Substitute Senate Bill No. 1092

Public Act No. 99-176

An Act Conforming the State Nursing Home Ombudsman Office with the Federal Older Americans Act.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 17b-400 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) As used in this chapter and sections 14 to 17, inclusive, of this act:

(1) "State agency" means the Division of Elderly Services of the Department of Social Services.

(2) "Office" means the Office of the Long-Term Care Ombudsman established in this section.

(3) "State Ombudsman" means the State Ombudsman established in this section.

(4) "Program" means the long-term care ombudsman program established in this section.

(5) "Representative" includes a regional ombudsman, a residents advocate or an employee of the Office of the Long-Term Care Ombudsman who is individually designated by the ombudsman.

(6) "Resident" means an older individual who resides in or is a patient in a long-term care facility who is sixty years of age or older.

(7) "Long-term care facility" means any skilled nursing facility, as defined in Section 1819(a) of the Social Security Act, (42 USC 1395i-3(a)) any nursing facility, as defined in Section 1919(a) of the Social Security Act, (42 USC 1396r(a)) a board and care facility as defined in Section 102(19) of the federal Older Americans Act, (42 USC 3002(19)) and for purposes of ombudsman program coverage, an institution regulated by the state pursuant to Section 1616(e) of the Social Security Act, (42 USC 1382e(e)) and any other adult care home similar to a facility or nursing facility or board and care home.

(8) "Commissioner" means the Commissioner of Social Services.

(9) "Director" means the director of the Division of Elderly Services of the Department of Social Services.

(10) "Applicant" means an older individual who has applied for admission to a long-term care facility.

[(a)] (b) There is established [a Nursing Home Ombudsmen Office] an independent Office of the Long-Term Care Ombudsman within the [state] Department of Social Services. [which shall be responsible for receiving and resolving health and human services complaints affecting patients or residents in nursing home facilities as defined in section 19a-521.] The Commissioner of Social Services shall appoint a State Ombudsman [and] who shall be selected from among individuals with expertise and experience in the fields of long-term care and advocacy to head the office and the State Ombudsman shall appoint assistant regional ombudsmen. In the event the State Ombudsman or an assistant regional ombudsman is unable to fulfill the duties of [his] the office, the commissioner [may] shall appoint an acting State Ombudsman [or] and the State Ombudsman shall appoint an acting assistant regional ombudsman. [Such State Ombudsman or acting State Ombudsman and the regional ombudsmen or acting regional ombudsman shall appoint local volunteer patients' advocates, as provided in section 17b-401, to carry out the provisions of sections 17b-400 to 17b-412, inclusive, 19a-523, 19a-524, 19a-530, 19a-531, 19a-532 and 19a-554.]

[(b)] (c) Notwithstanding the provisions of subsection [(a)] (b) of this section, on and after July 1, 1990, the positions of State Ombudsman and [assistant] regional ombudsmen shall be classified service positions. The State Ombudsman and [assistant] regional ombudsmen holding said positions on said date shall continue to serve in their positions as if selected through classified service procedures. As vacancies occur in such positions thereafter, such vacancies shall be filled in accordance with classified service procedures.

Sec. 2. Section 17b-401 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) [Patients'] Residents' advocates shall be appointed by the State Ombudsman, in consultation with the regional ombudsmen, for each region in sufficient number to serve the [nursing home] long-term care facilities within such region. Such [patients'] residents' advocates shall, if possible, be residents of the region in which they will serve, and shall have demonstrated an interest in the care of the elderly. [Patients'] Residents' advocates shall serve without compensation but may be reimbursed for reasonable expenses incurred in the performance of their duties, within available appropriations.

(b) The [patients'] residents' advocates shall be appointed [after consultation with the chief administrative officer and the committee on aging, if any, for each town, the area agency on aging and the director of health serving each town and] after submission of recommendations from at least two former employers or other nonrelated persons.

(c) The [patients'] residents' advocates shall serve for a term of years specified by the [Commissioner of Social Services] State Ombudsman provided a [patients'] residents' advocate may be removed by the State Ombudsman whenever [he] the State Ombudsman finds such [patients'] residents' advocate guilty of misconduct, material neglect of duty or incompetence in the conduct of the office.

(d) Nothing in [subdivision (20) of subsection (a) of section 2c-2b and] sections 17b-400 to 17b-412, inclusive, as amended by this act, 19a-523, as amended by this act, 19a-524, 19a-530, as amended by this act, 19a-531, 19a-532 and 19a-554 shall be construed to preclude the use of additional trained volunteers when it is deemed necessary to assist the State Ombudsman, regional ombudsmen or the [patients'] residents' advocates.

(e) Until such time as [patients'] residents' advocates are appointed in accordance with the provisions of [subdivision (20) of subsection (a) of section 2c-2b and] sections 17b-400 to 17b-412, inclusive, as amended by this act, 19a-523, as amended by this act, 19a-524, 19a-530, as amended by this act, 19a-531, 19a-532 and 19a-554, those [patients'] residents' advocates previously appointed shall continue to perform their assigned duties and responsibilities.

Sec. 3. Section 17b-402 of the general statutes is repealed and the following is substituted in lieu thereof:

[(a)] No person may perform any functions as a [patients'] residents' advocate until [he or she] the person has successfully completed a course of training [prescribed by regulation by the Commissioner of Social Services] required by the State Ombudsman. Any [patients'] residents' advocate who fails to complete such a course within a reasonable time after appointment may be removed by the State Ombudsman or the regional ombudsman for the region in which such [patients'] residents' advocate serves. The commissioner, after consultation with the State Ombudsman, shall adopt regulations, in accordance with the provisions of chapter 54, to carry out the provisions of this section. Such regulations shall include, but not be limited to, the course of training required by this subsection.

[(b) At the discretion of the Commissioner of Social Services, after consultation with the State Ombudsman the training requirement specified in subsection (a) may be waived upon a showing of adequate training or experience.]

Sec. 4. Section 17b-403 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The State Ombudsman shall establish and operate ombudsman programs in this state pursuant to Sections 711 to 713, inclusive, of the federal Older Americans Act of 1965, as amended from time to time. [(1) establish program policies and procedures for receiving, evaluating, referring and resolving complaints from nursing home facility patients and families, employees of nursing home facilities and the general public, relating to nursing home facilities; (2) carry out established policies and procedures, including receipt of appropriate complaints and reporting in writing on any action taken; (3) collaborate with state officials and other appropriate organizations to clarify complaints and pursue all necessary steps to resolve such complaints; (4) provide information as requested to state agencies and organizations; (5) collect data for research and analysis to substantiate recommendations for policy and program changes and study the problems encountered therein; (6) identify and document significant problems affecting a large segment of the nursing home facility population and communicate the documented problem area to groups or agencies with similar concerns and jurisdictional authority to deal with such problems; (7) establish local liaison and working relationships with the media, speakers bureaus and civic organizations and develop an ongoing program of publicizing the ombudsmen office, its purposes and mode of operation, and (8) submit legislative recommendations to the General Assembly.]

(b) The State Ombudsman shall serve on a full-time basis, and shall personally or through representatives of the office:

(1) Identify, investigate and resolve complaints that:

(A) Are made by, or on behalf of, residents or, as to complaints involving the application for admission to a long-term care facility, by or on behalf of applicants; and

(B) Relate to action, inaction or decisions that may adversely affect the health, safety, welfare or rights of the residents, including the welfare and rights of the residents with respect to the appointment and activities of guardians and representative payees, of (i) providers or representatives of providers of long-term care services, (ii) public agencies, or (iii) health and social service agencies;

(2) Provide services to protect the health, safety, welfare and rights of the residents;

(3) Inform the residents about means of obtaining services provided by providers or agencies described in subparagraph (B) of subdivision (1) of this subsection or services described in subdivision (2) of this subsection;

(4) Ensure that the residents and, as to issues involving applications for admission to long-term care facilities, applicants have regular and timely access to the services provided through the office and that the residents and complainants receive timely responses from representatives of the office to complaints;

(5) Represent the interests of the residents, and of applicants in relation to issues concerning applications to long-term care facilities, before governmental agencies and seek administrative, legal and other remedies to protect the health, safety, welfare and rights of the residents;

(6) Provide administrative and technical assistance to representatives to assist the representatives in participating in the program;

(7) (A) Analyze, comment on and monitor the development and implementation of federal, state and local laws, regulations, and other governmental policies and actions that pertain to the health, safety, welfare and rights of the residents with respect to the adequacy of long-term care facilities and services in this state and to the rights of applicants in relation to applications to long-term care facilities;

(B) Recommend any changes in such laws, regulations, policies and actions as the office determines to be appropriate; and

(C) Facilitate public comment on the laws, regulations, policies and actions;

(8) Advocate for: (A) Any changes in federal, state and local laws, regulations and other governmental policies and actions that pertain to the health, safety, welfare and rights of residents with respect to the adequacy of long-term care facilities and services in this state and to the health, safety, welfare and rights of applicants which the State Ombudsman determines to be appropriate;

(B) Appropriate action by groups or agencies with jurisdictional authority to deal with problems affecting individual residents and the general resident population and applicants in relation to issues concerning applications to long-term care facilities; and

(C) The enactment of legislative recommendations by the General Assembly and of regulatory recommendations by commissioners of Connecticut state agencies;

(9) (A) Provide for training representatives of the office;

(B) Promote the development of citizen organizations to participate in the program; and

(C) Provide technical support for the development of resident and family councils to protect the well-being and rights of residents;

(10) Coordinate ombudsman services with the protection and advocacy systems for individuals with developmental disabilities and mental illnesses established under (A) Part A of the Development Disabilities Assistance and Bill of Rights Act (42 USC 6001, et seq.), and (B) The Protection and Advocacy for Mentally Ill Individuals Act of 1986 (42 USC 10801 et seq.);

(11) Coordinate, to the greatest extent possible, ombudsman services with legal assistance provided under Section 306(a)(2)(C) of the federal Older Americans Act of 1965, (42 USC 3026(a)(2)(C)) as amended from time to time, through the adoption of memoranda of understanding and other means;

(12) Provide services described in subdivisions (1) to (11), inclusive, of this subsection, to residents under age sixty living in a long-term care facility, if (A) a majority of the residents of the facility where the younger person resides are over age sixty and (B) such services do not weaken or decrease service to older individuals covered under this chapter; and

(13) Carry out such other activities and duties as may be required under federal law.

Sec. 5. Section 17b-404 of the general statutes is repealed and the following is substituted in lieu thereof:

The State Ombudsman is authorized to investigate and make reports and recommendations concerning any act or the failure to act by any agency, official or public employee, with respect to their responsibilities and duties in connection with [nursing home] long-term care facilities, except the courts and their personnel, legislative bodies and their personnel and the chief executive of the state and [his] the chief executive's personal staff and all elected officials.

Sec. 6. Section 17b-405 of the general statutes is repealed and the following is substituted in lieu thereof:

[The regional ombudsmen shall: (1) Be responsible for the patients' advocates in the performance of their duties and shall assist such advocates in resolving problems; (2) investigate problems and complaints brought to them by such advocates and shall direct any complaint, so investigated, to the State Ombudsman for further action, if necessary; (3) collect data from their regions which shall be directed to the State Ombudsman for research and analysis; (4) carry out policies and procedures in their regions as established by the Nursing Home Ombudsmen Office, including reporting in writing any action taken concerning a complaint; (5) collaborate with local and regional officials and organizations in attempting to clarify and resolve complaints and (6) establish local liaison and working relationships with the media, speakers' bureaus and civic organizations and develop an ongoing program of publicizing the ombudsmen office, its purposes and mode of operation.]

The regional ombudsmen shall, in accordance with the policies and procedures established by the Office of the Long-Term Care Ombudsman and the director:

(1) Provide services to protect the health, safety, welfare and rights of residents;

(2) Ensure that residents in service areas have regular timely access to representatives of the program and timely responses to complaints and requests for assistance;

(3) Identify, investigate and resolve complaints made by or on behalf of residents that relate to action, inaction or decisions that may adversely affect the health, safety, welfare or rights of the residents or by, or on behalf of, applicants in relation to issues concerning applications to long-term care facilities;

(4) Represent the interests of residents and applicants, in relation to their applications to long-term care facilities, before government agencies and seek administrative, legal and other remedies to protect the health, safety, welfare and rights of the residents;

(5) (A) Review and, if necessary, comment on any existing and proposed laws, regulations and other government policies and actions that pertain to the rights and well-being of residents and applicants in relation to their applications to long-term care facilities, and (B) facilitate the ability of the public to comment on the laws, regulations, policies and actions;

(6) Support the development of resident and family councils; and

(7) Carry out other activities that the State Ombudsman determines to be appropriate.

Sec. 7. Section 17b-406 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) [Patients'] Residents' advocates, under supervision of the regional ombudsmen, shall assist the regional ombudsmen in the performance of all duties and responsibilities of the regional ombudsmen as described in section 17b-405, as amended by this act. [including, but not limited to, the following: (1) The establishment of program policies and procedures for receiving, evaluating, referring and resolving complaints from nursing home facility patients and families, employees of nursing home facilities and the general public, relating to nursing home facilities; (2) the carrying out of established policies and procedures, including receipt of appropriate complaints and the reporting in writing on any action taken; (3) the collaboration with state officials and other appropriate organizations to clarify complaints and the pursuit of all necessary steps to resolve such complaints; (4) the provision of information as requested to state agencies and organizations; (5) the collection of data for research and analysis to substantiate recommendations for policy and program changes and the study of the problems encountered therein; (6) the identification and documentation of significant problems affecting a large segment of the nursing home facility population and the communication of the documented problem area to groups or agencies with similar concerns and jurisdictional authority to deal with such problems; (7) the establishment of local liaison and working relationships with the media, speakers bureaus and civic organizations and the development of an ongoing program of publicizing the role of the state ombudsmen office and the patients' advocates; (8) the submission of legislative recommendations to the General Assembly; (9) the facilitation of private legal action for patients if necessary; (10) assuring that the patients' bill of rights, as established in section 19a-550, is properly posted and is distributed to each patient or, if such patient is a minor or incompetent, to his relative, guardian, conservator or sponsoring agency and assuring that all elements and provisions of the patients' bill of rights are adhered to properly; (11) assuring that all mandated posting of the availability of reports has been complied with; and (12) aiding patients in administrative procedures relating to transfers and discharges, and aiding in insuring that patients are satisfied with the management of their financial affairs.]

[(b) Such patients' advocates shall report to the Commissioner of Social Services, the Commissioner of Public Health and to the local director of health, board of health or official charged with the enforcement of the health laws any violations of subsection (a) of this section.]

[(c)] (b) All [nursing home] long-term care facilities shall post or cause to be posted in a conspicuous place therein a list of the names of the appropriate [patients'] residents' advocates and the names, addresses, and telephone numbers of the appropriate ombudsmen.

[(d)] (c) The Commissioner of Social Services shall have authority to seek funding for the purposes contained in this section from public and private sources, including but not limited to any federal or state funded programs.

Sec. 8. Section 17b-407 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Any physician or surgeon licensed under the provisions of chapter 370 or 371, any resident physician or intern in any hospital in this state, whether or not so licensed, and any registered nurse, licensed practical nurse, medical examiner, dentist, osteopath, optometrist, chiropractor, podiatrist, social worker, clergyman, police officer, pharmacist, physical therapist, [nursing home] long-term care facility administrator, nurses aide or orderly in a [nursing home] long-term care facility, any person paid for caring for a patient in a [nursing home] long-term care facility, any staff person employed by a [nursing home] long-term care facility [, any regional ombudsman or patients' advocate] and any person who is a sexual assault counselor or a battered women's counselor as defined in section 52-146k who has reasonable cause to suspect or believe that a [patient] resident in a [nursing home] long-term care facility has been abused, neglected, exploited or abandoned, or is in a condition which is the result of such abuse, neglect, exploitation or abandonment, shall within five calendar days report such information or cause a report to be made in any reasonable manner to the [Nursing Home Ombudsmen Office] Commissioner of Social Services pursuant to chapter 319dd. Any person required to report under the provision of this section who fails to make such report within the prescribed time period shall be fined not more than five hundred dollars.

(b) Such report shall contain the name and address of the [nursing home] long-term care facility, the name of the involved [patient] resident, information regarding the nature and extent of the abuse, neglect, exploitation or abandonment and any other information which the reporter believes might be helpful in an investigation of the case and for the protection of the [patient] resident.

(c) Any other person having reasonable cause to believe that a [patient] resident in a [nursing home] long-term care facility is being, or has been, abused, neglected, exploited or abandoned, or any person who wishes to file any other complaint regarding a [nursing home] long-term care facility, shall report such information in accordance with subsection (b) in any reasonable manner to the [Nursing Home Ombudsmen Office] Commissioner of Social Services who shall inform the resident of the services of the Office of the Long-Term Care Ombudsman.

(d) Such report or complaint shall not be deemed a public record, and shall not be subject to the provisions of section 1-210. Information derived from such reports or complaints for which reasonable grounds are determined to exist after investigation as provided for in section 17b-408, as amended by this act, including the identity of the [nursing home] long-term care facility, the number of complaints received, the number of complaints substantiated and the types of complaints, may be disclosed by the [State Ombudsman] Commissioner of Social Services, except that in no case shall the name of the [patient] resident or the complainant be revealed, unless such person specifically requests such disclosure or unless a judicial proceeding results from such report or complaint.

(e) Anyone who makes a report or complaint pursuant to this section or who testifies in any administrative or judicial proceeding arising from the report shall be immune from any civil or criminal liability on account of such report or complaint or testimony, except for liability for perjury, unless such person acted in bad faith or with malicious purpose.

(f) The person filing a report or complaint pursuant to the provisions of this section shall be notified of the findings of any investigation conducted by the [Nursing Home Ombudsmen Office] Commissioner of Social Services, upon request.

(g) The [State Ombudsman] Commissioner of Social Services shall maintain a registry of the reports received, the investigations made, the findings and the actions recommended and taken.

Sec. 9. Section 17b-408 of the general statutes is repealed and the following is substituted in lieu thereof:

Upon receipt of a report or complaint as provided in section 17b-407, as amended by this act, the [ombudsmen] commissioner shall determine immediately whether there are reasonable grounds for an investigation. If it is determined that reasonable grounds do not exist for an investigation, the complainant or the person making the report shall be notified of this determination within five working days after the receipt of such complaint or report. If such reasonable grounds are found, the [appropriate regional ombudsman in conjunction with the patients' advocates,] commissioner shall investigate such report or complaint within ten working days thereafter. The [regional ombudsman] commissioner shall complete [his] an investigation and make a report of [his] the findings, within fifteen working days after the receipt of the complaint or report. [, a copy of which shall be sent to the State Ombudsman.] If the investigation indicates that there is a possible violation of section 19a-533, 19a-535, or 19a-537, the [regional ombudsman] commissioner shall refer the report or complaint together with a report of any investigation [he] the commissioner has undertaken to [the Department of Social Services or] the Department of Public Health for action as appropriate. If the investigation indicates that there is a possible violation of the provisions of the Public Health Code with respect to licensing requirements, the [regional ombudsman] commissioner shall refer the report or complaint, together with a report of [his] the commissioner's investigation, to the Commissioner of Public Health for appropriate action. If no violation of the Public Health Code is indicated, the [regional ombudsman] commissioner shall take whatever action [he] the commissioner deems necessary, and shall notify the complainant or the person making the report, of the action taken within fifteen working days after receipt of the complaint or report.

Sec. 10. Section 17b-409 of the general statutes is repealed and the following is substituted in lieu thereof:

[Neither the State Ombudsman, nor any employee of the Nursing Home Ombudsmen Office, nor the regional ombudsmen, patients' advocates or any employee of any other state agency shall be held personally liable in any civil action for damages on account of any act or omission not wanton or wilful in the performance of his responsibilities or duties under sections 17b-400 to 17b-412, inclusive, 19a-523, 19a-524, 19a-530, 19a-531, 19a-532 and 19a-554. Any person to whom the provisions of this section apply and against whom any action is brought on account of any alleged act or omission shall be represented therein by the Attorney General in the manner provided in chapter 35.]

(a) The state agency shall ensure that:

(1) (A) Adequate legal counsel is available and is able, without conflict of interest, to: (i) Provide advice and consultation needed to protect the health, safety, welfare and rights of residents and applicants in relation to their applications to long-term care facilities; and (ii) assist the ombudsman and representatives of the office in the performance of the official duties of the ombudsman and representatives; and

(B) Administrative, legal and other appropriate remedies are pursued on behalf of residents and applicants in relation to their applications to long-term care facilities.

(b) The regional ombudsmen and residents' advocates shall be considered state employees under section 4-141 for the purposes of any civil action for damages on account of any act or omission that is not wanton, wilful or malicious and that is within the scope of employment or duties under sections 17b-400 to 17b-412, inclusive, as amended by this act, 19a-531 and 19a-532.

Sec. 11. Section 17b-410 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The ombudsman and representatives of the office shall have:

(1) Access to long-term care facilities and residents;

(2) Appropriate access to review the medical and social records of a resident, if (A) the representative has the permission of the resident, or the legal representative of the resident, (B) the resident is unable to consent to the review and has no legal representative, or (C) access to the records is necessary to investigate a complaint and a legal guardian of the resident refuses to give permission, a representative of the office has reasonable cause to believe that the guardian is not acting in the best interests of the resident, and the representative obtains the approval of the ombudsman;

(3) Access to the administrative records, policies and documents, to which the residents have, or the general public has access, of long-term care facilities; and

(4) Access to and, on request, copies of all licensing and certification records maintained by the state with respect to long-term care facilities.

[(a) Any nursing home] (b) Any person or entity who wilfully interferes with representatives of the office in the performance of the official duties of the representatives, or any long-term care facility or other entity which retaliates or exacts reprisals with respect to any resident, employee or other person for filing a complaint with, providing information to, or otherwise cooperating with any representative of the office, or long-term care facility which refuses to permit the State Ombudsman or any regional ombudsman or any [patients'] residents' advocate entry into such facility or refuses to cooperate with the State Ombudsman, or any regional ombudsman or any [patients'] residents' advocate in the carrying out of their mandated duties and responsibilities enumerated under sections 17b-400 to 17b-412, inclusive, as amended by this act, [19a-523, 19a-524, 19a-530,] 19a-531 [,] and 19a-532 [and 19a-554] or refuses to permit [patients] residents or staff to communicate freely with the State Ombudsman or any regional ombudsman or any [patients'] residents' advocate shall be subject to the penalty prescribed for a class B violation under section 19a-527.

[(b)] (c) In carrying out the duties enumerated in sections 17b-400 to 17b-412, inclusive, as amended by this act, [19a-523, 19a-524, 19a-530,] 19a-531 [,] and 19a-532, [and 19a-554,] the State Ombudsman, the regional ombudsmen and the [patients'] residents' advocates shall have access to all relevant public records, except that records which are confidential to a [patient] resident shall only be divulged with the written consent of the [patient] resident.

[(c)] (d) In the performance of the duties and responsibilities enumerated under sections 17b-400 to 17b-412, inclusive, as amended by this act, [19a-523, 19a-524, 19a-530,] 19a-531 [,] and 19a-532, [and 19a-554,] the State Ombudsman, the regional ombudsmen and the [patients'] residents' advocates may utilize any other state department, agency or commission, or any other public or private agencies, groups or individuals who are appropriate and who may be available.

Sec. 12. Section 17b-411 of the general statutes is repealed and the following is substituted in lieu thereof:

[Regulations shall be promulgated by the] The Commissioner of Social Services, after consultation with the State Ombudsman, shall adopt regulations in accordance with the provisions of chapter 54, to carry out the provisions of sections 17b-400 to 17b-412, inclusive, as amended by this act, [19a-523, 19a-524, 19a-530,] 19a-531 [,] and 19a-532. [and 19a-554.]

Sec. 13. Section 17b-412 of the general statutes is repealed and the following is substituted in lieu thereof:

[On or before September 1, 1978, and annually thereafter, the State Ombudsman shall submit, through the Commissioner of Social Services, a report to the Governor and the General Assembly of the activities of the ombudsmen office during the prior fiscal year and a projected budget for the coming fiscal year. The report shall include, but not be limited to, the number and general pattern of complaints received by the ombudsmen office, the number and nature of administrative acts investigated, the action taken on such investigations, the results of such actions and any opinions or recommendations which will further the state's capabilities in resolving nursing home complaints.] The director shall require the State Ombudsman to:

(1) Prepare an annual report:

(A) Describing the activities carried out by the office in the year for which the report is prepared;

(B) Containing and analyzing the data collected under section 14 of this act;

(C) Evaluating the problems experienced by and the complaints made by or on behalf of residents;

(D) Containing recommendations for (i) improving the quality of the care and life of the residents, and (ii) protecting the health, safety, welfare and rights of the residents;

(E) (i) Analyzing the success of the program including success in providing services to residents of long-term care facilities; and (ii) identifying barriers that prevent the optimal operation of the program; and

(F) Providing policy, regulatory and legislative recommendations to solve identified problems, to resolve the complaints, to improve the quality of the care and life of residents, to protect the health, safety, welfare and rights of residents and to remove the barriers that prevent the optimal operation of the program.

(2) Analyze, comment on and monitor the development and implementation of federal, state and local laws, regulations and other government policies and actions that pertain to long-term care facilities and services, and to the health, safety, welfare and rights of residents in the state, and recommend any changes in such laws, regulations and policies as the office determines to be appropriate.

(3) (A) Provide such information as the office determines to be necessary to public and private agencies, legislators and other persons, regarding (i) the problems and concerns of older individuals residing in long-term care facilities; and (ii) recommendations related to the problems and concerns; and (B) make available to the public and submit to the federal assistant secretary for aging, the Governor, the General Assembly, the Department of Public Health and other appropriate governmental entities, each report prepared under subdivision (1) of this section.

Sec. 14. (NEW) The state agency shall establish a state-wide uniform system to: (1) Collect and analyze data relating to complaints and conditions in long-term care facilities and to residents for the purpose of identifying and resolving significant problems; and (2) submit the data, on a regular basis to: (A) The Department of Public Health; (B) other state and federal entities that the State Ombudsman determines to be appropriate; and (C) the National Ombudsman Resource Center, established in Section 202(a)(21) of the federal Older Americans Act of 1965, as amended from time to time.

Sec. 15. (NEW) (a) The state agency shall:

(1) Provide that the files and records maintained by the program may be disclosed only at the discretion of the State Ombudsman or the person designated by the ombudsman to disclose the files and records; and

(2) Prohibit the disclosure of the identity of any complainant or resident with respect to whom the office maintains such files or records unless (A) the complainant or resident, or the legal representative of the complainant or resident, consents to the disclosure and the consent is given in writing; (B) (i) the complainant or resident gives consent orally; and (ii) the consent is documented contemporaneously in a writing made by a representative of the office in accordance with such requirements as the state agency shall establish; or (iii) the disclosure is required by court order.

Sec. 16. (NEW) In planning and operating the program, the state agency, in consultation with the ombudsman, shall consider the views of area agencies on aging, older individuals and providers of long-term care.

Sec. 17. (NEW) The state agency shall:

(1) Ensure that no individual, or member of the immediate family of an individual, involved in the designation of the State Ombudsman, whether by appointment or otherwise, or the designation of representatives is subject to a conflict of interest;

(2) Ensure that no officer or employee of the office, representative, or member of the immediate family of the officer, employee or representative, is subject to a conflict of interest;

(3) Ensure that the State Ombudsman: (A) Does not have a direct involvement in the licensing or certification of a long-term care facility or of a provider of a long-term care service; (B) does not have an ownership or investment interest, represented by equity, debt or other financial relationship, in a long-term care facility or a long-term care service; (C) is not employed by, or participating in the management of, a long-term care facility; and (D) does not receive, or have the right to receive, directly or indirectly, remuneration, in cash or in kind, under a compensation arrangement with an owner or operator of a long-term care facility; and

(4) Establish and specify, in writing, mechanisms to identify and remove conflicts of interest described in subdivisions (1) and (2) of this section, and to identify and eliminate the relationships described in subdivision (3) of this section, including such mechanisms as: (A) The methods by which the state agency will examine individuals and immediate family members to identify the conflicts; and (B) the actions that the state agency will require the individuals and such family members to take to remove such conflicts.

Sec. 18. Section 19a-521 of the general statutes is repealed and the following is substituted in lieu thereof:

As used in this section and sections [17b-406,] 19a-522 to 19a-534, inclusive, 19a-536 to 19a-539, inclusive, and 19a-550 to 19a-554, inclusive, unless the context otherwise requires: "Nursing home facility" means any nursing home or residential care home as defined in section 19a-490 or any rest home with nursing supervision which provides, in addition to personal care required in a residential care home, nursing supervision under a medical director twenty-four hours per day, or any chronic and convalescent nursing home which provides skilled nursing care under medical supervision and direction to carry out nonsurgical treatment and dietary procedures for chronic diseases, convalescent stages, acute diseases or injuries; "department" means the Department of Public Health and "commissioner" means the Commissioner of Public Health or [his] the commissioner's designated representative.

Sec. 19. Subsection (a) of section 19a-523 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) If, from the results of an inspection and investigation in accordance with section 19a-498, or upon receipt of a report or complaint from the [ombudsmen] Commissioner of Social Services, pursuant to section 17b-408, as amended by this act, and upon such review and further investigation, as [he] the Commissioner of Public Health deems necessary, the Commissioner of Public Health determines that such nursing home facility has violated any provision of the Public Health Code relating to the operation or maintenance of a nursing home facility, [said commissioner] the Commissioner of Public Health may, notwithstanding the provisions of chapter 54, request the Attorney General to seek a temporary or permanent injunction and such other relief as may be appropriate to enjoin such nursing home facility from continuing such violation or violations. If the court determines such violation or violations exist, it may grant such injunctive relief and such other relief as justice may require and may set a time period within which such nursing home facility shall comply with any such order.

Sec. 20. Section 19a-530 of the general statutes is repealed and the following is substituted in lieu thereof:

The Commissioner of Public Health, within ten working days, shall furnish the [appropriate regional ombudsman] Commissioner of Social Services a written report of any action taken pursuant to sections 19a-524 to 19a-527, inclusive, on any report or complaint referred to [him] the Commissioner of Public Health in accordance with the provisions of section 17b-408.

Sec. 21. Subsection (c) of section 19a-533 of the general statutes is repealed and the following is substituted in lieu thereof:

(c) Upon the receipt of a complaint concerning a violation of this section, the Department of Social Services [or the regional ombudsman] shall conduct an investigation into such complaint. [and shall report his findings to the Department of Social Services.]

Sec. 22. Subsection (c) of section 19a-535 of the general statutes is repealed and the following is substituted in lieu thereof:

(c) Before effecting a transfer or discharge of a patient from the facility, the facility shall notify, in writing, the patient and [his] the patient's guardian or conservator, if any, or [his] legally liable relative or other responsible party if known of the proposed transfer or discharge, the reasons therefor, its effective date, the location to which the patient is to be transferred or discharged, the right to appeal the proposed transfer or discharge and the procedures for initiating such an appeal as determined by the Department of Social Services, the date by which an appeal must be initiated in order to stay the proposed transfer or discharge, which date shall be ten days from the receipt of the notice from the facility, that the patient may represent himself or be represented by legal counsel, a relative, a friend or other spokesman, and information as to bed hold and hospital readmission policy when appropriate. The notice shall also include the name, mailing address and telephone number of the [state nursing home ombudsman] State Long-Term Care Ombudsman. If the patient is, or the facility alleges a patient is, mentally ill or developmentally disabled, the notice shall include the name, mailing address and telephone number of the Office of Protection and Advocacy. The notice shall be given at least thirty days and no more than sixty days prior to the patient's transfer or discharge, except where the health or safety of individuals in the facility are endangered or where the patient's health improves sufficiently to allow a more immediate transfer or discharge, or where immediate transfer or discharge is necessitated by urgent medical needs or where a patient has not resided in the facility for thirty days, in which cases notice shall be given as many days before the transfer or discharge as practicable.

Sec. 23. Section 19a-551 of the general statutes is repealed and the following is substituted in lieu thereof:

Each nursing home facility shall: (1) On or before the admission of each patient provide such patient or [his] such patient's legally liable relative, guardian or conservator with a written statement explaining such patient's rights regarding [his] the patient's personal funds and listing the charges which may be deducted from such funds. Such statement shall explain that the nursing home facility shall on and after October 1, 1992, pay interest at a rate not less than four per cent per annum and on and after October 1, 1994, pay interest at a rate not less than five and one-half per cent per annum on any security deposit or other advance payment required of such patient prior to [his] admission to the nursing home. In the case of patients receiving benefits under Title XVIII or XIX of the federal Social Security Act the statement shall include a list of charges not covered by said titles and not covered by the basic per diem rate provided by said titles. Upon delivery of such statement the person in charge of the nursing home facility shall obtain a signed receipt acknowledging such delivery; (2) upon written consent or request of the patient or [his] the patient's legally liable relative, guardian or conservator, manage such patient's personal funds, provided such consent by a patient shall not be effective unless cosigned by [his] the patient's legally liable relative or guardian if such patient has been determined by a physician to be mentally incapable of understanding and no conservator has been appointed. As manager of such personal funds the nursing home facility shall: (A) Either maintain separate accounts for each patient or maintain an aggregate trust account for patients' funds to prevent commingling the personal funds of patients with the funds of the facility. The facility shall notify in writing each patient receiving Medicaid assistance or [his] such patient's legally liable relative, guardian or conservator when the amount in the patient's account reaches two hundred dollars less than the dollar amount determined under the Medicaid program as the maximum for eligibility under the program and advise the patient or [his] such patient's legally liable relative, guardian or conservator that if the amount in the account plus the value of the patient's other nonexempt resources reaches the maximum the patient may lose his or her Medicaid eligibility; (B) obtain signed receipts for each expenditure from each patient's personal funds; (C) maintain an individual itemized record of income and expenditures for each patient, including quarterly accountings; and (D) permit the patient or [his] the patient's legally liable relative, guardian or conservator, and the regional [nursing home] long-term care ombudsman, and representatives from the Departments of Social Services and Public Health, access to such record; and (3) (A) refund any overpayment or deposit from a former patient or such patient's legally liable relative, guardian or conservator within thirty days of the patient's discharge and (B) refund any deposit from an individual planning to be admitted to the facility within thirty days of receipt of written notification that the individual is no longer planning to be admitted. A refund issued after thirty days shall include interest at a rate of ten per cent per annum. For the purposes of this section "deposit" shall include liquidated damages under any contract for pending admission.

Sec. 24. This act shall take effect July 1, 1999.

Approved June 23, 1999

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