursue the arbitration
				  process included herein as a remedy available within the agency for the
				  purposes of exhaustion of administrative remedies but may proceed, subsequent
				  to the final rate rehearing decision pursuant to Sec. 17-311(b) to the superior
				  court. The filing of an administrative appeal without the pursuit of the
				  arbitration process available herein shall not be the ground of objection to
				  said administrative appeal by the department. When a provider elects to invoke
				  this subsection and bring a Sec.
				  4-183
				  appeal of Sec. 17-311(b) rate rehearing final decision directly to the
				  Connecticut superior court, the provider waives any right to simultaneously or
				  subsequently initiate the aforesaid arbitration process to appeal said Sec.
				  17-311(b) rate rehearing final decision. Likewise, when the provider elects to
				  initiate the aforesaid arbitration process to appeal a Sec. 17-311(b) rate
				  rehearing final decision, the provider waives any right to simultaneously or
				  subsequently bring a Sec.
				  4-183
				  appeal of said Sec. 17-311(b) rate rehearing final decision.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-160 - Maximun allowable charges to self-pay patients

Current through July 10, 2024
(a)
				Effective July 1, 1980, and annually thereafter, the Commissioner of Income
				Maintenance (hereinafter referred to as Commissioner) shall authorize the
				maximum allowable charges to self-pay patients (hereinafter referred to as
				self-pay charges) for routine services as defined in Section
				17-311-161
				below in private and semiprivate accommodations of licensed chronic and
				convalescent hospitals, rest homes with nursing supervision and licensed homes
				for the aged, as defined in Section 19-576 of the general statutes (hereinafter
				referred to as facilities). The self-pay charges shall be determined on the
				basis of the cost related reimbursement system used for determining per diem
				rates of payment to long-term care facilities in the State of Connecticut as
				set forth in Section
				17-311-50
				through Section
				17-311-57 of
				these regulations, (hereinafter referred to as State rates), except as
				prescribed by the regulations below.
(b) Notwithstanding section
				17-311-161
				below, self-pay charges authorized by the commissioner may not be less than the
				state rates established for each facility. Therefore, a facility must increase
				its self-pay charge to the state rate or the state rate shall be lowered to the
				self-pay charge.
(c) Self-pay
				charges determined pursuant to the regulations herein shall be deemed to
				constitute reimbursement for all reasonable costs related to patient care plus
				a profit or an operating surplus and a fair rate of return on invested capital
				or equity. Therefore, no request for an increase, except as provided in section
				17-311-167
				shall be heard by the commissioner.
(d) No facility may charge its self-pay
				patients more than permitted by emergency regulation 17-311-159 until the July
				1, 1980 self-pay charges become effective.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-161 - Self-pay charges for routine services

Current through July 10, 2024
Self-pay charges for routine services shall be established
				  for each facility individually and for each level of care provided by such
				  facility in accordance with the following method:
(a) Routine services means the per diem
				charge by a nursing home for services and items includable in the facility's
				state rate calculated for purposes of Section
				17-311-161(b)
				(1) and shall include but not be limited to room accommodations, nursing care
				rendered by non-private duty nursing personnel, food, institutional laundry
				services, housekeeping services, services related to the use and maintenance of
				real property, social and recreation services, and all other allied and
				customary services offered pursuant to an express or implied agreement between
				the provider and the patient. Routine services shall not include those services
				defined below as ancillary services. Other than by charging up to the maximum
				allowable self-pay rates determined by the commissioner, under no circumstances
				shall a facility impose any additional charge upon any of its self-pay patients
				for any routine services.
(b) The
				Commissioner shall determine once during the period no less than thirty nor
				more than ninety days prior to the effective date of each new rate year the
				statewide median medicaid or public assistance rate for patients cared for by
				the State of Connecticut at each level of care, e.g., chronic and convalescent
				hospital, rest home with nursing supervision, and homes for the aged. Once such
				median for a new rate year is computed, it shall not be subsequently
				recomputed. The self-pay charge that may be imposed by each facility for
				routine services for each level of care shall be computed by adding:
(1) The facility's state rate as calculated
				for the purposes of these regulations, and
(2) The amount derived by applying the
				specific percentages of the statewide median state rate for each level of care
				(expressed in dollars and cents rounded to the nearest whole cent), as set
				forth in the schedule below:
Room
							 Accommodations
Percentage to be applied to
Statewide Median State
							 Rate
Private (one patient in a room)
50%
Semi-Private (two patients in a room)
25%
Semi-Private (three or more patients in a
							 room)
15%
Except that the commissioner has the discretion to promulgate
				  a self-pay rate to be charged to a patient who at the patient's request enters
				  into a contract with a facility for special accommodations larger than the
				  facility's private (one patient to a room) accommodation.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-162 - Self-pay charges for ancillary services

Current through July 10, 2024
(a) Ancillary
				services means those charges to patients which are directly identifiable as
				customary medical services rendered to individual patients, and furnished at
				the direction of a physician because of specific medical need and are either
				not reusable or represent a cost for each preparation (e.g., physical therapy,
				speech therapy, catheters, colostomy bags, prosthetic devices, and all other
				similar services or devices), provided that with respect to services, such
				services are rendered by employees of the Facility. Services rendered by
				outside consultants or independent contractors who establish and determine the
				charges to the patient for such services, and to which charges the facility
				does not add a mark-up for overhead or profit, shall not be considered
				ancillary services for the purposes of this regulation. Ancillary services
				shall not be construed to include any good or service for which the department
				reimburses a facility in the medicaid rate for the care of Title XIX
				patients.
(b) Effective July 1,
				1980, self-pay charges for ancillary services shall be the ancillary charges in
				effect on December 1, 1979 increased by the percentage factor used in section
				17-311-161(b)
				for semi-private 2-bed room accommodations. Thereafter, for each ensuing rate
				year, self-pay charges for ancillary services shall be the prior year's
				self-pay charges for ancillary services increased by the percentage factor used
				in section
				17-311-161(b)
				for semi-private 2-bed room accommodations. Each self-pay patient shall receive
				an itemized statement of the ancillary services for which the patient is
				charged. Effective with the rate year commencing July 1, 1986, self-pay charges
				for ancillary services shall be the ancillary charges in effect on July 1, 1985
				increased by the percentage factor by which the facility's self-pay rates for
				semi-private 2-bed room accommodations increased from the preceding rate year.
				Thereafter, for each ensuing rate year, self-pay charges for ancillary charges
				shall be the ancillary charges in effect on June 30 of the preceding rate year
				increased by the percentage factor by which the facility's self-pay rates for
				semi-private 2-bed room accommodations increased from the preceding rate
				year.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-163 - Unauthorized charges to self-pay patients

Current through July 10, 2024
(a) Any facility
				which is found by the commissioner to have overcharged its self-pay patients,
				is issued a demand by the commissioner pursuant to subsection (c), and fails to
				rectify its violation upon demand by the commissioner, shall not be permitted
				any increase pursuant to Section
				17-311-161
				of these regulations.
(b) Any
				facility which charges a self-pay patient or the self-pay patient's legal
				guardian or conservator an amount greater than that permitted by the
				commissioner shall either refund the excess amount paid or credit the account
				of the self-pay patient for the excess amount paid. In the event that the full
				amount of the overcharge cannot be returned to the patient through the use of
				the credit, the remaining amount of the overcharge shall be refunded to the
				patient, the patient's legal guardian or conservator, of his/her
				estate.
(c) If the Commissioner is
				notified that a facility has failed to meet the obligations of subsection (b),
				he shall cause the matter to be investigated for verification of the
				overcharges. If an overcharge is found to have been made, he shall make demand
				upon the facility in writing by certified mail demanding that the facility
				comply with the requirements of subsection (b). If after thirty-one (31) days,
				the facility has not complied with the demand made by the Commissioner of
				Income Maintenance, the matter shall be referred to the Office of the attorney
				general for enforcement of the rate determination pursuant to subsection (e) of
				section 17-314a of the Connecticut General Statutes.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-164 - Field audit and other rate adjustments

Current through July 10, 2024
(a) Every facility
				for which self-pay charges are established may be audited as deemed necessary
				by the commissioner. Therefore, each facility shall maintain all supporting
				expenditure records up-to-date and available for review for a minimum period of
				ten years from date of previous audit, regardless whether the facility has
				changed ownership or not.
(b) In
				the event that a recomputation of a facility's state rate due to field audits
				or otherwise requires a change in a state rate which has served as the basis
				for a prior computation of the facility's self-pay charges, the self-pay
				charges shall be recomputed. However the recomputation shall only be
				implemented retroactively if it constitutes a downward self-pay rate
				adjustment. Increases in self-pay rate may only be implemented after all
				self-pay patients in the facility have been given notice of the rate increase,
				as determined by the commissioner, at least thirty days prior to the effective
				date of such rate increase. The facility shall be required to make appropriate
				refund as provided in section
				17-311-163(b).
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-165 - Hearings

Current through July 10, 2024
(a) Prior to the setting of the self-pay
				charges on July 1 each year, the Commissioner shall hold public hearings at
				various locations around the state after first giving notice as provided
				hereinafter. The Commissioner shall publish a notice of the hearing in the
				Connecticut Law Journal, mail a notice to the Commissioner on Aging and the
				Commissioner of Health Services and to all facilities for which he established
				rates pursuant to Section 17-314a, announcing the date, time, place and purpose
				of the hearing. Each facility shall post such notice in a place conspicuous to
				the patients within the facility and each facility shall provide copies of the
				notice immediately to the residents of the facility or to their legal guardians
				or conservators.
(b) At the public
				hearing, in addition to any matters relevant to rate setting, the commissioner
				shall receive any complaint of alleged overcharges of self-pay patients, or
				violations of state or federal law which allegedly occurred within the past
				twelve months relating to the quality of patient care provided by a facility. A
				transcript of the hearing shall be made and a copy shall be given to the
				commissioner of the department of health services or his designee for
				appropriate review and/or investigation by that department.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-166 - Notification and hearings

Current through July 10, 2024
(a) The
				commissioner shall send a notice by mail to each facility, informing the
				facility of the commissioner's decision with respect to the self-pay charges
				approved, and the percentage of increase approved for self-pay charges for
				ancillary services for the prospective fiscal year beginning July 1st.
				Immediately upon receipt of the self-pay charges decision, each facility shall
				provide a written notice of the decision to any self-pay patient affected, or
				to his guardian or conservator. Any facility, self-pay patient, or the guardian
				or conservator of a self-pay patient, aggrieved by the decision with respect to
				the self-pay charges, may obtain by request in writing to the commissioner, a
				hearing with respect to the self-pay charges decision, provided that such
				written request is made not later than ten (10) days after the date that the
				written notice of the decision is provided by the commissioner to the
				facility.
(b) Notices shall be sent
				by the facility by regular mail, postage prepaid, to the last known address of
				the self-pay patient, guardian, or conservator, and the facility shall certify
				to the commissioner the date upon which the notices were mailed to the self-pay
				patients.
(c) Notices sent by the
				facility to self-pay patients, guardians, or conservators regarding the
				self-pay charges established by the commissioner must contain the following
				information:
(1) The self-pay charge
				established by the commissioner for the level of care and type of room occupied
				by the patient.
(2) The date of the
				decision by the commissioner.
(3)
				The manner in which the patient, guardian or conservator may contest the
				self-pay charge, i.e., by mailing to the commissioner a written request for a
				hearing within ten days of the date of the decision by the
				commissioner.
(4) The address of
				the commissioner.