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CT Department of Health Issues Order Modifying Requirements for Behavioral Health Facilities and Nursing Homes

May 27, 2020

On May 22, 2020, Acting Commissioner Deidre Gifford of the Connecticut Department of Health (“DPH”) issued an order modifying various requirements for behavioral health facilities and nursing homes. The modifications are set forth below.

Behavioral Health Facilities

With respect to behavioral health facilities, the order makes the following modifications.

  • Staffing of Private Freestanding Mental Health Residential Living Centers

    The order modifies section 19a-495-551(k)(7)(C) of the Regulations of Connecticut State Agencies “to allow for a minimum overall ratio of the total number of staff to residents of at least 1:10 provided at least one staff member is present whenever a resident is in the building.” Prior to this order, the minimum overall ratio of total number of staff to residents was 1:8.
     
  • Physical Examination Requirements for Substance Use Disorder Facilities

    The order modifies section 19a-495-570(m)(5)(C)(i) of the Regulations of Connecticut State Agencies to allow the required documented physical examination to be completed via telemedicine within ten (10) days of admission.

Nursing Homes

With respect to chronic and convalescent nursing homes and rest homes with nursing supervision, the order makes the following modifications.

  • Medical Staff Meetings

    The order modifies section 19-13-D8t(i)(4)(A) of the Regulations of Connecticut State Agencies by suspending the requirement that the medical staff of chronic and convalescent nursing homes and rest homes with nursing supervision meet, at a minimum, once every ninety (90) days. Instead, medical staff must “have a meeting via video or telecommunication device (i.e. Zoom, FaceTime, or other similar programs) once every ninety (90) days.”
     
  • Nurse's Aide and Feeding Assistant Training and Employment

    The order modifies section 19-13-D8t(1)(9)(B) of the Regulations of Connecticut State Agencies by waiving “the required minimum of ten (10) hours of training in a state-approved feeding assistant training program provided the nursing home develops and requires successful completion of a condensed training program pre-approved by the Department for a feeding assistant.” The order sets forth topics that are required to be covered in the training program and requires the facility to maintain documentation of such training. In addition, the order requires that the facility “ensure that the feeding assistant be assessed for competency in feeding skills by a Registered Nurse” and “identify and maintain a record of the staff who will provide supervision of such feeding assistant for each shift.”
     
  • Physical Examination of Residents

    The order modifies section 19-13-D8t(n)(5)(A) of the Regulations of Connecticut State Agencies by allowing “the nursing home medical staff to examine residents as necessary, and the interval between such examinations may exceed sixty (60) days but shall not exceed ninety (90) days, as long as it does not jeopardize the health of the resident.” The nursing home medical staff is required to ensure that the physician’s order for the resident is current so that the resident is provided with the appropriate care.
     
  • Postponement of Resident’s Annual Comprehensive Medical Examination

    The order modifies section 19-13-D8t(n)(7) of the Regulations of Connecticut State Agencies by allowing “nursing home medical staff to postpone a resident’s annual comprehensive medical examination and any routine testing until it is determined safe to do so during the COVID-19 pandemic, provided the facility shall continue to make arrangements for critical examinations and testing as determined by its medical staff.”
     
  • Positioning of Beds

    The order modifies section 19-13-D8t(v)(7)(C) of the Regulations of Connecticut State Agencies by permitting the facility to modify the positioning of beds so as to promote resident care, provided that the facility ensures the following: “the bed position does not act as a restraint; the call bell, over bed light and privacy curtain are of functional use to the resident; and the position of the bed does not create a hazard, i.e. against a heating source, create an entrapment possibility or create an obstacle to evacuation.” The order also specifies that beds should be spaced out at least six (6) feet apart. The order clarifies, however, that the facility must request a waiver if it “wishes to continue these services following the response efforts related to the COVID-19 pandemic.”
     
  • Intravenous Therapy

    In an effort to reduce the number residents transferred from a nursing home to an acute care setting, the order modifies section 19-13-D8u(b) of the Regulations of Connecticut State Agencies “by permitting a registered nurse in a nursing home who has been properly trained by the director of nursing or by an intravenous infusion company or consultant to (1) draw blood from a central line for laboratory purposes, provided the facility has an agreement with a laboratory to process such specimens; and (2) administer a dose of medication ordered via intravenous injection, provided such medications are limited to Lasix, up to a 40mg dose, Solu-medrol, a 10mg-40mg dose, Solu-cortef, up to a 100mg dose, and Decadron, a 0.5-20mg dose.” The nursing home is required to notify DPH in writing of its intention to provide these services. Furthermore, the facility must request a waiver if it wishes to continue such services following the COVID-19 response efforts.
     
  • Dialysis

    The order modifies section 19-13-D55a(g)(4) of the Regulations of Connecticut State Agencies “to allow a charge nurse in a freestanding dialysis unit to assist in patient care, provided the facility ensures that a registered nurse is on duty during all hours of operation and the nurse manager adjusts staffing based on a patient acuity system used to determine the appropriate number and types of patient care staff required to meet the predicted needs of patients on each shift.”

If you have any questions regarding these changes, please do not hesitate to contact any member of the Health Law Practice Group at Shipman & Goodwin LLP.

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