PA 08-91—sSB 559

Human Services Committee

Appropriations Committee


SUMMARY: This act directs the Department of Social Services (DSS) commissioner to establish a pilot program, within existing appropriations, to help develop up to 10 small house nursing homes in the state. The program's goals are to improve the quality of life for nursing home residents and provide nursing home care in home-like, rather than institutional, settings.

The act establishes requirements for pilot program guidelines and eligibility. It requires a small house nursing home participating in the pilot to comply with certificate of need (CON) requirements and processes. It also amends the current moratorium on additional nursing home beds.

When reviewing and selecting proposals, the commissioner must consult with the Long-Term Care Planning Committee. He must give priority to proposals that use energy efficiency technology, including fuel cells. And two of the ten proposals selected must develop a small house nursing home in a distressed municipality with more than 100,000 people. Currently, Bridgeport, Hartford, New Haven, and Waterbury meet these criteria.

EFFECTIVE DATE: July 1, 2008


Small House Nursing Home

The act defines a “small house nursing home” as a facility that:

1. consists of one or more units designed or modeled as a private home,

2. houses up to 10 individuals in each unit,

3. includes private rooms and bathrooms,

4. provides an increased role for support staff in resident care,

5. incorporates a philosophy of individualized care, and

6. is licensed as a nursing home.


The act requires the DSS commissioner to develop program guidelines for design specifications and requirements and submit them to the Human Services Committee by October 1, 2008. If the committee does not approve, deny or modify the guidelines within 30 days of receiving them, they are deemed approved. It authorizes the commissioner to establish additional criteria for homes and requires him to make all guidelines and criteria, once approved, available to applicants. It requires each participating home to seek Medicare and Medicaid certification.


A licensed nursing home may apply to the DSS commissioner to participate in the pilot program and to relocate existing Medicaid certified beds from its facility to the small house nursing home. An applicant must submit to DSS (1) a description of the proposed project, (2) information on the applicant's financial and technical capacity to undertake the project, (3) a project budget, (4) information that the relocation of beds results in a reduction in the number of the state's nursing home beds, and (5) any additional information the commissioner determines necessary.


The act requires a small house nursing home participating in the pilot to comply with CON requirements and processes.

It exempts Medicaid-certified beds relocated from a licensed nursing facility to a small house nursing home from the current moratorium on additional nursing home beds. (Current law already exempts the transfer of Medicaid-certified beds from one licensed nursing facility to another. )

It also exempts from the current moratorium on additional nursing home beds the relocation of up to 60 new or existing Medicaid-certified beds from a licensed nursing home in a city with a 2004 estimated population of 125,000 to another location within that city. (New Haven is the closest with 125,012. ) The act appears to apply only to existing beds since it is not clear how new beds can be relocated.


Certificate of Need for Nursing Homes

By law, any nursing home facility intending to do any of the following must apply for a CON from DSS:

1. transfer all or part of its ownership or control before initial licensure,

2. introduce an additional service or function into its program of care or expand an existing service or function,

3. terminate a service or decrease substantially its total bed capacity,

4. make a capital expenditure over $1 million that increases the facility's size by the greater of over 5,000 square feet or 5% of the existing footage,

5. make a capital expenditure of $2 million, or

6. acquire major medical equipment requiring a capital expenditure of over $400,000.

The law establishes a moratorium on CONs for additional nursing home beds until June 30, 2012. Exceptions are provided for:

1. beds restricted to use by patients with AIDS or traumatic brain injury;

2. beds associated with a continuing care facility that guarantees life care for its residents;

3. Medicaid-certified beds being relocated from one licensed nursing facility to another, provided (a) the availability of beds in an area of need will not be adversely affected, (b) the relocation will not result in increased state expenditures, and (c) the relocation reduces the number of nursing facility beds in the state;

4. a request for up to 20 beds from a nursing facility that does not participate in Medicaid or Medicare and demonstrates the financial ability to provide lifetime nursing home services to its residents without such participation; and

5. a request for up to 20 beds associated with a free standing facility authorized to provide hospice care for terminally ill people (CGS 17b-354).

“Small House” and “Green House” Nursing Home Models

Generally, “green houses” or “small houses” are “deinstitutionalized” nursing homes. They are self-contained dwellings for seven to 10 residents requiring nursing home levels of care. They incorporate physical design changes such as private rooms and bathrooms, a residential-style kitchen, a communal dining area, and accessible outdoor space. They avoid institutional elements. A cluster of green houses, in effect, forms a nursing facility.

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