Section 17-311-161 - Self-pay charges for routine servicesSelf-pay charges for routine services shall be established for each facility individually and for each level of care provided by such facility in accordance with the following method:
(a) Routine services means the per diem charge by a nursing home for services and items includable in the facility's state rate calculated for purposes of Section 17-311-161(b) (1) and shall include but not be limited to room accommodations, nursing care rendered by non-private duty nursing personnel, food, institutional laundry services, housekeeping services, services related to the use and maintenance of real property, social and recreation services, and all other allied and customary services offered pursuant to an express or implied agreement between the provider and the patient. Routine services shall not include those services defined below as ancillary services. Other than by charging up to the maximum allowable self-pay rates determined by the commissioner, under no circumstances shall a facility impose any additional charge upon any of its self-pay patients for any routine services.(b) The Commissioner shall determine once during the period no less than thirty nor more than ninety days prior to the effective date of each new rate year the statewide median medicaid or public assistance rate for patients cared for by the State of Connecticut at each level of care, e.g., chronic and convalescent hospital, rest home with nursing supervision, and homes for the aged. Once such median for a new rate year is computed, it shall not be subsequently recomputed. The self-pay charge that may be imposed by each facility for routine services for each level of care shall be computed by adding: (1) The facility's state rate as calculated for the purposes of these regulations, and(2) The amount derived by applying the specific percentages of the statewide median state rate for each level of care (expressed in dollars and cents rounded to the nearest whole cent), as set forth in the schedule below: Room Accommodations | Percentage to be applied to Statewide Median State Rate |
Private (one patient in a room) | 50% |
| Semi-Private (two patients in a room) | 25% |
| Semi-Private (three or more patients in a room) | 15% |
Except that the commissioner has the discretion to promulgate a self-pay rate to be charged to a patient who at the patient's request enters into a contract with a facility for special accommodations larger than the facility's private (one patient to a room) accommodation.
(c) The self-pay charges for those facilities which charge a uniform single rate for a given level of care regardless of room accommodation shall be determined using a weighted bed average as follows: multiply the maximum allowable self-pay charges as computed in accordance with subsection (b) above by the number of beds in each class of room accommodation, and divide the total of these products by the total number of licensed beds available for use in the level of care.(d) For purposes of determining self-pay charges the provisions of section 17-311-52(4) and 17-311-52(13) shall not apply.(e) The calculation of self-pay charges shall be predicated upon the provision of all services including those necessary to provide an adequate level of quality of care. If the commissioner finds after a formal administrative hearing that a facility has not provided an adequate level of quality of care; (1) The Commissioner shall not include in the state rates any cost efficiency adjustment pursuant to section 17-311-52 in the computation of the self-pay charges.(2) Self-pay charges shall not be greater than self-pay charges for the previous rate year except as required by section 17-311-160 above. The commissioner has the discretion to refer quality of care complaints and issues to the department of health services for investigation and either appropriate action by said agency or recommendations to the department of income maintenance.
(f) For the purposes of computing self-pay charges for the rate year beginning July 1, 1980, for those facilities which do not have a state rate, the dollar amounts used in subsection (b) (2) above shall be added to the facility's existing legal self-pay charge for each type of accommodation and level of care. In subsequent years, the facility shall file an annual report pursuant to section 17-311-168 and state rates shall be computed in accordance with the cost related reimbursement system as the basis for computing the self-pay charges.(g) In the event that the increase permitted pursuant to subsection (b) above, is less than 104% of the previously approved self-pay charge, the self-pay charge may be increased to 104% of the previously approved self-pay charge, except as provided in section 17-311-163.(h) In no event shall the self-pay charge computed pursuant to subsection (b) above be permitted to exceed 124% of the previously approved self-pay charge except as required by section 17-311-160(b).(i) For purposes of computing a facility's maximum allowable self-pay charges only, the commissioner shall include as a factor in such computations past self-pay rate adjustments in favor of the provider resulting from field audit adjustments or adjustments pursuant to Sec. 17-311-52(p) (Gross National Product deflator adjustments) which constituted uncollectable retroactive self-pay rate increases due to the thirty day notice of self-pay rate increase requirement of Conn. Gen. Stat. Sec. 17-314a. This subsection shall apply to all such field audit adjustments in favor of the provider and Sec. 17-311-52(p) adjustments in favor of the provider for periods subsequent to the effective date of this subsection.Conn. Agencies Regs. § 17-311-161