Sec. 17b-347. (Formerly Sec. 17-314g). Termination of Medicaid provider agreements by nursing home facilities. Rates to be charged self-pay patients.
Sec. 17b-347. (Formerly Sec. 17-314g). Termination of Medicaid provider
agreements by nursing home facilities. Rates to be charged self-pay patients. (a)
Any nursing home facility, as defined in section 19a-521, which intends to decrease its
services to persons who receive medical assistance benefits from the state by terminating
its Medicaid provider agreement shall notify the Commissioner of Social Services in
writing and shall transfer all patients who receive such benefits to another facility which
participates in the Medicaid program within thirty days of the date of such termination.
The facility terminating such agreement shall be responsible for any loss of federal
financial participation arising from such termination. At least six months prior to a
nursing home facility notifying the commissioner of its intention to terminate its Medicaid provider agreement the facility shall provide written notification of such intention to
each patient, applicant for admission and, if known, each patient's and each applicant's
legally liable relative, guardian or conservator. Failure of a nursing home to provide
such notice to each patient, applicant and legally liable relative, guardian or conservator
shall invalidate any notice provided to the commissioner.
(b) The commissioner may enter into a limited provider agreement to provide Medicaid reimbursement for care rendered to eligible patients for up to ninety days following
the date of termination of a facility's Medicaid provider agreement. Thereafter, the
commissioner shall enter into a limited provider agreement only for patients eligible
for Medicaid who are determined by the Department of Public Health to be in imminent
danger of death if involuntarily transferred or discharged in accordance with section
19a-535. The commissioner shall provide no reimbursement to any facility which has
terminated its Medicaid provider agreement other than the reimbursement provided
under a limited provider agreement entered into pursuant to this subsection.
(c) Notwithstanding the provisions of subsection (b) of this section, the commissioner shall enter into a limited provider agreement with any facility which provided
notice to the commissioner of its intention to terminate its Medicaid provider agreement
after July 1, 1989, and before March 1, 1990, to provide Medicaid reimbursement for
care rendered to (1) patients residing in such a facility who are eligible for Medicaid on
or before March 31, 1990, and (2) patients residing in such a facility on or before March
31, 1990, who become eligible for Medicaid. No such patient in such a facility shall be
involuntarily transferred or discharged on the basis of source of payment.
(d) Notwithstanding any provisions of the general statutes, the public or special acts
of 1989 or 1990 or the regulations of Connecticut state agencies, the Commissioner of
Social Services shall determine the maximum rate to be charged self-pay patients in any
nursing home facility which has notified the commissioner of its intention to terminate its
Medicaid provider agreement on or after March 1, 1990, by (1) determining the rate to
be paid for persons aided or cared for by the state or any town in this state pursuant to
regulations in effect March 1, 1990, adopted under section 17b-238; and (2) adding to
such rate a percentage of the state-wide median Medicaid rate as determined pursuant
to regulations in effect March 1, 1990, adopted under section 17b-238, according to the
following schedule:
Type of RoomPercentage Of
State-Wide Median
Medicaid Rate
Private27%
Semiprivate14%
Three or more beds per room10%
If a facility terminates or fails to renew its provider agreement during a rate year, the
commissioner shall revise the rate to be charged self-pay patients determined in accordance with this subsection. The revised rate shall take effect (A) on the date of termination
or expiration of the provider agreement if the revision results in a decrease in the rate;
or (B) upon thirty days notice to the self-pay patients if the revision results in an increase
in the rate.
(P.A. 89-325, S. 10, 26; P.A. 90-217, S. 2, 3; P.A. 92-163; P.A. 93-262, S. 1, 87; 93-381, S. 9, 39; P.A. 95-257, S. 12,
21, 58.)
History: P.A. 90-217 added provisions re notification required when a facility intends to terminate its provider
agreement, terms of limited provider agreements and rates to be charged self-pay patients in a facility which has terminated
its provider agreement and divided sections into Subsecs.; P.A. 92-163 amended Subsec. (b) by deleting provision requiring
patient to be eligible for Medicaid on the date of termination of a facility's provider agreement in order to be covered
under a limited provider agreement if in imminent danger of death if involuntarily transferred or discharged; P.A. 93-262
authorized substitution of commissioner and department of social services for commissioner and department of income
maintenance, effective July 1, 1993; P.A. 93-381 replaced department of health services with department of public health
and addiction services, effective July 1, 1993; Sec. 17-314g transferred to Sec. 17b-347 in 1995; P.A. 95-257 replaced
Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public
Health, effective July 1, 1995.