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SB 805 Connecticut Senate · 2025 Regular Session

AN ACT REQUIRING NURSING HOMES TO SPEND NOT LESS THAN EIGHTY PER CENT OF REVENUES ON DIRECT PATIENT CARE.

SB 805 establishes a new Medicaid reimbursement system for nursing homes, requiring facilities to report quality metrics and restructuring how costs are calculated. It divides allowable costs into five categories (including direct patient care, indirect costs, and administrative expenses) and sets specific maximums - for example, direct care costs cannot exceed 135% of the median peer group cost. This bill directly affects nursing homes receiving Medicaid payments, as it changes how their reimbursement rates are determined based on cost reporting and quality performance. The law takes effect July 1, 2025, with annual reporting requirements for quality metrics. (Note: The bill title mentions "80%," but the actual provision sets cost caps like 135% for direct care; the title appears inaccurate based on the text.)
Issues: ✓ HealthcareSupports HealthcareMandates 80% of nursing home revenues on direct patient care, ensuring Medicaid funds prioritize patient services over administrative costs, improving care quality and access.95% confidence
Bill status in committee 1 of 4 stages cleared
Introduction
Jan 2025
Committee Review
Floor Vote
Governor
Introduced Jan 21, 2025 Last action Apr 1, 2025
Maddy AI version diff · 1 comparison

What changed between versions

Proposed Bill → Committee Bill · 8 edits
MODERATE
The bill was amended from a proposed version to a committee version, shifting from a general medical loss ratio requirement for nursing homes to a detailed Medicaid reimbursement methodology based on case-mix and quality metrics. The committee version adds specific implementation dates, cost component definitions, and reporting requirements that were not present in the original proposal.
Scope change
The bill's scope changed from a broad medical loss ratio mandate to a specific Medicaid reimbursement framework with detailed cost calculations and quality metrics for nursing homes.
TIMELINE

Added specific effective dates including July 1, 2022 for case-mix adjustments and July 1, 2025 for the new Medicaid rate methodology.

REQUIREMENT

Added requirements for the Commissioner to implement an acuity-based methodology for Medicaid reimbursement with case-mix adjustments based on Minimum Data Set resident assessment data.

Added requirements for facilities to comply with quality metrics collection and reporting, with phased rate adjustments beginning July 1, 2022.

Added requirements for geographic peer groupings of facilities and establishment of allowable cost maximums based on peer group medians.

DEFINITION

Added detailed definitions for five cost components including direct costs, indirect costs, fair rent, capital-related costs, and administrative and general costs with specific maximum allowable percentages.

ENFORCEMENT

Added provisions for individualized reports to nursing homes showing Medicaid rate impact based on quality metrics and potential rate withhold for facilities failing to meet certain quality standards.

ELIGIBILITY

Modified the approach from a general medical loss ratio requirement to specific Medicaid reimbursement rates based on cost data and peer group comparisons.

TECHNICAL

Added provisions for pro rata fair rent increases for facilities with documented fair rent additions placed in service after June 30, 2022.

Floor votes

How they voted

No floor votes recorded yet.
Full legislative history

Actions timeline

Total actions
12
Key actions
2
Committee
4
Mar 14, 2025
Upper · Passed
Joint Favorable
upper
Mar 6, 2025
Committee
REF. TO JOINT COMM. ON Human Services
upper
Mar 5, 2025
Upper · Passed
DRAFTED BY COMMITTEE
upper
Jan 21, 2025
Committee
REF. TO JOINT COMM. ON Human Services
upper
0 primary · 0 co-sponsors

Sponsors

No sponsor information available.