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 17-311-209 - Admissions

Current through July 10, 2024
(a) Nursing homes may not discriminate
				against indigent persons and shall admit all applicants for admission in the
				order in which the names of such applicants appear on the waiting list, except
				as otherwise provided by statute or these regulations.
(b) A facility may admit applicants other
				than in the order in which their names appear on the waiting list, provided
				that the following exceptions are uniformly and consistently applied without
				regard to source of payment, only if:
(1) An
				applicant has yet to provide medical, social or financial information requisite
				to determine the individual's eligibility for admission provided that the
				nursing home had previously notified the applicant what specific medical,
				social and financial information was required and can document such
				notification. In such case, a dated notation must be made on the waiting
				list.
(2) An applicant for
				admission fails to meet the applicable level of care requirements contained in
				the Public Health Code, Reg. Ct. St. Ag. §
										19-13-D8T(d)
				(1) (A), and/or the applicant requires care or services without which the
				patient is at risk which the facility is unable to provide as certified by its
				Medical Director in accordance with Reg. Ct. St. Ag. §
										19-13-D8T(h)
				(2) (D) and 19-13-D8T (i) (4) (D) (iii). It shall constitute unlawful
				discrimination forbidden by this section, however, if a nursing home fails to
				properly and consistently apply the applicable level of care requirements or if
				it improperly determines that the applicant requires care or services beyond
				its capability as set forth
supra,
having the effect of
				denying admission of an indigent person to the nursing home.
(3) A person had previously been a resident
				of a nursing home who was absent from the nursing home for a reason of
				hospitalization and is entitled to priority admission as per Conn. Gen. Stat.
				§
										19a-537.
				Any person so admitted shall have a notation to that effect made on the daily
				log.
(4) Transfers of patients from
				one level of care to another within a facility licensed to offer more than one
				level of care, i.e., chronic disease hospital, chronic and convalescent nursing
				home, rest home with nursing supervision, home for the aged, are not subject to
				the provisions of Conn. Gen. Stat. §
										19a-533
				or these regulations, provided that such intrafacility transfers are for bona
				fide medical reasons.
(5) The
				nursing home admits a patient who has been determined by an appropriate state
				agency to be in need of protective services and is referred to the facility for
				admission by an appropriate state agency pursuant to the provisions of Conn.
				Gen. Stat. § 46a-14
et seq.
(6) Due to decertification or license
				revocation of another facility or some other public health reason, the
				Commissioner of Health Services or his representative refers a patient to the
				facility.
(7) The nursing home has
				been granted permission by the Connecticut Commission on Hospitals and Health
				Care to withdraw from the Medicaid program by terminating its provider
				agreement pursuant to the provisions of Conn. Gen. Stat. § 19a-154. In
				order to be excused from the admission requirements of this section, the
				facility must comply with the terms and conditions of any order entered by the
				Commission allowing a withdrawal from the program by appropriate discharge and
				transfer of all Medicaid patients provided that any withdrawal from the
				Medicaid program must be accomplished within (3) months of the order granting
				permission to withdraw, unless the order of the Commission allows the facility
				more than three months to withdraw from the program, except that if the Medical
				Director of the nursing home certifies that specific Medicaid patient(s) would
				suffer serious harm as a result of a discharge or transfer, the Department of
				Income Maintenance, may, if it concurs with the determination of the facility's
				Medical Director, enter into a limited provider agreement with the facility
				covering only such patients-which will otherwise excuse the facility from
				complying with the admission requirements of this section.
(8) The applicant (A) has entered into a
				continuing care contract in accordance with Conn. Gen. Stat. § 17-535 and
				regulations promulgated thereunder, and is a resident of a continuing care
				facility that provides for care to be given by the nursing home; or (B) resides
				in a residential facility for the elderly that offers meals, and some
				combination of housekeeping, emergency medical call systems and other social
				supports, and two or more health-related benefits in addition to shelter and is
				controlled, owned or operated by the owner or operator of a nursing home which
				is located on the same or an adjacent site or in the immediate geographic
				proximity. Health-related benefits include priority access to the nursing home
				without regard to source of payment, health care provided by a nursing home or
				by a home-health agency as defined in Conn. Gen. Stat. §
										19a-490,
				or the services of any licensed health professional on a regular, ongoing
				basis, either on staff or on contract.
(9) A designated number of beds set aside for
				respite care with a maximum stay of 30 consecutive days with such applicants
				admitted in the order in which their names appear on the waiting
				list;
(10) A designated number of
				beds set aside for short term rehabilitation with a 90 day maximum stay with
				such applicants admitted in the order in which their names appear on the
				waiting list;
(11) A designated
				number of beds set aside for the terminally ill with applicants in such
				condition accepted in the order in which their names appear on the waiting
				list;
(12) A designated number of
				beds in a specialized unit (e.g. Alzheimer's Unit, TBI Unit) and applicants
				with that condition accepted in the order in which their names appear on the
				waiting list;
(13) A spouse of the
				applicant is a patient in the nursing home;
(14) The applicant was discharged from the
				nursing home to the community within fifteen days of his/her request for
				readmission;
(15) A municipally
				owned and operated facility with residency requirement with resident applicants
				admitted in the order in which their names appear on the waiting
				list;
(16) The facility offers any
				of the following specialized medical treatments: nasogastric tubes with pump,
				respiratory therapy with or without a ventilator or other specialized
				tracheostomy care, intravenous therapy including hyperalimentation,
				Clinitron-type beds, Hubbard-type tanks, provided that patients in need of the
				treatment(s) are admitted in the order in which their names appear on the
				waiting list. A facility offering any such treatment shall designate a maximum
				number of beds for which such treatments will be offered;
(17) The facility is owned or operated by a
				religious organization exempt from taxation for federal income tax purposes
				which exists to provide long term care to members of its religion provided that
				all applicants who are members of such religion are admitted in their order of
				application without regard to their source of payment and without regard to any
				other factor including but not limited to either their own or their families'
				past financial contributions and/or volunteer efforts to such religion and/or
				its related organizations.
(18) The
				facility is owned, operated by or affiliated with a fraternal organization
				exempt from taxation for federal income tax purposes which exists to provide
				long term care to members of its fraternal organization provided that all
				applicants who are members of such fraternal organization are admitted in the
				order of application without regard to their source of payment and without
				regard to any other factor including but not limited to either their own or
				their families' past financial contributions and/or volunteer efforts to such
				fraternal organization and/or its related organizations.
(19) The facility is owned or operated by a
				non-stock, non-profit corporation exempt from taxation for federal income tax
				purposes which (1) provides now and provided in its original charter or
				certificate of incorporation that it is established for the benefit of the
				municipality in which it is located, and (2) receives financial assistance
				through grants or donations from the municipality in which it is located and/or
				the residents thereof, provided that all applicants who are residents of such
				municipality are admitted in the order of application without regard to their
				source of payment and without regard to any other factor including but not
				limited to either their own or their families' past financial contributions
				and/or volunteer efforts to such facility and/or its related
				organizations.
(20) The nursing
				home has entered into a contract or contracts with a hospital or hospitals
				pursuant to which patients to be discharged from the hospital are given
				priority in admission to no more than fifteen percent of the nursing home's
				beds as such beds become vacant, with said fifteen percent limitation referring
				to all such contracts combined. Such contracts may only be entered into when
				the municipality in which the nursing home is located is within forty (40)
				miles of the hospital. Such agreements shall provide that patients shall be
				referred by the hospital to the nursing home in the order in which such
				patients are medically ready for discharge without regard to their source of
				payment. Once a nursing home admits a patient pursuant to this subsection, it
				may not accept any payment in excess of the Title XIX Medicaid rate in the case
				of a Medicaid patient and it may not accept any payment in excess of the
				facility's applicable maximum allowable self-pay rate in the case of a
				private-pay patient. Whenever a nursing home has a vacant bed and the hospital
				does not have a patient to be referred pursuant to this subsection, the nursing
				home must immediately fill such vacancy from its waiting list for admission,
				provided that if the hospital has identified a patient whose discharge will be
				completed within four working days, the nursing home may hold the bed for this
				period under arrangement with the hospital.